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Mental health and loneliness in old age

Researcher Vasiliki Tzouvara will be presenting the results of her study into loneliness among nursing home residents at the RCN international nursing research conference in Edinburgh. She believes more initiatives should be targeted at this population.

Loneliness is an increasing problem as we grow older – and as the number of older people in the UK rises, it’s likely to get worse. Mental health problems such as depression are also growing in this age group and can heighten people’s sense of loneliness. So how do these two trends relate?

This is the issue that King’s College London nursing department research associate Vasiliki Tzouvara set out to investigate. Over the course of three years she examined how residents in nursing homes experienced loneliness and how this experience in turn related to their ‘self-stigma’ – that is, the negative way they may think about their own mental health problems.

Dr Tzouvara has been interested in old age and mental health issues for a long time after being partly brought up by her grandparents in Greece. She moved to the UK in 2011 to do a masters degree in public health – which in turn led to the PhD that resulted in this study.

Lack of social contact is a problem. Two thirds of nursing home residents said they felt lonely

Picture credit: Alamy

She approached 34 nursing homes in Bedfordshire to ask if they would be prepared to participate in the study. Only six agreed to open their doors and even arranging that took much longer than expected.

One of the main reasons for the rejections was the homes’ workload, says Dr Tzouvara. ‘They probably couldn’t see the long-term benefits of being involved in a research project and that’s understandable given all their other demands.’

As a result the preparatory work of agreeing the settings and recruiting interviewees took a year and a half and also necessitated a redesign of the original proposal and Dr Tzouvara wasn’t sure she would have enough time to complete everything in the timescale.

She chose a mixed methods approach to the study involving a quantitative face-to-face questionnaire survey answered by 16 residents, followed by in-depth interviews with ten of the 16.

The quantitative survey indicated that over two thirds (68.8%) experienced loneliness while a large minority (43.8%) scored highly on the self-stigma scale. It also appeared that loneliness was likely to increase with age while those who were quite or extremely religious were less likely to have feelings of loneliness. In addition those who were single, separated or widowed had more negative views about mental illness (and a higher level of self-stigma) compared to those who were married.

However, the small sample means these findings do not have external validity and are not generalisable to the wider target population.

The aim of the interviews with residents was to see how people with existing mental health issues experienced loneliness and self- stigma. The criteria for inclusion were that they were aged 60 or over, were living in a Bedfordshire nursing home and had participated in the initial survey, were able to provide consent, spoke or understood English and had a history of mental health problems or current fears about their psychological wellbeing.

What came through in the interviews, says Dr Tzouvara, is that all experienced social and emotional loneliness. ‘Social loneliness resulted from a lack of engagement with others and was linked to the fact that living in the home wasn’t what they’d wanted.’

Emotional loneliness was the result of having lost loved ones and having few if any close contacts with relatives. They also had an emotional reaction to their physical environment – ‘They felt sad they had to be moved to an environment they were not familiar with.’

She also found it striking that when interviewees talked about home they always meant their previous place of residence – even if, as was the case with one individual, they had not lived there for more than a decade.

In-depth interviews found that all yearned for more social contact

It was also clear that many experienced self-stigma, which was apparent in some cases in a reluctance to form new relationships. It was noticeable, says Dr Tzouvara, that they were wary of other older adults in the home with mental health problems – even though this might have been something they had in common.

Her study concludes that this group of residents experienced both emotional and social loneliness as well as high levels of self-stigma. ‘I believe there is a link between loneliness and self-stigma but I can’t say I found a clear relationship between the two,’ she says. For that reason she recommends that more research be carried out.

She believes the results of her study should prompt nursing homes to consider new techniques to boost relationships such as buddy groups, allowing residents to feel they have someone they can talk to when the need arises.

She also feels the study has policy implications. She notes, for example, that the government has devoted resources to tackling specific mental health problems such as dementia – but there is a limited focus on other types of mental health problems among older adults in nursing homes. ‘My study highlights the need for more policies and strategies aimed at this specific population.’

Dr Tzouvara says all the residents she interviewed were only too happy to meet and talk about their lives. ‘We discussed things outside my agenda and I learned a lot of personal things. Some wanted to show me their room and I feel lucky to have been involved like this.’

The interviews were one of the best parts of the whole study, she says. ‘The project was very intense and I couldn’t have done it if I didn’t feel that I was getting something out of it.’ The relationships Dr Tzouvara built up with nurses and residents proved most rewarding. ‘I have gained so much from meeting and getting to know all these people and seeing how nurses and other health professionals work,’ she says. ‘It was very insightful. It has helped me professionally and with my personal development.’

She is particularly grateful to the nursing homes and their residents and to her supervisors Chris Papadopoulos and Gurch Randhawa. ‘They helped me make the study real and produce findings that we can build on to improve people’s lives ’.

14.9 million people in the UK are aged 60 or over. This is predicted to rise to 20 million by 2030

28% of women over 65 and 22% of men over 65 have depression. 85% of older people with depression will not receive any help from the NHS

850,000 people have a diagnosis of dementia in the UK. The figure is expected to reach 1 million by 2025

430,000 older adults live in UK care homes. About 25,000 have dementia or other types of mental illness.

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