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Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.

This study assesses sociodemographic and health-related factors associated with loneliness and outcome differences between loneliness groups using a sample of 13,812 older adults from the U.S Health and Retirement Study. Descriptive and bivariate analyses were followed by logistic regression to evaluate risks and analysis of covariance testing to determine outcome differences. Overall, prevalence of loneliness was 16.9%. Nonmarried status, poorer self-report of health, lower educational level, functional impairment, increasing number of chronic illnesses, younger age, lower income, and less people living in the household were all associated with loneliness. The chronically lonely group reported less exercise, more tobacco use, less alcohol use, a greater number of chronic illnesses, higher depression scores, and greater average number of nursing home stays. Future research evaluating the effectiveness of both prevention and treatment interventions for loneliness in older adults would provide empirical data to further guide gerontological nursing practice.

C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect progression of vascular disease. Conflicting evidence suggests CRP may be a prognostic biomarker of ischemic stroke outcome. Most studies that have examined the relationship between CRP and ischemic stroke outcome have used mortality or subsequent vascular event as the primary outcome measure. Given that nearly half of stroke patients experience moderate to severe functional impairments, using a biomarker like CRP to predict functional recovery rather than mortality may have clinical utility for guiding acute stroke treatments. The primary aim of this study was to systematically and critically review the relationship between CRP and long-term functional outcome in ischemic stroke patients to evaluate the current state of the literature. PubMed and MEDLINE databases were searched for original studies which assessed the relationship between acute CRP levels measured within 24 hours of symptom onset and long-term functional outcome. The search yielded articles published between 1989 and 2012. Included studies used neuroimaging to confirm ischemic stroke diagnosis, high-sensitivity CRP assay, and a functional outcome scale to assess prognosis beyond 30 days after stroke. Study quality was assessed using the REMARK recommendations. Five studies met all inclusion criteria. Results indicate a significant association between elevated baseline high sensitivity CRP and unfavorable long-term functional outcome. Our results emphasize the need for additional research to characterize the relationship between acute inflammatory markers and long-term functional outcome using well-defined diagnostic criteria. Additional studies are warranted to prospectively examine the relationship between high sensitivity CRP measures and long-term outcome.

Type 2 diabetes mellitus contributes to poor health outcomes including mortality, yet there is a gap in the literature when seeking to understand the influence of psychosocial factors on coping in this population. The paper presents a systematic review of quantitative studies that examined relationships among psychosocial determinants and coping in adults with type 2 diabetes. This review is the second layer of knowledge discovery for the concept, “Taking on a life-altering change is a rhythmical journey of experiencing ups and downs on the way to acceptance.” The life-altering change was determined to be a diagnosis of type 2 diabetes, the journey is the ups and downs of coping with the diagnosis as people work toward acceptance of type 2 diabetes. The review includes a synthesis of findings from 22 quantitative studies of psychosocial factors and coping in adults with type 2 diabetes. Anxiety, depression, stress, and diabetes distress were identified as key influential psychosocial factors. Increased social support was inversely related to emotional distress and coping styles were related to social well-being, psychological health, and physical health outcomes. The positive coping style of problem-focused coping was linked to improved psychological and physical health. Emotional responses to diagnosis were related to depression and anxiety. Negative coping styles of resignation, protest, or isolation were higher in women and linked to poorer quality of life, while avoidance was linked to increased diabetes-related distress and depressive symptoms.

ObjectivesLoneliness is a biopsychosocial determinant of health and contributes to physical and psychological chronic illnesses, functional decline, and mortality in older adults. This paper presents the results of the first randomized trial of LISTEN, which is a new cognitive behavioral intervention for loneliness, on loneliness, neuroimmunological stress response, psychosocial functioning, quality of life, and measures of physical health.MethodsThe effectiveness of LISTEN was evaluated in a sample population comprising 27 lonely, chronically ill, older adults living in Appalachia. Participants were randomized into LISTEN or educational attention control groups. Outcome measures included salivary cortisol and DHEA, interleukin-6, interleukin-2, depressive symptoms, loneliness, perceived social support, functional ability, quality of life, fasting glucose, blood pressure, and body mass index.ResultsAt 12 weeks after the last intervention session, participants of the LISTEN group reported reduced loneliness (p = 0.03), enhanced overall social support (p = 0.05), and decreased systolic blood pressure (p = 0.02). The attention control group reported decreased functional ability (p = 0.10) and reduced quality of life (p = 0.13).ConclusionsLISTEN can effectively diminish loneliness and decrease the systolic blood pressure in community-dwelling, chronically ill, older adults. Results indicate that this population, if left with untreated loneliness, may experience functional impairment over a period as short as 4 months. Further studies on LISTEN are needed with larger samples, in varied populations, and over longer periods of time to assess the long-term effects of diminishing loneliness in multiple chronic conditions.

BACKGROUND: Loneliness is a prevalent problem for older adults and has been shown to be associated with negative physical, psychological, and social variables. There has been limited research focusing on the relationship of loneliness to health. There is a gap in the literature when it comes to understanding how the problem of loneliness relates to the health of older adults in the United States. PURPOSE: The purpose of this study was to address this gap in the literature through the testing of two models, the first model represented the postulated risks for loneliness and the second model represented the postulated outcomes for those who experience loneliness. Variables were chosen for inclusion in the models based on a review of pertinent quantitative and qualitative literature. METHODS: The models were tested using a representative sample of U.S. older adults. Data analysis was performed using data from the 2002 and 2004 waves of the Health and Retirement Study. The sample was limited to respondents aged 50 and older who participated in wave 6 (2002) and wave 7 (2004) without proxy, answered the lonely question at both waves, were community-dwelling in 2002 and who had complete data on selected variables in the model. Univariate and bivariate analyses were followed by logistic regression analysis to identify risks. One-way ANOVAs, comparative means testing and independent analysis of covariance tests were used to evaluate the difference in outcomes for those who were never lonely, briefly lonely, or chronically lonely. RESULTS: Non-married status was consistently the primary predictor of self-report of loneliness, followed by poorer self-report of health status, lower educational level, functional impairment, increasing number of chronic illnesses, younger age, lower income, and less people living in the household. Gender and use of home care were not significant predictors of loneliness. Those who were chronically lonely reported less exercise, more tobacco use, less alcohol use, a greater increase in number of chronic illnesses, higher depression scores, more physician contacts and greater average number of nights in a nursing home than those who were never lonely or briefly lonely. After controlling for significant covariates of loneliness, those who were chronically lonely did not have significantly more physician contacts. DISCUSSION: Loneliness is a prevalent problem for older adults in the United States with its own unique health-related risks and outcomes. Given the prevalence, it should be considered a healthcare priority in the United States. Based on the results of this study, inclusion of loneliness and loneliness risk screening as part of routine health histories for those aged 50 and over should be considered. Future research needs to focus on evaluating the effectiveness of both prevention and treatment interventions for loneliness to provide empirical data to guide evidenced based practice.

This study's purpose was to describe loneliness and to examine the relationships between loneliness, depression, social support, and QOL in chronically ill, older Appalachians. In-person interviews were conducted with a convenience sample of 60 older, chronically ill, community-dwelling, and rural adults. Those with dementia or active grief were excluded. The UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1985), Geriatric Depression Scale (Shiekh & Yesavage, 1986), Katz ADL scale (Katz, Down, & Cash, 1970), MOS Social Support Scale (Sherbourne & Stewart, 1991), and a visual analog scale for Quality of Life (Spitzer et al., 1981) scale were used. Diagnoses were obtained through chart reviews. SPSS was used for data analyses. The majority of the 65% female sample (M age = 75 years) were married and impoverished. Participants' number of chronic illnesses averaged more than 3. Over 88% of participants reported at least 1 area of functional impairment. Loneliness was prevalent with UCLA loneliness scores indicating moderate to high loneliness, ranging from 39 to 62 (possible scores were 20-80). Higher loneliness scores correlated with depression, lower Qol, and lower social support, particularly lower emotional support. This study provides evidence that loneliness is a significant problem for older chronically ill Appalachian adults and that it may be related to low emotional support. Further, it provides evidence that this population may be significantly lonely and may not self-identify as lonely. Screening for loneliness and designing interventions that target the emotional aspects of loneliness could be important in this population.