Prevention And Intervention Strategies For Isolation And Loneliness In Old Age

Discussion

Rapid improvement in modern healthcare technology has increased the life expectancy in current generation of human population. This in turn increased the population growth of elderly people needing various medical assistant. Health problem in elderly people is not just presence of disease or illness like young people. For elderly people, health problem can be psychological, social or physical. These factors have affected their life to live happily or challenge their nous of self-sufficiency. These factors can arise from various reasons such as absence of family bonding, living alone, living apart from their cultural origin and inability to participate in social gathering or activities (Farooqi 2014). As a result, major mental health issues like social isolation and loneliness are foremost problems for the elderly people (Franck, Molyneux and Parkinson 2016). The term loneliness and social isolation are interrelated but different in definition. Loneliness is the state of being alone or feeling apart from other family members whereas social isolation is the absence of interactions and contacts from social network. Survey and study over the years have shown that almost 33% people aged over 65 years sometimes feel lonely (Hauge and Kirkevold 2012). This percentage is even higher to the people aged over 80 years old (Hauge and Kirkevold 2012). Recently, various studies have been done on the effect of loneliness in elderly people. Also, many researches have been focused on the effectiveness of the prevention and intervention strategy for elderly people. Therefore, in this article, prevention and intervention strategies to reduce the loneliness and isolation of elderly people will be discussed. Along with that, each strategy will be analysed on the basis of their impact, context and implementation.

There are lot of intervention methods have been studied and examined by the researchers. Many of them are interrelated with each other. In general, six intervention strategies will be discussed here within. These strategies are social interventions, social and healthcare endowment, psychological rehabilitations, befriending interventions, leisurely activities and animal or pet interventions (Gardiner, Geldenhuys and Gott 2018).

Definition: The definition of social intervention can be defined as intentional interference to provoke changes with an aim to eradicate or reduce risk factors and harm in elderly people. These interventions might be complex or simple. The main goal of this intervention is to encourage lonely or isolated people to socially interact more with their peers (Gardiner, Geldenhuys and Gott 2018).

Context and Impact: Generally, this strategy involved in mutual beneficiary to all members and also requires some involvement. Social intervention can be both group activities and one-on-one interventions. This intervention can be performed in various activities like day care centres, friendship club and by technology based program (video conferencing or social media) (Khosravi, Rezvani and Wiewiora 2016). The result of the studies related to the social invention has shown mixed and contradictory results. Some studies have reported no significant difference in their findings. For example, Lecovich and Biderman (2012) have studied the loneliness between groups of day care users and non-users. Their aim was to study the co-relation between frequency of presence and loneliness. They used Jong Gierveld scale to measure the loneliness. They reported that there is no significant difference in loneliness between the groups. On the contrary, Hemingway and Jack (2013) have showed that participants were beneficial and their social well-being, friendship, support and relation have improved. They used as friendship club as a target for social intervention. Alviani et al. (2015) have also reported improved benefits for their target group in comparison with the control group. Unlike the previous authors, they have used a multi-tiered program. Their performance measure scale was UCLA loneliness scale.

Social intervention

Implementation: From the above discussion, it can be said that there is no particular method of social interventions. Different researchers have used different socials inventions. Singular intervention plan might be successful or might be not as depicted above. Hence, it will be better to use a multi-pronged strategy where chances of success will be higher compared to singular intervention plan.

Definition: In social and healthcare endowment, intervention strategies were involved in taking social help or support from medical practitioner regarding their health or related problems. This intervention can be categorised into two categories which are environment focussed or person focussed.

Context and Impact: Social and healthcare interventions can be applied in various ways like taking care of individual’s health, social and cultural commitment and interactions, and structural health (Gardiner, Geldenhuys and Gott 2018). Nicholson and Shellman (2013) studied the effect of CARELINK programme on social isolation in elderly people. CARELINK programme was to provide social health by visiting the elderly people. Nursing students visited the elderly people to enhance their relationship and community building skills. Their intervention was sixteen week long and performance was measured in Lubben Social Network Scale. They found out that the group which were on waiting list of CARELINK programme are more susceptible to isolation. Van der Heide et al. (2012) have also examined this intervention strategies using video conferencing like care TV. They used video conferencing to allow users to contact with a nurse any time. Subjects were also able to connect with their friends, family and carers. Their experiment length was for one year and pre and post design measurement were taken using De Jong-Gierveld loneliness scale. In their study, they have shown that a significant reduction in loneliness for the older people. However, they have also mentioned the implementation issues related to this particular intervention method which are organisational policies, technological non-awareness and financing problem. Other researchers have also reported decreased loneliness during their study.

Implementation: Therefore, it can be inferred that social and healthcare interventions has a positive impact on elderly people to reduce isolation and loneliness. Although, most of these methods are costly and have some implementation issues, these are at least effective in case to reduce the isolation and loneliness in elderly people.

Definition: Similar like other therapies or treatments, psychological rehabilitation aim to lessen the suffering, restore usual functioning and if possible prevent and cure difficulties. It is almost as effective to the older people as to the younger generations. Benefits of psychological rehabilitation in elderly people are many. They can spend meaningful, happy and fulfilling life due to personal renovation as a direct result of psychological rehabilitation. Context and Impact: Psychological rehabilitation can be useful to the elderly people for symptoms like depression and dementia other than just loneliness and isolation (Gardiner, Geldenhuys and Gott 2018). Fortunately, recently there has been steady increase in the information available in the psychological rehabilitation which leads to more application of this method. There are various common themes medical professionals encounter when dealing with patients needing psychological rehabilitation. One of them is self esteem of the patient. It is the medical professionals job to understand how the patients is seeking approval and how to maintain the patient’s self esteem better. Another common issues regarding old age is loss. Due to the old age, the patient is bound to experience some actual losses like friends, spouses or relatives. One side effect of this kind of loss is survivor’s guilt. The loss of their normal functionality and independence also affect their psychological behaviour. From the perspective of psychodynamic point of view, these losses in the older age are generally known as ‘narcissistic injuries’. A person with poorly developed psychology cannot deal with these losses whereas to a person with better developed psychology it is far less exhausting. Thus, psychological rehabilitation can be used to develop a patient’s psychology healthier to handle his/her losses better. Another psychological issue in old age is the fear of looming death. The thought of not existing and the question of life after death is a pressing concern to them, even if they are not religious. Psychological rehabilitation is a very useful technique to tackle these emotional problems and predicaments (Cuijpers et al. 2014).

Social and healthcare endowment

Implementation: In a nutshell, psychological rehabilitation in elderly people is more or less similar to psychological rehabilitation in younger people with some unique issues like transference and counter transference. An individualistic, tailored and flexible approach is needed to make psychological rehabilitation useful to elderly people.

Definition: Befriending interventions can be defined as a form of social assistance to provide new friendship to lonely and isolated people. This intervention has been mainly adopted by voluntary organisations. Volunteer from these organisations supports individuals suffering from loneliness, dementia or isolation. However, there is a disagreement amongst the academics about its exact definition, its mechanism or how it should be used most effectively. Context and Impact: Currently befriending interventions being used in the healthcare and social situation to provide compassionate support and companionship. Although, there is comparably little research available that examines the effectiveness of befriending interventions (Gardiner, Geldenhuys and Gott 2018). Some studies suggests that befriending interventions has been able to provide new direction, encouraged social activities and improved self esteem of people with mental and health problem. Generally these studies are basically qualitative studies and are not quantitative study. For one instance, Bartlett et al. (2013) have studied the effectiveness of befriending interventions on the project ‘Queensland Project to Reduce SI in Older People’. Data collection of their study was pre and post study basis with duration of six month. They used Social support scale and De Jong Gierveld scale to measure the effectiveness of the study. Their intervention projects included fitness program, buddy system, volunteer workers and individual or community building capacity. In their study, they have not found any conclusive quantitative results to support the effectiveness of their project on social support and loneliness. Along with that they have also noted a variety of methodological challenges while evaluating these kinds of interventions. On the contrary, a review study concluded that befriending interventions have significantly decreased anxiety and depression and enhanced social support in elderly people with chronic health conditions (Siette, Cassidy and Priebe 2017).

Implementation: Therefore, from above conclusion it can be deduced that befriending interventions have different effect on different social groups and it remains ambiguous whether befriending intervention have an impact on the outcome. Hence, it is imperative to study the effect of befriending interventions on different levels of social support groups with well defined befriending criteria and principles.

Definition: Penultimate intervention or category will be focussed on leisurely activities. Normally, leisurely activities act as a mediator and can be defined as enjoyable and preferred activities performed in one’s free time. Leisurely activities can help a person recover from stress or restore physical and social resources. Leisurely activities can be varied from use of internet, voluntary works, sports, holidays or gardening programmes (Gardiner, Geldenhuys and Gott 2018).

Context and Impact: In the past few years, lot of research have been performed to study the link between leisurely activities and mental health. For example, Heo et al. (2015) have studied the effect of internet usage on loneliness, physical well-being and social support. They performed secondary analysis of 5203 elderly people’s data. They reported that high level usage of internet was a major indicator for high level of reduced loneliness and social support. On the other hand, Toepoel (2013) have investigated the link between leisurely activities and isolation using leisurely programmes likes sports, holidays, watching TV, voluntary works, reading, shopping and cultural works. To measure the effectiveness Toepoel have used five dimension of social connectedness including De Jong Gierveld Scale. Toepoel reported that leisure has no effect on the loneliness for the age group of 65 – 74 years old. For the age group of above 75 years old, oldest age group, sports and cultural activities reduce loneliness. Toepoel also reported that increment of loneliness is directly proportional to age. Implementation: To summarize, leisurely activities is much broader area than just physical activities. Researchers have clearly shown that there is a link between reduction of loneliness and leisurely activities. Thus, it will be really helpful as an interventions tool for elderly people if future health policies were developed keeping this in mind.

Psychological rehabilitation

Definition: Final interventions category to reduce loneliness and isolation will be focussed on animal assisted interventions. Animal or pet interventions is a broad term and can be described as use of various species of animal to support and help human being to improve their social, physical, cognitive or emotional function (Gardiner, Geldenhuys and Gott 2018). Context and Impact: Animal or Pet interventions should be handled by professionally trained personnel and should be regularly monitored. Involvement of a Veterinarian in this program is paramount as they can advocate for the well-being of the animals involved in this program. Animal or Pet interventions can be performed in different way and can be majorly segmented in four segments which are Animal assisted therapy (AAT), Animal assisted education (AAE), Animal assisted activities (AAA) and Resident animals (RA). A number of studies have suggested animal assisted therapy as treatment for depression for institutionalized patients. One of this investigation, investigators used cat as a pet therapy. Half of their subjects were introduced to a cat supervised by a nurse where they could play with the nurse. Exposed subject did not show any significant difference in Geriatric Depression Screen score or MMSE but they did have significantly lower blood pressure level compared to non-exposed subjects. Although, studies have shown potential benefits of pet therapy, the studies still remain in preliminary stages. Also, application of pet therapy comes with an added risk of potential harm to elderly people. Along with that, pets can be time consuming, difficult to care for and expensive (Cherniack and Cherniack 2014).

Implementation: As a whole, detailed planning, use of skilled trainer and much more diverse research is needed in this area to transform it in an efficient technique.

Conclusion

Consequently, it can be deduced from the above discussion that a broad range of intervention method have been developed to battle loneliness and isolation amongst elderly people. Most of the interventions methods have success to some extent in reducing loneliness and isolation in elderly people, but no single method is efficient enough to work as a standalone intervention technique. Lots of researches have been devoted in this particular area, but unfortunately, further research is needed to arrive in a conclusive proof and to develop an efficient intervention technique to reduce isolation and loneliness in elderly people.

References

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