Serhiy Dekhtyar

Research problem and specific questionsLoneliness is associated with poor health and mortality, but the causal relationships between loneliness, mental health and care use are not well understood, and there is a lack of evidence-based methods for care professionals to recognise and respond to loneliness. This programme takes a holistic perspective on loneliness in older adults, how loneliness is understood and experienced, and its relationship with mental health. Our work packages (WPs) will address research gaps to support evidence-based approaches to identify, assess and address to loneliness in practice by:examining inequalities in risk factors and consequences of loneliness, and causal associations between loneliness, mental health and careexploring subjective experiences of loneliness and mental health from a life-course perspectivedeveloping an instrument to assess loneliness in practicecreating a loneliness literacy training programme for care professionalsenhancing care professionals’ response to lonelinessData and methodIn WP1, panel studies will be combined with register data to examine inequalities in loneliness and its causal associations with mental health and care use. In WP2, older adults’ experiences of loneliness and mental health will be explored in interviews, which will also support the development of an instrument to assess loneliness. In WP3, researchers and care professionals will co-design a loneliness literacy training programme to improve care professionals’ competencies to address loneliness. WP4 integrates research across WPs, embeds it in practice and promotes dissemination of findings. Workshops with stakeholders will explore how to enhance care professionals’ response to loneliness.Relevance and utilisationOur research will advance the understanding of risk factors and avoidable consequences of loneliness, produce the first instrument for assessing loneliness validated for use with older adults in Swedish care practice, and develop a unique loneliness literacy programme for care professionals. Close collaboration with stakeholders will ensure our findings can support social care and civil society in addressing loneliness and mitigate its negative outcomes.Plan for project realisationThe programme will be realised by an experienced multidisciplinary team with expertise in loneliness, mental health, gender and socioeconomic inequality, health literacy and care in old age. Collaboration with pensioner and mental health organisations and authorities ensures representation of older adults and the programme’s relevance and feasibility for practice. Scientific quality is supported by an international academic reference group. There will be thorough dissemination to academic, policy and practice communities.A budget of SEK 23.8 million includes staff costs (SEK 15.1 million)

running costs (e.g., meetings, fieldwork, dissemination, administration, IT, offices

SEK 4.4 million)

and indirect costs (SEK 4.3 million).

Research problem and specific questions: This project aims to contribute key knowledge for optimizing prevention, intervention, and care management of old-age depression by disentangling the complexities of this common and burdensome condition. Compared to earlier in life, old-age depression is characterized by distinct symptom patterns and a more complex clinical course, precipitating intricate care needs and increased healthcare use among older adults. The drivers of these complexities remain poorly understood, and we aim to conduct three interconnected sub-projects scrutinizing them. Specifically, we will: 1) investigate the role of psychosocial, behavioral, and socioeconomic determinants of diverse depressive symptom patterns and transitions between them

2) assess health and survival consequences of different depressive symptom patterns

and 3) evaluate healthcare utilization in people with old-age depression, focusing on complex and avoidable transitions across care settings.Data and method: Longitudinal data on more than 7,000 older adults from four population-based cohorts included in the Swedish National Study on Aging and Care (SNAC) and harmonized via the National E-Infrastructure for Aging Research (NEAR) will be used. We will exploit more than 20 years of already-collected follow-up data, gathered using shared instruments across cohorts. Multi-state transition models will be used to capture diverse shifts across depressive states (no depression, subsyndromal depression, major depression) and care settings (home, formal care, hospital, institution), as well as their associated determinants and consequences.Relevance and utilization: Depression in older adults is a cause of major distress for patients, their families, and the healthcare system. A better understanding of its fluctuating course is required to identify strategies promoting prevention, recovery, and care continuity. Planned in close connection with patient organizations and care provider networks, this project will bring about knowledge sought by multiple stakeholders, ensuring that older adults with depression experience old age with the dignity they deserve.Plan for project realization: The project will be carried out by a multidisciplinary team with expertise in geriatric mental health, epidemiology, and care sciences. Its results will be deployed through the National Association for Social and Mental Health (RSMH). Researcher salaries constitute key budgetary items.