[An appropriate approach to loneliness: A translation of empirical data into practice]. / Een passende aanpak van eenzaamheid: een vertaalslag van empirische data naar de praktijk.

We describe three subgroups of older lonely people (Persona), and design different approaches to loneliness that directly address their specific needs and circumstances: the combination approach. The use of Persona is a middle ground between 'one approach appropriate for all' and 'each person's own approach'. A Persona is described using various risk factors for loneliness. These are advanced age, living alone, small network, low perceived control, and low income. Based on this, we explore the potential effect of improving some of these situations for reducing loneliness (Cohen's d ranges between -0.33 and -0.58). For two approaches we report what the realized effect was (d=-0.83 in both interventions). The three Persona and the approaches are examples that designers of a loneliness approach can use by analogy to elaborate and substantiate their approach.

Loneliness of Older Immigrant Groups in Canada: Effects of Ethnic-Cultural Background.

This study aimed to explore the loneliness of several groups of older immigrants in Canada compared to native-born older adults. Data from the Canadian General Social Survey, Cycle 22 (N older adults = 3,692) were used. The dependent variable is the 6 item De Jong Gierveld loneliness scale. Determinants of loneliness included country of birth, ethnic background (cultural context); belongingness (community context) and social networks (social context). Results showed that only some immigrant groups are significantly lonelier than older adults born in Canada. Immigrants with similar language and culture are not lonelier; while those from countries that differ in native language/culture are significantly higher on loneliness. Multivariate analyses showed the importance of cultural background, of composition of the network of relatives and friends, and of local participation and feelings of belonging to the Canadian society in explaining loneliness of older immigrants.

"Being all alone makes me sad": loneliness in older adults with depressive symptoms.

ABSTRACT Background: The consequences of co-occurring persistent loneliness and late life depression are yet unknown. The aim of this study was to get a deeper insight into the mental health consequences of loneliness in older persons with depressive symptoms and their perspectives of emotional distress by using a mixed-methods study design. Methods: Two hundred and forty nine community-dwelling older persons with depressive symptoms according to the Patient Health Questionnaire-9 (≥6) were included. A validated cut-off score on the Loneliness Scale was used to distinguish lonely elders from elders who were not lonely. Quantitative and qualitative data were used to examine differences in mental health and perspectives on emotional distress between lonely and not lonely older persons with depressive symptoms. Results: Loneliness was highly prevalent among older persons with depressive symptoms (87.8%). Lonely people suffered from worse mental ill-health (e.g., more severe depressive symptoms, more often a depressive disorder and a lower quality of life) compared to not lonely individuals. Depressive symptoms were regarded as a logical consequence of loneliness. Lonely people perceived little command over their situation: causes of loneliness were attributed externally to perceived deficits in their social networks and they mainly expressed the need to be listened to. Conclusion: Our findings underline the importance of paying considerable attention to (severe) loneliness in older adults with depressive symptoms given its high prevalence and serious mental health consequences. Future studies should look into whether addressing loneliness when discussing depressive symptoms in clinical practice may provide an opportunity to better adjust to older persons' depression perceptions and might therefore improve care utilization.

Cross-national differences in older adult loneliness.

Loneliness concerns the subjective evaluation that the number of relationships is smaller than the individual considers desirable or that the intimacy that the individual wishes for has not been realized. The aim of this study was to assess variations in levels of late-life loneliness and its determinants across Europe. Data came from the SHARE surveys, Wave 2 (Borsch-Supan et al., 2008), encompassing adults aged 50 years and over in Austria, Belgium, the Czech Republic, Denmark, France, Germany, Greece, Ireland, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland (N = 12,248). Loneliness was measured by a single item derived from the CES-D (depression) scale. Using logistic models, the present authors tested several types of explanations for country differences: differences in demographic characteristics, wealth and health, and social networks. Older adults in the southern and central European countries were generally lonelier than their peers in the northern and western European countries. In the southern and central European countries, loneliness was largely attributable to not being married, economic deprivation, and poor health. Frequent contacts with parents and adult children, social participation, and providing support to family members were important in preventing and alleviating loneliness in almost all countries. To combat loneliness among older adults, the findings suggest both (a) generic approaches aimed at improving social embeddedness and (b) country-tailored approaches aimed at improving health and wealth.

A critical review and development of a conceptual model of exclusion from social relations for older people.

Social exclusion is complex and dynamic, and it leads to the non-realization of social, economic, political or cultural rights or participation within a society. This critical review takes stock of the literature on exclusion of social relations. Social relations are defined as comprising social resources, social connections and social networks. An evidence review group undertook a critical review which integrates, interprets and synthesizes information across studies to develop a conceptual model of exclusion from social relations. The resulting model is a subjective interpretation of the literature and is intended to be the starting point for further evaluations. The conceptual model identifies individual risks for exclusion from social relations (personal attributes, biological and neurological risk, retirement, socio-economic status, exclusion from material resources and migration). It incorporates the evaluation of social relations, and the influence of psychosocial resources and socio-emotional processes, sociocultural, social-structural, environmental and policy contextual influences on exclusion from social relations. It includes distal outcomes of exclusion from social relations, that is, individual well-being, health and functioning, social opportunities and social cohesion. The dynamic relationships between elements of the model are also reported. We conclude that the model provides a subjective interpretation of the data and an excellent starting point for further phases of conceptual development and systematic evaluation(s). Future research needs to consider the use of sophisticated analytical tools and an interdisciplinary approach in order to understand the underlying biological and ecopsychosocial associations that contribute to individual and dynamic differences in the experience of exclusion from social relations.

Intra-couple Caregiving of Older Adults Living Apart Together: Commitment and Independence.

Recently, rising numbers of mid-life and older adults are starting a "living apart together" (LAT) relationship following divorce or widowhood. LAT describes an intimate relationship wherein partners maintain separate households. This study investigated the characteristics of care arrangements in older long-term LAT couples and elicited personal comments about intra-couple care. We interviewed 25 LAT partners and a comparison group of 17 remarried older adults in the Netherlands in a side study of the Netherlands Kinship Panel Study. Results showed that about half of the LAT partners intended to exchange care if needed (partnership commitment); the other half had ambiguous feelings or intentions to refuse care (independence orientation). However, for those LAT partners already confronted with illness in their current relationship, all provided care to the partner in need. The minority of LAT partners who would not exchange care reciprocally are more likely to give as opposed to receive care.

Determinants of Loneliness among Older Adults in Canada.

The purpose of this study was to determine the key determinants of loneliness of older Canadians. We drew on the assumptions concerning the importance of person-environment fit to test the relative importance of personal characteristics, deprived living conditions, social network/social engagement, and satisfaction in explaining loneliness. Data comprised a sample of 3,799 respondents over age 65 drawn from Statistics Canada's General Social Survey, Cycle 22. Personal characteristics, social network size and composition, and satisfaction with network contact were found to be related to loneliness, as were indicators of living in economically and socially challenging conditions. Older adults who had experienced a recent downturn in their financial situation, and who lacked the help needed to cope with a recent personal challenge, reported higher levels of loneliness. A striking feature of our findings is the relatively low scores on loneliness of older Canadians compared to older adults in other countries.

Cross-national comparisons of social isolation and loneliness: introduction and overview.

This article provides an introduction to the special volume on research related to issues of social isolation and loneliness for older people. It discusses some key concepts and provides a brief overview of the articles included in the volume.

Gender and marital-history differences in emotional and social loneliness among Dutch older adults.

In this study, Weiss's (1973) theorizing about the sources of emotional and social loneliness is elaborated--with notions about the asymmetric gratifications derived from marriage, about the conflicting loyalties that result from remarriage, and about selection into marriage--in order to reach an understanding of gender differences in loneliness, both in and outside of marriage. First and subsequent marriages are considered, as well as marital disruptions and never marrying. The data (N = 3737) are from the 1992 Dutch survey on older adults' living arrangements and social networks (NESTOR-LSN). Marital-history differences emerge, not only for emotional loneliness, but also (and contrary to Weiss's theoretical conceptualizations) for social loneliness. The marital-history differences in emotional and social loneliness are greater among men than women. For men, the marriage bond appears not only to be more central to emotional well-being than is the case for women but also to play a pivotal role in their involvement with others. Marital history offers the best explanation for differences in emotional loneliness among men, but social embeddedness characteristics also account for differences in emotional loneliness among women. Apparently, whereas men are more likely to find an intimate attachment in marriage, women also find protection from emotional loneliness in other close ties. The marital-history differences in social loneliness are largely mediated by social embeddedness characteristics, partly in different ways for men and women. Involvement in activities outside the home serves as the context for sociability for men, whereas parenthood plays a more important role in women's social engagements.

Loneliness among older adults in The Netherlands, Italy, and Canada: a multifaceted comparison.

Loneliness is experienced in many cultures. To properly assess cross-cultural differences, attention should be paid to the level, determinants, and measurement of loneliness. However, cross-cultural studies have rarely taken into account more than one of these. Differences in the level of loneliness were hypothesized on the basis of national differences in partnership, kinship, and friendship, which were assumed to be related to cultural standards within a society. Differences were examined among married and widowed older adults aged 70 to 89 years living independently in The Netherlands (N = 1,847), Tuscany, Italy (N = 562), and Manitoba, Canada (N = 1,134). Loneliness was measured with an 11-item scale. The Manitobans were high on emotional loneliness and the Tuscans were high on social loneliness. Partner status excepted, the determinants were nearly the same across the three locations. Differential item functioning (DIF) related to the three locations was observed for most items. Interactions with gender and the availability of a partner relationship were observed.

Loneliness in old age in Eastern and Western European societies: theoretical perspectives.

Data from European countries participating in the Generations and Gender Surveys showed that mean loneliness scores of older adults are higher in Eastern than in Western European countries. Although co-residence is considered as one of the fundamental types of social integration, and although co-residence is more common in Eastern Europe, the mean loneliness scores of older co-resident adults in Eastern Europe are still very high. This article investigates mechanisms behind the puzzling between-country differences in social integration and loneliness. Firstly, the theoretical framework of loneliness is discussed starting from the individual's perspective using the deficit and the cognitive discrepancy approach and taking into account older adults' deprived living conditions. Secondly, mechanisms at the societal level are investigated: cultural norms, the demographical composition and differences in societal wealth and welfare. It is argued that an integrated theoretical model, as developed in this article, combining individual and societal level elements, is most relevant for understanding the puzzling reality around social integration and loneliness in country-comparative research. An illustration of the interplay of individual and societal factors in the emergence of loneliness is presented.

The De Jong Gierveld short scales for emotional and social loneliness: tested on data from 7 countries in the UN generations and gender surveys.

Loneliness concerns the subjective evaluation of the situation individuals are involved in, characterized either by a number of relationships with friends and colleagues which is smaller than is considered desirable (social loneliness), as well as situations where the intimacy in confidant relationships one wishes for has not been realized (emotional loneliness). To identify people who are lonely direct questions are not sufficient; loneliness scales are preferred. In this article, the quality of the three-item scale for emotional loneliness and the three-item scale for social loneliness has been investigated for use in the following countries participating in the United Nations "Generations and Gender Surveys": France, Germany, the Netherlands, Russia, Bulgaria, Georgia, and Japan. Sample sizes for the 7 countries varied between 8,158 and 12,828. Translations of the De Jong Gierveld loneliness scale have been tested using reliability and validity tests including a confirmatory factor analysis to test the two-dimensional structure of loneliness. Test outcomes indicated for each of the countries under investigation reliable and valid scales for emotional and social loneliness, respectively.

Loneliness in urban neighbourhoods: an Anglo-Dutch comparison.

Past studies in the UK and the Netherlands indicate that loneliness varies significantly according to characteristics of older people's residential environment. This raises questions regarding potential neighbourhood influences on individuals' social relationships in later life. This article examines neighbourhood influences on loneliness, using multiple classification analysis on comparable empirical data collected in the UK and the Netherlands. UK data arise from a survey of 501 people aged 60+ in deprived neighbourhoods of three English cities. Netherlands data derive from the NESTOR Living Arrangements and Social Network survey, with a sub-sample of 3,508 people aged 60+ drawn from a nationally representative sample of older people, living in 11 municipalities. Both surveys incorporated the 11-item De Jong Gierveld Loneliness Scale. In addition to neighbourhood characteristics and indicators of health and social embeddedness, a typology of eight groups of persons was developed that accounted for individuals' age, sex, and partner status. While 13% of participants in the UK were severely lonely, the proportion in the Netherlands was just four per cent. Mean loneliness scores in the UK varied significantly between the neighbourhoods under investigation. Additionally, the evaluated quality of the residential neighbourhood accounted for a relatively large degree of variance in loneliness in both countries.

Validation of the Chinese translation of the 6-item De Jong Gierveld Loneliness Scale in elderly Chinese.

BACKGROUND: This study aims to develop and validate a Chinese translation of the 6-item De Jong Gierveld Loneliness Scale - a widely used instrument to measure loneliness - specifically determining its psychometric properties in community-dwelling Chinese elders in Hong Kong. The relationships between loneliness and several clinical variables are also assessed. METHOD: The English version was translated into Chinese. Content validity was established by group discussion and Delphi panel. The questionnaire was administered to 103 Hong Kong Chinese community-dwelling elders. Statistical analysis was performed to test the reliability and validity of the scale. RESULTS: The content validity was high as shown by the results of the Delphi panel. Cronbach's alpha of the 6-item scale was 0.76. For the inter-rater reliability of the six items, the intra-class correlation coefficients ranged from 0.98 to 1.00. The emotional loneliness subscale significantly correlated with the social loneliness subscale (rho = 0.37; p < 0.001). In using a direct question to measure loneliness, 21 participants (20%) reported that they were lonely. The overall loneliness scale score significantly correlated with the answers on the direct question of loneliness (rpb = 0.71; p < 0.001). The overall loneliness score showed significant correlation with Cornell Scale for Depression in Dementia (rho = 0.29; p = 0.003), current smoking status (rpb = 0.24; p = 0.014), and some objective social characteristics. CONCLUSION: The Chinese version of the 6-item De Jong Gierveld Loneliness Scale is a reliable and valid measure of loneliness in Chinese elders.