Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Risk Factors Associated with Loneliness in the Elderly Living Alone

독거노인의 외로움에 영향을 미치는 위험요인

  • Lee, Seung Woo (Department of Psychiatry, College of Medicine, Dankook University) ;
  • Paik, Ki Chung (Department of Psychiatry, College of Medicine, Dankook University) ;
  • Lee, Kyung Kyu (Department of Psychiatry, College of Medicine, Dankook University) ;
  • Lee, Seok Bum (Department of Psychiatry, College of Medicine, Dankook University) ;
  • Kim, Kyung Min (Department of Psychiatry, College of Medicine, Dankook University) ;
  • Kim, Dohyun (Department of Psychiatry, College of Medicine, Dankook University) ;
  • Lee, Jung Jae (Department of Psychiatry, College of Medicine, Dankook University)
  • 이승우 (단국대학교 의과대학 정신의학교실) ;
  • 백기청 (단국대학교 의과대학 정신의학교실) ;
  • 이경규 (단국대학교 의과대학 정신의학교실) ;
  • 이석범 (단국대학교 의과대학 정신의학교실) ;
  • 김경민 (단국대학교 의과대학 정신의학교실) ;
  • 김도현 (단국대학교 의과대학 정신의학교실) ;
  • 이정재 (단국대학교 의과대학 정신의학교실)
  • Received : 2019.10.04
  • Accepted : 2019.10.24
  • Published : 2019.12.31
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Abstract

Objectives : Loneliness is associated with negative mental and physical health. However, little is known about the risk factors of loneliness in the Korean elderly living alone. The aim of this study was to examine sociodemographic and social network related risks for loneliness among the elderly living alone. Methods : This is a cross-sectional study that enrolled 1,091 subjects who are the community-residing elderly living alone. Sociodemographic status, medical condition, cognition, mood disorder and levels of loneliness were collected using a self-administered questionnaire and a specific semi-structured interview conducted by a trained nurse. Descriptive statistics were used to analyze data regarding sociodemographic variable and loneliness. Univariate and Multivariate regression analyses were applied to examine factors associated with loneliness. Results : The mean score of loneliness was 3.8 (SD=1.7). No family contact (standardized β=0.115, p<0.001), no religious attendance (standardized β=0.057, p=0.028), no gathering with friends (standardized β=0.088, p=0.001) and high score of Short for of Geriatric Depression Scale (standardized β=0.502, p<0.001) were significantly associated with high loneliness in the elderly living alone. Conclusions : Family function, social network and depressive mood could be significant risk factors for high loneliness in the elderly living alone. Public health promotion efforts to reduce loneliness should focus on improving family function, social network and decreasing depression.

연구목적 외로움은 정신 및 신체 건강과 관련이 있다고 알려져 있다. 하지만 우리나라에서 독거노인의 외로움에 영향을 주는 위험 요인에 대해서는 연구된 바가 거의 없다. 본 연구는 독거노인에서 외로움의 위험 요인을 확인하고자 하였다. 방 법 본 연구는 천안시에 거주하는 독거노인 1,091명을 대상자로 시행되었다. 훈련된 간호사외 면담과 외로움 척도, 인구사회학적 정보, 신체 건강상태(Cumulative illness rating scale, CIRS), 인지기능, 단축형 노인우울척도(SGDS-K) 등의 자가설문지를 통해 조사하였다. 통계분석은 인구학적 변인과 외로움 척도 간의 관계를 탐색하기 위해 기술적 통계분석을 시행하였으며 외로움과 관련된 위험 인자를 확인하기 위해 단변량 및 다중회귀분석을 사용하였다. 결 과 전체 대상자의 평균 외로움 척도 점수는 3.8 (SD=1.7)이었다. 가족과의 만남(standardized β=0.115, p<0.001), 종교(standardized β=0.057, p=0.028), 친교 활동(standardized β=0.088, p=0.001), SGDS-K 점수(standardized β=0.502, p<0.001)가 독거노인의 외로움에 유의한 영향을 주었다. 결 론 독거노인에게 가족관계, 종교 및 친교 활동, 우울증은 외로움의 위험요인이 될 수 있다. 독거노인의 외로움을 줄이기 위한 개입은 가족관계와 사회활동을 개선, 유지하고 우울증을 조기발견 및 치료하는데 초점을 맞추어야 할 것이다.

Keywords

References

  1. West AL, Cole S, Goodkind D, He W. 65+ in the United States: 2010. Washington, DC: U.S. Census Bereau;2014.
  2. Mischke J, Hagenkort-Rieger S, Preub S. Older people in Germany and the EU. Statistiches Bundesamt Wiesbaden; 2011.
  3. Korea Statistics. Korean Statistical Information Services: Household Projections [Internet]. Daejeon(KR): Statistics Korea; c2019 [cited 2019 Sep 11]. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1BZ0503&conn_path=I3.
  4. Redfors P, Isaksen D, Lappas G, Blomstrand C, Rosengren A, Jood K, Jern C. Living alone predicts mortality in patients with ischemic stroke before 70 years of age: a long-term prospective follow-up study. BMC neurology 2016;16:80-88. https://doi.org/10.1186/s12883-016-0599-y
  5. de Jong-Gierveld J, Van Tilburg T. Living arrangements of older adults in the Netherlands and Italy: Coresidence values and behaviour and their consequences for loneliness. Journal of Cross-Cultural Gerontology 1999;14:1-24. https://doi.org/10.1023/A:1006600825693
  6. de Jong-Gierveld J, Kamphuls F. The development of a Rasch-type loneliness scale. Applied Psychological Measurement 1985;9:289-299. https://doi.org/10.1177/014662168500900307
  7. Heinrich LM, Gullone E. The clinical significance of loneliness: a literature review. Clin Psychol Rev 2006;26:695-718. https://doi.org/10.1016/j.cpr.2006.04.002
  8. Chang EC, Wan L, Li P, Guo Y, He J, Gu Y, Wang Y, Li X, Zhang Z, Sun Y, Batterbee CN-H, Chang OD, Lucas AG, Hirsch JK. Loneliness and suicidal risk in young adults: does believing in a changeable future help minimize suicidal risk among the lonely? The Journal of Psychology 2017;151:453-463. https://doi.org/10.1080/00223980.2017.1314928
  9. Donovan NJ, Okereke OI, Vannini P, Amariglio RE, Rentz DM, Marshall GA, Johnson KA, Sperling RA. Association of higher cortical amyloid burden with loneliness in cognitively normal older adults. JAMA Psychiatry 2016;73:1230-1237. https://doi.org/10.1001/jamapsychiatry.2016.2657
  10. Donovan NJ, Wu Q, Rentz DM, Sperling RA, Marshall GA, Glymour MM. Loneliness, depression and cognitive function in older U.S. adults. International Journal of Geriatric Psychiatry 2017;32:564-573. https://doi.org/10.1002/gps.4495
  11. Leigh-Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N, Caan W. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health 2017;152:157-171. https://doi.org/10.1016/j.puhe.2017.07.035
  12. Pinquart M, Sorensen S. Gender differences in self-concept and psychological well-being in old age: a meta-analysis. J Gerontol B Psychol Sci Soc Sci 2001;56:P195-213. https://doi.org/10.1093/geronb/56.4.P195
  13. Essex MJ, Nam S. Marital status and loneliness among older women: the differential importance of close family and friends. Journal of Marriage and the Family 1987;49:93. https://doi.org/10.2307/352674
  14. Joo SS, Yoon SR. A comparative study on the general health between the couple and single aged. Journal of the Korea Gerontological Society 1993;13:55-62.
  15. Kim KT, Park BG. Life satisfaction and social support network of the elderly living alone. Journal of the Korea Gerontological Society 2000;20:153-168.
  16. Coyle CE, Dugan E. Social isolation, loneliness and health among older adults. Journal of Aging and Health 2012;24:1346-1363. https://doi.org/10.1177/0898264312460275
  17. Perissinotto CM, Covinsky KE. Living alone, socially isolated or lonely--what are we measuring? Journal of General Internal Medicine 2014;29:1429-1431. https://doi.org/10.1007/s11606-014-2977-8
  18. Kiecolt-Glaser JK, Glaser R, Cacioppo JT, Malarkey WB. Marital stress: immunologic, neuroendocrine, and autonomic correlates. Annals of the New York Academy of Sciences 1998;840:656-663. https://doi.org/10.1111/j.1749-6632.1998.tb09604.x
  19. Exline JJ. TARGET ARTICLE: Stumbling blocks on the religious road: fractured relationships, nagging vices, and the inner struggle to believe. Psychological Inquiry 2009;13:182-189. https://doi.org/10.1207/S15327965PLI1303_03
  20. Theeke LA. Predictors of loneliness in U.S. adults over age sixty-five. Archives of Psychiatric Nursing 2009;23:387-396. https://doi.org/10.1016/j.apnu.2008.11.002
  21. Yang K. Longitudinal loneliness and its risk factors among older people in England. Canadian Journal on Aging=La Revue Canadienne du Vieillissement 2018;37:12-21. https://doi.org/10.1017/S0714980817000526
  22. Cohen-Mansfield J, Hazan H, Lerman Y, Shalom V. Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights. International Psychogeriatrics 2016;28:557-576. https://doi.org/10.1017/S1041610215001532
  23. Domenech-Abella J, Lara E, Rubio-Valera M, Olaya B, Moneta MV, Rico-Uribe LA, Ayuso-Mateos JL, Mundo J, Haro JM. Loneliness and depression in the elderly: the role of social network. Social Psychiatry and Psychiatric Epidemiology 2017;52:381-390. https://doi.org/10.1007/s00127-017-1339-3
  24. Lykes VA, Kemmelmeier M. What Predicts Loneliness? Cultural Difference Between Individualistic and Collectivistic Societies in Europe: Journal of Cross-Cultural Psychology 2013;45:468-490. https://doi.org/10.1177/0022022113509881
  25. Zebhauser A, Baumert J, Emeny RT, Ronel J, Peters A, Ladwig KH. What prevents old people living alone from feeling lonely? Findings from the KORA-Age-study. Aging Mental Health 2015;19:773-780. https://doi.org/10.1080/13607863.2014.977769
  26. Song J, Jang S, Lim Y, Lee S, Kim S, Seol G. Factors affecting loneliness in community dwelling Korean elders. J Korean Acad Fundam Nurs 2007;14:371-388.
  27. De Jong-Gierveld J, Kamphuls F. The development of a Rasch-type loneliness scale. Applied Psychological Measurement 1985;9.
  28. De Jong-Gierveld J, Van Tilburg TG. A six-item scale for overall, emotional and social loneliness: Confirmatory tests on survey 2006.
  29. Kim TH, Jhoo JH, Park JH, Kim JL, Ryu SH, Moon SW, Choo IH, Lee DW, Yoon JC, Do YJ, Lee SB, Kim MD, Kim KW. Korean version of mini mental status examination for dementia screening and its' short form. Psychiatry Investig 2010;7:102-108. https://doi.org/10.4306/pi.2010.7.2.102
  30. Miller MD, Paradis CF, Houck PR, Mazumdar S, Stack JA, Rifai AH, Mulsant B, Reynolds CF, 3rd. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res 1992;41:237-248. https://doi.org/10.1016/0165-1781(92)90005-N
  31. Yesavage JA, Sheikh JI. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 1986;5:165-172. https://doi.org/10.1300/J018v05n01_09
  32. Bae JN, Cho MJ. Development of the Korean version of the Geriatric Depression Scale and its short form among elderly psychiatric patients. J Psychosom Res 2004;57:297-305. https://doi.org/10.1016/j.jpsychores.2004.01.004
  33. Leung GTY, de Jong Gierveld J, Lam LCW. Validation of the Chinese translation of the 6-item De Jong Gierveld Loneliness Scale in elderly Chinese. International Psychogeriatrics 2008;20:1262-1272. https://doi.org/10.1017/S1041610208007552
  34. de Jong Gierveld J, Van Tilburg T. The De Jong Gierveld short scales for emotional and social loneliness: tested on data from 7 countries in the UN generations and gender surveys. European Journal of Ageing 2010;7:121-130. https://doi.org/10.1007/s10433-010-0144-6
  35. Tijhuis MA, de Jong-Gierveld J, Feskens EJ, Kromhout D. Changes in and factors related to loneliness in older men. The Zutphen Elderly Study. Age and Ageing. 1999;28:491-495. https://doi.org/10.1093/ageing/28.5.491
  36. Jung S. Living arrangement and loneliness among elderly community residents. Korean Acad of Fam Social Work 2001.
  37. Lou VWQ, Ng JW. Chinese older adults' resilience to the loneliness of living alone: a qualitative study. Aging Mental Health 2012;16:1039-1046. https://doi.org/10.1080/13607863.2012.692764
  38. Bruce LD, Wu JS, Lustig SL, Russell DW, Nemecek DA. Loneliness in the United States: A 2018 national panel survey of demographic, structural, cognitive, and behavioral characteristics. American Journal of Health Promotion: AJHP 2019: 890117119856551.
  39. Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychology and Aging 2006;21:140-151. https://doi.org/10.1037/0882-7974.21.1.140
  40. Cacioppo JT, Hawkley LC, Thisted RA. Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychology and Aging 2010;25:453-463. https://doi.org/10.1037/a0017216
  41. Dahlberg L, Andersson L, McKee KJ, Lennartsson C. Predictors of loneliness among older women and men in Sweden: A national longitudinal study. Aging Mental Health 2015;19:409-417. https://doi.org/10.1080/13607863.2014.944091
  42. Zebhauser A, Hofmann-Xu L, Baumert J, Hafner S, Lacruz ME, Emeny RT, Doring A, Grill E, Huber D, Peters A, Ladwig KH. How much does it hurt to be lonely? Mental and physical differences between older men and women in the KORA-Age Study. Int J Geriatr Psychiatry 2014;29:245-252. https://doi.org/10.1002/gps.3998