The use of case management for community-dwelling older people: the effects on loneliness, symptoms of depression and life satisfaction in a randomised controlled trial.

AIM: To investigate the effects of a case management intervention for community-dwelling frail older people, with functional dependency and repeated contacts with the healthcare services, focusing on loneliness, depressive symptoms and life satisfaction. DESIGN: A two-armed, nonblinded, randomised control trial with repeated follow-ups, of N = 153 participants at baseline allocated to an intervention (n = 80) and control (n = 73) group. METHOD: Inclusion criteria were the following: ≥65 years of age, living in ordinary housing, in need of assistance in two or more self-reported activities of daily living, having at least two hospital admissions or at least four visits in outpatient care 12 months prior to enrolment. Case managers (nurses and physiotherapists) provided an intervention of general case management, general information, specific information and continuity and safety. The intervention ranged over 12 months with one or more home visit(s) being conducted per month. An intention-to-treat analysis was applied for the primary outcomes of loneliness, depressive symptoms and life satisfaction, along with complete case and sensitivity analyses. RESULTS: During the trial period n = 12 died and n = 33 dropped out. No significant difference was found between the groups at baseline regarding sociodemographic characteristics, subjective health or primary outcomes. The intention-to-treat analysis did not result in any significant effects for the primary outcomes at any of the follow-ups (6 and 12 months). The complete case analysis resulted in a significant difference in favour of the intervention regarding loneliness (RR = 0.49, p = 0.028) and life satisfaction (ES = 0.41, p = 0.028) at 6 months and for depressive symptoms (ES = 0.47, p = 0.035) at 12 months. CONCLUSIONS: The use of case management for frail older people did not result in clear favourable effects for the primary outcomes. However, the study indicates that case management may be beneficial in terms of these outcomes. Due to the complexity of the outcomes, an elaboration of the components and assessments is suggested.

Being in a Bubble: the experience of loneliness among frail older people.

AIM: The aim of this study was to explore the experience of loneliness among frail older people living at home. BACKGROUND: Loneliness is a threat to the physical and psychological well-being with serious consequences if left unattended. There are associations between frailty and poor psychological well-being, implying that frail older people who experience loneliness are vulnerable. DESIGN: Qualitative content analysis, focusing on both latent and manifest content. METHOD: Frail older people (65+ years), living at home and who have experienced various levels in intensity of loneliness, were purposively selected from a larger interventional study (N = 12). For this study, 'frail' means being dependent in activities of daily life and having repeated contacts with healthcare services. Data were collected between December 2009-August 2011. Semi-structured interviews were performed, audio recorded and transcribed verbatim. FINDINGS: The analysis resulted in the overall theme 'Being in a Bubble', which illustrates an experience of living in an ongoing world, but excluded because of the participants' social surroundings and the impossibility to regain losses. The theme 'Barriers' was interpreted as facing physical, psychological and social barriers for overcoming loneliness. The theme 'Hopelessness' reveals the experience when not succeeding in overcoming these barriers, including seeing loneliness as a constant state. A positive co-existing dimension of loneliness, offering independence, was reflected in the theme 'Freedom'. CONCLUSION: The findings suggest that future strategies for intervening should target the frail older persons' individual barriers and promoting the positive co-existing dimension of loneliness. When caring, a person centred approach, encompassing knowledge regarding physical and psychological aspects, including loneliness, is recommended.

Loneliness and health care consumption among older people.

Few studies have investigated loneliness in relation to health care consumption among frail older people. The aim of this study was to examine loneliness, health-related quality of life (HRQoL), and health complaints in relation to health care consumption of in- and outpatient care among frail older people living at home. The study, with a cross-sectional design, comprised a sample of 153 respondents aged from 65 years (mean age 81.5 years) or older, who lived at home and were frail. Data was collected utilising structured interviews in the respondent's home assessing demographic data, loneliness, HRQoL and health complaints. Patient administrative registers were used to collect data on health care consumption. Loneliness was the dependent variable in the majority of the analyses and dichotomised. For group comparisons Student's t-test, Mann-Whitney U-test and Chi-square test were used. The results showed that 60% of the respondents had experienced loneliness during the previous year, at least occasionally. The study identified that lonely respondents had a lower HRQoL (p = 0.022), with a higher total number of reported health complaints (p = 0.001), and used more outpatient services including more acute visits at the emergency department, compared to not lonely respondents (p = 0.026). Multiple linear regression analysis showed that a depressed mood was independently associated to total use of outpatient care (B = 7.4, p < 0.001). Therefore, it might not be loneliness, per se, that is the reason for seeking health care. However, reasons for using health care services are difficult to determine due to the complex situation for the frail older person. To avoid emergency department visits and to benefit the well-being of the frail older person, interventions targeting the complex health situation, including loneliness, are suggested.

Loneliness in Relation to Social Factors and Self-Reported Health Among Older Adults: A Cross-Sectional Study.

BACKGROUND: Loneliness is described as a public health problem and can be both a consequence of aging and a cause of ill health. Lonely older adults tend to have difficulties making new social connections, essential in reducing loneliness. Loneliness often varies over time, but established loneliness tends to persist. Maintaining good health is fundamental throughout the life course. Social connections change with aging, which can contribute to loneliness. AIM: This study aimed to investigate loneliness in relation to social factors and self-reported health among older adults. METHOD: A cross-sectional research design was used based on data from the Swedish National Study on Aging and Care, Blekinge (SNAC-B), from February 2019 to April 2021. Statistical analysis consisted of descriptive and inferential analysis. RESULTS: Of n = 394 participants, 31.7% (n = 125) stated loneliness. Close emotional connections were necessary for less loneliness. Loneliness was more common among those who did not live with their spouse or partner and met more rarely. Furthermore, seeing grandchildren and neighbors less often increased loneliness, and a more extensive social network decreased loneliness. CONCLUSION: This study underlined the importance of social connections and having someone to share a close, emotional connection with to reduce loneliness.