VINOS TINTOS
D. O.C. CÔTES DE PROVENCE (FRANCIA)
The quantitative data analysis identified 68.8% of the study sample to perceive themselves as sometimes lonely, while 12.5% reported severe levels of loneliness. In line with previous empirical evidence, this study reveals that loneliness is key issue among this population. Yet the small sample size of this study does not allow claims for findings generalisation. Drageset
et al., (2011) examined levels of loneliness and social support among 227 long-term nursing
home residents, in Norway. The findings revealed that 56% of the participants experience loneliness. A study by van Beljouw et al., (2014), in a sample of 249 older adults with mental health problems also found that prevalence of loneliness was high among them (87.8%). In addition, a UK-based study by WRVS (2012) which examined levels of loneliness amongst 500 older adults (≥75 years old), also identified prevalent loneliness (75%). Research by
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Victor and Bowling (2012) longitudinally examined levels of loneliness among British older adults (+65) over a 10-year period time. The findings revealed that 10% of them endure severe feelings of loneliness. The findings of this study report similar results in relation to severe levels of loneliness (12.5%). However Victor and Bowling’s study examined levels of loneliness among community-based older adults.
Loneliness is a common issue among UK-based older adults in nursing homes. This has also been highlighted by recent UK strategies. For example, the White Paper ‘Caring for our
future: reforming care and support’ (Department of Health, 2012a) acknowledges the need
for long-term care residents’ social integration, and launches a number of strategies to improve residents’ connection with community members. However the White Paper seems to disregard the multi-dimensional nature of loneliness, while seems to misinterpret loneliness with social isolation. These are two different concepts that should not be used interchangeably (see section 3.2.2). This is quite problematic given the findings of this study that identify loneliness as a real problem among this population, while the qualitative findings stress that both emotional and social loneliness (see section 10.6.1) are key issues among this age group. That is, both the quality and quantity of relationships matter. Therefore policies and strategies should aim to tackle loneliness, rather than aiming to exclusively reduce social isolation among this population.
Loneliness is a real problem and key issue among this population, and although we should view this study’s findings with caution, they still provide preliminary empirical findings on the topic (given the limited knowledge on levels of loneliness among UK-based long-term care residents), set the platform for future research, and reveal a key issue among this population. This is highly important given recent findings that showed that loneliness significantly correlates with increase mortality rates among nursing home residents (Drageset
et al., 2013).
8.7.2.1 Loneliness and socio-demographic factors
The quantitative findings revealed a positive correlation between age and levels of loneliness However, there is an inconsistency in the loneliness literature on whether and how age correlates with loneliness. There is a body of literature that suggests no age differences on levels of loneliness (e.g. Tesch-Römer et al., 2013; Nicolaisen & Thorsen 2014), while there
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are studies that reveal strong correlations between loneliness and age. Such an example is Dahlberg et al’s (2015) study. The authors using a national longitudinal study (n=587) examined predictors and changes in loneliness among Swedish older adults (70+). The findings show that there are differences in levels of loneliness among older adults, with the prevalence of loneliness to increase with age. In the same line the ONS (2013) in a UK- national study measuring older adults’ well being reveals that loneliness is more prevalent among the oldest age group. Specifically, almost 46% of participants aged 80 and over reported being often or sometimes lonely in comparison to almost 34% of all aged 52 years old and above. One possible explanation is the constant life changes that older adults endure and cope with. Losses, limited social interactions and inadequate social lives may negatively influence their feelings of loneliness. This is important and links with the theoretical implications discussed earlier in relation to the relationships between loneliness and self- stigma (see section 8.7.1). Poor mental and physical health could also explain increase levels of loneliness with age. With increasing age, poor health is also more prevalent. Frail older adults may become isolated due to their inability to interact with others because they are physically unable to do so. This may trigger feelings of loneliness to increase. The care-home context may also exacerbate feelings of loneliness among this population since older adults may feel they are far away, both physically and emotionally, from their previous environments. Finally, care homes’ structure may cause loneliness to worsen. Older adults follow a very specific schedule in the nursing home, and have a specific daily routine. This may influence their emotional stability by increasing feelings of hopelessness, may decrease likeliness for continuous social interaction with other residents, and may negatively impact to the development and maintenance of close relationships.
Religiousness was found to correlate with levels of loneliness. The quantitative findings indicate that older adults who are quite/extremely religiousness are less likely to endure feelings of loneliness compare to their atheist/not very religiousness counterparts. The current findings therefore support earlier claims, that is, that religiosity can ‘protect’ from and buffer feelings of loneliness (Williams et al., 1991), and give weight to previous empirical findings. For example Lauder et al., 2006 in a sample of 1289 survey participants (18+) found that people without strong religious beliefs are more likely to feel lonely. It seems therefore that religiousness is a key coping mechanism towards experiences of loneliness among older adults in nursing homes. Harrison et al’s (2001) systematic review on religious coping across various groups revealed that 30% to almost 80% of them utilise religion as a coping
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mechanism. One possible explanation is that older adults in nursing homes wish and desire to maintain close relationships and interaction with others. Religiosity therefore may satisfy their yearn for closeness and connectedness through their close relationship with God.
Relationships between loneliness and other socio-demographic variables (sex, educational level, marital status) were not found to be statistically significant. This seems to oppose findings from previous studies that revealed significant relationships between loneliness and socio-demographic variables such as gender (Nicolaisen & Thorsen 2014), ethnicity (Victor
et al., 2002), and marital status (Dahlberg et al., 2015). One explanation for the non-
significant relationships between the former variables and loneliness might be the small sample of this study. The non-identification of significant relationships between socio- demographic variables and loneliness among this population does not necessarily mean the absence of a relationship. After all, as this study’s findings have indicated, loneliness correlates with age and religiosity.
The findings are important because they provide grounds for further research on the topic, and pathways for re-thinking and potentially re-forming the theoretical conceptualisation of loneliness. Specifically, in relation to loneliness and age since the majority of older adults in nursing homes tend to be older, and have more complex healthcare needs (British Geriatric Society, 2011). In addition, the findings highlight the important role of age, and religiosity when developing policies and strategies for this population. However, the findings of this study should be viewed with caution because of lack of external validity, which is one of the key limitations of this study. In addition, the study sampled older adults who only speak and understand the English language. Therefore our knowledge about levels of loneliness and self-stigma among non-English older adults remains limited.
8.7.3 Cultural orientations and their inter-relationships with self-stigma
and loneliness
The quantitative results indicate that collectivism was prevalent among this population (50.3%). The findings seem both to oppose theoretical suggestions (Triandis 2001) and empirical findings (Paxman, 1999; Sun, 2004; Hofstede, 2008; Willis 2012; Papadopoulos et
al., 2013). For example, Willis et al., (2012) in a qualitative study explored cultural
differentiations in care giving behaviour among five different cultural groups (White British, White Irish, South Asia). The findings revealed that White British participants were more
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individually oriented, while they adopted an individualistic type of formal support behaviour. It is worth mentioning however that the majority of the studies do not distinguish their findings based on the individualism-collectivism model, while others do not adapt cultural assessment tools that directly measure individualism and collectivism cultural subscriptions. In addition, the majority of the studies examine cultural subscriptions at the cultural and not the individual level. The latter aspects make inferences problematic, while highlight the need for further investigation on the topic. It is worth mentioning, however, that this study suffers from low sample size, which make inferences problematic.
As stated earlier half of the study’s participants were found to subscribe to collectivistic cultural orientations. One possible explanation lies in the older age of the participants who are possibly in a stage in their lives that prioritise and yearn for closeness and tight relationships with their family members. In addition the life changes they face (e.g. death, physical inabilities) may exacerbate their need for close family communication and interaction. Therefore, older adults may become vulnerable and thus more dependent (both physically and emotionally) in their families and in-groups. This suggests that the older people get the more family oriented they might become. That is the individually-oriented cultural self gives room to collectivistic-oriented cultural self (as people are getting older).
On the other hand, the care home setting itself could explain why older adults tend to be more collectivistic oriented. Being far away from previous environment, family members, and in groups may influence, and potentially exacerbates, notions of closeness and connectedness. Therefore older adults who are unable to fulfil these needs, because of the nursing home setting, become collectivistic-oriented. Also the care setting may influence perceptions about what is important to life. When older adults relocate to their new environment, that is nursing home, they may start appreciating aspects of life that until then were taken for granted, that is, family closeness, and in-groups connectedness. Therefore, the nursing home setting may influence collectivism to arise because of the changes that marks in older adults lives. Finally older adults may become collectivists simply because they reside in a nursing home. They are being together with peers suffering from similar physical and health problems, and probably start feeling close to others, and thus inter-connected to each other. The literature review of this study reveals cultural variations of loneliness and self-stigma prevalence (see chapter 5, section 5.2.3). The literature through empirical evidence therefore suggests that there is an inter-relationship between cultural orientations, loneliness, and self-stigma. The small sample of this study did not allow any inferential analysis to be performed in examining these inter-
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relationships. Yet it is important to highlight that cultural differentiations on levels of self- stigma and loneliness are possible among this population.
8.8 Summary
The study lacks external validity because of its small sample size, which make inferences and generalisations to the target population problematic. However, the findings reveal that elf- stigma exists among the sampled population, and although its overall levels were reported as low, a substantial number of older adults scored moderate/high on the self-stigma scale. The findings of this study align with the self-stigma literature. Self-stigma is a real problem among this population. However, the limited number of studies makes inferences problematic. Marital status correlates with levels of self-stigma, however no significant correlations were found between self-stigma and several socio-demographic factors (sex, age, educational level, religiousness). The findings also reported no significant relationship between self-stigma and insight into illness; a well-established factor within the self-stigma literature. The findings are important because they provide empirical and theoretical developments on the topic, highlight the need for more investigation, and emphasise the need to re-form, and potentially develop, national mental health policies and strategies that specifically target the mental health needs of this population.
The quantitative results reveal that loneliness is a common issue among this population. This comes in line with the loneliness literature that reports similar findings. Age and religiousness correlate with feelings of loneliness, although no significant relationships were reported between loneliness and sex, educational level, and marital status. The findings are important because they provide preliminary empirical evidence on levels of loneliness, while advance our understanding of loneliness among this population. Also they highlight the need to re- form social care policies since they fail to address loneliness among this ageing group. This is very concerning given the findings of this study that report loneliness as a common issue, and a daily reality, for this population.
The majority of the participants were found to subscribe to collectivistic cultural orientations. This oppose to previous findings that reported England as an individualistic country. The low sample size of this study did not allow examining cultural variations on self-stigma and loneliness among this population. However, the strong indications in the literature about their inter-relationships highlight the need for more research on the topic. Finally the findings of this study should be viewed with caution because of the small sample size of this study.
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