The Dangers of Loneliness: Findings from a Study among Appalachian Elders

By Sylvia Foley, AJN senior editor

Arrow and mountains by taberandrew, via Flickr

Arrow and mountains by taberandrew, via Flickr

Writing for AJN in 1955, Hildegard Peplau described the complexities of loneliness, observing that “often loneliness is not felt; instead the person has a feeling of unexplained dread, of desperation, or extreme restlessness.”  Fast-forward to 2009: nurse researchers Laurie Theeke and Jennifer Mallow wanted to better understand the health implications of loneliness, and decided to conduct a study. This month’s original research CE, “Loneliness and Quality of Life in Chronically Ill Rural Older Adults,” reports on a data analysis of their findings.

One of the most striking findings was that 97% of the sample reported significant loneliness, an extremely high prevalence rate. Here’s a quick overview of the study:

Background: Loneliness is a contributing factor to various health problems in older adults, including complex chronic illness, functional decline, and increased risk of mortality.

Objectives: A pilot study was conducted to learn more about the prevalence of loneliness in rural older adults with chronic illness and how it affects their quality of life. The purposes of the data analysis reported here were twofold: to describe loneliness, chronic illness diagnoses, chronic illness control measures, prescription medication use, and quality of life in a sample of rural older adults; and to examine the relationships among these elements.

Methods: A convenience sample of 60 chronically ill older adults who were community dwelling and living in Appalachia was assessed during face-to-face interviews for loneliness and quality of life, using the UCLA Loneliness Scale and the CASP-12 quality of life scale. Chronic illness diagnoses, chronic illness control measures, and medication use data were collected through review of participants’ electronic medical records.

Results: Overall mean loneliness scores indicated significant loneliness. Participants with a mood disorder such as anxiety or depression had the highest mean loneliness scores, followed by those with lung disease and those with heart disease. Furthermore, participants with mood disorders, lung disease, or heart disease had significantly higher loneliness scores than those without these conditions. Loneliness was significantly related to total number of chronic illnesses and use of benzodiazepines. Use of benzodiazepines, diuretics, nitrates, and bronchodilators were each associated with a lower quality of life.

Conclusions: Nurses should assess for loneliness as part of their comprehensive assessment of patients with chronic illness. Further research is needed to design and test interventions for loneliness.

Theeke and Mallow stress the need for routine assessment of all older adults. They describe how nurses can use the Three-Item Loneliness Scale (a shorter version of the UCLA scale), which asks simply:

  • “How often do you feel that you lack companionship?”
  • “How often do you feel left out?”
  • “How often do you feel isolated from others?”

“Loneliness is treatable,” the authors conclude. Nurses who recognize this and respond proactively “may be able to prevent significant adverse physical and psychological outcomes for patients.”

To learn more, read the article and listen to the podcast, both free online. And if you’ve cared for people whose health seems affected by loneliness, we’d love to hear your stories and thoughts in the comments.


2017-07-27T14:50:14+00:00 September 4th, 2013|nursing research|3 Comments

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  2. mmcs1998 September 4, 2013 at 1:29 pm

    I too enjoyed the article and would like to see more about the solutions and not treatment with antidepressive meds. I believe that the focus on physical rehab should be secondary to emotional and spiritual rehab.

  3. Nursing Research (@NursingResearch) September 4, 2013 at 9:32 am

    It was my pleasure to write this article with Dr. Mallow for AJN. I would like readers to specifically note that loneliness is linked to functional decline and even mortality in the most recent literature. As a discipline, I think that Nursing is perfectly positioned to do something about it!

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