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Being disconnected from life: meanings of existential loneliness as narrated by frail older people
Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Department of Nursing and Integrated Health Sciences. Malmö University.ORCID iD: 0000-0002-9362-7464
Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Department of Nursing and Integrated Health Sciences. Kristianstad University, Faculty of Health Science, Forskningsmiljön Man - Health - Society (MHS). Lund University.ORCID iD: 0000-0002-7790-6906
Lund University.
Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Department of Nursing and Integrated Health Sciences.ORCID iD: 0000-0003-0161-4795
2018 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 22, no 10, p. 1357-1364Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: This study illuminated the meanings of existential loneliness (EL) as narrated by frail older people.

METHOD: Data were collected through individual narrative interviews with 23 people 76-101 years old receiving long-term care and services. A phenomenological hermeneutical analysis was performed, including a naïve reading and two structural analyses as a basis for a comprehensive understanding of EL.

RESULT: Four themes were identified related to meanings of EL: (1) being trapped in a frail and deteriorating body; (2) being met with indifference; (3) having nobody to share life with; and (4) lacking purpose and meaning. These intertwined themes were synthesized into a comprehensive understanding of EL as 'being disconnected from life'.

CONCLUSION: Illness and physical limitation affects access to the world. When being met with indifference and being unable to share one's thoughts and experiences of life with others, a sense of worthlessness is reinforced, triggering an experience of meaninglessness and EL, i.e. disconnection from life. It is urgent to develop support strategies that can be used by health care professionals to address older people in vulnerable situations, thereby facilitating connectedness.

Place, publisher, year, edition, pages
2018. Vol. 22, no 10, p. 1357-1364
Keywords [en]
Existential loneliness, frail, interviews, older people, phenomenological hermeneutical method
National Category
Nursing
Identifiers
URN: urn:nbn:se:hkr:diva-17090DOI: 10.1080/13607863.2017.1348481ISI: 000455491500016PubMedID: 28714734OAI: oai:DiVA.org:hkr-17090DiVA, id: diva2:1131633
Available from: 2017-08-15 Created: 2017-08-15 Last updated: 2022-11-01Bibliographically approved
In thesis
1. Existentiell ensamhet hos sköra äldre personer: äldre personers upplevelser samt dokumentation i patientjournalen
Open this publication in new window or tab >>Existentiell ensamhet hos sköra äldre personer: äldre personers upplevelser samt dokumentation i patientjournalen
2020 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to illuminate the meanings of existential loneliness(EL) and describe how it was eased, as narrated by frail older people, as well as toexamine existential aspects documented in patient records in specialised palliative care.Two of the constituent studies of this thesis were qualitative with an explorative anddescriptive design (i.e., studies I and II), and two studies were based on a retrospectivepatient record review, of which one was quantitative with an exploratory design (StudyIII) and the other was qualitative with a descriptive design (Study IV). The datacollection for studies I and II was based on individual interviews with frail older people75 or more years old. Studies III and IV were based on a randomly selected sample ofpatient records of frail older people who died in specialised palliative care during 2017.The data were collected using a pilot-tested review template to identify aspects of thedocumentation relating to the aims of the studies.The findings of Study I indicated that EL was a negative experience. Four themeswere identified related to meanings of EL: being trapped in a frail and deterioratingbody, being met with indifference, having nobody to share life with, and lacking purposeand meaning. The first theme was considered an overarching theme due to its closeinterrelatedness with the other three themes. The comprehensive understanding of ELamong frail older people was ‘being disconnected from life’, an experience of at leastmomentary abandonment, being left to one’s fate, and living a meaningless life. Study IIshowed that existential loneliness was eased when being acknowledged by others, beingthe focus of others’ concern, encountering intimacy, and having meaningful exchangesof thoughts and feelings. It was further eased when the participants could bracketnegative thoughts and feelings, that is, when they could adjust and accept the presentsituation, view life in the ‘rear-view mirror’, be in contact with spiritual dimensions, andwithdraw and distract themselves. Existential loneliness could be either in the forefront(i.e., feelings of ill-being) (Study I) or in the background (i.e., feelings of well-being)(Study II). The findings of Study III indicated that performed interventions were the14most common subject of documented clinical notes, mostly related to pharmacologicalinterventions. Pain was the most common documented problem, followed by circulatoryproblems, nutrition problems, and anxiety. Clinical notes concerning wishes and wellbeing-related details were documented, but not frequently. Overall symptom assessmenttools, especially multi-dimensional tools, were used to a small extent. More people whoreceived care in palliative in-patient wards died alone than did people who received carein their own homes. Study IV was based on notes extracted from 84 patient records.The results indicated that documented existential aspects had both negative and positiveconnotations and were related to the patients’ loss of freedom and self-determination,loneliness and community, anxiety and inner peace, and despair and hope. The notesconcerning existential aspects were, however, not recorded in a structured way and nocare plans relating to existential aspects were found.According to the studies, both ill-being and well-being were evident, and the livedbody occupied a central position in all studies. The frail body increased the patients’vulnerability and limited their living space. Meaningful activities and meaningfulcommunity and exchange with others eased the existential loneliness. Existentialloneliness remains invisible to others as long as nobody talks about it, and it remainsinvisible in the documentation as long as it is not documented in a structured way.This thesis demonstrates the importance of making existential loneliness and existentialaspects visible in encounters with frail older people and in the clinical documentation.

Place, publisher, year, edition, pages
Malmö: Malmö universitet, 2020. p. 108
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383
Keywords
Existential loneliness, frail older people, palliative care, experiences, encounter, existential aspects, meaning, interview, retrospective record review, documentation, ill-being, well-being
National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-21410 (URN)10.24834/isbn.9789178771462 (DOI)978-91-7877-145-5 (ISBN)978-91-7877-146-2 (ISBN)
Public defence
2020-12-17, Zoom, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2020-12-10 Created: 2020-12-10 Last updated: 2022-11-01Bibliographically approved

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Sjöberg, MarinaBeck, IngelaEdberg, Anna-Karin

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