"I don't want to make trouble": emotional distress, disconnection and loneliness among older people in China.

Abstract

Objectives: Loneliness affects more than a quarter of older people. The particular sociodemographic characteristics of Chinese society mean that there are growing numbers of older people, with fewer adults of working age to support them. We explored the experience, meaning and consequences of loneliness for Chinese older adults, as well as the strategies deployed to counteract unmet social needs.

Methods: This qualitative study was nested within the 10/66 DRG LIFE2YEARS study in China. We conducted in-depth interviews with 49 older people and 13 caregivers. Interviews covered experiences of ageing, including social life, expectations of health and social care and psychosocial support.

Results: We used thematic analysis and developed three main themes: a) The interconnection of negative emotions, depression & social deficits, b) Reasons for social deficits- avoiding "making trouble"; social exclusion/isolation; intergenerational strain, and c) Addressing unmet social needs. Older adults experienced loneliness as unexpected pain in later life. They practised withdrawal behaviours: to avoid social embarrassment and perceived risks to health. Older participants described living in communities where they felt increasingly alienated. Whilst some older people described effective strategies for counteracting loneliness, these were only feasible for those who were fit and able.

Discussion: Our findings relating to the shame of loneliness and avoiding burdening others are particularly salient against a backdrop of Confucian ideals. Our work highlights the importance of considering cultural expectations and values in loneliness research and the need to ensure those most at-risk of loneliness are not excluded from future research and intervention development.