Ample evidence underscores the deleterious effects of loneliness on health and mortality. Therefore, it is important that loneliness risks are identified across all ages and appropriate measures are devised to address those risks. Although almost a third of the US older adult population lives alone, there is limited research on the social connectedness (or its lack thereof) in this subset of older adults. This dissertation specifically focused on understanding loneliness (its extent, variance, and sources of variance) in older adults who live alone and do not use the Internet. The results indicate that the loneliness reported in this subset of older adults is greater than that found in general older adult samples. Social isolation (measured by social network variables) and emotional well-being emerged as significant predictors of loneliness in this group. Demographics, personality, and technology experience did not predict variance in loneliness beyond that predicted by social isolation and emotional well-being. To understand if Internet adoption can provide greater opportunities for connectedness, a qualitative study was also conducted. This study focused on the subjective experiences of living alone, relationships with friends, family, and groups in the context of living alone, and the role of technology in supporting connectedness needs. Loneliness was the most commonly reported challenge associated with living alone and was often described in terms of lack of companionship or someone to share one’s feelings with. The older adult Internet users perceived usefulness of Internet-based social media as a compensatory tool for communication, but valued in-person interactions more. Together these studies provided insights into the social connectedness of older adults who live alone. The findings advanced the understanding of the complexities of living alone in older age and helped identify directions to best address social connectedness needs while also supporting older adults’ desire to continue to age in the living arrangement of their choice. Finally, the gaps in research on older adults’ use of social media and its potential to support connectedness for an aging population were also addressed.

Background: A growing number of older people, mainly women, live in single households. They represent avulnerable group as staying at home may turn out challenging when care needs increase, particularly at the end oflife. Non-kin-carers can play an essential role in supporting individuals' preferences to stay at home. In research Little attention has been paid to non-kin-carers, such as friends and neighbors, yet. Thus, the Older People Living Alone (OPLA) study will evaluate whether non-kin support is robust enough to enable care dependent people to stay athome even at the end of life. This paper aims to introduce the research protocol. Methods: We plan to apply a qualitative longitudinal study to better understand how older people living aloneand their non-kin-carers manage to face the challenges with increased care needs towards the end-of-life. We willconduct serial interviews with the older persons living alone and their non-kin-carers. A total of 20-25 completedata sets and up to 200 personal interviews were planned. These will be complemented by regular telephonecontacts. All interviews will be analysed following the grounded theory approach and strategies for reconstructingcase trajectories, supported by MAXQDA software. In the course of the study, inter- and transdisciplinary workshopsshall assure quality and support knowledge transfer. Discussion: This study protocol aims to guide research in a field that is difficult to approach, with regard to itstopic, methodology and the interdisciplinary approach. As this study introduces longitudinal qualitative Research methodology in the field of home care in Austria, a deeper understanding of (end-of-life-) care trajectories will beenhanced, which is of major relevance for future care planning. With investment in additional reflexivity andcommunication procedures innovative results and robust knowledge are expected outcomes.

As individuals age, their likelihood of experiencing mental and physical problems increases, as does their risk of developing social isolation. Behavioral, physiological, and/or psychological changes are common manifestations of social isolation. Increased morbidity and mortality are the outcome. Ecological systems theory and social baseline theory provided the framework to explore 10 older individuals' perceptions of risk for social isolation and their perceived barriers to social integration. Data for this interpretive phenomenological study were collected from participant diaries, interviews, the 6-item de Jong Gierveld Loneliness Scale (DJGLS-6), the Lubben Social Network Scale 6 (LSNS-6), a demographic survey, and a social support profile. The Colaizzi method and interpretive phenomenological analysis were used to analyze diaries and interviews. Participant demographics, DJGLS-6, LSNS-6, and social support profile data were used to enrich descriptions of the participants and find other themes. Results indicated that most participants like living alone. However, more than half reported periods of loneliness and 4 reported estrangement from an offspring. Experiences of negative age-related treatment were described by many participants and most reported that transportation and mobility issues were the biggest barriers to social integration. Additionally, many participants reported that access to planned social activities would alleviate social isolation. Implications for positive social change arise from this research in the form of increased awareness of the experiences and perceptions of older individuals at risk for social isolation. Additionally, these findings can inform future research, policy change, and strategies for social isolation interventions and prevention.

In Sweden and elsewhere there is evidence of poorer cancer survival for patients of low socioeconomic status (SES), and in some settings differences in treatment by SES have been shown. The aim of this thesis was to explore factors which influence cancer treatment decisions, such as knowledge reaped from clinical trials, patient-related factors, and physician-related factors. In a register study of colorectal cancer, all stages, patients were stratified for SES-factors. Differences were seen with regards to clinical investigation, surgical and oncological treatment and survival, with the highly educated group being favored. Survival was better for highly educated patients in stages I, II and III but not in stage IV. In a Scandinavian cohort of newly metastasized colorectal cancer patients, recruitment to clinical trials was studied. Patients entering clinical trials had better performance status and fewer cancer symptoms than those who were treated with chemotherapy outside of a clinical trial. Median survival was 21.3 months for trial-patients and 15.2 months for those treated with chemotherapy outside a  trial. Those not treated with chemotherapy had a median survival of just 2.1 months. Patients in clinical trials are highly selected and conclusions drawn from studies cannot be applied to all patients. In the same cohort, treatment and survival were stratified for education, smoking and indicators of social structure. Highly educated patients did not have a survival advantage. Patients who lived alone were offered less combination chemotherapy and surgery of metastases than other patients and had 4 months shorter survival than those who lived with a spouse or child. In a fourth study, 20 Swedish gastrointestinal oncologists were interviewed on which factors they considered when deciding on oncological treatment. Oncologists feared chemotherapy complications due to lack of social support, and ordered less combination chemotherapy for patients living alone. Highly educated patients were seen as well-read and demanding, and giving in to these patients’ requests for treatment was regarded as a way of pleasing patients and relatives and of avoiding conflict.

Introduction: In Sweden today a third of all those 60+ live alone and the absolute number will continue to increase because of the aging population. The aim of this thesis was to identify if the subgroup, older individuals living alone, might be more disadvantaged in regard to the four key sources to vulnerability suggested by Mechanic and Tanner (2007): Poverty and low socioeconomic status, personal functions, low social network and lack of support, and physical location. Gender differences were also investigated.   Method: Data was from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) collected in 2014. The total sample in this thesis includes 987 individuals with an age between 70-105. To estimate the current living conditions in regard to vulnerability among the subgroup, five dimensions of vulnerability were analyzed with multiple logistic and linear regressions.   Results: More disadvantages are found for those men and women living alone in all domains, except in social activity for women where living arrangement made no difference. Significant gender differences can be seen in depressive symptoms and social activity, but not for financial insecurity, mobility problems or living in a disorganized local community.   Conclusion: Men and women living alone are more disadvantaged compared to those living with a partner, according to the four key sources to vulnerability. With this deeper insight it is possible to obtain a greater understanding in where policies to support and strengthen this subgroup should be placed.

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Introdução - A dinâmica do arranjo domiciliar (unipessoal ou acompanhado) e outros condicionantes podem influenciar o estado nutricional de idosos. Objetivo - Verificar a associação entre estado nutricional e variáveis referidas: arranjo domiciliar, alimentação, demográficas, socioeconômicas e clínicas, em coorte de idosos, domiciliados no município de São Paulo, em 2000 e 2006. Métodos - A população de estudo foi composta por idosos ( 60 anos), de ambos os sexos, participantes do Estudo SABE, em 2000 e 2006. As variáveis de estudo foram: estado nutricional, adequado (massa muscular, segundo área muscular do braço, percentil 25) e inadequado (massa muscular < percentil 25), dinâmica do arranjo domiciliar (mudança de unipessoal ou acompanhado, de 2000 para 2006); grupos etários (60-74 e 75); sexo; escolaridade ( 8 ou > 8 anos); renda mensal per capita, em quartis; alimentação, segundo número de refeições/dia (< 3 ou 3), e frequência de ingestão de alimentos, com resposta dicotômica (sim ou não): laticínios - 1 vez/dia, ovos ou leguminosas - 1 vez/semana; carnes - 3 vezes/semana; frutas, verduras ou legumes - 2 vezes/dia; sintomas depressivos, segundo Escala de Depressão Geriátrica (ausência: escore < 6, leves: 6 e < 11, e graves - 11). Para verificar a associação entre as variáveis, utilizou-se teste de Rao & Scott, razão de prevalência (RP) e regressão logística múltipla (p<0,05); e o programa Stata/SE® 10.1 for Windows. Resultados - Verificou-se associação positiva, com maior chance, para estado nutricional inadequado com grupo etário 75 anos (OR=1,53; IC=1,191,95; p=0,001); com sintomas depressivos graves (OR=2,07; IC=1,133,80; p=0,020); com dinâmica do arranjo domiciliar: acompanhado2000 e sozinho-2006 (OR=1,80; IC=0,98-3,31; p=0,056), e associação negativa, com menor chance, para ingestão referida de laticínios (OR= 0,60; IC= 0,38 0,96; p=0,034). Identificou-se prevalência de estado nutricional inadequado em 32 por cento dos idosos que apresentaram mudança do arranjo domiciliar (acompanhado-2000 e unipessoal-2006), assim como do grupo etário 75; e em 24 por cento , daqueles que referiram ingestão de laticínios, e, ainda, em 35 por cento , daqueles, com sintomas depressivos graves. Conclusão - Constatou-se associação positiva, de estado nutricional inadequado, com grupo etário 75, sintomas depressivos graves, mudança da dinâmica do arranjo domiciliar (acompanhado unipessoal), e negativa, para ingestão referida de laticínios / Introduction - The dynamic of living arrangement (alone or accompanied) and other conditions may influence the nutritional status of elderly. Objective - To study the association between nutritional status and such variables: living arrangement, food, demographic, socioeconomic and clinical, in a cohort of elderly people, living in São Paulo in 2000 and 2006. Methods - The study population consisted of elderly ( 60 years) of both genders, participants in the SABE Study, in 2000 and 2006. The variables were: nutritional status, adequate (muscle mass, the second arm muscle area, 25th percentile) and inadequate (muscle mass < 25th percentile), the dynamic of living arrangement (change of living alone or accompanied, from 2000 to 2006); age groups (60-74 and 75), gender, education ( 8 or > 8 years), monthly income per capita in quartiles, food, according to the number of meals/day (< 3 or 3), and frequency food intake, with dichotomous response (yes or no): dairy - 1 time/day, eggs or legume - 1 time/week; meat - 3 times/week, fruits, greenery or vegetables - 2 times/days, depressive symptoms, according to the Geriatric Depression Scale (absence: a score < 6, mild: 6 and < 11, and severe - 11). To investigate the association between variables, it was used test Rao & Scott, prevalence ratio (PR) and multiple logistic regression (p < 0.05) and Stata/SE 10.1 for Windows®. Results - There was a positive association, with a greatest chance for inadequate nutritional status with age group 75 years (OR = 1.53, CI = 1.19 to 1.95, p = 0.001), with severe depressive symptoms (OR = 2.07, CI = 1.13 to 3.80, p = 0.020), with the dynamic of living arrangement, accompanied-2000 and alone-2006 (OR = 1.80, CI = 0.98 to 3.31; p = 0.056) and negatively associated with less chance for the intake of dairy products (OR = 0.60, CI = 0.38 to 0.96, p = 0.034). It was identified a prevalence of inadequate nutritional status in 32 per cent of the elderly, showing change of living arrangement (accompanied-alone-2000 and 2006), as well as the age group 75, and 24 per cent of those who reported intake of dairy products, and also in 35 per cent of those with severe depressive symptoms. Conclusion - It was found a positive association of inadequate nutritional status, with age group 75, severe depressive symptoms, dynamic of living arrangement (together - alone) change, and negative, for the intake of dairy products

This study presented an overview of the use of Photovoice technique as an information gathering tool that is useful in the study of aging. The processes followed in this study lead to a possible method that could be helpful when assessing needs as they relate to activities of daily living as well as wellness information for individuals. The photos collected in this study along with first person accounts of the pictures enhanced the breadth and depth of information when compared to a traditional survey tool used to study activities of daily living. This study looked at the phenomenon of staying vital in ones home in the later stages of the life span from the perspective of the person living in the situation. / Fisher Institute for Wellness and Gerontology

Orientador: Adriana Piscitelli / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciencias Humanas / Made available in DSpace on 2018-08-09T08:17:14Z (GMT). No. of bitstreams: 1 Goncalves_Eliane_D.pdf: 2077207 bytes, checksum: 08c1e86e9f9f60f2f8362ba4564c2271 (MD5) Previous issue date: 2007 / Resumo: Nesta tese exploro como são construídas as noções de ¿mulheres sós¿ no Brasil contemporâneo a partir de três contextos distintos: estudos de população, textos da mídia brasileira e narrativas de mulheres de camadas médias, sem filhos, que moram sozinhas na cidade de Goiânia. Nos estudos de população, mulheres que moram sós são contempladas nas discussões sobre os ¿novos arranjos familiares¿ e na tendência de crescimento progressivo do número de pessoas morando sozinhas (¿domicílios unipessoais¿) observada a partir dos anos 1970. A mídia coloca em ¿evidência¿ o alto número de ¿solitárias¿ nas metrópoles brasileiras e chama a atenção para o estilo de vida das ¿novas solteiras¿, consideradas um fenômeno mundial. O debate ganha relevância nas ciências sociaisbrasileiras e assume uma dimensão de notícia em um processo no qual morar sozinha é freqüentemente associado à idéia de estar ¿solteira¿, compreendida enquanto ausência de vínculos amorosos e sexuais e, conseqüentemente, traduzido como ¿solidão¿. Várias noções atribuídas às mulheres ¿sós¿ nos distintos contextos remetem a algumas idéias proclamadas pelo feminismo, sendo a educação e o trabalho qualificado e remunerado percebidos como centrais à autonomia das mulheres. A partir de algumas terminologias recorrentes nos recortes considerados ¿ ¿nova mulher¿, mulher ¿independente¿, ¿livre¿ e ¿autônoma¿, etc. ¿, proponho uma reflexão sobre as possíveis conexões entre a produção da noção da ¿mulher só¿ e algumas noções centrais do ideário feminista / Abstract: In this thesis, I explore how contemporary notions of ¿single women¿ are constructed in three different contexts: Population studies (Demography), the Brazilian media, and the narratives of middle class childless women living alone in the city of Goiânia. In population studies, women living alone are considered in the discussion of ¿new families¿ and the increasing number of ¿single person households¿ observed beginning in the 1970s. The media emphasizes the ¿evidence¿ of the high proportion of ¿single¿ women in Brazilian metropolitan areas, drawing attention to their ways of life, in what is seen as a worldwide phenomenon. The debate becomes relevant in the Brazilian social sciences and draws the attention of the news in a process in which living alone is often associated with the idea of being single (unmarried), understood as the absence of partnership and sexual life, and therefore translated as ¿loneliness¿. Several notions attributed to single women in the three different contexts resonate with ideas proclaimed by feminism, where education and professional and paid work are perceived as central to the autonomy of women. Regarding recurrent terminologies such as the ¿new woman¿, ¿independent¿ woman, ¿free¿ and ¿autonomous¿, etc, I question the potential connections between the production of the notion of the ¿single woman¿ and key ideas in feminist thinking / Doutorado / Ciencias Sociais / Doutor em Ciências Sociais