Background: Loneliness in later life is often addressed with befriending interventions, yet evidence for their effectiveness is limited. Meanwhile it is known that loneliness has a deleterious impact on health. The aim of the study is to evaluate whether a befriending service for older adults mitigates the impact of loneliness on health outcomes, and to identify mechanisms through which befriending interventions might impact upon health. Methods: A mixed methods design is used. The quantitative component utilises an AB single-case experimental design, to gather intensive longitudinal data. These data will be analysed using a generalised additive modelling approach. The qualitative component of the study uses semi-structured dyadic interviews, structured and analysed according to the principles of constructivist grounded theory. Findings will then be triangulated according to an existing mixed methods integration protocol. Discussion: This mixed methods design has the potential to inform national and international policy in relation to befriending interventions for older adults. In addition, there is the potential for study results to inform our theoretical understanding of the nature of the relationship between loneliness and health. Trial registration: ClinicalTrials.gov identifier NCT04301167 (10th March 2020). Protocol version 1.1, 26th June 2020.

In the Republic of Ireland (RoI), COVID-19 public health guidelines have been most restrictive for people aged 70 and over. Such individuals are most likely to avail of befriending services offered by a network of Irish organisations. The aim of this study was to explore the impact of COVID-19 guidelines on befriending service users, and to develop recommended adaptations to befriending services compatible with such guidelines. A qualitative constructivist grounded theory approach was taken to the study design and analysis, using semi-structured interviews to collect data from 11 participants by telephone between May 2020 and January 2021. Results show a grounded theory describing how older users of a befriending service maintained their personal autonomy in the face of strict government guidelines. Participants described living life as usual, often contravening guidelines, and how they chose to adapt to the situation, yielding both positive and negative outcomes. Some potential adaptations were discussed to the befriending service (including a preserved focus on the social and emotional functions of the befriending relationship, and the accommodation of collaborative decision making about communicative alternatives), but ultimately it was made clear that participants would tailor the services to their own preferences. Results have implications for befriending service design and delivery, and for public health officials who wish to support the health of older adults during the COVID-19 pandemic.

Objectives The multifinger force deficit (MFFD) is the decline in force generated by an individual finger as the number of fingers contributing to the action is increased. It has been proposed that as a measure of neural sufficiency rather than muscle status, it provides a means of detecting individuals at risk of cognitive decline. Age‐related deficits in central neural drive exert a disproportionate impact on the rate at which force can be generated. We examined whether a MFFD derived from the maximum rate at which force is generated, is more sensitive to individual differences in cognitive status, than one calculated using the maximum level of force. Methods Monotonic associations between each of two variants of the MFFD, and cognition (measured with the Montreal Cognitive Assessment), were estimated cross sectionally using generalized partial rank correlations, in which age, level of education and degree of handedness were included as covariates. The participants (n=26) were community dwelling adults aged 66‐87. Results The MFFD derived using the maximum rate of force development was negatively associated with cognitive status. The association for the MFFD based on the maximum level of force, was not statistically reliable. The associations with cognitive status obtained for both variants of the MFFD were of greater magnitude than those reported previously for standard grip strength dynamometry. Conclusion The sensitivity with which the MFFD detects risk of cognitive decline may be enhanced by using the maximum rate of force developed by each finger, rather than the maximum force generated by each finger.

The authors analysed the effects of group Sandplay therapy on adolescents' psychological health and resilience in a mixed-method research. They explored and categorized the themes these adolescents expressed during therapy. Fifteen children (n=15) were recruited for the study; (Boarding school children = 5; Day school children = 5; Street children = 5). The selection process was conducted in cooperation with an orphanage in Kabale, Uganda. The children who participated in the study underwent a forty-five-minute sand play therapy every week for nine weeks. The SDQ and RCADS were administered to the groups both pre- and post-intervention, with the data entered and analysed using SPSS. Group sandplay was found to significantly decrease the adolescents' internalizing problems such as anxiety and depression, while their resilience had also significantly improved. The narrative analysis, in turn, yielded seven themes: basic needs; community-love-celebration; giving help-leadership-empowerment; security-danger, recreation-self-development-self-nurturance, education, and seeking help-faith.

Background: Loneliness in later life is often addressed with befriending interventions, yet evidence for their effectiveness is limited. Meanwhile it is known that loneliness has a deleterious impact on health. The aim of the study is to evaluate whether a befriending service for older adults mitigates the impact of loneliness on health outcomes, and to identify mechanisms through which befriending interventions might impact upon health. Methods: A mixed methods design is used. The quantitative component utilises an AB single-case experimental design, to gather intensive longitudinal data. These data will be analysed using a generalised additive modelling approach. The qualitative component of the study uses semi-structured dyadic interviews, structured and analysed according to the principles of constructivist grounded theory. Findings will then be triangulated according to an existing mixed methods integration protocol. Discussion: This mixed methods design has the potential to inform national and international policy in relation to befriending interventions for older adults. In addition, there is the potential for study results to inform our theoretical understanding of the nature of the relationship between loneliness and health. Trial registration: ClinicalTrials.gov identifier NCT04301167 (10th March 2020). Protocol version 1.1, 26th June 2020.

Background Many persons with dementia transition to nursing home care, but little is known about the impact, positive and negative, that this may have on the social isolation and loneliness of their spouse. Methods Using our existing theoretical synthesis of loneliness to provide sensitising concepts, we conducted a deductive grounded theory study of loneliness during the nursing home transitions. We recruited 11 spousal participants to engage in semi-structured remote interviews during 2021. Results Participants provided their own definitions of loneliness, and spoke about their life history of loneliness, the loneliness associated with living with a spouse with dementia, and the loneliness, and alleviation of loneliness through re-engagement with social contacts, associated with their spouse moving to the nursing home. Participants agreed with the idea that loneliness has a physical feeling. More distal parts of the theoretical synthesis, such as the influence that culture and gender have on loneliness, were not corroborated by the findings. Conclusion We conclude that loneliness is a frequent experience among spousal caregivers whose spouse has moved to nursing home care, but that loneliness is also associated with living with a spouse with dementia. Loneliness in this population was aggravated by the COVID-19 pandemic and associated lockdowns. Further research steps will involve more targeted interviewing to focus on the link between transitions and loneliness in this and in other populations.

Background Befriending services are commonly deployed in the support of older people living alone, but lack an established evidence base, particularly in relation to their association with health outcomes. Methods To explore the potentially therapeutic impact of befriending on Health-Related Quality-of-Life (HR-QoL) and cognitive function, we used a single case experimental design. Data were collected from 85 new users of ALONE’s befriending service between 2019 and 2021 in an AB multiple baseline design. Generalised additive modelling was then used to assess trajectories of HR-QoL and cognitive function (semantic fluency) over the course of six months, and its association with the onset of the befriending service intervention Results The befriending service was associated with less decline over time in HR-QoL, and with a mitigated impact of loneliness on HR-QoL too. No such effects were observed for cognitive function as an outcome, which did not change over time. Conclusion Befriending may exert a positive effect on health-related quality of life, and reduce the negative impact that loneliness has on this outcome.

Background the transition to nursing home care has previously been linked to negative outcomes for spousal caregivers of persons with dementia (PwD). However, little is known about the experience or trajectory of loneliness in spousal caregivers during this time. Objectives to explore experiences of loneliness in caregivers during the nursing home admission of their spouse or partner with dementia. Methods semi-structured interviews were conducted with 11 individuals living in Ireland between Oct 2020 and June 2021, who were married to/partnered with a PwD who had, in the past 7 years, moved to full-time nursing home care. Data were collected and analysed using a deductive qualitative analytic strategy in the grounded theory tradition. Results data were interpreted in the context of Weiss’ typology of social and emotional loneliness and indicated that social loneliness increased for many at the point of diagnosis, decreasing somewhat after the transition, while emotional loneliness increased across the transition. Data were used to refine an existing synthesised model of loneliness, providing an updated model of the causes and contexts of loneliness. Conclusions the transition to nursing home care differentially affects loneliness subtypes. Results have implications for other transitions, which should be assessed in terms of various subtypes of loneliness. Our refined theoretical synthesis model of loneliness also warrants further evaluation.