Research Highlights

The World Health Organization highlights the need for global collaboration for healthy aging among older people. However, loneliness and social isolation among older people are widespread nowadays and recognized as the foremost public health problems globally and locally. Hong Kong, which has one of the world’s longest life expectancies, is inevitably facing these issues. Migrant domestic workers (MDWs) provide round-the-clock services for older people globally, making up for dwindling support from family members. This study aimed to explore how dyadic relationship quality between older adults and live-in MDWs is associated with older adult loneliness, and to examine the lived experiences of loneliness and social isolation among older adults in Hong Kong.

A mixed-methods study was conducted from 2021 to 2024. Convenience sampling of older adults aged ≥60 living with MDWs was recruited from 34 Elderly Community Centers in Hong Kong for a face-to-face survey. The survey comprised several well-validated scales, e.g., the De Jong Gierveld Loneliness Scale, the Mutuality Scale, and the Lubben Social Network Scale. Some demographics, e.g., subjects’ age, marital status, educational level, living arrangement, MDW’s nationality, spoken language, and years of service, were adjusted in the analysis. Purposive sampling was used to select subjects with varying levels of loneliness and social isolation for in-depth interviews. Face-to-face semi-structured individual interviews were conducted with consent for audio recording. Interpretative phenomenological analysis was adopted for the data analysis of transcripts.

288 and 19 eligible elderly people participated in the survey and in-depth interviews, respectively. In mediation analysis, the standardized coefficient of the total effect of perceived dyadic relationship quality on social loneliness was -0.17, with a direct effect of -0.12. The standardized coefficient of perceived dyadic relationship quality on perceived social network was 0.23, and the coefficient of the perceived social network on social loneliness was -0.21. All these paths were significant. One core theme, ‘Should I stay at home alone?’, and six interconnected themes concerning older adults’ perceived loneliness and social isolation were identified. The interconnected themes include established relational interactions with MDWs; enjoyment of functional assistance and support from MDWs; deterioration in physical functioning and mobility limitations; experience of inadequate social support and networks; altered family dynamics and support; and experience of negative and complex emotions.

The study results suggested that enhancing the perceived dyadic relationship quality (Elderly/MDW) in elderly care can support older adults' social networks and address perceived loneliness. After understanding the lived experience of loneliness and social isolation among older adults locally, the government, non-governmental organizations, and healthcare institutions are recommended to establish appropriate strategies and integrated services to foster healthy aging and improve older adults’ lives, as well as to provide support from families and communities.