Quality Of Life Among The Elderly

Loneliness is a geriatric giant leading to impaired quality of life, greater need for institutional care and increased mortality. Routasalo, Pitkala, 2003

The phenomenon of loneliness occurs in people of all ages it may be a particular problem in the elderly according to a study carried out at Edinburg University in the nursing science department. It is acknowledged that loneliness is not necessary accompaniment to ageing and that ageing is not solely responsible for the development of loneliness in the elderly people; however there is a relationship between ageing and loneliness.

There is a need to understand the casual relationship between life-events and loneliness, how to predict it and whether negative consequences maybe alleviated.(Routasalo, Pitkala, 2003).

This study is about loneliness among the elderly people. I was interested in this topic because the fact that many old people are still experiencing loneliness at different levels cannot be overlooked. ‘Loneliness’ and social isolation have often been used to characterise the social world of older people and as an indicator of their quality of life (Victor, scamber and Bond, 2009) but loneliness among the elderly has been under addressed.Like many other social science concepts,loneliness is often a taken-for-granted idea from every day life.Loneliness is a common problem among the elderly that lead to widespread unhappiness and social exclusion.

The purpose of this study is therefore to portray loneliness among the elderly ,the main influencing factors and strategies to address it.

This study is entirely based on Qualitative Research methodology by probing into different academic disciplines so as to gather a deeper understanding of this particular topic.

WHAT IS LONELINESS?

Loneliness is a situation experienced by the individual as one where there is unpleasant or inadmissible lack of (quality of) certain relationships. This includes situations in which a number of existing relationships is smaller than is considered desirable or admissible as well as situations where the intimacy one wishes for has not been realised. (De jong gierveld, 1987, p.120 quoted in vangelisti and pelman 2006, p. 585-500)

(Peplau, 1981 quoted in vangelisti and pelman 2006, p. 585-500) defines loneliness as ‘the unpleasant experience that occurs when a person’s network of social relations is deficient in some important way either qualitatively (Quality related) or quantatively (size related).

Loneliness categories

(Weiss, 1973 in vangelisti and pelman 2006, p. 585-500) categorise loneliness as:

Emotional loneliness

This is as a result of absence of an intimate figure or a close emotional attachment (a partner, best friend) e.g. in divorce or widowhood.

We can further subgroup it as:

Developmental

Experienced when there is a need for intimacy balanced by a pursuit for personal happiness and independence (goals).

Internal

Often includes feelings of low-esteem and vulnerability.

Social loneliness

This kind of loneliness arises with the absence of a broader group of contacts or an engaging social network like friends, collegues and people in the neighbourhood.

It can also be termed as Situational/Circumstantial which can be explained by situations like loosing a relationship or moving to a new city.

Measurements of loneliness among the elderly

Loneliness is subjective(It is based on somebody’s opinions or feelings rather than on facts or evidence) and is measured using questions that seek perceptions of relationships,social activity and feelings about social activity(British Columbia ministry of health ,2004)

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Loneliness is very cultural and temporally specific(jylhä 2004).It is and has been difficult to compare levels of loneliness accross cuntries because the meaning of ‘loneliness’ is highly cultural(and possibly temporary)specific. Variations in measures used to measure loneliness by researchers in different countries has made it difficult to make a comparison across different countries.

Findings of the study

Main factors influencing loneliness among the elderly

Health resources

Chronic poor physical or mental health, Sensory impairments, Falls and

Self-rated health and Health expectations

(Tijhuis et al 1999) found that increase in loneliness was attributed to poorer subjective health but not on activity limitation or cognative function.Lonely and isolated peoples health may deteriorate because”they lack the environmental support,social ties and assistance by others that become critical factors in the maintainance of their independence later in life.(Bosworth and schaie 1997 p.197)

Mental health issues such as depression can impact self-rated score in an indirect way as those who are depressed may evaluate their social relationships negatively and therefore create apparent associations with other risk factors when infact it is depression that is the issue.(Russel et al,1997)

Social resources

E.g. Availability of family, friends and Social contacts

Recognition of the importance of the importance of the relationship between social engagements and ‘quality of life’ is not new (Victor, scamber and Bond, 2009). Social relationships and social engagements are a very important part of quality of life in old age according to (Victor, camber and Bond 2009).Rowe and Kahn (1997) suggest that a high level of social engagement is a key factor in achieving the goal of ‘successful ageing’. This same observation has been made in ideas of ‘healthy’ ageing and ‘active’ ageing.

Demographic factors

E.g. Age, gender, household composition, neigbourhood and

Marital status

Age and gender

Being widowed and living alone are more common among women because of their tendancy to outlive male partners.

Neigbourhood

Favorable neighborhood is associated with feeling safe and secure. Immediate neighborhood is of particular importance to the well-being and quality of life of older people(bowling 2006,Victor,Scamber and Bond 2009)Whilst there has been much focus on the importance of maintaining older people at ‘home’ this has been often interpreted as the narrow confines of the built dwelling or house rather than the wider environment of neighborhood or locality. Yet place is clearly important in providing the spatial context within old age (Berkman et al., 2000; berkman and Glass, 2000, Victor, Scamber and Bond 2009)

Household composition

Most people who live alone are lonely but not all people who live alone are lonely.Living alone also interacts with many other variables to create varying pictures of loneliness.Living together with someone and living in one’s own apartment(as opposed to an institition) showed a positive influence on feelings of loneliness for this population(Holmen et al 2000 as cited in gierveld,Tilburg and Dykstra in Vangelisti and perlmans 2006)

Material resources

E.g. Home ownership, access to car and education Qualifications

Economic status and self-esteem have been found to have a relationship with loneliness. Loneliness was expressed by those older persons with less adequate self-rated economic conditions and those living in actual poverty.(Mullins,Elston and Gutkoiski,1996) agrees that the less financially adequate individuals perceive their situation to be the more lonely they were.

Access to Transport/car

Driving status and transportation have an effect on the loneliness and social isolation of the elderly because of their role in facilitating access to the social network.(Kivett 1979) categorized older rural adults with transportation problems as a high risk of loneliness. Many seniors are restricted to pre-arranged van trips with community or volunteers drivers. Dependence on others for transportation related socializing may change the nature of social interaction for those people (Hall Havens,1999). Programs for seniors will be ineffective if they cannot access them.

Life Events

E.g. Bereavement ,widowhood and onset of illness

Death of a spouse and living alone is a major additive risk factor for loneliness and isolation.

Events like widowhood emphasize that bereaved persons are especially vulnerable for emotional isolation(loneliness)rather than social isolation (Van baarsen et al,1999)

Discussions of findings

Given the potential harmful effects of social isolation and loneliness in seniors,it is important to persue this issue in order to reduce emotional damage to seniors and inappropriate health and social service usage.However,caution should be observed when again interventions without knowing the target population and assessing the possible negative consequences of the planned intervention.( British Columbia Ministry of

Health.March 2004)

Strategies to address loneliness and isolation for older people.

A survey done in campaign launced by leeds metropolitan university on behalf of the british gas to combat isolation and lonelness developed recommendations with the

older people to address the issue of isolation and loneliness.Through interviewing older people and trying to identify what they want,the following suggestions were arrived at.

Involving older people in planning,developing and deliverly of activities that target social isolation and loneliness.

Practical,flexible and low level assistance that could help older people to remain indipendent,gain confidence to identifytheir own solutions and support them in retaining their own social networks.

Individually tairoled solutions to meet specific needs,within a variety of activities available within their local neighborhood and within the reasonable travelling distance.

Transport that takes the mobility of the elderly into account.

Availability of Services that cater for specific groups such as carers,ethnic minorities,older men and those with hearing impairments or mobility problems and those who have been isolated for a long time.

Support and encouragement for the elderly to learn new skills as well as the opportunity to share their skills with other older people.