Posted: April 13th, 2015

The association between physical fitness level and loneliness index among the older people who live alone

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The association between physical fitness level and loneliness index among the older people who live alone

Project Summary
This cross sectional study was designed to investigate the association between physical fitness level and loneliness index among the older people who live alone. The problem of population aging is getting worse. However, reflected by research, most of Hong Kong elderly was feeling lonely and unhappy. Elderly who are living alone are specifically vulnerable due to loss of friends, loss of spouse and family, loss of income or loss of mobility. Therefore, there is a great need to focus on this group and provide more insight to establish ways through which their loneliness can be reduced.
Eighty elderly who live alone and aged 60 or above were selected by convenience sampling from Chan Kwan Tung Social Centre for the elderly in Sham Shui Po. Physical fitness test of BMI, Chair Stand Test, Up and Go Test and 2mins Step Test were provided to test the older adults’ fitness level. Samples had to complete the self-administrated questionnaire and UCLA (University of California, Los Angeles) loneliness scale as well. All data analyzed by SPSS version 21. Descriptive statistics were used to provide a description on the participants’ characteristics. Majorly, the correlation of fitness test scores and loneliness index were figured out. In conclusion, participants who had better results on BMI and Steps Test significantly scoring lower on UCLA loneliness scale (r= 0.31, p=0.005; r=-0.24, p=0.03). However, there was no relationship between the results of Chair Stand Test or Up and GO Test and UCLA scale.

Study Aims
To investigate the association between physical fitness level and loneliness index among the older people who live alone.
Research Questions
 What is the association between physical fitness level and loneliness index among the older people who live alone.
 What are the risk factors of loneliness among older people living alone?
Research Hypothesis
There is no significant correlation between elderly fitness level and loneliness index as fitness level increase, the loneliness level decrease.
Study Design
This was a cross-sectional study to explore the relationship between physical fitness and loneliness index of older adults. To measure the elderly fitness level, physical test battery was provided to all subjects. Subjects completed the UCLA Loneliness scale after all fitness assessments. Subjects also had to answer the self-administrated questionnaire which was designed to explore the characteristics. The process of data collection for each sample took no more than 15mins. Pilot study had conducted prior to test the validation of the study design and the self-administration questionnaire ultimately.
Population and Sampling
Study population was all the older people living alone and aged 60 or above. In additional, those elderly who had or had not engaged in any physical exercise in the past were also considered. Shum Shui Po was one of the districts with high elderly population proportion. Therefore 80 samples were selected by convenience sampling from Chan Kwan Tung Social Centre for the elderly in Shum Shui Po. Basically, subjects were required with an ability to perform independent living.
Exclusion criteria
Participants with the following conditions were excluded from the study:
Suffering physical from medically diagnosed conditions such as coronary heart disease, stroke, Chronic Obstructive Airway Disease, Osteoporosis and serious cataract etc. that would interfere with participation in moderate and vigorous aerobic physical activities such as walking briskly, biking on level ground or with few hills, sports where you catch and throw (table tennis, volleyball), tennis (doubles), water aerobics, ballroom and line dancing (Central Health Education Unit of Department of Health, 2012)
With disability
Suffering neurological disorders that would interfere with participation in moderate and vigorous aerobic physical activities, for example, dementia and Parkinsonism.
High fall risk. This is determined by the high fall risk assessed by the health professional within six months. If the subject has not been diagnosed within six months, he/she will be provided the Morse Fall Scale (Appendix I) compulsorily. The subject who score 25 or below can participate into the study.
Answering “NO” once or more on Physical Activity Readiness Questionnaire (PAR-Q) (Appendix II)
Could not understand Cantonese, Putonghua and English.
Recruitment of Participants
To recruit participants, the researcher approached in person and explain the purpose of the study and what it entails. The researcher also illustrated the benefits of participating in the study, how data will be collected and stored. They were voluntary and informed of their right to withdraw from the study at any point with no punishment. All of the participants signed a letter of consent before they were allowed to participate in this study. Before fitness assessment, participants must pass the PAR-Q (Appendix II).

Ethical issue
Risk management
Before exercises, participants should passed the Physical Activity Readiness Questionnaire (PAR-Q). If answering “NO” on the questionnaire once or more, he/she was not be suggested to receive fitness test. During the physical fitness test, fall risk had been observed carefully. When the subject felt tire, enough time of rest was provided. Moreover, research helper stood beside the older subject anytime to avoid the fall accidence in those four fitness test stations. Considered completing chair stand test and 2 minutes step test may lead pants or muscle tire even ache, a nurse was arranged to stand by to lessen worry and risk at health problem after the test.
The research helpers were asked to look carefully at if there is any abnormal appearance or behavior that may indicate he/she was at risk of health problems such as example dizziness, shortness of breath and chest tightness. If there have any of such symptoms, the test will be stopped immediately and inform the in-charge of the Centre.

Table 1- Summary characteristics of participants
Variable Frequency (N=80) Mean ± S.D. percentage
Age 77.33 ± 6.89
60-69 11 13.8
70-79 37 46.3
80-85 16 20
>85 16 20
Gender
Women 67 83.8
Men 13 16.2
Education Level
None 31 38.8
Under Primary 27 33.8
Primary 20 25
Secondary 0
University 0
Missing data 2 2.5
Marital status
Single 14 17.5
Widowed 57 71.3
Separate 2 2.5
Divorce 7 8.8
Hobbies
Smoke 0 0
Alcohol 8 10
Smoke and Alcohol 1 1.3
None 71 88.8
Having Child
No 18 22.5
Yes 62 77.5
Frequency meeting child
Never 5 8.1
Once a month or more 43 69.4
Exceed one month a time 12 19.4
Missing data 2 3.2
Frequency of meeting friends
Never 7 8.8
Once a week or more 70 87.5
Once a week 3 3.8
others 0 0
Missing data 0 0
Doing Exercise
Never 18 22.5
Yes 62 77.5
Community Activities
Never 14 17.5
Yes 66 82.5
BMI 25.03 ± 4.38
Chair Stand Test 11.61 ± 2.64
Up and Go Test 9.6 ± 3.06
Step test 93.56 ± 16.56
UCLA scale 5.73 ± 3.95

Correlations
UCLA BMI CS UG ST
UCLA Pearson Correlation 1 .314** -.012 .106 -.237*
Sig. (2-tailed) .005 .919 .350 .034
N 80 80 80 80 80
BMI Pearson Correlation .314** 1 -.079 .283* -.473**
Sig. (2-tailed) .005 .488 .011 .000
N 80 80 80 80 80
CS Pearson Correlation -.012 -.079 1 -.545** .364**
Sig. (2-tailed) .919 .488 .000 .001
N 80 80 80 80 80
UG Pearson Correlation .106 .283* -.545** 1 -.281*
Sig. (2-tailed) .350 .011 .000 .011
N 80 80 80 80 80
ST Pearson Correlation -.237* -.473** .364** -.281* 1
Sig. (2-tailed) .034 .000 .001 .011
N 80 80 80 80 80
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).

Appendix I

Candidate no.: ____________________ Date: __________________________
Morse Fall Risk Assessment
Risk Factor Scale Score
History of Falls Yes 25
No 0
Secondary Diagnosis Yes 15
No 0
Ambulatory Aid Furniture 30
Crutches / Cane / Walker 15
None / Bed Rest / Wheel Chair / Nurse 0
IV / Heparin Lock Yes 20
No 0
Gait / Transferring Impaired 20
Weak 10
Normal / Bed Rest / Immobile 0
Mental Status Forgets Limitations 15
Oriented to Own Ability 0
Total score

Appendix II
Physical Activity Readiness Questionnaire (revised 2002) (PAR-Q)

體能活動準備度問卷(2002版)

參加者編號:_________________________ 日期:__________________________
(加拿大運動生理協會, 2002)

Appendix I1I
Questionnaire
參加者編號: 日期:
1. 性別 男  女 
2. 年齡 60-69歲之間  70-79歲之間 
80-85歲之間  85歲以上 
3. 教育程度 no, under pri, over pri 無  小學以下 小學
中學 大學/ 大專
4. 婚姻狀況 單身  已婚  喪夫/喪妻 
離婚  分居 
5. 居住情況 自住  跟親友同住 
安老院  其他  (________________)
6. 嗜好 y/n 吸煙  (___支/日) 飲酒  (___杯/日)
藥物  沒有嗜好
7. 你有子女嗎? once a week, y/n
如有，通常相隔多少時間見一次面？ 有  (___子/____女) 無 
無  少於一星期  一星期 
二星期  三星期 一個月
二個月  三個月 四個月或以上
8. 你通常相隔多少時間會會見朋友？
once a week, y/n 無  少於一星期  一星期 
二星期  三星期 一個月
二個月  三個月 四個月或以上
9. 你有定時做運動的習慣？ 有  (__________________) 沒有 
10. 你有定時做參加社區活動？ 有  (__________________) 沒有 

Appendix IV
UCLA 孤獨感測量表
參加者編號:________________________ 日期:__________________________
O表示 “我常常感到如此”
S表示 “我有時候感到如此”
R表示 “我很少感到如此”
N表示 “我從未感到如此” ________________________________________
當你自己做很多事情的時候，你常常不快樂嗎？ O S R N
你常常覺得沒人可以跟你講話嗎？ O S R N
你常常不能忍受獨自一人嗎？ O S R N

你常常覺得沒有人真正的了解你嗎？ O S R N
你常在等別人的電話或回信嗎？ O S R N
你常常覺得自己是獨自一人嗎？ O S R N

你常常覺得你無法與周圍的人溝通嗎？ O S R N
你常常渴望有個伴嗎？ O S R N

你常常覺得交朋友有困難嗎？ O S R N
你常常把自己關在房裡不跟任何人接觸嗎？ O S R N