Discuss about the Research Project for World Health Organization.
Social isolation has been identified as a prevalent and major health problem among the older adults dwelling in the community that is leading to several detrimental health conditions. The prevalence is increasing with the increasing number of older adults in the community, social isolation is bound to affect the quality of life, well-being and health of the older adults now and in the near future (Steptoe et al. 2013). Giuli et al. (2012) carried out a longitudinal study to analyze the association between the functional, socio-demographic and psychological aspects on the risks of re-hospitalization, mortality and social isolation on the elderly. From the study, it was derived that women were more on the risk of social isolation than men and the patients whose family components were higher with better quality of life were found to be less socially isolated. Another research work by Hawton et al. (2011) highlighted the fact that social isolation has a burden on the well-being and health of the older people. The health state values and health status were found to be lower than the general population of UK. The limitation of the study was that the relationship directionality between the health status quality of life and social isolation was not deduced from the analysis. Therefore, from the study, a gap was identified that had to be addressed. Pettigrew et al. (2014) carried out a research work to suggest that group activities may be helpful for reducing the social isolation. The lay theories adopted by the researchers were not applied to a broad range of groups for generalizing the results. Therefore, older people with poor health were not included in the study that indicated a drawback of the study that did not facilitate comprehensive interpretation. According to the research by (Pantell et al. 2013), social isolation was identified as a predictor of mortality and found to possess equal potential when compared to the traditional clinical risk factors. This study had limitations like the true data for social activity was not captured that might have affected the relationship. From these limitations and gaps, the research question was designed to address them and identify the issues that are the potential risk factors associated with the social isolation in the older people None of the papers discussed the importance of the risk factors or identified them for the mitigation of social isolation related health issues of the elderly population. Therefore, it was essential to identify the risk factors that are associated with the social isolation in the older people. Identification of the risk factors will be of definite help for the clinical practice and professional knowledge for preventing social isolation of the older people in the community and help them achieve healthy aging.
What risk factors are associated with social isolation in older people?
Paper: 1
Aylaz, R., Aktürk, Ü., Erci, B., Öztürk, H. and Aslan, H., 2012. Relationship between depression and loneliness in elderly and examination of influential factors.Archives of gerontology and geriatrics, 55(3), pp.548-554.
The authors carried out a correlation and descriptive study for examining the relationship that existed between loneliness due to social isolation and depression in the older people and studied the influencing factors.
The authors carried out a thorough investigation with a study population of 17,080 older people who were aged over 60 years and the study setting consisted of 6 FHCs (Family Healthcare Centers) located in Malatya. Study sample was focused on 913 older people and the sampling procedure followed was cluster and simple random sampling. Data collection was done using a set of questionnaire that was developed by the research investigators. The development process considered the literature, the ULS (UCLA Loneliness Scale) and the GDS (Geriatric Depression Scale). Stepwise linear regression was used for the statistical analysis of the obtained data by frequency distribution. The mean score from the GDS was found to be 13.83±4 and from the ULS it was found to be 40.50±12.1. Therefore, a positive correlation was derived between the loneliness due to social isolation and geriatric depression where r=0.608 and pË‚0.001.
The main limitation of the study was that the older people were randomly included in the study as samples and the exclusion criteria were not satisfactory as it ignored the sample who were vulnerable to depression due to loneliness. In addition, the study was conducted in a small demographic area ignoring the health problems of the older people who were not registered.
This article will be useful for the research question as the study concluded on the fact that a significant relationship exists between depression and loneliness due to social isolation and therefore, depression has been identified as a risk factor that is associated with social isolation in older people.
Paper: 2
Mick, P., Kawachi, I. and Lin, F.R., 2014. The association between hearing loss and social isolation in older adults.Otolaryngology–Head and Neck Surgery, 150(3), pp.378-384.
In this article, the authors determined that hearing loss that is age related is associated with social isolation and examined whether the factors like race, income, gender and age had moderate effects on the association.
The authors conducted a thorough investigation in the form of a cross-sectional study and the study setting included the communities of United States that were randomly sampled. Analysis of the cross sectional data was carried out on the cycles of the National Health and Nutrition Examination Survey for the years 1999 to 2006 on the older adults aged 60 to 84 years. The study participants included 860 people in the 60 to 69 years group and 593 people in the 70 to 84 years group. Social isolation was the dependent variable in the study and it was defined by using SIS (Social Isolation Score). The scores of SIS ≥2 indicated social isolation and the predictor or independent variable was the hearing thresholds of speech frequency in the ear. Otologic, demographic and medical cofounders made up the covariates. Multivariate logistic regression evaluated the possible association between social isolation and hearing loss. Hearing loss was found to be associated with social isolation in the women who were aged 60 to 69 years where the confidence interval was 95% and PË‚001. Effect of gender was found to be significant in the studied group and was found to be P = 0.003.
The main limitation of the study was that the SIS and SSQ questionnaire were not formally standardized and evaluated without appropriate weighing of the composite scores. Information was not gathered for the individuals who did not participated in the study or were excluded under the criteria.
It is relevant to the project because the authors concluded on the note that hearing loss is associated with social isolation and that is a risk that is associated with social isolation in older people.
Paper: 3
DiNapoli, E.A., Wu, B. and Scogin, F., 2014. Social isolation and cognitive function in Appalachian older adults.Research on aging, 36(2), pp.161-179.
In this article, the authors investigate the relation between cognitive function and social isolation for identification of the components to incorporate into the cognitive interventions.
The research of the authors focuses on the specific cognitive domains and overall cognitive functioning of 267 older adults who were community dwellers in the 14 counties of West Virginia in the age range of 70 to 94 years. This assessment was done from the data collected from a neuropsychological battery that was self assembled and used for frequently used tasks. Perceived isolation, social disconnectedness and social isolation were measured using the Lubben Social Netwrok scale-6. From the results of the study, positive association was found between the outcome variables and the predictor variables. Perceived isolation was found to be almost double for the variance between the cognitive functioning and the social disconnectedness and the found value was 10.2% with 5.7% respectively.
The main limitation of the study was that it is a cross sectional study and longitudinal studies well explain the direction of the association between cognition and social isolation. Diverse ethnic and racial backgrounds were not taken into consideration in the state of West Virginia.
This article is useful for the research question as the study finding suggested that cognitive functioning is associated with social isolation and therefore, it can be identified as a risk factor that is associated with social isolation in older people. The finding of the study remains true and valid across the various cognitive domains and social isolation.
Paper: 4
Kvaal, K., Halding, A.G. and Kvigne, K., 2014. Social provision and loneliness among older people suffering from chronic physical illness. A mixedâ€Âmethods approach.Scandinavian journal of caring sciences, 28(1), pp.104-111.
The authors described and compared the social provision between two groups one of which was not lonely and the other was lonely due to social isolation by a mixed method approach.
The authors carried out a thorough investigation of loneliness due to social isolation and 101 study participants were included in the of from the geriatric wards. Inclusion criteria consisted of the age factor which was 65 years or older and should not possess dementia with multiple physical disorders that are chronic. The mean age of the study was 81.3 years and comprised of 68% as women participants and 66% lived alone. Assessments of loneliness and social provisions were collected using MADRS (Montgomery-Aasberg Depression Rating Scale) and SPS (Social Provision Scale). The participants were also asked to describe their loneliness and their statements were condensed into smaller sentences. Ethical considerations were observed during the study and the ward nurses and the patients were appropriately informed of the study. Results of the study showed that 75% of the participants felt lonely out of which 18% had depression and 54% lived alone. Loneliness was described by the participants as negative emotions and emptiness.
The main limitation of the study was that the questionnaires used in the study were not constrained to the context of the hospital. Therefore, the experiences collected from the participants were basically of their home lives and general feelings.
In particular, this article will assist in the research project as the study demonstrated that 75% of older people who felt lonely due to social isolation suffered from chronic illness. Therefore, it can be well stated that chronic illness is a risk factor associated with social isolation in older people.
Aylaz et al. (2012) carried out their study for examining the relationship between loneliness and depression in the older people. Loneliness comes from social isolation and depression is one of the risk factor in the elderly that associated with social isolation (Cacioppo et al. 2011). The authors have also investigated the other demographic variables like income level, occupation, age and security. Social withdrawal is the commonest sign of depression and it worsens the illness by amplifying the stress response of the brain. Increasing social association can improve the condition of the older people and reduce the symptoms of depression thereby, reducing the risk factor (Hawton et al. 2011). The authors in the study have recommended that higher income and social security can reduce social isolation however, proposal for the development of government policies to take care of the isolated elderly people could have improved the situation on a larger scale. Mick, Kawachi and Lin (2014) determined that social isolation is associated with hearing loss and other factors like race, income, gender and age. Older people suffering from hearing loss often struggle to keep up with the conversation and finally withdraw once they fail to put up with it. Consequently, it leads to withdrawal from the social events and other interactions and leads to social isolation (Dickens et al. 2011). Although the study provided a detailed account for the establishment of the relationship between hearing loss and social isolation, it lacked in the demonstration of the efficacy of overcoming social isolation after successful repairing of hearing impairment of the older people. This aspect could have given the study a better platform for declaring hearing loss as an essential risk factor for social isolation. DiNapoli, Wu and Scogin (2014) investigated the relationship between cognitive function and social isolation for its identification as a risk factor for social isolation. Cognitive decline has been regarded as an important issue of healthcare that is faced by the older population and due to the barrier in recognizing people socially, they tend to stay alone and it brings about social isolation among the older people. Poor mental health conditions cause them to live alone and the authors have built up the relation to demonstrate this fact (Shankar et al. 2013). However, a substantial gap has been identified as the authors did not exhibit any study to show the improvement of the cognitive health with the appropriate intervention strategies. Kvaal, Halding and Kvigne (2014) compared and described the feelings of loneliness and social provision for the older people who suffered from chronic physical illness. It is evident that chronic physical illness often leads to psychosocial risk factors due to the lack of physical energy to communicate with people. Therefore, the older people choose to stay aloof and suffer social isolation (Coyle and Dugan 2012). The authors have demonstrated this fact by a comparison among two groups but did not give enough evidence to demonstrate whether intervention by mental and moral support improve the condition for the older people, in spite of the physical illness. Although the articles discussed in this research project thoroughly described the risk factors and their association with social isolation in older people, further research in their implementation of intervention strategies could give a better insight to overcome this issue in the older people. As the problem of social isolation is increasing in the community, providing the correct strategies could have led to a new direction in better and healthier aging.
Conclusion
According to World Health Organization, social isolation among the older adults is associated with higher premature death rates, increased depression, lower health and well-being and chronic diseases (World Health Organization, 2016). Community health and nurses have an important role to play to solve the issues of chronic diseases and well-being that causes social isolation in older adults. Few research articles were discussed in this project where the researchers investigated the associated risk factors. However, determination of the risk factors alone would not solve the problem of social isolation. It requires implication of the suggested intervention strategies and further research to discover newer procedures to reduce social isolation which was the commonly identified gap in the research papers (Nicholson 2012). Apart from the discussed risk factors, there are several other risk factors which need a discussion that can provide a future direction for research. Social isolation is associated with a large number of deaths every year and a future research in identifying and eliminating the risk factors could improve the aged lives of the older people.
References
Aylaz, R., Aktürk, Ü., Erci, B., Öztürk, H. and Aslan, H., 2012. Relationship between depression and loneliness in elderly and examination of influential factors. Archives of gerontology and geriatrics, 55(3), pp.548-554.
Cacioppo, J.T., Hawkley, L.C., Norman, G.J. and Berntson, G.G., 2011. Social isolation. Annals of the New York Academy of Sciences, 1231(1), pp.17-22.
Coyle, C.E. and Dugan, E., 2012. Social isolation, loneliness and health among older adults. Journal of Aging and Health, 24(8), pp.1346-1363.
Dickens, A.P., Richards, S.H., Greaves, C.J. and Campbell, J.L., 2011. Interventions targeting social isolation in older people: a systematic review.BMC public health, 11(1), p.1.
DiNapoli, E.A., Wu, B. and Scogin, F., 2014. Social isolation and cognitive function in Appalachian older adults. Research on aging, 36(2), pp.161-179.
Giuli, C., Spazzafumo, L., Sirolla, C., Abbatecola, A.M., Lattanzio, F. and Postacchini, D., 2012. Social isolation risk factors in older hospitalized individuals. Archives of gerontology and geriatrics, 55(3), pp.580-585.
Hawton, A., Green, C., Dickens, A.P., Richards, S.H., Taylor, R.S., Edwards, R., Greaves, C.J. and Campbell, J.L., 2011. The impact of social isolation on the health status and health-related quality of life of older people.Quality of Life Research, 20(1), pp.57-67.
Hawton, A., Green, C., Dickens, A.P., Richards, S.H., Taylor, R.S., Edwards, R., Greaves, C.J. and Campbell, J.L., 2011. The impact of social isolation on the health status and health-related quality of life of older people.Quality of Life Research, 20(1), pp.57-67.
Kvaal, K., Halding, A.G. and Kvigne, K., 2014. Social provision and loneliness among older people suffering from chronic physical illness. A mixedâ€Âmethods approach. Scandinavian journal of caring sciences, 28(1), pp.104-111.
Mick, P., Kawachi, I. and Lin, F.R., 2014. The association between hearing loss and social isolation in older adults. Otolaryngology–Head and Neck Surgery, 150(3), pp.378-384.
Nicholson, N.R., 2012. A review of social isolation: an important but underassessed condition in older adults. The journal of primary prevention,33(2-3), pp.137-152.
Pantell, M., Rehkopf, D., Jutte, D., Syme, S.L., Balmes, J. and Adler, N., 2013. Social isolation: a predictor of mortality comparable to traditional clinical risk factors. American journal of public health, 103(11), pp.2056-2062.
Pettigrew, S., Donovan, R., Boldy, D. and Newton, R., 2014. Older people’s perceived causes of and strategies for dealing with social isolation. Aging & mental health, 18(7), pp.914-920.
Shankar, A., Hamer, M., McMunn, A. and Steptoe, A., 2013. Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosomatic Medicine,75(2), pp.161-170.
Steptoe, A., Shankar, A., Demakakos, P. and Wardle, J., 2013. Social isolation, loneliness, and all-cause mortality in older men and women.Proceedings of the National Academy of Sciences, 110(15), pp.5797-5801.
World Health Organization. (2016). Mental health and older adults. [online] Available at: https://www.who.int/mediacentre/factsheets/fs381/en/ [Accessed 17 Aug. 2016].
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