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Changes in social engagement and depression predict incident loneliness among seriously ill home care clients

Published online by Cambridge University Press:  16 March 2017

Samantha Fernandes*
Affiliation:
Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Jacob G.S. Davidson
Affiliation:
Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
Dawn M. Guthrie
Affiliation:
Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
*
Address correspondence and reprint requests to Samantha Fernandes, Institute of Medical Science, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada. E-mail: sr.fernandes@mail.utoronto.ca.

Abstract

Objective:

This study identified the predictors of incident loneliness in a group of seriously ill older adults (aged 65+) receiving home care.

Method:

Existing data collected with the Resident Assessment Instrument for Home Care (RAI–HC) were utilized. A cohort of clients (N = 2,499) with two RAI–HC assessments and no self-reported loneliness at time 1 were included. Self-reported loneliness, upon reassessment, was the outcome of interest. Clients with a prognosis of less than six months or severe health instability were included.

Results:

The average length of time between assessments was 5.9 months (standard deviation = 4.10). During that time, 7.8% (n = 181) of the sample developed loneliness. In a multivariate regression model, worsening symptoms of depression, a decline in social activities, and not living with a primary caregiver all increased the risk of loneliness.

Significance of results:

These results highlight how changes in psychosocial factors over time can contribute to loneliness, which can inform clinicians as they seek to identify those who may be at risk for loneliness.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2017 

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References

REFERENCES

Brannstrom, M., Ekman, I., Norberg, A., et al. (2006). Living with severe chronic heart failure in palliative advanced home care. European Journal of Cardiovascular Nursing, 5(4), 295302. Epub ahead of print Mar 20.CrossRefGoogle ScholarPubMed
Brummett, B.H., Barefoot, J.C., Siegler, I.C., et al. (2001). Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality. Psychosomatic Medicine, 63(2), 267272.Google Scholar
Burrows, A.B., Morris, J.N., Simon, S.E., et al. (2000). Development of an MDS-based depression rating scale for use in nursing homes. Age and Ageing, 29(2), 165172.Google Scholar
Cacioppo, J.T., Hawkley, L.C., Crawford, L.E., et al. (2002). Loneliness and health: Potential mechanisms. Psychosomatic Medicine, 64(3), 407417.Google Scholar
Cacioppo, J.T., Hawkley, L.C. & Thisted, R.A. (2010). Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychology and Aging, 25(2), 453463. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922929/.Google Scholar
Canadian Hospice Palliative Care Association (2002). A Model to Guide Hospice Palliative Care. Ottawa: Canadian Hospice Palliative Care Association. Available from http://www.chpca.net/media/319547/norms-of-practice-eng-web.pdf.Google Scholar
Cook, N.R. (2008). Statistical evaluation of prognostic versus diagnostic models: Beyond the ROC curve. Clinical Chemistry, 54(1), 1723. Epub ahead of print Nov 16, 2007. Available from http://clinchem.aaccjnls.org/content/54/1/17.long.Google Scholar
Cornwell, E.Y. & Waite, L.J. (2005). Social disconnectedness, perceived isolation, and health among older adults. Journal of Health and Social Behavior, 50(1), 3148. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756979/.Google Scholar
Dahlberg, L., Andersson, L., McKee, K.J., et al. (2015). Predictors of loneliness among older women and men in Sweden: A national longitudinal study. Aging & Mental Health, 19(5), 409417. Epub ahead of print Aug 15, 2014.Google Scholar
Dykstra, P.A. (2009). Older adults loneliness: Myths and realities. European Journal of Ageing, 6(2), 91100. Epub ahead of print Apr 4. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693783/.Google Scholar
Fisher, K.A., Seow, H., Brazil, K., et al. (2014). Prevalence and risk factors of depressive symptoms in a Canadian palliative home care population: A cross-sectional study. BMC Palliative Care, 13(1), 113. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003817/.Google Scholar
Flora, D.B. & Curran, P.J. (2004). An empirical evaluation of alternative methods of estimation for confirming factor analysis with ordinal data. Psychological Methods, 9(4), 466491. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153362/.Google Scholar
Fries, B.E., Simon, S.E., Morris, J.N., et al. (2001). Pain in U.S. nursing homes: Validating a pain scale for the minimum data set. The Gerontologist, 41(2), 173179.CrossRefGoogle ScholarPubMed
Gadermann, A.M., Guhn, M. & Zumbo, B.D. (2012). Estimating ordinal reliability for Likert-type and ordinal item response data: A conceptual, empirical, and practical guide. Practical Assessment, Research & Evaluation, 17(3), 113. Available from http://pareonline.net/getvn.asp?v=17&n=3.Google Scholar
Han, J. & Richardson, V.E. (2010). The relationship between depression and loneliness among homebound older persons: Does spirituality moderate this relationship? Journal of Religion & Spirituality in Social Work, 29(3), 218236.CrossRefGoogle Scholar
Hawkley, L.C., Preacher, K.J. & Cacioppo, J.T. (2010). Loneliness impairs daytime functioning but not sleep duration. Health Psychology, 29(2), 124129. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841303/.CrossRefGoogle Scholar
Hirdes, J.P., Frijters, D.H. & Teare, G.F. (2003). The MDS–CHESS scale: A new measure to predict mortality in institutionalized older people. Journal of the American Geriatrics Society, 51(1), 96100.Google Scholar
Hirdes, J.P., Ljunggren, G., Morris, J.N., et al. (2008). Reliability of the interRAI suite of assessment instruments: A 12-country study of an integrated health information system. BMC Health Services Research, 8(1), 277. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631461/pdf/1472-6963-8-277.pdf.Google Scholar
Hirdes, J.P., Freeman, S., Smith, T.F., et al. (2012). Predictors of caregiver distress among palliative home care clients in Ontario: Evidence based on the interRAI Palliative Care. Palliative & Supportive Care, 10(3), 155163. Epub ahead of print Mar 22.Google Scholar
Hosmer, D.W. & Lemeshow, S. (2000). Applied Logistic Regression, 2nd ed. New York: John Wiley & Sons.CrossRefGoogle Scholar
Hughes, N. & Arber, A. (2008). The lived experience of patients with pleural mesothelioma. International Journal of Palliative Nursing, 14(2), 6671.Google Scholar
Kaasa, S. & Loge, J.H. (2003). Quality of life in palliative care: Principles and practice. Palliative Medicine, 17(1), 1120.Google Scholar
Luanaigh, C.O. & Lawlor, B.A. (2012). Loneliness and the health of older people. International Journal of Geriatric Psychiatry, 23(12), 12131221.CrossRefGoogle Scholar
Luo, Y., Hawkley, L.C., Waite, L.J., et al. (2012). Loneliness, health and mortality in old age: A national longitudinal study. Social Science & Medicine, 74(6), 907914. Epub ahead of print Jan 25. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303190/.Google Scholar
Martin, L., Poss, J.W., Hirdes, J.P., et al. (2008). Predictors of a new depression diagnosis among older adults admitted to complex continuing care: Implications for the Depression Rating Scale (DRS). Age and Ageing, 37(1), 5156. Epub ahead of print Nov 21, 2007.Google Scholar
Mishara, B.L. (1999). Synthesis of research and evidence on factors affecting the desire of terminally ill or seriously chronically ill persons to hasten death. Omega, 39(1), 170.Google Scholar
Morris, J.N., Fries, B.E., Mehr, D.R., et al. (1994). MDS Cognitive Performance Scale. Journal of Gerontology, 49(4), M174M182.Google Scholar
Morris, J.N., Fries, B.E., Steel, K., et al. (1997). Comprehensive clinical assessment in community setting: Applicability of the MDS–HC. Journal of the American Geriatrics Society, 45(8), 10171024. Available from https://deepblue.lib.umich.edu/bitstream/handle/2027.42/111099/j.1532-5415.1997.tb02975.x.pdf?sequence=1&isAllowed=y.Google Scholar
Morris, J.N., Fries, B.E. & Morris, S.A. (1999). Scaling ADLs within the MDS. The Journals of Gerontology. Series A: Biological Sciences and Medical Sciences, 54(11), M546M553.Google Scholar
National Consensus Project for Quality Palliative Care (2013). Clinical Practice Guidelines for Quality Palliative Care, 3rd ed. Pittsburgh, PA: National Consensus Project for Quality Palliative Care. Available from http://www.nationalconsensusproject.org/guideline.pdf.Google Scholar
Nyqvist, F., Cattan, M., Anderson, L., et al. (2013). Social capital and loneliness among the very old living at home and in institutional settings: A comparative study. Journal of Aging and Health, 25(6), 10131035. Epub ahead of print Aug 29.Google Scholar
O'Connor, M. (2014). A qualitative exploration of the experiences of people living alone and receiving community-based palliative care. Journal of Palliative Medicine, 17(2), 200203.Google Scholar
Ontario Ministry of Health and Long-Term Care (2006). Home Care Database Year in Review, 2005/06. Toronto: Ontario Ministry of Health and Long-Term Care. Available from https://hsim.health.gov.on.ca/HDBPortal/.Google Scholar
Ontario Ministry of Health and Long-Term Care (2007). Community Care Access Centres Client Services Policy Manual. Toronto: Ontario Ministry of Health and Long-Term Care. Available from http://www.health.gov.on.ca/english/providers/pub/manuals/ccac/ccac_mn.html.Google Scholar
Rokach, A., Matalon, R., Safarov, A., et al. (2007). The loneliness experience of the dying and of those who care for them. Palliative & Supportive Care, 5(2), 153159.Google Scholar
Russell, D.W. (1996). UCLA loneliness scale (version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66(1), 2040.Google Scholar
SAS Institute Inc. (2001). The SAS System for Windows. Cary, NC: The SAS Institute Inc.Google Scholar
Savikko, N., Routasalo, P. & Tilvis, R.S. (2004). Predictors and subjective causes of loneliness in an aged population. Archives of Gerontology and Geriatrics, 41(3), 223233.Google Scholar
Theeke, L.A. (2009). Predictors of loneliness in U.S. adults over age sixty-five. Archives of Psychiatric Nursing, 23(5), 387396.Google Scholar
Tiikkainen, P. & Heikkinen, R.L. (2005). Associations between loneliness, depressive symptoms and perceived togetherness in older people. Aging & Mental Health, 9(6), 526534.Google Scholar
Tilvis, R.S., Laitala, V., Routasalo, P.E., et al. (2011). Suffering from loneliness indicates significant mortality risk of older adults. Journal of Aging Research, 2011, 15. Available from https://www.hindawi.com/journals/jar/2011/534781/.Google Scholar
van Baarsen, B., Snijders, T.A., Smit, J.H., et al. (2001). Lonely but not alone: Emotional isolation and social isolation as two distinct dimensions of loneliness in older people. Educational and Psychological Measurement, 61(1), 119135.Google Scholar
Victor, C., Scambler, S., Bond, J., et al. (2002). Loneliness in later life: Preliminary findings from the Growing Older Project. Quality in Ageing and Older Adults, 3(1), 3441.Google Scholar
Wilson, R.S., Krueger, K.R., Arnold, S.E., et al. (2007). Loneliness and risk of Alzheimer disease. Archives of General Psychiatry, 64(2), 234240. Available from http://jamanetwork.com/journals/jamapsychiatry/fullarticle/482179.Google Scholar
Zhang, J. & Yu, K.F. (1998). What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. The Journal of the American Medical Association, 280(19), 16901691. Available from http://jamanetwork.com/journals/jama/fullarticle/188182.Google Scholar