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PROF. DR. SHERINA MOHD SIDIK

PSYCHIATRY DEPARTMENT,

FACULTY OF MEDICINE AND HEALTH SCIENCES,

UNIVERSITI PUTRA MALAYSIA (UPM)

Empty Nest Syndrome

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Content

Definition Symptoms Associated

factors

Empty nest syndrome

and depression

Health services

utilization

Coping strategies

Home-based care

Conclusion

Definition The empty nest syndrome can be defined as:

• The loneliness and sadness of parents in response to their children’s departure from home (Long & Martin, 2000)

Empty nest refers to the time when children are grown and no longer living at home

The migration of their children, leaving behind an ‘empty nest’ is usually due to:

• Marriage

• Studies

• Work

• Living in their own home

• because they have a family of their own (Abraham, 2012) 3

Definition

Symptoms of emptiness syndrome:

i. sadness

ii. continuous grief

iii. feeling lonely

iv. feeling useless

v. feeling a void in their lives

vi. feeling incomplete in their relationship with their spouse

(Abraham, 2012)

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Symptoms

Being recognised worldwide, including in Malaysia

Many studies in China

• Liu & Guo

• Urban communities: Beijing

• Rural communities: Yuan’an County

• Medium sized cities: Taiyuan, Shanxi Province

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Empty Nest Syndrome

The process of urbanization and the development of the economy:

• For example, some farmers go to the big cities to work and live, while their parents remain living in rural areas (Liu & Guo, 2007)

The attachment of parents to their children increases their feelings of love;

• The departure of children plays a significant role in the loneliness of their parents (Liu & Guo, 2007)

• It is very important to provide social and emotional support for the parents especially in elderly (Liu & Guo, 2008)

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Associated Factors

• Significant differences between rural and urban empty-nester old people in Hunan province, China (Su et al, 2012):

i. Gender

ii. Education level

iii. Marital status

iv. Economic status

v. Self-perceived income

vi. Insurance

vii. Frequency of children visits

viii. Religious beliefs factors

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Associated Factors

Guo et al’s study (2016) on Mental Health and Related Influencing Factors among Elderly in Taiyuan, China found that empty-nest elderly were mostly:

• Male

• Married

• Higher education level

• Higher income

• Living in urban areas

A study in rural areas of Jerantut, Pahang found that mothers were more prone to empty nest syndrome compared to fathers (Nik Norliati and Suriati, 2016)

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Associated Factors

The study among empty-nest elderly in rural areas of Yuan’an, China (Liu & Guo, 2008) found that they had

• Lower life satisfaction

• Lower income

• Poorer relationships with children

• Less social support

• Higher prevalence of chronic diseases

• More feelings of depression and loneliness compared to the not-empty-nest elderly.

"Empty-nest status" was negatively related with life satisfaction

Depression was the strongest predictor of life satisfaction

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Associated Factors

A baseline investigation of Zhejiang Major Public Health Surveillance in

China conducted in 2014, showed that among 9215 participants aged 60

years and above, more than half (57.4%) were empty nest elders (Zai et

al, 2015)

• The prevalence of depressive symptom was higher in empty nest

elders (11.6% vs. 8.6%, p<0.001)

• Empty nest was positively associated with depressive symptom, OR

(95%CI) was 1.223(1.045, 1.431)

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Empty Nest Syndrome and Depression

Another study in the rural area of YongZhou, China found that the prevalence of depressive symptoms among empty nesters was 74.5% (Xie et al, 2010)

The empty-nest group, in comparison with the non-empty nest group, had higher levels of depression

Multivariate linear regression analysis showed associations between depressive symptoms and:

• Health service & support utilization

• Negative coping style

• Religious beliefs

• Socio-economic status

• Marital status

One major area of concern was the health service utilisation 11

Empty Nest Syndrome and Depression

In the rural areas of Yuan’an County, China, empty-nesters had contacted physicians less frequently (39.2%) than the non-empty-nest group (50.8%) (p<0.05) (LiJuan et al, 2007)

More reports of unmet health-care needs were made by the empty-nesters (40.0%) as compared with the non-empty-nest group (29.2%) (p<0.05)

The most commonly reported barriers were :

• Cost (64%),

• Lack of coverage by the health care plans (37%)

• Inability to find help (28%)

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Health Services Utilization

Non-visiting rate among empty-nest elderly

(37.7%) was significantly higher than that among

non-empty-nest ones (32.7%) (Zhou et al., 2015)

Non-hospitalization rate among empty-nesters

(36.1%) was slightly higher than that among non-

empty-nesters (31.6%)

Financial difficulty was the leading cause for both

non-visiting and non-hospitalization of the empty-

nesters

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Health Services Utilization

Both non-visiting and non-hospitalization among empty-nest seniors were

independently associated with (Zhou et al., 2015):

i. low-income households

ii. health insurance status

iii. non-communicable chronic diseases

The non-visiting rate was also found to be higher among the empty-

nesters with lower education and those from rural areas

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Health Services Utilization

Support from spouses could decrease feelings of loneliness in the elderly

• Couples in China are often encouraged to stay together because the Chinese culture discourages divorce and separation (Chen et al., 2006)

Social support from:

• Friends

• Neighbours

• Other family members (Liu & Guo, 2007)

Formation of Senior Associations help the empty-nest elderly to participate in social activities including:

• Singing

• Dancing

• Calligraphy 15

Coping Strategies

• Fishing

• Taijiquan (a kind of traditional Chinese shadowboxing)

A study in Beijing, China found that another major care need by the empty-nest elderly was home-based care (Liu et al, 2015)

In view of their physical conditions, these elderly had:

• Need of support based on their own physical and security problems

• They would like to have aging-in-place

• Home-based care by housemaid employment

• Or institutionalized care

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Home-based Care

Support from children

Social support from children is of vital importance in ensuring the well-being of elderly parents:

• the ‘kenang budi’ (appreciate kindness) concept is applied (Wan Ibrahim and Zainab, 2014)

Kenang budi in the culture of Malay society means the importance of children’s obligation to pay back their parents’ sacrifice (Suriati 1999)

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Home-based Care

Support from children

The study in rural areas Pahang reported that all (100%) of the elderly studied received support from their family even though they lived alone (Nik Norliati and Suriati, 2016)

i. Children who lived close by

a. Visit them frequently and

b. Took them to hospitals or nearby village clinics

• to receive their regular medical check up

• medication (if needed)

ii. Children who live far away would telephoned them frequently

iii. Adult children would often bring their parents to socialize:

Eg weddings & other festivities which increase their elderly parents’ happiness 18

Coping Strategies

Support from children

By receiving constant family support:

• Most respondents stated that they did not feel lonely when living alone (65.9%) (Nik Norliati and Suriati, 2016)

Similarly, Wan Ibrahim and Zainab (2014) also reported that majority of elderly in rural areas were satisfied with various support and help from their children

• Children remain crucial in helping elderly parents

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Coping Strategies

Support from neighbours and relatives

Nik Norliati and Suriati (2016) also found that neighbours replace children’s role in looking after the elderly when their children have migrated out of the village

• there are always neighbours who would come to visit at home and help to buy groceries

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Coping Strategies

Support from friends

Cultural trait in Malaysia (Nurizan et al., 2013)

• Maintain good relationships with neighbours

• Neighbours usually assist the elderly in performing daily activities

oGoing to mosque

oReligious activities such as Quranic classes are good support for elderly (Nik Norliati and Suriati, 2016)

Activity among friends are beneficial for an elderly living alone

• May reduce the feelings of loneliness after the decease of the spouse

• Maintains the ability of an elderly in contributing to the society

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Coping Strategies

Richelle (2012) suggested that lifelong learning is crucial in helping older citizens to stay active

Activities such as learning and reading Quran was one of the ways for the elderly to live actively (Nik Norliati and Suriati, 2016)

Stay active

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Coping Strategies

Other suggestions in coping with empty nest syndrome include:

1. Accept the change: Focus on helping your child to succeed and live independently and at the same time cherish the freedom and release from responsibilities that you are going to have.

2. Acknowledge your feelings even if you think that no one understands. Allow yourself to feel sad / lonely.

3. Give yourself time to adapt to the feelings.

4. Create rituals to acknowledge your feelings such as planting a tree or re-decorating your child’s old room.

5. Share your feelings with your spouse. Discuss your plans and future plans with him/her.

(Mayo clinic April 2018) 23

Coping Strategies

6. Spend more time with your partner. Go for vacations, have long talks and / or walks together, or any other activities you both enjoy doing together.

7. Seek advice from friends or family members who may share the same experience.

8. Prayers according to your own religion may help you to find peace.

9. Keep a journal to express your feelings.

10. Pursue back your hobbies. It’s time for you to enjoy again what you used to love.

(Mayo clinic April 2018)

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Coping Strategies

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Abraham, S. (2012). Ageing Successfully for Managing Empty Nest Syndrome. Help Age India-Research & Development Journal, 18 (2), 39-41.

Guo, Y. Q., Zhang, C. C., Huang, H., Zheng, X., Pan, X. J., & Zheng, J. Z. (2016). Mental health and related influencing factors among the empty-nest elderly and the non-empty-nest elderly in Taiyuan, China: a cross-sectional study. Public Health, 141, 210–217. http://doi.org/10.1016/j.puhe.2016.09.005

Long, M. V. & Martin, P. (2000). Personality, relationship closeness, and loneliness of oldest old adults and their children. The Journal of Gerontology: Series B: Psychological Sciences, 55, 311–319.

LiJuan, L., Xun, S., ChunLi, Z., & Qiang, G. (2007). Health-care utilization among empty-nesters in the rural area of a Mountainous County in China. Public Health Reports.

Liu, J. E., Tian, J. Y., Yue, P., Wang, Y. L., Du, X. P., & Chen, S. Q. (2015). Living experience and care needs of Chinese empty-nest elderly people in urban communities in Beijing, China: A qualitative study. International Journal of Nursing Sciences, 2(1), 15–22. http://doi.org/10.1016/j.ijnss.2015.01.008

Liu, L. J. & Guo, Q. (2007). Loneliness and health-related quality of life for the empty nest elderly in the rural area of a mountainous county in China. Quality of Life and Research, 16, 1275–1280.

Liu, L. J. & Guo, Q. (2008). Life satisfaction in a sample of empty nest elderly: A survey in the rural area of a mountainous county in China. Quality of Life Research, 17, 823–830.

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References

Nik Norliati F. M. N. & Suriati G. (2016). Loneliness and its impacts to the health of elderly in rural Pahang.

International Journal of Environment, Society and Space, 4(1), 29-37.

Nurizan Y., Yadollah A. M., Tengku Aizan H. & Siti Suhailah A. (2013). Social Support and Psychological Well-

being Among Older Malay Women in Peninsular Malaysia. Indian Journal of Gerontology, 27 (2): 320–332.

Richelle, K. (2012). Active Aging: Good for Older People, Good for Society, The Journal of AARP International.

2012(02). http://journal.aarpinternational.org/a/b/2012/02/Active-Aging-Good-for-Older-People-Good-for-

Society.

Suriati, G. (1999) Socio-economic changes in the peri-urban villages in Penang, Malaysia. Ph.D Thesis, School

of Geography, University of Leeds.

Su, D., Wu, X. N., Zhang, Y. X., Li, H. P., Wang, W. L., Zhang, J. P., & Zhou, L. S. (2012). Depression and social

support between China’ rural and urban empty-nest elderly. Archives of Gerontology and Geriatrics, 55(3),

564–569. http://doi.org/10.1016/j.archger.2012.06.006

Wan Ibrahim W. A. & Zainab I. (2014). Satisfaction of Family Support of Older Rural Malaysia. World Applied

Sciences Journal, 30 (7), 919-922.

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References

Xie, L.-Q., Zhang, J.-P., Peng, F., & Jiao, N.-N. (2010). Prevalence and related influencing factors of depressive

symptoms for empty-nest elderly living in the rural area of YongZhou, China. Archives of Gerontology and

Geriatrics, 50(1), 24–29. http://doi.org/10.1016/j.archger.2009.01.003

Zhai, Y., Yi, H., Shen, W., Xiao, Y., Fan, H., He, F., … Lin, J. (2015). Association of empty nest with depressive

symptom in a Chinese elderly population: A cross-sectional study. Journal of Affective Disorders, 187, 218–

223. http://doi.org/10.1016/j.jad.2015.08.031

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References

Thank you

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