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OBJECTIVES: Loneliness arises from a discrepancy between the relationships one desires and those one experiences. This study examines the relative importance of relationship quantity and quality for loneliness in older adults.

METHOD: The study was a cross-sectional, representative survey of 474 adults aged 77 and above living in Dalarna, Sweden. Loneliness was measured using the three-item UCLA Loneliness Scale. Four ordinal logistic regression models of loneliness were developed: one for quantity of relationships and three for quality of relationships (closeness; conflict; closeness and conflict combined). Perceived social support was included in the quality models.

RESULTS: The quality models explained the most variance in loneliness and had better model fit. Having a partner was associated with less loneliness, even when there was conflict. Having a close relationship with children was associated with less loneliness, but a lack of closeness or the presence of conflict was associated with more loneliness. Perceived social support was associated with less loneliness.

CONCLUSION: Quantity and quality of relationships are both associated with loneliness in older adults, but relationship quality appears to have greater importance. Specific types of relationships are also relevant, highlighting the need to consider relationship dynamics when designing interventions to reduce loneliness.

Loneliness refers to the negatively perceived mismatch between one’s desired and actual engagement in social relations. Besides the individual suffering it implies, epidemiological evidence has suggested that loneliness is a critical determinant of mental health in late life. In this chapter, we provide definitions, operationalisations, prevalence estimates, and risk factors of loneliness in older people. Further, we summarise epidemiological evidence on the association between loneliness and depression, anxiety, suicide, and cognitive disorders and cover their potential underlying mechanisms. Despite an existing link between loneliness and mental health disorders, more evidence is needed to disentangle causality, bidirectionality and underlying mechanisms. Last, we discuss intervention strategies to reduce loneliness in older adults, focusing on their individual goals, challenges, and potential future development, as well as on the importance of inclusive communities and neighbourhoods. Interventions to facilitate social interactions and improve one’s social cognition seem promising yet challenging to implement and assess. Addressing loneliness remains a critical task to promote health in an ageing society.

Introduction Loneliness and social isolation are public health concerns. This study aimed to examine levels and trends in loneliness and social isolation among older adults (77+ years) in Sweden, assess subgroup variations, and determine associations between loneliness and social isolation.

Methods The 1992, 2002, 2004, 2011, 2014 and 2021 waves of the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) were analysed through ordered logistic and linear regressions.

Results On average, 12.5 percent of the participants experienced loneliness often/nearly always, while 6 percent were categorised as severely isolated. Loneliness and social isolation were more common in women, those aged 85+, and persons with basic education, in psychological distress or with mobility limitations. Loneliness was also associated with living alone. No increases in loneliness or isolation were identified; instead, loneliness tended to decrease in groups already experiencing lower levels of loneliness. Loneliness and social isolation were moderately associated each survey year.

Discussion This study challenges perceptions of high and increasing levels of loneliness and social isolation. Given the impact on health and wellbeing and the ageing of populations, policy and practice should still address these issues and target vulnerable groups. Subgroup analyses in trends are scarce and should be explored further in future research.

Informal caregivers play a crucial role in the care of individuals with dementia, and their caregiving may significantly impact their own health and well-being. This cross-sectional survey study focuses on the perceived importance of various types and characteristics of formal support in a convenience sample of caregivers aged 65 years or older (N = 175) caring for a spouse with dementia. Participants completed a questionnaire containing 17 items describing different types of support and 12 items describing different characteristics of support, rating their importance. The questionnaire also contained questions on various caregiving-related factors. Principle components analysis (PCA) was carried out on the importance ratings, separately, on the types of support items and the characteristics of support items. Each PCA produced three components. For types of support, they were Proficiency and Opportunity, Supportive Structures, Flexible Counselling. For characteristics of support, they included Respectful and Competent, Timely Support, and Accessible and Acceptable. The three characteristics of the support components all had higher mean importance ratings than the three types of support components. The content of some components indicated that while spouse caregivers rate support for their caregiving needs as important, they may not always differentiate their own needs from those of their partner with dementia. The negative impact of caregiving was the factor most strongly and consistently associated with the components' importance ratings. This study emphasizes the need for health and social care providers to address the unique needs of spouse caregivers while simultaneously ensuring the delivery of quality care for individuals with dementia.

There is an increasing recognition of the impact of built environment in the neighbourhood on healthy ageing, especially in the context of ageing in place. This study examines perceptions of third place and its potential value for mitigating loneliness in older adults. Thirty participants aged 65-89, living in ordinary housing across three neighbourhoods in the city of Stockholm, Sweden, conducted the interview-based sorting procedures, namely, Multiple Sorting Tasks (MST). In each individual MST procedure, the participant was asked to sort twenty pictures into groups using his or her own categories. The data were analysed using Multidimensional Scalogram Analysis, integrating qualitative data input and quantitative statistical analysis of the categorisations. Accessible local third places, which facilitate physical activities (especially walking) and community building (meaningful social connections) and provide options for food (a medium for social interactions), were seen as vital resources to combat loneliness. Thus, these places are supportive built environment elements of healthy ageing and ageing in place. The management aspect in third places operated by municipalities, including designing diverse public programs and services, and the service mentality of the staff members play an important role in making these places feel safe, at home, and potentially lessen the experience of loneliness to some extent. This study adds an urban design and planning perspective that can be integrated into environmental approaches to combat loneliness among older adults living in the community.

INTRODUCTION: Persons with dementia experience time-related problems, but there is a lack of instruments evaluating their time processing ability and daily time management. This study aimed to evaluate the psychometric properties of the instruments KaTid®-Senior measuring time processing ability, and Time-S© Senior and Time-Proxy© measuring daily time management for persons with dementia.

METHODS: Persons with dementia (n = 53) and their significant others (n = 49) participated in the study. Rasch analyses were used to evaluate the instruments' rating scale functioning; internal scale validity; person-response validity; unidimensionality; person-separation reliability; and internal consistency. Versions excluding items with poor fit to the Rasch model were also evaluated.

RESULTS: Overall, the Rasch analyses showed acceptable psychometric properties. All instruments met the criteria for unidimensionality and the reliability was good. More challenging items should be added in KaTid-Senior for better targeting of persons with mild dementia. Person-response validity issues in Time-S Senior need to be addressed.

CONCLUSION: The instruments can validly and reliably be used to assess time processing ability and daily time management in persons with dementia in clinical research and healthcare settings. In turn, this can contribute to the development of methods to compensate for impaired time processing ability and daily time management. The assessments can also increase the possibility of early detection of impaired time processing ability and daily time management, thereby facilitating adequate timing of interventions and enhanced occupational performance.