Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Arch Gerontol Geriatr. 2022 Jan-Feb;98:104572. doi: 10.1016/j.archger.2021.104572. Epub 2021 Nov 13.
Loneliness is associated with poorer cognitive functions, lower quality of life, with increased mortality and healthcare utilization. Despite an estimated 2-5% of elderly residing in nursing homes, there is limited knowledge on their loneliness experience. This study seeks to obtain an indicative prevalence of loneliness among nursing home residents in Singapore, explore associations of loneliness with different variables, and better understand their loneliness experience.
A cross-sectional mixed methods study was conducted between May to July 2018. Loneliness was determined by the UCLA three-item loneliness scale, with other information collected on health statuses and social contacts. 57 cognitively-intact nursing home residents above 65 years old were recruited for the quantitative strand, and prevalence ratios were estimated using modified Poisson model with robust estimator. Eight participants were subsequently recruited for the qualitative strand, where analysis was conducted using a line-by-line inductive approach with grounded theory techniques.
59.6% of study participants experienced loneliness. After statistical adjustment, significant associations were detected between frailty and loneliness, and history of falls and loneliness. The estimated prevalence ratio of loneliness among frail elderly is 1.37 times that of those pre-frail (p=0.018), and estimated prevalence ratio of loneliness among elderly with history of falls is 1.35 times that of those without (p <0.0001). The loneliness experience may be amplified by deficiencies in health, social contact, and engagement, and mitigated through reminiscence and anticipation. Individuals' perspective of circumstances and autonomy levels may amplify or mitigate loneliness.
This study reinforces existing evidence of relationship between frailty and loneliness, and illustrates a potential association between history of falls and loneliness. With older and frailer elderly residents, and circumstances such as structured routines and lack of autonomy, the observed experience may be unique to nursing homes, with potentially higher loneliness prevalence compared to community-dwelling elderly.
孤独与认知功能下降、生活质量降低、死亡率和医疗保健利用率增加有关。尽管估计有 2-5%的老年人居住在养老院中，但对于他们的孤独感知之甚少。本研究旨在了解新加坡养老院居民孤独感的普遍程度，探讨孤独感与不同变量的关系，并深入了解他们的孤独感体验。
本研究于 2018 年 5 月至 7 月期间采用横断面混合方法进行。采用 UCLA 三项目孤独量表来确定孤独感，同时收集健康状况和社会联系等其他信息。共招募了 57 名认知功能正常、年龄在 65 岁以上的养老院居民参与定量研究，使用带稳健估计量的修正泊松回归模型来估计患病率比。随后，招募了 8 名参与者参与定性研究，采用线对线的归纳方法和扎根理论技术进行分析。
研究参与者中有 59.6%经历孤独感。经过统计学调整，发现虚弱和孤独感之间、跌倒史和孤独感之间存在显著关联。与非虚弱老年人相比，虚弱老年人孤独感的患病率比为 1.37（p=0.018），有跌倒史的老年人孤独感的患病率比为 1.35（p<0.0001）。健康、社会联系和参与度的不足可能会放大孤独感，而怀旧和期待则可能减轻孤独感。个人对情况和自主权的看法可能会放大或减轻孤独感。
本研究证实了虚弱和孤独感之间存在关联的现有证据，并说明了跌倒史和孤独感之间可能存在关联。对于更年长、更虚弱的养老院居民，以及结构化日常生活和缺乏自主权等情况，观察到的孤独感体验可能与养老院有关，与社区居住的老年人相比，孤独感的患病率可能更高。
