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Introduction: Loneliness can have a negative impact on people's physical and psychological well‐being; building social capital is a potential means of addressing this connection. Community initiatives (e.g. groups, clubs, neighbourhood activities) may be a route that enables people to build social capital to tackle loneliness. Understanding what is known, and where gaps in knowledge exist, is important for advancing research on this topic. Methods: A scoping review was undertaken to explore the question – What community initiatives, with a focus on well‐being, have been evaluated in the United Kingdom that include information about social capital and loneliness? Four databases (Medline, CINAHL, ASSIA and Embase) were searched for relevant research papers. References were screened by two researchers to identify if they met the review's inclusion criteria. Data were summarised as a narrative and in tables. Results: Five papers met the review's inclusion criteria. They all used qualitative methods. Findings suggested that social capital could be developed through creating a sense of trust, group cohesion and reciprocity among participants in the community initiatives. This connection enabled people to experience a sense of belonging and to feel they had a meaningful relationship with others, which appeared to alleviate feelings of loneliness. Conclusion: More research is warranted on the review topic, including studies that have employed quantitative or mixed methods. Clarity around definitions of social capital and loneliness in future research is required. Engagement with community initiatives can provide a formalised route to help people develop connections and counteract limitations in their social networks. However, individuals may be wary about attending community initiatives, needing support and encouragement to do so. Social prescribing link workers are one means of motivating people to access groups, events or organisations that could improve their well‐being. [ABSTRACT FROM AUTHOR]

This paper presents some findings from the IN-AGE ("Inclusive ageing in place") study, which the authors carried out in 2019 in Italy. It explores the available social support resources for frail older people with functional limitations ageing in place alone, and possible links between their social isolation and perceived loneliness. The authors conducted qualitative/semi-structured interviews involving 120 participants aged 65 years and over, and used a mixed-methods analysis (quantitative/qualitative). The main results show the family as the main help resource for daily activities, but also for intimate confidences against social isolation, especially when said relatives live close. Family confidants are less present when seniors are supported by friends/neighbours or/and public services. Moreover, the family is valuable for decreasing loneliness, although not always. However, some older people feel particularly alone when they are supported by public services. Such a complex context draws attention on the need of support for frail seniors living alone and could provide insights for policymakers on adequate policies for preventing and managing loneliness and social isolation in later life. This is especially relevant when family (and other) resources are not available or scarce, also considering the opportunities offered by technology, which can help seniors remain socially connected to relatives, friends and their overall community. [ABSTRACT FROM AUTHOR]

Background: Whilst qualitative research has previously been conducted on older people's personal resilience and wellbeing during COVID-19, there are fewer empirical studies on the impact it had on social connectedness for this age group. In this paper we seek to examine older people's social connectedness to others during the pandemic, their personal experiences of seeking out those connections, and whether there are any identifiable pre-existing factors that enabled them to minimise the impact of enforced isolation. Methods: Using a phenomenological methodology, we conducted in-depth interviews with 13 older people between March and May 2021. These interviews explored the participant's lived experiences of staying socially connected to others during the enforced lockdowns and various restrictions. Results: Our findings reveal strong themes of personal resilience, sense of coherence and other protective factors, but also highlight the benefits of establishing connections to friends, family, organised groups and community prior to the pandemic. Conclusion: Older people's ability to stay socially connected is influenced by personal resilience and a positive mindset; pre-existing social ties to others and maintaining a personal sense of coherence and a sense of belonging to people or places. Our findings shed light on the importance of informal social interactions, what it means to feel lonely in older age and indicate that for some the pandemic restrictions may even have offered a welcome space in which to process significant life events. [ABSTRACT FROM AUTHOR]

INTRODUCTION With the advent of new tobacco products, poly-tobacco use among adolescents is increasing. Smoking among adolescents negatively impacts both their physical and mental health. This study aimed to determine poly-tobacco use among adolescents in South Korea and to identify the mental health problems caused by single-, dual-, and poly-tobacco use. METHODS Data from 54948 adolescents in the 2020 Korea Youth Behavior Web-based Survey were included. Mental health variables of our primary outcome were loneliness, anxiety, and depression. Descriptive statistics, Rao-Scott χ² test and complex sample multivariable logistic regression analysis were conducted to determine the association between the type of tobacco product use and mental health. RESULTS Among the subjects, 95.2% were non-tobacco users, followed by single (3.0%), dual (1.1%), and poly users (0.7%). The subjects with poly-tobacco use had significantly higher rates of loneliness (33.2%, p<0.001), anxiety (22.3%, p<0.001), and depression (49.9%, p<0.001) than those who used fewer tobacco products. Subjects who used poly-tobacco products were 2.13 (95% CI: 1.61-2.83) times more likely to report loneliness, 1.52 (95% CI: 1.12-2.07) times more likely to report anxiety, and 2.18 (95% CI: 1.68-2.82) times more likely to report depression than non-tobacco users. CONCLUSIONS Among adolescents, poly-tobacco use is associated with symptoms of loneliness, depression, and anxiety, which are internalized mental health problems. Poly-tobacco use warrants early assessment of high-risk groups, education on the need for tobacco-use cessation, and active intervention for the psychological difficulties that these high-risk groups experience. [ABSTRACT FROM AUTHOR]

Prior research suggests that people with Posttraumatic Stress Disorder (PTSD) may experience a form of accelerated biological aging. In other populations, loneliness has been shown to elevate risk for many of the same components of accelerated biological aging, and other deleterious outcomes, as seen in people with PTSD. Although standard diagnostic criteria for PTSD include "feelings of detachment or estrangement from others", the relationship of such feelings to the concept of loneliness remains uncertain, in par potentially due to a failure to distinguish between loneliness versus objective social isolation. In order to catalyze wider research attention to loneliness in PTSD, and the potential contribution to accelerated biological aging, the present paper provides three components: (1) a conceptual overview of the relevant constructs and potential interrelationships, (2) a review of the limited extant empirical literature, and (3) suggested directions for future research. The existing empirical literature is too small to support many definitive conclusions, but there is evidence of an association between loneliness and symptoms of PTSD. The nature of this association may be complex, and the causal direction(s) uncertain. Guided by the conceptual overview and review of existing literature, we also highlight key areas for further research. The ultimate goal of this line of work is to elucidate mechanisms underlying any link between loneliness and accelerated aging in PTSD, and to develop, validate, and refine prevention and treatment efforts. [ABSTRACT FROM AUTHOR]

Background: Participatory research is particularly suitable in adressing know-do gaps in health systems. There is a disparity between what is known about the benefits of social participation and home care's responsibility to provide conditions amenable to older adults' social participation, and what is accomplished in home care practice. Home care workers are a large, low-power group, whose competences should be better harnessed. We carried out a participatory action research (PAR) project with the goal of generating an improved structure for identifying and alleviating loneliness. This article aims to explore the co-creative process of designing a work model that guides home care workers in supporting social participation among older care recipients.Methods: Multimodal data from 16 PAR workshops with 14 home care workers were described and explored through the 'recursive PAR process' and the 'framework for occupational enablement for change in community practice".Results: The PAR process is outlined through the objectives, activities, and work model, as well as enablement strategies employed throughout the PAR process; as are its opportunities, challenges and implications. The work model describes how care workers can act as discoverers of care recipients' unmet social needs, employ intentional communication, and link to relevant professions or community services to alleviate loneliness among older home care recipients.Conclusions: This research process included opportunities of collaborating with enthusiastic and competent home care workers, but also challenges of moving between theory and practice and maintaining active participation between workshops. The resulting work model is in step with the requirements of elderly care, is unique in its field and could comprise a first step toward a more systematic approach of assessing and addressing loneliness. The vivid delineation of the PAR process provided in this paper can aid other researchers in navigating participatory research in home care contexts. [ABSTRACT FROM AUTHOR]

This paper provides an in-depth research analysis of occupational therapy strategies and psychological regulation of students' Internet addiction in the existing mobile social media environment. Based on the definition of Internet use peer pressure, a preliminary scale with 2 dimensions of specific behavioral pressure and psychological cognitive pressure was developed. First, a professor of mental health education and a master's degree student in mental health education were invited to rate the scale, while 47 junior high school students were selected to try the scale to ensure that the questions of the scale were clearly expressed. Secondly, 461 subjects were selected to take the initial test of the scale, and item tests and exploratory factor analysis were conducted to ensure that the structure of the scale was as expected and the scale was expressed to psychometric standards. Finally, 810 subjects were selected for the scale retest, and item analysis and validated factor analysis were conducted, and their results met the psychometric criteria. Student peer attachment significantly and positively predicted adolescent Internet addiction; Internet use peer pressure played an incomplete mediating role in the prediction of peer attachment to Internet addiction; loneliness played a moderating role in the pathway of peer attachment to Internet addiction, and loneliness also played a moderating role in the pathway of peer attachment to Internet use peer pressure. The attitude towards online games is entertainment to kill time, a tool to escape the pressure of study and to gain the fun of friends comparing with each other. The main online motivations of adolescents included individual and situational factors, and behaviors were characterized by pan-entertainment and gamification, mainly through mobile social networks to obtain external information and knowledge, maintain interpersonal relationships, and gain a sense of belonging; they were characterized by a fixation on time, space, and online content. The interaction of family members is more of a behavioral habit, and the communication habits and behavior patterns established in the family will influence the construction of children's relationships with others, while parents' head-down behavior will also influence children's attention to various needs of an Internet-dependent behavior problem, which in turn affects children's problem-solving and intimate relationships with family members. [ABSTRACT FROM AUTHOR]

INTRODUCTION Significant changes occurred in the way people socialize and interact with each other since China reported its first COVID-19 cases. However, little is known about how smoking behaviors may have changed due to the COVID-19 pandemic in China. The aim of this study was to assess changes in smoking behavior and intention to quit during the early stage of the COVID-19 pandemic in China and to investigate the associated factors. METHODS An online cross-sectional survey was conducted among Chinese adult smokers. Participants were recruited through snowball sampling from 19 March to 2 April 2020. RESULTS A total of 1388 smokers participated in this study. Of those, 1014 (73.0%) reported not changing their cigarette consumption, 104 (7.5%) reported smoking more and 268 (19.3%) reported smoking less due to the pandemic. Average daily cigarette consumption among all participants decreased from 15.0 (IQR: 10.0--20.0) to 13.0 (IQR: 8.0-20.0) (W=6.919, p<0.001). For intention to quit, 270 (19.5%) respondents reported becoming more willing to quit, and 91 (6.6%) reported becoming less willing to quit. Multivariate analyses showed that tobacco addiction, overall knowledge about the relationship between smoking and COVID-19, level of attention devoted to COVID-19, anxiety, living alone, and number of smokers in the family were significantly correlated with cigarette consumption and intention to quit, and living alone was the strongest factor associated with increased cigarette consumption (AOR=5.29; 95% CI: 1.51-18.56). CONCLUSIONS The COVID-19 pandemic led to a slight decrease in cigarette consumption and an increase in quitting intention among Chinese smokers. During the early stages of the pandemic, it was important to focus on the anxiety of smokers, dispel smokers' misunderstandings of smoking and COVID-19 and create a supporting environment in the family to help smokers quit. [ABSTRACT FROM AUTHOR]

Background: Family caregivers are family members or friends of care recipients who assist with activities of daily living, medication management, transportation, and help with finances among other activities. As a result of their caregiving, family caregivers are often considered a population at risk of experiencing increased stress, isolation, and loneliness. During the COVID-19 pandemic in the US, social isolation and decrease in social activities were a top concern among older adults and their family caregivers. Using secondary analysis of survey data as part of a multi-site implementation trial of a caregiver skills training program, we describe differences in caregiver experiences of loneliness before and during the COVID-19 pandemic. Methods: Health and wellbeing surveys of family caregivers were collected on 422 family caregivers of veterans before and during COVID-19. Logistic regression modeling examined whether the loneliness differed between caregiver groups pre vs during COVID-19, using the UCLA 3-item loneliness measure. Rapid directed qualitative content analysis of open-ended survey questions was used to explore the context of how survey responses were affected by the COVID-19 pandemic. Results: There were no significant differences in loneliness between caregivers pre vs during COVID-19. In open-ended responses regarding effects of COVID-19, caregivers described experiencing loneliness and social isolation; why they were unaffected by the pandemic; and how caregiving equipped them with coping strategies to manage negative pandemic-related effects. Conclusion: Loneliness did not differ significantly between pre vs during COVID-19 caregivers. Future research could assess what specific characteristics are associated with caregivers who have resiliency, and identify caregivers who are more susceptible to experiencing loneliness. Understanding caregiver loneliness could assist other healthcare systems in developing and implementing caregiver support interventions. [ABSTRACT FROM AUTHOR]

Background: Nursing homes and other long-term care services account for a disparate share of COVID-19 cases and casualties worldwide. During COVID-19 there is a distinct need to preserve a holistic view of the wellbeing of residents of nursing homes, be mindful of their rights as citizens, and to be aware of protecting residents from infection. The delivery of health and social care throughout a pandemic must remain person-centred and adhere to a human rights-based approach. Methods: This study aimed to capture nursing home residents, their families and staff's perspective of the nursing homes residents experience, approaches of staff and the nursing home environment. An online survey was distributed via stakeholder networks and online platforms across Ireland. This study was performed and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). Results: 25 residents, 42 family members and 51 staff completed the survey (n = 118). Across the domains measured all but one aspect scored above 50% (residents get up and go to bed when they want 41.5%) with the highest score of 89.1% scored for the nursing home is comfortable and well-kept. Results highlight evidence of positive experiences and endeavours to preserve social connections, residents were in a safe place cared for by staff who did their best in a difficult position and who went above and beyond their duty of care. However, some families reported poor communication, no internet connections, not enough phones or tablets, and that staff were busy and unable at times to assist residents who needed help using phones/tablets. Conclusion: This study highlights the importance of human rights and how they ought to inform and shape the advancement of public health advice and policy documents. Overall, nursing home residents, their families and staff reported favourably on the study measures. However, issues pertaining to communication are essential and there is a need to address issues such as the provision of accurate timely information, communication infrastructure and resources, and inconsistencies in communications. Of note is that while healthcare professionals have a duty to uphold the rights of nursing home residents, they themselves have human rights which must also be protected and supported. [ABSTRACT FROM AUTHOR]

(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients' social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation. [ABSTRACT FROM AUTHOR]

Aim: To describe patients' with chronic obstructive pulmonary disease (COPD) experiences of group‐based self‐management education with a digital website. Design: A qualitative approach with a phenomenologicalmethod. Patients participating in an earlier study, with self‐experience of COPD as a special competence, were involved as research partners at the design of this study. Methods: Eleven individual and two group interviews with five participants in each group were conducted. Results: Group‐based self‐management education with a digital website supports learning. Sharing experiences with others in similar situations creates security and reduces the feeling of being alone. Based on questions and discussion in the group, and through self‐reflection, general information is transformed into useful knowledge and understanding of one's own situation. COPD information on the website provides an opportunity to gain knowledge continuously based on needs that contributes to learning. This research has demonstrated that adapting learning activities to individual learning styles increases sustainability of learning. Sharing experiences reduces feelings of loneliness. It is therefore important to create spaces for sharing experiences and in‐depth reflection that support learning over time. [ABSTRACT FROM AUTHOR]

Background: Loneliness was found to be a commonly experienced feeling among older adults during the COVID-19 pandemic and is considered to be a high-risk factor for depressive symptoms. Maintaining meaning in life has been found to be a protective resource for mental health among older adults. The purpose of this study was to examine the mediating effects of an individual's meaning in life in the relationship between loneliness and depressive symptoms among older Korean adults. Methods: The data were obtained from a sample of 213 community-dwelling older adults aged over 65. The instruments were the UCLA Loneliness Scale, the Center for Epidemiologic Studies Depression Scale, and the Meaning in Life Questionnaire. Results: Loneliness was positively associated with depressive symptoms and negatively associated with the presence of and search for meaning among older adults. The presence of meaning mediated the relationship between loneliness and depressive symptoms but the search for meaning did not. The search for meaning mediated the relationship between loneliness and depressive symptoms through the presence of meaning. Conclusions: Our study findings suggest that efforts to reduce loneliness and improve meaning in life should be undertaken to prevent depressive symptoms among older adults. [ABSTRACT FROM AUTHOR]

Background: Older persons with age-related and complex health problems will increasingly depend on care provision from nurses in their own homes. However, a barrier to quality care is ageism and nursing students´ disinterest in geriatrics. In addition, nurse education often falls short in preparing students for the complexity of geriatric care. Welfare technology (WT) is progressively implemented in home care to help older persons live at home despite their health problems. However, this process is intricate and requires acceptance and digital literacy among caregivers and older persons. Despite these challenges, nurse education can address and change negative attitudes through innovative teaching methods such as age suit simulation. Therefore, the study aims to describe nursing students´ experiences of age suit simulation in a home-like environment with WT and technical aids, and will reveal their perspective on ageing and providing care to older adults. Methods: A qualitative explorative design using semi-structured group interviews (n=39) among nursing students. Data was analysed through reflexive thematic analysis. Results: The analysis generated three main themes; "It's like walking in a bubble", "An eye opener" and "Concerns about ageing and the current structure of geriatric care". The main themes included eight subthemes. Adapting to the sensory and physical limitations of the age suit was an immersive experience and caused feelings of frustration, loneliness and disconnection. A prominent result was a raised awareness of cognitive loss, especially impaired vision, and students felt the simulations had made them aware of the everyday challenges older persons faced. Students highlighted the importance of patience and giving enough time in care situations by being present and having a critical perspective of WT. The students were mostly negative towards their own ageing and could better relate to older persons´ vulnerability. Conclusions: Age suit simulation was described as an embodied and eye-opening experience, raising nursing students´ awareness of older persons´ functional limitations and the consequences for dignity and independence. Coping with cognitive loss was especially difficult. Students were motivated to apply their new knowledge to clinical practice. Age suit simulation can complement geriatric education, preparing students for the complex care needs of older persons. [ABSTRACT FROM AUTHOR]

A school's commitment to promoting health extends beyond students' efforts to encompass parental involvement and must recognize the critical role of parents in enhancing overall student well-being. This study, conducted in 27 schools across Lebanon, assessed parents' awareness of their children's physical and mental health. A school health campaign involved direct medical interventions on 7184 students, followed by phone interviews with 3880 parents to compare their responses with the medical findings. Discordances ranged from extreme mismatches (≥50%) to mild mismatches (<15%), with notable disparities in incomplete vaccination (67.8%), BMI (59%), and mental health indicators (expressions of sadness (69.1%), loneliness (61.0%), and anxiety (53.4%)). Factors such as school type, child's age, governorate, family income, parents' occupation, education level, and marital status significantly influenced discordance rates. Notably, mental health aspects exhibited higher disparities, emphasizing the need for improved communication between parents, physicians, and children. Bridging these gaps could empower parents with better knowledge, fostering environments conducive to lifelong healthy behaviors in children. The study underscores the urgency for enhanced communication strategies to bridge discrepancies and ensure a more comprehensive understanding of children's physical and mental well-being. [ABSTRACT FROM AUTHOR]

In 2022, COVID-19 continued to spread across the globe, and to stop the spread of the virus and protect people's health, universities across China continued to remain in a lockdown state. Loneliness is an important topic among college students, and the coronavirus pandemic has exacerbated loneliness. This prolonged school lockdown was unprecedented and it caused severe social isolation and emotional loneliness for students. Few people know how nursing students experience loneliness and find a way through their experience. This qualitative phenomenological study was conducted to reveal the lived experiences of nursing students who indicated COVID-19 lockdown-related loneliness in a previous quantitative survey. We performed 20 semi-structured interviews with nursing students aged 19–23 yrs during their lockdown (April 2022 to June 2022). Our research applied Colaizzi's seven-step data analysis processes to reveal shared patterns in terms of how nursing students experienced lockdown and found the following four themes: emotional challenges associated with loneliness; causes of loneliness; positive and negative motivation to learn; and accepting solitude and reconstructing real life. [ABSTRACT FROM AUTHOR]

Introduction: With increasing attention to models of transitional support delivered through multisectoral approaches, third-sector organizations (TSOs) have supported community reintegration and independent living post-hospitalization. This study aimed to identify the core elements of these types of programs, the facilitators, and barriers to service implementation and to understand the perspectives of providers and recipients of their experiences with the programs. Methods and Analysis: A collective case study collected data from two UK-based 'Home from Hospital' programs. An inductive thematic analysis generated rich descriptions of each program, and analytical activities generated insights across the cases. Results: Programs provided a range of personalized support for older adults and addressed many post-discharge needs, including well-being assessments, support for instrumental activities of daily living, psychosocial support, and other individualized services directed by the needs and preferences of the service user. Results suggest that these programs can act as a 'safety net' and promote independent living. Skilled volunteers can positively impact older adults' experience returning home. Conclusions: When the programs under study are considered in tandem with existing evidence, it facilitates a discussion of how TSO services could be made available more widely to support older adults in their transition experiences. [ABSTRACT FROM AUTHOR]

The Single Site Order (SSO)—a policy restricting staff from working at multiple long-term care (LTC) homes—was mandated by the Public Health Agency of Canada to control the spread of COVID-19 in LTC homes, where nearly 70% of COVID-19-related deaths in Canada occurred. This mixed methods study assesses the impact of the SSO on LTC residents in British Columbia. Interviews were conducted (residents (n = 6), family members (n = 9), staff (n = 18), and leadership (n = 10) from long-term care homes (n = 4)) and analyzed using thematic analysis. Administrative data were collected between April 2019 and March 2020 and between April 2020 and March 2021 and analyzed using descriptive statistics and data visualization. Qualitative and quantitative data were triangulated and demonstrated that staffing challenges became worse during the implementation of the SSO, resulting in the mental and physical health deterioration of LTC residents. Qualitative data demonstrated decreased time for personalized and proactive care, increased communication challenges, and increased loneliness and isolation. Quantitative data showed a decline in activities of daily living, increased antipsychotic medication use, pressure ulcers, behavioural symptoms, and an increase in falls. Addressing staff workload and staffing shortages during SSO-related policy implementation is essential to avoid resident health deterioration. [ABSTRACT FROM AUTHOR]

Purpose: Postpartum Depression (PPD) --a common health problem for mothers' postpartum increases the risk of negative interaction between mothers and infants as it reduces the former's ability to respond to the latter's needs appropriately. Migrant mothers exhibit a higher prevalence of risk factors for PPD. Hence, this study aimed to investigate migrant mothers' life experiences pertaining to motherhood and PPD. Methods: Qualitative interviews were conducted with 10 immigrant mothers in the south of Sweden during 2021. Results: The qualitative content analysis revealed the following main themes: 1) PPD (two sub themes--psychosomatic symptoms and burden of responsibility due to feelings of loneliness); 2) mistrust of social services (one sub-theme--afraid of losing their children and Swedish social services' lack of understanding); 3) inadequate healthcare (two subthemes-- limited healthcare literacy for migrant mothers and language barrier; 4) women's coping strategy for well-being (two sub-themes--better awareness and understanding of the Swedish system and society, and freedom and independence in the new country). Conclusions: PPD, mistrust of social services, and inadequate healthcare lacking personal continuity were common among immigrant women, thus precipitating discrimination-- including lack of access to services because of limited health literacy, cultural differences, language barriers, and insufficient support. [ABSTRACT FROM AUTHOR]

The aim was to explore existential loneliness in different long-term care contexts as narrated by older people. A qualitative secondary analysis was performed of 22 interviews with older people in residential care, home care, and specialized palliative care. The analysis started with naive reading of interviews from each care context. As these readings showed similarity with Eriksson's theory of the suffering human being, the three different concepts of suffering were used as an analytic grid. Our result indicates that suffering and existential loneliness are interrelated for frail older people. Some situations and circumstances that trigger existential loneliness are the same in the three care contexts while others differ. In residential and home care, unnecessary waiting, not feeling at home and not being encountered with respect and dignity can trigger existential loneliness while seeing and hearing others suffering can give rise to existential loneliness in residential care. In specialized palliative care, feelings of guilt and remorse are prominent in relation to existential loneliness. In conclusion, different healthcare contexts have various conditions for providing care that meet the existential needs of older people. Hopefully our results will be used as a basis for discussions in multi-professional teams and among managers. [ABSTRACT FROM AUTHOR]

Purpose: Loneliness is a fundamentally subjective experience that is common at various life stages. Studies have qualitatively explored loneliness, but a comprehensive overview is lacking. This research therefore provides a fine-grained review of studies on loneliness experiences across the lifespan. Methods: A systematic review and thematic synthesis were performed on studies that qualitatively investigated experiences of loneliness in people of any age from non-clinical populations. Sensitivity analysis assessed the impact of lower-quality studies and specific age groups on the findings. Results: Twenty-nine studies of 1,321 participants aged between 7 and 103 were included. Fifteen descriptive themes and three overarching analytical themes were developed: (1) Loneliness is both psychological and contextual, (2) Loneliness centres on feelings of meaningful connection and painful disconnection, and (3) Loneliness can exist in a general, pervasive sense or can relate to specific other people or relationship types. Some features were particularly pertinent to children, younger adults, and older adults, respectively. Conclusions: Loneliness involves a primarily aversive psychological experience of perceived disconnection which is linked to physical, personal, and socio-political contexts and can be pervasive or relate to specific relationships or relationship types. An awareness of context, life stage, and personal experiences is essential to understand loneliness. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

There is concern about the expanding size of the ageing population and burgeoning care costs for older adults. Robotic technology could assist older adults. In this study, the effectiveness of the robotic technologies is evaluated. A systematic literature review was undertaken of peer-reviewed literature. An initial set of 8533 studies was evaluated for relevance; these were reduced to a final subset of 58 studies finally subjected to analysis. This study categorised the problems encountered by older adults, identified robot types deployed to overcome them and derived a subjective effectiveness score. The most used and most effective robots were companion robots followed by telepresence robots. The findings imply positive effects of robotic technologies in helping elderly people's problems. Although robotic technologies could bring some innovation into aged care, more research is needed to design and develop robots to be of assistance and support elderly in having an independent lifestyle. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to increase the understanding of emotions and coping strategies used by head and neck cancer patients before cancer treatment, and to explore their emotions and coping strategies in relation to symptoms and side effects after treatment. Furthermore, we aimed to investigate the patients' perceptions of received treatment and support. Methods: Semi-structured in-depth interviews were conducted with 10 patients who had been treated for head and neck cancer, which included radiotherapy, at the Department of Oncology and the Department of Oral and Maxillofacial Surgery at Sahlgrenska University Hospital in Gothenburg. The interviews were analyzed in accordance with the method for Qualitative Content Analysis. Results: The result picture revealed three head themes. The first theme "Management of simultaneously influencing mind-sets before cancer treatment" described the patients experiences of feeling "Scared and worried," "Lonely and disappointed," and "Relieved and confident", and how they tried to handle the diagnosis and preparations for treatment by "Applying a positive mind-set", "Searching for support," and "Trusting the healthcare system". The second theme "Experiences of becoming a pale shadow of oneself", illustrated experiences of affecting post-treatment symptoms and side effects. To which, the last theme "Handling contextual influencing experiences after cancer treatment" displayed post-treatment emotions of being "Shocked and disappointed" and "Concerned and unsupported" but also "Grateful and forward-thinking", where strategies such as "Appreciating Life", "Networking socially," and "Adapting to the new life" were used. Conclusions: The results indicated the need for a more patient-centered care approach, with clearer structures and improved individual support both before and after treatment and in connection to rehabilitation. Patients' cognitive changes after cancer treatment should be considered in the aftercare, which should also include adaptation to situation and strengthening of patients' self-management as a goal. [ABSTRACT FROM AUTHOR]

Aims: To investigate loneliness, depression and sleep quality in patients with Type 2 Diabetes (T2DM) and to examine the mediating role of depression between loneliness and sleep quality among this group of patients with T2DM. Design: A cross‐sectional study. Methods: A group of T2DM patients was recruited from a tertiary hospital affiliated with a university in Wuhu City, Anhui Province from May to October 2021 by convenient sampling. Pearson correlation analysis and structural equation modelling were used for data analysis in this study. Results: The direct effect of loneliness on sleep quality was not statistically significant, but the indirect effect of depression on sleep quality was statistically significant. Depression mediated the relationship between loneliness and sleep quality. Depression can affect emotional health and reduce sleep quality. We should reduce the loneliness of patients, prevent the occurrence of depression and improve the quality of sleep. [ABSTRACT FROM AUTHOR]

This study aimed to examine differences in mental health and alcohol use outcomes across distinct patterns of work, home, and social life disruptions associated with the COVID-19 pandemic. Data from 2093 adult participants were collected from September 2020 to April 2021 as a part of a larger study examining the impacts of the COVID-19 pandemic on substance use. Participants provided data on COVID-19 pandemic experiences, mental health outcomes, media consumption, and alcohol use at baseline. Alcohol use difficulties, including problems related to the use, desire to use alcohol, failure to cut down on alcohol use, and family/friend concern with alcohol use, were measured at 60-day follow-up. Factor mixture modeling followed by group comparisons, multiple linear regressions, and multiple logistic regressions was conducted. A four-profile model was selected. Results indicated that profile membership predicted differences in mental health and alcohol use outcomes above and beyond demographics. Individuals experiencing the most disruption reported the strongest daily impact of COVID-19 and significantly high levels of depression, anxiety, loneliness, overwhelm, alcohol use at baseline, and alcohol use difficulties measured at 60-day follow-up. The findings highlight the need for integrated mental health and/or alcohol services and social services targeting work, home, and social life during public health emergencies in order to respond effectively and comprehensively to the needs of those requiring different types of support. [ABSTRACT FROM AUTHOR]

Background: It is well known that the COVID-19 pandemic has caused a global health crisis, especially for young people. However, most studies were conducted during the first waves of the pandemic. Few Italian studies specifically attempted to broadly assess young people's mental health status during the fourth wave of the pandemic. Methods: This study aimed at evaluating the mental health status among a group of Italian adolescents and young adults during the fourth wave of the COVID-19 pandemic. 11,839 high school students and 15,000 university students (age range 14–25) were asked to complete a multidimensional online survey, of which 7,146 (26,6%) agreed to participate. The survey also included standardized measures for depression, anxiety, anger, somatic symptoms, resilience, loneliness and post-traumatic growth. Two separate clusters were identified through cluster analysis. Random forest, classification tree and logistic regressions analyses were applied to identify factors associated to a good or a poor level of mental health and, thus, to define students' mental health profiles. Results: Overall, the students in our sample showed high levels of psychopathology. The clustering methods performed identified two separate clusters reflecting groups of students with different psychological features, that we further defined as "poor mental health" and "good mental health". The random forest and the logistic regressions found that the most discriminating variables among those two groups were: UCLA Loneliness Scale score, self-harm behaviors, Connor-Davidson Resilience Scale-10 score, satisfaction with family relationships, Fear of COVID-19 Scale score, gender and binge eating behaviors. The classification tree analysis identified students' profiles, showing that, globally, poor mental health was defined by higher scores of loneliness and self-harm, followed by being of female gender, presenting binge eating behaviors and, finally, having unsatisfying family relationships. Conclusions: The results of this study confirmed the major psychological distress caused by the COVID-19 pandemic in a large sample of Italian students, and provided further insights regarding those factors associated with a good or poor mental health status. Our findings suggest the importance of implementing programs targeting aspects that have been found to be associated to a good mental health. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic increased psychiatric distress and impacts differed by family structure. We aimed to identify mechanisms contributing to these inequalities. Methods: Survey data were from the UK Household Longitudinal Study. Psychiatric distress (GHQ-12) was measured in April 2020 (first UK lockdown; n = 10,516), and January 2021 (lockdown re-introduced following eased restrictions; n = 6,893). Pre-lockdown family structure comprised partner status and presence of children (< 16 years). Mediating mechanisms included: active employment, financial strain, childcare/home-schooling, caring, and loneliness. Monte Carlo g-computation simulations were used to adjust for confounding and estimate total effects and decompositions into: controlled direct effects (effects if the mediator was absent), and portions eliminated (PE; representing differential exposure and vulnerability to the mediator). Results: In January 2021, after adjustment, we estimated increased risk of distress among couples with children compared to couples with no children (RR: 1.48; 95% CI 1.15–1.82), largely because of childcare/home-schooling (PE RR: 1.32; 95% CI 1.00–1.64). Single respondents without children also had increased risk of distress compared to couples with no children (RR: 1.55; 95% CI 1.27–1.83), and the largest PE was for loneliness (RR: 1.16; 95% CI 1.05–1.27), though financial strain contributed (RR: 1.05; 95% CI 0.99–1.12). Single parents demonstrated the highest levels of distress, but confounder adjustment suggested uncertain effects with wide confidence intervals. Findings were similar in April 2020 and when stratified by sex. Conclusion: Access to childcare/schooling, financial security and social connection are important mechanisms that need addressing to avoid widening mental health inequalities during public health crises. [ABSTRACT FROM AUTHOR]

Background A decline in physical activity and the ability to perform activities of daily living (ADL) and instrumental activities of daily living (IADL) could interfere with independent living and quality of life in older patients, but may be prevented with tailored interventions. The aim of the current study was to assess changes in physical activity and ADL/IADL in the first 5 years after breast cancer diagnosis in a real-world cohort of older patients and to identify factors associated with physical decline. Methods Patients aged ≥70 years with in situ or stages I-III breast cancer were included in the prospective Climb Every Mountain cohort study. Linear mixed models were used to assess physical activity (according to Metabolic Equivalent of Task (MET) hours per week) and ADL/IADL (according to the Groningen Activity Restriction Scale (GARS)) over time. Secondly, the association with geriatric characteristics, treatment, quality of life, depression, apathy, and loneliness was analyzed. Results A total of 239 patients were included. Physical activity and ADL/IADL changed in the first 5 years after diagnosis (mean change from baseline −11.6 and +4.2, respectively). Geriatric characteristics at baseline were strongly associated with longitudinal change in physical activity and ADL/IADL, whereas breast cancer treatment was not. A better quality of life was associated with better physical activity and preservation of ADL/IADL, while depression and loneliness were negatively associated with these outcomes. Discussion Geriatric characteristics, loneliness, and depressive symptoms were associated with physical decline in older patients with breast cancer, while breast cancer treatment was not. [ABSTRACT FROM AUTHOR]

(1) Background: Social isolation and loneliness are determinants of healthy longevity. However, previous research has focused on either social isolation or loneliness and has not considered household types. This study sought to clarify loneliness and social isolation among older adults using single-person (ST) or multi-person (MT) household types. (2) Methods: We administered a national, anonymous, self-administered survey to 5351 Japanese older adults aged 65 years or older. The survey included subjects' demographic characteristics and scores for loneliness (University of California Los Angeles (UCLA) Loneliness Scale version 3 (Cronbach's α = 0.790)), social isolation (Lubben Social Network Scale (LSNS-6) (Cronbach's α = 0.82)), and self-efficacy (GSES). (3) Results: After adjusting for age and gender, ST individuals had significantly lower LSNS-6 and significantly higher UCLA scores than MT individuals (p < 0.001). Lower LSNS-6 and higher UCLA scores were significantly associated with lower GSES scores, and the effect of GSES was greater for ST than for MT (LSNS-6, ST (β = 0.358, p < 0.001); MT (β = 0.295, p < 0.001)) (UCLA, ST (β = −0.476, p < 0.001); MT (β = −0.381, p < 0.001)). (4) Conclusions: Specific healthcare systems and programs based on self-efficacy should be developed by household type to reduce both social isolation and loneliness. [ABSTRACT FROM AUTHOR]

Background the transition to nursing home care has previously been linked to negative outcomes for spousal caregivers of persons with dementia (PwD). However, little is known about the experience or trajectory of loneliness in spousal caregivers during this time. Objectives to explore experiences of loneliness in caregivers during the nursing home admission of their spouse or partner with dementia. Methods semi-structured interviews were conducted with 11 individuals living in Ireland between Oct 2020 and June 2021, who were married to/partnered with a PwD who had, in the past 7 years, moved to full-time nursing home care. Data were collected and analysed using a deductive qualitative analytic strategy in the grounded theory tradition. Results data were interpreted in the context of Weiss' typology of social and emotional loneliness and indicated that social loneliness increased for many at the point of diagnosis, decreasing somewhat after the transition, while emotional loneliness increased across the transition. Data were used to refine an existing synthesised model of loneliness, providing an updated model of the causes and contexts of loneliness. Conclusions the transition to nursing home care differentially affects loneliness subtypes. Results have implications for other transitions, which should be assessed in terms of various subtypes of loneliness. Our refined theoretical synthesis model of loneliness also warrants further evaluation. [ABSTRACT FROM AUTHOR]

Recent studies have focused on the negative effects of loneliness on health and quality of life in older adults. The De Jong Gierveld Loneliness Scale (DJGLS) has been widely used and has proven to be a valid and reliable instrument for loneliness assessment. However, research on this topic and on the validation of measurement scales among the older population is still incipient. The objective of this study was to examine the psychometric properties of the Spanish version of the 11-item DJGLS in Mexican older adults. Data from a representative sample of cognitively intact older adults aged 60 years and over (mean, standard deviation [SD]) age = 72.0 years (SD 8.1) from two Mexican cities (n = 1913), interviewed face to face at their homes during 2018–2019, were analyzed. The psychometric properties of the DJGLS were examined, including (1) construct validity, examined by Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), discriminate validity and convergent validity, (2) reliability, calculated using Cronbach's alpha. The overall data quality was high, and the scaling assumptions were generally met with few exceptions. Using EFA and CFA, the findings showed that the DJGLS presents a two-factor structure (Social Loneliness and Emotional Loneliness), with 11 items that explain 67.2% of the total variance. Reliability is adequate at the full-scale level (Cronbach´s α = 0.899), also for the two subscales Social and Emotional Loneliness (Cronbach´s α = 0.892 and 0.776, respectively). These results highlight that most participants with a low score for depressive symptoms and or with a high social support score belonged to the "No loneliness" group. The results showed that the Spanish version of the 11-item DJGLS is adequate for use in Mexican older adults and should be used not only for loneliness screening but also for social and emotional loneliness assessment. [ABSTRACT FROM AUTHOR]

Municipal home-healthcare services are becoming increasingly important as growing numbers of people are receiving healthcare services in their home. The COVID-19 pandemic represented a challenge for this group, both in terms of care providers being restricted in performing their duties and care receivers declining services for fear of being infected. Furthermore, preparedness plans were not always in place. The purpose of this study is to investigate the consequences for recipients of home healthcare in Norway of the actual level of COVID-19 infection spread in the local population, as observed by licensed nurses working in home-healthcare services. Approximately 2100 nurses answered the survey. The most common adverse consequences for home-healthcare recipients were increased isolation and loneliness, increased health concerns, and the loss of respite care services. An increased burden for relatives/next of kin and fewer physical meetings with service providers were frequently observed and reported as well. This study shows that there were more adverse consequences for service users in municipalities with higher levels of contagion than in those with lower levels of contagion. This indicates that the municipalities adapted measures to the local rate of contagion, in line with local municipal preparedness strategies. [ABSTRACT FROM AUTHOR]

Background: Much of the evidence about good practice and commissioning in dementia services focuses on the person with dementia-carer dyad. We know that people with dementia who live alone and do not have informal support experience worse outcomes, but we know little about the additional support needs experienced by this group, nor do we know about service responses to accommodate any additional or different needs. Aim: This research aims to understand the needs and experiences of people with dementia who live on their own and do not have someone to help them access services or act as a point of contact. It will also explore whether and how services respond to the unique needs of this group of people with dementia to help them to live at home for as long as possible. Methods: The project commenced in April 2022 and will report in November 2023. There are four consecutive elements: an on-line audit of social care dementia commissioners in local authorities in two regions of England about services for this client group; in person/on-line interviews/focus groups with people with dementia who live alone and don't have someone to navigate their care; and qualitative case studies of four different service examples. Two stakeholder consultation workshops will be held at the end of the project to identify areas for action and co-design resources for different stakeholders. The findings from each element will inform subsequent ones. Impact: Feedback loops will be embedded throughout this research to maximise opportunities for rapid action in response to findings. These include regional Sharing and Learning Networks and bi-monthly newsletters. A series of outputs targeted at different audiences, including academic and practice publications and events, and co-produced resources for people with dementia and social care commissioners and providers, will be produced. Dementia-focused networks will facilitate dissemination. [ABSTRACT FROM AUTHOR]

The aim of the study was to describe the loss of a family member by suicide, based on the lived experience of suicide survivors. A phenomenology study with a Reflective Lifeworld Research approach was conducted, consisting of sixteen interviews with eight suicide survivors. The essence of losing a family member by suicide encompasses experiences of involuntary and existential loneliness, life suffering, and additional burdens in a life that is radically transformed, comprising prolonged and energy-intensive attempts to understand. Life for the family member encompasses a constant fear of being judged and an ambiguous silence, where this silence can both lead to involuntary loneliness and be a source of support and fellowship. Support mechanisms inside the family fall apart, and it becomes obvious that the survivors' experiences affect others. The loss also implies an active endeavour to maintain the memory of the deceased. Based on these results, it is important for professionals to accept the survivors as suffering human beings early—from the point of the notification of death—and consider them as patients in need of compassionate care. Such support might reduce life suffering, counteract stigma and involuntary loneliness, and work simultaneously as suicide prevention. [ABSTRACT FROM AUTHOR]

This is the protocol for a Campbell systematic review. The objectives are as follows: the aim is to map available evidence on the effects of digital interventions to mitigate social isolation and/or loneliness in older adults in all settings except hospital settings. [ABSTRACT FROM AUTHOR]

The open studio art therapy model offers a space for free creation; in this space, the art therapist supports the participants' art process. According to this model, the creative process is the central component of the therapeutic work. This qualitative study seeks to learn, through an analysis of interviews and artwork, about the subjective experiences of at-risk children living in a foster-care village who participated in an open studio. In addition, it seeks to identify changes in the artwork over time. This study involves a qualitative thematic analysis, while the analysis of visual data is based on the phenomenological approach to art therapy. The data include interviews and 82 artworks of five participants, aged 7–10 years. Five main themes emerged from the analysis of the visual and verbal data: (a) engaging in relationships; (b) moving along the continuum from basic, primary, art expressions (e.g., smearing, scribbling, etc.) to controlled expressions; (c) visibility, on a range between disclosure and concealment; (d) holding versus falling/instability; and (e) experiencing and expressions of change. The discussion expands on the themes in relation to key concepts in the field of psychodynamic psychotherapy and art therapy. It also examines the unique characteristics of this population in reference to empirical studies on developmental trauma and challenges of out-of-home placement. Finally, it discusses the study's limitations and presents recommendations for further research. [ABSTRACT FROM AUTHOR]

Background: There is limited data on the use of digital technologies in outpatient care in Switzerland. Our objectives were therefore to determine which digital technologies are used and whether they had an impact on loneliness and social isolation in the wake of the COVID-19 pandemic. Methods: A cross-sectional survey design was used with a convenience sample of 1272 outpatient care providers in Switzerland. The questionnaire used is based on an unsystematic literature review and a previous qualitative study with six outpatient caregivers and two caring relatives, based on which the 30 items for this questionnaire were developed. Data were analyzed descriptively, and group comparisons were made using the Kruskal Wallis test. Changes over time were measured using Friedman test with Bonferroni post hoc tests and Wilcoxon test for paired samples. Results: The impact of the COVID-19 pandemic was evident both on the part of the health care system, e.g., inadequate protective equipment; on the part of health care providers, e.g., increasing fatigue in keeping abreast of the virus as the pandemic progressed; and on the part of clients, who reduced services of care, e.g., out of fear of infection. According to the assessment of the outpatient caregivers, loneliness and social isolation of the clients was high in spring 2020 and increased strongly in the following winter. Alternative solutions, such as digital technologies, were hardly used or not used at all by the clients. Conclusions: The results suggest that the pandemic is dramatically impacting clients. This highlights the urgent need to invest in the development of appropriate digital technologies reducing the impact of social isolation and loneliness and the associated long-term costs to the healthcare system. [ABSTRACT FROM AUTHOR]

A considerable body of research using the Mental Health Test (MHT) has explored the psychological repercussions of the physical separation of children from one or both parents as they pursue better economic prospects in cities. Generally, these studies compare the mental health status (MHS) between left-behind children (LBC) and non-left-behind children (NLBC). That notwithstanding, little is known about the real policy impact of these studies on the ground over the years. Using a relevant search strategy and selection criteria, we identified qualified studies (N = 102: 2004 to 2019). Cross-temporal meta-analysis (CTMA) was performed on these studies for dynamic trends. Our results demonstrate: (1) a slight but significant change in MHS of both LBC and NLBC, with LBC being significantly worse off over time; (2) a significant deterioration in MHS of LBC over time, particularly among left-behind boys (LBBs); (3) a stable and significant decline in MHS of left-behind junior high and elementary school students, respectively; and (4) a more substantial degradation in MHS of LBC with both parents absent compared with LBC with a parent present. The findings reveal that the efforts of, and collaboration among, researchers, policy experts and politicians are producing results. Nevertheless, more targeted research is needed to unearth the underlying issues that generate the differences among subpopulations of LBC to better inform pragmatic interventions for collective psychological wellness of LBC. [ABSTRACT FROM AUTHOR]

Background: Urban greening may reduce loneliness by offering opportunities for solace, social reconnection and supporting processes such as stress relief. We (i) assessed associations between residential green space and cumulative incidence of, and relief from, loneliness over 4 years; and (ii) explored contingencies by age, sex, disability and cohabitation status.Methods: Multilevel logistic regressions of change in loneliness status in 8049 city-dwellers between 2013 (baseline) and 2017 (follow-up) in the Household, Income and Labour Dynamics in Australia study. Associations with objectively measured discrete green-space buffers (e.g. parks) (<400, <800 and <1600 m) were adjusted for age, sex, disability, cohabitation status, children and socio-economic variables. Results were translated into absolute risk reductions in loneliness per 10% increase in urban greening.Results: The absolute risk of loneliness rose from 15.9% to 16.9% over the 4 years; however, a 10% increase in urban greening within 1.6 km was associated with lower cumulative incident loneliness [odds ratio (OR) = 0.927, 95% confidence interval (CI) = 0.862 to 0.996; absolute risk reduction = 0.66%]. Stronger association was observed for people living alone (OR = 0.828, 95% CI = 0.725 to 0.944). In comparison to people with <10% green space, the ORs for cumulative incident loneliness were 0.833 (95% CI = 0.695 to 0.997), 0.790 (95% CI = 0.624 to 1.000) and 0.736 (95% CI = 0.549 to 0.986) for 10-20%, 20-30% and >30% green space, respectively. Compared with the <10% green-space reference group with 13.78% incident loneliness over 4 years and conservatively assuming no impact on incident loneliness, associations translated into absolute risk reductions of 1.70%, 2.26% and 2.72% within populations with 10-20%, 20-30% and >30% green space, respectively. These associations were stronger again for people living alone, with 10-20% (OR = 0.608, 95% CI = 0.448 to 0.826), 20-30% (OR = 0.649, 95% CI = 0.436 to 0.966) and >30% (OR = 0.480, 95% CI = 0.278 to 0.829) green space within 1600 m. No age, sex or disability-related contingencies, associations with green space within 400 or 800 m or relief from loneliness reported at baseline were observed.Conclusions: A lower cumulative incidence of loneliness was observed among people with more green space within 1600 m of home, especially for people living alone. Potential biopsychosocial mechanisms warrant investigation. [ABSTRACT FROM AUTHOR]

Context: Despite being widely used with older adults in the community, there is limited literature on using the de Jong Gierveld Loneliness Scale with older adults living in long-term care (LTC). Objective: The purpose of this article is to discuss the considerations of using this scale with older adults in LTC. Method: Our team consisted of older person and family partners, a clinician, and academic researchers working together in all stages of research using the Loneliness scale to conduct individual interviews with 20 older adults in LTC in Vancouver, Canada, as part of a study exploring the experience of loneliness during the COVID-19 pandemic. Team reflection was embedded in the research process, with reflection data consisting of data transcripts, field notes, and regular team meeting notes. Thematic analysis was employed to identify lessons learned and implications. Findings: Participants had various challenges responding to the scale. Our analysis identified five themes: a) diverse meanings of loneliness, b) multi-faceted factors of loneliness, c) technical challenges, d) social desirability, and e) situational experience. We also offer five recommendations to consider when using this scale with older adults in LTC. Limitations: We used this scale with a small sample of older adults in LTC, which is a more time and labour-intensive population. Data on marital status and educational background was not collected but might help in understanding considerations for using the scale with older adults in LTC. Implications: We offer practical recommendations for using the scale with older adults in LTC, especially how qualitative open-ended questions can complement the scale by providing useful insights into context and complex experiences. [ABSTRACT FROM AUTHOR]

We investigated the prevalence of loneliness among 1206 adults aged 40 + from six minority communities in England and Wales: Black Caribbean, Black African, Indian, Pakistani, Bangladeshi and Chinese. Replicating the approach from the previous studies, we demonstrate robust acceptability, reliability and validity for both the six-item De Jong Gierveld (DJG) and single-item loneliness scales in our six ethnic groups. The prevalence of loneliness using a single-item question (loneliness reported as often/always) ranges from 5% (Indian) to 14% (Chinese) compared with approximately 5% for the general population aged 40 + in Britain. Levels of loneliness are very much higher using the DJG scale. Using a loneliness threshold score of 5 +, the percentage ranged from 13% (Indian) to 36% (Chinese). We explored the importance of six established loneliness vulnerability factors for our sample using regression modelling. Three factors were not associated with loneliness—number of children, gender and health rating, and three factors were protective: younger age, being married and low financial strain. The addition of ethnicity did not change these relationships or enhance statistical power of our models. Being a member of the African Caribbean group was protective against loneliness but not for the other groups included in our study. We suggest that exposure to loneliness vulnerability factors rather than ethnicity per se or measurement artefact underpins differences in loneliness across ethnic groups. [ABSTRACT FROM AUTHOR]

Purpose: Spouses are in a vulnerable situation when caring for a frail partner late in life. Exploring their existential loneliness can be a way to understand more about their existential needs. Method: A hermeneutic approach was used. Multistage focus group interviews were conducted with two groups consisting of five spouses, respectively, who met three times each. To work with the text, an approach was adapted where quotations are converted into poems in a linguistic manner. Results: Existential loneliness can be understood as the following: 1) being in a transition from us to merely me, 2) being forced to make decisions and feeling excluded, 3) navigating in an unfamiliar situation and questioning oneself, and 4) longing for togetherness but lacking the energy to encounter other people. The main interpretation is that existential loneliness emerges when one is in moments of inner struggle, when one is forced to make impossible choices, when one is approaching and is in limit situations, and when one is experiencing the endless loss of the other. Conclusion: For health care professionals to achieve a holistic picture, person-centeredness can be a way to make the spouses' existential needs visible and to provide support based on their needs. [ABSTRACT FROM AUTHOR]

Adolescence is a critical period characterized by physical, social, and developmental changes that impact on health and eating behaviour. Indonesia is experiencing dramatic economic and infrastructural changes, causing greater access to the global food industry and media. This transition is influencing food intake trends, leading to new nutritional challenges in adolescent girls. Qualitative research was conducted between November 2016 and January 2017 in five urban sites in Java, Indonesia, to examine individual, social, environmental, and macrosystem factors affecting snacking behaviours in unmarried adolescent girls 16–19 years of age. Methods entailed 30 freelisting exercises, nine key informant interviews, and 16 in‐depth interviews. Freelisting results identified over 200 snack foods, with the most salient processed convenience foods such as chips and cookies. Respondents typically snacked multiple times daily. Widespread availability of affordable and "tasty" snacks makes snack foods appealing meal substitutes. Snacks provide a distraction to boredom and loneliness and an enhancement to social gatherings. Girls exhibited limited understanding or concern about potential negative effects of snacking. Parents facilitate acquisition of nutrient‐poor snacks, whereas friends exert pressure for routine consumption of snack foods. Social media infiltrated with promotions of eateries and snack foods is likely contributing to the preponderance of snack food consumption. Routine consumption of snack foods high in sugar, salt, and fat and skipping meals will likely have long‐term consequences on the nutritional status and health of Indonesian adolescent girls. Findings underline the urgent need to develop contextually relevant, targeted behavioural change strategies to modify the potentially harmful eating and activity patterns of adolescent girls identified in this study and to curb the trajectory of overweight in urban Indonesia. [ABSTRACT FROM AUTHOR]

Background Loneliness and social inequality in health are important public health concerns. We examined (i) trends in loneliness among adolescents from 1991 to 2014 in Denmark and (ii) trends in social inequality in loneliness. Methods Study population: 11–15-year olds in random samples of schools in 1991, 1994, 1998, 2006 and 2014, n = 19 096. Loneliness was measured by a single item and social background by parents' occupational social class (OSC). We calculated absolute (%) differences in loneliness between high and low OSC and relative differences by odds ratio for loneliness. Results Across all surveys, 6.3% reported feeling lonely. The prevalence increased from 4.4% in 1991 to 7.2% in 2014. The prevalence of loneliness in high, middle and low OSC was 5.8, 5.9 and 8.0%. The increase in loneliness was more pronounced in higher than lower OSC, resulting in a decreasing absolute social inequality in loneliness. The statistical interaction between OSC and survey year was significant, P = 0.0176, i.e. the relative social inequality in loneliness also decreased from 1991 to 2014. Conclusion The prevalence of loneliness increased from 1991 to 2014. The social inequality in loneliness decreased in both absolute and relative terms because of a rising prevalence of loneliness among children from high OSC. [ABSTRACT FROM AUTHOR]

Background: While previous research establishes an association between social relations, health and use of healthcare services among older people, how to implement this knowledge in real-life settings has received much less attention. This study will explore the relationship between social relations, health and use of healthcare services in a Danish mid-life population sample. In addition, the study will explore individual and contextual factors affecting the implementation of a group-based life story intervention aimed at establishing and strengthening social relations among older people at nursing homes in Denmark.Methods/design: A combined quantitative register-based approach and a qualitative implementation approach will be applied in this study. First, we will quantitatively analyse the relationship between social relations, health status and use of healthcare services among middle-aged people in Denmark by linking survey data on social relations, loneliness, self-perceived health and disease status from the Copenhagen Aging and Midlife Biobank (CAMB) (n = 7191) with national registries through the Public Health Database on use of healthcare services and demographic and socioeconomic factors. Second, we will qualitatively analyse individual and contextual factors affecting the implementation process of the group-based life story intervention based on semi-structured interviews (n = 16), observations and field notes with and among intervention stakeholders, i.e., participants and group leaders facilitating the intervention.Discussion: The results of this study are expected to improve knowledge about mechanisms through which social relations are associated with health status and use of healthcare services and to inform the implementation of future interventions targeting social relations among older people at nursing homes.Trial Registration: The study has been registered and approved by the Danish Data Protection Agency. Seperate approvals have been attained for the qualitative data (Approval No. SUND-2016-08), and for the quantitative data in the CAMB database which has also received approval from the local ethical committee (approval No.H-A-2008-126 and No. 2013-41-1814, respectively). [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated that loneliness is more frequently present in citizens of ethnic minority groups than in natives. The current study investigates whether ethnic differences in emotional and social loneliness between Moroccan, Turkish, Surinamese and Dutch adults living in the Netherlands are due to ethnic differences in the presence and/or impact of an array of possible risk factors, such as partnership, health and socioeconomic status. Methods: The data were collected in 2012 as a part of a general health questionnaire of the Public Health Services in the four major cities of the Netherlands, containing 20.047 Dutch, 1.043 Moroccan, 1.197 Turkish and 1.900 Surinamese respondents. Results: Structural equation models showed that ethnic differences in emotional and social loneliness can be ascribed to ethnic differences in the prevalence and impact of several risk factors. Main findings were that all three ethnic minority groups reported feeling less healthy and more discriminated against than the Dutch group, which was related to increased loneliness. Perceived financial difficulties and people in the neighbourhood not getting along had more impact on feelings of loneliness for the Turkish group than loneliness for the other ethnic groups. Furthermore, members of the Turkish group were found more at risk to feel anxious or depressed, which was in turn related to increased loneliness. Conclusions: Policy makers are encouraged to develop multifaceted prevention strategies concerning those risk factors that are most changeable, thereby focusing per risk factor on those ethnic groups for which it is an important contribution to loneliness. [ABSTRACT FROM AUTHOR]

The article presents a study that examined loneliness as a determinant of emotion regulation associations with depressive symptoms in women with breast cancer. Topics discussed include the mental health benefits of emotional approach coping having been identified as a potentially adaptive form of emotion regulation. Also mentioned are findings supporting implicit processes as influential mechanisms of emotion regulations and suggest targets for intervention among breast cancer survivors.

Does employment provide respite or add stress to caregivers? As a result of population aging and increasing female employment rates, growing numbers are facing the competing demands of paid work and caregiving. This study explores the effect of providing regular personal care by employment status on six dimensions of psychological well-being. We concentrate on partner and parent care recipients and differentiate between in-household and out-of-household caregiving. We use cross-sectional data from the Norwegian Life Course, Ageing and Generation study ( n = 11,047, age 25-64). Results indicate that out-of-household caregiving has no significant relationship with men or women's well-being, irrespective of employment status. In-household caregiving, however, relates to lower psychological well-being, but only among women who do not work full-time. The advantages of full-time employment to caregivers may be due to greater opportunity to achieve the full benefits that this role has to offer. There is little to suggest that combining work and caregiving harms well-being. In fact, a 'double burden' seems to be experienced by women who combine extensive caregiving with limited employment. [ABSTRACT FROM AUTHOR]