Journal of Gerontological Nursing

Letter to the Editor Free

Importance of Flow for Lonely Nursing Home Residents During the COVID-19 Pandemic

Fei-Hsin Huang, PhD; Liang-Chih Chang, PhD

To the Editor:

The relationship between social support and loneliness in nursing home residents has been well-established (Eskimez et al., 2019). However, the loneliness construct simultaneously comprises the emotional and social dimensions (Gierveld & Tilburg, 2006). Although many gerontological studies have focused on the social dimension to determine the effect of social support on loneliness, the emotional dimension has been observed to account for variance in loneliness more than the social dimension (Gierveld & Tilburg, 2006). In addition, the detrimental effects of loneliness can be regulated by positive emotions (Newall et al., 2013). Therefore, identifying an emotion-related factor that can effectively predict loneliness provides valuable information for developing strategies to reduce loneliness in nursing home residents.

Flow, which refers to a state of optimal experience arising from intense involvement in an activity when older adults have sufficiently high skills to meet challenges from the activity, enables them to become fully immersed in feelings of enjoyment and interest during the activity (Chang, 2020). Because enjoyment and interest are positive emotions, flow may be negatively related to loneliness. However, no research has examined a relationship between flow and loneliness in nursing home residents. This relationship warrants investigation.

To examine whether flow can significantly predict loneliness, a cross-sectional study was conducted. We used the flow scale of Jackson et al. (2008) and the loneliness scale of Gierveld and Tilburg (2006) to collect data. For consistency, we conducted face-to-face interviews with all participants residing in a nursing home and read the scale items aloud to them. However, during our survey period, COVID-19 rapidly spread worldwide. We were informed that our survey had to be stopped to prevent nursing home residents from being infected with the coronavirus. We requested other nursing home managers for a possible survey but none agreed with our request for the same reason. Before our survey was interrupted, we interviewed 24 participants with a mean age of 77.08 years (SD = 9.16 years, range = 65 to 92 years), of whom 18 were women (75%).

Collected data were analyzed by descriptive statistics and regression analysis. The results revealed that the average scores were 34.08 (SD = 7.73) for flow, on a scale with scores ranging from 9 to 45, and 13.54 (SD = 4.85) for loneliness, on a scale with scores ranging from 6 to 30. High scores indicated high levels of flow and low levels of loneliness. In addition, flow was significantly and negatively correlated with loneliness (β = −0.439; p = 0.032; R2 = 0.193). Although the statistical power was low because of our small sample size, the results were significant. Specifically, an increase in the flow of nursing home residents led to a significant decrease in their loneliness.

The results have important practical implications during the COVID-19 pandemic. Receiving social support depends highly on others but experiencing flow does not. Nursing home residents can experience flow by themselves or with others. Because all visits are forbidden, nursing home residents may have insufficient social support to cope with their loneliness during this period. However, they can still reduce their loneliness by experiencing flow.

Although nursing home residents may achieve flow in some activities, leisure programs that balance challenges with skills increase their likelihood of experiencing flow. Moreover, flow formation is dynamic. After participating in the same activity several times, they may improve their skills through practice. Such improvement means that the activity provides them with less of a challenge, resulting in boredom. They can experience flow again when managers offer them new challenges that are commensurate with their improved skills. Therefore, to help nursing home residents continually experience flow, managers should dynamically assess their changing skills and update leisure programs.

Fei-Hsin Huang, PhD
Assistant Professor
Department of Tourism and Leisure
Lunghwa University of Science and Technology
Taoyuan City, Taiwan

Liang-Chih Chang, PhD
Department of Living Sciences
National Open University
New Taipei City, Taiwan


  • Chang, L. (2020). Relationship between flow experience and subjective vitality among older adults attending senior centres. Leisure Studies, 39(3), 433–443 doi:10.1080/02614367.2020.1763441 [CrossRef]
  • Eskimez, Z., Demirci, P. Y., TosunOz, I. K., Oztunç, G. & Kumas, G. (2019). Loneliness and social support level of elderly people living in nursing homes. International Journal of Caring Sciences, 12(1), 465–474.
  • Gierveld, J. D. J. & Tilburg, T. V. (2006). A 6-item scale for overall, emotional, and social loneliness: Confirmatory tests on survey data. Research on Aging, 28(5), 582–598 doi:10.1177/0164027506289723 [CrossRef]
  • Jackson, S. A., Martin, A. J. & Eklund, R. C. (2008). Long and short measures of flow: The construct validity of the FSS-2, DFS-2, and new brief counterparts. Journal of Sport & Exercise Psychology, 30(5), 561–587 doi:10.1123/jsep.30.5.561 [CrossRef] PMID:18971512
  • Newall, N. E., Chipperfield, J. G., Bailis, D. S. & Stewart, T. L. (2013). Consequences of loneliness on physical activity and mortality in older adults and the power of positive emotions. Health Psychology, 32(8), 921–924 doi:10.1037/a0029413 [CrossRef] PMID:

The authors have disclosed no potential conflicts of interest, financial or otherwise. This study was funded by the Ministry of Science and Technology Taiwan (MOST 108-2410-H-180-004-SSS).


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