Comparing Loneliness, Social Inactivity, and Social Isolation: Associations with Health-Related Quality of Life and Mortality among Home-Dwelling Older Adults.

INTRODUCTION: Loneliness, social inactivity, and social isolation are intertwined concepts. When assessed separately, they indicate poor well-being, adverse health effects, and increased mortality. Studies exploring overlapping and comparing the prognosis of these concepts are scarce. We investigated (1) overlapping of concepts of loneliness, social inactivity, and social isolation, (2) characteristics of groups: group 0 (not lonely, socially inactive, or socially isolated), group 1 (lonely), group 2 (not lonely but socially inactive and/or socially isolated), and (3) the health-related quality of life (HRQoL), psychological well-being (PWB), and 3.6-year mortality of these groups. METHODS: The home-dwelling older adults (n = 989; 75 y+) of the Helsinki Aging Study in 2019-2022 completing all required questionnaires were assessed. Group 0 included 494, group 1 included 280, and group 2 included 215 participants. Variables studied were demographics, diagnoses, mobility, physical functioning (Barthel index), and cognition (Mini-Mental State Examination). Outcomes were HRQoL (15D) and PWB. Mortality was retrieved from central registers. RESULTS: Half of the sample was lonely, socially inactive, or socially isolated, but only 2% were simultaneously lonely, socially inactive, and socially isolated. Of lonely participants, 38% were also socially inactive and/or socially isolated. The lonely participants were significantly more often widowed or lived alone and had the lowest HRQoL and poorest PWB compared with the other groups. After adjustments (age, sex, Charlson Comorbidity Index), mortality did not statistically differ between the groups. CONCLUSION: Loneliness is an independent determinant of poor HRQoL and PWB, and it should be considered separately from social inactivity and social isolation.

Participants' baseline characteristics and feedback of the nature-based social intervention "friends in nature" among lonely older adults in assisted living facilities in finland: a randomised controlled trial of the RECETAS EU-project.

BACKGROUND: Loneliness is common among older adults in institutional settings. It leads to adverse effects on health and wellbeing, for which nature contact with peers in turn may have positive impact. However, the effects of nature engagement among older adults have not been studied in randomised controlled trials (RCT). The "Friends in Nature" (FIN) group intervention RCT for lonely older adults in Helsinki assisted living facilities (ALFs) aims to explore the effects of peer-related nature experiences on loneliness and health-related quality of life (HRQoL). In this study we aim describe the participants' baseline characteristics of the RCT, feasibility of FIN intervention and intervention participants' feedback on the FIN. METHODS: Lonely participants were recruited from 22 ALFs in Helsinki area, Finland, and randomised into two groups: 1) nature-based social intervention once a week for nine weeks (n = 162) and 2) usual care (n = 157). Demographics, diagnoses and medication use were retrieved from medical records, and baseline cognition, functioning, HRQoL, loneliness and psychological wellbeing were assessed. Primary trial outcomes will be participants' loneliness (De Jong Giervald Loneliness Scale) and HRQoL (15D). RESULTS: The mean age of participants was 83 years, 73% were female and mean Minimental State Examination of 21 points. The participants were living with multiple co-morbidities and/or disabilities. The intervention and control groups were comparable at baseline. The adherence with intervention was moderate, with a mean attendance of 6.8 out of the nine sessions. Of the participants, 14% refused, fell ill or were deceased, and therefore, participated three sessions or less. General subjective alleviation of loneliness was achieved in 57% of the intervention participants. Of the respondents, 96% would have recommended a respective group intervention to other older adults. Intervention participants appreciated their nature excursions and experiences. CONCLUSIONS: We have successfully randomised 319 lonely residents in assisted living facilities into a trial about the effects of nature experiences in a group-format. The feedback from participants was favourable. The trial will provide important information about possibilities of alleviating loneliness with peer-related nature-based experiences in frail residents. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT05507684. Registration 19/08/2022.

Determinants of a sense of insecurity among home-dwelling older people.

Aims: A sense of insecurity may have an impact on older people's well-being and their courage to engage actively in meaningful activities. Studies on a sense of insecurity among older people are scarce. The aim of this study was to determine the extent to which home-dwelling older adults perceive their life as being insecure and how a sense of insecurity is associated with their health, functional status, active social engagement, well-being and perceptions of the societal treatment of older people. Methods: This study is part of the Helsinki Aging Study, a cohort study ongoing since 1989. Data were collected using a postal questionnaire that was mailed in 2019 to a random sample of home-dwelling older people ⩾75 years of age living in Helsinki (N=2917; response rate 74%). The questionnaire inquired about the respondents' sense of security/insecurity, and they were subcategorised into those feeling secure and those feeling insecure based on their answers. Results: Seven per cent of respondents felt insecure in their lives. In a stepwise logistic regression analysis, loneliness, living alone and perceived poor societal treatment of older people were associated with a sense of insecurity, while having good self-rated health, having children and meeting friends at least weekly were associated with lower odds of insecurity. Conclusions: Our findings highlight the importance of recognising and combating loneliness, social isolation and societal ageism in order to reduce insecurity among older people and to support their active engagement in life.