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Background: Today’s older people drink more alcohol than earlier cohorts of older people. Social integration has been identified as an important factor for older people’s drinking, but the association is complex. This study investigates both high and low levels of social integration and their associations with longitudinal patterns of alcohol consumption among older women and men.

Methods: Longitudinal nationally representative data of older Swedish women and men aged over 65 – the Swedish Level of Living Survey (LNU) and Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) – from 2010/2011 and 2014 (n = 1048). Associations between social contacts and social activities at baseline and longitudinal patterns of drinking frequency were examined with multinomial logistic regression analyses. Results: Men reported drinking alcohol more often than women, but the most common drinking frequency among both women and men was to drink monthly or less. Drinking habits were generally stable over time. People with high levels of social activity at baseline were more likely to have a stable daily or weekly drinking frequency or increased drinking frequency over the four-year follow-up period, particularly women. People with low levels of social contacts and/or social activities were less likely to have a stable daily or weekly drinking frequency, compared to people in the low and stable drinking frequency group.

Conclusions: Alcohol consumption is embedded in a social context, older people drink in social situations and social integration predicts continued drinking patterns.

Social exclusion is complex and dynamic, and it leads to the non-realization of social, economic, political or cultural rights or participation within a society. This critical review takes stock of the literature on exclusion of social relations. Social relations are defined as comprising social resources, social connections and social networks. An evidence review group undertook a critical review which integrates, interprets and synthesizes information across studies to develop a conceptual model of exclusion from social relations. The resulting model is a subjective interpretation of the literature and is intended to be the starting point for further evaluations. The conceptual model identifies individual risks for exclusion from social relations (personal attributes, biological and neurological risk, retirement, socio-economic status, exclusion from material resources and migration). It incorporates the evaluation of social relations, and the influence of psychosocial resources and socio-emotional processes, sociocultural, social-structural, environmental and policy contextual influences on exclusion from social relations. It includes distal outcomes of exclusion from social relations, that is, individual well-being, health and functioning, social opportunities and social cohesion. The dynamic relationships between elements of the model are also reported. We conclude that the model provides a subjective interpretation of the data and an excellent starting point for further phases of conceptual development and systematic evaluation(s). Future research needs to consider the use of sophisticated analytical tools and an interdisciplinary approach in order to understand the underlying biological and ecopsychosocial associations that contribute to individual and dynamic differences in the experience of exclusion from social relations.

An inclusive neighbourhood is a key facilitator enabling older adults to age in place. Neighbourhoods have been identified as a dimension of social exclusion important to older adults, and it has been argued that older adults are particularly vulnerable to neighbourhood change. The aim of this study was to explore older adults’ experiences of neighbourhood exclusion within the context of neighbourhood change. Focus groups were undertaken in the urban and rural areas of a metropolitan borough in England involving a total of 41 older adults, with data analysed via thematic analysis. Urban areas in the borough studied have transformed following the closure of the mining industry, with a high level of deprivation in many areas, while some rural areas have undergone gentrification. Within the context of structural neighbourhood change, four themes were identified: community cohesion, political agency, feelings of safety and the physical environment. The themes were interlinked, which calls for collaboration across traditional lines of professional responsibility, and for research that encompasses different aspects of neighbourhood exclusion. This study contributes with knowledge on older adults’ experiences of exclusion, including novel findings on the importance of political agency and collective memory, and identifies actions to combat exclusion. An active involvement of older adults in the development of initiatives to tackle social exclusion is recommended.

It is important to identify factors associated with loneliness in older people if effective policies and strategies to prevent and reduce loneliness are to be developed. In this presentation two studies that identify factors associated with loneliness in old age are reported. Strengths and weaknesses of the studies, which differ in design and focus, shed light on issues of importance for future studies on loneliness.

The first study was based on data from two waves of SWEOLD, a Swedish longitudinal national survey study (N=613). It aimed to examine the extent to which older people (70+) report feelings of loneliness with a focus on changes in loneliness over time, and on factors predicting loneliness in women and men, respectively. This study showed that older people moved in and out of loneliness over time, but there was a general increase in loneliness as they aged. It also identified gender differences in both incidence and risk factors.

The second study was based on data from the Barnsley Social Exclusion in Old Age Study, an English cross-sectional community survey (N=1255), and aimed to identify risk factors for social and emotional loneliness in older people (65+). This study identified different, as well as shared, risk factors for social and emotional loneliness, thereby providing further empirical support for the conceptual separation of emotional and social loneliness.

Taken together, these studies demonstrate the importance of: 1) longitudinal research in order to determine risk factors for loneliness; 2) considering women and men separately; and 3) looking at social and emotional loneliness separately. These approaches in combination will aid the development of effective interventions to reduce loneliness in the older population and to ensure those interventions are targeted at the appropriate groups.

Responses to the COVID-19 pandemic in terms of physical distancing risk collateral damage such as increased loneliness. Older adults have been identified as being at higher risk of poor outcomes if infected and in many countries have been subjected to greater restrictions on physical contacts with others. Most research so far points towards an increase in loneliness during the pandemic. However, there has been a lack of prospective studies based on representative samples of older adults, with the oldest old, older adults with low or no Internet usage, and those in poor health currently underrepresented. Despite the significance of cultural norms for individuals' standards for social relations and, thus, the experience of loneliness, there has been a lack of comparative research on loneliness in older adults during the pandemic. Reviews have found little evidence for what interventions and what elements of interventions are effective in reducing loneliness. There is potential for social relations to be maintained via technology-based solutions, although there is a risk of excluding older adults with limited resources who are both least likely to use technology and most vulnerable to loneliness. Furthermore, remote social contacts cannot fully compensate for the loss of physical contacts. Where stay-at-home orders are not imposed, supporting neighbourliness and the community use of accessible open spaces are other options. Finally, policy responses to the pandemic need to be more nuanced and non-ageist in order to avoid unnecessary increases in loneliness in older adults.

Responses to the COVID-19 pandemic in terms of physical distancing risk collateral damage such as increased loneliness. Older adults have been identified as being at higher risk of poor outcomes if infected and in many countries have been subjected to greater restrictions on physical contacts with others. Most research so far points towards an increase in loneliness during the pandemic. However, there has been a lack of prospective studies based on representative samples of older adults, with the oldest old, older adults with low or no Internet usage, and those in poor health currently underrepresented. Despite the significance of cultural norms for individuals’ standards for social relations and, thus, the experience of loneliness, there has been a lack of comparative research on loneliness in older adults during the pandemic. Reviews have found little evidence for what interventions and what elements of interventions are effective in reducing loneliness. There is potential for social relations to be maintained via technology-based solutions, although there is a risk of excluding older adults with limited resources who are both least likely to use technology and most vulnerable to loneliness. Furthermore, remote social contacts cannot fully compensate for the loss of physical contacts. Where stay-at-home orders are not imposed, supporting neighbourliness and the community use of accessible open spaces are other options. Finally, policy responses to the pandemic need to be more nuanced and non-ageist in order to avoid unnecessary increases in loneliness in older adults. © 2024 selection and editorial matter, André Hajek, Steffi G. Riedel-Heller and Hans-Helmut König; individual chapters, the contributors.

Introduction: Social exclusion has been defined as “a process whereby certain individuals are pushed at the edge of society and prevented from participating fully” (Council of the European Union, 2004: 8). Loneliness is a central aspect of social exclusion, which has been found to be detrimental to physical and mental health. Objectives: This paper presents data from the second, quantitative phase of a study examining how and to what extent older people are socially excluded, factors leading to social exclusion, and how social exclusion can be prevented/reduced. This presentation will focus on the data on loneliness. Methods: A questionnaire survey was undertaken, administered face-to-face with a random sample of 1,255 older people, half of whom lived in former industrial areas and half in rural areas. The study was conducted in Barnsley Metropolitan Borough, England. Among the many variables measured in the survey, loneliness was measured using a scale developed by de Jong-Gierveld and Kamphuis (1985). Results: Forty-six percent of the respondents experienced some level of loneliness, i.e. they were either moderately (38%), severely (5%) or very severely (3%) lonely. There was no significant difference between former industrial and rural areas regarding prevalence of loneliness, but, emotional loneliness was more common in former industrial areas than in rural areas. There was no significant association between loneliness (emotional, social, total) and length of stay at current address, area of residence, or gender. Amongst respondents aged 80 years or older, the proportion of lonely people was 55%, compared to 42% of those under the age of 80. This association is explained by civil status, as the level of loneliness amongst widows was 56% compared to 38% amongst non-widows, and when controlling for widowhood, there was no significant association between loneliness and age. There was also an association between loneliness and living alone. Conclusions: Loneliness becomes more common as people age, but should be understood as a consequence of becoming a widow and living alone rather than ageing per se.

Previous research has shown that different providers of social welfare tend to provide complementary services at a local level, but that there is no complete task specialisation. This means that elements of complementarity theory are challenged, especially the so-called 'principle of matching', i.e. that actors only undertake tasks which match their characteristics. The aim of the present study was to explore complementarity between Swedish local authorities and voluntary organisations in their support for relatives of older people. Interviews were carried out with 55 politicians, civil servants and representatives of voluntary organisations drawn from four municipalities. These municipalities were selected from a sampling frame that ensured representation of different combinations of high and low levels of voluntary and statutory services. Qualitative analysis of interview transcripts showed that, while local authorities are seen as responsible for the support for relatives, voluntary organisations are expected to be complementary, offering 'the icing on the cake', i.e. social support and activities which are regarded as less demanding. Overall, substantial support for a norm of complementarity was found. It is argued that, if those who are active in social policy and voluntary work at a local level agree with the ideal of complementarity, this will influence their wish to arrange activities and services. Therefore, the complementarity norm - rather than the principle of matching - influences the outcome in terms of service provision.

To live with feelings of loneliness has negative implications for quality of life, health and survival. This study aimed to examine changes in loneliness among older people, both with regard to prevalence rates, and socio-demographic, social and health-related correlates of loneliness. This study had a repeated cross-sectional design and was based on the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Analyses of trends in loneliness covered the years 1992, 2002, 2004, 2011 and 2014, and included people aged 77 years or older (n=2 572). Analyses of correlates of loneliness covered 2004 and 2014, and included people aged 70 years or older (n=1 962). Logistic regression analyses were conducted with findings presented as average marginal effects. Contrary to what is often assumed, there has been no increase in loneliness among older people over time (1992-2014). Regression analyses for 2004 and 2014 showed that social and health-related correlates were more strongly associated with loneliness than socio-demographic correlates. Psychological distress was most strongly associated with loneliness, followed by widowhood. Most associations between the correlates and loneliness were stable over time.

Objective

To examine the relationship between social factors and planned and unplanned hospital admissions among older people.

Data Sources/Study Setting

2011 data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and data from the Swedish National Patient Register until December 31, 2012.

Study Design

The study had a prospective design. Data were analyzed via Cox proportional hazard regressions with variables entered as blocks (social factors, sociodemographic and ability factors, health factors).

Data Collection

Data were collected via interviews with people aged 76+ (n = 931).

Principal Findings

Living in institutions was negatively associated with planned admissions (hazard ratio (HR): 0.29; confidence interval (CI): 0.09–0.88), while being in receipt of home help was positively associated with unplanned admissions (HR: 1.57; CI: 1.15–2.14). Low levels of social contacts and social activity predicted unplanned admissions in bivariate analyses only. Higher ability to deal with public authorities was positively associated with planned admissions (HR: 1.77; CI: 1.13–2.78) and negatively associated with unplanned admissions, although the latter association was only significant in the bivariate analysis.

Conclusions

Hospital admissions are not only due to health problems but are also influenced by the social care situation and by the ability to deal with public authorities.

Objectives: There is a general lack of longitudinal research on loneliness in old age. Drawing on life course theory and the convoy model, this study aimed to examine whether there is an association between loneliness in old age and social engagement 20 years earlier.

Method: Data from the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (2002 and 2011 data collection waves) and the Swedish Level of Living Survey (1981 and 1991 data collection waves) were used, including 823 individuals with an average age of 82.4 years at follow-up.

Results: Each form of social engagement in old age was associated with the same form of social engagement 20 years earlier. Close forms of social engagement were negatively associated with loneliness in old age; as were more distant forms of social engagement, but only when they were considered solely in old age.

Conclusion: Patterns of social engagement in old age were established at least 20 years earlier. Close forms of social engagement are long-term predictors of loneliness, although current social engagement tended to be more influential on loneliness. The study underlines the importance of interventions targeted at close relationships that can provide social support in old age.

Objectives: Longitudinal research on loneliness in old age has rarely considered loneliness separately for men and women, despite gender differences in life experiences. The objective of this study was to examine the extent to which older women and men (70C) report feelings of loneliness with a focus on: (a) changes in reported loneliness as people age, and (b) which factors predict loneliness.

Method: Data from the 2004 and 2011 waves of SWEOLD, a longitudinal national survey, was used (n D 587). The prediction of loneliness in 2011 by variables measured in 2004 and 20042011 variable change scores was examined in three logistic regression models: total sample, women and men. Variables in the models included: gender, age, education, mobility problems, depression, widowhood and social contacts.

Results: Older people moved into and out of frequent loneliness over time, although there was a general increase in loneliness with age. Loneliness at baseline, depression increment and recent widowhood were significant predictors of loneliness in all three multivariable models. Widowhood, depression, mobility problems and mobility reduction predicted loneliness uniquely in the model for women; while low level of social contacts and social contact reduction predicted loneliness uniquely in the model for men.

Conclusion: This study challenges the notion that feelings of loneliness in old age are stable. It also identifies important gender differences in prevalence and predictors of loneliness. Knowledge about such differences is crucial for the development of effective policy and interventions to combat loneliness in later life.

Objectives: To examine the extent to which older women and men (70+) report feelings of loneliness with a focus on: a) changes in reported loneliness as people age, and b) which factors predict loneliness.

Methods: Data from the 2004 and 2011 waves of SWEOLD, a longitudinal national survey study, was used. The prediction of loneliness in 2011 by data collected in 2004 was examined in three logistic regression models for the total sample (n=587), for women and for men.

Results: Older people moved in and out of frequent loneliness over time, but there was a general increase in loneliness as they aged. Recent widowhood and depression increment were associated with loneliness in both women and men. Loneliness, widowhood, depression and mobility problems measured in 2004 predicted loneliness uniquely in women in 2011; whereas low level of education and social contact reduction predicted loneliness uniquely in men.

Discussion: Loneliness is not always a stable condition, demonstrating the importance of longitudinal research. Gender differences in incidence and predictors make it important to look at women and men separately both when researching loneliness and when targeting interventions to prevent or reduce loneliness in older people.

Sweden is seen as a typical example of a social-democratic welfare regime, with universal and generous welfare policies. However, in the last decades, there have been substantial reductions in the Swedish provision of care for older people. This study aimed to examine trends in sources of care-receipt in older people (77+) living in their own home and with a perceived need of help with two specific tasks: house cleaning or food shopping. Trends in care-receipt were examined in relation to gender, living alone, having children and socioeconomic position. Data from the 1992, 2002 and 2011 data collection waves of the national study SWEOLD was used. Response rates varied between 86 and 95 per cent, and the sample represents the population well. Trends and differences between groups were explored in bivariate and logistic regression analyses. There was a reduction in formal care-receipt regarding house cleaning and food shopping over the study period. It was more common for women than men to receive formal care, and more common for men than women to receive informal care. Reductions in formal care have affected older women more than older men. Still, living alone was the most influential factor in care-receipt, associated with a greater likelihood of formal care-receipt and a lower likelihood of informal care-receipt. It can be concluded that public responsibility for care is becoming more narrowly defined in Sweden, and that more responsibility for care is placed on persons in need of care and their families.

Introduction: This paper presents data from a study examining how and to what extent older people are socially excluded, factors leading to social exclusion, and how social exclusion can be prevented/reduced. The data is drawn from the first qualitative phase of the study that explores the factors that older people report as causing social exclusion. Methods and materials: Older people were recruited within each of the five districts of Barnsley Metropolitan Borough, England, via networks established by Age Concern. All individuals recruited within a given district formed the membership of a focus group, with each of the five groups meeting on two separate occasions. A total of 40 older people participated. Discussions were guided by a topic schedule and analysed using the framework method. Results: Being active was seen as important for life satisfaction by all participants. However, not all participants were able to achieve a satisfactory level of activity and some reported being isolated and lonely. Contributing factors to low levels of activity were identified as depression, low self confidence and caring responsibilities. A minority of participants argued that lack of activity was the individual’s own fault. Analysis identified factors linked to social exclusion in general: deterioration in community spirit; fear of crime; life changing events such as retirement and widowhood; frailty; poor finances; transport; and accessibility including the physical environment. Conclusion: There was a consensus among older people that being active is central to preventing social exclusion. The data suggest a model of social exclusion in which many of the factors identified as related to social exclusion may act on an individual’s quality of life primarily through their effects on social activity levels. This model will be tested in the next stage of the study, a questionnaire survey of 1,200 older people in Barnsley.

This paper identifies variations in the age and gender characteristics of informal carers in the UK. The paper is based on the Individual Sample of Anonymous Records, a 3% random sample of the 2001 UK Census. The sample size was 1 825 595. Of this sample, 10% were reported to be carers. The analysis shows that informal caregiving is systematically linked with both age and gender. Caregiving increased with age until reaching a peak in the 45-59 age group, in which almost 20% were carers. Similarly, the amount of time spent caregiving increased with age, with the highest levels of caregiving commitment in people aged 80-89 years. Regarding gender, 11.3% of women were carers compared to 8.6% of men and overall women committed more time to caregiving than men. However, this pattern was reversed in later life (70+), where there was a higher proportion of carers and greater time commitment to caregiving amongst men. While the predominance of women as informal carers has been well reported, the importance of men as informal carers in old age is much less commented upon. This study thus suggests that informal caregiving is most prevalent in groups of the population that, according to previous research, may experience most strain from doing so: elderly people who may be frail and often are in a spousal relationship with the care-recipient, and middle-aged women with multiple roles. Therefore, it is of great importance that their particular needs and circumstances are fully taken into account both in the development of formal support and when information about available support is targeted.

Rapporten presenterar översikter av tidigare forskning och analyser av känslan av ensamhet bland äldre personer. Överlag finns det kunskap om ensamhetens konsekvenser för ohälsa, men det behövs ytterligare forskning där starkare slutsatser kan dras om sambandens riktning, och ett tydligare fokus på ensamhet i gruppen äldre personer. En systematisk översikt visar att det finns god kunskap om en del faktorer som ökar risken för ensamhet, men mer forskning behövs om andra potentiella riskfaktorer. Analyserna visar en relativt låg och stabil förekomst av ensamhet bland äldre personer i Norden, samt att ohälsa och olika indikatorer för social exkludering (t.ex. bristande sociala relationer, otillräcklig inkomst, samt otrygghet i närområdet) har samband med ensamhet. Slutligen konstateras att forskningen om nordiska interventioner för att minska ensamhet bland äldre personer är begränsad.

Practical Research and Evaluation is a handbook of social science research methods for practitioner-researchers. It enables readers to carry out research projects and evaluations; commission research and evaluation projects; and better understand research/evaluation reports. The book offers step-by-step guidance to different research approaches, both qualitative (for example interviews and focus groups) and quantitative (for example surveys). It encompasses recent developments such as Internet-based literature reviews, online surveys and tools for questionnaire design. The book covers the entire research/evaluation process: basic concepts; planning and design; proposal development and commissioning; ethical issues; execution; and dissemination. Practical Research and Evaluation will be particularly valuable for people who may have limited research experience or training, including people working for the public sector and voluntary organisations, academics, and undergraduate and postgraduate students. It is accessible, uses non-technical language, employs practice-based examples, and provides practical tips, checklists and suggested further reading throughout.

Objectives: Loneliness is an important influence on quality of life in old age, and has been conceptualised as consisting of two dimensions, social and emotional. This paper describes analyses that sought to produce models of social and emotional loneliness in older people, using demographic, psychological and health, and social variables.

Method: Older people (aged 65+, N=1255) from the Barnsley metropolitan area of the United Kingdom were recruited randomly from within a stratified sampling frame, and received a questionnaire-based interview (response rate: 68.1%). The questionnaire contained items and scales on demographic, psychological and health and social characteristics, and a validated measure of loneliness that assesses both social and emotional loneliness.

Results: Of the respondents, 7.7% were found to be severely or very severely lonely, while another 38.3% were moderately lonely. Social and Emotional Loneliness shared 19.36% variance. Being male, being widowed, low well-being, low self-esteem, low income comfort, low contact with family, low contact with friends, low Activity, low Perceived Community Integration, and receipt of community care were significant predictors of Social Loneliness (R=.50, R²=.25, F(18, 979)=18.17, p<.001). Being widowed, low well-being, low self-esteem, high activity restriction, low income comfort, and non-receipt of informal care were significant predictors of Emotional Loneliness (R=.55, R²=.30, F(18, 973)=23.00, p<.001).

Conclusion:  This study provides further empirical support for the conceptual separation of emotional and social loneliness. Consequently, policy on loneliness in older people should be directed to developing a range of divergent intervention strategies if both emotional and social loneliness are to be reduced.

Older people have been identified as being at risk of social exclusion. However, despite the fact that care is commonly required in later life and the majority of that care provided by informal carers, a connection between social exclusion and informal care-receipt has rarely been considered. The aim of this study was to examine how informal care-receipt is related to social exclusion.

A face-to-face questionnaire survey on social exclusion and informal care-receipt was carried out among older people (n=1255) living in Barnsley, United Kingdom. Multivariable analyses examined the association between social exclusion and categories of informal care-receipt: care receiver; assurance receiver; non-receiver with no need; non-receiver with need.

Compared to being a non-receiver with no need participants were more likely to be a care receiver or assurance receiver if they had higher levels of social exclusion. The highest level of social exclusion, however, was found in non-receivers with need. Despite a lack of informal care and support, formal practical support and personal care was also low in this latter group. Findings are discussed in relation to the conceptualisation of care-receipt and how contact with medical services could be an opportunity for identification and appropriate referral of non-receivers with need.

Background: Loneliness in old age has been shown to have negative outcomes such as mortality, physical and mental health problems, and reduced activity levels. To reduce loneliness in older people, factors associated with loneliness and open to intervention must be identified.

Methods: Older people (aged 65+, N=1255) from the United Kingdom received a questionnaire-based interview (response rate: 66.0%). The questionnaire covered items on demographic, psychological, health and social characteristics. It also contained the de Jong-Gierveld Loneliness Scale (de Jong-Gierveld & Kamphuis, 1985), measuring Emotional and Social Loneliness.

Findings: Eight percent of the respondents were found to be severely or very severely lonely, while another 38% were moderately lonely. Being female, widowed, low well-being, low self-esteem, high activity restriction, and high concern about personal finances were significant predictors of Emotional Loneliness (F(17, 976)=25.59, R²=.31, p<.001).  Being female, widowed, low well-being, low self-esteem, high concern about personal finances, low contact with family, low contact with friends, low engagement, and low perceived community integration were significant predictors of Social Loneliness (F(17, 982)=19.63, R²=.25, p<.001).

Discussion:  This study provides empirical evidence for conceptual separation of emotional and social loneliness. Consequently, different targets for intervention are required in order to reduce emotional and social loneliness respectively, although psychological intervention has the potential to reduce both. 

Background: Loneliness in old age has been shown to have negative outcomes such as mortality, physical and mental health problems, and reduced activity levels. To reduce loneliness in older people, factors associated with loneliness and open to intervention must be identified.

Methods: Older people (aged 65+, N=1255) from the United Kingdom received a questionnaire-based interview (response rate: 66.0%). The questionnaire covered items on demographic, psychological, health and social characteristics. It also contained the de Jong-Gierveld Loneliness Scale (de Jong-Gierveld & Kamphuis, 1985), measuring Emotional and Social Loneliness.

Findings: Eight percent of the respondents were found to be severely or very severely lonely, while another 38% were moderately lonely. Being female, widowed, low well-being, low self-esteem, high activity restriction, and high concern about personal finances were significant predictors of Emotional Loneliness (F(17, 976)=25.59, R²=.31, p<.001).  Being female, widowed, low well-being, low self-esteem, high concern about personal finances, low contact with family, low contact with friends, low engagement, and low perceived community integration were significant predictors of Social Loneliness (F(17, 982)=19.63, R²=.25, p<.001).

Discussion:  This study provides empirical evidence for conceptual separation of emotional and social loneliness. Consequently, different targets for intervention are required in order to reduce emotional and social loneliness respectively, although psychological intervention has the potential to reduce both. 

Background: Social exclusion (SE) is a process that limits participation in society across life domains, and is associated with poor quality of life. Neighbourhood exclusion has been identified as particularly important for older adults. This paper examines the association between SE and well-being in older adults from urban and rural areas, focusing on neighbourhood exclusion.

Methods: Using a cross-sectional survey design with a stratified sampling frame, participants (aged 65+) from rural (n=628) and urban (n=627) areas of Barnsley, United Kingdom, completed a questionnaire containing indicators of five SE domains: civic activity, material resources, social relationships, services and neighbourhood. Sequential linear regression models were developed for 1) total sample; 2) rural areas; and 3) urban areas, with well-being regressed on SE indicators after controlling for self-reported health.

Results: SE indicators explained 13.4% of the variance in well-being in the total sample (of which neighbourhood exclusion explained 1.2%); corresponding figures for the rural model were 13.8% (3.8%) and for the urban model 18.0% (1.7%); the addition of neighbourhood exclusion significantly improved all three models.  Five SE indicators were significant in the rural model, compared with seven in the urban model, with four common to both.

Discussion: Neighbourhood exclusion explained more variance in well-being in rural than urban areas, whereas exclusion from services explained more variance in urban than rural areas. Area characteristics and the role of neighbourhood should be considered in policy initiatives to reduce SE and promote well-being.

OBJECTIVES: To effectively reduce loneliness in older adults, interventions should be based on firm evidence regarding risk factors for loneliness in that population. This systematic review aimed to identify, appraise and synthesise longitudinal studies of risk factors for loneliness in older adults.

METHODS: Searches were performed in June 2018 in PsycINFO, Scopus, Sociology Collection and Web of Science. Inclusion criteria were: population of older adults (M = 60+ years at outcome); longitudinal design; study conducted in an OECD country; article published in English in a peer-review journal. Article relevance and quality assessments were made by at least two independent reviewers.

RESULTS: The search found 967 unique articles, of which 34 met relevance and quality criteria. The Netherlands and the United States together contributed 19 articles; 17 analysed national samples while 7 studies provided the data for 19 articles. One of two validated scales was used to measure loneliness in 24 articles, although 10 used a single item. A total of 120 unique risk factors for loneliness were examined. Risk factors with relatively consistent associations with loneliness were: not being married/partnered and partner loss; a limited social network; a low level of social activity; poor self-perceived health; and depression/depressed mood and an increase in depression.

CONCLUSION: Despite the range of factors examined in the reviewed articles, strong evidence for a longitudinal association with loneliness was found for relatively few, while there were surprising omissions from the factors investigated. Future research should explore longitudinal risk factors for emotional and social loneliness.

Background: Social exclusion is a framework for understanding the complexity of disadvantage across various domains of life such as material resources, social relations, civic activities and services. Reviews have identified a lack of gender perspective in social exclusion research. This paper will introduce the framework of social exclusion, and examine trends over time in the levels of social exclusion across different life domains for older women and men in Sweden.

Methods: Data on indicators of social exclusion were analysed from respondents aged 76+ years who participated in the 1992, 2002 and 2011 waves of the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD).

Results: There was evidence of a gender different in exclusion from material resources and civic activities, from which women were more often excluded than men. Regardless of gender there were improvements in access to material resources, such as owning a house/apartment.  Social contacts (visiting or being visited by friends) decreased over time, while engagement in cultural activities and going to restaurants increased.

Conclusions: Trends in social exclusion in older adults over the last 20 years are dependent on the domain considered. Over a range of indicators, older women were more vulnerable to exclusion than men, which needs to be taken into account in policy to combat exclusion.