Mima Cattan

Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions

Preventing and alleviating social isolation and loneliness among older people is an important area for policy and practice, but the effectiveness of many interventions has been questioned because of the lack of evidence. A systematic review was conducted to determine the effectiveness of health promotion interventions that target social isolation and loneliness among older people. Quantitative outcome studies between 1970 and 2002 in any language were included. Articles were identified by searching electronic databases, journals and abstracts, and contacting key informants. Information was extracted and synthesised using a standard form. Thirty studies were identified and categorised as ‘group’ (n=17); ‘one-to-one’ (n=10); ‘service provision’ (n=3); and ‘community development’ (n=1). Most were conducted in the USA and Canada, and their design, methods, quality and transferability varied considerably. Nine of the 10 effective interventions were group activities with an educational or support input. Six of the eight ineffective interventions provided one-to-one social support, advice and information, or health-needs assessment. The review suggests that educational and social activity group interventions that target specific groups can alleviate social isolation and loneliness among older people. The effectiveness of home visiting and befriending schemes remains unclear.

Social capital as a resource for mental well-being in older people: A systematic review

Social capital has previously been reviewed in relation to mental health. However, none have focused specifically on positive aspects of mental health such as mental well-being. This review aimed to explore the relationship between social capital and mental well-being in older people. Ten relevant databases were systematically searched using an extensive search strategy for studies, analyzing the link between social capital and mental well-being. Criteria for inclusion in the systematic review were: the study sample included older people (≥50 years); the study reported a mental well-being outcome; social capital was an exposure variable; and empirical research using quantitative methods and published in English, between January 1990 and September 2011. Eleven studies met the inclusion criteria. Each study was assessed against seven possible exposure measures (structural, cognitive; bonding, bridging, linking; individual, collective). The results showed that all included studies found positive associations between parts of social capital and aspects of mental well-being. Typically, the relationship between social capital and mental well-being differed within as well as between studies. Our results highlight that there is no ‘gold standard’ of how to measure social capital or mental well-being. Social capital is generated in the interaction between individual and collective life. A possibility for future research is therefore to follow Bronfenbrenners classical division into macro, meso, and micro levels. We consider family and friends at the micro level to be the key factors in generating social capital and well-being in older people.

The use of telephone befriending in low level support for socially isolated older people--an evaluation.

There is increasing policy recognition that the alleviation of social isolation and loneliness in older people should be prioritised. Recently, technology, such as telephone networks and the Internet, has received attention in supporting isolated and lonely older people. Despite lack of evidence, telephone befriending has been considered an effective low-level method to decrease loneliness among older people. This study evaluated the impact of a national befriending scheme for isolated and/or lonely older people, involving eight project sites across the UK 2007-2008. The purpose was to assess the impact of different models of telephone-based befriending services on older peoples health and well-being. A mixed methods approach was used. This paper reports on the findings from 40 in-depth interviews with older service recipients. The most important finding was that the service helped older people to gain confidence, re-engage with the community and become socially active again. Three topics were identified: why older people valued the service, what impact it had made on their health and well-being and what they wanted from the service. In addition, nine subthemes emerged: life is worth living, gaining a sense of belonging, knowing they had a friend, a healthy mind is a healthy body, the alleviation of loneliness and anxiety, increased self-confidence, ordinary conversation, a trusted and reliable service, the future--giving something back. In conclusion, the findings present in-depth qualitative evidence of the impact of telephone befriending on older peoples well-being. Befriending schemes provide low-cost means for socially isolated older people to become more confident and independent and develop a sense of self-respect potentially leading to increased participation and meaningful relationships.

Alleviating Social Isolation and Loneliness among Older People

This study investigated the evidence base for health promotion interventions targeting social isolation and loneliness in older people. The research comprised: a systematic literature review, a survey of projects in northern England, and case studies involving interviews with staff and older people. The majority of projects were not evidence based with large variations in evaluation. The review identified a small number of relevant studies. Effective interventions targeted older people at risk and enabled participants some control over project activities. Older people differentiated between chronic and situational loneliness, and isolation versus loneliness, suggesting a need for different interventions. Many projects did not have strategies for identifying isolated, lonely older people. Access to activities intended to alleviate social isolation and loneliness among older people was often inequitable, tailored to participants? expectations, rather than to the needs of those most isolated and lonely. Many projects consulted older people superficially, providing activities, which did not necessarily meet the needs of isolated, lonely older people.

Research priorities for public mental health in Europe: recommendations of the ROAMER project

BACKGROUND The ROAdmap for MEntal health Research in Europe project aimed to create an integrated European roadmap for mental health research. Leading mental health research experts across Europe have formulated consensus-based recommendations for future research within the public mental health field. METHODS Experts were invited to compile and discuss research priorities in a series of topic-based scientific workshops. In addition, a Delphi process was carried out to reach consensus on the list of research priorities and their rank order. Three web-based surveys were conducted. Nearly 60 experts were involved in the priority setting process. RESULTS Twenty priorities for public mental health research were identified through the consensus process. The research priorities were divided into summary principles-encompassing overall recommendations for future public mental health research in Europe-and thematic research priorities, including area-specific top priorities on research topics and methods. The priorities represent three overarching goals mirroring societal challenges, that is, to identify causes, risk and protective factors for mental health across the lifespan; to advance the implementation of effective public mental health interventions and to reduce disparities in mental health. CONCLUSIONS The importance of strengthening research on the implementation and dissemination of promotion, prevention and service delivery interventions in the mental health field needs to be emphasized. The complexity of mental health and its broader conceptualisation requires complementary research approaches and interdisciplinary collaboration to better serve the needs of the European population.

We're all thrown in the same boat ... : A qualitative analysis of peer support in dementia care

Peer support is well established in fields such as the disability movement and mental health and is increasingly recognised as one way of enabling support by and for people with a diagnosis of dementia and their immediate carers. It was central to the implementation of the National Dementia Strategy (NDS) for England, when 40 demonstration sites were established. This mixed-methods study included in-depth qualitative interviews with people living with dementia (n = 101) and staff/stakeholders (n = 82) at 8 of the 40 sites. Data analysis was a five-stage process: coding framework developed (using 25 transcripts); further development of the framework (using a further 70 transcripts); development of emerging themes; modelling of themes and verification of models based on the entire data set. Peer support had positive emotional and social impact that was rooted in identification with others, a commonality of experience and reciprocity of support. There was also a contrast between the quality of peer support and support from professionals. This emphasises the significance of lived experience and promoting a strength-based approach to interpersonal support that is enabling and challenges a deficit approach to understanding dementia.

The Experiences and Expectations of Care and Support Among Older Migrants in the UK

This paper reports and critically discusses, against the literature on culturally sensitive and cultural competency practices, the findings of a qualitative study which explored the needs and expectations of older people and their carers from eight different migrant communities and the white British majority. The study investigated the accessibility and acceptability of care and support services in Bradford, UK, a city with a large migrant population. A total of 167 study participants were recruited from February 2008 to October 2008; of these 134 were older people and 33 carers. The age ranged from 25 to 90 years. The study found that older migrants and their carers described expectations of services as complex constructions of ‘abstract expectations’, the study participants’ general beliefs regarding what services should be about, and ‘pragmatic expectations’, their specific views about how they would like to receive care and access services. All groups, irrespective of their ethnic background, expressed three ‘abstract expectations’: high standards of good practice; cultural understanding; and responsiveness to individual expectations. This similarity did not imply a similarity in their preferences for how services should provide for their ‘abstract expectations’. Dignity was a central expectation for all older people in the care of their bodies. However, a number of culturally specific ‘pragmatic expectations’ emerged in the practices that older people and carers associated with maintaining dignity in older age. Nevertheless, differences could not always be explained as an outcome of different cultural backgrounds, but were rather linked to individual characteristics and life experiences. This study indicates that whether and how older migrants’ knowledge systems inform their expectations of care and support should be objects of investigation rather than taken for granted, as implied in some literature on culturally sensitive practices. Exploration of older migrants’ knowledge systems may help us to understand if older migrants’ expectations differ with regard to what they expect to receive from a certain service, their ‘abstract expectations’, and/or how they expect to receive it, their ‘pragmatic expectations’. This information should help to identify if different communities require different culturally competent interventions and of what type: interventions at the organisational level, at the structural level or at the clinical level.

The meanings older people give to their rehabilitation experience

Promoting older peoples ability to manage at home is important both for themselves and for society, but few studies have explored whether geriatric rehabilitation actually meets the needs of this heterogeneous group. The purpose of this study was to investigate the meanings that older adults attribute to their geriatric rehabilitation experiences. A group of 27 older adults in inpatient rehabilitation were interviewed during the programme and after returning home. Semi-structured interviews were analysed using a qualitative method, which identified three categories of meaning. In the category ‘sense of confidence with everyday life’, rehabilitation was perceived as facilitating everyday living at home; in the category ‘sense of vacation’, rehabilitation was seen as a means of getting away from normal life and enjoying oneself; and in the category ‘sense of disappointment in the rehabilitation programme’, the participants expressed frustration with the limited opportunities to participate in the planning of their rehabilitation, and with the mismatch between the offered programme and what was needed. To promote older peoples autonomy and to enhance their ability to live at home, professionals must involve their clients to a greater extent in the planning of the rehabilitation than is currently the case, and also individualise the rehabilitation regimen.

A comparison of older workers’ and retired older people’s social capital and sense of mastery

Aim: To assess if older people with higher levels of social capital experience higher levels of sense of mastery than those with lower levels of social capital and to assess whether this association is stronger for retired older people than for older workers. Methods: The data originates from a general population mental health survey conducted among 2610 older people (50 years of age or older) in Finland in 2011. The response rate was 57.1%. The association between sense of mastery, measured by Pearlin’s Sense of Mastery Scale, and social capital, measured by social networks, organisational activities, trust, and sense of belonging, were tested by logistic regression analyses. Results: The results showed that older workers experienced greater sense of mastery than retired older people. Trust and neighbourhood belonging were positively associated with sense of mastery. Conclusions: Inequalities in mental wellbeing between older people included in or excluded from the workforce are a public health challenge. Our findings imply that social capital needs to be prioritised as a means for enhancing mental health. More attention should be paid to promote mental wellbeing in retired older people.

The association between social capital and loneliness in different age groups: a population-based study in Western Finland

BackgroundPrevious studies of loneliness have largely focused on establishing risk factors in specific age groups such as in later life or in young people. Researchers have paid less attention to the link between social capital and loneliness across different age groups. The aim of this study was to examine the association between social capital and experienced loneliness in different age groups in a Finnish setting.MethodsThe data originates from a population-based cross-sectional survey conducted among 4618 people aged 15–80 in Western Finland in 2011. The response rate was 46.2 %. The association between social capital, measured by frequency of social contacts, participation in organisational activities, trust and sense of belonging to the neighbourhood and loneliness was tested by logistic regression analyses stratified by four age groups.ResultsFrequent loneliness (defined as experienced often or sometimes) was higher among younger people (39.5 %) compared to older people (27.3 %). Low levels of trust were linked to loneliness in all four age groups. The association between other aspects of social capital and loneliness varied across age groups.ConclusionsFrequent loneliness is common among the general adult population and could be seen as a public health issue. Our findings imply that low social capital, especially in terms of low trust, may be a risk factor for loneliness. However, further research is needed to assess the influence of poor health and reverse causality as explanations for the findings.