Existential loneliness and end-of-life care: A systematic review

Abstract

Patients with a life-threatening illness can be confronted with various types of loneliness, one of which is existential loneliness (EL). Since the experience of EL is extremely disruptive, the issue of EL is relevant for the practice of end-of-life care. Still, the literature on EL has generated little discussion and empirical substantiation and has never been systematically reviewed. In order to systematically review the literature, we (1) identified the existential loneliness literature; (2) established an organising framework for the review; (3) conducted a conceptual analysis of existential loneliness; and (4) discussed its relevance for end-of-life care. We found that the EL concept is profoundly unclear. Distinguishing between three dimensions of EL—as a condition, as an experience, and as a process of inner growth—leads to some conceptual clarification. Analysis of these dimensions on the basis of their respective key notions—everpresent, feeling, defence; death, awareness, difficult communication; and inner growth, giving meaning, authenticity—further clarifies the concept. Although none of the key notions are unambiguous, they may function as a starting point for the development of care strategies on EL at the end of life.

Encountering existential loneliness among older people: perspectives of health care professionals

“…Although loneliness has been described as a part of being human (Yalom, 1980) and a part of the human predicament (Tillich, 1963) in terms such as aloneness, solitude , and isolation , no clear consensus has been reached on a definition of the concept in general (Karnick, 2005) or of existential loneliness in particular (Ettema, Derksen, & van Leeuwen, 2010). Loneliness also has different aspects and meanings.…”

“…According to Applebaum (1978), the full impact of existential loneliness is often felt during the contemplative realization of one’s aloneness in the universe, and responses can vary from fright to excitement and acceptance of reality and one’s autonomy. Ettema et al (2010) described three dimensions of existential loneliness as (1) a condition, (2) an experience, and (3) a process of inner growth, indicating its positive as well as negative aspects, which concern aspects of being with others in fellowship and connectedness, and of being without others.…”

The Social Construction of Loneliness: An Integrative Conceptualization

“…Indeed, whereas solitude and isolation have been used and evaluated in the literature both positively and negatively, to the best of our knowledge, loneliness has been consistently depicted as negative and painful, albeit encompassing an opportunity for growth (Ettema, Derksen, & van Leeuwen, 2010;Moustakas, 1961).…”

“…Furthermore, an experience of isolation grounded in existential reflection might not be eliminated altogether (Mijuskovic, 2012;Moustakas, 1961), thus calling for a therapeutic intervention that would address different aspects of the experience. Such intervention might include guided self-reflection to transcend the experience into one of freedom and growth (Ettema et al, 2010;Mijuskovic, 2012;Yalom, 1980), thereby eliminating the element of discrepancy. The notion that one might substitute one type of Other with another, either internal or external, Other(s), as evident in Mickey's account above, is one worth empirical investigation as well.…”

Dignity and existential concerns among nursing homes residents from the perspective of their relatives

“…Maybe the feeling of loss of dignity and loneliness in addition, gives rise to a feeling of distress. Existential loneliness has become a topic in the literature and is understood as an intolerable emptiness, sadness and longing that results from the awareness of one's fundamental separateness of human being [14] .…”