Community Cohesion, Meanings of Life Activities and Loneliness Among Community-Dwelling Older Adults with Disabilities

Background and Purpose

Disabled older people encounter multiple lost experiences and sense more loneliness comparing to earlier stages of life. Moreover, limited by physical and mental status, they have higher levels of loneliness than their healthier counterparts. Previous research showed that participating health promotion programs can reduce the loneliness of older individuals; however, few studies have discussed how subjectively meaningful activities are related to loneliness among older adults with disabilities in community settings. So far, Taiwan has launched Long-Term Care Program 2.0 that aims to provide a comprehensive service system for older adults across different health status since 2017. Herein, this study has two aims, first, to explore how community cohesion, meanings of life activities are related to loneliness of community-dwelling older adults with disabilities; second, to elucidate how the association between meaningful activity participation and loneliness is mediated by community cohesion. Results of this investigation offer insights to suggestion towards better services for disabled older residents in communities.

Methods

Data on a sample of 829 community-dwelling older individuals in Taiwan were collected by trained interviewers through face-to-face interviews between April and July 2020. Personal factors such as age, gender, level of education, marital status, monthly income, ADL and IADL functioning and cognitive status, home- (HBS) and community-based service (CBS) use were measured. Meanings of life activities (i.e., IADL, interpersonal, and group activities), community cohesion (i.e., community participation and sense of belonging), and loneliness were accessed using reliable and validated scales. Bivariate analyses and hierarchical linear modeling were performed for analyses.

Results

Male sex, non-HBS male users, having a spouse, and better ADL functioning, valuing more on IADL and interpersonal activities, and having higher community cohesion predicted less loneliness. Moreover, sense of belonging to the community fully mediated the relationships between meanings of IADL activities and loneliness. Sense of belongings also partially mediated the relationships between meanings of interpersonal activities and loneliness.

Conclusions and Implications

Since IADL and interpersonal activities both require interactions with others, disabled older individuals could perform such activities better if they live in a more inclusive community that gives them a sense of belonging. Therefore, they could reduce loneliness by performing activities that are subjectively meaningful to them. While the current programs for community-dwelling adults mainly focus more on maintaining older persons’ physical and cognitive performance, more progress could centre on strengthening their sense of belongingness and cohesiveness toward the community where they resident to optimize the effectiveness of meaningful activity participation in reducing their extent of loneliness.