Loneliness: An essential aspect of the wellbeing of older people

The overall aim of this thesis was to explore loneliness by identifying associated factors and predictors for loneliness among older people. This research was also undertaken to examine the association between loneliness and healthcare consumption. In addition, the reserach explored the experience of loneliness and evaluated the effects on loneliness, symptoms of depression and life satisfaction of a case management intervention for frail older people. Study I was a quantitative study with a longitudinal design involving persons 78 years or older and drawn from the Swedish National Study on Aging and Care. The sample comprised of 828 people at baseline (2001) who were followed-up after three years (n=511, 2004) and six years (n=317, 2007). The sample was divided into two groups, based on if the persons felt lonely or not. Factors such as personality traits, health complaints, self-reported health status and life satisfaction were included for identifying associated factors and predictors for loneliness. Studies II-IV were based on a main study with an experimental design, comprising 153 persons, 65+ years, living at home, with dependency in ADL and repeated contact with the healthcare services. Study II had a cross-sectional design drawn from the baseline assessment (n=153) of the main study. Self-reported data and register data was used to investigate the association between use of healthcare and loneliness, health status and health complaints. Study III had a qualitative design and explored the experience of loneliness by performing interviews with 12 persons (10 women), recruited from the main experimental study. The interviews were analysed by using qualitative content analysis. Study IV was a randomised controlled trial, including 153 persons randomised to an intervention (n=80) or control group (n=73) and evaluated the effect of a case management intervention after six and 12 months.Three outcomes were evaluated in regards to effectiveness; loneliness, symptoms of depression and life satisfaction. The results in Study I showed that 52 per cent of the sample at baseline felt lonely sometimes or often (mean age 84 years). The strongest associated factor for loneliness was living alone (OR=6.1, 95%, CI=3.8-9.9) and the strongest predictors for loneliness at both follow-ups, at three and six years, was feeling lonely at baseline (OR=7.2, CI=3.9-13.4 and OR=5.4, CI=2.8-10.5). Those associated factors and predictors that were identified were mainly related to psychosocial outcomes. Study II showed that 60 per cent of the frail older participants (mean age 82 years) had experienced loneliness occasionally or more often during the previous year. Those who felt lonely used significantly more outpatient services, including visits at the emergency department, compared to their peers who did not feel lonely (p=0.026). Only depressed mood was found to be independently associated with total use of outpatient services (B=7.4, p