As one approaches life's end, existential issues become increasingly important and events that create the basis for existential loneliness are common — such as having to move away from one's home, losing a partner, or undergoing an involuntary separation.

Malin Sundström, a PhD student in health sciences, has investigated the healthcare professionals' experiences of existential loneliness in frail, older people — an issue which has never been so pressing under the spectre of the current corona pandemic.

Although health care professionals have clear tasks in their roles, there are other human aspects that they encounter in everyday duties. Sundström studied how healthcare professionals from home care, residential care, hospitals, and palliative care, perceive existential loneliness in frail, older people.

‘Should I try to find an opportunity and dare to ask? Or leave them alone?’

Across all contexts it was found that it was not easy to deal with existential loneliness and that the caregiver feels great uncertainty about it. But how to talk about these issues depends on the environment and situation.

“There is, for example, a connection between existential loneliness and death in all the types of care, but in residential care settings and medical care at home, there is more of a connection to life and living. It is more common to speak about existential matters in palliative care, it is built in with supervising and reflection since one works with death. That support is not as present or as common in other types of care,” says Sundström.

Health care staff reported that calls received in the evening, when the work pace is lowered, are often about aging, illness and the end of life, when a deeper sense of loneliness is felt. The staff are affected both by the fact that it feels meaningful when someone reaches out to them, and frustrated when time and issues surrounding privacy prevent them dealing with the matter.

“There are older people who want to talk about their fragility, not being able to move, about both life and death, and then there are those who are satisfied and do not need to talk. It requires staff to be able to recognise and meet different needs. ‘Should I try to find an opportunity and dare to ask? Or leave them alone?’. Sometimes there are other things that hinder the conversation, such as dementia or poor hearing,” says Sundström.

The study, carried out in a region in the south of Sweden, also included interviews with volunteers, as well as a survey of first-line managers in special housing and home care. It shows that volunteers have a role that staff and relatives do not offer, as the older have a dependency on staff and often do not want to burden their relatives. Many volunteers approach the subject of aging themselves and have a different life perspective.

“Volunteers can be complementary to health care professionals. They have another opportunity to approach these issues if they are included in the dynamic. Healthcare professionals often work in an environment where the tempo is high and there are many tasks, and it can be difficult to change perspectives from a task to perceive a signal that there is an issue. But the most important thing is that staff and volunteers receive support in creating meaningful relationships with the older,” she adds.

Text: Hanna Svederborn

Read more about the research