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Differences in Assessing Loneliness among Japanese Older Adults:
A Comparison of Family Physicians and Nurses
Kazutaka Yoshida,a Aya Goto,a,b and Ichiro Kawachi c
a Takemi Program in International Health, Harvard T.H. Chan School of Public Health
b Department of Global Health and Population, Harvard T.H. Chan School of Public Health
c Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
Background
- The Japanese Cabinet Secretariat released the National Survey in 2021/2022. 40% were lonely.
- During the same period, 15% in the U.K. and 1 in 2 in the U.S. were lonely.
- Recognition of loneliness is crucial in primary (health) care.
- Few reports compare family physicians and nurses regarding patient perception of loneliness.
Objectives
This study highlights the distinctions between Japanese family physicians and nurses in assessing factors that indicate patient loneliness.
Methods / Results 1
- Study Design: A cross-sectional study using self-administered Q
- Setting: Two family medicine clinics in Fukushima
- Subjects: Patients aged 50 years or older, Family physicians & nurses
- Period: From August 1 to 31, 2020
- Survey Items: 1-item question “Do you think the patient is lonely, based on the past 6 months of medical records?” for family physicians & nurses, UCLA Loneliness Scale (3rd ed) for patients
- Epidemiological analysis (Stata/SE ver. 18.0): Screening test and Chi-square test
- Ethics: Fukushima Medical University (General 2020-025)
Table 1: Comparison of Family Physician and Nurse Perception of Patient Loneliness
| Characteristics of patient | Family physician perception | Nurse perception | ||||||
|---|---|---|---|---|---|---|---|---|
| Yes n (%) | No n (%) | Sensitivity | Specificity | Yes n (%) | No n (%) | Sensitivity | Specificity | |
| Education | ||||||||
| Junior high school and below | 28 (35.0) | 37 (18.9) | 24.6 | 56.9 | 17 (46.0) | 54 (22.0) | 9.4 | 76.1 |
| High school or above | 52 (65.0) | 159 (81.1) | 20 (54.0) | 192 (78.0) | ||||
| Marital status | ||||||||
| Married | 40 (50.0) | 159 (82.4) | 54.1 | 79.9 | 15 (38.5) | 198 (81.8) | 35.3 | 93.0 |
| Unmarried, divorced or bereaved | 40 (50.0) | 34 (17.6) | 24 (61.5) | 44 (18.2) | ||||
| Living conditions | ||||||||
| Living with someone | 57 (71.3) | 183 (94.3) | 67.7 | 76.3 | 21 (53.9) | 231 (94.7) | 58.1 | 91.7 |
| Living alone | 23 (28.7) | 11 (5.7) | 18 (46.1) | 13 (5.3) | ||||
| Community activities | ||||||||
| Participating | 26 (33.8) | 120 (61.9) | 40.8 | 82.2 | 12 (30.8) | 146 (60.1) | 21.8 | 92.4 |
| Not participating | 51 (66.2) | 74 (38.1) | 27 (69.2) | 97 (39.9) | ||||
Methods / Results 2
- Study Design: Quantitative analysis of free written opinions collected by a self-administered questionnaire
- Subjects: The same healthcare providers in Methods 1
- Participants: 10 participants (3 family physicians, 7 nurses), 65 sentences
- Period: From July to August, 2023
- Survey Items: “When do patients feel lonely?” (free-response type)
- Text Mining Analysis: Sentence-by-sentence analysis, Co-occurrence network (KH Coder 3)
- Ethics considerations: Fukushima Medical University (General 2023-009)
Lessons Learned 1
- Sensitivity of diagnosing loneliness was higher among physicians than nurses.
- Physicians/nurses relied on different patient characteristics to diagnose loneliness in patients.
Lessons Learned 2
Compared to physicians, nurses tended to focus more on individual cases, which may have led to their lower sensitivity in diagnosing loneliness.
Related Work
Yoshida K, Honda K, Goto A, Kawachi I. Collateral Health Effects of Loneliness Care in Japan. Health Serv Res Manag Epidemiol. 2024; 11: 23333928241240970.
Acknowledgements
Takemi Program in International Health, Harvard T.H. Chan School of Public Health