Journal of Gerontological Nursing

LONG-TERM RESIDENCE AND LONELINESS: Myth or Reality?

Gloria Francis; Shirley H Odell

Abstract

This is the report of a study of a probability sample of 42 persons residing in a home for the aged in Eastern Virginia. The purpose of the study was to measure secondary loneliness among such a group. Secondary loneliness is the reactive response to separation from persons and things in which one has invested himself and his energy.1'2 They are his loved ones and cherished things.. .those things which are meaningful. Secondary loneliness is differentiated from primary loneliness, also called existential loneliness, which is universal and the result of being an individual organism without the capability of merging with other organisms. This state has also been called cosmic loneliness.3 Secondary loneliness is what most persons are referring to when they use the words lonely or loneliness.

Much is said about loneliness, but can it be identified or measured? This study used the Schedule for the Measurement of Loneliness and Cathectic Investment4'5 tested on two populations of hospitalized, ädult, medical patients as well as on a large sample of city jail inmates. The tool has proven highly reliable. The reliability coefficient for the loneliness scale is r = .980. The validity of the tool remains unknown because of the lack of external criteria. It was found on the first study, however, that the loneliness scaleresults were in significant agreement with respondent pronouncements of their own loneliness or absence of it. Hence, given the state of the art in measuring abstractions such as loneliness, it can be said that loneliness can be measured with good reliability and with some, but unknown, validity.

The 25-item schedule is an ordinal scale of the LikertType variety. It is composed of four parts. Five items measure cathectic investment and five items measure loneliness. These items have five response categories. The first cathectic investment item asks, for example, if the individual lived in a house, an apartment, a room, an institution, or just "drifted around" without a permanent address before coming to the nursing home. The more one has in his livingabode in which to invest, the more he can potentially invest. The first loneliness item asks, for example, if and how much the individual misses that home, apartment, or whatever, since he has come to the nursing home. Loneliness is a reaction to separation from cathectically invested objects. Six open-ended items attempt to identify further, for example, aspects such äs who specifically the persons are who are most missed, and what the objects or things are that are most missed. These items do not contribute to the cathectic investment score or the loneliness score. The remaining nine items elicit demographic data, eg, marital status, previous occupational group, and highest grade of school completed. These data also do not contribute to either of the two scorés, but permit the opportunity to capture the profile of the group being studied, and also allow for some correlational analysis between demographic variables and loneliness.…

This is the report of a study of a probability sample of 42 persons residing in a home for the aged in Eastern Virginia. The purpose of the study was to measure secondary loneliness among such a group. Secondary loneliness is the reactive response to separation from persons and things in which one has invested himself and his energy.1'2 They are his loved ones and cherished things.. .those things which are meaningful. Secondary loneliness is differentiated from primary loneliness, also called existential loneliness, which is universal and the result of being an individual organism without the capability of merging with other organisms. This state has also been called cosmic loneliness.3 Secondary loneliness is what most persons are referring to when they use the words lonely or loneliness.

Much is said about loneliness, but can it be identified or measured? This study used the Schedule for the Measurement of Loneliness and Cathectic Investment4'5 tested on two populations of hospitalized, ädult, medical patients as well as on a large sample of city jail inmates. The tool has proven highly reliable. The reliability coefficient for the loneliness scale is r = .980. The validity of the tool remains unknown because of the lack of external criteria. It was found on the first study, however, that the loneliness scaleresults were in significant agreement with respondent pronouncements of their own loneliness or absence of it. Hence, given the state of the art in measuring abstractions such as loneliness, it can be said that loneliness can be measured with good reliability and with some, but unknown, validity.

The 25-item schedule is an ordinal scale of the LikertType variety. It is composed of four parts. Five items measure cathectic investment and five items measure loneliness. These items have five response categories. The first cathectic investment item asks, for example, if the individual lived in a house, an apartment, a room, an institution, or just "drifted around" without a permanent address before coming to the nursing home. The more one has in his livingabode in which to invest, the more he can potentially invest. The first loneliness item asks, for example, if and how much the individual misses that home, apartment, or whatever, since he has come to the nursing home. Loneliness is a reaction to separation from cathectically invested objects. Six open-ended items attempt to identify further, for example, aspects such äs who specifically the persons are who are most missed, and what the objects or things are that are most missed. These items do not contribute to the cathectic investment score or the loneliness score. The remaining nine items elicit demographic data, eg, marital status, previous occupational group, and highest grade of school completed. These data also do not contribute to either of the two scorés, but permit the opportunity to capture the profile of the group being studied, and also allow for some correlational analysis between demographic variables and loneliness.

The sample profile for this present study was characterized as follows: the mean age was 82 in a range from 69 to 92 years; the mean length of time in residence was 44 months in a range from seven months to seven and one half years. With a few exceptions, the sample was composed mainly of Protestant white women and herein lies a story about trying to determine socioeconomic status via the usual indicators of education, occupation, and family income. The women could not say how many years of formal education they had completed because as one put it "we did not reckon education that way in those days." As nearly as could be determined the majority had not completed high school. Previous occupation data were also not very revealing. The majority never worked outside the home. Spouses of respondents did seem to cluster in the skilled occupations category. Knowledge of previous family income data was also indicative of a past era in relation to women. They simply had no idea what their spouses' incomes were and said they never cared to know. As several respondents indicated, "Dad took care of all that." It is probably very safe to assume, however, that this was a solid, middle class group most of whom lived reasonably comfortably most of their adult lives.

But what about the amount of loneliness? If this group is representative of other old persons living in residential homes, such groups are not lonely. The mean loneliness score was 11 in a range from 5 to 25. Of the now completed four studies of loneliness among separated groups, this was the lowest mean score. The mean score for the combined groups of hospitalised adults was 14 and for the jail inmates, 18. A mean score of 11 is in the lower third of the score range and is considered no to minimal loneliness.

After the interviews were completed, never having mentioned the word loneliness, respondents were asked if they felt they had experienced "loneliness" since they had come to the home. The largest .proportion (29%) said "no." The next largest group (24%) said they believed they would have been lonely at times, but that it had been averted as the result of visitors, phone calls, mail, new friendships, and many other things. Actually only four persons (9.5%) said "yes" they had experienced loneliness since coming to the home. In other words, there is both-objective and subjective agreement that this group, as a whole, had not been experiencing loneliness.

But is this really denting the myth that the old and institutionalized are lonely? Theoretically one would like to think it is reasonably safe to generalize to similar persons in similar settings. But then the setting must be examined more closely. It is, to be sure, an institution, but perhaps it came closer then many to genuinely being a home away from home. It is a three story modern brick building with approximately 130 private rooms or suites with surrounding grounds including space for individual flower and vegetable gardens. There is a library where residents' crafts can also be seen and bought. Each room contains a bed and a chest, and one's own furniture and appointments can also be brought in. Comfortable chairs are probably the favorite pieces brought in. There is a living room and multiple sitting rooms for each wing. There is daily bus service to town. The home is church related and the approach is one of manipulating the system to meet the needs of the resident rather than the all too frequent approach of "helping" the residents to fit into the system.

Theoretically, loneliness is a response to separation from loved ones and things, and therefore, it can logically be reduced or eliminated by either reunion with the separated persons and things, or, by reinvest- ment of one's energies into new persons and things. This sample of aged, "separated" persons, who should have been predictably experiencing loneliness did not do so. It cannot be said with certainty, because of lack of empirical data, whether they were different from most aged, institutionalized persons, or whether some of the thinking has been wrong about generalizing loneliness to old and institutionalized persons. In the two hospital studies the older age group, ie, over 50 years, were significantly less lonely than their younger counterparts. This was interpreted to be a function of less investment than the younger patients in the things of this world, greater experience with separation (simply having lived longer), and hence more practice in adapting, which theoretically means faster and more effective reinvestment in new persons and things. These findings, along with the present findings, would lead one to conclude that perhaps generally ascribing 'loneliness to the institutionalized aged has been in some error. But one also wonders if there is still not a good deal of loneliness in other, perhaps, less creative and humanistically oriented homes for the aged.

This probability sample of 42 decidely older persons found them to be not lonely by both objective measure and by their own subjective assessment. To be sure, they are not among society's terribly neglected or deprived older persons, but given the present state of empirical knowledge about loneliness there should have been greater loneliness among them. Someone has said that effective research generates more questions than it answers. The author, shielded by that supposition, then asks, was this group significantly different from other aged, institutionalized persons; or has the popular v view, and to some extent the professional view, of this group been based on some false assumptions and perceptions? Assuming that the former is perhaps closer to reality, and that there is a great deal of loneliness among the institutionalized aged generally, implications are clear for those who work with them. Reunion with as many persons and things as is realistically possible is in order. Obviously many loved ones have died, but seldom is there no one left who could be contacted and actively encouraged to visit, call, or write. And, seldom are there not some favorite objects that could be brought in and substituted for the institution's things. The latter, of course, means manipulating the environment to meet the resident's needs, and more and more this is the case. Many hospitals still continue to insist that the patient may not bring anything in and even strip him of his clothing for one of those "paper things," but homes for long-term and permanent residency must seriously reevaluate such policies.

Along with whatever reunion is possible, staff can also direct some of their energies toward aiding the reinvestment process. The investment in those persons and things (homes, cars, activities, pets, etc) from whom one is now separated might be able to be reinvested in new and perhaps more appropriate things and activities. Care can be given to roommate or next-door neighbor selection rather than placement according to empty bed. For some, puttering in a garden could mean the difference between loneliness and contentment and satisfaction. Obviously each new person coming to the home cannot bring his pet, but in Virginia, for example, pets are not barred from living in homes for the aged so why not normalize living with a house dog or cat. For those who learned to live with and love animals reinvestment in a new pet occurs quickly. Simply knowing that loneliness is a reaction to separation, one has at least theoretical direction for "curing" it.

References

  • 1. Mousiakas CE: Loneliness. New Jersey, Prentice-Hall, 1961.
  • 2. Sullivan HS: The Interpersonal Theory of Psychiatry. New York, W. W. Norton. 1953.
  • 3. von Witzleben HD: On loneliness. Psychiatry 21:37-43, 1958.
  • 4. Francis GM: Loneliness: A study of hospitalized adults. PhD dissertation. University of Pennsylvania, 1972, pp 97-100.
  • 5. Francis GM: Loneliness: Measuring the abstract. Int Nurs Stud 13:153-160, 1976.

10.3928/0098-9134-19790101-04

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