A d z m e l M a h m u d 1, R o h a n a J a n i 2, R a u d h a t u l M a h f u z a h S h a f i a i 1

1N a t i o n a l P o p u l a t i o n a n d F a m i l y B o a r d , M a l a y s i a , 2U n i v e r s i t y o f M a l a y a , M a l a y s i a

Determinants of Loneliness Among Elderly in Malaysia

INTCESS16 3rd INTERNATIONAL CONFERENCE ON EDUCATION AND

SOCIAL SCIENCES 8-10 February, 2016

Istanbul, Turkey

Outline of presentation

Introduction

Objective

Method

Analysis

Results and findings

Summary and conclusion

Acknowledgement

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Introduction

Population ageing (aged 60 years and over) is taking place in both developed and developing countries in the world. The older population will increase from

841 million in 2013 to more than 2 billion in 2050.

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Source:

(1) United Nations, Department of Economic and Social Affairs, Population Division (2013). World Population Ageing 2013.

ST/ESA/SER.A/348

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0.8 Billion

2.0 Billion

Introduction… cont.

Malaysia is likely to reach an ageing nation status by 2035

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5.8 6.2

7.9

10.6

13.6 14.9

0

2

4

6

8

10

12

14

16

1991 2000 2010 2020 2030 2035

%

Proportion of the population aged 60 years and over, 1990-2040, Malaysia

2.2 million

5.5 million

Source:

(1) Department of statistics, Malaysia (2006), Time Series Data Population and Housing Census, 1911-2000.

(2) Department of Statistics, Malaysia (2011), Population Distribution and Demogrpahic Characteristics, 2010.

(3) Department of Statistics, Malaysia (2012), Population Projection s, Malaysia, 2010-2040.

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Introduction… cont.

As the number of elderly population continues to grow, loneliness is becoming one of the major issues leading to

impaired quality of life among elderly people.

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Why study loneliness

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Introduction… cont.

Loneliness can be defined in many ways based on the situation and condition of individuals who experienced it.

Loneliness is based on the perception of having few or less close interpersonal relationship than one would like (Van Baarsten, Snijders, Smit, & van Duijn, 2001; Cornwell & Waite, 2009a).

Loneliness is the difference between desired and actual social relations either in quantity or quality of relationships or both (Peplau and Perlman (1982)

Loneliness refer to the subjective, negative feelings related to perceived social isolation, a lower level of contact than that desired or the absence of a specific desired companion (Wenger et al. 1996)

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What is loneliness?

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Introduction… cont.

The prevalence rate of loneliness among the elderly is different ranging from 7% (Victor et al., 2000) to 49% (Holmén, Ericsson & Winblad, 1994).

It was expected that 25% of the world population will experience loneliness (Miedema & Tatemichi, 2003).

More than half (53.4%) of Malaysian elderly population experienced loneliness (Teh, Tey & Ng, 2014).

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Prevalence of loneliness

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Introduction… cont.

Loneliness increases with age (Dykstra, Van Tilburg, & De Jong Gierveld, 2005)

A higher percentage of women than men report feeling lonely (Beaumont, 2013)

There is a negative association between prevalence of loneliness and health among the elderly (Pennix et al., 1999).

More than half (59%) of adults aged over 52 who report poor health say they feel lonely “some of the time or often”, compared to 21% among those who reported they are in excellent health (Beaumont, 2013)

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Literature on risk factors of loneliness

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Introduction… cont.

Loneliness predict depression (Cacioppo et al., 2006; Momtaz et al., 2012), physical activity management (Cacioppo, Hawkley & Thisted, 2010) and it also will affect the quality of life (Victor et al., 2000)

Feeling of loneliness increases the risk of mortality (Patterson & Veenstra, 2010)

Family that provides major sources of support plays a role of shield against depression, loneliness, and isolation in later life (Murphy, 1982).

Financial difficulties and unstable employment have been noted as contributing factors to psychological disturbances (Nicasso, 1983).

Having an intensive social network decreases the feeling of loneliness Jylhä (2004).

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Literature on risk factors of loneliness

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Objective

The objective of this study is to examine prevalence of loneliness and to identify the risk of loneliness with respect to

(i) demographic variables

(ii) socio-economic status

(iii) health and physical conditions

(iv) living arrangement

(v) family interaction and support, and

(vi) social connection and interaction

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Method

Data Source • Data for this study is a sub-

sample of a bigger national study gathered through the Fifth Malaysian Population and Family Survey(MPFS-5) conducted in 2014 by the National Population and Family Development Board Malaysia.

• MPFS is conducted every 10 years since 1974

Data Collection

• Stratified sampling design

• Face-to-face interview conducted by trained interviewers

Respondents

• Malaysian citizens aged 60 and above with Children

• Sample size = 3,701

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12

Variables Variable code

Perceived loneliness 0 = Not lonely; 1 = Lonely

A. Demographic variables

1. Age 1 = 60-64; 2 = 65-69; 3 = 70-74 ; 4=75+

2. Gender 0 = Female ; 1 = Male

3. Ethnicity 1 = Malays; 2 = Other Bumiputras ; 3 = Chinese,

4 = Indians

4. Place of residence 0 = Rural ; 1 = Urban

5. Marital status 0 = Currently married ; 1 = Widowed/divorced

B. Socio-economic status

6. Educational level 1 = No schooling ; 2 = Primary; 3 = Secondary;

4 = Tertiary

7. Work status 0 = Not working; 1 = Currently working

8. Savings 1 = None; 2 = 1-2 savings; 3 = 3+ savings

Method… cont.

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Method… cont.

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Variable Variable code

C. Health and physical condition

9. Health status 1 = Good ; 2 = Fair; 3 = Poor

10. Disease 1 = None; 2 = 1-2 diseases; 3 = 3+ diseases

11. Physical limitation 1 = None; 2 = 1-2 limitations; 3 = 3+ limitations

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Method… cont.

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Variable Variable code

D. Family interaction and support

12. Living arrangement 0 = Non coresidence; 1 = Coresidence

13. Received money 0 = No; 1 = Yes

14. Payment of bills 0 = No; 1 = Yes

15. Food and other necessities 0 = No; 1 = Yes

16. Housework 0 = No; 1 = Yes

17. Care giving 0 = No; 1 = Yes

18. Emotional support 0 = No; 1 = Yes

E. Social activities

19. Religious participation 0 = No; 1 = Yes

20. Leisure activity 0 = No; 1 = Yes

21. Community participation 0 = No; 1 = Yes

22. Internet usage 0 = No; 1 = Yes

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Method… cont.

Loneliness

Demographic variables

Socio Economic

Status

Health & Physical

Condition

Family Interaction &

Support

Social Activities

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Analysis

Descriptive statistics – frequency distribution and cross-tabulation

Statistical Analysis

Association analysis (Chi-Square test)

Null Hypothesis (Ho) : There is no association between loneliness and independent variables (age, gender, ethnicity, place of residence, marital status etc.)

Alternative Hypothesis (Ha) : There is an association between loneliness and independent variables

Logistic regression – to identify significant factors that influence loneliness

( 0 = not lonely (ref); 1 = lonely)

where independent variables are:

demographic variables, socio-economic status, Health & Physical Condition, Living Arrangement, Family Interaction & Support and Social Activities

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Characteristics of respondents 17

Demographic variables

Characteristics All

(n=3,701)

Female

(n=2,033

Male

(n=1,668)

Age

60-64 38.9 40.0 37.5

65-69 27.7 26.4 29.3

70-74 17.6 17.2 18.1

75+ 15.8 16.4 15.2

Gender

Male 45.1

Female 54.9

Characteristics All

(n=3,701)

Female

(n=2,033

Male

(n=1,668)

Ethnicity

Malay 65.7 66.8 64.4

Other Bumiputra 10.1 10.2 9.9

Chinese 17.3 15.7 19.4

Indian 6.9 7.3 6.4

Place of Residence

Rural 45.8 47.3 44.0

Urban 54.2 52.7 56.0

Marital Status

Currently

Married 69.1 51.6 90.3

Widowed/

divorced 30.9 48.4 9.7

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Characteristics of respondents… cont. 18

Socio-Economic Status

Characteristics All

(n=3,701)

Female

(n=2,033

Male

(n=1,668)

Educational level

No schooling 20.1 29.8 8.3

Primary 49.7 48.4 51.4

Secondary 25.0 19.5 31.8

Tertiary 5.1 2.5 8.5

Work Status

Not Working 77.7 86.5 66.9

Currently

working 22.3 13.5 33.1

Savings form

None 42.4 43.9 40.5

1-2 savings 41.4 42.7 39.9

3+ savings 16.2 13.4 19.6

Health & Physical Condition

Characteristics All

(n=3,701)

Female

(n=2,033

Male

(n=1,668)

Health status

Good 34.5 31.2 38.4

Fair 52.4 54.8 49.3

Poor 13.1 14.0 12.3

Diseases

None 24.2 21.6 27.5

1-2 Diseases 52.4 54.3 49.9

3+ Diseases 23.4 24.1 22.6

Physical limitations

None 68.8 60.8 78.5

1-2 limitations 19.7 24.8 13.5

3+ limitations 11.5 14.4 8.0

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Characteristics of respondents… cont. 19

Characteristics All

(n=3,701)

Female

(n=2,033

Male

(n=1,668)

Living Arrangement

Non coresidence 41.3 40.9 41.8

Coresidence

with children 58.7 59.1 58.2

Received money

No 20.4 15.9 25.8

Yes 79.6 84.1 74.2

Payments of Bills

No 53.2 47.5 60.2

Yes 46.8 52.5 39.8

Food and other necessities

No 31.8 24.5 40.7

Yes 68.2 75.5 59.3

Family Interaction & Support

Characteristics All

(n=3,701)

Female

(n=2,033

Male

(n=1,668)

Housework

No 34.9 30.6 40.2

Yes 65.1 69.4 59.8

Care Giving

No 38.0 30.3 47.3

Yes 62.0 69.7 52.7

Emotional Support

No 43.9 41.2 47.2

Yes 56.1 58.8 52.8

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Characteristics of respondents… cont. 20

Social activities

Characteristics All

(n=3,701)

Female

(n=2,033

Male

(n=1,668)

Religious Participation

No 24.6 30.6 17.2

Yes 75.4 69.4 82.8

Leisure activity

No 77.9 84.3 70.2

Yes 22.1 15.7 29.8

Community participation

No 84.8 87.9 81.1

Yes 15.2 12.1 18.9

Internet Usage

No 91.8 95.1 87.8

Yes 8.2 4.9 12.2

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Results and findings 21

Prevalence of loneliness

Not Lonely

64.4

Lonely 36.5

ALL

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Results and findings… cont. 22

Demographic Variables

68.8 64.6 63.6 54.1

31.2 35.4 36.4 45.9

60-64 65-69 70-74 75+

Age**

Not Lonely Lonely

74.0 56.5

26.0 43.5

Male Female

Gender**

62.3 50.1

80.7 64.6

37.7 49.9

19.3 35.4

Malay Other Bumiputra Chinese Indian

Ethnicity**

58.5 69.3

41.5 30.7

Rural Urban

Place of Residence**

72.3 46.7

27.7 53.3

Currently Married Widowed/divorced

Marital Status** Feeling lonely increases with age highest among those age 75+

Higher among females and those residing in rural areas,

Much higher among widowed/divorced

Lowest among Chinese

**P

Results and findings… cont. 23

Socio-Economic Status

45.3

64.5 75.3

85.3

54.7

35.5 24.7

14.7

Noschooling

Primary Secondary Tertiary

Educational Level**

Not Lonely Lonely

57.9 66.4

76.1

42.1 33.6

23.9

None 1-2 savings 3+ savings

Savings**

62.9 69.7

37.1 30.3

Not Working Currentlyworking

Works Status**

Feeling lonely was also common among those who had no schooling, not working and had no sources of income

**P

Results and findings… cont. 24

Health and Physical Condition

73.5 62.9

46.5

26.5 37.1

53.5

Good Fair Poor

Health Status**

Not Lonely Lonely

70.2 64.6 57.8

29.8 35.4 42.2

None 1-2 Diseases 3+ Diseases

Diseases**

69.9 57.7

43.1

30.1 42.3

56.9

None 1-2limitations

3+limitations

Physical limitations**

Respondents with poor health status, with diseases and physical limitations were more inclined to feel lonely

**P

Results and findings… cont. 25

Family Interaction & Support

60.9 66.9

39.1 33.1

Noncoresidence

Coresidencewith children

Living Arrangement**

Not Lonely Lonely

66.9 63.2

33.1 36.8

No Yes

Food and Other Necessities*

67.3 62.6

32.7 37.4

No Yes

Care Giving*

67.4 62

32.6 38

No Yes

Emotional Support**

Feeling lonely is higher among those who are not living with their children and received supports from their children in the form of food and other necessities, care giving and

received emotional support.

**P

Results and findings… cont. 26

Social Activities

55.8 67.2

44.2 32.8

No Yes

Religous Participation**

Not Lonely Lonely

61.5 74.5

38.5 25.5

No Yes

Leisure Activity**

61.5 74.5

38.5 25.5

No Yes

Community Participation**

62.7

83.2

37.3

16.8

No Yes

Internet Usage**

Feeling lonely is lower among those who participated in religious; leisure activities; community participation and internet usage

**P

Results and findings… cont. 27

Logistics Regression

Variable Sig. OR 95% CI Age_group (ref:60-64) 65-69 0.520 1.06 (0.88-1.28)

70-74 0.203 0.87 (0.69-1.08)

75+ 0.832 1.03 (0.81-1.30)

Male* 0.007 0.78 (0.65-0.93)

Ethnicity (ref: Malay) Other Bumiputra 0.059 1.28 (0.99-1.65)

Chinese* 0.000 0.40 (0.32-0.51

Indian 0.286 0.85 (0.63-1.15)

Urban* 0.022 0.83 (0.71-0.97)

Divorced* 0.000 2.22 (1.86-2.65)

Educational Level (ref: no schooling)

Primary* 0.000 0.69 (0.57-0.85)

Secondary* 0.000 0.60 (0.46-0.77)

Tertiary* 0.001 0.44 (0.26-0.72)

Currently Working 0.852 0.98 (0.81-1.19)

Saving (ref: none) 1-2 savings* 0.009 0.81 (0.69-0.95)

3+ savings* 0.000 0.58 (0.46-0.74)

Health status (ref: good) Fair* 0.008 1.27 (1.07-1.52)

Poor* 0.000 1.98 (1.53-2.55)

Variabel Sig. OR 95% CI Disease (ref: none) 1-2 diseases 0.511 1.07 (0.88-1.30)

3+ diseases 0.137 1.20 (0.95-1.51)

Physical_limitation (ref: none) 1-2 limitations 0.166 1.15 (0.95-1.39

3+ limitations * 0.000 1.75 (1.37-2.24)

Coresidence with children* 0.000 0.69 (0.59,0.80)

Received money 0.481 1.08 (0.88-1.31)

Payment of bills 0.764 0.97 (0.82-1.16)

Food and other necessities 0.125 0.86 (0.71-1.04)

Housework 0.388 0.92 (0.76-1.11)

Care giving 0.817 0.98 (0.81-1.18)

Emotional support* 0.003 1.28 (1.09-1.50)

Religious participation* 0.007 0.78 (0.65,0.93)

Leisure activity 0.356 0.91 (0.74-1.11)

Community participation 0.689 0.96 (0.77-1.19)

Internet usage 0.648 0.92 (0.64-1.32)

Chi Square : 4.842; P value: 0.774

Results from the logit model show that demographic and socioeconomic factors, health, co residence with children, emotional support and religious participation have significant effects on the feelings of loneliness among older persons.

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Summary and conclusion

Slightly more than one third (36%) of Malaysian elderly experienced loneliness

Gender – male elderly is less likely to feel lonely than female

Ethnicity – No significance difference between and other Bumiputra and the Malays but Chinese is less likely to feel lonely than the Malays elderly

Place of residence – urban respondents are less likely to feel lonely than rural

Marital status – widowed elderly is two times more lonely than the married elderly

Education level – those respondents with no education are more likely to feel lonely than their counterparts

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Summary and conclusion… cont.

Savings – the more savings they have the less likely they felt lonely

Physical limitations – the higher their limitations the lonelier they felt as compared to those that are more mobile

Co-residence – those that stayed with their children experience less lonely than otherwise.

Emotional support – those with emotional support less likely to feel lonely

Social activity – religious activities keep them busy and less lonely.

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Acknowledgement

The authors are grateful to the National Population and Family Development Board of Malaysia for granting the permission to use the 2014 Malaysian

Population and Family Survey data

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THANK YOU

adzmel@lppkn.gov.my

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