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Understanding Loneliness and Its Impact on Quality of Life in Older Sinhalese People Living in Aged Care Facilities in Sri Lanka

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Date

2023

Authors

Supervisor

Sandham, Margaret
Zeng, Irene
Holroyd, Eleanor

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Doctor of Philosophy

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Publisher

Auckland University of Technology

Abstract

Background: Loneliness is a common problem that significantly impacts the physical and psychological health of older people. Physical separation from the family could make older people living in aged care facilities more susceptible to loneliness when compared to community-dwelling older people. To date, little is known about loneliness in older people living in aged care facilities in Sri Lanka. Aim: This study sought to understand loneliness in Sinhalese older people living in aged care facilities in Sri Lanka. The four objectives were to 1) examine the psychometric properties of the De Jong Gierveld Loneliness Scale (DJGLS) and the World Health Organization Quality of Life-BREF for the study sample; 2) assess and understand participants’ levels of loneliness; 3) investigate the relationship between loneliness, quality of life and health status; and 4) explore participants’ perception of loneliness. Method: A mixed methods approach was used. Using stratified random sampling, a total of 517 Sinhalese participants aged 60 years and above were recruited from 86 aged care facilities located in seven provinces in Sri Lanka. Quantitative data on loneliness and quality of life were gathered from the total sample using interviewer-administered tools including the DLGLS and WHOQOL-BREF. Descriptive statistics with correlational analysis, factor analysis, and regression analysis, were utilized to answer quantitative study questions. Semi-structured interviews in Sinhalese were conducted to gather qualitative data exploring perceptions of loneliness from a subset of 26 consenting participants of the total sample using purposive sampling. An interpretive descriptive method was used to analyze qualitative interview data exploring participants’ perceptions of loneliness. Findings: The quantitative results revealed that loneliness is prevalent among aged care residents in Sri Lanka and 75% of them have at least a moderate level of loneliness while 20% of them have very severe loneliness. Regression analysis further showed that the degree of total loneliness negatively impacts their quality of life (regression coefficient β=-2.42, t =-18.83,p<0.001). While all aspects of quality of life were negatively influenced by social and emotional loneliness, participants’ psychosocial quality of life was the most impacted aspect by both types of loneliness (regression coefficient β=-0.32, p<0.001; β=-0.26, p<0.001 respectively). In addition, the two individual indicators of not being visited by family members and having no opportunity to attend social activities outside the facility were the strongest predictors of social and emotional loneliness. These quantitative results were well supported by the qualitative findings derived under three themes. Three themes emerged from the qualitative data analysis: 1) how I came to be lonely; 2) loneliness makes me feel…, and 3) how I manage/cope with loneliness. Participants perceived that being overgenerous and trusting others, along with no longer being wanted by others were reasons for their loneliness. Further, they perceived that loneliness made them feel hopeless and worthless, created further disconnection from others, and resulted in unwellness and suffering. Participants at times blamed others for their loneliness and some engaged in religious activities to manage their loneliness. Conclusion: The development of flexible aged care facility rules aimed towards facilitating social integration of residents should be considered to create age-friendly care environments. Planning and implementing adequate indoor activities for residents is recommended to increase peer interactions and enable residents to remain engaged during leisure times is equally important. This knowledge is intended to inform increasing residents’ psychosocial satisfaction and reduce their loneliness.

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http://hdl.handle.net/10292/16742

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