Year: 2020
Type: dissertation
Study design: Observational Study
Abstract: Loneliness increases the risk of admission to long-term care facilities and is associated with various adverse health outcomes. In previous studies the prevalence of loneliness has been even higher in these settings than among community-dwelling older people. Despite the adverse health outcomes, loneliness has received surprisingly little attention in long-term care facilities. The aim of this study was to explore loneliness in long-term care facilities: its prevalence, associated factors and prognosis (Study I), as well as temporal trends over time (Study II). The aim also included exploration of how loneliness was experienced by older people in long-term care facilities (Study III). Furthermore, we aimed to assess the effectiveness of a group intervention process among lonely residents in long-term care facilities (Study IV). In addition, we aimed to investigate how this group model, “Circle of Friends” (CoF) has been implemented over ten years in Finland, and what is its fidelity and feasibility (Study V). The current work involved the use of both quantitative and qualitative methods complementing each other in order to explore loneliness. Cross-sectional interviews and assessments (Study I) among all residents (n=2072) in Helsinki long-term care facilities explored the prevalence of loneliness, its associated factors and prognostic significance over a 3.6-year follow-up period. Repeated cross-sectional interviews and assessments (Study II) in 2011 and 2017 among all residents (n=1563 and n=1367, respectively) in Helsinki long-term care facilities were used to explore the temporal trends of loneliness. Loneliness was inquired about thus: “Do you suffer from loneliness?” (seldom or never/sometimes/often or always). In both studies participants with severe dementia were excluded. The associated factors explored included demographic factors, diseases, functioning, psychological well-being (PWB) and nutrition (MNA). The qualitative studies (Studies III and IV) involved a multi-method approach among six cognitively impaired (MMSE score 15–23) and seven cognitively intact participants. Individual and focus-group interviews, observations on CoF group processes, and group facilitators’ field-diaries were used as data. Study V was based on survey data collected from participants (n=1041) and facilitators (n=319) of the CoF group intervention in Finland in 2006−2016. In Study I, 35% of the respondents suffered from loneliness at least sometimes. Loneliness was associated with poor self-rated health, dependency in activities of daily living and mobility, higher cognitive function and poor psychological well-being. Loneliness predicted mortality. In Study II there was no change in the prevalence of loneliness over time in cross-sectional samples in 2011 and 2017: propensity score-adjusted loneliness was 36% at both time points. Feeling depressed was the only independent variable associated with loneliness in a multivariate logistic regression model. The prevalence of loneliness among respondents feeling depressed was 55%, and among those not feeling depressed, 24%. Study III gave voice to older people who suffered from loneliness and described their experiences. Loneliness proved to be a severe and idiosyncratic experience, anchored in time and location of the long-term care facilities. The respondents described loneliness in varied ways, richly, often using figurative metaphors. Loneliness was dependent on time of day, day of the week, and season. Passing lonely time was meaningless and full of waiting, stagnation and nothingness. In place-dependent loneliness, respondents felt mentally homeless: none of them named their apartment as home, but instead they used coarse descriptions, such as hospital or prison. The respondents had to spend long periods of time in their apartments and their desire to get out, get away from their loneliness, was not met. Respondents felt themselves invisible, and others in the facilities unknown, distant; some even unapproachable. A facilitated CoF group process (Study IV) with clear progressing steps, meaningful activities and mutual interaction revealed lonely older people’s capability to groupwork, despite their frailty and cognitive impairment. Loneliness was reflected upon and ventilated among peers in versatile ways. The goal-oriented group acknowledged participants’ own expectations and made them visible. The group empowered the participants to self-direction, which in the cognitively impaired happened sooner than in the cognitively intact. Study V showed that facilitators of older people’s CoF groups have maintained the key elements, objectives and structure of the original model over ten years. CoF training has been essential in achieving its aims: alleviation of loneliness and participants’ continuing meetings on their own in a high proportion of participants. Of the facilitated groups, 67% continued on their own after the official group meetings. It seems that this model is beneficial and also feasible in long-term care facilities, along with rigorous training of the professionals. Loneliness among older people in long-term care facilities is linked to health, well-being and mortality. It should be recognized in a work routine by asking about and documenting experiences. Interventions and their means should address loneliness in long-term care facilities. To be heard, feel visible, be connected, socially attached to the place, and recognized as persons should be a priority in daily practices in long-term care facilities. Older people in these facilities have faced a major event in their recent past, moving from a “real”, meaningful home. Many older people are also aware of another major event in the near future, approaching death. It is obvious that the time remaining should be made as good as possible. Knowing the harmful effects of loneliness, it is the ethical duty of professionals to prevent and alleviate it.
Source: Työväentutkimus Vuosikirja
Author: Anu Jansson
Language: English
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G120588393, G2199538917
OpenAlex ID: W3103295236