Psycho-social and health predictors of loneliness in older primary care patients and mediating mechanisms linking comorbidities and loneliness.

BACKGROUND: Aging is associated with many personal, social, and environmental challenges that increase the risk of loneliness. Loneliness is a painful emotional experience associated with a perceived lack of connection and intimacy. Loneliness accelerates health deterioration, but the presence of chronic health conditions (comorbidities) in older individuals may potentiate the feeling of loneliness. The relationships between health status and loneliness in older individuals have not been assessed in an integrated manner, although it is necessary for planning efficient interventions. The aim of this study was to fill in this knowledge gap, by attempting to create an integrated model of loneliness in older individuals. METHODS: The sample consisted of 189 (58% F) older individuals (> 60 years) (mean ± SD, 78.47 ± 6.65), attendees in Primary Health Care. Different factors associated with loneliness in the older population were assessed, and classified as demographic, environmental, physical (health-related), and psychological, in addition to functional abilities. A set of standard questionnaires was used to assess psychological factors and functional abilities. The hierarchical regression model assessed the effect of particular blocks of factors on status loneliness. The second aim was to analyze how psychological factors mediate associations between health status (comorbidity level) and loneliness. RESULTS: Indicated that increasing comorbidity, anxiety, lack of positive moods, not having hobbies/activities, low perception of social support, impaired cognitive function, and suppression of emotion expression, are significant predictors of loneliness. Mediation analysis informed us of how to help patients with comorbidities feel less lonely. Interventions that were suggested were those that can reduce anxiety and depression, improve cognitive abilities and emotional regulation control, and enhance social support. CONCLUSIONS: Results can help understand the pathophysiology loops linking poor health status (comorbidity level) of older individuals and loneliness, and have significant potentials from the translational perspectives, as a decision-support tool.

Efforts in fighting against cancer in Croatia have to be focused on the primary health care.

This manuscript is a comprehensive review of the long-lasting tradition and the state-of-the-art in the prevention and early detection of cancer in Croatia. Compared with other European countries, Croatia holds a high and unfavourable position in cancer morbidity and mortality. Global experience in implementation of national programmes for the early detection of cancer clearly shows that such approach is the most successful and in the long-term the least expensive method for fighting against cancer. In Croatia, numerous separate actions in cancer care have been taken, but never systematically, nor included in a health care policy. The National Programme for the Prevention and Early Detection of Cancer of the common localizations for which effective screening tests are available (breast, uterine cervix, colon and prostate) has recently been launched. Local long-standing experience of the Osijek-Baranja County in implementation of programmes of cancer care contributed significantly to these initiatives. In this review, draft National Programme and the early results of its implementation were presented. In addition, preparations for the research project "Model of early cancer detection integrated in a practice of family physician", recently set up by the Department of Family Medicine of the School of Medicine, University of Osijek, were described. In this project, the programme of the early detection of cancer in which family physicians take responsibility for the programme implementation is suggested. Possible advantages of this model, compared with the model proposed by the National Programme, centrally directed and mostly supplied by the public services, are pointed out.