Sociodemographic and health -related risks for loneliness and outcome differences by loneliness status in a sample of older U.S. adults

Background. Loneliness is a prevalent problem for older adults and has been shown to be associated with negative physical, psychological, and social variables. There has been limited research focusing on the relationship of loneliness to health. There is a gap in the literature when it comes to understanding how the problem of loneliness relates to the health of older adults in the United States.;Purpose. The purpose of this study was to address this gap in the literature through the testing of two models, the first model represented the postulated risks for loneliness and the second model represented the postulated outcomes for those who experience loneliness. Variables were chosen for inclusion in the models based on a review of pertinent quantitative and qualitative literature.;Methods. The models were tested using a representative sample of U.S. older adults. Data analysis was performed using data from the 2002 and 2004 waves of the Health and Retirement Study. The sample was limited to respondents aged 50 and older who participated in wave 6 (2002) and wave 7 (2004) without proxy, answered the lonely question at both waves, were community-dwelling in 2002 and who had complete data on selected variables in the model. Univariate and bivariate analyses were followed by logistic regression analysis to identify risks. One-way ANOVAs, comparative means testing and independent analysis of covariance tests were used to evaluate the difference in outcomes for those who were never lonely, briefly lonely, or chronically lonely.;Results. Non-married status was consistently the primary predictor of self-report of loneliness, followed by poorer self-report of health status, lower educational level, functional impairment, increasing number of chronic illnesses, younger age, lower income, and less people living in the household. Gender and use of home care were not significant predictors of loneliness. Those who were chronically lonely reported less exercise, more tobacco use, less alcohol use, a greater increase in number of chronic illnesses, higher depression scores, more physician contacts and greater average number of nights in a nursing home than those who were never lonely or briefly lonely. After controlling for significant covariates of loneliness, those who were chronically lonely did not have significantly more physician contacts.;Discussion. Loneliness is a prevalent problem for older adults in the United States with its own unique health-related risks and outcomes. Given the prevalence, it should be considered a healthcare priority in the United States. Based on the results of this study, inclusion of loneliness and loneliness risk screening as part of routine health histories for those aged 50 and over should be considered. Future research needs to focus on evaluating the effectiveness of both prevention and treatment interventions for loneliness to provide empirical data to guide evidenced based practice

A Pilot One Group Feasibility, Acceptability, and Initial Efficacy Trial of LISTEN for Loneliness in Lonely Stroke Survivors.

Loneliness is a prevalent problem for adult stroke survivors, and a known contributor to hypertension, secondary stroke, functional decline, poorer quality of life, and mortality in older adults. LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a theoretically based behavioral health intervention designed to target loneliness, in a sample of lonely survivors of ischemic stroke

Using Multidisciplinary Focus Groups to Inform the Development of mI SMART: A Nurse-Led Technology Intervention for Multiple Chronic Conditions

Used as integrated tools, technology may improve the ability of healthcare providers to improve access and outcomes of care. Little is known about healthcare teams’ preferences in using such technology. This paper reports the findings from focus groups aimed at evaluating a newly developed primary care technology platform. Focus groups were completed in academic, outpatient, and community settings. Focus groups were attended by 37 individuals. The participants included professionals from multiple disciplines. Both prescribing (=8) and nonprescribing healthcare team members ( = 21) completed the focus groups and survey. The majority were practicing for more than 20 years (44.8%) in an outpatient clinic (62%) for 20–40 hours per week (37.9%). Providers identified perceived obstacles of patient use as ability, willingness, and time. System obstacles were identified as lack of integration, lack of reimbursement, and cost. The positive attributes of the developed system were capability for virtual visits, readability, connectivity, user-friendliness, ability to capture biophysical measures, enhanced patient access, and incorporation of multiple technologies. Providers suggested increasing capability for biophysical and symptom monitoring for more common chronic conditions. Technology interventions have the potential to improve access and outcomes but will not be successful without the input of users

Strategies for recruiting a sample of adults with type 2 diabetes from primary care clinics in rural Appalachia: Incorporating cultural competence

Background: Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics, making it critically important to incorporate strategies of cultural competence in the overall design of clinical research. Objectives: The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia. Design: The Purnell model of cultural competence and relevant literature served as a framework for study design. Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan. Procedures: The approaches included selection of research sites, establishing collaborations, sustaining collaborative relationships, and enhancing understanding of benefits of participation. Four recruitment sites were selected based on potential to enhance diversification of participants; multiple steps were included in each of the three remaining approaches to build relationships and gain participation. A study log was maintained to provide evaluation data. Results: Recruitment took 14 months and a sample of 102 subjects provided consent with 101 partici- pants providing complete data. Demographics were representative of the region except that African American participation was higher (6.9%) compared to current north central Appalachia (3%). Over 72% of participants indicated they would be interested in participating in future studies. Conclusions: These findings emphasize the importance of employing strategies for cultural competence in study design. Use of concepts from the Purnell model led to enhanced representativeness and po- tential for subsequent generalizability

A Systematic Review of the Relationships Among Psychosocial Factors and Coping in Adults With Type 2 Diabetes Mellitus

Type 2 diabetes mellitus contributes to poor health outcomes including mortality, yet there is a gap in the literature when seeking to understand the influence of psychosocial factors on coping in this population. The paper presents a systematic review of quantitative studies that examined relationships among psychosocial determinants and coping in adults with type 2 diabetes. This review is the second layer of knowledge discovery for the concept, “Taking on a life-altering change is a rhythmical journey of experiencing ups and downs on the way to acceptance.” The life-altering change was determined to be a diagnosis of type 2 diabetes, the journey is the ups and downs of coping with the diagnosis as people work toward acceptance of type 2 diabetes. The review includes a synthesis of findings from 22 quantitative studies of psychosocial factors and coping in adults with type 2 diabetes. Anxiety, depression, stress, and diabetes distress were identified as key influential psychosocial factors. Increased social support was inversely related to emotional distress and coping styles were related to social well-being, psychological health, and physical health outcomes. The positive coping style of problem-focused coping was linked to improved psychological and physical health. Emotional responses to diagnosis were related to depression and anxiety. Negative coping styles of resignation, protest, or isolation were higher in women and linked to poorer quality of life, while avoidance was linked to increased diabetes-related distress and depressive symptoms

Perceived Self-Efficacy, Confidence, and Skill Among Factors of Adult Patient Participation in Transitional Care: A Systematic Review of Quantitative Studies.

Introduction: An advancing healthcare system in which patients are often required to self-manage care needs across countless settings and clinicians is increasing focus on participation in care. Mismanagement of care during already risky care-transitions further increases adverse care outcomes. Understanding factors of patient participation in transitional care in an adult population can help guide ways to reduce this burden. Methods: A systematic review of the literature guided by the PRISMA method was conducted to identify factors of patient participation in transitional care. Quantitative studies in which patient participation was measured as an outcome variable and related statistics reported, and data were collected from an adult sample, were included. Two authors independently reviewed, critiqued, and synthesized the articles, and later categorized study variables according to identified trends. Results: Twelve studies across international and multidisciplinary backgrounds were identified. Across studies, efforts were largely based on understanding or improving patient self-management of care during transitions. The majority of studies were experimental and care interventions grounded in patient and healthcare team partnerships, delivered beyond the hospital setting. An array of measures was used to quantify patient participation. Factors of patient participation in transitional care included higher perceived levels of self-efficacy, confidence, and skills to participate in care. Conclusion: The results of this study suggest patient participation in transitional care is largely based on perceptions of self-efficacy, confidence, and skill. Patient-centric transitional care interventions targeting these factors and delivered beyond the hospital setting may improve care outcomes. Implications and direction for further studies includes conceptual clarity, the study of a broader-reaching patient population demographic, and use of multidisciplinary interventions. Outcome variables should remain focused on patient perception of care involvement and participation and expanded to include variables such as functional abilities and social determinants of health

The development of LISTEN: A Novel Intervention for Loneliness

Purpose: The purpose of this paper is to present the development of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a new intervention for loneliness. Methods: LISTEN was developed using the Medical Research Council (MRC) framework for intervention development. Extensive literature review revealed that belonging, relating, place in community, challenges, and meanings of coping were concepts significant to loneliness. Past interventions were limited but it was determined from a recent meta-analysis that enhanced effectiveness may result from interventions that targeted the poorly adapted cognitive processes of loneliness. These processes include social undesirability, stigma, and negative thoughts about self in relation to others. LISTEN is designed to be delivered in a determined logical sequence of 5 sessions, each focusing on the concepts relevant to loneliness as derived from the literature. For each session, intervention delivery is guided by the concepts from story theory (including intentional dialogue, nurse as listener, examination of self in relation to others and community, synthesizing concerns and patterns, and identifying messages) and the principles of cognitive restructuring (self-assessment of maladaptive cognitions, emotions, and behaviors, identifying challenges of changing, reconceptualization of self, new skill acquisition through group interaction, and identifying patterns of meaning in loneliness). Results: LISTEN is developed and the first randomized trial is complete with a sample of 27 lonely, chronically ill, community dwelling, and older adults. LISTEN was evaluated as feasible to deliver by the study team and acceptable for significantly diminishing loneliness by participants of the LISTEN groups who were compared to attention control groups (p \u3c 0.5). Conclusions: LISTEN has the potential to enhance health by diminishing loneliness which could result in improving the long-term negative known sequelae of loneliness. Future longitudinal randomized trials are needed in varied populations to assess long term health and healthcare system benefit of using LISTEN to treat loneliness

Relationship between negative emotions and perceived support among parents of hospitalized, critically ill children.

Objectives: The purpose of this study was to describe relationships between negative emotions and perceived emotional support in parents of children admitted to the pediatric intensive care unit (PICU). Methods: This cross-sectional descriptive study conducted face-to-face interviews between January 2019 and January 2020. Study variables included depression (PHQ-9 Scale), anxiety (Emotional Distress-Anxiety-Short Form 8a), anger (Emotional Distress-Anger-Short Form 5a), fear (Fear-Affect Computerized Adaptive Test), somatic fear (Fear-Somatic Arousal-Fixed Form), loneliness (Revised 20-item UCLA Loneliness Scale), and perceived emotional support (Emotional Support-Fixed Form). Results: Eighty parents reported symptoms of depression 8.00(4.00, 13.75), anxiety (23.43 ± 7.80), anger (13.40 ± 5.46), fear (72.81 ± 27.26), somatic fear 9.00(6.00, 12.75), loneliness (39.35 ± 12.00), and low perceived emotional support (32.14 ± 8.06). Parents who were young, single, low-income, and with limited-post secondary education reported greater loneliness and lower perceived emotional support. Fear correlated with depression ( Conclusions: The cluster of negative emotions identified will serve as potential targets for future interventions designed to enhance support for parents of critically ill children

Life after stroke in Appalachia

Objective The purpose of this study was to describe the structure of meaning in the experience of surviving stroke for adults living in Appalachia. Methods This qualitative phenomenological study includes a sample of 6 adult survivors of ischemic stroke who were discharged from either a community or university hospital to home in the Appalachian region. Data was collected through semi-structured interviews, transcribed, and analyzed thematically by two investigators. The explicated themes were verified by the survivors as representative of their experience. Results Five main themes emerged: 1) Frustration with new physical and functional impairment, 2) Negative emotions including anger, guilt, loneliness, and depression 3) Need for accessible support, 4) Longing for home during recovery and, 5) Stepping forward after stroke which included sub-themes of perseverance, acceptance, and retraining. Anger was described as contributing to delayed recover and emotional lability was described as a source of anger. The familiarity of home was viewed as key to reestablishing control over one\u27s life. Survivors described how they developed perseverance to move forward and emphasized that willingness to participate in retraining led to adapting to impairments. Acceptance was described as letting go of prior expectations of self and others so one could live in the present

Effectiveness of LISTEN on Loneliness, Neuroimmunological Stress Response, Psychosocial Functioning, Quality of Life, and Physical Health Measures of Chronic Illness

Objectives: Loneliness is a biopsychosocial determinant of health and contributes to physical and psychological chronic illnesses, functional decline, and mortality in older adults. This paper presents the results of the first randomized trial of LISTEN, which is anew cognitive behavioral intervention for loneliness, on loneliness, neuroimmunological stress response, psychosocial functioning, quality of life, and measures of physical health. Methods: The effectiveness of LISTEN was evaluated in a sample population comprising 27lonely, chronically ill, older adults living in Appalachia. Participants were randomized intoLISTEN or educational attention control groups. Outcome measures included salivary cortisol and DHEA, interleukin-6, interleukin-2, depressive symptoms, loneliness, perceived social support, functional ability, quality of life, fasting glucose, blood pressure, and body mass index. Results: At 12 weeks after the last intervention session, participants of the LISTEN group reported reduced loneliness (p¼0.03), enhanced overall social support(p¼0.05), and decreased systolic blood pressure (p¼0.02). The attention control group reported decreased functional ability (p¼0.10) and reduced quality of life (p¼0.13). Conclusions: LISTEN can effectively diminish loneliness and decrease the systolic blood pressure in community-dwelling, chronically ill, older adults. Results indicate that this population, if left with untreated loneliness, may experience functional impairment over a period as short as 4 months. Further studies on LISTEN are needed with larger samples, in varied populations, and over longer periods of time to assess the long-term effects of diminishing loneliness in multiple chronic condition