GeoHealth Laboratory, University of Canterbury, Christchurch, New Zealand.
Department of Medicine, University of Otago, Christchurch, New Zealand.
Soc Sci Med. 2019 Apr;227:84-92. doi: 10.1016/j.socscimed.2018.08.002. Epub 2018 Aug 11.
Loneliness is a significant negative predictor of ageing well and a contra-indicator for resilience against requiring long-term residential care. Health geographers can contribute to the loneliness and ageing literature through examining how exposures in the physical and social landscape can affect positive and negative health outcomes. As well as improving individual experiences of ageing, spatial analysis may help to contribute to better understandings of loneliness and help reduce the $1.7 billion per annum New Zealand currently spends on publicly-funded aged residential care. Using New Zealand Home Care International Residential Assessment Instrument data from 2012 to 2016, the spatial distribution of the interRAI-HC cohort was examined. Urban and rural distribution, socioeconomic status, and ethnicity within the interRAI-HC cohort was compared against total population and population aged 65 plus. Relative to the socioeconomic status of the 65 plus cohort, those being interRAI-HC assessed were more likely to live in socially deprived areas. Socioeconomic deprivation also positively correlated with loneliness (OR = 1.002). Carer stress was negatively correlated with socioeconomic status (OR = 0.99). Those in rural areas were predicted to be less lonely than urban dwellers (OR = 0.98), and this observation remained similar and significant when socioeconomic status, the experience of negative social interactions or carer stress, and whether they lived alone were included. Living in rural areas had a protective effect against loneliness for all ethnic groups apart from Pasifika. 'Hot' and 'cold' clusters of loneliness were identified, with the distribution of interRAI-HC assessments in hot clusters less likely to be rural areas (OR = 0.71). Our findings did not diverge greatly from prior research on older people and loneliness in rural areas. Observations of regional differences regarding rurality and socioeconomic status did not show large differences, and this research will benefit in future from analysis at finer geographic scale.
孤独是老龄化不良的重要负面预测指标，也是对需要长期居住护理的弹性的反指标。健康地理学家可以通过研究物理和社会环境中的暴露如何影响积极和消极的健康结果，为孤独和老龄化文献做出贡献。除了改善个体的老龄化体验外，空间分析还可能有助于更好地理解孤独感，并有助于减少新西兰目前每年在公共资助的老年居住护理上花费的 17 亿美元。使用 2012 年至 2016 年新西兰家庭护理国际居住评估工具数据，研究了 interRAI-HC 队列的空间分布。将 interRAI-HC 队列的城乡分布、社会经济地位和种族与总人口和 65 岁以上人口进行了比较。与 65 岁以上队列的社会经济地位相比，接受 interRAI-HC 评估的人更有可能生活在社会贫困地区。社会经济贫困也与孤独感呈正相关（OR=1.002）。照顾者的压力与社会经济地位呈负相关（OR=0.99）。与城市居民相比，农村地区的人预测会更少感到孤独（OR=0.98），当包括社会经济地位、负面社会互动或照顾者压力的经历以及是否独居时，这种观察结果仍然相似且具有统计学意义。与城市居民相比，生活在农村地区对所有族裔群体（除了太平洋岛民外）都有保护作用，避免孤独。孤独的“热点”和“冷点”集群被识别出来，热点集群中 interRAI-HC 评估的分布不太可能是农村地区（OR=0.71）。我们的研究结果与农村地区老年人和孤独感的先前研究没有太大区别。关于农村地区和社会经济地位的区域差异的观察结果并没有显示出很大的差异，未来这项研究将受益于更精细的地理尺度分析。
