Report on the study of boredom in older adults

When a researcher sets out to gain an in-depth knowledge of a phenomenon, whatever its characteristics, the first thing to do is to find out what is the state of the art of its study at the present time. Familiarising oneself with the preceding literature is essential in order to reach a certain degree of specialisation from which to establish the starting point of one's own contribution. 

In 2020, when I started contributing to this blog with my reflections on the experience of boredom in older adults, I ventured into the first systematic literature review on the subject in order to find out for sure what was known about this issue and how it had been approached from different angles over time. 

My first impression after a quick contact was that scientific studies covering the topic of boredom in the elderly were few and far between. I then published a couple of texts on this blog that highlighted this. I immediately realised that we lacked a conceptual map capable of facilitating its understanding and the proposal of interventions, and I knew that, if I wanted to master this reality and be in a position to intervene in it, it was necessary to identify and examine all the existing literature to know where I stood.  

That summer I immersed myself in this exhaustive and integrative review of peer-reviewed studies on boredom in the elderly at the international level, also covering the grey literature. After almost two years of back and forth, the Spanish journal Health, Aging and End of Life, published by Herder since 2016 and directed by Dr Joaquín Tomás Sábado and Dr Montserrat Antonín Martín and Dr Amor Aradilla Herrero, from the Escola Universitària d'Infermeria Gimbernat (Universitat Autònoma de Barcelona), announced a few days ago that my paper "The Experience of Boredom in Older Adults: A Systematic Review" had seen the light in volume 6 of its annual publication. 

As it could not be otherwise, I wanted to share my findings with the attentive readers of Ageing in Society, writing this brief report that collects the main keys of my article to make it accessible to all those who are interested in learning about what we know today about how boredom affects older people. 

But first, a little bit of methodology. To find out the total population of published works on the pair 'boredom' and 'older people', the first thing I did was to carry out a search in eight electronic databases such as PubMed or Web of Science, including Google Scholar, following the PRISMA method. 

The search strategy included keywords such as "boredom", "ageing", "elderly", "elderly person", "older adult", "retired", "residence", "geriatrics" or "gerontology", among others. It was not limited in terms of date, as the idea was to comb the entire population, but by language, including only English, Spanish, French, Portuguese and Italian. I considered eligible all types of academic, empirical or theoretical works, such as articles, reviews, discussions, books and theses, whether they were entirely focused on boredom in the elderly or dealt with the issue in a secondary way. 

My search yielded a total of 9,748 results that were downloaded and stored using the Zotero tool. After eliminating duplicates, I was left with 5,860 items. I proceeded to analyse their titles and abstracts to check which of them actually met the eligibility criteria. After this step, I reduced the number to 158 studies, which I then examined in detail. In the end, 109 were excluded from the review, 15 of them because they were inaccessible and 94 because they did not focus on boredom in the elderly in whole or in part. 

Of the remaining 49 that were selected for my review, only 13 addressed the issue of boredom in the elderly directly. The other 36 were tangential. From these, I extracted information on authorship, date and place of publication, the language in which they were written, the type of study they proposed, their design, objectives, methodology, the scenarios they considered, the results obtained and the conclusions reached. 

Then, from the database obtained, I carried out a narrative synthesis following the principles of the inductive model of qualitative analysis NCT (Noticing, Collecting, Thinking) to present the main themes into which these 49 works could be classified:

1. Experience of boredom and propensity to boredom in the elderly
2. Boredom, housing and institutionalisation in the elderly
3. Boredom and retirement
4. Boredom and mental illness in the elderly
5. Boredom and mental disorders in the elderly
6. Boredom, loneliness and feelings of uselessness in the elderly
7. Boredom and reminiscence in the elderly
8. Boredom and leisure in the elderly

Before going on to describe the content of these topics, I would like to record some interesting figures that I learned from this review. The papers included had been published between 1954 and 2018, although around 45% of them were concentrated between 2012 and 2017. In terms of geography, almost 35% came from the United States, followed by Spain, France and the United Kingdom, with 8% each, as well as South Africa and Israel, with 6% respectively. Other countries such as Norway, India, Canada, New Zealand, Brazil, Belgium, Cameroon, Japan, Ireland and Austria had shown a residual interest in the issue. More than 85% of the studies were in English. Only 6% were written in Spanish, another 6% in French and a single paper in Portuguese. About 80% were scientific articles, 8% were opinion pieces, another 8% were doctoral theses, and I also found one book chapter and one report. More than half (61%) used qualitative designs. Just over 26% involved quantitative designs and 12% were mixed. In terms of settings, 39% of the research was carried out in residential homes, 39% in private homes, 12% in retirement homes and the remainder in day centres, hospitals and rehabilitation centres. 61% of the participants in these settings were in residential homes. Sixty-one percent of the participants in these studies were women, with an average age of 76. Finally, the majority (18%) focused on the theme of boredom in dependence on housing (2.), followed by the experience of boredom and individual propensity to suffer from it (1.), mental disorders (5. ), mental illness (4.), leisure time (8.), retirement (3.) and the relationship between boredom, unwanted loneliness and feelings of worthlessness (6.), with the least explored topic being reminiscence (7.).

In summary, the profile of the studies on boredom in older adults was, in general, qualitative scientific articles written in English and published in the last decade, only partially focused on the topic at hand and paying attention to women around 75 years of age living both in their own homes and in nursing homes in the United States. 

The articles in the thematic block 1. on the experience of boredom and the propensity to boredom in the elderly described boredom as a virulent disease affecting two out of three older people, who reported having nothing to do, and warned gerontologists of the need to pay more attention to boredom. They also found that boredom was more prevalent among those who thought a lot about things, those who went from house to house to receive care, and those who lived alone and had no possibility of caring for others. With regard to gender, they explained that men were bored by not knowing how to entertain themselves during their free time and women by the absence of care opportunities, the latter being more prone to boredom. In relation to age, there was a contradiction as to whether the most bored were the elderly or those under 85 years of age. Of course, some studies denied that older people were bored.  

In block 2. on housing, the studies confirmed that boredom was a persistent problem in any institution for older adults, but especially in residential care homes. This was mainly due to the lack of interesting stimuli in the facilities and the fact that opportunities for engagement in meaningful, pleasurable and challenging activities were rare due to repetitive routines and rigid schedules. Some work identified that the problem lay with the residents themselves, who were reluctant to participate in the daily life of the care homes. Other causes identified were lack of companionship and opportunities to offer care to others. In conclusion, the research found that boredom in care homes negatively affected mental health and contributed to unsafe environments, prompting managers to promote activities demanded by the residents themselves. This problem was replicated to a lesser extent in other institutions such as hospitals, day centres and rehabilitation centres. 

Regarding retirement (block 3.), the studies found, published between the 1960s and the 1980s, pointed out that boredom stemmed from having nothing to do or not knowing what to do, especially among lower-class men. It was established as a major cause of depression, apathy and even suicidal ideation. A more recent study highlighted that boredom would be even worse for early retirees. 

Mental illness and boredom took up block 4. with articles focusing on dementia. I won't dwell on this set because I previewed the results in the posts entitled "Boredom and dementia: an explosive cocktail", part 1 and part 2 of 2021. There is something to be said for block 5. on mental disorders. Some studies claimed that boredom was related to cognitive decline, psychological frailty and stress. In particular, the papers focused on the relationship between boredom and two mental disorders such as depression and anxiety and two behavioural disorders such as gambling addiction and suicide, holding boredom directly responsible for the worsening of these conditions. 

Not surprisingly, a large part of the texts analysed approached boredom from the perspective of the plague it constitutes, together with unwanted loneliness and the feeling of uselessness, based on the assumptions of The Eden Alternative. In block 6, which is named after these three plagues, these and also the antidotes proposed from this approach were collected. Again, I refer the reader to any of my posts on this organisation to delve deeper into its principles. Apart from this, two articles were intended to show that boredom was the cause of loneliness and vice versa, and that these two states should always be addressed together. 

The penultimate block (7.) consisted of articles dealing with boredom and reminiscence. These told how the elderly tend to relive painful memories of the past when the environment and activities are not stimulating, especially in cases of Alzheimer's, depression or anxiety. They advised taking measures to reduce boredom and thus the use of reminiscence in this negative sense. 

Finally, articles devoted to the study of the occurrence of boredom during the free time available to the elderly were classified in block 8. They found that the elderly have large amounts of free time which they do not know how to fill and that more education is needed to learn how to fill the hours of the day in a meaningful way, both at home and in the nursing home, as well as better personalised programmes of activities. Among these texts were some examples of what form such programmes could take and one article even advocated the use of Artificial Intelligence as a fundamental element of entertainment. 

Through this review exercise, I was able to see that there is still a lot of work to be done. The number of studies taken into consideration shows that we have hardly given any importance to the boredom experienced by the elderly in different circumstances. Although this reality is recently gaining prominence, in practice we know nothing about its nature, its causes and consequences or, more strikingly, how to deal with it. We need much more empirical research, focused entirely on boredom, to determine the significance of this phenomenon and to offer solutions consistent with the demands of the elderly and the resources available to them in the places where they live. 

Like other countries in the world, Spain is lagging behind in this task. The PRE-BORED project that I lead, funded by the European Horizon 2020 programme under a Marie Skłodowska-Curie Actions contract, is the only one working in this direction specifically in Spain and the rest of the world at present. It has only just started, but has already attracted the interest of some well-known Spanish home care chains. However, to find out more about this initiative, you will have to wait until the next post, in which I will present it properly and tell you, in detail, what it consists of and how our institutions can take part.

Reference: Ros Velasco, J. (2022). The Experience of Boredom in Older Adults: A Systematic Review. Health, Aging and End of Life, 6, 11.