Loneliness and coping strategies in older adults in nursing homes in the Northern region of Malaysia: A mixed-method study

Background: Loneliness among institutionalized older adults poses significant health risks, yet remains understudied. A deeper understanding can help shape more compassionate, culturally appropriate, and effective care approaches for the aging demographic. This study aimed to explore the lived experiences of loneliness and the coping mechanisms adopted by older adults residing in institutionalized nursing homes in the Northern region of Malaysia. Methods: A mixed-method study was used. A qualitative phenomenological approach was conducted at Rumah Seri Kenangan Taiping, Perak, Malaysia. Participants were selected via purposive sampling. Data collection comprised face-to-face semi-structured interviews. A quantitative approach using the Malay version of the 6-item De Jong Gierveld Loneliness Scale triangulates the methods. Thematic analysis was applied to the interview transcripts using NVivo version 14, and descriptive statistics were performed in SPSS version 27 to analyze loneliness scale scores. Results: Twenty-three older adults participated in both qualitative and quantitative analyses. All participants experienced loneliness; 13 respondents were most lonely, with a mean (SD) loneliness score of 4.52 (1.04). Five causes contributing to loneliness were identified: loss of loved ones, health-related issues, socio-economic challenges, socio-cultural changes, and environmental restrictions within the institution. Loneliness impacted participants’ physical health, emotional well-being, and mental health. Coping strategies clustered into three themes: spiritual coping (religious fulfillment and acceptance), strengthening social ties (contact with family, bonding with residents, and visitor interactions), and attention distraction (hobbies, social media use, and participation in institutional activities). Conclusions: Loneliness among institutionalized older adults is a multidimensional experience with significant physical and emotional repercussions. However, participants demonstrated resilience through spiritual, social, and behavioral coping strategies. These findings underscore the importance of holistic interventions that enhance emotional support, spiritual well-being, and meaningful engagement to improve the quality of life for older adults living in institutional settings.