Ageing with chronic conditions and older persons’ experience of social connections: a qualitative descriptive study

Cristina Thompson; Elizabeth Halcomb; Malcolm Masso; Amy Montgomery

doi:10.1071/PY24019

RESEARCH ARTICLE (Open Access)

Next Contents Vol 30(4)

Ageing with chronic conditions and older persons’ experience of social connections: a qualitative descriptive study

Cristina Thompson

^A ^* , Elizabeth Halcomb

^A , Malcolm Masso ^B and Amy Montgomery

^A

+ Author Affiliations

- Author Affiliations

^A School of Nursing, University of Wollongong, Wollongong, NSW 2522, Australia.

^B Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia.

^* Correspondence to: cjt54@uowmail.edu.au

Australian Journal of Primary Health 30, PY24019 https://doi.org/10.1071/PY24019

Submitted: 1 March 2024 Accepted: 11 June 2024 Published: 4 July 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Chronic conditions may limit older peoples’ social engagement and wellbeing. Reduced social connections can result in loneliness and social isolation. This study aimed to explore the experience of social connection in older people living with chronic conditions, and the factors influencing their social participation.

Methods

A purposive sample of 19 community-dwelling older Australians (mean age 75.5 years) with one or more chronic conditions participated in a qualitative descriptive study. Semi-structured interviews explored participants’ perceptions of their social connections and the potential impact of their chronic conditions. Views about the role of general practice in supporting older persons’ wellbeing were discussed. Data were analysed inductively using thematic analysis.

Results

Five themes were identified: (1) the experience of loneliness, (2) managing diminishing social contacts, (3) living with chronic conditions, (4) barriers to social connection, and (5) facilitators of social connection. Participants felt that ageing with chronic conditions contributed to loss of function and independence, which limited social connections, and increased loneliness and social isolation. Barriers to social connections included issues with mobility, transport and forming new networks. Families were a primary support, with continued community engagement and general practice support crucial to staying well and socially connected.

Conclusions

Understanding older peoples’ experiences, and the barriers and facilitators of social connections can guide clinicians’ interventions. General practice is a promising intervention point because of its high use by those with chronic conditions to stay well. General practice nurses are well-placed to collaboratively address the barriers older people face in maintaining social connections.

Keywords: chronic conditions, general practice, nursing, loneliness, older adults, qualitative, social connection, social isolation.

References

Australian Bureau of Statistics (2021) Remotness structure – Australian Statistical Geography Standard (ASGS) Edition 3. 3rd edn. Vol. 2024. Australian Bureau of Statistics, Canberra. Available at https://www.abs.gov.au/statistics/standards/australian-statistical-geography-standard-asgs-edition-3/jul2021-jun2026/remoteness-structure

Beer A, Faulkner D, Law J, Lewin G, Tinker A, Buys L, Bentley R, Watt A, McKechnie S, Chessman S (2016) Regional variation in social isolation amongst older Australians. Regional Studies, Regional Science 3(1), 170-184.
| Crossref | Google Scholar |

Bindels J, Cox K, De La Haye J, Mevissen G, Heijing S, van Schayck OCP, Widdershoven G, Abma TA (2015) Losing connections and receiving support to reconnect: experiences of frail older people within care programmes implemented in primary care settings. International Journal of Older People Nursing 10(3), 179-189.
| Crossref | Google Scholar | PubMed |

Braun V, Clarke V (2022) ‘Thematic analysis: a practical guide.’ (Sage: London)

Coll-Planas L, Nyqvist F, Puig T, Urrútia G, Solà I, Monteserín R (2017) Social capital interventions targeting older people and their impact on health: a systematic review. Journal of Epidemiology and Community Health 71(7), 663-672.
| Crossref | Google Scholar | PubMed |

Ending Loneliness Together (2020) Ending loneliness together in Australia: White Paper November 2020. Available at https://endingloneliness.com.au/wp-content/uploads/2020/11/Ending-Loneliness-Together-in-Australia_Nov20.pdf

Forsman AK, Herberts C, Nyqvist F, Wahlbeck K, Schierenbeck I (2013) Understanding the role of social capital for mental wellbeing among older adults. Ageing and Society 33(5), 804-825.
| Crossref | Google Scholar |

Galvez-Hernandez P, González-de Paz L, Muntaner C (2022) Primary care-based interventions addressing social isolation and loneliness in older people: a scoping review. BMJ Open 12(2), e057729.
| Crossref | Google Scholar | PubMed |

Gerst-Emerson K, Jayawardhana J (2015) Loneliness as a public health issue: the impact of loneliness on health care utilization among older adults. American Journal of Public Health 105(5), 1013-1019.
| Crossref | Google Scholar | PubMed |

Ghosh A (2019) Population health profile: South Eastern NSW. COORDINARE South Eastern NSW Primary Health Network, Wollongong, NSW. Available at https://www.coordinare.org.au/assets/Files-2022/Population-Health-Profile.pdf

Halcomb E, Ashley C (2019) Are Australian general practice nurses underutilised?: an examination of current roles and task satisfaction. Collegian 26(5), 522-527.
| Crossref | Google Scholar |

Halcomb E, Thompson C, Tillott S, Robinson K, Lucas E (2022) Exploring social connectedness in older Australians with chronic conditions: results of a descriptive survey. Collegian 29(6), 860-866.
| Crossref | Google Scholar |

Holt-Lunstad J (2017) The potential public health relevance of social isolation and loneliness: prevalence, epidemiology, and risk factors. Public Policy & Aging Report 27(4), 127-130.
| Crossref | Google Scholar |

Holt-Lunstad J, Robles TF, Sbarra DA (2017) Advancing social connection as a public health priority in the United States. American Psychologist 72(6), 517-530.
| Crossref | Google Scholar | PubMed |

Kharicha K, Iliffe S, Manthorpe J, Chew-Graham CA, Cattan M, Goodman C, Kirby-Barr M, Whitehouse JH, Walters K (2017) What do older people experiencing loneliness think about primary care or community based interventions to reduce loneliness? A qualitative study in England. Health & Social Care in the Community 25(6), 1733-1742.
| Crossref | Google Scholar | PubMed |

Kim H, Sefcik JS, Bradway C (2017) Characteristics of qualitative descriptive studies: a systematic review. Research in Nursing & Health 40(1), 23-42.
| Crossref | Google Scholar | PubMed |

Lincoln Y, Guba E (1985) ‘Naturalistic inquiry.’ (SAGE Publications: California, USA)

Lucas E, Halcomb E, McCarthy S (2017) Connecting care in the community: what works and what doesn’t. Australian Journal of Primary Health 22(6), 539-544.
| Crossref | Google Scholar |

Maresova P, Javanmardi E, Barakovic S, Barakovic Husic J, Tomsone S, Krejcar O, Kuca K (2019) Consequences of chronic diseases and other limitations associated with old age – a scoping review. BMC Public Health 19, 1431.
| Crossref | Google Scholar |

Martins LCG, Lopes MVdO, Diniz CM, Guedes NG (2021) The factors related to a sedentary lifestyle: a meta-analysis review. Journal of Advanced Nursing 77(3), 1188-1205.
| Crossref | Google Scholar | PubMed |

Misra-Hebert AD, Perzynski A, Rothberg MB, Fox J, Mercer MB, Liu X, Hu B, Aron DC, Stange KC (2018) Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system. Journal of General Internal Medicine 33(11), 1928-1936.
| Crossref | Google Scholar | PubMed |

National Academies of Sciences Engineering and Medicine (2020) ‘Social isolation and loneliness in older adults: opportunities for the health care system.’ (National Academies Press)

Nyqvist F, Victor CR, Forsman AK, Cattan M (2016) The association between social capital and loneliness in different age groups: a population-based study in Western Finland. BMC Public Health 16(1), 542.
| Crossref | Google Scholar |

Putnam RD (2000) ‘Bowling alone: the collapse and revival of American community.’ (Simon and Schuster: New York, NY, USA)

Roy K, Smilowitz S, Bhatt S, Conroy ML (2023) Impact of social isolation and loneliness in older adults: current understanding and future directions. Current Geriatrics Reports 12(3), 138-148.
| Crossref | Google Scholar |

Schrempft S, Jackowska M, Hamer M, Steptoe A (2019) Associations between social isolation, loneliness, and objective physical activity in older men and women. BMC Public Health 19, 74.
| Crossref | Google Scholar |

Shi Y, Yang Y, Wang L, Zhang J (2023) The lived experiences of loneliness of older adults with chronic conditions aging at home: a qualitative systematic review and meta-aggregation. Geriatric Nursing 51, 274-285.
| Crossref | Google Scholar | PubMed |

Taube E, Jakobsson U, Midlöv P, Kristensson J (2016) Being in a Bubble: the experience of loneliness among frail older people. Journal of Advanced Nursing 72(3), 631-640.
| Crossref | Google Scholar | PubMed |

Thompson C, Halcomb E, Masso M (2023) The contribution of primary care practitioners to interventions reducing loneliness and social isolation in older people—an integrative review. Scandinavian Journal of Caring Sciences 37, 611-627.
| Crossref | Google Scholar |

Veazie S, Gilbert J, Winchell K, Paynter R, Guise J-M (2019) Addressing social isolation to improve the health of older adults: a rapid review. Rapid evidence product. (Prepared by Scientific Resource Center under Contract No. 290-2017-00003-C.). (Agency for Healthcare Research and Quality: Rockville, MD) Available at https://doi.org/10.23970/AHRQEPC-RAPIDISOLATION

World Health Organization (2021) Social isolation and loneliness among older people: advocacy brief. Report number 9240030743. WHO, Geneva.

World Health Organization (2024) WHO Commission on Social Connection. Vol. 2024. Available at https://www.who.int/groups/commission-on-social-connection

Yang G, D’Arcy C (2022) Physical activity and social support mediate the relationship between chronic diseases and positive mental health in a national sample of community-dwelling Canadians 65+: a structural equation analysis. Journal of Affective Disorders 298, 142-150.
| Crossref | Google Scholar | PubMed |