Loneliness The Elderly Family Health And Social Care Essay

The purposes of the study was to find out more about the reasons and possible implementations to loneliness in the elderly family caregiver,it was also intended to find out various supports for the elderly familycaregiver.The study was done as a result of the authors’ practical training encounters with the elderly living with their spouse and their loneliness as a reslut of the burden they encounter.

The research questions used for the study were: how the elderly family caregiver’s loneliness was linked to social isloation;what are causes of loneliness in the elderly family caregiver;what are the symptoms associated with loneliness;what are the effects of loneliness; Are there any supports for the elderly caregiver?.The theoretical frame used for the study was Nicholas R. Nicholson Jnr’s theory of social isolation. The study also noted the institutional care approach to the elderly caregiver compared to being at home.

The method used for the study was a qualitative research method.A systematic literature review was used to answer the research question through content analysis.

The result of the study findings were that loneliness in the elderly caregiver resulted from social isolation,disengagemnets from social funtions,bereavemnet,loss of social contacts,and loss of jobs.The most commonly used scale in measuring loneliness was the University of Calofornia Los Angeles(UCLA) loneliness scale,to identify the level of lonelinss of the elderly family caregiver.

The study then identified types of supports that could help the elderly caregiver in coping and managing loneliness to enhance the quality of life.

The author therefore recommends the continuation of the study to sensitize and educate the elderly caregiver with major interest in socialization.

Keywords:

Loneliness,depression,family,caregiver,Elderly

Number of pages:

62

Language:

English

Date of acceptance:

OPINNÄYTE

Arcada

Koulutusohjelma:

Human Ageing and Elderly Service

Tunnistenumero:

9411

Tekijä:

Nana Yaa Essandor

Työn nimi:

Iäkkäiden omaishoitajien kokema yksinäisyys

Työn ohjaaja (Arcada):

Jari Savolainen

Toimeksiantaja:

Tiivistelmä:

Tutkielman tarkoituksena oli selvittää iäkkäiden omaishoitajien yksinäisyyden syitä ja mahdollisia täytäntöönpanoja.Tarkoituksena oli myös keksiä heille erilaisia tuen muotoja.

Tutkielma valmistui kirjoittajan käytännön harjoitteluissa tapahtuneiden kohtaamisten perusteella. Kohdatut omaishoitajat asuivat puolisoidensa kanssa ja he kokivat yksinäisyyttä taakkansa vuoksi.

Tutkimuksessa käytettiin seuraavia tutkimuskysymyksiä: kuinka iäkkään omaishoitajan yksinäisyys oli sidoksissa sosiaaliseen eristäytyneisyyteen; mitkä olivat syinä omaishoitajan kokemaan yksinäisyyteen; millaisia oireita yksinäisyyteen liitettiin; millaisia seurauksia yksinäisyydellä oli; oliko iäkkäille omaishoitajille olemassa tukea?

Tutkimuksessa käytettiin teoreettisena viitekehyksenä Nicholas R. Nicholson nuoremman tutkimusta sosiaalisen eristäytymisen teoriasta. Teoriassa huomioitiin myös laitoshoidollinen lähestymistapa verrattuna kotona pysymiseen.

Tutkimuksessa käytetty metodi oli luonteeltaan kvalitatiivinen. Systemaattista kirjallisuuskatsausta käytettiin tutkimuskysymyksiin vastattaessa sisällön analyysin avulla.

Tutkimustuloksena nähtiin omaishoitajien yksinäisyyden syiden johtuvan sosiaalisesta eristäytymisestä, sosiaalisista tapahtumista vetäytymisestä, surusta, sosiaalisten kontaktien puutteesta ja työpaikan menetyksestä.

Yleisimmin käytetty asteikko yksinäisyyden mittaamisessa oli Kalifornian yliopiston (UCLA) yksinäisyysasteikko, jonka avulla yksinäisyyden asteita omaishoitajien keskuudessa voitiin identifioida.

Sen jälkeen tutkimuksessa identifioitiin erilaisia tuen muotoja, jotka voisivat auttaa omaishoitajia selviytymään ja käsittelemään yksinäisyyttä, jotta heidän elämänlaatunsa paranisi.

Kirjoittaja suosittelee tutkimuksen jatkamista, jotta iäkkäät omaishoitajat tiedostaisivat ja oppisivat asioita paremmin pääpainon ollessa sosialisoinnissa.

Avainsanat:

yksinäisyys, depressio, perhe, omaishoitaja, vanhukset

Sivumäärä:

62

Kieli:

Englanti

Hyväksymispäivämäärä:

TABLE OF CONTENTS

Figures

Tables

FOREWORD

I will want to first of all thank the Almighty God for bringing me this far, this is a dream come true.

My sincere thanks to my dedicated supervisor Jari Savolainen, for your support guidance and encouragement that has led me to finish this project, I am very grateful.

I want to thank all HAGEL 07 teachers who helped me to be who I am today, uttermost thanks to Solveig Sundell and Åsa Rosengren.

My appreciation to all my family and friends who have contributed in diverse ways to help me accomplish this task for my future, may God bless you so much, my dear Flora Agalga now the victory is ours, I am grateful for your friendship and love.

I will want to say thank you to all my classmates of HAGEL 07 who contributed to my studies especially Roland Ngang and Yirgalem, and also my work colleague Maija Aapakari for helping me with the translation, I am grateful.

Again I will want to dedicate this work to my two lovely boys Nester and Daniel, I love you so much and will continue to go the extra mile to support you so you can even go higher than what I have and will achieve. To my dear one Nana Yaw Essien, I say a big thank you for your consistent encouragements for me to finish my course, I know you almost thought it was going to be impossible but today it is a reality and I know you are proud of it.

Lastly I will want to say I have fought the good fight and My God has rewarded me, though it has tarried it has come to pass, to him be all glory and honour.

Introduction

There are so many ways of a person feeling accepted or rejected, but feeling lonely can be described as the most unfortunate thing, it is an awful experience when a person feels left alone in life, that is when bad actions and ideas come to mind. In that situation, there is no one to confide in or talk to for example. For this reason, the author having been on three practical training working with elderly people chose to research more about loneliness and how best the elderly will be confident and feel belonged in the late cycle of their lives. It was the authors’ priority and concern to study further about the topic since the author was of the opinion that “feeling belonged grants the elderly person/people peace and comfortability.

Loneliness researches tend to identify individual factors on either personality or absence of social contacts, Jylha & Jokela, (1990).Meanwhile loneliness is said to also be an individual’s relationship to society. It is also identified that differences in cultures and the manner of various peoples’ social relations results in a cross-cultural dimensions of the way people are able to cope with loneliness, Rokach and Brock (1997).

Since loneliness is pervasive and debilitating, it is of both theoretical and clinical necessity to identify the way different people cope with loneliness and how their coping skills are affected by the culture of a person, as coping with the stressful situations by individual and social resources Folkman & Moskowitz (2000).

Weil (1997), states that people are highly social, communal animals and are supposed to live in families, tribes and communities and once those connections do not exist, the human being suffers.

Previous studies on loneliness show it is a universal phenomenon that identifies it with mental health and wellbing.Cohen & Syme (1985); Ganster & Victor, (1988), Landis & Umberson, (1988).

Loneliness has many adverse effects on the human being and mind has been therefore linked to depression, anxiety and interpersonal hostility which can lead to bad health. Nursing Research (1999).

It has also been identified that, psychological variables which includes loneliness is associated with changes in the immune functioning and may thus weaken a person’s capacity to fight disease, journal of psychosocial oncology (1992).

Definitions of key words used for the study

Keywords are the words that were relevant and helped the author to focus on the selected topic study.

Loneliness

This term is described as the system of emotional and social isolation; loneliness could also be explained as a natural response of an individual’s response to certain situations and not as a form of weakness. Emotional and social isolation are two distinct forms of loneliness which can be listed as well as feeling of emptiness, anxiety, and restlessness Psycinfo Database Record (c) (2012).

Again according to Psycinfo Database Record (2012) APA, Real loneliness one of the least satisfactorily conceptualized psychological phenomena, plays an essential role in the genesis of mental disorder.

Nonconstructive loneliness has much in common with such states as panic and anxiety.

Descriptions of loneliness by poets, patients, and philosophers are reported and discussed. Different types of enforced and experimental isolation, physical loneliness, and the problems of psychotherapy with the lonely are considered.

Depression

Depression is generally a common type of psychiatric disorder in children, adolescents, adults, and the elderly. Depressed people have various bad feelings such as; sadness, loneliness, irritability, worthlessness, hopelessness, agitation, and guilt that may be accompanied by an array of physical symptoms, Psychoinfo Data Base record (2012).

It is difficult to identify people with depression in a primary care because of lack of time but other depression screening measures helps to diagnose the disorder.

According to Am Fam Physician (2002), depression is the second most common chronic disorder seen by primary care physicians. On the average, 12 percent of patients seen in primary care settings have major depression. The degrees of suffering and disability associated with depression are comparable to those in most chronic medical conditions.

A study found out that lonely people showed more depressive symptoms such as wanting to isolate themselves from group or social gatherings. Again, people who are lonely and depressed tend to experience less togetherness in various social interactions.

Research has also found out that depression and loneliness cannot be interchanged since they always prolong each other’s disorder, since both work on an individual at a time, and may not be interchanged. Depression is often described as the emotional expression of the ego-helplessness to live up to certain strong aspirations. PsycInfo database (2012).

Caregiver

A person rendering services or assisting a person in a particular disability or giving support is basically termed a caregiver. Caregivers normally experience burden or stress related issues because of the process in giving care to the patient or person in question.

In another study, a caregiver refers to someone who provides unpaid support to a family member, partner. This could be because the person is ill, frail, disabled or has mental disability or substance misuse problems. GSA, (1991) (Gerontological Society of America).

In various examinations about this, studies that evaluated burden of care for a mentally ill relative using measurement instruments with established validity and reliability.

Mean age of respondents (69% female) of the studies reviewed was 52 years. Some review identifies aspects of caregiving as most burdensome to caregivers, and also seeks to describe the nature of the relationships between sociodemographic, illness-related, caregiver stress-related, and psychological resources variables and different dimensions of caregiver burden, it also identifies mixed findings that are theoretically relevant to caregiver burden.

In reading about a caregiver and the challenges associated with it, research findings in light of the methodological issues and research designs characterizing various literatures, briefly summarizes the effects of burden on the caregiver’s life. PsycINFO Database Record (2012).

Although it is assumed that the occurrence of depression in patients correlates strongly with the caregiver burden linked with depression, the vulnerability of caregivers to depression is linked to their own age, gender, physical ability, personality, and available social supports, JAMA (2002).

Elderly

In many researches and studies, “elderly” has been defined as a chronological age of 65 years old or older, while those from 65 through 74 years old are referred to as “early elderly” and those over 75 years old as “late elderly.”

However, the evidence on which this definition is based is unknown. Researchers have tried to review the definition of elderly by analyzing data collected from long-term longitudinal epidemiological studies, and clinical and pathological studies that have been accumulated at the Tokyo Metropolitan Geriatric Hospital and the Tokyo Metropolitan Institute of Gerontology.GGI, (2006).

In practice, most studies 13 out of 19, set the definition of elderly patients at 60 years. Median age of patients varies from 64 to 69 years from one study to another, which suggests, that, with regard to age, most studies are comparable, even if the definition of elderly people varies from 55 to 65 years, The Hematology Journal (2002).

Family

According to Alberto Alesina & Paola Giuliano (2007), family is an important socio-economic institution in every society. The nature of the links between family members varies across the globe. Depending on the environment, certain aspects must be taken into consideration in order to identify someone as a family relative. In this study, family is considered to comprise of husband, wife and children.

Motivation of Study

The research topic came into existence during the author’s practical training in a nursing home. In the course of the training, the author noticed most of the elderly patients were lonely and needed attention. One of the patient even made a comment “I wish my husband is here with me” in Finnish language. This drew attention and generated a scene of conversation between the patient and the author. The conversation yielded fruitful results and filled the author with a need to research on how it feels for elderly caregiver to care for their partners.

Previous Research

The author with the interest of the topic now tried to find previous information and articles about the subject, which different authors have discussed.

In one development, it was identified that by the year 2050,family members will be providing most of the homecare needed by the 11-16 million people in the United States proposed to have dementia, Alzheimer’s Association(2009);Herbert, Scherr, Bienias, Bennett & Evans(2003).

The author again identified that the burden of providing care at home for an elderly person with dementia gradually increases the risk for depreciating health effects for the person providing that care, Pinquart & Sorensen, (2003); Vitaliano et al, (2005).Schulz and Beach(1999) also reported that caregivers stress experiences was a high increasing risk of 63% mortality rate compared to noncaregivers.Again, it was reported that caregivers for spouses with dementia had developed high levels of emotional stress,depression,loneliness and other health related problems, Adams,(2008);Mills et al,(2009).

The caregiving process has generally been identified that spouse caregivers are at greater risk of stress related mental and physical problems than the adult children caregivers for the elderly, Pinquart & Sorensen (2003); Vitaliano et al (2005) specifically because the spouses are older and have more chronic conditions which needs assistance to their own health conditions, Kolanowski, Fick, Waller & Shea, (2004); Schubert, (2008).

The depreciating health of the caregiver has been attributed to living with the elderly burden of constant caregiving, Schulz & Martire (1999) and not having the usual life for healthy living, for example caregivers have reported less participation in healthy behaviours, disabling physical conditions and poor attention to personal health, Bruce (2005); Pinquart & Sorensen (2003); Schubert, (2008).

It was thereby recognized that caregiver burden or difficulties attributed to the greater incidence of caregiver psychological effects, primary anxiety and depression as a result of loneliness, Cooper, (2008); Pinquart& Sorensen, (2003).

The diagram below shows the relationship of the factors affecting the caregiver.

BACKGROUND AND CONTEXUAL FACTORS

CAREGIVER BURDEN

(PREDICTOR)

FINDING MEANING THROUGH CAREGIVING

(MEDIATOR)

CAREGIVER PHYSICAL HEALTH

CAREGIVER MENTAL HEALTH

(OUTCOMES)

Research design by, (Farran, Miller, Kaufman&Davis, 1997; Hilgeman, Allen, DeCoster, &Burgio, 2007).

Figure .The caregiver burden

Once again, the author identified that since the population in Finland and everywhere else in the world continues to age and growing effort to develop better outpatient services for the elderly people was a necessity, the idea was to help support the elderly people to cope and live independently in the community as long as possible to promote wellbeing, Krach, (1996) and also less expensive option compared to the institutional care, Chiu, (2000).

The policy in Finland is therefore to facilitate family care for elderly people at home and support family caregivers in their demanding jobs, Ministry of social affairs and Health, (1999).

It was then realized that coping demands aroused from distress, which was a s a result of stimulus that is perceived as a threat, harm or challenge that exceeds the individual (caregiver) ability to cope, Nolan & Lundh (1999).

The coping demands are always great when the caregivers only get limited support or no support at all from the immediate government,environment,family and friends, Robinson & Steele,(1995);Coen (2002);Rawlings and Spenser (2002) and again if the interaction and encouragement for the elderly person does not work, Pyykko (2001).

Former researchers also found out that family caregivers have less interaction with other people due to the evolvement of their life’s around the home and coping with their caring responsibilities, Jykyla & AStedt-Kurki, (1998); Pyykko et al (2001).It was with that reason that the elderly family caregivers often have negative experiences such as loneliness, isolation, boredom and frustration, Chambers (2001); Samuelsson (2001); Rawlings& Spenser (2002).

According to Wright (1999);Chambers et al (2001);Pyykko et al (2001);Samuelsson et al (2001),various emotional reactions exhibited by family caregivers includes feelings of guilt, anger, anxiety and depression which are difficult to cope with except by getting professional assistance.

Finally, in another research about the subject, the author came across studies which showed that emotional and physical strains were so much imposed on family caregivers in connection with the responsibility of caring for the elderly with mental illness,Hoenig & Hamilton (1966); Martyns-Yellowe (1992).

In a survey of five European family associations about psychiatric services, the respondents stressed on the need for interventions at creating stability and social functioning,Haan et al (2002).

The research done by the author on the articles above therefore authenticate the many challenges experienced by the elderly family caregiver which loneliness is a part of.

AIM OF STUDY AND RESEARCH QUESTIONS

The author realized during her practical training in the various home care centers, how the older people experience rejection and left alone to face their last life’s by themselves, and the situation was even sad with the one’s living with their spouses(husband or wife),they rather felt lonely at most times because although they are also going through the stages of their lives and suffering various sicknesses and diseases, they will always have to abandon themselves and take care of the other spouse because the situation might be worse than his/hers, therefore making them have too much stress and pain. In such an instance, it is then possible that the other spouse taking care of the one supposed to be worse rather experiences various forms of neglect and even lead to psychological malfunction, then instead of being together, they are rather split apart from each other so that each one can take care of him/herself and not harm or maltreat the other.

This study was to find out more about reasons and possible implementations and guidelines which might support the elderly person’s caregiver.

The author of this study used content analysis and literature review, to ascertain the ongoing facts and findings further about the topic, since we all get or are lonely at some point in our lives, it must not dominate the human nature to bring up difficulties in coping especially in the last days of the human cycle (life).

Furthermore, the study aimed at getting inventions and interventions’ about this concept of loneliness and depression. Within the context of the study, two research questions were derived as seen below;

1. How is loneliness in the elderly family caregiver, linked to social isolation?

1. A. What is/are the causes of loneliness in the elderly family caregiver?

1. b. What are the symptoms associated with loneliness?

1. c. What are the effects of loneliness?

2. Is there any form of support for the elderly care giver?

A. What are the supports for the family caregiver?

BACKGROUND STUDY

Loneliness is defined as the time of feeling neglected and left alone, it is a condition of being lonely; solitude. Loneliness is also described as a personal feeling of depression resulting from being alone. Hsu, Hailey, Range (2001)

Basically, every person experiences loneliness from time to time, for example on valentines’ day when everyone has a dear one around and during some cases or encountering some stress, that is the time a person feels very lonely when there’s no one around.

There are a quite number of people who experience loneliness more, it is because people do not talk about their feelings of being lonely, and even if they do feel lonely, they don’t know what to do or how to react at these times of experiencing such feeling of loneliness. There are so many ways that loneliness may or can affect a person’s life such as emotional, physical pain and depression.

Physical Pain

Research has identified the area of the brain that deals with social exclusion as the same that processes physical pain, thus a scientific explanation to the often romanticized experience of a “broken heart”

Physical Health

In reading about physical health it was realized that studies have been linked to emotional stress and depression. Other researches link loneliness and depression with poor health and wellbeing. This means that people who are experiencing loneliness are susceptible to a variety of health issues and problems.

Loneliness in later life remains a serious problem despite extensive research across life span. Studies of loneliness includes elderly people who are lonely, other studies recommend interventions depending on the external factors such as socialization and functional activities.

Some interventions are not always suitable for elderly people who might have experienced social and functional losses. Nurses and healthcare professionals must therefore adopt a new way of examining loneliness in later life. This new perspective must include a better positive approach that focuses on elderly people who are not lonely eventhough they may have experienced decreased socialization or physical function. Identifying some of those strategies by the elderly people in question can be used to help other elderly people avoid loneliness and help others to cope with the related losses.

The findings from biological psychiatry cannot be ignored somehow because the empirical evidence is mounting that many elderly people are biologically vulnerable to the onset of depression, Alexopoulos (2000); Krishnan, (2002).Epidemiological studies document that depression is less frequent among the elderly until they reach the oldest old, Blazer, (2002).

When the issue is analyzed, it would mean that elderly people are biologically vulnerable to depression, meanwhile, psychological and social factors are more protective in late life compared to mid-life when cognitive dysfunction and physical illness are held constant, Blazer,(2002).

UCLA Loneliness Scale

The UCLA loneliness scale is a method that was devised to assess the subjective feelings of loneliness or social isolation.

The original version was based on statements used by lonely individuals to describe how they feel, Russell, Peplau, & Refuson, (1978).

Questions were all worded in a negative or “lonely” direction, with the various individuals indicating how often they felt, this was therefore described on a four point scale which ranged from “never” to “often”.

This scale is represented below as follows;

Table 1.A loneliness scale

O

“I often feel this way”

S

“I sometimes feel this way”

R

“I rarely feel this way” and the last letter

N

“I never feel this way”.

How often do you feel unhappy doing so many things alone? OSRN

How often do you feel you have nobody to talk to? OSRN

How often do you feel you cannot tolerate being so alone? OSRN

How often do you feel as if nobody really understands you? OSRN

How often do you find yourself waiting for people to call or write? OSRN

How often do you feel complete alone? OSRN

How often do you feel you are unable to walk out and communicate with those around you? OSRN

How often do you feel starved for company? OSRN

How often do you feel shut out and excluded by others? OSRN

After these questions were asked, then a score was added up ranging between 1 and 4, 4 for each O, 3 for each S, 2 for each R and 1 for N.

Scores between 15 and 20 were considered a normal experience of loneliness, and scores that were above 30 identified a person was experiencing severe loneliness.

This scale has therefore become the most widely measure of loneliness. Scores of this loneliness scale has predicted a wide variety of mental (for example depression) and physical (nursing home admission, mortality), Russell, (1996).

THEORETICAL FRAME AND PHENOMENA OF LONELINESS

Feeling lonely is something common and is a universal experience that is significant to health and quality of life. However, loneliness was described earlier on in fictional works, poetry and painting, Munch; Hertervig (1998).

In the Nordic countries and the USA, research groups and individual researchers emerged in the late 1970s and studied loneliness first as subthemes and subsequently as the subject for independent studies.

It appears that the influence of modern research had asserted itself. In a contextual perspective, western industrialized society is termed a ‘Narcissistic Age’, but it is also referred to as ‘The Age of Loneliness’, in which the phenomenon of loneliness, regardless of victims’ age, has become almost epidemic. Loneliness as a dysfunction in modern times is revealed partially in surveys concerning society’s technological advancement in the use of internet and its relation to loneliness. Cultural background also plays a significant role in studies of loneliness.

Loneliness is further regarded as an important factor in the development of medical dysfunctions, such as psychosomatic disorders, breast cancer, and cardiovascular dysfunctions among others.

However, the author decided to use Nicholas R. Nicholson Jr (2008) theory of social isolation as the main theoretical frame of the study. The essence of this theory is to highlight to the reader the possible impact/s that may evolve as a result of isolation most especially with elderly caregiver.

Theory of Social Isolation

Following the work of the aforementioned writer, it exhibits that one of the cause of loneliness among elderly people is due to social isolation. It has long run adverse health consequences which if not well taken care of might affect a great number of elderly people in the future. The United States census Bureau (2004) predicted that the situation might double by 2025. Another recent US census bureau report that older adults (65 years and over) represent 12% of the total US population, Gist & Hetzel (2004). With the continual aging of America, it is expected that the older adult population will double within 25 years, Fowles & Greenberg (2003).

Similarly, in Europe, a fifth to a quarter of the population in many countries will consist of older adults over the next two decades, Grundy et al. (2006). Grundy et al. (2006) note that there are changing family and household patterns in Europe, which may weaken family bonds and have a negative impact on social aspects of older adults health, particularly support.

Elderly people are more concerned with social isolation because of their diminished vitality and health, Bondevik & Skogstad (1998). Some researchers report rates of social isolation as high as 35% in this population, Tremethick (2001). Elderly people who live alone or have difficulty leaving home are at increased risk of being socially isolated, Lien-Gieschen (1993).

The importance of social isolation is emphasized in many research publications internationally. Another Australian-based research group found that “social isolation is a significant factor affecting the health status of the ageing Australian population” Howat, (2004). International interest in this topic extends well beyond Australia and the US. For example, researchers in Spain, Zunzunegui, (2003), Sweden, Fratiglioni, (2000) and England, Cattan, (2005) have all examined social isolation.

It was then identified that elderly people with lesser social interactions and associations with people had increased risk for mortality, Berkman (1995) compared to the elderly people with consistent and social interactions with families, friends and the society as a whole.

On another account it was realized that elderly people with suffering from social isolation suffered from various negative health consequences, such as poor nutrition, Locher, (2005), rehospitalization,Mistry, (2001), cognitive decline,Bassuk, (1999) and heavy alcohol consumption, Hanson (1994).

Is Loneliness a Meaningful Dimension in the Existence?

Through this study, the author gradually realized the positive dime