Relief for the Lonesome

When the COVID-19 pandemic struck, Professor Doris Yu Sau-fung of the School of Nursing was overseeing a team of nurses working to identify and engage with ‘hidden elders’ – those who live alone – and bring them to community facilities for health assessments and counselling. The pandemic put a halt to that work, but team members saw a deep need in this group for social contact. They organised a get-around of ‘gate nursing’ where they stood at the gates of people’s homes and did exercises and provided them with psychological support.

For Professor Yu, the experience revealed the vulnerability of older people in Hong Kong when it comes to loneliness. It has inspired her to dig deeper into the problem and apply those insights to her other research.

In one study, she surveyed more than 10,000 older people in all 18 of Hong Kong’s districts and the results confirmed her concerns: 58 per cent of people aged over 65 reported being lonely. “The high prevalence calls for more attention to be paid to effective interventions for this growing public health problem,” she said.

Professor Yu also undertook a detailed and systematic review of the literature on interventions to classify them in a consistent way and determine which had the best results. Psychological intervention, either alone or with other activities such as exercise, was found to be the most effective.

“There are a lot of studies about psychological counselling and helping people build up their self-image. They may feel lonely because they don’t feel they are good at socialising. So self-esteem is a very important individualised factor contributing to loneliness,” she said.

Loneliness and healthy ageing

Professor Yu has incorporated loneliness into her work on healthy ageing. Building on earlier work on sarcopenia (muscle loss) in the elderly, she is looking at the environmental and social demographic factors associated with loneliness. The focus is on life-space mobility which captures ‘real-life mobility’ extending from one’s bedroom to the neighbourhood area and community, as well as technology acceptance and subjective memory loss – all of which can impact or interact with loneliness.

“How often a person goes out depends not only on their physical ability but also on their psychological status and the social environment,” she said. “Our preliminary findings are significant. We found that technology acceptance and subjective memory loss predict life-space mobility, and that mobility is a very important mediator of the effect of loneliness.”

On technology use, Professor Yu has also found that people who live alone, once trained on digital technology, tend to engage more with apps that have a psychological component, such as a laughing yoga app to boost mood, which supports her finding that psychological interventions could be important for combating loneliness.

She has also found that it is best to engage with older adults in person, given many elderly are not familiar or comfortable with digital technology. That insight has been applied in other research she is doing to test apps that help people monitor heart disease – it motivated her to add a component where the app is paired with human interaction.

Moving forward, Professor Yu will combine data on the physical environment, socio-economic demographics and loneliness surveys to see which factors are affecting or determining loneliness among Hong Kong’s elderly. She also has a project to train elderly people as health coaches that she hopes can engage people who live alone to become coaches. “I am thinking of how to use interventions that are not labelled as combating loneliness, but can still help older people tackle lonely feelings,” she said.

Social robots as companions

Professor Vivian Lou Weiqun, Director of the Sau Po Centre on Ageing, has been collaborating with the Singapore University of Social Sciences to see if technology in the form of social robots can help relieve loneliness. These robots offer emotional support and a sense of connectedness, rather than just entertainment.

A preliminary study of people aged from 60 to 75 living alone in Hong Kong and Singapore found that they fell into three groups: the practicalists, who wanted the robots to perform specific tasks such as medication reminders; the traditionalists, who were reluctant to acknowledge the robots as pets and wanted human contact; and the enthusiasts, who enjoyed interacting with the robots.

But while overall loneliness levels were reduced among subjects in Singapore, in Hong Kong “the loneliness level increased after initial interactions with ‘the robot’, which may be attributed to a desire for human interactions among study participants,” Professor Lou said.

“Given the growing ageing trend,it is time to reconceptualise social relationships and companionship. Traditionally, it meant spending time with certain people, in particular family members. But we need to admit that more older adults are spending more time alone and social robots should be designed and introduced properly to them to allow greater acceptance.”