Chinese late-life immigrants' loneliness and social isolation in host countries: An integrative review.

AIMS AND OBJECTIVE: To synthesise current international empirical evidence on loneliness and social isolation in Chinese late-life immigrants. BACKGROUND: Loneliness causes adverse health consequences in Chinese late-life immigrants leading to increased utilisation of often increasingly limited healthcare resources. However, little is known about how Chinese late-life immigrants perceive and experience loneliness and social isolation in their host countries. DESIGN: An integrative review methodology. METHODS: Using a systematic search strategy, Google scholar and databases, such as Scopus, Web of Science, PubMed, CHNAHL, Medline and open access Theses were searched. No limitation was placed on publication date. Peer-reviewed studies published from the database inception to May 6, 2021 in the English language were included. The review process is reported according to PRISMA. RESULTS: Eight articles met the criteria and were included in this review. Two themes resulting from the data synthesis process were identified. Firstly, 'disrupted social relations after late-life immigration' and secondly 'moving away from filial expectations'. CONCLUSION: Loneliness and social isolation are commonly experienced by Chinese late-life immigrants when residing in host countries. Understanding and identification of the sources of loneliness and social isolation among late-life immigrants are essential prompts for healthcare professionals, particularly nurses, to engage sensitively with Chinese late-life immigrants. Nurses culturally relevant care delivery in a variety of settings may best serve recipients' social and health related needs. RELEVANCE TO CLINICAL PRACTICE: This integrated review informs the planning of health and social services for addressing Chinese late-life immigrants' experiences of loneliness and social isolation. Focused attention on cultural responsiveness is an important component of providing quality and safe nursing care. This review of the recent evidence on socially-rooted health concerns affected by both immigration and ageing will help advance nursing practice in providing culturally responsive care interventions.

An evaluation of wrist and forearm movement during purposeful activities and range of movement exercises after surgical repair of a distal radius fracture: A randomized crossover study.

PURPOSE: Following surgical repair of distal radius fractures, range of movement (ROM) exercises are the primary approach for restoring movement during early rehabilitation. Specified purposeful activities can also be used, but the movement produced by activities is not well-understood. The study aimed to evaluate and compare movement during purposeful activity and ROM exercises METHODS: Thirty-five adults with a surgically repaired distal radius facture undertook two 10-minutes interventions: purposeful activity (PA) and active ROM exercises (AE), separated by a 60 minute washout, in random order. Data collection occurred during a single session on the same day. Electrogoniometry was used to measure time-accumulated position (TAP), a global metric of movement range and amount, maximum active end range, movement repetitions, excursions >75% of available ROM, and active time. Data were analyzed using linear mixed and generalized linear mixed regression models. RESULTS: Purposeful activities selected were predominantly household or food preparation. TAP was significantly higher during AE than PA: -1878 [-2388, -1367], p ≤.001, for wrist extension/flexion. PA produced significantly greater movement repetitions for wrist extension/flexion and deviation, excursions beyond 75% of available ROM, and active time, than AE. During PA the wrist was extending/flexing a mean of 97% [92, 101], of the time, compared with 43% [40, 47], during AE. There were no significant differences in maximum end range for wrist extension between PA, 33.7° [29.8, 37.5] and AE, 34.5° [30.7, 38.4], or for ulnar deviation. CONCLUSIONS: ROM exercises produced higher volumes of sustained joint position than purposeful activity but activities, selected for importance and challenge, produced significantly higher volumes of continuous, repetitious motion in equivalent ranges of movement as exercise repetitions. The study challenges therapists to consider the rehabilitative potential of movement produced by activity for restoring movement and function in the early postoperative weeks.

Patients' experiences of nurses' heartfelt hospitality as caring: A qualitative approach.

AIMS AND OBJECTIVES: To answer the question "What is the lived experience of hospitality during a patient's hospital stay for elective surgery?" BACKGROUND: Hospitality centres on a host offering comfort to others, as in a personal care context. Caring constitutes the essence of what it is to be human, having a profound effect on well-being and recovery from surgery. Caring is one of the most elusive and diversely contested concepts in nursing; however, care provided by nurses seldom transcends as deep human connections and social utility. This study explored the nature, meaning and experience of hospitality as care from the perspective of elective surgery patients. Consolidated Criteria for Reporting Qualitative criteria were used. DESIGN: A hermeneutic phenomenological methodology. METHODS: Data were gathered through semi-structured, face to face interviews with seven patients from both private and public hospitals, and from different cultural backgrounds. RESULTS: Three interpretative notions were as follows: experiences of hospitality as feeling "really" cared for, being at ease and being healed. Hospitality exists in the receiver's lived experience, evoking a special moment which leads to feelings of great comfort and feelings of being truly cared about. When hospitality is received, patients feel a connection; they begin to trust and their healing begins. CONCLUSION: The offering of often small, yet heartfelt acts of hospitality, indicated that nurses can evoke powerful lived experiences which benefit patients undergoing elective surgery. RELEVANCE TO CLINICAL PRACTICE: The importance of prioritising emotional and social connections to the hospitality experience needs emphasis at all levels of the clinical structure. Hospitality as caring needs to form a part of all undergraduate and postgraduate nursing curricula, and ongoing professional development. The participant quotes presented in this article could form exemplars for the provision of hospitable nursing care practices, highlighting nurses getting to know and understand their patients, and being interested in their lives.

Late-life living and care arrangements of older Filipino New Zealanders.

AIMS AND OBJECTIVES: To explore the living and care arrangement plans of older Filipino immigrants in New Zealand. BACKGROUND: New Zealand is rapidly becoming the host to an increasing number of ageing Filipino immigrants. Despite this sizeable population growth of ageing Filipinos in New Zealand, still very little is known about this ethnic group's care needs and living arrangement preferences in later life within the New Zealand context. DESIGN: Qualitative descriptive approach. METHODS: Data were collected from 15 older Filipinos who participated in face-to-face interviews. Data were analysed using a thematic analytical framework. RESULTS: Two major themes were identified from the data analysis. The first theme "preferred living and care arrangements" is about older Filipinos' preferred plans for future residence and in receiving care when no longer able to function independently in their own homes. The second theme "negotiating readiness and acceptance" is about hypothetical situations that older Filipinos described and anticipated that will greatly facilitate their readiness and acceptance to living in aged care facilities. CONCLUSION: The study results have implications for service delivery within the New Zealand residential aged care sector. Due to an increasing number of older Filipino immigrants requiring care, residential aged care facilities must ensure their care models meet the needs of this growing group of older people. RELEVANCE TO CLINICAL PRACTICE: Nursing staff skill sets in the aged care sector require sensitivity to older immigrants' health needs without compromising cultural beliefs and practices while living in residential aged care facilities.

Impacts of older people's patient and public involvement in health and social care research: a systematic review.

Background: patient and public involvement (PPI) in research has been linked with numerous beneficial impacts, however, evidence for older people's involvement is limited. Objectives: to evaluate the impacts of involving older people in health and social care research on older co-researchers, academic researchers, and research processes and outcomes. A secondary aim was to explore critical success factors and future considerations for PPI. Design: systematic review. Methods: six databases were searched for English language articles published between 2006 and 2017. A supplementary search was conducted. Two authors independently retrieved articles using standardised inclusion criteria and data extraction forms. Articles reporting formal evaluation of older people's involvement were included. Results: nine articles, all using qualitative methodology, were included. Benefits for older co-researchers included psychological and social benefits, new learning, and activism and career opportunities, while challenging impacts comprised demanding workloads, difficult relationships and dissatisfaction with level of involvement. Benefits for academic researchers entailed new learning and shared workloads; challenges related to demanding workloads and difficult relationships. Both positive and negative effects on research quality and impact were observed. Benefits for participants and the community were demonstrated. Building relationships, facilitating communication and breaking down barriers to participation were identified as critical success factors. Conclusions: evidence for the impacts of older people's involvement is mixed although benefits appear to outweigh the challenges. Future considerations for PPI include matching older people's skills and motivations to the project and level of involvement, and establishing an iterative research process in which evaluation is embedded.

Exploring the lived experience of migrants dying away from their country of origin.

PURPOSE: Migrants experience challenges settling into a new society, while retaining their cultural and religious values. Concurrently facing an end-of-life illness can result in existential distress affecting quality of dying. This study aimed to explore the lived experience of migrants dying away from their country of birth or origin. METHODS: The study design used a phenomenological approach using Heidegger's philosophy to gather and interpret dying migrants' stories. Participants were a purposive sample of New Zealand immigrants experiencing end-of-life illness and under hospice care. Participants were interviewed at home. Coherent stories were drawn from the transcribed interviews and analysed using iterative methods. Interpretive notions were formed through contemplation and writing. RESULTS: The ten participants, seven males and three females, were of different ethnicities and countries of origin. Three notions emerged. The first was dual possession of a new hybrid identity developed in their adoptive country, and an inner ethnic and cultural identity, in varying degrees of harmony with each other. The second was being in life review-reliving homeland memories and letting go of dreams. The third notion showed how they sought resolution by enacting continuity through their children, hoping for a final homeland visit, or conveying their dying wishes. CONCLUSIONS: How life review was enacted for each migrant and resolution depended on finding some degree of belonging in their country of adoption. Implications for end-of-life care include education to increase practitioner awareness and use of formal and informal life review. Enhancing spiritual well-being can assist resolution of end-of-life adjustment.

Strengthening Community: Older Asian Immigrants' Contributions to New Zealand Society.

This study sought to uncover the process through which older Chinese, Indian and Korean immigrants residing in Auckland, New Zealand contribute to, and participate in, local community. There is a paucity of literature addressing the everyday activities of older Asian immigrants living in New Zealand. The few studies that do exist focus solely on one ethnic group with little discussion of how community participation occurs. Grounded theory methodology was employed. Focus groups and individual interviews with 76 Chinese, Indian or Korean older immigrants were recorded, transcribed, translated, and analysed using grounded theory methods of dimensional analysis to develop a theory of participation. Older Asian immigrants contribute to society through a process of Strengthening Community; comprising three perspectives: Advancing Cultural Connectedness, Giving Service and Caring for Family. Each perspective is mediated by conditions and strategies that facilitate when and how participants engage in their chosen activities. Older Asian immigrants are active social contributors to New Zealand communities. Although they encounter barriers to participation, they constantly seek ways to work individually and in community groups to effectively contribute to civic society. In doing so, they take pride in giving back to their host country.

Ethnic and Gender Differences in Preferred Activities among Maori and non-Maori of Advanced age in New Zealand.

This study explored active aging for older Maori and non-Maori by examining their self-nominated important everyday activities. The project formed part of the first wave of a longitudinal cohort study of aging well in New Zealand. Maori aged 80 to 90 and non-Maori aged 85 were recruited. Of the 937 participants enrolled, 649 answered an open question about their three most important activities. Responses were coded under the World Health Organization's International Classification of Functioning, Disability and Health (ICF), Activities and Participation domains. Data were analyzed by ethnicity and gender for first in importance, and all important activities. Activity preferences for Maori featured gardening, reading, walking, cleaning the home, organized religious activities, sports, extended family relationships, and watching television. Gendered differences were evident with walking and fitness being of primary importance for Maori men, and gardening for Maori women. Somewhat similar, activity preferences for non-Maori featured gardening, reading, and sports. Again, gendered differences showed for non-Maori, with sports being of first importance to men, and reading to women. Factor analysis was used to examine the latent structural fit with the ICF and whether it differed for Maori and non-Maori. For Maori, leisure and household activities, spiritual activities and interpersonal interactions, and communicating with others and doing domestic activities were revealed as underlying structure; compared to self-care, sleep and singing, leisure and work, and domestic activities and learning for non-Maori. These findings reveal fundamental ethnic divergences in preferences for active aging with implications for enabling participation, support provision and community design.

The lived experience of physically active older prostate cancer survivors on androgen deprivation therapy.

This study sought to explore the lived experiences of physically active prostate cancer survivors on androgen deprivation therapy (ADT), who exercise individually. Three older men (74-88 years old) with prostate cancer, using ADT continuously for at least 12 months and regularly exercising for at least 6 months, participated in this qualitative pilot study, informed by interpretive phenomenology. Data were gathered using individual semi-structured interviews, audio recorded and transcribed verbatim. Coherent stories were drawn from each transcript and analyzed using iterative and interpretive methods. van Manen's lifeworld existentials provided a framework for interpreting across the research text. Three notions emerged: Getting started, Having a routine and Being with music. Together they reveal what drew the participants to exercising regularly despite the challenges associated with their cancer and treatments. This study provides insights into the benefits of, and what it means for, older men with prostate cancer to regularly exercise individually. These findings may assist cancer clinicians and other allied health professionals to be more attuned to prostate cancer survivors' lived experiences when undergoing ADT, allowing clinicians to better promote regular exercise to their patients as a foundational component of living well.

Community integration after traumatic brain injury: a systematic review of the clinical implications of measurement and service provision for older adults.

OBJECTIVE: To explore the scope, reliability, and validity of community integration measures for older adults after traumatic brain injury (TBI). DATA SOURCES: A search of peer-reviewed articles in English from 1990 to April 2011 was conducted using the EBSCO Health and Scopus databases. Search terms included were community integration, traumatic brain injury or TBI, 65 plus or older adults, and assessment. STUDY SELECTION: Forty-three eligible articles were identified, with 11 selected for full review using a standardized critical review method. DATA EXTRACTION: Common community integration measures were identified and ranked for relevance and psychometric properties. Of the 43 eligible articles, studies reporting community integration outcomes post-TBI were identified and critically reviewed. Older adults' community integration needs post-TBI from high quality studies were summarized. DATA SYNTHESIS: There is a relative lack of evidence pertaining to older adults post-TBI, but indicators are that older adults have poorer outcomes than their younger counterparts. The Community Integration Questionnaire (CIQ) is the most widely used community integration measurement tool used in research for people with TBI. Because of some limitations, many studies have used the CIQ in conjunction with other measures to better quantify and/or monitor changes in community integration. CONCLUSIONS: Enhancing integration of older adults after TBI into their community of choice, with particular emphasis on social integration and quality of life, should be a primary rehabilitation goal. However, more research is needed to inform best practice guidelines to meet the needs of this growing TBI population. It is recommended that subjective tools, such as quality of life measures, are used in conjunction with well-established community integration measures, such as the CIQ, during the assessment process.

Cross-cultural understandings of festival food-related activities for older women in Chiang Mai, Thailand, Eastern Kentucky, USA and Auckland, New Zealand.

This cross-country, cross-cultural study explored the meaning of older women's food-related activities for the annual festivals of Songkran (Thai New Year) in Chiang Mai, Thailand; and Christmas in Richmond, Kentucky, USA; and Auckland, New Zealand. A derived etic method was used. The community-dwelling participants were 33 Thai women, aged 60 and older, and 16 New Zealand and 23 eastern Kentucky women, aged 65 and older. This article focuses on the final cross-cultural analysis of the data. Emic, or within-country, findings are presented, followed by the derived etic, or cross-cultural, interpretations for two themes of meaning; older women's 'protecting what matters' and 'leading the way'. Applying derived etic methods helped reveal how, despite the highly different food-related practices, preparing and sharing celebratory foods at Songkran or Christmas held related meanings for older women in Thailand, Kentucky USA, and New Zealand.

"The more I do, the more I can do": perspectives on how performing daily activities and occupations influences recovery after surgical repair of a distal radius fracture.

PURPOSE: The study aimed to explore perceptions and experiences about how engaging in daily activities and occupations influenced recovery in the first eight weeks after surgical treatment of a distal radius fracture. METHODS: Twenty-one adults completed an online activity and exercise log then participated in a semi-structured interview between weeks 6 and 8 postoperatively. Interviews were transcribed and analysed using reflexive thematic analysis. RESULTS: Daily activities and occupations were highly influential in facilitating recovery of movement and function of the operated limb. Five themes provided an understanding of how occupation operated to promote recovery. Occupation was (i) a primary driver of the rehabilitative process, providing an impetus for recovery, (ii) offered ready-to-hand challenges for opportunistic, automatic movement, (iii) invited intentional use of the affected wrist, (iv) habituated the wrist to movement through repetition and confidence-building, and (iv) drew on psychosocial resources to enable reengagement with life activities and roles. CONCLUSIONS: Incorporating the performance of graded, modified activities during the early weeks of rehabilitation creates opportunities for wrist movement, enhances wellbeing, and assists in the habituation of wrist movement. Activities and occupations can be used as a therapeutic strategy to promote recovery from surgical treatment of a distal radius fracture.Implications for rehabilitationRehabilitation after surgical repair of distal radius fractures has traditionally focused on exercise routines.Daily activities and occupations can also be used to promote wrist movement and function during the early weeks of rehabilitation.Occupation is a naturally occurring source of wrist movement, motivation, and wellbeing that can be harnessed for therapeutic advantage after surgical repair of distal radius fractures.Therapists can collaborate with patients to select and modify daily activities and occupations to incorporate into early postoperative therapy programmes.

Feeling a deep sense of loneliness: Chinese late-life immigrants in New Zealand.

OBJECTIVES: To explore Chinese late-life immigrants' perceptions of loneliness and social isolation. METHODS: A qualitative descriptive methodology underpinned this study. In-depth individual interviews were conducted in Mandarin with purposively recruited participants. The twenty-three participants in the study had all emigrated from China, were 65-80 years old on arrival and had lived in New Zealand for between 2.5 and 16 years. An inductive thematic analytic process was undertaken. The COREQ checklist was followed to ensure study rigour. RESULTS: Three themes, 'high value placed on meeting family obligations', 'feeling a deep sense of imbalanced intergenerational reciprocity' and 'moving away from filial expectations', were identified. Confucianist values of 'women's domestic duty of caring for grandchildren', 'filial piety', and 'saving face' to be accepted and respected by others negatively attributed to participants' understandings and experiences of loneliness. To plan for increasing frailty and to avoid family conflict while ameliorating potential loneliness, some participants reluctantly discarded prior customary filial piety expectations in favour of formal aged care options. CONCLUSIONS: Participants' profound sense of loneliness was seen to be attributed to their deeply rooted cultural values and backgrounds from having lived for a significant period of time in China. Loneliness occurred as a result of the resettlement process in later life. These experiences highlight the importance of using cultural framing that takes into account beliefs and adaptations to host societies anticipated during the process of late-life immigration.

Prevalence of Loneliness and Its Association With General and Health-Related Measures of Subjective Well-Being in a Longitudinal Bicultural Cohort of Older Adults in Advanced Age Living in New Zealand: LiLACS NZ.

OBJECTIVES: There is evidence that loneliness is detrimental to the subjective well-being of older adults. However, little is known on this topic for the cohort of those in advanced age (80 years or older), which today is the fastest-growing age group in the New Zealand population. We examined the relationships between loneliness and selected subjective well-being outcomes over 5 years. METHODS: We used a regional, bicultural sample of those in advanced age from 2010 to 2015 (Life and Living in Advanced Age: a Cohort Study in New Zealand). The first wave enrolled 937 people (92% of whom were living in the community): 421 Maori (Indigenous New Zealanders aged 80-90 years) and 516 non-Maori aged 85 years. We applied standard regression techniques to baseline data and mixed-effects models to longitudinal data, while adjusting for sociodemographic factors. RESULTS: For both Maori and non-Maori, strong negative associations between loneliness and subjective well-being were found at baseline. In longitudinal analyses, we found that loneliness was negatively associated with life satisfaction as well as with mental health-related quality of life. DISCUSSION: Our findings of adverse impacts on subjective well-being corroborate other evidence, highlighting loneliness as a prime candidate for intervention-appropriate to cultural context-to improve well-being for adults in advanced age.

Doing everyday occupations both conceals and reveals the phenomenon of being aged.

BACKGROUND/AIM: The phenomenon of ageing is so commonplace that it is ordinarily taken-for-granted, with little call to question its meaning. Of importance to occupational therapists is the recent appeal to understand older adults' ordinary ways of everyday living. The aim of this interpretive phenomenological study was to understand the meaning of 'being aged' through the everyday experiences of those who are long-lived. METHODS: The writings of two philosophers, Hans-Georg Gadamer and Martin Heidegger, guided the study's design and research methods. Being aged in the context of everyday living was the phenomenon of interest. Individual interviews were conducted with 15 community-dwelling New Zealand elders: four Maori aged 71-93 years and 11 non-Maori aged 80-97 years. Stories of going about daily occupations and particular moments in the day were elicited during conversational-style interviews. Hermeneutic methods and phenomenological reflection were used to analyse the data. RESULTS: Two overarching notions were illuminated. The ordinary ways of 'being in the every day', such as having a routine and a familiar purposefulness, conceal being aged. In contrast, 'experiencing the unaccustomed', such as suddenly noticing an unaccustomed weakness or oldness, in the midst of doing deeply familiar occupations is an announcing of being aged. CONCLUSIONS and SIGNIFICANCE OF THE STUDY: As such, engaging in everyday, familiar occupations holds the potential to both conceal and reveal the phenomenon of being aged. These results point to the importance of illuminating the lived experience of occupational engagement as a fruitful way of informing occupation-focussed practice.

Older Filipino immigrants' reconfiguration of traditional filial expectations: a focus ethnographic study.

BACKGROUND: One of the many socio-cultural issues impacting older immigrants in host countries is the cultural expectations of filial piety from their adult children. OBJECTIVE: To understand older Filipino immigrants' beliefs and values towards filial expectations. DESIGN: Focused ethnography. RESULTS: Two major themes were identified. The first theme 'moving away from filial expectations' drew out older Filipino's changing views of cultural expectations from their adult children. The second theme 'maintaining cultural values through good family relationships' highlighted the importance of acknowledging the cultural values considered to be most important by older Filipinos, which was having harmonious relationships and avoiding family conflict. CONCLUSION: The reconfigured expectation was salient with participants' who identified 'not being a burden' to their adult children and the ardent desire to maintain positive family relationships. Impact Statement: Nurses need to be aware of changes to our current understanding of filial piety when providing care to older Filipinos.

Influence of Purposeful Activities on Upper Extremity Motor Performance: A Systematic Review.

Following upper extremity injury, exercise-approaches are commonly used to address motor impairments. Occupation-based approaches are also used but less widely promoted and their mechanisms of action not well-understood. Movement performed during purposeful activities and occupations may yield better motor performance than during nonpurposeful tasks. This review investigated the influence of engagement in purposeful activities and occupations on upper extremity motor performance in healthy and musculoskeletal populations. Databases were searched for studies in healthy or upper extremity musculoskeletal-injured adults that compared motor performance during purposeful activities against nonpurposeful movements. Twenty-one studies of moderate quality, conducted predominantly in healthy populations, were included. Upper extremity movement quantity and quality were enhanced when performed during purposeful conditions. Purposeful activities have potential to be used following injury to enhance movement and address motor impairments to a greater extent than is currently promoted. Research in musculoskeletal populations is required.

What makes community-based physical activity programs for culturally and linguistically diverse older adults effective? A systematic review.

OBJECTIVE: This integrative review aimed to determine the features of effective physical activity programs for culturally and linguistically diverse (CALD) older adults. METHODS: We searched for relevant articles in MEDLINE, PubMed, Google Scholar, Scopus and CINAHL. Articles were selected for evaluation if they included CALD older adults and implemented physical activity programs with culturally specific design features. Consistent with the Whittemore and Knafl integrative review methodology, we used the Downs and Black Checklist, Mixed Methods Appraisal Tool and the McMaster University appraisal tool for quantitative studies to assess the quality of included articles. RESULTS: Seven articles were included in this review. Effective community-based exercise or physical activity programs for CALD populations commonly featured close-to-home delivery, native language instruction and adaptations of culturally familiar activities. CONCLUSION: The provision of culturally appropriate community-based physical activity programs appears to support and encourage engagement among CALD older adults.

Financial difficulty and biopsychosocial predictors of loneliness: A cross-sectional study of community dwelling older adults.

AIM: To investigate the interplay of sociodemographic, health, functional and psychosocial factors in predicting loneliness in community dwelling older adults accessing home support services and long-term aged residential care. METHODS: Older New Zealanders (age 65+), who had their first interRAI Home Care assessment between July 2014 and June 2016, were included. The outcome variable was the binary interRAI item "Lonely". The predictor variables included sociodemographics, hearing, vision, self-reported health, activities of daily living, social interaction and support, and depression. RESULTS: Data from 51,239 assessments of older adults (mean age: 82.3 years; female: 61%; European: 87.3%) were analysed. Loneliness was reported in 21%. A stepwise logistic regression model explained 12.1% of the variance and was statistically significant (Chi2 = 3501.0.8, df = 22; p < 0.001). The factors with the largest odds ratios (OR > 1.5) were depression, living alone, being Asian, financial difficulty and not in a relationship. Functional impairment was negatively associated with loneliness. CONCLUSIONS: Determining the predictors of older adults' loneliness is complex, multi-factorial, with each factor having a small, additive effect on the development of loneliness. Depression, social factors and financial difficulty are the strongest predictors but much of the variance remains unexplained. These factors could be targeted as modifiable risk factors for addressing loneliness in older adults.