Surviving Through Solitude: A Prospective National Study of the Impact of the Early COVID-19 Pandemic and a Visiting Ban on Loneliness Among Nursing Home Residents in Sweden

Abstract

Objectives Targeted social distancing measures were widely implemented for nursing home residents when the extremely high COVID-19 mortality in this setting became apparent. Still, there is still scarce rigorous research examining how the pandemic and accompanying social distancing measures impacted loneliness in this group. This prospective nation-wide Swedish study of nursing home residents aimed to examine the impact on loneliness of the early phase of the pandemic and of a national visiting ban at nursing homes. Methods A panel was selected from a total population survey of all nursing home residents in Sweden March-May 2019 and 2020 (N=11,782; age range 70-110 years; mean age 88.2 years; 71% women). Prospective pretest-posttest and controlled interrupted time series designs were employed, with time trends estimated by date of returned questionnaire. Generalized linear models were used for estimation of effects, adjusting for demographic, survey-, and health-related covariates. Results Loneliness prevalence increased from 17 to 19% from 2019 to 2020 (Risk Ratio, RR (95% confidence interval, CI)=1.104 (1.060; 1.150)), but which was explained by self-reported health (RR(95%CI)=1.023 (0.982; 1.066)). No additional impact of the visiting ban on loneliness trends was found in the interrupted time series analyses (RR(95%CI)=0.984 (0.961; 1.008)). Discussion The moderate but health-dependent increased risk of loneliness, and the lack of impact of the nation-wide visiting ban at nursing homes, suggest that this ostensibly vulnerable group of nursing home residents also show signs of resilience, at least during the early phase of the pandemic.

The association between leisure engagement and loneliness before and during the COVID-19 pandemic: A Nordic population-based study

“…On a population level, we observed similar levels of loneliness before and during the pandemic. This corroborates some findings [3,4] and contradicts others pointing to an increase in loneliness, particularly among those who were most at risk of social isolation and loneliness, including those receiving home care [18,19]. It is noteworthy that in the analysis of region as an explanatory factor in the likelihood of experiencing loneliness in 2021, Finland scored higher.…”

“…For example, Finland implemented lockdown in the spring of 2020, whereas Sweden remained relatively open and chose to rely more on voluntary adherence to recommendations. The authorities in both countries, however, emphasised the need to protect children, older adults over the age of 70 and the chronically ill. For example, all kinds of leisure activities, including social gatherings, in Swedish nursing homes were banned for older adults [18] and highly restricted for all other older adults, including physical and social distancing [19]. It has been shown that in areas with social isolation and restrictions, an increased sedentary lifestyle was reported among older adults whose level of physical activity decreased [20].…”

Intersectional inequalities in loneliness among older adults before and during the early phase of the COVID-19 pandemic: A total population survey in the Swedish eldercare setting

“…Analyses were performed separately for the 2019 (before the pandemic) and 2020 (during the pandemic) surveys, as well as collapsed for comparison of estimates between the years. Collapsing all observations within each year was chosen as previous studies on the same population have found no specific loneliness impact attributable to the introduction of restrictive policies among either home care recipients ( Gustafsson et al, 2022a ) or nursing home residents ( Gustafsson et al, 2022b ).…”

“…Despite this ostensibly vulnerable position of older adults, empirical research has found a surprisingly modest impact on elderly's loneliness during at least the early phase of the pandemic ( Lebrasseur et al, 2021 ; Parlapani et al, 2021 ), including in Sweden ( Gustafsson et al, 2022b ; Kivi et al, 2021 ). These observations have subsequently led to measured discussions about older adults' vulnerability and resilience to the psychosocial impact of the pandemic ( Fristedt et al, 2021 ; Gustafsson et al, 2022b ; Losada-Baltar et al, 2021 ; Parlapani et al, 2021 ).…”

“…Despite this ostensibly vulnerable position of older adults, empirical research has found a surprisingly modest impact on elderly's loneliness during at least the early phase of the pandemic ( Lebrasseur et al, 2021 ; Parlapani et al, 2021 ), including in Sweden ( Gustafsson et al, 2022b ; Kivi et al, 2021 ). These observations have subsequently led to measured discussions about older adults' vulnerability and resilience to the psychosocial impact of the pandemic ( Fristedt et al, 2021 ; Gustafsson et al, 2022b ; Losada-Baltar et al, 2021 ; Parlapani et al, 2021 ). However, any universal depiction of older adults' vulnerability or resilience fails to take into account the inherent heterogeneity within the group of older adults, for example, with regard to the deeply entrenched social inequalities shaping the outcomes of the pandemic ( Bambra et al, 2020 ; Marmot and Allen, 2020 ; Pentaris et al, 2020 ).…”