Loneliness in assisted living facilities: An exploration of the group process.

BACKGROUND: More than one in three older people in assisted living facilities suffer from loneliness that leads to adverse health outcomes. Group work may have the potential to improve residents' quality of life. AIMS/OBJECTIVES: The purpose of this feasibility study was to thoroughly describe a facilitated group process and compare its effects on cognitively impaired (n = 6) and cognitively intact (n = 7) lonely resident groups in assisted living facilities. MATERIAL AND METHODS: We used a closed, occupational therapy-oriented group model designed for lonely people. The study used a qualitative, multi-method approach. Material included individual and focus group interviews, observations and the facilitators' field diaries. RESULTS: Loneliness was reflected in diverse ways in both groups. Meaningful activities in mutual interaction played an important role in empowering the participants and enabling the development of the group process. Group processes had similar, parallel steps, from which the participants seemed to benefit. Surprisingly, the cognitively impaired group progressed towards self-direction more quickly than the cognitively intact group. CONCLUSIONS: A group process with clearly progressing steps revealed that lonely older people are capable of empowerment and self-direction - despite their frailty and cognitive impairment. Facilitators should be familiar with group processes to enable them to progress effectively.

Longitudinal changes in functional capacity: effects of socio-economic position among ageing adults.

INTRODUCTION: Health and functional capacity have improved especially in Western countries over the past few decades. Nevertheless, the positive secular trend has not been able to decrease an uneven distribution of health. The main aim of this study was to follow-up changes in functional capacity among the same people in six years time and to detect whether the possible changes vary according to socio-economic position (SEP). In addition, it is of interest whether health behaviours have an effect on these possible changes. METHODS: This longitudinal follow-up study consisted of 1,898 individuals from three birth cohorts (1926-1930, 1936-40, 1946-50) who took part in clinical check-ups and answered to a survey questionnaire in 2002 and 2008. A sub-scale of physical functioning from the RAND-36 was used to measure functional capacity. Education and adequacy of income were used as indicators of socio-economic position. Repeated-measures ANOVA was used as a main method of analysis. RESULTS: Physical functioning in 2002 and 2008 was poorest among those men and women belonging to the oldest cohort. Functional capacity deteriorated in six years among men in the oldest cohort and among women in all three cohorts. Socio-economic disparities in functional capacity among ageing people existed. Especially lower adequacy of income was most consistently associated with poorer functional capacity. However, changes in functional capacity by socio-economic position remained the same or even narrowed independent of health behaviours. CONCLUSION: Socio-economic disparities in physical functioning are mainly incorporated in the level of functioning at the baseline. No widening socioeconomic disparities in functional capacity exist. Partly these disparities even seem to narrow with ageing.

Self-rated health and social capital among aging people across the urban-rural dimension.

BACKGROUND: Previous studies have found self-rated health to be associated with social capital. However, there is lack of studies examining social capital among aging people and its impact on self-rated health in the urban-rural context. PURPOSE: The purpose of this study was to investigate associations between self-rated health and indicators of social capital (trust, various social contacts, social participation, and access to help) among aging people living in urban and rural areas in Finland. METHOD: A postal survey was conducted in 2002 among men and women born in 1926-1930, 1936-1940, or 1946-1950 and dwelling in 14 municipalities in the Päijät-Häme hospital district in Finland. A total of 2,815 participants represented 66% of the original stratified (by age, gender, and municipality) sample. Logistic regression analyses were used to examine the associations. RESULTS: Active social participation and easy access to help from others were associated with good self-rated health, especially in the urban and sparsely populated rural areas. Trust was a particularly important correlate of subjective health in the urban area, though its significance diminished after adjusting to all background variables. No overall disparities in self-rated health between the areas emerged. Social participation and access to help as indicators of social capital seem to be important resources when aging men and women assess their subjective health. CONCLUSION: Increasing efforts to encourage social participation and facilitate access to help from other persons should be included among the key priorities in community health promotion.

Social participation, trust and self-rated health: a study among ageing people in urban, semi-urban and rural settings.

This study examined associations between self-rated health and combinations of social participation and trust among ageing people in three living areas of Finland (N=2815, 66% response rate). Social participation and trust combinations were: low social capital (low participation/low trust), traditionalism (low/high), "the miniaturisation of community" (high/low) and high social capital (high/high). The highest rate of good self-rated health was found among the high social capital group, but after adjusting for background variables, statistical significance remained only in the urban area. High social capital measured at an individual level may thus promote health among ageing people.

Rural-urban differences in health and health behaviour: a baseline description of a community health-promotion programme for the elderly.

STUDY OBJECTIVE: To (1) describe the setting and design of the Good Ageing in Lahti Region (GOAL) programme; (2) by using the baseline results of the GOAL cohort study, to examine whether living in urban, semi-urban, or rural communities is related to risk factors for chronic diseases and functional disability in ageing individuals. DESIGN: The baseline data of a cohort study of ageing individuals living in three community types (urban, semi-urban, rural). Data were collected by two questionnaires and laboratory assessments. SETTING: Fourteen municipalities in the Lahti region (Päijät-Häme County) in Finland. PARTICIPANTS: A regionally and locally stratified random sample of men and women born in 1946-50, 1936-40, and 1926-30. A total of 4,272 were invited and 2,815 (66%) participated. MAIN RESULTS: Elevated serum cholesterol, obesity, disability, sedentary lifestyle (<2 times/week walking), and high fat intake were more prevalent in rural vs. urban and semi-urban communities. After adjustment for sex, age, education, obesity, diet, physical activity, smoking, and alcohol use, rural communities remained the only community type with increased (p<0.05) probability for high BMI (OR 1.33) and high waist circumference (OR 1.43). CONCLUSIONS: The unfavourable health and lifestyle profile, together with an old population, makes health promotion for elderly citizens a special challenge for rural communities such as those in Päijät-Häme County, Finland. Most, if not all, of the differences in health between the three community types were explained by educational background, physical activity, and smoking.

Contacts between elderly parents and their children in four European countries: current patterns and future prospects.

Frequency of contacts with the family is an indicator of the strength of intergenerational exchange and potential support for older people. Although the availability of children clearly represents a constraint on potential family support, the extent of interaction with and support received from children depends on factors other than demographic availability alone. This study examined the effects of socio-economic and demographic variables on weekly contacts with children in Great Britain, Italy, Finland and The Netherlands using representative survey data which included information on availability of children and extent of contact. Our results confirm the higher level of parent adult-child contact in Italy than in northern European countries, but levels of contact in all the countries considered were high. Multivariate analysis showed that in most countries characteristics such as divorce were associated with a reduced probability of contact between fathers and children; in Finland this also influenced contact between mothers and children. Analyses are also included of possible future scenarios of contact with children that combine the observed effects of the explanatory variables with hypothetical changes in population distribution.