Friendship in Befriending? Older Service Users’ Notions of Friendship in a Befriending Scheme

ABSTRACT

Social isolation and feelings of loneliness are main reasons that befriending services are approached by older adults. The promise of an individually matched volunteer, a befriender, paying them regular visits, offers hope of increased social interaction, meaningfulness, and connectedness in everyday life. The current consensus in qualitative research literature is that loneliness and isolation may be alleviated by such home visits. Still, the actual mechanisms of successful befriending have not been identified. In this small-scale qualitative study, we highlight older befriendees’ notions of friendship in befriending. Drawing on in-depth interviews with seven Norwegian befriendees over the age of 80 years, we suggest that having a befriender visit regularly spurs a new bond and supports befriendees’ notions of a relationship consistent with a traditional understanding of friendship. Our findings illustrate how the older befriendees identify and portray notions of friendship in terms of bonding, compatibility and meaningful activities, commitment, appreciation, and insecurities. Understanding how a formalized volunteer service is recognized and valued as a friendship may contribute to a better starting point for improving befriending services. Furthermore, it can improve our understanding of the significance of friendship in old age.

KEYWORDS:

• Older adults
• befriending
• friendship
• home visits
• qualitative
• loneliness

Reaching an advanced old age often comes with the cost of losing one’s near and dear, and with a shrinking social network. In the older age groups, people report seeing friends less often, and fewer have confidant friends (Nicolaisen & Thorsen, 2017). Such costs, combined with an increasing loss of functional abilities, might heighten the risk of social isolation and loneliness (Shankar et al., 2017; Warner & Adams, 2016). In recognizing the beneficial role that social ties and close relationships play in the maintenance of life satisfaction and well-being in old age (Blieszner et al., 2019; Cohen-Mansfield et al., 2016; Miche et al., 2013), an increasing number of volunteer organizations now offer older adults regular one-to-one home visits. These services are called “befriending services” or “friendly visiting services” and aim to assist older adults in their efforts to create and strengthen social relationships. The promise of an individually matched volunteer, a befriender, and regular home visits, likely make older adults contact befriending services. These services offer hope of increased social interaction, genuine and reciprocal relationships, and connectedness in everyday life (Wiles et al., 2019).

In the research literature, befriending is often defined as “A relationship between two or more individuals which is initiated and supported and monitored by an agency that has defined one or more parties as likely to benefit” (Dean & Goodlad, 1998, p. 13). Furthermore, the relationship is “Ideally, non-judgmental, reciprocal, purposeful, and involves a commitment over time” (ibid.). Befriending is thus an organized social intervention aimed at providing the older adult with individual and social support through developing an affirmative, emotion-focused, one-to-one relationship over time (Windle et al., 2011). In a concept analysis, Balaam (2015) emphasizes the complexity of befriending and states that befriending is associated with a friend-like relationship. The term “friend-like” is used because the relationship does not fit the traditional definitions of friendship. A traditional friendship is defined as “a voluntary, personal relationship, typically providing intimacy and assistance, in which the two parties like one another and seek each other’s company” (Fehr, 1996, p. 7). In recent years, communication technology and social media have necessarily rendered friendships and friendship formation more diverse (Amichai-Hamburger et al., 2013). However, studies suggest that late-life face-to-face friendships remain traditional as they often are mutual, flexible, and terminable relationships that emphasize equality and reciprocity – or the perception of reciprocity (Fyrand, 2010; Nicolaisen & Thorsen, 2017). These qualities stand in contrast to befriending as a social intervention established and overseen by an organization. However, the term “friend-like” signals a recognition of the fact that, during the intervention, an emotional relationship often develops between the voluntary befriender and the older service user – the befriendee.

Currently, there is little agreement on whether one-to-one befriending services indeed affect social isolation and loneliness in older adults. Quantitative studies on befriending services generally conclude that one-to-one interventions have no significant effect on specific outcomes (Siette et al., 2017). However, qualitative studies report positive outcomes and experiences. The few qualitative studies that take the perspectives of older home-dwelling befriendees without a specific diagnosis contain first-hand accounts of how one-to-one befriending reduces the service users’ feelings of loneliness and isolation by compensating for elective relationships, providing emotional support, and offering connectedness (Andrews et al., 2003; Fakoya et al., 2021; Gardiner & Barnes, 2016; Holton et al., 2021; Lester et al., 2012; Wiles et al., 2019).

The discrepancy between quantitative and qualitative research results is interesting and somewhat confusing. While it may be explained by methodological issues, population characteristics, and type of befriending scheme (Lester et al., 2012), the discrepancy also suggests that we have yet to understand and identify the underlying mechanisms of befriending (Balaam, 2015; Fakoya et al., 2021; Gardiner & Barnes, 2016). We do know that such mechanisms are relational and have structural and functional aspects and, in this paper, we draw on the theoretical framework of social relationships by Due et al. (1999) – and find support in previous studies illustrating that the interplay between structural and functional aspects might be complex in befriending (Andrews et al., 2003; Lester et al., 2012). However, most studies on befriending in old age focus primarily on the effects befriending services have on loneliness (see, e.g., Fakoya et al., 2021; Holton et al., 2021; Lawlor et al., 2014). To date, there has been less research attention toward the relational aspects of befriending. In this paper, we investigate older befriendees’ relationships with their befrienders, concentrating on their notions of friendship.

The investigation is founded on the acknowledgment that a uniform construal of befriending or friendship exists neither in the research literature nor in everyday language. People “do them” in different ways. Some friendships grow to deep closeness and persist for decades, others remain casual or are short-lived (Chopik, 2017; Doherty, 2021) – these also seem to be characteristics of “befriendships” (Lawlor et al., 2014; Lester et al., 2012).

Material and methods

The Red Cross has by far the largest befriending service in Norway. In line with national policy initiatives to increase volunteer work as a supplement to public care and welfare services (Ågotnes et al., 2021), the goal of their befriending service is to prevent and alleviate loneliness and exclusion amongst adults through regular one-to-one home visits. Of the service’s 20,000 users, most are female and older than 65. The service is organized by local chapters who register, educate, and follow-up on volunteer befrienders. Furthermore, they recruit and welcome service users. When contacted by someone who wants a befriender, a service coordinator makes a home visit to inquire about interests and needs. During the home visit, the befriendee is informed about the service’s formalized framework. For instance, the Red Cross suggests that befriender and befriendee meet two hours every other week. Information on the service’s limitations is also shared. Limitations are related to what the befriender cannot do for the befriendee, such as provide medical care, give legal advice, or perform housework, and what the befriendee cannot do for the befriender, such as offer money for services. Information on interests and needs is used to “match” the befriendee with a befriender.

Design and participants

In-depth individual interviews were used in this study; the aim was to explore and describe notions as expressed by the participants themselves. This approach proved fruitful as some participants had hearing difficulties, some repeated themselves, and some needed extra time to find a word. Individual interviews allowed them to express themselves using their own words and voicing their own priorities – in their own time (van Wijngaarden, 2022).

Participants were recruited by local service coordinators who distributed information about the study to home-dwelling befriendees 65+ who had had a befriender for minimum a year. Twelve befriendees, all coincidently 80+, were willing to participate and their contact information was given to the first author. The first author called all to make an appointment for the interview, discuss the research, and build a rapport. However, due to a national Covid-19 lockdown, only six women and one man, between 80 and 94 years of age, were interviewed.

Six of the participants lived alone. Five received weekly or daily visits from home nurses and one attended a day care center twice a week. All relied on walking aids and were mostly housebound. All had a bi-weekly home cleaning service. Three had previously had other befrienders. The current befriender had visited them from one year up to five years.

Data collection and analysis

All interviews were conducted by the first author in the participant’s home between February and March 2020. For the interview, all participants had prepared coffee and the interviewer brought cake. Interviews were digitally recorded and lasted between 55 and 71 minutes.

The interview guide explored the reasons why participants wanted a befriender, the process of being assigned a befriender and getting to know the befriender, what they do together, and experiences of personal benefits from having a befriender. For this paper, questions eliciting participants’ experiences of getting to know the befriender, as well as experiences of personal benefits, were relevant.

Interviews were transcribed verbatim and analyzed with Systematic Text Condensation, a cross-case method for thematic analysis (Malterud, 2012). All authors were involved and negotiated the following four steps: (1) Reading transcripts to gain a contextualized impression of the discussions and choose preliminary themes. (2) Agreeing upon code groups and identifying units of meaning. (3) Condensing the meaning in the coded groups. (4) Synthesizing – from condensation to general descriptions and concepts that reflected the main findings regarding participants’ notions of friendship. The analysis followed these four steps, constantly moving back and forth between steps, and resulted in five themes: Bonding, Compatibility and Meaningful Activities, Commitment, Appreciation, and Insecurities. The themes are illustrated by quotations assigned a pseudonym.

Malterud (2012) emphasizes researchers’ preconceptions. In this study, authors are a social anthropologist, a sociologist, and a theoretical psychologist. All have extensive experience from gerontological and geriatric research. The authors’ different preconceptions proved to be valuable in interpreting the material. For example, the second author currently works in the Norwegian Red Cross and her knowledge of befriending service policies was fruitful in understanding synergies and tensions in participants’ accounts regarding the service’s formalized framework.

Ethical considerations

Throughout the research process, principles of informed consent, confidentiality, and appropriate data storage were emphasized. All participants received written information and signed an informed consent form before being interviewed. The study was approved by the Norwegian Centre for Research Data (approval number 707711).

Results

Bonding – hoping for a connection

After having the local service coordinator over for a home visit, participants had to wait for their newly assigned befriender to call and arrange the first visit. Participants remembered feeling excited and somewhat nervous before the first visit. It was, after all, a total stranger coming to see them. Ada remembers: ‘I was a bit excited, because you know … but I thought to myself, “Whatever type of person I get, I am just so happy that somebody is coming.” That I get somebody to talk to and all that.’ Even Ingrid, an experienced befriendee, admits that she became nervous when hearing that her new befriender was a young woman:

I was wondering about how I would be able to handle that. How will that work out? Then suddenly, she’s there and we’re talking like old acquaintances. Instant connection! I’ve never experienced that before!

The term “instant connection” Ingrid uses here resembles terms such as “we hit it off” and “we clicked” used by other participants when describing the first visit. They felt real chemistry between themselves and the befriender from the start. When asked to further describe how they felt at the time, their body language underlines their enthusiasm. One points repeatedly toward the front door as if to illustrate that it happened right there, and others close their eyes, as if to relive the moment they first saw their new befriender: ‘She came in here, and she was smiling and all – it was so good! I thought “Oh, lucky me!”’ (Ada). A common denominator in their descriptions was the befriender as a beautiful and smiling woman. They felt lucky, and very relieved because the first step in the relationship was a success. Only Edel did not emphasize an immediate connection with her new befriender. She simply said: “Well, she just came, and we talked for a bit. She’s not a very talkative person.”

Compatibility and meaningful activities – spending quality time together

Finding similar interests was understandably highly prioritized by participants in the beginning of the relationship. As a result, common backgrounds, experiences, and interests were identified. One participant reasoned that she matched well with her befriender because they both used to work with children, and they were from the same place. Another described how they connected over childhood memories from a nearby village. Now, during visits, they explored local history books from that village. Reminiscing about the old days and co-constructing a shared history was highly appreciated.

When asked what they do together with their befriender – all answered cheerfully that they talk. A few would go out for a walk with the befriender – if the weather allowed it. Others sometimes asked their befriender to accompany them on errands. However, all maintained that talking at home or in a café, over a cup of coffee, was the best bit of the visit. Ingrid elaborated on this:

To talk, and to be with another person. [My husband] just sits there and sleeps. So, just talking to somebody … oh my word, oooh, to be able to talk about stuff that interests me. She is so … she’ll answer anything.

Several emphasized that their conversations were meaningful and of a private and intimate nature, and that they generally avoided gossip or topics that concerned health problems. Instead, participants shared experiences from their lives, as did befrienders. This allowed them to become well informed on their respective befriender’s family, friends, and hobbies.

A shared interest in books was also highlighted by all participants. During visits, they discussed books. Such discussions often encouraged further sharing of their own experiences. For example, Ada and her befriender had both recently lost their spouses:

Yes, we do talk about books, and we talk about how life was before – that is something that comes naturally, right? And there is a trust between us when we talk about these things. She talks about her husband passing away, and I talk about my husband passing away and how our married life was and all that. She loved her husband a lot and had a hard time when he died – and it was like that for me too.

Discussions on books also led to sharing thoughts on politics and the society. A common interest in politics and society was considered positive and allowed participants to discuss “the news of the world” with their befriender. Thus, the conversations fostered not only a social and personal connection, but also a societal connection. Being mostly housebound, befrienders helped participants to metaphorically “get out” of the house by providing them with news of the world. Several explained that to actively partake in the conversations, they prepared by keeping tabs on televised sporting events, following political debates, or reading newspapers. Being able to contribute to meaningful conversations influenced participants’ perceptions of themselves as informed individuals. Ada explained the effect this had: “It’s not that I develop as a human being, but I am able to maintain a lot of the person inside me … that she doesn’t fade away.”

Commitment – recognizing reciprocity

Most participants follow the Red Cross’ recommendations regarding frequency and duration of visits. For example, the befriender visits every other Tuesday at 12 o’clock and stays for two hours. There is no doubt that participants found comfort in a fixed arrangement, and several noted that they never made other appointments on that day. Being able to rely on the befriender to show up was important and even with a fixed arrangement in place, some befrienders always called to reconfirm their arrival. Others, such as Solveig, were telephoned only if the befriender was unable to come: “If so, she’ll always call. Yes, she is very protective of those days. So, yes, that is like our [day].” The perception of “our day” as protected by a fixed agreement and mutual commitment is noticeable in several participants’ accounts. There was, of course, room to cancel, but then the befriender would reschedule so that the day together was not lost.

Some participants did not receive their befriender on a fixed weekday. Jenny’s befriender, for instance, always telephoned to set a date for the next visit. So, to maintain a sense of predictability of visits, these participants kept track of the befriender’s other commitments. For instance, Jenny knew that the befriender babysat her grandchildren on Mondays. This information allowed her to make other plans that weekday.

Participants highlighted commitment and reciprocity in their relationships with befrienders in several other ways too. For instance, by referring to the times when befrienders stated that they liked them, appreciated them, or wanted to spend time with them, or as in Ada’s case when they mutually redefined the relationship: “Not long after [our first meeting] we decided that we were good friends. She wasn’t just a befriender anymore, but it was … .” Verbally uttered confirmations of reciprocity empowered participants, because they were not only benefitting from the relationship, but also contributing to it. They felt liked and seen by their befriender. Ingrid said: “We all need a friend, a human being that sees us.”

Being liked as a person was additionally confirmed when the befriender acted in a way that benefitted the participant but conflicted with the Red Cross service guidelines. This was experienced as the befriender “doing extra” for them. Examples of such actions were offering additional visits, sending text messages, making dinner, or inviting the befriendee to a party. In these acts, participants found confirmation that the befriender liked them and enjoyed their company – and that these feelings were not limited to their role as befriendee. They were interpreted as signs of friendship.

Appreciation – feeling lucky

All participants felt lucky to have their specific befriender, and as such they emphasized the element of chance present in the matching of befriender and befriendee. Feeling lucky was apparent in their descriptions of the first meeting, but that specific feeling also appeared to be strengthened over time. For instance, one participant admired her befriender for committing to visit two older people: “Can you ever imagine such a remarkable person?” Such words of praise were found in all participants’ accounts. Ranging from recognizing that “she is such a competent lady,” “a great lady” and “she is so fit and active” to more heart-warming characteristics like this quote from Solveig: “She is beautiful. Downright beautiful – in her soul.” These descriptions leave no doubt that participants admire their befrienders. Some participants described how visits had an impact on their perception of life, heightening feelings of wellbeing, and promoting a sense of purpose. Ingrid said:

She knows that I love her. I have undoubtedly said it: “You are a wonderful person!” She is – I just can’t understand anything else – open and considerate, and always in a good mood! I look at her face … well, it’s probably like this for everybody … that we need people? How was I so lucky? A lot of times one does not feel like living anymore. It would be nice to just sleep and not wake up again, but [with her] it’s fun! She is wonderful!

Having health conditions that in various ways affected their everyday activities, the befrienders’ ability to handle distressing situations were highlighted. For instance, Konrad admired how physically strong his befriender was. She handled his heavy wheelchair when they were on outings. The participants that struggled with short-term memory loss also emphasized how well their befrienders coped. Mari explained: “Even if I am forgetful and talk staccato. It’s ok. She understands me and I absolutely understand her.”

Insecurities – noticing the relationship boundaries

The befriending service is a volunteer service, and all participants were aware that the relationship was initiated by their needs. However, only a few participants mentioned aspects of insecurity in their relations with befrienders. This was particularly the case for the first-time befriendees with only one year of experience. Their worries were composed of two parts. The first part was of a practical nature – it was task-oriented, particularly related to what befrienders could help them with. Konrad highlighted a specific episode when he had asked his befriender to take him to the optician. Konrad knew that the befriender had guidelines to follow – and worried that the help he had asked her for was not allowed. So, he asked the service coordinator “to send me something in writing about what my task is and what her task is.” Edel had a similar problem – she knew that the befriender should not do housework for her, but she was not sure of what qualified as housework:

I asked her to do something, and she did. Amongst other things, to take down something from up in the closet that I am not able to reach and such different things (…). Help me clean my closet so I can go to the Salvation Army with some things. And she has agreed to that – such different things. I asked that, and that’s fine. But I kind of do not know what they are told [by the Red Cross] – what to do and what not to do.

The uncertainties mentioned here seemed to be directly related to the fact that these participants were new befriendees, and it is likely that access to written guidelines could help reduce some of the uncertainty they experience.

The second part of the worries were of a more emotional nature and concerned the qualities of the friendship. Though, most participants were satisfied with how the relationship had evolved into what they considered a genuine friendship, a few voiced concerns about the relation. These concerns were primarily related to how personal they could and should be. While Konrad repeatedly expressed concern about whether he and his befriender were too open with each other; “We have allowed ourselves to be open with each other. That may not be allowed, I do not know. I asked [the service coordinator] to get this in writing.” Edel’s concern was the opposite. She did not feel that she had an open and intimate relationship with her befriender.

Our chemistry is good, just not like all there … some things are too personal. I have not wanted to ask about personal stuff – like why she lives alone and stuff. You know, with some people you can share your inner thoughts right away? But not with all people.

Edel hoped that over time the relationship would change for the better. She already noticed a positive change and expected it to ameliorate further. Although optimistic, Edel expressed disappointment in the relationship throughout the interview. This disappointment was connected to the lack of intimacy between the two, but also to her not being able to sway the befriender into joining her on weekend outings and trips abroad.

Discussion

All participants in this study found being a befriendee rewarding. They valued the relationship and the time spent with the befriender. Our findings revealed elements central to their notions of friendship and highlight the interplay between these elements.

Reconstructing a relationship formally constructed for your benefit

The befriending scheme is a constructed and controlled relationship, created to benefit the service user. The fact that befriendees and befrienders initially experience the relationship as somewhat unclear and that they in a Goffmanian fashion co-create an acceptable role definition and order of interaction, is noted is several studies (see, e.g., Andrews et al., 2003; Fakoya et al., 2021; Lester et al., 2012; Wiles et al., 2019). A prominent finding in our study is the relevance of interpersonal attraction in the co-creation of roles. Interpersonal attraction is considered the earliest stage of friendship and must occur before one can make friends with another person. Similarity, proximity, and attractiveness are considered central in this initial stage (Amichai-Hamburger et al., 2013; Roberts-Griffin, 2011). Experiences of interpersonal attraction – feelings of instant chemistry, relief, luck, and joy – were emphasized by several participants. Our findings suggest that interpersonal attraction spurs the participants’ notions of a potential friendship. Such attraction seemed to support and encourage them to redefine the relation and reconstruct roles beyond the frame of the befriending scheme. As noted in Piercy (2000), feelings consistent with friendship trumped the framework for the formal service arrangement.

Our findings suggest that interpersonal attraction might alleviate the tension between a formalized befriendship and a friendship that has been identified in prior studies (see e.g. Andrews et al., 2003). Only the first-time befriendees, articulated a continued tension by highlighting their insecurities and portraying a relationship in a state of limbo. Both experienced attempts at redefining or reconstructing the relationship as distressing and beyond their control. The Red Cross and the local service coordinator usually represent an invisible third party in befriending (Balaam, 2015), but when unable to define the relationship according to their own expectations, needs, and wishes these two participants turned to the Red Cross for guidance. However, despite feelings of prolonged insecurity or instant joy, participants implied that as the relationship developed, a reliable relational rhythm founded on meaningful activities was established. An interesting finding is how this rhythm is interrupted when the befriender does something extra for the participant. Doing extra implied acting beyond the frame of the befriending remit (Andrews et al., 2003) such as inviting the befriendee to a party or offering to visit more often. In these acts, the tension between befriendship and friendship reappeared, and the relationship boundaries were recognized. However, most participants did not experience these acts as causing insecurity in the relationship, rather the opposite. They were highly appreciated – triggering energizing feelings of reciprocity and interpreted as a confirmation of friendship as the befriender’s revealed fondness and a personal investment in the relationship.

Friendship in the context of befriending

Research shows that bonding in befriending is positively influenced by matching befriender and befriendee according to demographics and life experience (Andrews et al., 2003), or common interests (Wiles et al., 2019). Lester et al. (2012) challenge the significance of careful matching. In their study, the befriender’s personal qualities are highlighted, especially good conversational skills and empathy. Our participants recognized the befriender’s personal qualities, as well as common interests, life experiences, and demographics. The befrienders’ personal qualities seemed to facilitate for further bonding in which additional common interests were identified. This indicates that participants actively searched for mutually shared interests and experiences, probably making the initial matching less important. This suggest that when common interests were identified, they were often used to confirm the relationship’s success. It, thus, seems that common interests and perceptions of similarity on key attributes played a significant part in establishing and maintaining a notion of a real friendship (Blieszner & Roberto, 2004).

Looking into studies on the reported qualities in friendships, it is evident that these qualities differ across populations, contexts, and cultures (Amichai-Hamburger et al., 2013; Miller et al., 2014). Friendships are social relationships that adapt to the environmental context. To better understand the participant’s notions of friendship in the context of one-to-one befriending, we suggest noting that social relationships such as friendships have structural and functional aspects (Due et al., 1999). The structural aspects were highlighted in participants’ appreciation for regular visits. The visits were a significant feature in participants’ bi-weekly routines – it gave them something to look forward to in an otherwise monotonous everyday life. The befrienders’ commitment to “our day” also paved the way for feelings of reliability. Furthermore, the tension between befriendship and friendship identified by some participants must be acknowledged as inherently structural because it concerns the tension between the service’s established codes of conduct and individual expectations and needs. The functional aspects were found in general descriptions of emotional wellbeing and appreciation, as well as in specific accounts of meaningful conversations, reciprocal social exchanges, and trust – all of which are qualities in a traditional understanding of friendship (Fehr, 1996). Indeed, companionship, that is, enjoying good times together, is fundamental in maintaining friendship (Amichai-Hamburger et al., 2013). Participants in our study illustrated that spending meaningful and quality time together was their goal. Several even explained that they prepared for the befriender’s visits. Conversations about common experiences and interests contributed to expanding participants’ horizons, but particularly appreciated were the private and intimate conversations (Fehr & Harasymchuk, 2017). Such conversations empowered feelings of connectedness: connectedness toward the befriender and toward the social sphere from which they experienced being isolated.

The significance of friendship for emotional well-being in old age is widely recognized (Blieszner et al., 2019; Cohen-Mansfield et al., 2016). However, friendships are at risk as functional ability declines in old age and as older people often are excluded from contexts where friendships usually are generated. Most participants in this study were housebound due to physical illness and they reported emotional well-being from befriending. From their accounts, we gather that friendship in befriending comes in many shapes and forms, but that a common denominator is that it supported their well-being. Successful befriendships seem to be founded on similar structural and functional aspects, as are successful friendships. Friendship may very well be the overarching ingredient to successful befriendships and being the first study focusing on older service users’ notions of friendship in befriending, our findings may contribute to more clarity regarding the underlying mechanisms of befriending.

Limitations and strengths

This small-scale qualitative study depicts what is happening when a befriending program works. Despite a few insecurities, all participants had a well-functioning relationship with their befrienders. The sample can, thus, create a one-sided positive impression of befriending. So, to better understand how befriending schemes work or do not work, and for whom, it is necessary in future studies to include befriendees that have had negative experiences. However, the present results allow us to identify factors crucial to a good befriending service.

Conclusion

Our findings provide insight into the older befriendees’ notions of friendship in befriending. Omnipresent in their accounts were notions of friendship or a search for friendship where bonding, compatibility and meaningful activities, commitment, appreciation, and insecurities were central and interplaying elements. As befriending services become ever more prominent in discussions on public care and welfare, understanding how a formalized volunteer service is recognized and valued as a friendship by service users may contribute to a better starting point for improving these services. It can, also, improve our understanding of the significance of friendship in old age.

Acknowledgements

The authors thank participants and the Red Cross service coordinators.

Disclosure statement

We have no known conflict of interest to disclose.

Additional information

Funding

The work was supported by the Norwegian Red Cross.