Effect OF Loneliness on elderly peoples PDF

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EFFECT OF LONELINESS ON ELDERLY PEOPLE’S LIVES Bachelor’s thesis

Khadra Muhumed Marketa Cervinkova

Bachelor’s thesis October 2011 Degree Programme in Nursing Tampereen ammattikorkeakoulu Tampere University of Applied Sciences

ABSTRACT Tampereen ammattikorkeakoulu Tampere University of Applied Sciences Degree Programme in Nursing and Health Care Option of Medical-surgical Nursing MUHUMED, KHADRA & CERVINKOVA, MARKETA: Effect of Loneliness on Elderly People’s Lives Bachelor’s thesis, 37 pages, appendices 3pages November 2011

The purpose of this thesis was to explore how elderly people experience the effect of loneliness on daily activities and the ways of loneliness alleviation. This study aimed to give better understanding of the loneliness among elderly people and to improve quality of elderly care and services of partners of project Active Aging in Tampere region, which part this Bachelor’s thesis was. As the study dealt with human emotions and feelings, qualitative approach was used. Data was collected through semi-structured interviews of six elderly people, residents or service users of Kuusela Senior Centre. Data was analysed by method of content analysis. Results were divided into three categories, meaning of loneliness, causes of loneliness and coping with loneliness. Loneliness was perceived as both, positive, a time of one’s own, as well as negative feeling, which was connected to living alone, social isolation and estrangement from the society. The most discussed issue concerning loneliness was lack of social contacts, either due to death of friends or missing their children, and this topic was especially connected to winter time, when there was little possibility to meet other people. Moreover, own personality and dependency limited the amount and choice of activities and contributed to social isolation. Bereavement over partner’s death but also lack of interest from younger generations led to withdrawal from active life of some participants as well. Concerning coping strategies, solitary activities, like reading, watching television or light housework, helped the participant to stay occupied but social network, social activities and family support were more beneficial. The findings of this thesis highly correlate with previous studies in this field and show the importance of social contacts and meaningful activity for elderly people once again, as the elderly people themselves highlighted the beneficence of different psychosocial rehabilitation groups, physiotherapy and social activities. This thesis also linked loneliness and decreased level of activities together, no matter in what order they were reported. Key words: loneliness, elderly, activity, content analysis

TIIVISTELMÄ Tampereen ammattikorkeakoulu Tampere University of Applied Sciences Hoitotyön koulutusohjelma Sisätauti-kirurgisen hoidon suuntautumisvaihtoehto MUHUMED, KHADRA & CERVINKOVA, MARKETA: Yksinäisyyden vaikutus vanhusten elämään Opinnäytetyö, 37 sivua, liitteet 3 sivua Marraskuu 2011

Opinnäytetyön tarkoituksena oli tutkia vanhusten kokemusta yksinäisyyden vaikutusta päivittäisiin toimintoihin ja tavoista yksinäisyyden lievittämistä. Tämä opinnäytetyö oli Aktiivisesti Ikääntyen Pirkanmaalla-projektin osa. Tutkimuksen tavoitteena oli antaa parempi käsitys vanhusten yksinäisyydestä ja parantaa projektin yhteistyökumppaneiden vanhusten hoitoa ja palvelua. Koska tutkimuksessa käsitellään ihmisten tunteita ja tuntemuksia, laadullista menetelmää käytettiin. Tiedot kerättiin teemahaastattelulla ja siihen osallistui kuusi ihmistä Kuuselan seniorikeskuksen asukkaista tai palvelukäyttäjistä. Tiedot analysoitiin sisällön analyysi-menetelmällä. Tulokset jaettiin kolmeen ryhmään, yksinäisyyden merkitys, yksinäisyyden aiheuttajat ja yksinäisyydestä selviytyminen. Yksinäisyys koettiin sekä positiivisesti, omaan aikaan liittyen, että negatiivisesti, joka liittyi yksin asumiseen, sosiaaliseen eristäytymiseen tai etääntymiseen. Eniten keskustelut yksinäisyydestä koskivat sosiaalisen kontaktin puutteesta, joka johtui joko ystävien kuolemasta tai omien lasten ikävöinnistä, ja tämä aihe oli erityisen kytketty talviaikaan, kun mahdollisuus tavata muita ihmisiä vähentyi. Lisäksi oma persoonallisuus ja riippuvaisuus rajoittivat toiminnan määrää ja valintaa ja johti sosiaaliseen eristäytymiseen. Puolison kuoleman, mutta myös nuorempien sukupolvien kiinnostuksen puutteen takia osallistujista osa vetäytyi aktiivisesta elämästä. Kun puhutaan selviytymisstrategioista, yksinäinen toiminta, kuten lukeminen, television katselu tai kotityöt, auttoivat osallistujia pysymään toiminnassa, mutta sosiaalisesta verkostosta, yhteisestä toiminnasta ja perheen tuesta oli enemmän hyötyä. Opinnäytetyön tulokset vastaavat aiempien tutkimusten tulosteita ja osoittavat, miten tärkeitä sosiaaliset kontaktit ja mielekäs toiminta ovat vanhuksille, kuten he itse korostivat eri psykososiaalisen kuntoutuksen ryhmien, fysioterapian sekä yhteisen toiminnan hyötyä. Tämä opinnäytetyö yhdisti yksinäisyyden ja toiminnan laskun, molemmista suunnista katsottuna. Avainsanat: yksinäisyys, vanhus, toiminta, sisällön analyysi

4 CONTENTS 1 INTRODUCTION ......................................................................................................... 5 2 LONELINESS ............................................................................................................... 7 2.1 Concept of loneliness .............................................................................................. 7 2.2 Loneliness and aging ............................................................................................... 9 2.3 Loneliness and functional ability .......................................................................... 10 3 PURPOSE OF THE STUDY AND RESEARCH QUESTIONS ................................ 13 4 METHODOLOGY ....................................................................................................... 14 4.1 Qualitative research method .................................................................................. 14 4.2 Data collection ....................................................................................................... 15 4.3 Data analysis.......................................................................................................... 16 4.4 Ethical considerations............................................................................................ 18 5 FINDINGS ................................................................................................................... 20 5.1 Meaning of loneliness ........................................................................................... 20 5.2 Effect of loneliness on daily activities .................................................................. 20 5.3 Coping strategies ................................................................................................... 22 5.4 Activities of interest .............................................................................................. 24 6 DISCUSSION .............................................................................................................. 26 6.1 Discussion of the process ...................................................................................... 26 6.2 Discussion of the findings ..................................................................................... 26 6.3 Trustworthiness ..................................................................................................... 29 7 CONCLUSION ............................................................................................................ 31 REFERENCES................................................................................................................ 32 APPENDICES

5 1 INTRODUCTION

Elderly population is the fastest growing population in the world (World Health Organization 2002, 6). This increases demands on social and health services and also on governments to finance these services (Eliopoulos 2010, 11). Efforts to maintain elderly people active have been done by investigating all possible factors that may affect their lives. Although, loneliness is not only a specific problem to elderly people, a relationship between aging and loneliness has been established (Donaldson & Watson 1996, 952). Concerning Finland, the number of people over 65 years of age is estimated to rise from present 17% (905 000 people) to 29%, which would represent 1.79 million people, by the year 2060 (Official Statistics of Finland 2009). The incidence of loneliness in Finnish elderly population is rather high. According to Savikko (2008, 40-43), 39% of Finnish elderly population experience loneliness at least sometimes. Loneliness has been studied from many different points of view and there is no unified definition. There are other close concepts related to it, which makes the definition statement difficult. Mainly, loneliness is thought as being estranged from others. (Killeen 1998, 763-764.) Solitude is, on the other hand, seen as a positive experience needed to “achieve personal growth and freedom” (Karnick 2005, 9). Another close concept is aloneness, a state when a person is alone but does not feel lonely (Killeen 1998, 764). Loneliness can affect both, mental and physical health. It has been linked to a variety of problems like depressive symptoms (Tiikkainen, & Heikkinen 2005, 532; Barg, HussAshmore, Wittink, Murray, Bogner & Gallo 2006, 333-335), increased alcohol consumption (Acquire 2002), physical illnesses (Holmén, Ericsson, Andersson & Windblad 1993, 59; Avlund, Lund, Holstein & Due 2004, 95-96; Victor, Scambler, Bowling & Bond 2005, 369; Theeke 2009, 393)

but as far as our knowledge,

the research concerning loneliness and functional ability has been inadequate (Savikko 2008, 21).

6 The topic „Loneliness and its effect on elderly people’s lives“ was given by a project Active Aging in Tampere region, a project of Tampere University of Applied Sciences, and this Bachelor’s thesis is a part of the project. The project is financed by European Social Fund and Centre for Economic Development, Transport and the Environment. Objectives of this project are to improve and to support of physical ability and promotion of active life among elderly people in Tampere region. This project involves a variety of professionals and units specialized in elderly care. (www.piramk.fi/aip.) The research was held in Kuusela senior centre. The topic was chosen because of authors’ interest in elderly care. The authors hope that results of this thesis help better understanding of loneliness among elderly population and improve quality of care and services of project’s partners.

7 2 LONELINESS

2.1 Concept of loneliness Even though the phenomenon of loneliness has been described in literature and arts since ancient time, it is difficult to define it. Loneliness is universal, still very subjective feeling, natural to all human beings. For its subjectivity, many people may be ashamed of talking about it or admitting they feel lonely because they are afraid of being stigmatized. Loneliness may also have different meaning for different people which makes understanding of loneliness even more difficult. (Killeen 1998, 763-764.) Philosophy and literature have provided different points of view on loneliness over past centuries. Ancient Greek philosophers saw people as social beings and therefore, loneliness was something undesirable. In Christianity, on the other hand, loneliness has represented a way of one’s self-fulfilment and connection with God. By contrast, romanticism deals with loneliness as one’s fate, unwanted but unchangeable. R omantic heroes rebel against conventions and laws given by hypocritical society and they become outcasts. In spite of being strong individuals, they feel lonely and end tragically. Finally, existentialists and humanists give another perspective of loneliness. Although they agree that person stands and acts alone and he alone is responsible for his own choices, humanists add that loneliness is a choice of one’s own free will. (Karnick 2005, 8-9.) Killeen (1998) summarizes all these perspectives into alienation-connectedness continuum. Be ginning from the negative side, there are estrangement and alienation, a rejection by others or a feeling of a complete worthlessness. Next to them stays loneliness which is viewed as “emptiness due to an unfulfilled social and/or emotional life” (Killeen 1998, 764). Social isolation and aloneness are two other related concepts. Social isolation balances between loneliness and aloneness, depending on whether it is one’s choice or not. Consequently, aloneness can be understood as one’s preference of being alone. Unlike previous concepts, solitude has a positive meaning. It is a time on one’s own that can be used for self-reflection and creativity. Killeen also covers a concept of connectedness in her work. (Killeen 1998, 764-765.) This concept was first mentioned by Younger (1995) who proposes that through suffering of loneliness, one can find connection with others, nature and universe.

8 Further, some authors, based on interactionist theory, distinguish between emotional and social aspects of loneliness (Younger 1995; Donaldson & Watson 1996, 955; Killeen 1998, 764). Whereas the social element simply means lack of social contacts or disaffection with a present social network (Savikko 2008, 14), Younger (1995) depicted the emotional loneliness as: “the kind of desperate, lonely Why? felt by most anyone in moments of crushing hurt, ruin, and deepest despair. ... That which gave life its meaning has become empty and void.” (Younger 1995.) Besides, interactionists believe that one’s personality determines how loneliness is perceived. According to this theory, not only quality but also the extension of loneliness may be evaluated. Interactionist theory was criticised for excluding positive side of loneliness, absence of others does not necessarily have to be a negative experience. (Donaldson & Watson 1996, 955; Savikko 2008, 16.) Figure 1 modifies Killeen’s alienation -connectedness continuum according to authors’ understanding of the concepts of loneliness. First, social isolation was put into middle, as it was seen as a turning point between positive and negative sides of the continuum. Secondly, alienation was understood as the most negative case on the emotional, and estrangement on the social side of loneliness. Yet, authors were not able to decide which one is more severe. Finally, in authors’ point of view, there were no major differences in meanings of solitude and connectedness. Therefore, they are standing equally at the positive end.

FIGURE 1. Alienation-connectedness continuum (Killeen 1998, 765, modified)

In this thesis, loneliness is thought as a negative experience. Thus, definition given by Rook (1984, according to Donaldson & Watson 1996, 953) will be used. Loneliness is: an enduring condition of emotional state that arises when a person feels estranged from, is misunderstood or rejected by others, and/ or lacks appropriate social partners for desired activity, particularly activities that provide a sense of

9 social integration and opportunities for emotional intimacy. (Rook 1984, according to Donaldson & Watson 1996, 953) In relation to nursing practice, terms social isolation and risk for loneliness, can be found in NANDA nursing diagnoses (Nilsson, Lindström & Nåden 2006, 98). According to Killeen (1998), the problem of loneliness in nursing is simplified and loneliness is viewed as a disease. She argues that there is no treatment for it and that it can only be alleviated to some degree. (Killeen 1998, 768-769.) Donaldson and Watson (1996, 953), therefore, suggest utilization of theoretical perspectives of loneliness in nursing practice. In addition to theory utilizing, Younger (1995) stresses true presence, therapeutic silence and empathy when dealing with loneliness.

2.2 Loneliness and aging Feeling of loneliness occurs among all age groups. Though, the most vulnerable seems to be adolescents and elderly people. (Donaldson & Watson 1996, 952; Killeen 1998, 766.) Donaldson and Watson (1996, 952) claim that loneliness among teenagers is transient and more attention should be pay to elderly because they are at risk of social isolation due to reducing contacts with other people. Loneliness among elderly population has been examined, in quantitative studies, according to demographic factors, education, socio-economic status or health. In average, one third of elderly population suffers from loneliness at least sometimes (Victor et al. 2005, 364; Savikko 2008, 40; Theeke 2009, 392). Illness, death of a spouse and lack of friends were the most common causes of loneliness (Savikko 2008, 42). Most of studies found that loneliness is more common among women (e.g. Victor et al. 2005, 369; Savikko 2008, 40). Nevertheless, some authors (Rokach, Matalon, Rokach & Safarov 2007, 249; Theeke 2009, 394) argue that these findings are not relevant because, unlike women, men are less likely to talk about their emotions. Moreover, Rokach et al. (2007, 250) adds that there are gender differences in quality of loneliness and women are able to profit from the positive perspective of loneliness more than men.

10 Loneliness was associated with increasing age. The reason behind is shrinking of the social network, caused by loss of partner and friends. (Victor et al. 2005, 369; Savikko 2008, 40-43; Theeke 2009, 393-394.) However, it has been found that after age of eighty-five, loneliness does not play a significant role in elderly people’s lives (Tiikkainen, & Heikkinen 2005, 529; Victor et al. 2005, 371). In this age, not amount of social contact but a quality of relationship is more important (Holmén & Furukawa 2002, 269). Another explanation of decreased perception of loneliness in this age group may be “survivor effect and adaptive response ” (Victor et al. 2005, 371). Lonely people either die or move from community to institutional care or they overcome the bereavement process and adjust to new circumstances. (Tijhuis, De Jong-Gierveld, Feskens & Kromhout 1999, 494; Holmén & Furukawa 2002, 271; Victor et al. 2005, 371; Tilvis, Laitala, Routasalo & Pitkälä 2011.) Qualitative studies focus on elderly people’s perception of loneliness and their coping strategies. In Pettigrew and Roberts’ study (2008), loneliness was thought, by most of elderly Australians, to be a natural part of aging and older age as a result of decreased participation in social activities due to health problems, death of friends and busy life of their children. On the other hand, many of the participants felt that loneliness can be decreased by constructive free-time activities, like reading, gardening or taking part in voluntary work. (Pettigrew & Roberts 2008, 304-306.) Unlike in the Australian study, Hauge and Kirkevold (2009) explored elderly people’s understanding of loneliness more deeply. Their findings confirmed that loneliness is highly subjective. Differences of loneliness description were found between “not lonely” and “lonely” group, by lonely people giving more comprehensive description. What more, loneliness was seen negatively and was stigmatized. The group of “not lonely” reported loneliness to be one’s own fault connected to one’s personality and passive attitude to life. (Hauge & Kirkevold 2009.)

2.3 Loneliness and functional ability Biological theory of aging explains natural changes in body systems. Quality of life may be affected by decreased cardiac output and diminishing ability of heart to respond to stress, decreased lung capacity and decreased gas exchange. Loss of bone density and

11 muscle strength and size, and degeneration of joint cartilage can limit mobility. Therefore, reduced speed in nerve conduction affects response time, and reduced cerebral circulation affects balance. Decreased efficiency of sensory organs strongly impacts functional ability of elderly people. (Eliopoulos 2010, 49-61.) Referring to above mentioned, impaired vision and hearing as well as po...