Catherine Macomber, PhD

Understanding the Intersection of Loneliness and Recovery Setting in Older Cardiac Patients

Loneliness has significant negative impact on health. Loneliness is the difference between the amount of social support you expect to receive and the amount you perceive you are getting. Age is one risk factor of loneliness, and life events such as a move to a nursing home or the need for professional care to provide assistance with Activities of Daily Living also increase the risk of loneliness. There is little evidence comparing the experience of loneliness between settings of nursing homes and at home with home care, and yet much current policy sees aging-in-place, staying in your own home, as the most appropriate setting for growing older. This mixed methods study compares the experience of loneliness in two settings, nursing home and at home, and the influence demographics and social support have on this relationship. The theoretical framework used is the Health Belief Model.

Data for the quantitative secondary data analysis came from the Health and Retirement Study. The qualitative interviews were conducted in the Great Lakes Bay Region with older adults who were recently discharged from the hospital to home or nursing home settings. Interpretative Phenomenological Analysis was used to understand the meaning interviewees made of their experience of discharge from the hospital, their expectations and perceptions of social support, and their feelings (or lack) of loneliness.

The study findings were mixed when comparing loneliness outcomes between nursing home and at home settings with quantitative data indicating no difference and qualitative data indicating some differences. Age, marital status, ethnicity, and perceived socioeconomic status were all significant predictors of loneliness. Social support from spouse, children, other family, and friends was found to have an influence on the experience of loneliness. Social support from children was found to be a moderator of loneliness between settings, with decreased loneliness associated with the presence of positive social support from children. These results were confirmed with qualitative interviews which helped to clarify why these differences in loneliness occur.

Interventions to address loneliness depend on an understanding of the underlying causes of the discrepancy between expected and perceived support and yet are often only focused on adding more people to the life of an individual who says they are feeling lonely. This does not address either expectation or perception. Using the Health Belief Model to interpret these findings, this study suggests that health care providers need to know what older adults expect when they contemplate social support and what they perceive when they are recovering.

Findings from this research may lead to additional intervention strategies for prevention of and intervention with individuals who are experiencing loneliness. Social work practice, education, research, and policy may all be influenced by the findings of this study. The findings provide an understanding of why loneliness differs between settings and what social support may do to reduce the loneliness individuals experience.