Loneliness and the Contributing Factors in the Elderly Patients with Type II Diabetes: A Descriptive Cross-sectional Study

Diabetes is a chronic, lifelong disease that could occur at any age. The incidence of type II diabetes increases with age. According to the International Diabetes Federation (IDF), the prevalence of type II diabetes is higher among the elderly compared to other age groups. Type II diabetes is associated with various complications and may lead to several physical and mental problems in the elderly. Loneliness is one of the psychological complications in the elderly with chronic diseases such as diabetes. Loneliness is a unique psychological structure, which is characterized by feeling unhappy due to the lack or reduction of the expected interpersonal relationships. Loneliness is an important indicator of psychological health, with a two-way relationship with diabetes as it is also an important factor in the treatment of these patients. Loneliness in the elderly could lead to chronic diseases such as cardiac disorders, hypertension, stroke, obesity, diabetes, lung diseases, and even death. Identifying the psychological issues associated with diabetes is prioritized in health care. The present study aimed to assess loneliness and the contributing factors in the elderly with type II diabetes in order to determine the significant factors that may be associated with loneliness. Examining the state of loneliness as a psychological component in the elderly with diabetes could lay the groundwork for nursing interventions and improving healthcare resources for these patients.

This descriptive, cross-sectional study was conducted on 257 elderlies diagnosed with insulin-dependent type II diabetes referring to the comprehensive health centers of the elderly affiliated to Iran University of Medical Sciences during October-December, 2019. The participants were selected via continuous sampling. The inclusion criteria were consent to participate, age of 60 years or more, no cognitive impairment (minimum score of 7 out of 10 in cognitive impairment test), ability to communicate, no known mental illnesses (based on the medical records statement of the patient), and definitive diagnosis of insulin-dependent diabetes (based on medical record). Data were collected using a demographic questionnaire consisting of data on age, gender, marital status, occupation status, education level, insurance status, type of insurance, housing state, having a companion/support in life, the most important needs in life, and living with others. In addition, we used the abbreviated mental test (AMT), which is a short cognitive test for the cognitive assessment of the elderly. AMT consists of 10 items, with scores ≤7 indicating the presence of a cognitive disorder (maximum score: 10). Another tool was the University of California at Los Angeles (UCLA) questionnaire, which was developed by Russell et al. in 1980 and has 20 four-response items, 10 negative statements, and 10 positive statements. This scale is used to measure the degree of loneliness. In the present study, the revised version of the loneliness questionnaire was used, and the content validity was confirmed by two faculty members. In addition, the reliability was confirmed at the Cronbachchr('39')s alpha of 0.9. Data analysis was performed in SPSS version 16 using descriptive statistics, including absolute frequency distribution and frequency percentage for qualitative variables and mean and standard deviation for quantitative variables, to describe the characteristics of the samples. Independent t-test and analysis of variance (ANOVA) were also applied for statistical analysis.

In total, 55.3% of the elderlies were aged 60-69 years. The sample population included 55.3% women and 44.7% men. Approximately 65.4% the participants lived with their spouse, and 96.9% had insurance. Regarding the correlation between loneliness and demographic characteristics in the patients, it was observed that age (P<0.001), marital status (P<0.001), occupation status (P<0.001), living with another elderly (P<0.001), maximum support (P<0.001), the most important needs in life (P<0.001) and insurance status (P=0.032) were significantly correlated with loneliness. In addition, paired comparison by Tukeychr('39')s test indicated that the feeling of loneliness was more significant in the elderly aged more than 80 years compared to those aged 60-69 years. Loneliness was significantly less in the married patients compared to the divorced, widowed, and single elderlies, while it was also significantly less in the widowed elderlies compared to the singles (P=0.003). Overall, 82.1% of the elderly patients reported slight loneliness, whereas 17.9% reported significant feelings of loneliness.

According to the results, feelings of loneliness were associated with the demographic and clinical characteristics of the elderly with insulin-dependent type II diabetes. Unlike most studies, the score of loneliness was relatively low in the current research, and the discrepancy may be due to the presence of trained elderly nurses in the ward and the demographic and clinical characteristics of the participants. Given the growing number of the elderly patients with type II diabetes, proper strategies should be adopted to improve physiological and psychological health of these individuals. Patients with type II diabetes (especially insulin-dependent diabetes) are more likely to feel lonely, and increased loneliness may reduce their desire and motivation for treatment. Therefore, we believe that nurses, physicians, and other healthcare providers should pay attention to the effects of loneliness on these patients during treatment and clinical care. In addition, preventive measures should be taken, and the importance of the issue should be explained to patients and their caregivers. It is recommended that interventional studies be performed to reduce the feeling of loneliness in the elderly with chronic diseases (e.g., diabetes). Furthermore, opportunities should be provided for the public awareness of the importance of loneliness as a mental health alert that may affect chronic illnesses (e.g., diabetes) and even mortality.