Mindfulness and loneliness in retired older adults in China: mediation effects of positive and negative affect.

Objectives: Drawing from the mindfulness framework and the broaden-and-build theory, this study investigates the extent to which mindfulness influences loneliness and whether the relation is mediated by positive and negative affect.Method: Data were collected from 748 retired older adults aged 60 and above in Chengdu, China in 2022. Loneliness and mindfulness were measured by the UCLA loneliness scale and by the short-form version of the Five Facet Mindfulness Questionnaire, while the positive and negative affect was assessed by the International Positive and Negative Affect Schedule.Results: The results of this study show that mindfulness was positively associated with positive affect (ß = 0.37, p<.001), negatively related to negative affect (ß=-0.21, p<.001) and loneliness (ß=-0.13, p<.001), and had an indirect effect on loneliness via positive and negative affect (ß=-0.20, p<.001).Conclusion: The findings suggest that mindfulness could be a positive resource for improving mental health and reducing loneliness among retired older adults in China.

Analysis of initial sandplay characteristics among university students with different levels of loneliness.

BACKGROUND AND OBJECTIVE: Loneliness is detrimental to mental health, with university students at higher risk of feeling lonely than other population groups. The mental health of college students is a hot topic at present. Despite numerous studies exploring interventions for loneliness among university students. However, little research has explored early psychological manifestations of university students with different levels of loneliness. Despite numerous studies exploring interventions for loneliness among university students, little research has explored early psychological manifestations of university students with different levels of loneliness. Initial sandplay is a good tool to reveal psychological activity. Therefore, our study aims to explore the characteristics of initial sandplay application among university students with different levels of loneliness. METHODS: We recruited 60 volunteers from a university to perform a sandplay experiment from January to April 2021. The UCLA Loneliness Scale measured the levels of loneliness. These 60 participants were divided into the experimental group (n = 30) and control group (n = 30) according to their levels of loneliness. The experimental group included participants with a scale score of more than 44. Other participants with a scale score of less than 44 belong to the control group. We recorded their sandplay artwork and statistically analyzed it by the Sandplay Process Record Form. Group comparisons were performed using the t-test or Wilcoxon rank-sum test for continuous variables, and the chi-square test or Fisher's exact test for categorical variables. The logistic regression analysis by forward stepwise method was conducted to analyze the sandplay theme features for loneliness. RESULTS: Regarding the sandplay tools, the experimental group used fewer transportation tools (t=-3.608, p < 0.01) and more natural elements (t = 2.176, p < 0.05) than the control group. Moreover, the experimental group created more natural scenes (χ2 = 4.310, p < 0.05) and used less of the lower left (χ2 = 4.593, p < 0.05) and lower right (χ2 = 5.934, p < 0.05) spaces. With regards to sand changes, the experimental group was less likely than the control group to make substantial changes (χ2 = 5.711, p < 0.05) and more likely to make almost no changes (χ2 = 4.022, p < 0.05). In terms of the themes, the experimental group was more likely to exhibit sandplay artwork themes of emptiness (χ2 = 8.864, p < 0.05) and neglect (χ2 = 6.667, p < 0.05), and less likely to show themes of energy (χ2 = 5.079, p < 0.05). In the logistic regression analysis of the sandplay themes, emptiness (OR = 5.714, 95%CI: 1.724-18.944, p = 0.003) and neglect (OR = 7.000, 95%CI: 1.381-35.479, p = 0.010) were demonstrated a nominal association with high levels of loneliness among both groups (F = 16.091, p < 0.01, ΔR2 = 0.193), but failed to pass the Bonferroni testing correction (p threshold < 0.0025). CONCLUSION: University students with higher degree of loneliness do not like to drastic changes and prefer to use natural elements in element selection, while the control group likes to drastic changes and prefers to use transportation tools in element selection. Regression analysis of sandplay theme features revealed emptines and neglect may as significant associated factors for loneliness. We propose sandplay characteristics can help identify university students with different levels of loneliness during psychological evaluations. Therefore, it is important that the school and healthcare systems assist college students in identifying the loneliness through initial sandplay and carrying on the necessary psychological counseling to the lonely student population.

Loneliness at end-of-life: A scoping review.

AIMS AND OBJECTIVES: To map and synthesise the literature on loneliness at end-of-life and identify key knowledge gaps in loneliness research. BACKGROUND: Declined health conditions, reduced social engagement, loss of social roles, and fear of death may lead to loneliness at end-of-life. However, systematic information about loneliness at end-of-life is scant. METHODS: This scoping review followed the methodology proposed by Arksey and O'Malley. Nine electronic databases were searched from January 2001 to July 2022. Studies about loneliness at end-of-life were included. Two review authors independently screened and selected relevant studies and performed the data charting. The PAGER framework was employed to collate, summarise and report the results. The PRISMA-ScR checklist was included. RESULTS: A total of 23 studies were included in this review (12 qualitative, 10 quantitative, and one mixed-methods design). There was not reliable data about the prevalence of loneliness among adults at end-of-life internationally. Three or 20-item UCLA loneliness scale was frequently used to measure loneliness. Factors predisposed adults at end-of-life to loneliness included passive and active withdrawal from social networks, inability to share emotions and to be understood, and inadequate support on spirituality. Four strategies were identified to alleviate loneliness, yet none have been substantiated in clinical trials. Interventions facilitating spirituality, social interactions and connectedness seem effective in alleviating loneliness. CONCLUSIONS: This is the first scoping review on loneliness at end-of-life, synthesising evidence from qualitative, quantitative, and mixed-methods studies. Loneliness among adults at end-of-life is under-investigated and there is a prominent need to address existential loneliness at end-of-life. RELEVANCE TO CLINICAL PRACTICE: All nurses should proactively assess loneliness or perceived social isolation for clients with life-limiting conditions, regardless of social networks. Collaborative efforts (e.g., medical-social collaborations) to promote self-worthiness, social engagement and connectedness with significant others and social networks are needed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.

Existential aspects documented in older people's patient records in the context of specialized palliative care: a retrospective review.

BACKGROUND: Documentation of older people's end-of-life care should cover the care given and provide an overview of their entire situation. Older people approaching the end of life often have complex symptoms, live with bodily losses, and face an unknown future in which existential aspects come to the forefront. Knowledge of the existential aspects recorded in palliative care documentation is sparse and merits improvement. This knowledge is relevant to the development of more holistic documentation and is necessary in order to promote reflection on and discussion of documentation of the sensitive existential considerations arising in palliative care. The aim of this study was to describe the documentation of existential aspects in the patient records of older people receiving specialized palliative care. METHODS: Data were obtained from a retrospective review of the free-text notes in 84 records of randomly selected patients aged ≥75 years enrolled in specialized palliative care units who died in 2017. The notes were analysed using an inductive qualitative content analysis. RESULTS: The notes documented existential aspects in terms of connotations of well-being and ill-being. Documented existential aspects were related to the patients' autonomy concerning loss of freedom and self-determination, social connectedness concerning loneliness and communion, emotional state concerning anxiety and inner peace, and state of being concerning despair and hope. The notes on existential aspects were, however, not recorded in a structured way and no care plans related to existential aspects were found. CONCLUSIONS: Existential aspects concerning both ill-being and well-being were sparsely and unsystematically documented in older people's patient records, but when notes were extracted from these records and analysed, patterns became evident. Existential aspects form an important basis for delivering person-centred palliative care. There is a need to develop structured documentation concerning existential aspects; otherwise, patients' thoughts and concerns may remain unknown to healthcare professionals.

Living With Cardiovascular Disease: Existential Meaning of Lifestyle Change.

This study aims at exploring the perspectives of patients with cardiovascular disease (CVD) on the existential meaning of lifestyle change as an evidence base for spiritual care by nurses and other health professionals. This study has been carried out within the paradigm of phenomenological caring sciences. The sample of 18 participants was purposively selected. Data consisted of in-depth interviews among adults with an episode of CVD. Data analysis of transcribed audio recordings was done using the method of Reflective Lifeworld Approach. For patients with CVD, changing one's lifestyle is an experience of transition in self-image. This transition has a twofold dynamic. On the one hand, it entails alternating phases in what is meaningful for the patient: letting go (loss of the normal, of health, of bodily functions) and holding on (desire to be healthy and to be normal). On the other hand, through the vulnerability and loneliness patients often experience, patients report a need to be encouraged by and connected to others/the Other. Making brave choices and connecting to the patients' spiritual resources of inner strength are crucial for successful lifestyle changes and meaningful transition to a new lifestyle. Lifestyle change is not only a physical and psychological process for the patient with CVD but also an existential transition that involves fundamental views and values of being human. It is an experience that is in part socially influenced, that is, by encouragement from meaningful others. For the health care worker, knowledge of this experience may help provide spiritual care after CVD.

The Psychological Structure of Loneliness.

Despite the current surge of interest in loneliness, its health consequences, and possible remedies, the concept itself remains poorly understood. This paper seeks to contribute to a more fully worked out account of what loneliness consists in. It does this by stressing that loneliness always has an experiential component and by introducing a simple psychological structure to analyze the experience. On this basis, it suggests that we can distinguish between three ways of thinking about the phenomenal dimension of loneliness. There are objectivist views that seek to understand loneliness by a description of its intentional object, subjectivist views that consider its holistic relation to other aspects of the sufferer's psyche, and embodied and enacted views that focus on the relation between the lonely person's mental life and her social environment. The aim is not to adjudicate between these views or to suggest that they are mutually exclusive. Rather, this paper recommends a pluralistic framework on which all three approaches have something to contribute to a fuller understanding of the condition and may be of use in devising measures aimed at improving sufferers' health.

From anxious loneliness to meditation: a mental health self-care strategy to cope with the COVID-19 pandemic.

It has been a matter of public knowledge that physical and mental health are intertwining concerns. With a high association between the individuals' experience of the novel Corona Virus Disease in 2019 (COVID-19) and their psychological distress, mental health experts recognized mental health as a coterminous public health concern with the COVID-19 pandemic. In this journal, a systematic review study pointed out that mental health is the most affected issue concerning implementing governments worldwide adopted policies like staying at home, social distancing and 'lockdown' measures. However, we argue that these containment measures could be non-detrimental to mental health when one transforms his or her experience of anxious loneliness into an avenue of practicing meditation as a strategy of mental health self-care.

Efficacy of group reminiscence therapy based on Chinese traditional festival activities (CTFA-GRT) on loneliness and perceived stress of rural older adults living alone in China: a randomized controlled trial.

OBJECTIVES: This study aimed to explore the efficacy of group reminiscence therapy based on Chinese traditional festival activities (CTFA-GRT) to mediate the loneliness and perceived stress of older adults living alone in rural China. The results can provide a scientific foundation for improving psychological health. METHOD: A randomized controlled trial of 64 (aged 65.70 ± 3.69 years) Chinese rural older adults living alone was conducted. They were randomly divided into either an eight-month intervention group or a control group. The perceived stress scale (PSS) and the UCLA loneliness scale (UCLA-LS) evaluated the perceived stress and loneliness of the two groups at three different times. A repeated-measures analysis of variance model was used to compare each outcome measure of the two groups. RESULTS: The CTFA-GRT yielded a benefit for the perceived stress and loneliness of rural older adults living alone in the intervention group. Combined with a simple effects test, the PSS and UCLA-LS of those in the intervention groups significantly decreased at eight months after the baseline (F PSS = 23.540, F UCLA-LS = 40.159; all P < 0.01). In addition, the sustainable effect of this program lasted three months after the intervention (F PSS = 65.756, F UCLA-LS = 60.983; all P < 0.01). CONCLUSION: The CTFA-GRT significantly decreased the perceived stress and loneliness of rural older adults living alone in China.

The 'loneliness pandemic': implications for gerontological nursing.

The COVID-19 pandemic compelled states to limit free movement, in order to protect at-risk and more vulnerable groups, particularly older adults. Due to old age or debilitating chronic diseases, this group is also more vulnerable to loneliness (perceived discrepancy between actual and desired social relationships) and social isolation (feeling that one does not belong to society). This forced isolation has negative consequences for the health of older people, particularly their mental health. This is an especially challenging time for gerontological nursing, but it is also an opportunity for professionals to combat age stereotypes reinforced with COVID-19, to urge the measurement of loneliness and social isolation, and to rethink how to further adjust interventions in times of crisis, such as considering technology-mediated interventions in these uncertain times.

Short-Term Impact of Social Distancing Measures During the COVID-19 Pandemic on Cognitive Function and Health Perception of Brazilian Older Adults: A Pre-Post Study.

Social distancing, a critical measure to manage COVID-19 transmission, is consistently associated with social isolation, a major health issue. Social isolation negatively impacts mental and physical health, particularly among older adults. A pre-post comparison study examined changes in cognitive function and perceived health among 36 community-dwelling Brazilian older adults, assessed pre and post social distancing measures enacted due to COVID-19. A significant increase in cognitive function was found 1 month into social distancing (M = 16.3, p = .002, power = 0.88), with declining scores for vitality (M = -29.3, p < .001, power = 0.99) and mental health (M = -38.1, p < .001, power = 0.99), particularly among participants who lived alone (t = -3.8, p = .001). Older adults exhibit rapid changes in perceived health when excluded from participation in social activities. Health care professionals should consider holistic approaches when addressing the impacts of social isolation on this population.

Use of virtual reality in the inpatient rehabilitation of COVID-19 patients.

INTRODUCTION: Use of virtual reality (VR) in healthcare has expanded in recent years. The challenges faced by patients with prolonged COVID-19-related hospitalizations - social isolation, disability, neurologic sequelae, adjustment-related anxiety, depression, and stress - may be mitigated by the novel use of VR as one modality of a comprehensive rehabilitation plan. This descriptive study aimed to understand patient satisfaction and perceived benefit of virtual reality on a COVID-19 recovery unit, as well as the logistical and operational feasibility of providing VR content for patients and staff. MATERIALS AND METHODS: During the COVID-19 surge in New York City in 2020, the COVID-19 Recovery Unit (CRU) of a large academic hospital invited patients and staff to participate in VR sessions with three categories of experience: (1) Guided meditation, (2) Exploration of natural environments, (3) Cognitive stimulation games. Patients and staff were surveyed about satisfaction and perceived benefit. RESULTS: 13 patients and 11 staff were surveyed, with median patient satisfaction scores of 9 out of 10, with ten representing "extremely satisfied," and median staff satisfaction scores of 10. 13/13 patients answered "yes" to recommending the therapy to others, and 12/13 answered "yes" to perceived enhancement of their treatment. 11/11 staff answered "yes" to recommending the therapy to others, and 11/11 answered "yes" to perceived enhancement of their wellbeing. DISCUSSION: A VR program implemented on a COVID-19 rehabilitation unit for patients and healthcare providers was rated as highly satisfactory with perceived benefit by survey respondents. Participants commented that the use of VR was useful in coping with isolation and loneliness, and could be implemented within the context of clinical care for COVID-19 patients as part of a comprehensive rehabilitation model. The use of VR was also logistically and operationally feasible on the CRU. Future work to compare benefits of VR to standard neuropsychological rehabilitation is needed.

Heartfulness meditation improves loneliness and sleep in physicians and advance practice providers during COVID-19 pandemic.

Objective: Unprecedented work pressures and social isolation during the COVID-19 pandemic may worsen loneliness and sleep problems in health-care professionals. Heartfulness meditation has been shown to improve burnout and sleep. In the current study, the effects of remote Heartfulness meditation in improving loneliness and sleep quality were measured. Methods: Physicians and advance practice providers were randomly assigned to receive either daily Heartfulness Meditation program or no intervention (control group) in a prospective four-week randomized control study design. UCLA loneliness and PSQI scores were collected at baseline and after the program duration of 4 weeks. The study was retrospectively registered with trial Number, ISRCTN85787008 (8 January 2021). Results: Of the 155 subjects enrolled in the study, 50% were lonely and 97% had sleep problems. Attrition rate was 36%. Among those who completed the study, the mean UCLA loneliness scores decreased from 42.1 to 39.4 in the Heartfulness group (N = 40, p = 0.009) and 42.2 to 41.15 in the control group (N = 57, p = 0.254). The mean PSQI scores decreased from 10.75 to 9.14 in the Heartfulness group (N = 41, p = 0.001) and 9.41 to 8.87 in the control group (N = 58, p = 0.122). Younger participants aged 30 and under had higher loneliness and sleep problems. Conclusions: The current study is one of the first attempts to assess loneliness and sleep problems among physicians and advance practice providers during COVID-19 pandemic in the US. A significant burden of loneliness and sleep problems was identified. An improvement of sleep and loneliness was noted with the practice of Heartfulness meditation. This remote intervention might be a useful tool to be explored in larger studies.

Effects of Laughter Therapy on Life Satisfaction and Loneliness in Older Adults Living in Nursing Homes in Turkey: A Parallel Group Randomized Controlled Trial.

PURPOSE: This study examined the effects of laughter therapy on life satisfaction and loneliness in older adults living in nursing homes. DESIGN: A single-blind, parallel-group, randomized controlled trial (ClinicalTrials NCT03687788) with a pretest-posttest design was conducted. METHODS: There were 31 experimental participants and 31 controls. The experimental group received laughter therapy twice a week for 6 weeks, along with usual care. The control group received usual care only. Loneliness was measured with the De Jong Gierveld Loneliness Scale, and life satisfaction was measured with the Satisfaction With Life Scale. FINDINGS: After 6 weeks, there was a statistically significant difference in De Jong Gierveld Loneliness Scale total score between the two groups, and the subscale scores of the experimental group decreased. CONCLUSIONS: Laughter therapy may reduce loneliness in older adults. CLINICAL RELEVANCE: Healthcare professionals, especially nurses, can potentially use laughter therapy to reduce loneliness in older adults.

The COVID-19 Context Calls for a Broader Range of Healthcare Chaplaincy Models: An Exploratory Translational Study Utilizing Evolutionary Psychology and Social Neuroscience Loneliness Research.

Shifts in chaplain requests from patients and families and lack of engagement by staff in now traditional support forms in the COVID-19 context suggest that new insights and resourcing are needed. This exploratory translational study suggests that the evolutionary psychology of R. I. M. Dunbar and the social neuroscience of J. T. Cacioppo, his collaborators, and successors and their concerns for human loneliness have potential for use in development of effective healthcare chaplaincy practice in the COVID-19 context.

Loneliness, social isolation, cardiovascular disease and mortality: a synthesis of the literature and conceptual framework.

To conduct a systematic review and develop a conceptual framework on the mechanisms linking loneliness, social isolation, health outcomes and mortality. Electronic databases were systematically searched (PubMed, MEDLINE, Scopus and EMBASE) from inception to October 2018 followed by manual searching to identify research on loneliness, social isolation and mortality in adults published in the English language. Articles were assessed for quality and synthesised into a conceptual framework using meta-ethnographical approaches. A total of 122 articles were included. These collated observational designs examining mediators and moderations of the association in addition to qualitative studies exploring potential mechanisms were included. A framework incorporating 18 discrete factors implicated in the association between loneliness, social isolation and mortality was developed. Factors were categorised into societal or individual, and sub-categorised into biological, behavioural and psychological. These findings emphasise the complex multidirectional relationship between loneliness, social isolation and mortality. Our conceptual framework may allow development of more holistic interventions, targeting many of the interdependent factors that contribute to poor outcomes for lonely and socially isolated people.

A Community Choir Intervention to Promote Well-Being Among Diverse Older Adults: Results From the Community of Voices Trial.

OBJECTIVES: To test effects of the Community of Voices choir intervention on the health, well-being, and health care costs of racial/ethnically diverse older adults. METHOD: Twelve Administration-on-Aging-supported senior centers were cluster randomized into two groups: the intervention group started the choir immediately and a wait-list control group began the choir 6 months later. The choir program was designed for community-dwelling adults aged 60 years and older. The multimodal intervention comprises activities that engage participants cognitively, physically, and socially. Outcome measures assessed these three domains as well as health care utilization and costs. The intention-to-treat comparison was at 6 months. RESULTS: The sample (N = 390) had a mean age of 71.3 years (SD = 7.2); 65% were nonwhite. Six-month retention was 92%. Compared to controls, intervention group members experienced significantly greater improvements in loneliness (p = .02; standardized effect size [ES = 0.34] and interest in life (p = .008, ES = 0.39). No significant group differences were observed for cognitive or physical outcomes or for health care costs. DISCUSSION: Findings support adoption of community choirs for reducing loneliness and increasing interest in life among diverse older adults. Further efforts need to examine the mechanisms by which engagement in choirs improves aspects of well-being and reduces health disparities among older adults, including potential longer-term effects. CLINICALTRIALS.GOV REGISTRATION: NCT01869179 registered January 9, 2013.

Psychological Health Benefits of Companion Animals Following a Social Loss.

BACKGROUND AND OBJECTIVES: In later life, the loss of a spouse due to divorce or widowhood is common and can lead to elevated depressive symptoms and loneliness. Research suggests that companion animal (CA) may be beneficial for psychological health, but limited research has explored whether CA can buffer negative consequences of social losses. RESEARCH DESIGN AND METHODS: This study uses data drawn from the Health and Retirement Study (HRS) to examine changes in depressive symptoms and loneliness in relation to a social loss among those with/without a CA. We used inverse-probability weighted regression to adjust for selection factors and isolate effects of CA ownership on changes in psychological health. RESULTS: Regardless of CA ownership, spousal loss was associated with psychological health consequences. Facing a social loss without a CA was related to statistically greater increases in depressive symptoms relative to those with a pet (2.580 vs. 1.207 symptoms, respectively). Similarly, experiencing a loss was associated with significantly greater increases in loneliness, with statistically greater increases in loneliness among those without a CA (p < .01). However, those with a CA did not experience greater increases in loneliness than those who did not experience a loss. DISCUSSION AND IMPLICATIONS: In later life, CA ownership may buffer against the detrimental consequences of major social losses on psychological health. Future research on the therapeutic effects of CA ownership, as well as pet therapy, during other major life stage transitions is needed to help isolate potential mechanisms driving the benefits of human-animal interactions.

The wounded self-lonely in a crowd: A qualitative study of the voices of children living with atopic dermatitis in Hong Kong.

Atopic dermatitis (AD) imposes significant physical and psychosocial burdens on affected children. However, little has been done to learn from the subjective experiences, perspectives and emotions of children living with AD. Their voices are not heard in healthcare settings. This study aims to share these children's voices and provide a deep understanding of the subjective experiences of children living with AD. We conducted qualitative research by conducting semi-structured interviews and analysing the drawings of 17 children in Hong Kong aged between 8 and 12 years who were diagnosed with AD. Using a phenomenological approach, we transcribed, coded and described the interviews. We found that for the children in this study, living with AD meant contending with an accumulation of challenges and crises. At the individual level, the essential experience of living with AD manifested a vicious cycle of skin and mental issues. At the family level, conflicts between children and parents concerning AD management coexisted with parental support. The children commonly experienced bullying and isolation in school and discrimination and stigmatisation in their neighbourhood, thereby making living with AD a traumatic experience. The synergy between individual and environmental factors contributed to shaping an incapable and wounded "self" living with AD. Based on our findings, we propose a child-centred biopsychosocial framework for understanding the living experiences of children with AD. This study suggests different practice strategies for healthcare professionals working with the individual challenges experienced by children living with AD and the challenges these children experience in their family, school, and neighbourhood. The needs of these children should be addressed through an integrated, holistic approach for improving their long-term health outcomes.