By Team Mental: Heitzer, F Rust, R.M Saadun, A Tomassen, C.M.M

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1 By Team Mental: Heitzer, F Rust, R.M Saadun, A Tomassen, C.M.M

2 Table of contents Contents Introduction:... 2 Abstract Defining problem and approach Problem First approach Research Envisioning Brainstorming Interviewing: Literature Designing intervention: Acquiring data: User testing and interviewing the target group Analysing and validating: Envisioning Interviewing Brainstorming: Designing intervention Acquiring data Analyzing and validating Slimmer leven challenge: Business Model 12 5 Final user testing final and conclusion References Attachments Attachment 1: Interview Reanne Attachment 2: Dagje meelopen met Thuiszorg David Attachment 3: Interviews Attachment 4: User-test Ali Attachment 5: User-test Floyd Attachment 6: User-test Chris Attachment 7 Interview GGzE Attachment 8: Poll Results Attachment 9: Contributions. 40 1

3 Introduction One sometimes wonders why things are as they are. One way to find an answer to that question is to define the subject and then go out and ask, try and test. Experience in the elderly care gave insights into the feelings of the elderly, which seemed, at first, to be lonely. Various studies in different countries confirmed these thoughts(age UK, 2015; de Jong Gierveld, 2010; Perlman, 2004), so the next logical step is to confirm this subject and accept the challenge to try to enhance the life quality of the lonely elderly. The quality of life is not only about your physical health but also about your environment, education, recreation, and social environment. (Nussbaum & Sen, 1993; Wiley, n.d.) As loneliness a feeling that is caused by your social environment it contributes to your life quality.(liu & Guo, 2007; Theeke & Mallow, 2013) The subject loneliness of elderly is a hard subject to tackle, because it is not something that can be easily measured.(costanza et al., 2008) According to De Jong-Gierveld, loneliness refers to the experience of negative feelings due to the inadequacy of existing relationships, while Weiss describes loneliness as a chronic distress without redeeming features and according to Peplau loneliness is the distress that occurs when one s social relationships are perceived as being less satisfying than what is desired.(de Jong Gierveld, 2010; Peplau & Perlman, 1982; Weiss, 1975) Though the majority of the scholars believe that loneliness is an important subject for social research, especially the elderly-part, as it relates directly to health and well-being on which will be elaborated in the section problem.(cacioppo et al., 2002; Cattan, White, Bond, & Learmouth, 2005; de Jong-Gierveld, 1987) Loneliness among elderly may even cause a major impact in their lives that it can cause diseases which lead to health-risks.(hawkley & Cacioppo, 2003) Hawkley shows that loneliness can become a pathway to diseases. During a research into loneliness among elderly, you will find yourself swimming in a sea of uncertainties. These uncertainties arise as questions like; The goal is to reduce the feeling of loneliness of elderly, but does that feeling bother them, if there is even some sort of that feeling?, Are the elderly, who perfectly fit in the criteria of being lonely, willing to get in contact with others, and if so, does that contact really reduce the feeling of being lonely?, What kind of contact are we talking about, physically or virtually? and many more questions. Because there are a lot of uncertainties, one will encounter during this research. To guide this research the method as mentioned in the first two sentences of this page was used. More specific, the EDL cycle method which consisted the use of a probe was used extensively. In this report, you will find the taken route which was made based on the goal: designing an artifact that can reduce the loneliness among elderly and which led to the creation of the FamilyFrame, which goal is to enhance the relationship between elderly and their family members. 2

4 Abstract Loneliness can smoothen the pathway to many diseases. Decreasing loneliness will increase the quality of life of the elderly. Strengthening the contacts of elderly with their relatives will drop the loneliness level among those elderly and to achieve that a few barriers like time and distance have to be overcome. The FamilyFrame could lower these barriers to have social contact with your grandparents or relatives and it enables to share moments via pictures in a unique way. The pictures you make will appear on a nice frame at the home of your relative. It s a user friendly product which makes it for elderly practical to use. First results through user testing offer promising prospects for further validation of the concept In addition there has been an app developed which will enhance the use of the product. 1. Defining problem and approach 1.1 Problem Loneliness among elderly is a very urgent problem which affects a lot of elderly.(aartsen & Jylhä, 2011) It is not a new phenomenon though isolation among elderly has been detected for a long time now.(coyle & Dugan, 2012) The feeling of loneliness is considered unpleasant and is correlated to depression, other mental health issues and physical health.(drageset, 2004; Dykstra, 2009; Glassman-Feibusch, 1981) In addition these feelings of loneliness were found to be a major risk factor for increasing mortality in older men. (Holwerda et al., 2012) These feelings are often a result because of the low quality of social network and not the quantity. According to a study performed between 2002 and 2008 on 1,604 older adults with a mean age of 71 showed that Loneliness the unpleasant feeling of emptiness can creep in and cause suffering to people at any age, but especially to older adults and may predict serious health problems and even death. [Perissinotto C.M. et al., 2012] It is emphasized in literature that loneliness is an important subject for research, because there is a growing awareness of the phenomenon of loneliness in elderly people. [Donaldson, J. M. et al., 1996] A lot of studies tried to conceptualize the phenomenon of loneliness or tried to develop a testing model for loneliness, but these studies also show that this approach is hard, because loneliness incorporates a lot of variables e.g. social network, background, personality characteristics, age, education and many more. [R.F. Creecy et al, 1985; L.C Copel, 1988; de Jong-Gierveld J., 1987] This lack of contact with other people is most unfortunate because it is said that the quality of personal relationships is one of the best predictors of health and life expectancy.(peeters, Megens, Hummels, & Brombacher, 2013) As can be deduces from all those studies, loneliness is recognized since many years, yet it is unique for every individual and thus hard to conceptualize, model and solve. Other approaches were tried to link loneliness directly with family life e.g. marriage, never-married elderly and family in general. It is shown that losing a partner, increased physical disabilities and uselessness are origins for feeling lonely. [B. Glassman-Feibusch, 1981] Elderly with contacts with children, siblings and family, unsurprisingly, showed a stronger negative relationship with loneliness which was the same for married adults, whereas divorced and widowed adults were more likely to profit from contact with adult children. [M. Pinquart, 2003] In general, it can be stated that marriage is associated with substantially less loneliness and that this trend is cross-national. [S. Stack, 1998] 3

5 Now it became clear that loneliness is a major problem. The hardest part in the path to solving, or partially solving, this truly interesting phenomenon are the first steps, where to start and which information is needed? Trends and studies as abovementioned show that elderly who are physically lonely suffer from loneliness most. It is also obvious that loneliness guides to paths which will lead to illness, health problems and even death. Company, in all forms e.g. a partner, children of neighbors, and active participation in society are linked to substantially less loneliness which makes this part of this phenomenon very interesting for our further research. 1.2 First approach The focus on this project lays on improving mentally caused problems because that seemed to our group more interesting and challenging. It s hard to find the exact problem and an exact solution because it s not something you can measure from the outside. Therefore the loneliness that is caused because of physical disability will be out of the scope. As social network and contact seemed, as illustrated in the previous section, rather important this will be the main subject in this research. Therefore the aim will be to develop a product which enhances the social life of elderly. 2. Research The design will be developed with an EDL (Experimental Design Landscape) based approach. The purpose of our design will be to change the feeling of loneliness among elderly. The EDL cycle is used because the first idea that comes to mind is sometimes not the best idea and by going through the different steps in the EDL cycle more insights will be gained. The envisioning process is to trigger new ideas this can be done via literature research, interviews, or observations. Then of course the ideas that are obtained during envisioning should be realized and the intervention should be designed. Then the design can be tested on the users this can be done in various ways. The design can be presented and feedback can be asked or one can just put the design in the environment of the users and observe the reactions. Finally all the information retrieved in the previous steps should be analyzed. So what is the general feedback?, Are there reoccurring subjects?, Has there been any interesting or out of ordinary responses?. Then these new insights are used to start the EDL cycle again and improve the design. This is why different iterations are important it enables you to improve the product and adapt the design towards the client wishes. 4

6 The user plays a central role while designing as can be diluted from the previous elaboration on the EDL cycle. The opinion and actions of the uses play an important role during envisioning and then again when acquiring data. This is very important because in the end these are the people who will use the design. In the following paragraphs the steps in the EDL cycle will be used as a guideline. 2.1 Envisioning Brainstorming The project has started with a big brain storming session and was followed by several ideas like games, apps, and gadgets. At the end the idea of incorporating a design into the daily life of elderly seemed very appealing to the whole group. Therefor a probe was designed to see if more information could be obtained from potential users. A probe should be helpful to analyze the patters of everyday behavior amongst elderly.(peeters et al., 2013). A probe can be integrated in the daily life of people. It can be a small or a big objects with not yet a specific goal. As one interacts with the probe it will give it a definition according to his or her own interpretation of the object. By studying the behavior of the people who use the probe you can actually tell something about their way of thinking and see what their needs are Interviewing Several questionnaires were made and were held amongst elderly to find out if the feeling of loneliness was common amongst these elderly and if not how they prevent being lonely. As can be seen in the attachment the questions were not specifically about loneliness. They were more directed in the form of: Does your family often visit? And do you like having them around? Would you like it if they visit more? or What does your regular day look like? or Would you like to join in activities organized by the zonnebloem? And why or why not? The question: are you lonely has never been asked to someone directly, because we didn t expect a fair answer as it is still a sensitive subject. See attachment. People were interviewed at retirement homes but also people who still live on their own. Overall one did not consider oneself lonely which was against the expectations. This can be explained because the group interviewed consisted in total out of 20 people. This group is too small to make big assumptions. Secondly the majority in this group were years of age. Recent study has shown that people below the age of 80 don t experience loneliness as much as people above this age do.[23] Also interesting was that one couple was complaining about the amount of caring they got. In their opinion too many caretakers visit during day and everyone at different hours therefor their day feels crowded and they actually appreciate some time alone. This is something which probably strongly depends on the organization that is taking care of you and how much caretaking you need Literature Several literature studies were done to explore the field of loneliness amongst elderly. Most of the papers read and discussed in during this period can be found in the library at the end of this report. 2.2 Designing intervention The probe should be simple, understandable and useful. Therefor the probe was given simple and easy to interpret pictures with features which are very user friendly. The use of words was limited so people would not need their reading glasses and would not be distracted by the reading. The decision was made to make a wooden board which would display some nice activities elderly could 5

7 do. Next to these activities your availability would be displayed. In addition two different colors were used to emphasize the difference between the activities and the availability. The cards with the activities on it were attached to a wooden board by means of some nails. The cards were replaceable. 2.3 Acquiring data User testing and interviewing the target group The probe was taken to retirement homes but also the elderly who live separated from the retirement home. The reaction of all the people was analyzed. Overall the reactions were disappointing there was no motivation to use the probe. Most of the elderly didn t have the urge to meet other new people they felt fine just the way it was. Some elderly didn t feel comfortable to get in contact with strange unknown people. The elderly were more interested though if the people they could interact with would be some of their own relatives. Some of the elderly who were familiar with the one giving the interview proposed to the activity together. So again they were more open for activities with people they knew. To retrieve a broader feedback another user test was planned. Our group had the opportunity to receive feedback on the probe from a few elderly at GGzE. As the probe was discussed rather than tested, an interview was the only way to get feedback. The topic of the probe was discussed in an indirect way to avoid the elderly from framing it with preassumptions right away. During the interview, opinions were sometimes contradicting, which made clear that a classic interview is not the ideal way to test a probe. Our probe received the following feedback at GGzE: 6

8 In a well-known area, the probe will make things uncomfortably personal. The anonymity can make people who are socially not very confident feel quit anxious. Possible confrontations with someone you already know but don t connect well to make it unlikely people will interact with the probe. The surprise-element concerning the activity itself appeals well to the older age. Especially when the activity is experienced as serviceable. Initiatives such as De Zonnenbloem, who aim at empowering elderly. Digital interests are low. 2.4 Analysing and validating The rather negative feedback did give some new ideas. A few elderly mentioned that they would like to have more interaction with their relatives. Also the elderly who didn t mention this did still spoke enthusiastically about their children and grandchildren specifically. A citation from an interview after the question was asked if they would like to meet their children and grandchildren more often: Yes, I would absolutely love to, but it s just not possible because of their busy time schedules. They are very grateful that I understand that they are not able to visit me that often, but I may say that I really long for their visits. In addition the probe also helped determine the need for contact with familiar people and not with strangers. Several times the question was raised if also complete strangers would contact you if you would put the probe on the door. This idea made the several woman feel uncomfortable. Also the a men mentioned that he didn t like his neighbors so he would prefer if his neighbors left him alone. However if his family wanted to do any activity he would participate. Also in the interview with GGZE the contact with family was mentioned by Henk. He said that he didn t had the need to meet new people, but would appreciate it more see people with whom he already has a strong connection, like his family. However after Chris asked, if the amount of contact with his family was a little disappointing, he mentioned that his family saw the visits as an obligation and in that case he doesn t want them to visit any more. So although not mentioning it directly a trend was noticed among the elderly there was a need for social interaction with their own family. Therefor a device should be developed that lowers the barriers within a family to approach each other. 2.5 Envisioning Interviewing First some interviews were taken with elderly to ensure that the idea of increasing the social interaction within the family would be appropriate and meaningful. People were much more enthusiastic which was encouraging. 7

9 2.5.2 Brainstorming: A new brainstorm session was needed to get grip on a new idea. The design must still be easy incorporated in the lifestyle of elderly. This criterion stood out during the whole process based on the reasons described earlier. As a result the idea of an interactive photo frame stood out. It would be similar to sending a picture on WhatsApp but then it will appear in a nice frame in the living room. Which will be a nice decoration for the elderly and they will be involved in the life s of their children/ grandchildren. Communication via audio Connect family via Wi-Fi Geographical issues Increase contact Communication via pictures Make quick to use design Lack of time Family, imortant. Family forget to visit Time tracker since last visit Make an app which can be used on every location Brainstorm, design against lonelines Decorative desgin Adaptive frame Easy to incorporate Photoframe 8

10 2.6 Designing intervention As a start digital already existing photo frames were used. Some pictures were put on it in advance and therefor a slideshow displayed on the frame. This gave a good impression what the final design would look like. After this impression, steps were taken to connect the standard photo frame with a smartphone, to make the photo frame able to receive pictures on-line and to show them directly to the user. As most Photo frames do not have internet (the ones which do are 5 times more expensive than the ones that we used), other ways should be tried to make this connection happen. At first, connecting the standard photo frame with a Wi-Fi-connected SD-card and then linking the SD card to a smartphone in order to receive pictures was tried out. It turned out that the internal system of the SD card didn t allow the connection to be in two directions, so the Wi-Fi of the SD-card is only sending and not receiving. The next step was to try to change the directions (make it receive instead of send) with the help of computer scientist, but it was too hard to achieve that so other routes were analyzed. The next option considered was using a tablet instead of a photo frame and using the tablet as photo frame, which caused some problems. The problems tackled were; The tablet screen should lit up all the time, it should be able to receive pictures after being sent from a smartphone, it should directly synchronize the received picture with the shown pictures and show the newest picture first. The first problem was to use an application that keeps the tablet lit all the time. The problem that this causes is that no other app can be opened in the background; because this app is occupying the ram storage (it was a cheap tablet, to reduce costs for research and minimize the price of the final product). This problem was solved to use an app that mimics the use of a photo frame on a tablet, but this too causes a problem, which is receiving the picture and the direct synchronization of the picture. This was solved by thinking of combining these specifications with a receiving medium, compatible with a smartphone and tablet and after some research it seemed that the best medium is dropbox. This formed the basis of our FamilyFrame app. An app called dayframe was found and it partly fills in the gaps of these requirements. This app was linked to dropbox and let it synchronize over time.this resulted in picture that were uploaded instantly from the moment one put it in the dropbox folder. This was still a bit devious though. At last the idea rose that an app should be developed to overcome the rather complexity of the system with dropbox and the dayframe app. 9

11 2.7 Acquiring data Research at elementary school We have two customer segments which we want to gather data from in this project. The most obvious are the elderly with which we discussed and researched on how we could improve their state of live and decrease their feelings of loneliness. The other customer segments are the party with which we want to strengthen their contact with the elderly: the young grandchildren and the older grandchildren and grown up children. For these parties we want to research how their contact with their grandparents is now, what they do and don t like from this contact. And what activities they partake in with their (grand) parents That s why we decided to go to an elementary school and survey children there about their contact with their grandparents. We got in contact with some teachers from OBS De Kring located in Hellevoetsluis, who agreed in working with us. The way we did the survey was by asking the crowd of children if they could raise their hands when they agreed with what we said (for example: do you see your grandparents a lot? Do you rarely see your grandparents?). We surveyed 2 classes, one class from the 4 th grade (groep 4) which had 28 children and one from the sixth grade (groep 6) which had 21 children. We could only make a movie of the first class because some children in the second class didn t have permission to be filmed User Poll Test To get some information of the rest of the family, (the elders of the children, uncles etc.), we made a poll asking how they kept in contact with their grandparents or their elderly parents (Appendix 6). We used google documents to create the poll, we spread it around and we received 31 responses. 10

12 2.8 Analyzing and validating For us in the end the things that were most important were the poll results, they showed that indeed it was often very hard for children to visit the elderly parents or grandparents due to large distances and time restrictions. Also they felt like often a visit would take up to much time and they would not have a lot to talk about while being there leaving them unfulfilled. This observation can also be found in literature.several papers mentioned that the frequency of grandchildren visiting their grandparent was considered low (Geurts, Poortman, Tilburg, & Dykstra, 2009)(Harwood & Lin, 2000) Furthermore several papers showed that geographical distance is the most important factor that influences the frequency of visits. There frequency of visits decreases drastically when the distance increases and it becomes less feasible to make a short visit.(uhlenberg & Hammill, 1998).So a design should be made that overcomes this distance problem. The data we gained from the children also brought some things to light about how the two parties communicated. When children visited their grandparents the topics of conversation was often about the children s day to day activities and how their lives instead of the grandparents, this reveals that what grandparents seek in a relationship with their grandkids is a desire to be learn about and be a part of their lives. We also found out that often children would be well able to communicate via WhatsApp despite them being very young. 3. Slimmer leven challenge Chris and Floyd entered the Slimmerleven Challenge with the concept of the physical photo-frames with a live connection. This design-competition was focused at wellbeing in healthcare and elderly, in which students from TU/e, Fontys and Summa College work together. During the 1 st round, a group-brainstorm session was scheduled, with the ability to require feedback from external experts. When Floyd and Chris introduced the concept of the photo-frames, the group decided to go more into depth with the idea. The eventual concept received a wide variety of comments from the separate experts. This made clear that the professional background heavily influences the opinion of the idea. After our group advanced to the finals, there were 3 workshops available to learn how to take care of all the different stakeholders when trying to implement an innovation. This made our group, consisting of Chris, Floyd and two Summa College students, think about our concept from a business perspective. During an additional event from the Slimmerleven challenge, the same experts were present to give additional feedback on the refined concepts. Although there were still some disagreements on the multifunctionality of the concept, Familyframe received mostly positive comments. One of the experts, Paul Slaats from Acknowledge, was interested in helping us exploring the further possibilities with the concept. His interest sparked the ambition to win the final of the Slimmerleven Challenge. The Friday before the final pitches were held we visited Acknowledge to discuss the presentation, the business model Floyd made (see Attachment 7) and talk about eventual further collaborations. It was decided Floyd would do the final pitch due to having the most experience with what we wanted to tell about the product and because Chris could not be present for the final pitches. Paul Slaats gave feedback on the Business model, and also helped us tweak the presentation a bit. Finally on the 3 rd of June the Final pitches were given. The pitch went really well and as planned, the audience was very positive about the product and the pitch. We didn t win however, which when looking back on it was rather disappointing. The judges chose an idea which in their eyes was a product that approached healthcare in the reverse direction, also they were under the impression that Phillips and other companies were interested in helping them develop the product (however the group themselves only mentioned they had contacted some of the companies and would maybe 11

13 see them as stakeholders). So in hindsight even though our product was in a much further stage in development and we had already had done quantitative and qualitative research, the judges chose a lot less developed idea which was arguably better sold and fitted their expectations of what they wanted to achieve with the slimmer leven project (a different approach to healthcare) more. So even though we didn t win the challenge we did meet some interested companies, had a better understanding of where we wanted to take our product and there is the potential of the slimmer leven challenge helping us develop our idea further. 4. Business Model Key Partners Our suppliers consist of companies that: create the software for the photo frame, create the software for the app for the smartphones and create the physical photo frame. This number can probably be reduced to two if we ask one company to do both the software for the photo frame and for the app; this is beneficial for both costs and communication.. Our Distribution channels will mostly consist of healthcare organizations, a web shop and shops that sell lifestyle product. Other key partners consist of: a company that can create a website for us and support it, companies, banks and foundations that are willing to invest in us and companies that can help us with our promotion like magazines, blogs, newspapers etc. Key Activities: Our key activities are the production, promotion, selling and servicing of our product. In addition to maintaining customer relationships is a key activity. The manufacturing has to be done mainly by our suppliers that make the hardware and software for the frame. The promotion must be done by us through various channels that can reach both customer segments. The selling of our product must be done by our distributions channels like health care organizations and lifestyle stores and through our website with web shop. Providing service for our product can best be done by both employees of the company that produced the software and hardware and us. Maintaining client relationships must be done by us. Maintaining the company must be done by us and any third parties such as a website developer. 12

14 Key Resources: To start with we need starting funds to manufacture the product, start a website and a company, and maintain them. We have to get this from investors, loans, crowdfunding and promotion on for f.e. Facebook and Twitter. Value Propositions: We offer a product with which we want to bridge communication problems caused by technological generation gaps. With this we hope that the communication between the young and older generation is more fun and accessible. For this reason, we offer the product as a bundle of application and picture frame. The app for the virtual youth and photo frame for the conservative older generation. We want the product to be as simple as possible for the older generation that often have difficulty with new technologies, but also the cost to minimize increasing the cost at an acceptable level continues for example as a gift from young to be given to old. The selling price must be below the 100- for that reason. About 98- including taxes for example. Customer Segments: Our product is mainly focused on elderly (or other groups in need of an alternative form of communication) by increasing contact they feel a greater involvement with their family and will experience a greater wellbeing in their live. Our 2nd customer segment is youth and possibly the parents who send photos; they will feel better knowing they build a better relationship with the first party and will also have an easier time making a connection when visiting again. The "receiver" is the focus of the customer segment and has the most benefit to the product but the other party is also very important to keep them happy and to marketing because it is easier to sell the product to them (as a gift). Customer Relationships: In customer relations, we should think of support in the use of the product and create a community for feedback and sharing of user experiences. This community can be created easily through social media like Facebook and Twitter, but also through our website. For support, our customer segments can reach us and our suppliers through various channels. Channels: The two customer segments will have to be approached differently. For the older generation promotion is the best by putting messages in newspapers and lifestyle magazines. Also, word-of-mouth is important, for example, by informing elderly groups about the product other elderly can be reached on an individual level. The other party may similarly be informed to the product through newspapers and magazines but possibly also by well-known Internet bloggers who writes about these types of products, the product also can be spread through mouth-to-mouth but in this case via social media here we can also communicate with the customer. The best way to provide service to this group: , website with a FAQ, social media and the most accessible through the app itself. Cost Structure: De initial costs for designing and programming the product shouldn t be to high as the product is fairly simple and we already covered a large part of this product ourselves. The production costs for each product should be fairly easy to integrate in the retail price 13

15 The total costs of the initial product should be around 30 euros. Revenue Streams: Our product is a consumers product that should be sold through multiple distribution channels. This product needs to be sold as a package which parents or children can give to their grandparents; this is why marketing in holiday season will be the most fruitful. The retail price should not be higher than 100 euros. If we keep a cost price of 30 euros, keep 30 euros ourselves, the margin of the distributors 21 euros and include taxes of 21%, the total retail price would be 98 euros. 5. Final user testing and conclusion As can be read in attachments 4 and 5, the FamilyFrame is tested and the data is evaluated. The outcome of these tests is that the users, in this case only the elderly are interviewed, like the FotoFrame a lot, because they do not have to do much effort in order to receive the pictures. Though the elderly have to put minor effort in order to see the pictures of their relatives, they are in touch with their relatives, which indicate that the idea of the FotoFrame is going into the right direction. Some changes are to be done on the FamilyFrame to finalize its design, like saving favorite functions or changing the exterior of the FamilyFrame, but in general the users are positive and are very enthusiastic about the idea. So finally an interactive social photo frame and a prototype of the app have been developed. The frame can be adapted to one s own personal preferences. This makes the device easy to incorporate in someone s home. The app is user friendly and will allow elderly to use it without any disturbance. 6. References [1]: Age UK (2010) Loneliness and Isolation Evidence Review. Available at [2]: Jong Gierveld, J. de (2010),Eenzaamheid onder oudere mensen in Oost- en West-Europa. [Gerongrafiek]. Geron 12 (2): 62 [3]:D. Perlman (2002), European and Canadian Studies of Loneliness among Seniors, Canadian Journal on Aging/ La Revue canadienne du vieillissement 23 (2) : [4]: Weiss, R. S. (1973). Loneliness: The experience of emotional and social isolation. Cambridge, MA: MIT Press. [5]: J de Jong Gierveld, B Havens, Cross-national comparisons of social isolation and loneliness: introduction and overview, Canadian Journal on Aging/La Revue canadienne du vieillissement 23 (02), 2004,

16 [6]: Peplau, L. A., & Perlman, D. (1982). Perspectives on loneliness. In L. A. Peplau & D. Perlman (Eds.), Loneliness: A Sourcebook of Current Theory, Research and Therapy (pp. 1-20). New York: John Wiley & Sons. [7]: De Jong-Gierveld, J. (1987), Developing and testing a model of loneliness, Journal of Personality and Social Psychology, 53: [8]: Cacioppo, J. T., Hawkley, L. C., Crawford, L. E., Ernst, J. M., Burleson, M. H., Kowalewski, R. B., Malarkey, W. B., Van Cauter, E. and Berntson, G. G. (2002), Loneliness and health: potential mechanisms, Psychosomatic Medicine, 64: [9]: Cattan, M., White, M., Bond, J. and Learmouth, A. (2005), Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions, Ageing and Society, 25: [10] Hawkley, L. C. and Cacioppo, J. T. (2003), Loneliness and pathways to disease, Brain, Behavior, and Immunity, 17: S98 S105. [11] M. Aartsen and M. Jylhä, Onset of loneliness in older adults: results of a 28 year prospective study, Eur. J. Ageing, vol. 8, no. 1, pp , Feb [12] B. Glassman-Feibusch, The socially isolated elderly, Geriatr. Nur. (Lond.), vol. 2, no. 1, pp , Jan [13] C. E. Coyle and E. Dugan, Social Isolation, Loneliness and Health Among Older Adults, J. Aging Health, vol. 24, no. 8, pp , Dec [14] P. M. Karnick, Feeling Lonely: Theoretical Perspectives, Nurs. Sci. Q., vol. 18, no. 1, pp. 7 12, Jan [15]A. Singh and N. Misra, Loneliness, depression and sociability in old age, Ind. Psychiatry J., vol. 18, no. 1, pp , [16] E. Y. CORNWELL and L. J. WAITE, Social Disconnectedness, Perceived Isolation, and Health among Older Adults, J. Health Soc. Behav., vol. 50, no. 1, pp , Mar [17] T. J. Holwerda, A. T. F. Beekman, D. J. H. Deeg, M. L. Stek, T. G. van Tilburg, P. J. Visser, B. Schmand, C. Jonker, and R. A. Schoevers, Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMS ), Psychol. Med., vol. 42, no. 04, pp , Apr [18] Perissinotto C.M, Stijacic Cenzer I, Covinsky KE., "Loneliness in older persons: a predictor of functional decline and death.", Arch Intern Med Jul 23;172(14): [19] Donaldson, J. M. and Watson, R. (1996), "Loneliness in elderly people: an important area for nursing research", Journal of Advanced Nursing, 24: doi: /j tb02931.x [20] RF Creecy et al, "Loneliness Among the Elderly: A Causal Approach", Journal of Gerontology Volume 40, Issue 4, Pp , [21] LC Copel, "Loneliness. A conceptual model.", J Psychosoc Nurs Ment Health Serv Jan;26(1):

17 [22] de Jong-Gierveld J., "Developing and testing a model of loneliness.", J Pers Soc Psychol Jul;53(1): [23]P. A. Dykstra, Older adult loneliness: myths and realities, Eur. J. Ageing, vol. 6, no. 2, pp , Apr [24] Martin Pinquart, "Loneliness in Married, Widowed, Divorced, and Never-Married Older Adults" Journal of Social and Personal Relationships February 2003 vol. 20 no [25] Steven Stack, "Marriage, Family and Loneliness: A Cross-National Study", Sociological Perspectives June 1998 vol. 41 no [26] M. (Michel) Peeters, C. (Carl) Megens, C. (Caroline) Hummels, and A. (Aarnout) Brombacher, Experiential Probes : probing for emerging behavior patterns in everyday life, Jan

18 6. Attachments Attachment 1: Interview Reanne Phone call: Joop van Dopperen (IJsselstein) -Introductie- Reanne: Hoe is het met u? Joop: Z n gangetje. Op zich wel aardig. Ik heb verkeerde medicijnen gekregen afgelopen week en daar werd ik goed ziek van. Ik zag ook in het nieuws dat ze daar heel erg op bezuinigen en slechte goedkope medicijnen weg geven. Die heb ik dus gehad! Verder heb ik het ook zo koud. Dat had ik je gezegd toch? Ik zit met verwarming op 22 en als nog een jas aan en ik heb net al een kop thee op. Reanne: Ah, wat vervelend! Misschien een lekker dekentje er bij pakken? Joop: Ja ja ja, dat kan ik nog wel eens doen ja. Reanne: Ik vroeg me eigenlijk af hoe u het vond dat er zo veel in de zorg geknipt wordt. Want nou krijgt het huishoudelijk hulp maar de helft van de uren toch? Joop: Ja ja ja, echt heel vervelend. Normaal kwamen ze altijd 6u in de week en nu nog maar 3! Dat kan toch niet. Ik kan zelf mijn huis echt niet meer overal schoonmaken en ik ben het ook gewoon zo gewend. De zusters komen ook al minder en nu drink ik dus ook geen koffie meer, want normaal drink ik dat altijd met de zuster en de huishoudelijke hulp, maar die zijn er niet meer. Reanne: Oh, maar behalve het werk wat ze doen mis je dus ook een beetje het gezelschap? Joop: Ja ja ja, jazeker. Normaal kon ik nog even kopje koffie doen of dan aten we zelfs wel eens een gebakje net als met jou, maar dat gaat eigenlijk niet. Aniek is nu ook veel bij haar vader dus die zie ik nu ook weinig. Jij komt met de kerst toch langs? Dan vraag ik of Aniek ook komt dat zou nou eens gezellig zijn! Reanne: In de tweede week van de kerstvakantie kom ik even langs. Maar wat doet u nu dan om die tijd te vullen. Je hebt nu best wat uren over toch! Joop: Ja ja, ik ga nog wel eens naar de supermarkt. De lidl dat lukt niet meer maar de c1000 of jumbo daar kom ik nog wel eens. Een soort uitstapje. Ik ken ook een meisje die daar werkt en daar heb ik goed contact mee. Zo ben ik nog eens bezig ook. Reanne: Zou je het misschien leuk vind om meer contact met mensen te hebben? Joop: Ja ja natuurlijk, maar jij komt in de kerst vakantie toch? Reanne: Ja in de tweede week! Maar Joop, fijn dat je kon bellen en we spreken elkaar nog wel! -afsluiting- 17

19 Attachment 2: Dagje meelopen met Thuiszorg David Dagje meelopen met Thuiszorg David Op 30 december 2014 ben ik meegelopen met Ilse Dierkx, verpleegster bij thuiszorg Land van Horne, Weert. In totaal bezochten we 9 patiënten die hulp nodig hadden met wassen, inname van medicatie, aantrekken van steunkousen, enz. Vanwege de tijdsdruk (er is maar 15 tot 30 minuten tijd per patiënt) heb ik niet uitgebreid met iedereen gesproken, bij een aantal mensen heeft Ilse, tijdens het wassen een praatje gemaakt over hoe de mensen contact onderhouden met anderen, waar ze behoefte aan hebben, enz. Per patiënt heb ik een aantal interessante bevindingen opgeschreven. Uit privacy oogpunt zijn de namen weggelaten. Mevrouw 1 Haar huis stond vol oude spulletjes, iets nieuws wil ze ook niet, behalve de tv; die moet goed zijn aangezien ze erg geïnteresseerd is in programma s van Discovery en National Geographic. Haar kinderen komen regelmatig langs en ook spreekt ze vaak met vriendinnen af. Op dit moment even niet, omdat er sneeuw en ijs ligt. Echtpaar (2 en 3) Terwijl Ilse de één verzorgt, knoop ik een gesprek aan met de ander. Beiden zijn slechthorend, wat communiceren wat lastiger maakt. Mijnheer geeft aan dat er in het complex een ontmoetingsruimte is, die hij één keer per week gebruikt om te gaan kaarten. Mevrouw gebruikt de ruimte niet. Ze heeft nog meer moeite dan meneer om mensen te kunnen verstaan. Daarom vindt ze het vervelend om met vreemden te praten. De ontmoetingsruimte wordt steeds minder gebruikt, vroeger was het er veel drukker. Er is bij beiden weinig behoefte aan meer contact. Ze hebben elkaar en dat is genoeg. We zouden ze graag willen dat de elektrische rolstoel wat sneller zou gaan, zodat ze samen kunnen wandelen. Mevrouw 4 Deze mevrouw wordt tijdelijk geholpen vanwege het feit dat ze haar heup heeft gebroken. Ze is vrijwilligster op twee plekken. Ook zij geeft aan dat de belangstelling voor gezamenlijke activiteiten terugloopt. Er komen nauwelijks nieuwe mensen op af. Met nieuwjaar hadden ze bijvoorbeeld eerder altijd een receptie. Die is dit jaar vanwege gebrek aan belangstelling afgelast. Ze weet niet waardoor dit komt. Ze vermoedt dat veel ouderen die nog fit zijn voor de kleinkinderen zorgen. Ze doet boodschappen in de stad, ze belt daarvoor de regiotaxi. Dat is goedkoop, ook al moet ze dan af en toe een beetje omrijden. Mijnheer 5 Deze mijnheer woont in een appartementencomplex in het centrum. Hij heeft wat modernere spullen in huis waaronder een laptop. Als ik vraag wat hij hier mee doet antwoord hij, dat hij een 18

20 paar maanden geleden een beveiligingswaarschuwing kreeg, waarna hij hem niet meer gebruikt heeft. Mijnheer geeft aan dat hij geen behoefte heeft aan contact. Hij is een keer met de Zonnebloem mee geweest, maar dat is hem niet goed bevallen. Om ergens anders te komen is hij afhankelijk van anderen of taxi. De regiotaxi vindt hij niks. De busjes zijn vol en rijden ver om. Hij heeft lange tijd zijn zus verzorgd die onlangs is overleden. Verder heeft hij geen familie in de buurt wonen. Hij heeft weinig contact met de buren, wel hebben ze een sleutel van zijn appartement voor als hij op een noodknop drukt. Hij heeft een vast programma om de dag door te komen. Mijnheer 6 Deze mijnheer heeft wel kinderen in de buurt wonen die beiden één vaste dag per week langs komen. Ook is hij bij een kaartclubje, maar omdat er pas één van de spelers in het ziekenhuis ligt, kunnen ze nu niet kaarten omdat ze vier spelers nodig hebben. Een vriend komt hem ook regelmatig ophalen. Hij duwt dan de rolstoel en dan gaan ze het centrum in om wat te wandelen of een café te bezoeken. Hij gaat ook elke week naar de bieb, hij leest 3 tot 4 boeken per week. Hij heeft een pc staan, maar die gebruikt hij zelf niet. Zijn zoon gebruikt hem om bankzaken e.d. te regelen. Hij heeft pas een nieuwe tv. Hij snapt niet precies hoe die werkt maar hij kan hem aan en uit zetten. We zijn nu eenmaal uit de tijd dat er nog niks was. Mijnheer 7 Deze mijnheer woont in een appartementencomplex. Zijn vriendin woont in het zelfde complex. Hij gaat regelmatig wandelen, bij voorkeur de stad in om een glaasje te drinken. Omdat het nu te glad is (sneeuw en ijs) kan dat even niet. Hij dacht dat Ilse niet zou komen vandaag want er had zich iemand afgemeld. Hij geeft aan dat er zoveel hulpverleners komen dat hij ze niet uit elkaar kan houden. Hij heeft een pc in huis, maar die gebruikt hij niet meer zoveel sinds er een nieuwe Windows versie op zit. Hij wordt vooral gebruikt door zijn kinderen en kleinkinderen. Mijnheer 8 Deze mijnheer heeft in het afgelopen jaar zowel zijn vrouw als zijn enige dochter verloren. Hij viert dus geen kerst en oud en nieuw omdat hij dat te pijnlijk vindt. Hij heeft last van een teen en maakt zich daar zorgen om. Hij is bang dat die moet worden afgezet omdat de dokter daar iets over heeft gezegd. 19

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