Nostalgia Intervention on Alleviating Loneliness Amongst Older Adults

A convenience sample of 294 older adults from six participating community centres, with 49 participants from each centre. Eligible older adults will be randomly assigned to either a waitlist control group (n = 147) or an intervention group (n = 147). Both groups will receive standard community support services, whilst the intervention group will also participate in five weekly face-to-face nostalgia sessions (approximately 90 min each) in a group format. Additionally, a purposive subsample of 30 participants from the intervention group will be invited for focus group interviews.

The primary outcome (loneliness) and secondary outcomes will be assessed at baseline (T0), immediately post-intervention (T1), 3 months post-intervention (T2) and 6 months post-intervention (T3) using validated questionnaires. The investigators will analyse the quantitative data using a generalised estimating equation model with intention-to-treat and path analyses. The qualitative data will be analysed using reflexive thematic analysis. The findings of this proposed study will inform healthcare professionals and policymakers, offering practical strategies to combat loneliness in this vulnerable group.

• Nostalgia intervention (Behavioral): Participants in the intervention group will receive the face-to-face nostalgia intervention weekly for 5 weeks (each session lasting approximately 90 minutes), with each group consisting of 5-8 older adults. The intervention consists of 5 sessions: Session 1 (understanding nostalgia and its benefits), Session 2-4 (music/ photos/ meaningful objects and nostalgia), Session 5 (reaffirming the benefits of nostalgia).

Primary outcomes

• Emotional and social loneliness [Asessed at baseline (T0), immediate after (T1), 3 months (T2), and 6 months (T3) post-intervention]: The Chinese version of the De Jong Gierveld Loneliness Scale. This six-item scale scores range from 0 to 6, with higher score indicates higher level of loneliness. This scale demonstrates good internal consistency (Cronbach's α = 0.76) and inter-rater reliability (ICC = 0.98-1.00), as well as a strong correlation with direct assessments of loneliness.
• Existential Loneliness [Asessed at baseline (T0), immediate after (T1), 3 months (T2), and 6 months (T3) post-intervention]: Existential Loneliness Questionnaire, which comprises 22 items focused on loneliness in social ties, loneliness in close relationships and the search for meaning in life. The scores range from 22 to 132, higher scores indicate higher level of existential loneliness. The questionnaire also demonstrates good internal consistency (Cronbach's α = 0.90).

Secondary outcomes

• Negative emotions [Asessed at baseline (T0), immediate after (T1), 3 months (T2), and 6 months (T3) post-intervention.]: The Chinese version of the Depression Anxiety Stress Scale consists of 21 items that assess symptoms of depression (7 items), anxiety (7 items), and stress (7 items). Each subscale scores range from 0 to 21, with higher scores indicating greater levels of negative emotions. The Chinese version demonstrates good internal consistency (Cronbach's α = 0.92 to 0.94).
• Social connectedness [Asessed at baseline (T0), immediate after (T1), 3 months (T2), and 6 months (T3) post-intervention]: The revised Social Connectedness Scale to measure the perceived connection of participants to others in their social environment. This scale comprises 20 items measuring four aspects: belongingness, closeness, support and satisfaction. The scores range from 20 to 120, higher scores indicate greater feelings of social connectedness. This scale demonstrates good internal consistency (Cronbach's α = 0.92) and validity.
• Meaning in life [Asessed at baseline (T0), immediate after (T1), 3 months (T2), and 6 months (T3) post-intervention.]: Meaning in Life Questionnaire, which comprises 10 items measuring presence for and search for meaning in life, to measure meaning in life. The score ranges from 10 to 70, higher scores indicates stronger sense of meaning in life. The Chinese version demonstrates good internal consistency (Cronbach's α = 0.85).
• Nostalgia [Asessed at baseline (T0), immediate after (T1), 3 months (T2), and 6 months (T3) post-intervention]: The Southampton Nostalgia Scale to measure participants' nostalgia. This scale comprises five items that measure the importance participants attribute to nostalgia and two items related to frequency of nostalgia. The scores range from 7 to 49, higher scores indicate a greater dispositional tendency toward nostalgia. This scale demonstrates good internal consistency (Cronbach's α = 0.93).
• Experiences and perceptions of older adults in intervention group [Assessed within 1 day (T1) after the intervention]: Focus group interviews will be conducted to explore the experiences and perceptions of older adults in intervention group regarding their participation in nostalgia interventions and the impact of the intervention on their loneliness using an interview guide.

Sex: All, ages: 60 Years to any

Inclusion Criteria:

* older adults aged 60 years or above
* residing in the community
* capable of speaking and understanding Chinese
* experiencing loneliness (scoring ≥3 on a three-item loneliness screening scale)

Exclusion Criteria:

* currently undergoing psychological intervention
* having a clinical diagnosis of mental illness
* being cognitively impaired (Abbreviated Mental Test score <6)
* having visual/language/communication difficulties

• Cho Lee Wong, PhD, Principal investigator, The Nethersole School of Nursing, CUHK