The Impacts of Loneliness and Community Navigator Intervention

Part 1: Articles Summary

1.       Loneliness and social isolation causal association with health-related lifestyle risk in older adults: a systematic review and meta-analysis protocol:

The main research question of this scholarly article sought to explore and evaluate the extent and nature of any relationship between loneliness/social isolation health-related behaviors among the old people. The research comprised of a systematic study of evidence, and therefore, it has several literature reviews that present their views on how social isolation and health issues are related. The research, as mentioned earlier, applies the systematic review and meta-analysis methods to establish the evidence gap in this topic. Two reviewers of this study checked the titles and abstracts of the studies to establish their authenticity. New-Ottawa Scale was used to appraise the studies that were included in the systematic research by the lead author, and then the second reviewer rechecked them. The discrepancies in authenticity were then resolved through discussion by the two reviewers. The reviewers then synthesized and reported the results according to the Centre for Reviews (CRD) principles. Any associations in the results of different studies reviewed were analyzed using Bradford-Hill criteria to examine causal associations, which, if they existed, were to be presented using a computed causation score.

For studies that found an association between loneliness and health-related behaviors among the old people, a few indicated that loneliness was associated with misuse of alcohol, low physical engagements, and smoking. Other studies found no relationship between social isolation and health-related behaviors. According to these studies, the health behavior of lonely people is just the same as those who are non-lonely. Therefore, different studies reviewed in this article seem to contradict each on how loneliness and health-related behavior among old people are associated. However, the prominence of this issue has been growing to the extent that it has become a public health challenge. People thus need to understand how the two are related and develop strategies and interventions that would deal with loneliness and social isolation.

2. Social integration and loneliness among long-term care home residents: protocol for a scoping review

This review aimed to present an overview of studies that have been done on social integration and loneliness among the long-term care home residents. Methods of scoping review of peer-reviewed researches associated with social integration and loneliness were reviewed by two reviewers who screened the topics and abstracts of the studies. The reviewers then reviewed the full texts for inclusion. The researchers further engaged LTC home community members who helped in refining the questions, interpreting the results as well as participating in the translation of knowledge.

The scoping review found that loneliness had a negative impact on a person’s health—social integration from the family, friends, and community, in general, all were essential determinants of health situation.

3. Effectiveness of digital technology interventions to reduce loneliness in adults: a protocol for a systematic review and meta-analysis

The main objective of this paper was to systematically review the effectiveness of digital technology interventions in dealing with loneliness among adults. This study aimed to try and reduce loneliness among adults. The study used systematic review and meta-analysis methods to review and assess different articles on the topic. The researchers used guidelines from Joanna Brings as well as Preferred Reporting Items protocols for their systematic and meta-analysis.

During the data analysis, statistical synthesis and narrative summary were used to obtain and analyze the data. Findings were reported using the features of the study summaries and findings of the DT findings. The study used a strong search strategy to identify primary research studies using digital interventions. Using the strong strategy of collecting and evaluating different studies, the review was able to provide the latest research on how effective DTs are in reducing loneliness among adults.

4.      Social isolation and loneliness among immigrant and refugee seniors in Canada: a scoping review

This paper aimed to examine the existing studies on loneliness and social isolation among refugee seniors and immigrants in Canada. The paper hypothesized that social isolation and loneliness were health issues that affected many refugee seniors and immigrants in Canada. The study applied a five-stage methodological framework, which was proposed by Arksey and O’Malley to review different studies on the topic. The researchers used several databases like PubMed, MEDLINE, CINAHL, Web of Science, HealthStar Ovid, PschyInfo Ovid, and Social Services.

After the search of articles was done, 17 articles published between 1996 and 2017 were used to conduct the scoping review. Fourteen of the studies were qualitative; the other three were either quantitative or mixed the two methods. Samples used in the study ranged from 5 to 3,692 participants. Ten of the pieces of literature reviewed showed that there was an association between social isolation and loneliness. The rest of the literature focused on establishing the relationship between social isolation/loneliness and health impacts and found that the two contributed to both physical and mental issues like stress and depression.

5.      The Role of Perceived Loneliness in Youth Addictive Behaviors: Cross-National Survey Study

Technology has increased the tendency of children to have social interactions through the web. As a result, this study purposed to a social psychological perspective on youth additions using the cognitive discrepancy loneliness model. The study used a comprehensive survey to collect data from 212 Americans, and 1192 South Koreans who were mostly youths of ages 15-25 years. From the participants, three addictive behaviors were measured; misuse of alcohol, gambling, and excessive use of the Internet.

All three additive behavior mentioned above were significantly related to youth’s loneliness. However, it was more significantly related to the excessive use of the internet in all youths regardless of the location. The researchers concluded that loneliness would promote excessive use of the internet among the youth. Therefore, it was important to find effective interventions to reduce loneliness among youths.

6.      Attrition in an Online Loneliness Intervention for Adults Aged 50 Years and Older: Survival Analysis

The study aimed to examine how activating consent, engagement in attrition, and coping preference within online intervention contributed to loneliness among adults aged 50 years and above.

The study utilized 352 participants who were aged 50 years and older, 46 of which did not start the introduction. The 306 participants remaining were divided into two classes, 233 who stated the intervention lessons and 73 who did not start the intervention. After results obtained on the three behaviors were found to be insignificant, the researchers of this study concluded that the severity of loneliness was not related to attrition. Therefore, to reduce attrition among the adults of this age, online developers of loneliness interventions should focus more on stimulation of active behavior within the intervention.

7.      Lonely young adults in modern Britain: findings from an epidemiological cohort study

The study aimed to present a detailed integrative correlation of young adults’ feelings of loneliness concerning their present health and experiences of their childhood functioning. The study used data from the Environmental Risk Longitudinal Twin Study and used 2232 participants from England and Wales, who were born between 1994 and 1996. Their loneliness was measured, and regression analysis was used to test the relationship between loneliness and health and functioning in young adulthood.

The results of this study showed that loneliness of young adults contributed to mental health problems. This led them to engage in health risk behaviors as well as using negative approaches to cope with stress. Therefore, just like children, young adults were negatively affected by loneliness.

8.      Reducing Patient Loneliness with Artificial Agents: Design Insights from Evolutionary Neuropsychiatry

This was an explanatory study that sought to explore whether artificial agents like chatboxes, robots, or conversation agents can reduce loneliness among the patients. The study used different studies to collect evidence-based information on how artificial agents can reduce the loneliness of patients. The study showed that the relationship of the patient with artificial agents could affect a patient’s care engagement and support effectiveness.

Therefore, the study found out that incorporating mammalian attachment-building behavior as part of the agents’ capabilities can enhance the quality of relationships and engagement between the patients and the agents. As a result, the researchers encouraged artificial agents’ developers to incorporate design insights on the agents to help to relieve patients’ loneliness.

9. Loneliness amongst Low-Socioeconomic Status Elderly Singaporeans and its Association with Perceptions of the Neighbourhood Environment.

This research aimed to examine the relationship between socio-economic factors and loneliness among elderly people in Singapore. The participants of this study were 60 years and above. The researchers used questionnaires to measure loneliness among this group. Afterwards, chi-square was used to establish the association between socioeconomic and loneliness. The population was 800, and the response rate was 62.1%. The multivariate analysis of the results showed that people of this age who were living in flats were associated with loneliness due to their socio-economic status.

The problem of loneliness in Singapore was prevalent as almost more than one-third of the people living in flats expressed feelings of loneliness. This is because tenants in a flat could not freely interact with strangers, and therefore in most cases, they would remain psychologically isolated.

10. Loneliness in Young Children

The study aimed to examine the consequences of loneliness among young children and the interventions that can be undertaken to deal with loneliness. The paper hypothesized that loneliness is a big problem that can cause young children, both short-term and long-term negative impacts. A review of sources that explored loneliness and its consequences, as well as interventions, were used to study loneliness and present a strong case of the situation among the children.

The study found out that lonely children are likely to experience poor relationships and difficulty in associating with other people than peers who have friends. The main contributing factors of loneliness among children include the death of a pet or someone they knew or a friend, sadness, alienation by other peers, boredom, and low self-esteem. Therefore, strategies and interventions need to be put in place to reduce the problem of loneliness among children. Some of the important interventions include observing and assessing young children’s situations at home and in schools. Parents and teachers need to observe their children keenly and provide support and advice on how they can increase their integration and interaction with other peers. This would reduce loneliness by a great deal among young children.

Part 2: Article Integration

Introduction

The relationship between loneliness/ social isolation and mental health has become an important topic in the field of research. Loneliness and social isolation are two terms that are used together in the body of literature. Loneliness is defined as the gap that exists between the desired and actual levels of social relationships.

In contrast, social isolation is referred to as the individual loss of social associations within social institutions from the community level. Though used together, these two terms are somehow different. Whereas social isolation is objective feelings, loneliness is subjective feelings. Loneliness has been increasing at an alarming rate, especially in developed countries like United States, Japan, and Australia. It is fast becoming an epidemic in those countries, and it is becoming a common public health problem. This is because loneliness results in mental, social as well as health problems that cannot be easily treated unless the right interventions are put in place. Several studies have been done on the topic of loneliness and its impact on the affected. The studies have also cited several interventions that can be put in place to deal with loneliness, but they are no point of consensus among the studies reviewed. They have also presented the impacts of loneliness on different age groups. However, despite loneliness becoming a common public health problem, there is no systematic research that has put together the impacts of loneliness and interventions that can be used to tackle loneliness among individuals. The first research question for this paper is; what is the prevalence and impact of loneliness on different groups of people? The second research question is how Community Navigator Intervention can be used to reduce and alleviate loneliness among the different groups like youths, adults, patients and old people?

Loneliness is related to both environmental and social factors. These factors include losing loved ones like family members, boredom, having inadequate resources, inactivity, as well as not accessible to proper housing (Johnson, Bacsu, McIntosh, Jeffery & Novik, 2019). Also, environmental factors, unsafe neighborhoods, and migration patterns may be other causes of loneliness. All these factors mentioned above are within every social setting, and therefore, we face them every day. This means that from time to time, everyone may experience loneliness in one way or another. Studies done on this topic also show that loneliness is positively related to poor living arrangements, high poverty levels, as well as a lack of psychological support (Johnson et al., 2019). The number of adults at the risk of loneliness has not only increased, but also the costs associated with the situation has rapidly been increasing. Loneliness usually affects people of all ages and members from any society, from youths to young adults to even old adults of over 50 years. It is usually more prevalent in children and youths who are majorly affected by loneliness as they go through mental, social, and personal transformation. In both youths and children, loneliness is mainly related to chronic physical conditions (Bethell, Babineau, Iaboni, Green, Cuaresma-Canlas, Karunananthan & McGilton, 2019). However, in adults, it is associated with more diverse factors such as low levels of education, marital status, female gender, high poverty levels due to low income, poor quality social relations as well as poor age. In older age, it is usually associated with age-related changes and losses, and this age tends to be very vulnerable to loneliness. Finally, in patients, loneliness is associated with low recovery, poor health, not being able to freely interact with others, and even lack of energy to engage in some physical activities. Since studies have found that loneliness is there and affects almost everyone in the society, it would be important to look at the impact of loneliness on the people and some of the interventions and strategies to tackle this dangerous situation in each group. This will enable us to understand what exactly needs to be done to successfully to help each group to recover from the impacts of loneliness.

Loneliness and both physical and mental risks are positively related. It is also significantly associated with chronic conditions like cardiovascular diseases and cancer. Additionally, anyone who suffers loneliness experience negative impacts on the quality of life they live, general health, and well-being as well as one’s survival. As mentioned earlier, older people are more susceptible to loneliness than other age groups (Wee, Tsang, Toh, Lee, Yee & Koh, 2019). In the older age group, loneliness is associated with depressed moods, poor health, decreased quality of life, risk of developing Alzheimer’s disease. It is also thought to lead to perceived stress, low self-esteem, depression, shame and fear, anxiety, dementia, suicidal thoughts, and sleep disorders. Therefore, in older adults, loneliness not only increases the risk of physical and mental health, but it also increases cases of premature mortality. The social well-being of a person is positively related to better physical and mental health regardless of the person’s age (Matthews, Odgers, Danese, Fisher, Newbury, Caspi & Arseneault, 2019). Although the impacts of loneliness are not as severe in other groups as in older people, everyone in a society is affected both physically and mentally by loneliness. Since the impacts of loneliness are very severe on all groups of the people, it is necessary to come up with a range of strategies and interventions to deal with this two-sided edged sword.

The community navigator intervention practices can be used to assist children and adolescents in dealing with loneliness. Parents and teachers can play a role of community navigator to assist the children. They are usually important people in the life of both children and adolescents. From time to time, children may find themselves at high degrees of loneliness as well as social dissatisfaction (Mentalhelp.net, (n.d). This may be due to rejection by other children, friends, relatives, or any other person that may psychologically affect the child. The adolescents may also experience loneliness as they go through physical and mental changes. They become shy and avoid other people because of the transition they are undergoing. Children and adolescents sometimes cannot understand how to deal with loneliness situation due to a lack of experience and knowledge of what they are supposed. It is during this time that parents and teachers need to offer support to the children and show them how to adapt to different situations and behaviors of other children. They should also teach the students how to communicate and share their problems, desires, and feelings to avoid cases of depression that is caused by loneliness. Studies have shown that if children and adolescents are nurtured, and supported they are likely to interact with other peers as well as experience less rejection from their peers (Savolainen, Oksanen, Kaakinen, Sirola & Paek, 2020). Rejection and failure to interact freely and positively with other peers are the main causes of loneliness among children. Therefore, nurturing and supporting a child is the most effective way that parents can enable the children to avoid loneliness.

The youth is another group that is affected by loneliness. The loneliness of the youth results from participating in addictive behaviors such as compulsive use of the internet, excessive use of alcohol, and the problem of gambling. According to a study done by Savolainen et al., (2020), loneliness among the young is significantly associated with the three aforementioned addictive behaviors. Notably, compulsive use of the internet is consistently associated with experiencing loneliness among the youth than gambling and misuse of alcohol. Since the addictive behaviors are the main causes of loneliness among the youth, preventing the youth from engaging in such behaviors can greatly help to reduce loneliness among the youth (Savolainen et al., 2020). Compulsive use of the internet is the most causal addictive behavior of loneliness among the youth. The community navigators can assist the youth in participating in community social programs. This will greatly reduce loneliness among the youth as youth will be made to interact with the rest of people in society. As a result, there will be little time for youths to engage in addictive behaviors which eventually causes loneliness.

The adults and especially young adults are also another group that experiences loneliness due to different causal factors. Digital technology interventions can be, and community navigator services can be used to deal with loneliness among adults. Digital technology is defined as applications, technology, or equipment that process information that is processed by several other technological devices like robots, computers, and smartphones (Shah, Nogueras, van Woerden & Kiparoglou, 2019). Due to their tendency to be always busy, adults may find themselves in a state of loneliness because of low social interactions. However, in most cases, adults have digital technology within their reach. Computers, smartphones, among many other technological devices, have become an integral part of our daily lives. Through these devices, people can easily interact through online platforms like Facebook, Twitter, among others. Research has shown that digital technology and social change are two important interventions that can be applied to reduce and alleviate loneliness among adults. Robots, technologies, smartphones, computers, passive sensors, and monitories devices can be used by adults to alleviate loneliness. Social change of adults will, however, not be promoted by digital interventions, but community navigator services that will enable the adults to take part in social forums and interact with others.

Patients may be the group that experiences most loneliness among the groups that so far have been discussed. They are faced with all kinds of problems and pain, which may lead to stress and consequently lead to loneliness. It would be very unbearable for a patient to experience loneliness while having another health condition. Loneliness has been proved to be another public health problem, and therefore, if it not alleviated for the patients, it may have devastating impacts on the patient (Loveys, Fricchione, Kolappa, Sagar & Broadbent, 2019). Community navigators can play an important role in the recovery of patients (Bethell, Babineau, Iaboni, Green, Cuaresma-Canlas, Karunananthan & McGilton, 2019). Studies have also shown that the relationship of the patient with community navigators can affect a patient’s care engagement and support effectiveness. It is thus necessary to incorporate mammalian attachment-building behavior as part of the community navigator’s capabilities to enhance the quality of relationships and engagement between the patients and the community navigators. The community navigators should guide the patients on what they supposed to do to speed up their recovery process. Participating in community navigator services can reduce the loneliness of a patient as they encourage the patients not to remain idle but mingle with others within the society.

Community navigator intervention is one of the most effective in-person interventions that can be used to reduce and alleviate loneliness. They are particularly effective in alleviating loneliness among older adults of more than 50 years. Research has shown that older people become lonely easily due to detachment from their work environment (Malcolm, Frost & Cowie, 2019). Unless an older person is self-employed, he or she will spend almost 24 hours at home, day in day out. Although they may become used to it, in most cases, it affects them because they cannot socialize with others in society to expect neighbors and family members. Whenever people stay in one place without interacting with others, loneliness creeps in, and older adults are not different. Community navigators should, therefore, come up with programs of making the older people take part and interact with other members of society. They will feel loved and part of the community, and therefore, loneliness will not have a place in them. If done effectively, community navigator services stimulate active behavior among older adults, and this makes them stay active in society throughout their life (Bouwman, van Tilburg & Aartsen, 2019). This would help them to avoid loneliness as their time winds up.

In conclusion, loneliness continues to be a big issue among all types of people in society regardless of age. It can affect children, adolescents, young adults, patients, and even older adults. Its impacts cannot be underestimated as it is associated with some chronic conditions like cancer and cardiovascular. It can also cause depression, stress, suicidal thoughts, and dementia, among other physical and mental health problems. At its extreme, loneliness can also increase the risk of morbidity and mortality. The existence of the gap between desired and actual relationship levels is the main cause of loneliness. Therefore, to deal with this loneliness situation, this gap should be reduced by encouraging social integration in society. Community navigator interventions increase social integration and therefore if used frequently and effectively, they can reduce and alleviate loneliness in all groups of people, whether young or old.

References

Bethell, J., Babineau, J., Iaboni, A., Green, R., Cuaresma-Canlas, R., Karunananthan, R. .. & McGilton, K. S. (2019). Social integration and loneliness among long-term care home residents: protocol for a scoping review. BMJ Open, 9(12). https://www.ncbi.nlm.nih.gov/pubmed/31822544

Bouwman, T., van Tilburg, T., & Aartsen, M. (2019). Attrition in an Online Loneliness Intervention for Adults Aged 50 Years and Older: Survival Analysis. JMIR ageing, 2(2), e13638.

Johnson, S., Bacsu, J., McIntosh, T., Jeffery, B., & Novik, N. (2019). Social isolation and loneliness among immigrant and refugee seniors in Canada: a scoping review. International Journal of Migration, Health, and Social Care.

Loveys, K., Fricchione, G., Kolappa, K., Sagar, M., & Broadbent, E. (2019). Reducing Patient Loneliness ith Artificial Agents: Design Insights from Evolutionary Neuropsychiatry. Journal of medical Internet research, 21(7), e13664.

Malcolm, M., Frost, H., & Cowie, J. (2019). Loneliness and social isolation causal association with health-related lifestyle risk in older adults: a systematic review and meta-analysis protocol. Systematic reviews, 8(1), 48.

Matthews, T., Odgers, C. L., Danese, A., Fisher, H. L., Newbury, J. B., Caspi, A., & Arseneault, L. (2019). Loneliness and neighborhood characteristics: a multi-informant, nationally representative study of young adults. Psychological science, 30(5), 765-775.

Mentalhelp.net. (n.d). Loneliness in Young Children. An American Addiction Centers Resource.

Savolainen, I., Oksanen, A., Kaakinen, M., Sirola, A., & Paek, H. J. (2020). The Role of Perceived Loneliness in Youth Addictive Behaviors: Cross-National Survey Study. JMIR Mental Health, 7(1), e14035.

Shah, S. G. S., Nogueras, D., van Woerden, H. C., & Kiparoglou, V. (2019). The effectiveness of digital technology interventions to reduce loneliness in adult people: A protocol for a systematic review and meta-analysis. medRxiv, 19000414.

Wee, L. E., Tsang, T. Y. Y., Yi, H., Toh, S. A., Lee, G. L., Yee, J., … & Koh, G. C. H. (2019). Loneliness amongst low-socioeconomic status elderly Singaporeans and its association with perceptions of the neighborhood environment. International journal of environmental research and public health, 16(6), 967.