title: Loneliness and Its Determinants in Relation to Suicidal Behavior of Seniors type: Research Articles language: English published: 05 Aug 2019 updated: 05 Aug 2019 category: Psychológia author: Mgr. Katarína Kotradyová, PhD source: https://www.prohuman.sk/psychologia/osamelost-a-jej-determinanty-v-nadvaznosti-sa-suicidalne-spravanie-seniorov
Loneliness and its determinants in relation to suicidal behavior of seniors Loneliness is a concealed phenomenon of contemporary times, yet it is a social phenomenon affecting a diverse group of people. Loneliness is also individual and stems from the subjective experience of objective reality. It is, in some sense, tied to a person’s emotional world, which is shaped by various life events and makes one feel lonely. Loneliness is a feeling of distress accompanied by perceived deficits in social relationships. It often appears together with social isolation, but a person may be socially isolated without feeling lonely, and one may feel lonely without being socially isolated. Unlike social isolation, loneliness is more closely related to the perceived quality of social relationships than to their quantity. Recent empirical evidence supports three distinct dimensions of loneliness: intimacy-related loneliness, relational loneliness, and collective engagement loneliness (Leahey, Hawkley, 2010).
Bruno (2002), in defining loneliness, draws on the hierarchy of needs and places loneliness in the context of the unmet fulfillment of these needs. He defines loneliness as a negative mental and emotional state characterized by feelings of isolation and a lack of significant relationships with other people.
Sýkorová (2007) argues that we understand loneliness through two paradigmatic models. One is based on an existential feeling, which can be either negative or positive; the second dimension is linked to the current life situation into which the person enters due to life circumstances.
Yet we assume that when loneliness is viewed this way, it can also appear as temporary aloneness caused by a specific situation, and it does not necessarily have a negative charge by itself. Loneliness, however, is fundamentally a subjective experience for each individual and is generally the result of perceiving some form of deficiency in interpersonal relationships. It is characterized by an unpleasant feeling. (Hrozenská, 2007) Other definitions emphasize especially the subjective perception of loneliness. They point mainly to the discrepancy between idealized and perceived relationships, the gap between the number of friends one wishes to have and the number one actually has, and, from a psychoanalytic perspective, loneliness is experienced as a failure to satisfy the basic need for intimacy. (Molčanová, Baumgartner, & Kaňuková, 2007)
From these definitions, we infer that perceived loneliness is always individual because it derives from subjective evaluation of objective reality, and feelings of loneliness are always associated with a negative affect linked to interpersonal relationships, especially their intensity, depth, and frequency. Individuals differ significantly in their approach to coping with loneliness, as well as in their ability or even possibility to create a network of relationships that is satisfying enough to prevent negative loneliness experiences. The basic precondition for loneliness to develop is solitude. The term solitude is often integrated, even confused, with loneliness, yet these are two different concepts. Solitude is understood as a real life circumstance that unfolds into a specific situation in which a person finds himself or herself. Solitude as a form of experience can be voluntary or can arise from external factors. It does not always represent an unpleasant experience of loneliness.
Weiss distinguishes two types of loneliness: social and emotional. Emotional loneliness is characterized by the absence of a close or intimate relationship, while social loneliness is linked to the direct experience of absence of a broader social network. (Weiss, 1987, cited in Výrost, Slameník, 2001).
Looking at loneliness by age, the largest group living in loneliness is people over sixty-five. This is partly because most of these individuals have already raised their children, who no longer live with their parents, and partly because many of them have lost their partners. In addition, various mental disorders and other social determinants that increase with age contribute heavily to the negative feelings arising from loneliness. Older individuals may even express a wish to die in connection with loneliness, and some of them show a significant tendency toward suicide, precisely in the context of long-term experience of solitary living.
According to Stravynski and Boyer, some significant associations between loneliness and various manifestations of suicidal behavior have been reported across different subgroups, but a marked increase in suicide due to loneliness is reported particularly among older individuals. A strong association between suicidal tendencies and loneliness in seniors is defined both subjectively and objectively. Furthermore, the occurrence of suicidal thoughts increases with the level of loneliness. (Stravynski, Boyer, 2001)
Demographic aging, together with social and economic changes occurring in society, increases the likelihood of a rise in loneliness in this age group, especially due to the reduced availability of various sources of social support. The loneliness of older people differs in qualitative terms; its characteristics are influenced by marital status, gender, age, education level, economic status, life arrangement, health condition, and the overall amount of social support provided. Family is perceived as the most important source of social support, followed by friends. The very receipt of support from family and friends subsequently improves subjective psychological wellbeing and mental health in seniors. Yet research in this area shows that older people receive relatively little social support from neighbors or from governmental and other community organizations. (Chen, Hicks, & While, 2014)
Aging is often associated with deepening loneliness and isolation. Adult children are typically immersed in their own lives and often do not have time to be with parents. Aging therefore brings isolation from family or from family in one’s immediate environment. Illness creates further feelings of isolation and loneliness, which can then lead to depression in older adults. (Glicken, 2009).
Morley and Glicken (2009), writing about social isolation leading to depression across the life course, note that loneliness among seniors is a serious and often unrecognized problem. Older adults experiencing loneliness are, according to Stanley, at increased risk for both physical and mental illnesses, including premature death. The authors note that by identifying potential sources of social belonging, one can better understand how to support health and psychological wellbeing among older adults. (Stanley, et al., 2014) Loneliness in seniors is often identified through emotional and social isolation, while social, psychological, and physical factors can also contribute to intensified loneliness feelings. Loneliness also influences the worsening of health status in older adults. (Dong, Chang, Wong, & Simon, 2012) According to Patterson and Veenstra (2010), chronic loneliness significantly increases mortality risk, as risk is significantly higher in respondents who report feeling lonely compared with those who report never or rarely feeling lonely. Loneliness in seniors is also noticeable with long-term health decline. Following Elias, Neville, and Scott (2015), we rely on the claim that loneliness, anxiety, and depression are common among older adults in long-term care, largely due to worsening health status. A lack of positive relationships is a major factor in broad patterns of morbidity and mortality; research suggests loneliness increases sensitivity to social threats and may motivate attempts to restore social contact, but it can also, on the other hand, significantly disrupt executive functioning, sleep, and mental wellbeing. (Cacioppo, Capitanio, 2014)
In the following lines, we review current studies related to the experience of loneliness. Social isolation and loneliness have been recognized as major risk factors for morbidity and mortality for more than a quarter century. There is evidence that perceived social isolation and loneliness affect the brain and behavior and are a high-risk factor for mortality. Although testing the causal role of loneliness in neural mechanisms and death is difficult in humans, experimental studies show that social isolation produces significant changes in brain structures and processes. (Cacioppo, Capitanio, & Cacioppo, 2014) Luo and Waite note, regarding loneliness and increased mortality among lonely older adults, that in their study they found up to 28% of older Chinese adults feel lonely, and lonely Chinese older adults will face increased mortality risk in coming years because of persistent loneliness. (2014) According to Dahlberg and McKee, loneliness has a significant influence on quality of life in old age and must therefore be conceptualized as a model consisting of two dimensions: social and emotional. In a study conducted by these authors in the United States in 2014, among 1,255 respondents over 60 years of age, 7.7% reported feeling very lonely, while a further 38.3% described themselves as moderately lonely. Social and emotional loneliness was shared by as many as 19.36% of respondents. This study provides further empirical support for conceptually separating emotional and social loneliness. As a result, policies aimed at reducing loneliness in older adults should be directed toward a range of different intervention strategies, especially when both types—emotional and social loneliness—co-occur. (Dahlberg, McKee, 2014) The goal of research conducted by Chen and Feeley in 2014 was to increase social support for older adults experiencing loneliness in each of four relational support sources (partner, children, family, and friends). Final findings showed support from partners and friends was able to partially reduce loneliness. It was also established that in later life, different support sources can have distinct effects on loneliness and wellbeing, and that loneliness is a serious social determinant associated with overall wellbeing. Holwerda (2014) tested the relationship between social isolation and loneliness on one side and increased dementia on the other within a cohort study of 2,173 seniors, with participants followed for three years. According to the results, loneliness was associated with a higher likelihood of developing dementia than among those without such feelings. Loneliness can therefore be considered a major risk factor for dementia, including the onset of Alzheimer’s disease, and thus merits greater clinical attention, according to the study authors. (Holwerda, et al., 2014) Utz, in relation to loneliness, pointed to the aspect that even with increased social support after widowhood, loneliness remains among the most common reasons why bereaved persons report death-related strain. The research analysis examined the dynamic relation between social support and loneliness among bereaved older adults who had lost a partner. To estimate changes in participants’ lives caused by loneliness and subsequent social support over the first one and a half years after the partner’s death, latent growth curve modeling was used for adults aged 50 and above. It is noteworthy that loneliness declined during the first year and a half after the partner’s death because greater social support predicted lower overall loneliness; however, receiving social support did not alter loneliness in the later period, when social support was no longer provided at such a high level. Loneliness correlates more with support from friends than with support from family. Combined support from both friends and family reduced negative feelings linked to loneliness by up to 35%. Yet study findings suggest loneliness after widowhood cannot be resolved only through interventions aimed at increasing social support; additional interventions are needed to reduce loneliness independently of such support. Social support, especially from friends, seems to be more effective than support from family. (Utz, et al., 2014)
Regarding social support from a partner, we also mention research by Holtfreter, Reising and Turanovic (2016). The authors claim that, among individuals with poor health but a strong positive partner relationship, loneliness does not appear as strongly. The authors also emphasize that it is not merely the number of family ties that influences loneliness, but rather the quality of those ties and relationships.
A study conducted in 2012 by Aylaz, Aktürk, Erci, Öztürk, and Aslan describes relationships between depression and loneliness among older people in relation to influencing factors. It was found that there is a significant correlation between loneliness and depression among community-dwelling older adults, while the presence of good social security and higher income, on the other hand, was associated with even lower average scores.
Higher levels of loneliness also appear among older people who live alone and do not use social networks online. In general, we can therefore state that internet use has a meaningful role in methods that contribute to reducing loneliness among mature adults. (Sar, Göktürk, Tura, Kazaz, 2012)
Suicide and Physical Age in the Context of Loneliness
Loneliness is associated with an increased risk of involving seniors in suicidal behavior. To date, however, relatively few studies have been conducted specifically on this topic. Loneliness is, more generally, associated with suicidal behavior in the adult population. (Stickley, Koyanagi, 2016).
The risk of suicide is high in older age, especially among older men. Mood disorders are known risk factors, but suicide risk connected to poor physical health remains unclear. Older Australian men with multiple health conditions have, for example, the highest risk of suicide death, particularly when mood disorders are present, often due to loneliness itself. (Almeida, McCaul, Hankey, Yeap, Golledge & Flicker, 2016)
Loneliness is often expressed through intense feelings of emptiness and abandonment and can lead to depression and suicide, according to Bekhet, Jaclene, and Zauszniewski. (2012) The prevalence of loneliness among older people is estimated by these authors to be as high as 40%. Findings from this study suggest that certain intervention programs aimed at preventing or reducing loneliness in older adults could be beneficial in preserving their mental health.
Suicide is a global problem among older people, but relatively few studies have examined suicidal thoughts in older Asian psychiatric outpatient populations. The purpose of the study conducted in 2015 was to examine triggers of suicidal ideation among older adults. Data were collected through individual interviews and analyzed using content analysis. It was found that suicidal thoughts were triggered by illness and physical discomfort. However, reasons for not carrying out suicide included support from family members or friends. (Lee, Chen, Huang, 2015). From these findings we can infer that if no social support had existed in their lives, and if they had not felt less lonely, the likelihood would have been greater that suicidal thoughts could eventually lead to actual life ending. According to Paraschakis, Athanassios Douzenis, Michopoulos, Christodoulou, Vassilopoulou, Koutsaftis, & Lykouras (2012), the number of suicides in older age in Greece is highest among all age groups. Greece is one of the countries with the highest share of older people in the European Union (EU). Older individuals who commit suicide appear to have different characteristics from other age groups, and the study aimed to describe these characteristics. Data were obtained from a two-year psychological study conducted in the Athens Forensic Medicine Department in Greece. Older individuals who died by suicide account for 35% of all suicides. The majority (69.5%) were men. Only 12.4% had prior psychiatric hospitalization, but more than half (65.2%) had psychiatric history (81% of them had depression in their history). As expected, there was a high prevalence of physical illness, up to 81.6%. Most (82%) of older people who attempted suicide did so for the first time. The authors divided older suicide victims into two groups: the younger-old and the oldest-old. Group differences existed in that persons over 75 had more physical problems and a more frequent psychiatric history. According to the authors, suicides at older ages can be categorized into groups with different characteristics, and these differences may be meaningful indicators for formulating needed suicide prevention strategies.
Kanchan (2016), in this context, points out that studies of suicide and suicidal behavior among seniors provide necessary datasets for understanding these multi-layered and complex phenomena. Psychiatric disorders such as depression, personality disorders, alcohol misuse, substance dependence, schizophrenia, suicidal thoughts, chronic physical illnesses, social isolation, hopelessness, and easy access to lethal methods are some well-defined risk factors for suicide.
The aim of another study was to determine suicide risk among older patients hospitalized and treated for physical illnesses, as well as the factors affecting this risk. The study used a cross-sectional design and involved 459 older adults hospitalized in a public hospital. In the study, 24.0% of seniors were at high risk of suicide. Suicide risk was highest among those aged 60–74 who lived alone, drank alcohol, perceived their religious belief as weak, and/or were being treated for cancer. Higher suicide risk also appeared in older participants with a history of psychiatric treatment, and anxiety and depressive symptoms were also identified as risk factors. (Avci, Tari Selcuk, Dogan, 2016). According to Ondrejkovič, suicidal threat, suicidality, and life fatigue rise dramatically with age. Males contribute decisively to the number of completed suicides in age counts. Compared with the total number of suicide attempts (non-fatal attempts), their numbers are significantly lower among those aged 85 and older. In gerontologically oriented suicide research it is noted that for suicidal threat in older people, this is often a prolonged maturation of suicidal thoughts, which sometimes begin already in youth. (Ondrejkovič, 2015) Many experts believe that older adults’ suicidality is linked to, or directly connected with, a diseased state; however, Schmitz-Scherzer (in Ondrejkovič, 2015) warns that this generalization is incorrect and that suicidality in old age does not always rest solely on pathological processes. He suggests that even a psychiatric disorder—or even severe mental illness—is not always sufficient to explain older people’s suicide. According to Ondrejkovič, determinants of suicide include, above all, major financial constraints and poverty, but also solitude and isolation; therefore, we cannot overlook the social and cultural aspects of older adults’ lives. (Ondrejkovič, 2015)
In addition to loneliness, natural disasters (earthquakes, floods) contribute to senior suicides, as they are accompanied by subsequent immediate psychological problems linked to adverse life and economic conditions. (Kõlves, De Leo, 2013)
Among key factors contributing to suicide in lonely seniors, Appleton and Pridmore identify excessive use of alcohol or drugs, a conflicted relationship or breakup followed by life in loneliness, and mental disorders and health-related problems. (2012) Suicide is a complex phenomenon associated with multiple temporal and spatial factors. Some studies even show that geographic aspects may be directly linked to rising suicide rates among seniors. One example is the observed phenomenon that older people living in rural areas attempt suicide more often than those living in urban areas. This may be related to the influence of loneliness, which may be stronger in rural settings. (Bolzam, Zandonade, 2012) Suicide is a major public health issue worldwide, and it occurs more often in rural than urban areas. The literature review of rural senior suicide suggests an increasing amount of empirical and theoretical work on this topic. Geographic and interpersonal isolation, insufficient access to care, and rural ideologies all contribute to a higher suicide risk for older adults in rural areas. (Hirsch, Cukrowicz, 2014)
Suicide among seniors is a major health issue in North America as well, especially among men over age 50. The most common mechanism is firearms (28%), followed by hanging (25%), poisoning (21%), and falling from heights (7%). In addition to loneliness, suicide causes include low socioeconomic status, depression, psychosis, neurosis, and illnesses such as cancer or stroke, among others. (Voaklander, Rowe, Dryden, Pahal, Saar, Kelly 2008).
The results of a large study in Japan indicate that suicide among seniors during the first five years after stroke has a strikingly increasing tendency. This makes increased social and psychological care for patients after stroke necessary, rather than focusing only on medical care. Stroke clearly increases suicide risk in older individuals, primarily because physical limitations then produce loneliness. (Yamauchi, Inagaki, Yonemoto, Iwasaki, Inoue, Akechi, Tsugane, 2014). Therefore, in older people who have had a stroke and whose life is marked by severe physical limitation, regular screening for depression and suicidal thinking is needed. (Fuller‐Thomson, Tulipano, Song, 2012).
If we summarize the previous statements, it is clear that loneliness may be triggered directly by physical and/or psychological illness, while chronic loneliness can also cause depression, sleep disorders, and other mental disorders, and importantly, may lead to suicidal behavior in older people. Loneliness therefore clearly increases mortality risk in older adults, whether directly or indirectly through causal pathways of causes and consequences. It is therefore necessary to note and agree with the authors below that clinical professionals involved in suicide prevention among older adults should pay special attention to loneliness and lack of social support, which may prevent suicidal behavior in this age group. (Innamorati, Pompili, Di Vittorio, Baratta, Masotti, Badaracco, Conwell, Girardi, Amore, 2014).
Qualitative Research – Open Coding
Open coding is the part of analysis that deals with labeling and categorizing concepts through data examination. At its core, coding uses two analytical procedures; the substance of these procedures changes by coding type. The first concerns comparison, and the second involves asking questions. These two procedures are used in open coding for conceptualization and categorization of data. (Strauss, Corbinová, 1999) Our first step in open coding was conceptualizing data, that is, analyzing it and then assigning a name that represented the phenomenon. When we identified certain phenomena in the data, we then began grouping the concepts. The process of grouping concepts that express affiliation with a given social phenomenon is called categorization. In the next phase, we further developed the categories, established so-called subcategories (properties), and then described their dimensional ranges. Following Strauss and Corbinová (1999), we rely on their description that “properties are characteristics or attributes of categories, while dimensions represent the location of these properties on a continuum. Open coding stimulates the discovery not only of categories, but also of their properties and dimensions.” (1999) To increase theoretical sensitivity, we used techniques in open coding proposed by these same authors: question-asking techniques using questions such as who, when, what, how, how much, why, as well as temporal questions—frequency of occurrence, duration, speed, timing—and contrast techniques, comparing similar and distant phenomena, and “red flagging.”
Open coding is part of grounded theory, yet it can also be conducted as an independent investigation without subsequent axial and selective coding. Strauss and Corbinová (1999) state that the initial research question is broad enough to include all possibilities and not so narrow as to exclude emergence, which is its primary purpose. The research question we chose, covering a wider context of loneliness, was: What determinants characterize loneliness in seniors? The object of research was ten seniors over 65 who declared loneliness in counseling interviews at a specialized social counseling office in Krompachy.1 In most cases, participants agreed to audio recording; in one case no consent was given, and the interview was therefore recorded in writing. The first two unstructured interviews were transcribed verbatim. For the rest, selective transcription was used.2 Later, as our theory developed, we listened to the recorded interviews and transcribed only the parts—sentences—useful for the developing theory; at the beginning of the study it is not yet clear what is essential. In the empirical research we also used unstructured observation, through which we mapped participant behavior. The sample was purposively selected. The sample consisted of ten participants: five men and five women. The age range was 68 to 78 years. Participants lived alone, with six in family houses and four in apartment buildings. Three participants were under psychiatric care for persistent depressive and anxiety states. Of the ten participants, only one had no children. All participants described their loneliness as long-term, lasting more than five years.
Table 1. Proposed Categorical System: Source – Author’s Processing
Within open coding, three categories emerged: feelings, consequences, and experience. Within these categories, we then identified the subcategories and their properties or dimensions listed below.
Table 2. Overview of Selected Categories and Subsequent Subcategories – source: author’s processing
The Category of Feelings is linked to persistent feelings of worthlessness and inferiority, which participants identify as a phenomenon causing psychological pain. These are stable feelings primarily tied to society and to an environment that participants describe as a closed system. Participants feel they have already fulfilled their role in society and are no longer needed. Feelings arising from loneliness also include guilt. This phenomenon concerns participants blaming their environment for their situation, for example children, close relatives, and acquaintances who have lost interest in them, but it also includes internal guilt—self-blame for not maintaining a marriage or never entering one. Self-directed guilt is then reflected in clear hostility that respondents turn either toward themselves or toward their environment. Expressed fears are associated with death and with being alone at life’s final moment. These fears are often masked in questions about the afterlife and what comes next. Respondents expressed, when fearing death, that they did not have anyone to discuss this with. Uncertainty in daily activities again stemmed from health status and, for respondents, loneliness was connected to this because during everyday tasks they had no one to lean on; even activities they had previously performed without obvious difficulty became associated with uncertainty. Waiting for death is of course age-related, but living in loneliness intensifies this sense of inevitability; meanwhile uncertainty (“How long will I live—maybe I will die today”) creates an image of a person who waits for death every day. Loneliness is also associated not only with waiting for death but with wanting to die, or literally a wish to die as relief. This subcategory was separated as a standalone subcategory, but it is clearly determined by other feelings that strongly intensify the wish for death. The wish to die was identified in all respondents, and within the subcategory’s property scale we rate it as high. Of the twelve respondents, however, none declared a direct intention to commit suicide in the context of this wish. Participants associated anger with loneliness very strongly, but unlike guilt, they did not turn this anger toward themselves; rather, they did the opposite. They directed anger toward family members who rejected them or failed to listen, and toward society in relation to low pensions that did not allow them to experience the later years as they had envisioned.
Table 3. Subcategories and Their Dimensions (Feelings Category)
The Category of Consequences is strongly shaped by subcategories of inner agitation, psychomotor slowing, apathy, poor sleep, loss of energy, crying, and reminiscing about the past. Besides reminiscing, all noted consequences of loneliness are prominent or less prominent signs of depressive disorder or anxiety-depressive pathology. Participants attribute these manifestations to loneliness and state that they would likely not have them if they did not live alone. It is obvious that sleep problems may also be associated with aging; however, participants described their sleep problems as severe and persistent. Crying appears among respondents in different situations, often in the context of random encounters with peers living in extended families with children and perhaps grandchildren, or with a life partner. Constantly comparing one’s life in loneliness with others’ lives is painful and contributes to the emergence of subsequent depressive symptoms. Reminiscing about the past is a common behavioral pattern among older individuals, primarily involving a return to periods participants identify as happy. This form of reminiscence has some justification. Individuals should draw strength and energy from those periods, but for research participants it often produced negative associations. This category shows from interview results that there is likely a connection between mental health and the degree of perceived loneliness.
Table 4. Subcategories and Their Dimensions (Consequences Category)
We divided Causes of the Onset of Loneliness into two subcategories: internal and external causes, although this distinction was not originally planned. Participants identified causes of loneliness as phenomena they could not significantly influence: primarily the death of a partner, children moving away, and worsening health. Worsened health is shaped by reduced mobility, reduced mental performance, and also impaired vision and hearing. Surprisingly, we also found participants strongly maintained so-called internal causes of loneliness. They mention a complex or unsocial nature. Participants see the cause of their loneliness in complicated relationships with their own children. This is naturally an intergenerational issue, involving both the long-hours demands of the current working generation and the fact that children often do not know what to say to their parents. Visits by children are sporadic and increasingly rare. Participants describe unsocial disposition as resulting from a steadily shrinking number of social contacts; they report that they do not understand contemporary times, the world is too fast for them, and therefore they withdraw from it, which in the eyes of others makes them appear as odd and solitary people.
Table 5. Subcategories and Their Dimensions (Causes Category)
Discussion and Conclusion
Based on participants’ responses, we can confirm that loneliness as a subjective phenomenon is perceived by participants as a negative experience and is linked to interpersonal relationships, most often to the absence of one close person (spouse/partner). Furthermore, we can state that the present era significantly deepens loneliness in the lives of older adults. Based on participants’ responses, we can also confirm that loneliness is conditioned not only by the number of maintained relationships but also by other partial aspects, such as co-residence with family members, mutual relationships, frequency of meeting, distance from relatives, or frequency of visits. Even when a person is surrounded by several friends, whether closer or less close, the absence of one specific person triggers the mixture of negative feelings described above.
Through open coding, we sought to enrich scientific knowledge with new findings through authentic interviews with participants for whom loneliness is a serious and complex issue, especially in connection with their final life stage.
Based on research results, we can confirm that loneliness in an older person’s life creates strong negative connotations linked to thoughts of death, which can culminate in suicide. All participants reported that in the context of persistent loneliness they frequently considered death. Nine of ten respondents would like to die as soon as possible and view death as a release from loneliness, which they consider unbearable. None of the respondents explicitly declared suicide as a clear intention, yet there remains risk of premature life termination. Within the feelings category, two subcategories emerged that are associated with death: feelings directly linked to thoughts connoted with death, specifically feelings connected with waiting for death and feelings connected with the wish to die. Participants reported waiting for death as frequent to constant on the scale, and desire for death as constant to persistent. Social relationships that are not sufficiently nourishing play a major role in describing loneliness among seniors; they contribute to deepening negative feelings in everyday experience and can naturally lead to various mental disorders. We therefore agree with Santiny, Fiori, Feeney, Tyrovolas, Haro, Koyanagi (2016), who state that interventions aimed at improving relationship quality and strengthening existing social network structures, with special focus on reducing loneliness, may be beneficial in preventing depressive symptoms in older adults.
The evidence we obtained generally suggests that loneliness increases emotional sensitivity to social threats but can also impair executive functioning, sleep, and mental and physical wellbeing. Loneliness among seniors is therefore becoming a serious societal problem and may contribute to higher and earlier mortality in this age group. A similar view is shared by Cacioppo, S., Capitanio, J. P., & Cacioppo, J. (2014), who describe the aspects of loneliness and social isolation as factors contributing to higher morbidity and mortality specifically in older adults.
The question remains: who or what could improve this state of loneliness in seniors? We believe the state can play a role here: the state itself, through creating networks of social support services for this group. Many authors addressing loneliness argue that communities and social services that would create wider social networks could jointly assume responsibility for reducing social isolation and loneliness among seniors, as well as improving relationships across generations. This entire set of supportive measures could be part of services that would accompany vulnerable older adults. (Dong, Chang, Wong, Simon, & 2012)
In the public health improvement context, there is an urgent need to identify societal interventions that reduce suicide risk in older age stemming from loneliness. In conclusion, we also want to draw attention to determinants of suicidal behavior in seniors: if we want to reduce suicides caused by loneliness, it is necessary to deconstruct commonly accepted myths about suicide that have become ingrained in society.
Suicide among seniors can be prevented, and we should clearly attempt to do so, as it is very possible that such attempts can be successful, because humans are fundamentally life-oriented. (Špateková, 2004)
Research in social epidemiology within loneliness suggests that the absence of positive social relationships in older adults is a significant risk factor for broad morbidity and mortality. The nature of these social relationships and mechanisms is significant because populations are aging, and healthcare costs related to chronic illness can lead to suicides in industrialized countries. It is necessary to determine the degree to which an individual feels isolated (that is, feels lonely) in social life and then offer that person a helping hand.
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1 Krompachy sú malé mestečko nachádzajúce sa východe Slovenskej republiky. 2 Opierali sme sa o Straussa a Corbinovú (1999), ktorí navrhujú „úplne prvé rozhovory prepísať celé a takisto celé analyzovať a až potom pristúpiť k tým ostatným. Toto počiatočné kódovanie poskytuje akúsi podporu pre všetky nasledujúce pozorovania alebo rozhovory.“