Assessment of loneliness and factors that modify it in the group of patients staying in the Admissions Department with particular emphasis on the frequency of stays

INTRODUCTION

Loneliness is a growing civilisation problem of the 21st century. It affects the human physiology and psyche and other aspects of quality of life. As observations in large agglomerations show, the increase of loneliness results in condi-tions that enforce artificiality and shallowness of inter-human interactions, interpersonal relationships become incom-plete, contacts superficial, random, and broken [1]. The civilisation model that we have observed in recent years in Po-land, in the situation of cessation or reduction of professional and family obligations, gives profit in the form of a free time pool [2]. Such situations include, for example, converting from a multigenerational family into a single-generation household, or changing the occupational situation or marital status.
In 1986, over 8% of Polish society were people over 65 years of age. As predicted by demographers, in Poland in 2050 as much as 35.8% of people will be over 60 years old [2]. Basic data available on the website of the Central Statistical Office inform that the demographic load ratio, defined as the number of non-working age population per 100 persons of working age, in 2017 already reached a worrying level of 63, which in the long term will have significant economic and social consequences [3, 4].
The course of aging and old age is individualised. The form of spending time has an impact on this process, which translates into a lifestyle that can be diametrically different for people of the same age. Attitudes towards old age represented by the seniors can be divided into several types:
• working people who continue their work despite reaching retirement age;
• gardeners who remain physically active, resting in the form of an active hobby;
• home and family people, involved in the life of relatives and family matters, closely related to the role of grandmother and grandfather;
• social, active in various associations, organisations and volunteers;
• entertainment, benefiting from cultural institutions;
• globetrotters who have found time to travel and visit new places;
• pious people who increase the importance of religion and the need to participate in religious rites;
• patients who focus on activities related to themselves and their health [2, 5, 6].
Literature defines various forms of seniors’ activity; however, the study “The social situation of people aged 65+” carried out by ARC Rynek i Opinia shows that seniors try to fight with loneliness mainly through activities per-formed alone, such as: reading or solving crosswords, watching TV [7].
Data obtained from the Municipal Social Welfare Centre in Szczecin show that 93.2% of single women in all age groups benefited from the help of the city in the form of care services; the percentage in the group of men was low-er and amounted to 73.6%. In 2017, the percentage of women remained at the same level, but men more often took advantage of caring services – 81.8% [8].

AIM OF THE STUDY

The purpose of the paper was to assess the occurrence of loneliness and factors modifying it in patients staying in the Admissions Department, with particular emphasis on the frequency of stays.

MATERIAL AND METHODS

The study was conducted in the period from October 2018 to January 2019 in the Admissions Department of the Independent Public Health Care Centre of the Ministry of Interior Affairs and Administration in Szczecin. The subject study did not require the approval of the Bioethics Committee, but an appropriate certificate was obtained in this mat-ter (KB-0012/287/10/18). The permission of the hospital’s management was obtained to conduct the research. Partici-pation in the study was voluntary and anonymous. Criteria for inclusion in the study were:
• age over 65 years,
• initial diagnosis: according to classification ICD-10 I10 – hypertension or ICD-10 R53 – malaise, fatigue,
• no risk to health or life at the moment of reporting to the Admissions Department,
• expressing conscious consent to participate in the study.
The study included 108 people brought to the Admissions Department by the Medical Rescue Team or report-ing themselves with a referral. The majority of the group were women (63.9%). The average age was 78 ±7.9 years. The sociodemographic characteristics of the group are included in Table 1.
Due to the small number of people living in the rural areas (n = 4) of the categorical variable, the place of resi-dence is not included in further statistical analysis.
The study used the method of a diagnostic survey, a questionnaire technique. The research tool was the au-thor’s questionnaire and the De Jong Gierveld and Kamphuis scale for measurement of the sense of loneliness in the Polish adaptation of Grygiel, Humenny, Rębisz, Świtaj, and Sikorska-Grygiel [9]. The scale for measurement of the sense of loneliness is a tool consisting of 11 statements: six items containing negative sentences, formulated, describing the lack of satisfaction from social contacts; and the remaining five – positively formulated – measuring satisfaction related to interpersonal relationships. The respondent assesses to what extent the scale theorems express his/her current situation and feelings, on a five-point Likert scale, from “definitely yes” to “definitely not”. The higher the total score, the greater the loneliness. The questionnaire of our own design concerned family relations and information regarding the stay in the Admissions Department. It consisted of 11 closed questions.
The qualitative variables as well as the answers to questions were described by numbers (n) and frequency (%). The measurable variables are described using the basic parameters: the arithmetic mean (M), the standard deviation (SD), the median (Me), and the minimum and maximum values (min. and max.). To check the significance of differ-ences in the level of loneliness in two groups, the Mann-Whitney U test was used, and in at least three groups – the Kruskal-Wallis test. The correlation between age and loneliness was examined by the significance test of Spearman’s rank correlation coefficient. The Pearson 2 independence test was used to investigate the relationship between quality variables. Differences in the age level in patients with different frequency of stays at the Admissions Department were verified by means of analysis of variance (ANOVA). A p-value < 0.05 was considered statistically significant. Statistical calculations were carried out using the Statistica 10 PL statistical package.

RESULTS

In the first stage of the study, the relationship between the gender of patients and the frequency of stays was ana-lysed, and it was observed that there was no statistically significant relationship between the two variables (p > 0.05). The average and median age were the highest in patients who were in the Admissions Department 5-9 times a year, and the lowest in patients who were there for the first time. Analysis of variance, however, did not show a significant statisti-cal difference in the age level in patients with varying frequency of stays (p > 0.05). Thus, the age of patients did not affect the frequency of stays in the Admissions Department.
The data obtained from the author’s questionnaire show that more than half of the patients lived in the house-hold alone (51.9%), and for 83.3% it was not their first stay in the Admissions Department. 55.6% notified a close per-son about their current stay in the hospital. The vast majority of patients (63%) stayed alone until the end of their stay in the Admissions Department. Detailed data are presented in Table 2.
A sense of loneliness in the subjects studied. The De Jong Gierveld and Kamphuis scale for measurement of the sense of loneliness included between 11 and 52 points. The average sense of loneliness in patients was 31.1 ±8.9 points. The distribution of the obtained points of the scale clearly divided the subjects into two groups, non-lonely persons and lonely persons.
In the presented results, 34.3% of the respondents experienced general emptiness, 37% thought that they lacked the company of other people, and 34.2% thought that there was a shortage of people around them. Rejection was felt by 39.9% of respondents, and 31.5% stated that there are not many people whom they can trust completely. Detailed results obtained using a scale for measurement of the sense of loneliness are presented in Table 3.
During the studies, the date and day of the week in which the tests were carried out were also marked. Table 4 shows the number and incidence of patients for each day of the week. It shows that the smallest percentage of patients were observed on Fridays, and the highest on Sundays.
At a later stage of the analysis of the collected material, the relationship between the loneliness of patients and the frequency of their stays in the Admissions Department was assessed. A statistically significant relationship was found for both variables. The sense of loneliness increased with the frequency of stays in the Admissions Department (p < 0.0001) (Figure 1).
Statistical calculations showed that the gender and education level of patients did not affect the feeling of loneliness; for all calculations, p > 0.05. Similarly, no statistically significant correlation was found between the age of patients and the sense of loneliness (p > 0.05).
The p level of probability of the result of multiple comparison test for the sense of loneliness in patients with different marital status showed statistically significant differences that occurred between groups (Table 5):
• single and in a permanent relationship (p = 0.022), where the higher sense of loneliness was in single subjects rather than in patients who lived in a permanent relationship,
• in a permanent relationship and widow/widower (p < 0.0001), where the higher sense of loneliness was in wid-ows and widowers rather than in patients who lived in a permanent relationship.
The variables that significantly shaped the loneliness were:
• residence status, where the sense of loneliness was higher in people living alone in relation to those living with a family or partner,
• residence of the closest people, where the feeling of loneliness was the lowest in people living with their rela-tives in the same property, and the highest in patients whose relatives live in another country.

DISCUSSION

In our own studies, data such as age and gender did not show any significance for the loneliness of the subjects; however, Kubicki’s and Olcoń-Kubicka’s studies showed a significant influence of these elements [10]. The dependence of age on the sense of loneliness was not observed by Zalewska-Puchała et al. [11]. The PolSenior study from 2012 showed that the sense of loneliness grows with age, and it pointed to gender as the dominant factor affecting social isolation. The latest data will be available after the completion of the PolSenior 2 project, which began in September 2018 and will last until the end of 2019.
Our own research showed the dependence of a sense of loneliness from the place of residence of the closest people. The convergent results were obtained by Sidorczuk and Halicka, who showed a dependence of a sense of lone-liness from their place of residence and family relations [12]. This is also confirmed by the study of Świtoń and Wnuk [13].
The team of Zalewska-Puchała et al., in studies carried out at internal medicine departments, also used the De Jong Gierveld scale of measurement of the sense of loneliness. The average result obtained in the study group was 31.8 points [11]. Thus, it was almost entirely congruent with the result obtained in our own research (31.1 points) on a comparable group of 108 people.
In his research, Szukalski assessed the impact of residing alone on the perception of loneliness and isolation. He stated unequivocally that living together with relatives is a factor that reduces loneliness [14]. This result coincides with our own research. Analysis titled “The social situation of people aged 65+” implemented for the “Mali Bracia Ubogich” Association by ARC Rynek i Opinia shows that people over 65 years of age most often live in single-generation households (78%), while every third respondent lives alone (34%) [7]. A much higher percentage of people living alone was obtained in our own studies (51.9%). This result may be associated with higher reporting to the Admis-sions Department by this category of person. In her work, Fopka-Kowalczyk quotes conclusions from Janiszewska and Barańska’s (2013) work, showing that having a family is not protection against the feeling of being alone, but it can be an auxiliary factor so that loneliness is not felt [15]. Similar conclusions can be drawn from the results of our own re-search, which show that the sense of loneliness increases in proportion to the increase in distance from loved ones. However, the feeling of loneliness also applies to people who live with their loved ones – often to a lesser extent than in single-person households, but it does exist. In a study carried out in other countries, an example of which is the analysis carried out by Zhen-Qiang et al. in 2010 among the residents of Anhui, there was a relationship between residing alone and a sense of loneliness. The conclusions of this author coincide with those obtained in the course of our own research also in aspects such as the influence of marital status, and the lack of influence of gender and education on the feeling of loneliness. The author shows the influence of age on the feeling of loneliness, which does not coincide with our own research. He also shows that poor family function is associated with greater loneliness [16]. In our own research, this perspective was not considered; however, the results showing the dependence between living alone and with a close family and the place of residence of the closest persons may give rise to the deepening of this aspect. Nummela, in studies of the influence of loneliness on self-esteem of health, showed that loneliness is an important factor contrib-uting to lower self-esteem of health, and concluded that good health is common in people who do not feel lonely. A similar conclusion stems from our own research, in which it was shown that the feeling of loneliness affects the fre-quency of stays in the Admissions Department [17]. Studies in the United Kingdom among people over the age of 65 years have shown the impact of changes in marital status, living conditions, and social relationships on the feeling of loneliness. Conclusions from the study conducted by Victor and Bowlig in 2012 on changes in marital status coincide with results from our own research, in which a clearly higher level of loneliness was recorded in the group of widows and widowers [18].

CONCLUSIONS

The factors associated with an increased sense of loneliness among people staying in the Reception Department were: widowhood, being a pensioner, lonely residence, and distance from the place of residence of a senior citizen. A higher sense of loneliness favoured more frequent visits to the Admissions Department. The sense of loneliness in pen-sioners is higher than in working people; therefore, it is necessary to consider undertaking social activities directed to this group that will support the implementation of the process of successful aging, reducing the loneliness of the elderly.

Disclosure

The authors declare no conflict of interest.

References

1. Stefańska-Klar R. Z psychologii samotności. Psychologia i Rzeczywistość 2002; 2: http://www.psycholog.alleluja.pl.
2. Zych A. Poznać, zrozumieć i zaakceptować starość. Wybór materiałów konferencyjnych. Łask: Over Group 2012; 22-55.
3. Główny Urząd Statystyczny: http://stat.gov.pl/podstawowe-dane/ (on-line: 04.03.2019).
4. Karakiewicz B, Jurczak A. Starzejące się społeczeństwo wyzwaniem dla zdrowia publicznego. Wyd. PUM, Szczecin 2014; 134-150.
5. Fabiś A, Wawrzyniak J, Chabior A. Ludzka starość. Wybrane zagadnienia z gerontologii społecznej. Wyd. Impuls, Kraków 2015; 66-69.
6. Kaczmarczyk M, Trafiałek E. Aktywizacja osób w starszym wieku jako szansa na pomyślne starzenie. Gerontol Pol 2007; 15; 116-118.
7. ARC Rynek i Opinia. Samotność seniora. https://www.mp.pl/geriatria/aktualności/186910,samotnosc-seniora (on-line: 04.02.2019).
8. MOPS Szczecin. Tabela dotycząca realizacji w Szczecinie usług opiekuńczych w miejscu zamieszkania w latach 2016 i 2017.
9. Grygiel P, Humenny G, Rębisz S, et al. Validating the Polish adaptation of the 11-item De Jong Gierveld Loneliness Scale. Eur J Psychol Assess 2013; 29: 129-139.
10. Kubicki P, Oleoń-Kubicka M. Osamotnienie osób starszych w Polsce – skala, przejawy oraz sposoby przeciwdziałania zjawisku. Studia Humanistyczne AGH 2010; 8: 129-138.
11. Zalewska-Puchała J, Kostrz M, Majda A, et al. Poczucie samotności osób starszych. Problemy Pielęgniarstwa 2015; 23: 233-238.
12. Sidorczuk A, Halicka M. Rodzina i stosunki rodzinne. W: Halicka M, Halicki J (red.). Przemoc wobec ludzi starych. Temida 2, Białystok 2010; 141-146.
13. Świtoń A, Wnuk A. Samotność w obliczu niesprawności osób starszych. Geriatria 2015; 9: 243-249.
14. Szukalski P. Poczucie samotności i osamotnienia wśród sędziwych seniorów a ich sytuacja rodzinna. Auxilium Sociale – Wsparcie Społeczne 2005; 2: 217-238.
15. Fopka-Kowalczyk M. Samotność osób starszych i czynniki ją warunkujące. Kultura i Edukacja 2018; 119: 70-80.
16. Zhen-Qiang W, Liang S, Ye-Huan S, et al. Correlation between loneliness and social relationship among empty nest elderly in Anhui rural area, China. Aging Ment Health 2010; 14: 108-112.
17. Nummela O, Seppänen M, Uutela A. The effect of loneliness and change in loneliness on self-rated health (SRH): A longitudi-nal study among aging people. Arch Gerontol Geriatr 2011; 53: 163-167.
18. Victor CR, Bowling A. A longitudinal analysis of loneliness among olser people in Great Britain. J Psychol 2012; 146: 313-331.