Socialstyrelsen har konstaterat att äldres psykiska hälsa är ett eftersatt område, trots att många äldre drabbas av psykiska besvär, och efterlyser behandlingsalternativ till medicinering. Man konstaterar samtidigt att det saknas undersökningar av effekten av psykoterapi för personer i högre åldrar, något som delvis kan bero på att många studier har en åldersgräns på 75 år. Tidigare studier visar också att psykoterapeuter föredrar att ta emot yngre patienter i psykoterapeutisk behandling. Studien är en beskrivning av några psykoterapeuters upplevelser av det psykoterapeutiska arbetet med personer som är 75 år och äldre. Sju psykoterapeuter intervjuades i denna kvalitativa undersökning där datainsamling skedde genom semistrukturerade intervjuer som analyserades med tematisk analys. Det som upplevs vara vanligast förekommande tema för denna åldersgrupp är förluster och skam kopplat till detta. Det finns många tankar som rör det existentiella men samtal som rör den egna döden tycks förekomma i väldigt begränsad utsträckning. Det framkommer också att samtliga psykoterapeuter i studien ser behovet och nyttan med psykoterapi för äldre men att det oftast handlar om mycket korta terapier, mellan en till tio gånger. / The National Board of Health and Welfare has found that older peoples mental health is a neglected area, despite the fact that many older people suffer from mental health problems and calls for alternative treatment to medication. It also notes that there are no studies of the efficacy of psychotherapy for people at older ages, which may partly be due to the fact that many studies have an age limit of 75 years. Previous studies also show that psychotherapists prefer to receive younger clients in the psychotherapeutic treatment. The study is a description of some therapists experiences of psychotherapeutic work with people who are 75 years and older. Seven psychotherapists interviewed in this qualitative study in which data collection was done through semi-structured interviews were analyzed by thematic analysis. What is perceived to be more predominant theme for this age group is loss and shame attached to loss. There are many thoughts concerning the existential issues but topic concerning their own dead seems to occur to a very limited extent. It also emerges that all therapists in the study sees the need and usefulness of psychotherapy for older people but it usually involves very short therapies, between one to ten times.

Syftet med denna studie har varit att undersöka skyddsfaktorer mot emotionell ensamhet ur äldres perspektiv. För att besvara vårt syfte har vi genom elva kvalitativa intervjuer med äldre personer i en kommun norr om Stockholm försökt fånga intervjupersonernas subjektiva upplevelse av skyddsfaktorer mot emotionell ensamhet. Intervjupersonerna vi har träffat är mellan 79 år och 98 år, hemmaboende, ensamstående med hemtjänstinsatser. Empirin har bearbetats genom kodning där materialet kategoriseras och nyckelbegrepp identifierades. Utifrån kodningsarbetet gjordes en tematisk analys med stöd av tidigare forskning och en teoretisk referensram. Teorin vi använt oss av är gerotranscendensen som är en gerontologisk teori. I studien har vi identifierat fyra skyddsfaktorer som intervjupersonerna upplever vara ett skydd mot emotionell ensamhet, nära relationer i form av familj, självständighet trots hjälpberoende, acceptans, trygghet och att få bo kvar i sitt eget hem. Sorg och saknad efter en partner är en stor utmaning för den äldre som blir kvar på jordelivet men det uppstår också praktiska utmaningar där man efter ett långt liv tillsammans står ensam kvar med allt ansvar. Vi har också genom våra intervjupersoners utsagor förstått att ensamhet inte alltid behöver vara något negativt, att vara ensam har i vissa fall visat sig vara välkomnat hos flera äldre. / The purpose of this study has been to examine protective factors against emotional loneliness from the elderly’s perspective. To accomplish this we have conducted 11 qualitative interviews with the members of the elderly community in a municipality north of Stockholm, with the aim to capture the participants’ subjective experiences in terms of protective factors against emotional loneliness. The subjects, aged between 79 and 98 years old, are single homeowners assisted by home care services. The empirics have been compiled through coding where the material has been categorised and key concepts identified. Through the coding process a thematic analysis was conducted, supported by previous research and a theoretical frame of reference. The theory we have used is the gerotranscendence, which is a gerontological theory. In this study we have identified five protective factors that the subjects consider to be a protection against emotional loneliness; close relationships with family members, independence despite the need of home care, acceptance, security, and remaining a resident in your own home. Grief and the loss of a partner can be a great challenge for the elderly. But there are also practical challenges to encounter when you are left handling all the responsibilities that used to be shared with a spouse. We have also, from the statements of our subjects, come to the conclusion that being alone is not always seen as a negative thing and can sometimes even be embraced by the elderly.

This study investigates the characteristics of and the interrelationships between disease, disability, service use and social support in a random sample of 647 community dwellers aged 75 years and over. The two broad objectives of the study are: to examine the physical aspects and manifestations of health by investigating disease and disability and the interrelationships between these two factors, and; to examine the social aspects of health by investigating service use and social support and the interrelationships between these two factors. Given the dramatic population ageing in Australia, particularly in the very old age groups, the health, well-being and quality of life of older Australians are of paramount importance and will be well into the future. The proportion of the population with diseases and disabilities increases significantly with age. As the physical aspects of health are manifested with increasing age the social aspects of health also become increasingly important. Older adults, particularly those in advanced old age, are disproportionately high users of health and community services. Despite the high use of services in this age group, far more older adults living in the community rely on their families, friends and neighbours for social support and many older adults use a combination of formal services and informal social support. Little is known about people aged 75 years and over living in the community in Australia. In particular, significant knowledge gaps exist with regard to the relationship between disease and disability and that between service use and social support. The characteristics of social support in this group of older adults are also largely unknown. The papers presented in this thesis are based on data collected in The Sydney Older Persons Study (SOPS). This is a large longitudinal multidisciplinary project which began in 1991 in order to investigate the health and service use patterns of people aged 75 years and over living in the community in the Central Sydney Health Area. The initial sample consisted of two groups: first, the Australian Bureau of Statistics (ABS) selected census districts with probability proportional to size and 9271 households were door-knocked to obtain a random sub-sample of the general community (n=320, response rate 73%); second, community-living veterans and war widows residing in the Central Sydney Health Area were selected at random from a list provided by the Department of Veterans Affairs to obtain a veteran/war widow sub-sample (n=327, response rate 82%). Respondents participated in both an interview conducted by a social scientist and a medical assessment performed by a medical practitioner with experience in geriatric medicine. An informant was sought for each respondent and this informant participated in a phone interview conducted by a social scientist. The first paper in this thesis investigates the characteristics of diseases (neurodegenerative, systemic and psychiatric) including their prevalence and association with age. The second paper extends the first by examining the nature of the relationship between disease and disability and in particular which individual diseases and groups of diseases have the greatest impact on disability. The third paper expands the analysis in the second paper by focusing in greater detail on the relationship between disease and disability. The contribution of clinically-diagnosed individual diseases and groups of diseases to three different measures of disability (clinician-rated, informant-rated or proxy and self-report) is investigated here. The fourth paper examines the possibility of disease and disability being the major predictors of service use and social support. It focuses on the determinants of service use and social support using Andersen's behavioral model. The fifth paper investigates the characteristics of social support, in particular gender differences and the socio-demographic variables associated with social support. This is an important research area because lower levels of social support have been found to predict mortality, disease and lower levels of well-being. Finally, the sixth paper links the major themes of the fourth and fifth papers by investigating the relationship between service use and social support. This paper tests Cantor's 'hierarchical-compensatory' mechanism, which predicts a negative association between service use and social support, and the 'bridging' mechanism which predicts a positive association between these two factors. Thus it assesses the extent to which demands for service use and for social support are made together or in a compensatory fashion for respondents of equal disease and disability. The presented work demonstrates that neurodegenerative diseases [dementia, cognitive impairment, parkinsonism, instability (gait ataxia), immobility (gait slowing) and motivation loss/behaviour change] have the largest and most significant increases with age of all disease groups. Therefore the hypothesis made in paper one that neurodegenerative diseases will come to dominate the health care needs of older adults, particularly when combined with population ageing, is supported. Further, results of papers two and three indicate that neurodegenerative diseases result in greater levels of disability, lending credence to the finding that it is these neurodegenerative diseases that are of central importance to the future of the health care needs of older adults of advanced age. While systemic diseases play an important role in disability, the neurodegenerative diseases are under-recognised by self-report and yet are most strongly associated with severe disability. A major recommendation of this study is that assessments and diagnosis of neurodegenerative diseases be included in disability assessments. With regard to the social aspects of health, the fourth paper finds that disease and disability are the main predictors of service use and social support. The fifth paper highlights important gender differences in social support and also finds that lower levels of social support are associated with increased age, male gender, single marital status and lower socioeconomic status. Because it is widely accepted that social support is protective against adverse health outcomes and low levels of wellbeing, these groups of older adults are at risk of poorer health and wellbeing. Finally the sixth paper fills some knowledge gaps with regard to the relationship between service use and social support. It shows that with regard to IADL (instrumental activities of daily living) services and IADL social support, Cantor's 'hierarchical-compensatory' mechanism (negative correlation) applies but with regard to medical services and both ADL (activities of daily living) and IADL social support the 'bridging' mechanism (positive correlation) is supported. These complex interrelationships between disease, disability, service use and social support are summarised schematically in a model. In light of significant population ageing, substantial resources in the form of medical and community services and social support from carers, family, friends and neighbours will need to be devoted to older adults with diseases, in particular neurodegenerative diseases, and to those with disabilities. Given the increasing importance of disease, disability, service use and social support in very old age, it is crucial that knowledge and understanding of these factors and their interrelationships be advanced in order to better allocate and sustain resources and to ultimately improve the health, well-being and quality of life of very old adults.