We examined the links between HIV-stigma, loneliness and sleep quality in 181 people living with HIV (PLWH) who completed an online self-report questionnaire. Results suggested that the indirect effect of stigma on poorer sleep through increased loneliness was significant. Researchers will address implications for research on stigma and health.

We hypothesized that higher levels of self-compassion among people living with HIV (PLWH) would be related to lower levels of loneliness, which in turn would be associated with better psychological well-being (lower levels of depression and negative affect and higher positive affect). 106 PLWH completed an online survey that measured demographic variables, self-compassion, loneliness, and psychological well-being. Mediation analyses revealed that loneliness mediated the relationship between self-compassion and depression and negative affect, but not positive affect. These findings indicate that encouraging self-compassion may have a positive effect on psychological well-being among people living with HIV by reducing loneliness.

Loneliness is a widespread public health concern. Loneliness may be less frequent but have more severe consequences for cardiovascular disease (CVD) in a collectivist (e.g., Japanese) versus individualist (e.g., United States [U.S.]) culture but little is known about cross-cultural associations of loneliness. This study determined if loneliness would be higher in the U.S. and in persons lower in collectivism. We also studied if loneliness would be positively associated with CVD indicators and if these associations would be stronger in (1) Japan than the U.S. and (2) individuals higher in collectivism. U.S. (n = 529) and Japanese (n = 292) adults from the Midlife in the United States Series, aged 36 to 78, completed psychosocial questionnaires, provided blood samples, and underwent a physical exam. Logistic regression and path analyses using structural equation modeling determined individual differences in loneliness, whether loneliness predicted CVD indicators (e.g., metabolic dysregulation, inflammation, blood pressure, and sleep dysfunction), and whether nationality and collectivism moderated these associations. Japanese adults reported less loneliness compared to the U.S. Unexpectedly, loneliness did not predict any CVD indicators. For U.S. adults with low interdependence, loneliness was associated with elevated metabolic dysregulation. For Japanese adults, loneliness was associated with decreased metabolic dysregulation. We decided to test additional models that included gender as a moderator of the association between loneliness and CVD indicators. Complex associations between gender, nationality, interdependence, and loneliness were found. Clinicians should consider addressing metabolic dysregulation and sleep in lonely patients, especially males and U.S. females. Future work could investigate how loneliness is appraised by Japanese men and U.S. women, and how loneliness affects the health behaviors and eating patterns of these groups.

During the COVID-19 pandemic, the Veterans living in the Kerrville VA community living center were required to shelter in place, isolate, and quarantine, much like the rest of the world during the Spring of 2020. Although the Veterans were potentially safe, they were experiencing increased loneliness and feelings of isolation; in turn, their quality of life suffered. In the Ibrahim & Dahlan (2015) article, the authors underscore the importance of engagement in occupations to improve quality of life, as occupational engagement facilitates life’s purpose. Healing Heroes Virtually aims to improve quality of life, provide opportunities for occupational engagement, learning a new skill to bridge the digital divide gap among the older adult population living in long-term care facilities. The Diffusion of Innovation Theory (DOI) will direct this program improvement project within long-term care facilities. This theory introduces innovation to potential adopters (Veterans & staff at the Kerrville VA) and disseminates it into social systems. Timing is also essential when utilizing the DOI theory to move the program. The authors (Abbott-Gaffney et al., 2022) found that “organizations can remove barriers by providing multiple learning opportunities and support to reinforce the learner’s confidence, therefore increasing the likelihood of continued use of telehealth as a service delivery model.” Adult Learning Theory will also be utilized considering the various learning styles adult learners receive/learn information. It is essential for the Veteran to feel comfortable and confident in the newfound skill. The program should run for ten weeks, two times a week, to educate and introduce the iPad, Zoom application, and program to the Veterans. Between weeks four and seven, the goal will be troubleshooting and increasing independence with technology use. During weeks eight through ten, programs such as an exercise session, current events hour, or a virtual Bible study will occur. The Veterans will be given surveys, and staff will evaluate the program’s success for future use. The goal is to create a library of various activities/sessions available to Veterans. Healing Heroes was made with the idea that if the world shuts down again, these Heroes will have the opportunity for occupational engagement and not have to endure occupational deprivation and alienation.

Bakgrund: Ålderdom påverkar livet, kroppen och sinnet. Långvarig, ofrivillig ensamhet är skadligt för hälsan och vanligt förekommande bland äldre personer. Existentiell ensamhet utgör en form av ofrivillig ensamhet och definieras som en plågsam insikt om att vara separerad från världen och andra människor. Nästan alla erfar det någon gång i livet, särskilt i samband med kriser eller att man upplever sig stå inför döden. Inom existensfilosofi och existentiell psykoterapi beskrivs ångest och lidande som grundläggande livsvillkor och existentiell ensamhet är ett resultat av detta. Lidandet är i sig meningslöst men med hjälp av copingmekanismer och stöd kan man ta sig igenom lidandet och skapa mening. Äldre personer uttrycker ofta ett behov av att samtala om existentiella frågor medan sjuksköterskor inte sällan undviker dem då de upplever samtalen som svåra och ofta känner sig otillräckliga. Stöd till vård- och omsorgspersonal är därför viktigt. Samhällsutvecklingen pekar mot ett allt mer ansträngt läge inom vård och omsorg och arbetsgivare och fackförbund tvistar om ansvarsfördelningen. Ansvaret för äldres hälsa ligger dels på individen själv, dels på vård- och omsorgspersonal och samhället. Syfte: Att undersöka äldre personers upplevelser av existentiell ensamhet. Metod: En systematisk litteraturöversikt genomfördes. Urvalet bestod av tio kvalitativa vetenskapliga originalartiklar publicerade mellan år 2003–2023. Deltagarna bestod av äldre personer från 60 år. Materialet tematiserades med en induktiv ansats, därefter diskuterades resultatet i relation till Katie Erikssons lidandeteori. Resultat: Tre teman med underteman togs fram ur resultaten: Det första temat var Att känna sig frånkopplad från världen med undertema meningslöshet och När orden inte räcker till. Det andra temat var Att förlora och omdefiniera sig själv med undertema Frihetsförlust, Kontrollförlust och Identitetskris. Det tredje temat var Att leva i ett relationellt tomrum med undertema Att känna sig isolerad och Tankar på döden. Slutsats: Upplevelser av att sakna djupa relationer samt att förlora kontrollen över sitt liv kunde utlösta existentiell ensamhet hos äldre personer. Det gjorde att de kände sig frånkopplade från världen och andra människor samt upplevde meningslöshet. För att kunna hjälpa äldre personer med dessa känslor behöver sjuksköterskor kunskap om vad som orsakar existentiell ensamhet och vad den innebär. / Background: Old age affects both life, body and mind. Long-term involuntary loneliness is harmful to ones health and common among elderly people. Existential loneliness is a form of involuntary loneliness and is defined as a painful insight in being separated from the world and other people. Most people experience it sometime during their lifetime, especially during a time of crisis or when one feels confronted with death. Within the realm of existential philosophy and existential psychotherapy, anxiety and suffering are described as fundamental conditions for life and existential loneliness is a result of this. Suffering itself is meaningless but with the help of coping mechanisms and support, one can get through it and create meaning. Elderly people often express a need to talk about existential concerns while nurses can be avoidant since they find these conversations tough and feel insufficient. This makes support for the nursing staff an important matter. The societal development indicates an increasingly strained situation within healthcare and elderly care, with employers and trade unions disputing over the allocation of responsibilities.  The responsibility for the health of elderly people lies partly on the individuals themselves, partly with healthcare and care personnel, and partly with society. Aim: To explore elderly persons’ experiences of existential loneliness. Method: A systematic literature review was carried out. The literary sample consisted of ten qualitative, scientific original articles published between 2003–2023. The participants in the studies were elderly people from the age of 60 and older. The material was thematized with an inductive approach, thereafter it was discussed in relation to Katie Erikssons theory of suffering. Results: Three themes with subthemes emerged in the results. The first theme was To feel disconnected from the world with the subthemes Meaninglessness and When words aren’t enough. The second theme was To lose and redefine oneself with the subthemes Loss of freedom, Loss of control, and Identity crisis. The third theme was To live in a relational void with the subthemes To feel isolated and Thoughts on death. Conclusions: Experiences of lacking deep relationships and losing control of their lives could trigger existential loneliness within elderly persons. This made them feel disconnected from the world and other people and made them experience meaninglessness. To be able to help elderly persons with these feelings, nurses need knowledge regarding what the cause of existential loneliness is and what it means.

Loneliness affects Black older adults (BOAs) in different and debilitating ways. BOAs aged 65 years and above make up 7.3% of the Black population and 15.9% of the total population of those aged 65 years and above in Canada. Also, the population of BOAs in Canada has doubled within the last two decades, highlighting the need to understand the unique experience of aging of this population, including their experiences of loneliness and social participation. Contrarily, there exist notable gaps within the loneliness literature on the experience of loneliness and social participation among BOAs living in Canada. This doctoral dissertation addresses these knowledge gaps by providing insight into the factors influencing social and emotional loneliness and lack of social participation among BOAs and proffers ways to address the issues, expressly informing future research, services, and programs targeting this group. This dissertation is comprised of four papers. Paper 1 is a scoping review of 27 articles that reveal the dearth of empirical evidence on the experience of loneliness or subjective social isolation and the contributing factors among BOAs in Canada. The data used for the remaining three papers were collected through 25 narrative interviewing conducted with 13 BOAs living in Hamilton and Windsor, Ontario. Findings from this paper shows that in addition to unavailability of social provisions (relational gains), loneliness among BOAs is exacerbated by socio-economic factors, health-related factors and behaviours, and technology, media device possession and usage. The results also indicate that there is need for inclusion of BOAs in loneliness research in Canada. Following Paper 1, Paper 2 investigates the unique experience of loneliness among BOAs living in Canada and the suitability of the social provision framework in identifying and understanding the experience of loneliness among this group. Findings from this paper demonstrates the significance of social connection, reliable relationships and relational gains in reducing and increasing experience of loneliness among BOAs. Paper 3 analyzes the constellation of factors that contribute to loneliness among BOAs and how they cope with their experience of loneliness. The results from this paper highlight the complex overlapping factors that contribute to the experience of loneliness among BOAs including time, sense of place and belonging, weak socio-personal interaction, and level of exclusions. Paper 4 and final paper uncovers the micro and macro level factors that hinder BOAs from participating in social programs and services and suggests ways to improve their social participation. Specifically, findings from this paper uncovers the need for programs and services that are culturally diverse and sensitive to the unmet needs of racialized and minoritized groups. Collectively, the four papers contribute to knowledge on the experience of loneliness among BOAs and contributory factors and highlight the need for more inclusive research and practice on addressing loneliness among this group. / Thesis / Doctor of Philosophy (PhD) / This research aims to understand how loneliness affects Black older adults (BOAs) living in Canada and how to reduce their loneliness. This is a group that is not usually included in the loneliness literature. The dissertation is organized into six chapters comprising of the introduction, four papers and the conclusion. Paper One analyzes 27 articles describing the factors that contribute to loneliness among Black older adults globally. The 27 papers reveal while loneliness is devastating for BOAs, studies that have examined the experience of loneliness among BOAs in Canada is very scanty. Paper Two, Three and Four all report results from narrative interviews conducted with 13 Black older adults living in Windsor and Hamilton, Ontario. Paper Two explores the unique experience of loneliness among BOAs. Paper Three analyzes the influence of time, place and interaction as factors that contribute to the experience of loneliness among Black older adults and their coping strategies. The final paper explores the significant factors that hinder BOAs from participating in social programs and services and ways to improve their participation. Generally, the results of these papers provide important insights into the ways to address loneliness and the lack of social participation among BOAs. The results show that programs and services targeting loneliness in Ontario need to be made more culturally sensitive and representational of minoritized groups. Lastly, it highlights the need for the inclusion of BOAs in loneliness research among older adults in Canada.

Social isolation and loneliness (SIL) represent a growing public health and public policy concern, particularly among older adults. Half of older adults over the age of 60 are at risk of social isolation and one-third experience loneliness. SIL is a particular concern for individuals aging-in-place in low-density and rural areas. SIL increases the risk of premature death from all causes in older individuals, and results in $6.7 billion in additional Medicare spending annually. Tennessee is ranked tenth in the nation for risk of social isolation. Strategies to promote social connections are a critical step in designing age-friendly communities. A cross-sectional survey of a convenience sample of older adults (62 years and older) living in affordable housing apartment complexes in Hawkins County, TN was conducted in February and March 2023. Loneliness (UCLA 3-item Loneliness Scale), social isolation (Lubben Social Network Scale 6-item), and sense of community (Brief Sense of Community Scale) were assessed. Data were also gathered on demographic characteristics, health status, social engagement, and strategies to support older adults aging-in-place. Data from 82 participants aged 62 to 95 (73.14 mean age; SD = 7.00) were analyzed. The majority of participants were female (67%), non-Hispanic White (93%), lived alone (90%), and were retired (84%) with an average annual income less than or equal to $14,225 (43%). Nearly half (44%) report their health as fair or poor compared to others their age and 79% of participants have 4 or more chronic conditions. Overall mean loneliness score indicated moderate loneliness (mean = 4.9; SD = 2.08; range 0-9). 48% were at risk of social isolation (mean = 13.35; SD = 6.14; range 0-29). The total mean sense of community score was moderate (mean = 22.9; SD = 1.09; range 0-40). Factors associated with SIL will be analyzed using Pearson’s correlation test. Strategies to promote social engagement will be discussed. Living and growing older in rural communities is considered a primary risk factor for SIL. To support healthy aging, local efforts must include strategies to increase social engagement for rural older adults and their communities. Results from this needs assessment will be used to generate recommendations that can be used to improve social connectedness among older adults living in Hawkins County, TN.

Loneliness has long been understood as a part of the human condition, however, its ability to be measured remains a struggle, much due to its subjective nature and many complexities. As loneliness has recently been highlighted as a global health concern in need of intervention, an accurate measurement of the phenomenon is perhaps more crucial than ever. This study aims to give an in-depth understanding of loneliness, in particular how it pertains to a practical tool of measurement. The text discusses limitations of previous measurements and analyzes which areas of loneliness still remain to be underrepresented in established measuring scales. To reach the goal of the study and find the best way to measure loneliness, we implemented our own loneliness scale using both questions from established questionnaires as well as our own formulated questions. Three distinct categories within loneliness emerged- social networks, actual loneliness and experienced belonging. These, along with relevant descriptive factors of the participants, were used to measure loneliness. The final measurement scale was shared in the form of an online questionnaire to a total of 479 participants. The results showed all categories to be distinct aspects of all significant to one another and in the measurement of loneliness as a whole. Both socioeconomic, participants origin, as well as age-related factors also proved to be relevant in measuring loneliness but they did not have the same predictive strength as the main three variables. Furthermore, this scale included previously underrepresented questions which aimed to distinguish trait and state loneliness and situational loneliness-triggers. These all proved significant in the wider category of experienced belonging but did not warrant a distinct category of its own. The final loneliness scale measures both more subjective and qeualitative as well as objective and quantitative aspects of loneliness. As the measurement showed good internal consistency, it can be considered a valid and reliable tool to gain an in-depth understanding of loneliness.

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