Exploration of loneliness and informal carer stress in older adults
Eldernet Gazette 

Dr Rebecca Abey-Nesbit  November 5, 2021Ageing in place, Health & Wellbeing, Research, Residential Care Comments Offon Exploration of loneliness and informal carer stress in older adults 1,759 Views

Dr Rebecca Abey-Nesbit, a researcher at the University of Otago, Christchurch, has spent the past four years working as part of a team dedicated to better ageing research. In this article, Rebecca shares her research into the impacts of loneliness and carer stress on older adults.

Social supports for older adults have been identified as being important to help reduce the impact of loneliness and informal carer stress. We conducted research to identify the impacts of loneliness and carer stress on older adults living in the community who receive home care support services.

We used information provided by the interRAI home care assessment, which is a questionnaire used to identify areas of health care services that a person requires1. The interRAI assessment contains one question on loneliness which is whether or not the person feels lonely2. Carer stress was identified through three different questions about the informal carer’s ability to continue caring activities. Anyone who answered yes to one or more of the questions “informal carer is unable to continue caring activities”, “primary informal helper expresses feelings of distress”, and “Family or close friends report feeling overwhelmed by person’s illness” were considered as having carer were considered as having carer stress 2,3.
 
Our dataset looked at 54,345 people aged 65-105 across New Zealand with 11,491 (21.1%) of these people stating they were lonely and 16,406 (32.4%) people reported informal carer stress3. Our initial research showed that people who were lonely or who had stressed informal carers were more likely to enter aged residential care facilities than those who were not lonely or did not have a stressed informal carer3. Of those who were lonely 2,833 (24.6%) entered into rest homes, and for those who had a stressed informal caregiver 4,361 (26.5%) of people entered rest homes.
We also explored differences between loneliness and living arrangement in 71,859 people who had an interRAI assessment4. We found that approximately half of the people lived alone 35,612 (49.5%) and of the people who lived alone 29% felt lonely. We also found there were differences in loneliness amongst the different ethnic groups. Pacific people reported being the least lonely with 283 (17%) people and Asian individuals were the loneliest with 376 23% people stating they were lonely4.
 
We are currently conducting further research to identify factors that contribute to carer stress and loneliness in order to reduce these issues in the future. It’s important for informal carers to identify when they’re feeling overloaded and burned out. The Ministry of Health offer several respite ideas for informal carers, including services available in your area5. Additionally, the Let’s End Loneliness website has many options on what you can do to combat loneliness6.
 
References:

1. https://www.interrai.co.nz/about/interrai-assessments-in-new-zealand/
2. Morris, J.N., 2010. interRAI Home Care (HC) assessment form and user’s manual. interRAI
    Publications.
3. Jamieson, H., Abey-Nesbit, R., Bergler, U., Keeling, S., Schluter, P.J., Scrase, R. and Lacey, C., 2019.  
    Evaluating the influence of social factors on aged residential care admission in a national home
    care assessment database of older adults. Journal of the American Medical Directors  
    Association, 20(11), pp.1419-1424.

 With prompting
 
Get their attention and tell them you want them to get up from the chair.  

Ask them to:

• put their hands on the arms of the chair
• shuffle their bottom forward in the chair 
• place legs shoulder width apart
• tuck feet under chair 
• lean forward, feet on the floor, nose over toes
• rock their body back and forth (if required)
• on the count of “Ready, steady, stand” push up through their hands and feet to stand

With assistance - If they need more than just a prompt to get up
​
Get their attention and tell them you want them to get up from the chair. Ask them to:

• put their hands on the arms of the chair
• shuffle their bottom forward in the chair 
• place legs shoulder width apart
• tuck feet under chair
• lean forward, feet on the floor, nose over toes
• on the count of “Ready steady stand” ask them to push up through their hands and feet to stand

 
You will: 

• stand beside them looking in the direction they will be going.
• have your legs in a lunge position with one leg along side the person and the other where you’ll end up standing 
• place your arm across their back and place yourp hand on their bottom or hip
• tuck the back of their shoulder into the front of your shoulder
• place your other hand on the front of their shoulder (their shoulder should be sandwiched firmly between your shoulder and hand)
• keep yourself close to the person
• ask them to rock their body back and forth (optional)
• on the count of “Ready, steady, stand” ask them to push up through their hands and feet to stand
• step forward with them, your front foot at the same level of the client’s feet.

 
You can walk holding them in this position, ensuring you keep them close.
 
If they need more support two people can do the move

​Swallowing difficulties (Dysphagia) are a common consequence of many health conditions, and head and neck surgeries, however swallowing difficulties can also be associated with ageing.  Estimates suggest up to 20% of all adults over 50 may be affected. 

Changes might include such things as reduction in muscle strength for chewing, taste and smell, dental issues, dry mouth or throat, or recurrent illness such as pneumonia.
 
These changes may result in poor nutrition and hydration, unintended weight loss, avoidance of eating in public, loss of enjoyment in previously enjoyed food, and/or a risk of food/fluid entering the lungs (aspiration) leading to pneumonia and chronic lung disease.

Suggestions to help:
​

• Eat when you are feeling comfortable and relaxed. 
• Reduce distractions and keep conversation to between mouthfuls of food.
• Have smaller meals or snacks more frequently throughout the day instead of three larger meals.
• Chop or grate harder textured foods, and/or add sauces and gravies to keep food moist and easy to swallow.
• Take your time to eat
• Make sure you have swallowed everything in your mouth before taking another bite or sip.
• Drink a glass of water after eating to wash down any residual food.
• Remain upright for at least 30 minutes after eating and drinking. 
• Ensure dentures fit well. Use of a denture paste may assist.

 
Who can you talk to?

• General Practitioner: For medical assessment and advice.
• Pharmacist: About difficulties swallowing medications
• Dentist: to check dentures for fit and function. 
• Dietitian: to give advice to improve and maintain nutrition and hydration
• Speech Language Therapist: for assessment and treatment of swallowing difficulties

For further information or advice please contact Therapy Professionals Ltd as follows:
            
            Phone                         (03) 3775280,
            Email:                          [email protected]
            Website:                      http://www.therapyprofessionals.co.nz