Social and emotional loneliness among non-demented and demented elderly people

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Abstract

There is a lack of studies about loneliness and cognitive functioning among elderly people and, above all, among those with cognitive impairment. The aim of this study is to investigate loneliness, both social and emotional, in non-demented and demented elderly people. The study is based on 589 persons, who answered the question about social loneliness (often being lonely) in the Kungsholmen longitudinal project. All subjects were examined extensively to reach a diagnosis and to determine the dementia level. Data were collected through structured interviews on subjective social loneliness as well as emotional loneliness (feelings of loneliness, from often to never) and background variables (age, sex, housing and housing conditions). Non-demented elderly subjects reported themselves to be lonely significantly less often compared to demented subjects, but there were no differences in the emotional experience of loneliness. Social loneliness was more common in the different levels of dementia and increased with reduced cognitive functioning, while emotional loneliness decreased. Living together with someone and living in one's own apartment showed a positive influence on feelings of loneliness.

Introduction

Loneliness is a complex concept that has been studied both theoretically and clinically and that involves psychological as well as social aspects. Weiss (1973) and Perlman (1987), for example, found that childhood experiences could be crucial for the development of loneliness among elderly people. Townsend (1957) and Weiss, 1973, Weiss, 1982 made distinctions between the concepts social isolation and loneliness. Studies (Henderson et al., 1986, de Joung-Gierveld et al., 1987) have shown that people living alone often experienced more loneliness than those living together with a partner. They also found that living alone and experiencing loneliness do not necessarily mean the same thing. You can feel lonely in a crowd and you can be happy alone. Another study of people aged 90 years and over, reported that loneliness was evident among some elderly people, although many still were part of a close family network (Bury and Holme, 1990).

A review of the loneliness literature (Weiss, 1987) presented a number of sociological and psychological mini-theories as to why Weiss was interested in broader future definitions of loneliness. Weiss meant that experienced loneliness involves both emotional loneliness and social isolation. This supports the theory that experienced loneliness is an overall concept, including both emotional and social loneliness, objective as well as subjective. According to Mellor and Edelmann (1988) and Rokach (1989), emotional loneliness is a loss or absence of confiding in and imitating attachment to a special and beloved person, while feeling lonely probably is connected with something akin to separation, anxiety, restlessness and emptiness (Ainsworth, 1985).

Social loneliness corresponds more to the absence of a meaningful friendship. Creecy et al. (1985) and Larsson (1990) described socially lonely subjects with more experienced feelings of boredom and passivity. Most elderly people are not socially isolated and do not report feelings of loneliness (Holmén et al., 1992a). However, feelings of loneliness are generally more common among elderly people living alone (Samuelsson et al., 1998). On one hand it is well known that a person who is alone or who lives alone may either experience loneliness or not, on the other hand a person feeling lonely may be alone, live alone or with others. In fact, human consciousness and subjective experience may vary in many ways over time and between persons. A longitudinal study of elderly people in Sweden (67–80 years old) indicated a low frequency of loneliness and a fairly stable pattern during 13 years (Samuelsson et al., 1998). Also as to social changes, such as contacts, marital status and living conditions during this period, loneliness stability was shown. These results were also found in loneliness follow-up studies among elderly people (over 75 years old) after 21/22two and a half years (Holmén, 1994).

Results from a loneliness study of an elderly population (Holmén et al., 1992a) demonstrated that cognitively impaired subjects more often reported feelings of loneliness than elderly subjects without cognitive impairment. According to Barzargen and Barbre (1992), loneliness was a strong predictor of self-reported memory problems. Another study of subjective loneliness comparing elderly persons' experiences and relatives' appraisal of the situation, showed that the relatives tended to overestimate the elderly persons' loneliness, especially among those with cognitive difficulties (Holmén et al., 1992b). Elderly people with impaired cognition are a vulnerable group and in relation to subjects with intact cognition, they find it much more difficult to solve and cope with problems occurring in everyday life.

How valuable is a subjective study of loneliness related to dementia? How reliable are answers from demented subjects? From a humanistic caring perspective as to demented subjects, the question must be: ‘How sure can we be that demented subjects are not as likely as non-demented subjects to give adequate answers of their experience?’ We can never be sure and subjectively expressed answers can never be contradicted. Lipinska Terzis (1996) reports from a study with demented subjects that patients with Alzheimer's disease remembered more than believed when they received adequate dementia support. In a methodology of quality of life for older people and demented, Weeks (1994) found that some self-reports were not valid for patients with dementia because of their cognitive impairments. However, researchers also found several papers showing that patients with an early stage of dementia could provide some reliable self-reports.

Parse (1996) studied the meaning of quality of life for 25 persons with mild to moderate Alzheimer's disease. She used open-ended questions during a conversation. The results showed that the subjects described their quality of life with much detail and when they had difficulties in using the correct words in a sentence, they told their own stories (Parse, 1996). In agreement with Parse, this knowledge will provide a new understanding of human experiences and it adds substantial information to the literature on the care of demented persons. ‘Who can describe the quality of another person's life? Who?’ The answer is: ‘Only the person living the life’ (Parse, 1996, p. 132). This is true, even among those with cognitive impairment (Parse, 1996).

There is a lack of studies on loneliness and cognitive functioning among elderly people and, above all, among elderly people affected with dementia and with symptoms such as problems with thinking, learning and remembering. However, Noguchi et al. (1998) found a negative correlation between loneliness and dementia and suggested that loneliness might play a role in the development of dementia. Fratiglioni et al. (2000) also stressed that elderly people living alone with a poor social network indicated an increasing risk (60%) of becoming demented compared to elderly people with a good social network.

This study is part of a larger ongoing study on loneliness among elderly people (Holmén, 1994), trying to describe different aspects of loneliness. The first step was to study loneliness among elderly people (Holmén et al., 1992a), where social relationships, subjective health, cognition, age and sex were factors significant enough to explain loneliness. The second step was to study loneliness in relation to cognitive impairment in everyday life (Holmén et al., 1992b, Holmén et al., 1993, Holmén et al., 1994a, Holmén et al., 1994b), where experienced loneliness (often and sometimes) showed a negative influence on the variables, especially among cognitively impaired subjects. The third step concerned quality of life, in terms of the present state of mood and experienced loneliness in cognitively intact and impaired elderly persons (Holmén et al., 1999b). This study, the fourth step, focuses on designated non-demented and demented elderly persons' emotional and social loneliness. Findings from the studies bring further knowledge to take into consideration in the care of elderly people, especially of those who are affected with dementia.

It is difficult to validate data, but this study is an effort to describe in social and emotional loneliness terms, elderly persons' living situation related to age, gender, housing both in non-demented and demented subjects, according to the global Washington Clinical Dementia Rating scale (CDR) (Hughes et al., 1982). The purpose of the study was to investigate the existence of emotional and social loneliness in non-demented and demented elderly people.

Section snippets

Materials and methods

This study is part of the Kungsholmen project, ‘Ageing and Dementia’, a longitudinal population-based survey. The study design is described in Fratiglioni et al. (1992) and it involves elderly people, aged 75 and over, living within a limited area of the central city of Stockholm. Information on loneliness, health, living situation and social network was obtained from the subjects by means of a personal interview (structured questions) carried out by trained nurses. The nurses, physicians and

Social and emotional loneliness: background variables

As to social loneliness significant difference (P≤0.001) was found as to age (higher ages) between the variables ‘often lonely’ and ‘not often lonely’, while no significance occurred between the two variables as to emotional loneliness (Table 3).

Discussion

The two loneliness questions, ‘Do you often feel lonely?’ and ‘Do you experience loneliness?’ were presented in different parts of the questionnaire and related to the context of health and respectively social network. For example, sometimes the subjects answered ‘I often experience loneliness, but I do not feel lonely’. The answer reflects that emotional loneliness can be seen as an overall feeling, while loneliness sometimes can be seen as a part of it, but not necessarily. This is in

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