Scoping Review of the Literature Social Isolation of Seniors 2013-2014

Suggested approaches to counter social isolation

Hawton et al., (2010) suggested that policy and practices should target seniors at risk of social isolation as individuals need to be identified early with interventions before deterioration of their health or quality of life occurs. By contrast, Dickens, Richards, Greaves & Campbell (2011) indicated that interventions that target people who were socially isolated or lonely were less likely to report positive effects than studies with no explicit targeting. Additionally, Seeman (2000) suggests that social supports can have both health promoting and health damaging effects in older adults. Therefore, aspects of the social environment play an important role in health promotion efforts for older adults (as cited in Seymour & Gale, 2004, p.61).

Literature demonstrates that seniors should be actively involved in program development as well as implementation of changes because they know what is meaningful in their lives, the factors that could place seniors at risk of social isolation, and how to promote social inclusion (Senate Committee on Social Affairs, Science and Technology, 2013; MacCourt, 2007; Federal/Provincial/Territorial Ministers Responsible for Seniors, 2007; Hall et al., 2003; Cattan et al., 2005). It was noted by Butler (2006) and the AQCCA (2007) that elder-helping-elder programs tend to be advantageous from a social contact perspective for both the volunteer and the elder. Intergenerational programming has also been deemed a positive approach to help counter social isolation for both seniors and the younger generations (AQCCA, 2007).

As per British Columbia Ministry of Health (2004), most interventions for socially isolated seniors available in the literature are small programs that are population specific. Knowing the target population and assessing possible consequences of planned interventions is deemed important (British Columbia Ministry of Health, 2004). For example, the needs of specific groups such as lesbian, gay, bisexual people were discussed in the literature. It was suggested that guidance for care providers was necessary as was a public campaign on older lesbian, gay and bisexual social and health issues (Guasp, 2011). Health Canada (2009) indicated home assessments could be used to identify isolated seniors in their summative evaluation of the First Nations and Inuit Home and Community Care. Furthermore, they stipulated that by addressing social problems, such as poverty, housing, substance abuse and depression, social isolation among elders could be alleviated.

Dickens et al., (2011) concluded that future interventions should incorporate specific characteristics that have proven to be successful in targeting socially isolated older people. In fact, research literature reports that group interventions are effective for some individuals (Wenger & Burholt, 2004; Cattan, White, Bond & Learmouth, 2005; Medical Advisory Secretariat, 2008; Raymond et al., 2008; MacCourt, 2007). These include social support activities within a group format (e.g. regular meetings at rehabilitation centre, involving elderly individuals, therapeutic writing, physical activities, such as Nordic stick walking, swimming, etc.), and interventions developed within the context of a theoretical basis and where seniors are active participants (Dickens et al., 2011; Pitkala, Routasalo, Kautiainen & Tilvis, 2009). Moreover, it was demonstrated in a study by Winningham & Pike (2007) that by exposing older adults in an institutionalized setting to a cognitive enhancement programme (group-based intervention), it may have a positive influence on the quality of their social networks, cognitive functioning, mental health and quality of life. Support groups can also provide opportunities to share experiences and help to develop coping skills (Federal/Provincial/Territorial Ministers Responsible for Seniors, 2007).

Support can arise from a variety of sources. Raina, Waltner-Toews & Bonnett (1999) demonstrated that social isolation and loneliness could be improved by companionship from a pet (as cited by Seymour and Gale, 2004). Another study supports pet companionship as an accessible coping mechanism for older women living in the community (Krause-Parello, 2008).

In a report for the Mental Health Commission of Canada, it was noted that there is a need to raise awareness among seniors, the general public, and health and social service providers to dispel the myths about aging. As well, helping individuals to identify the signs and symptoms of mental health problems could increase early detection and interventions (MacCourt, Wilson & Tourigny-Rivard, 2011).

The use of the internet as a means to reduce feelings of loneliness and increase well-being was studied by Sum, Mathews, Hughes & Campbell (2008). It was suggested that increased use of the internet as a communication tool was associated with decreased social loneliness (Sum et al., 2008; Seymour & Gale, 2004). White, McConnell, Clipp, Branch, Sloane, Pieper & Box (2002) also conducted a randomised controlled trial that assessed the psychological effect of providing internet access to older adults, where this resulted in lowering loneliness and depression (as cited by Seymour & Gale, 2004). The feasibility of using low cost videophones between nursing home residents and their families was conducted by Mickus and Luz (2002) and demonstrated that this technology reduces isolation of older people living in institutions (as cited by Seymour & Gale, 2004, p.62). Authors stipulated that seniors should be trained to use specific internet functions to help reduce loneliness and increase well-being (Sum et al., 2008). Cotten et al., (2013) also indicated that internet use helps to counteract effects of social isolation. As per Lennon & Curran (2012) attitudes towards social networking (e.g. Twitter, Facebook) are positive among older users; however, they do not like to be pressured into being active on social networking sites.

Federal initiatives

The federal New Horizons for Seniors Program (NHSP)Footnote 2  is also described in the literature as a program that encourages seniors to contribute to their communities through active and social participation (MacCourt, 2007; Senate Committee on Social Affairs, Science and Technology, 2013). The summative evaluation of the NHSP (2010) revealed that projects that are based on community collaborations and raise awareness of or improve seniors’ access to available resources and services help seniors to form and strengthen connections and engage in formal and informal social support networks. The evidence indicates that in many cases, these connections endure beyond the life of the projects.

In addition, the federal government collaborates with provinces to promote the World Health Organization’s Age-Friendly Communities Initiative that has a purpose of making communities better, healthier and a safer place to live for seniors. Included among its goal are ensuring transportation is accessible and improving access and opportunities for seniors to participate in civic, cultural, employment and volunteer activities in their communities (Senate Committee on Social Affairs, Science and Technology, 2013.

The federal government also supports numerous programs that indirectly reduce risk factors associated with social isolation; these include pension programs and housing support programs.

Provincial/territorial initiatives

There are many provincial and territorial programs and services that currently address social isolation either directly or indirectly. Ciliska, Hayward, Thomas, Mitchell, Dobbins, Underwood, Rafael & Martin (1996) demonstrated that home visits by public health nurses with all groups in Canada has been shown to be effective in countering depression and showed reduced levels of care required for older people (as cited by Seymour & Gale, 2004). Likewise, recommendations from Hall et al. (2003) include establishing home visiting services for seniors who are unable to participate in community programs as well as supporting service providers and volunteers to spend extra time with homebound individuals who are at risk of social isolation. As per Timonem & O’Dwyer (2010), delivery volunteers of meals on wheels programs can also have a positive impact on the lives of socially isolated seniors.

British Columbia Ministry of Health (2004) noted that peer visiting models are the most common type of programs with the goal of reducing social isolation and that many Canadian cities have established this type of program. Cattan et al. (2011) examined the impact of telephone befriending programs on older people’s well-being. Their study found that such a low-cost program helped older people to gain confidence, re-engage with the community and become socially active.

Another strategy that facilitates access to community resources is the BC Health and Seniors’ Information Line, which provides information to seniors about provincial and federal health and social services via a 1-800 telephone number. Information representatives can also respond to questions about services for seniors, provide direct contact to other agencies and assist in filling out forms (MacCourt, 2007). Examples of strategies that facilitate social participation and promote wellness include the BC Healthy Aging through Healthy Living: Blueprints for healthy aging (MacCourt, 2007).

Community initiatives

Since caregiving places seniors at increased risk of social isolation, adult day programs or in-home respite can provide caregivers with relief to run errands, attend appointments and remain socially engaged (MacCourt, 2007; Wenger & Burholt, 2004; Sherman & Lacarte, 2012). Furthermore, by providing in-home support for activities of daily living, frail seniors may be able to conserve their energy for activities that are meaningful to them, such as social activities (MacCourt, 2007).

Linkages between transportation and level of participation in social activities were discussed in the literature. Access to public transit, taxis and car pools are of great value especially for seniors (particularly women) who are less likely to drive after the age of 85. It was stipulated that organizations that offer services to seniors should also be encouraged to offer them transportation and/or for communities to ensure that accessible transportation options are available for those with limited mobility (Turcotte, 2012; Hall et al., 2003; Pinquart & Sorensen, 2001; Abbott & Sapsford, 2005; AQCCA, 2007).

Other than transportation, access to information about available resources, services and education for seniors using a variety of methods that are sensitive to potential barriers such as literacy and communication impairments are also strategies that facilitate access to community resources (MacCourt, 2007; Federal/Provincial/Territorial Ministers Responsible for Seniors, 2007; Hall et al., 2003; AQCCA, 2012). Moreover, staff and volunteers should be supported and provided with ongoing training opportunities to ensure that they understand social isolation and identify those at risk of social isolation (Federal/Provincial/Territorial Ministers Responsible for Seniors, 2007; Cattan et al., 2005; Paul et al., 2006).

The Ottawa Public Health Community Connect Program (2013) provides information on the signs that older adults may be at risk of social isolation. The program helps to link socially isolated or at-risk older adults with services and supports to ensure their safety and independence in their home. It also offers training to those who have regular contact with older adults.

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