“Not Alone in Loneliness”: A Qualitative Evaluation of a Programme Promoting Social Capital Among Lonely Older People in Primary Health Care (original) (raw)
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Promoting social capital to alleviate loneliness and improve health among older people in Spain.
Loneliness is especially frequent among older people in Southern Europe. Furthermore, promoting social capital to tackle loneliness and its health effects is an understudied intervention strategy. Therefore, a complex intervention was piloted in Spain in a pre-post study with a 2-year follow-up. Its aims were to explore the feasibility of the intervention and its short- and long-term effects. It was conducted in one mixed rural-urban and two urban areas of diverse socioeconomic levels from 2011 to 2012. The intervention framework was based on social capital theory applying a behaviour change model and care co-ordination. The intervention comprised: (i) a co-ordinated action aimed at building a network between primary healthcare centres and community assets in the neighbourhood and (ii) a group-based programme, which promoted social capital among lonely older people, especially social support and participation. Older people active in senior centres volunteered as gatekeepers. The main outcome domain was loneliness. Secondary outcome domains were participation, social support, self-perceived health, quality of life, depressive symptoms and use of health resources. Pre-post changes were assessed with t-test, Wilcoxon signed-rank test and McNemar's test. Differences between the three time points were assessed with a one-way ANOVA with repeated measures. Social workers and nurses were successfully involved as group leaders, 10 volunteers took part and 38 participants were included. After the intervention, loneliness decreased while social participation and support significantly increased. Furthermore, the number of visits to nurses increased. Exactly 65.8% of the participants built social contacts within the group and 47.4% became engaged in new activities. Two years later, social effects were maintained and depressive symptoms had decreased. Exactly 44.7% of the participants continued to be in contact with at least one person from the group and 39.5% continued participating. The intervention contributes a novel and feasible social capital-based approach for alleviating loneliness among older adults while prompting meaningful changes in their lives.
Health & social care in the community, 2017
Loneliness in later life is a common problem with poor health outcomes. However, interventions to prevent or ameliorate loneliness have a weak evidence base. The views of older people experiencing or at risk of loneliness in the community are important in identifying features of potential support, but have been little studied. Twenty-eight community dwelling people, aged 65 and over who reported being 'lonely much of the time' or identified as lonely from the de Jong Gierveld six-item loneliness scale in a larger study, participated in in-depth interviews, between June 2013 and May 2014. Views and experiences on seeking support from primary care and community based one-to-one and group based activities, including social and shared interest groups, were explored. Interviews were recorded and transcribed. Thematic analysis was conducted by a multidisciplinary team, including older people. Using two different measures of loneliness enabled a spectrum of loneliness experience to...
Healthcare Professionals’ Perceptions of Loneliness amongst Older Adults: A Qualitative Study
International Journal of Environmental Research and Public Health, 2021
Background: Loneliness amongst older adults is linked to poor health outcomes and constitutes a public health issue worldwide. Healthcare professionals’ perceptions could influence the strategies they implement in order to prevent, detect and manage loneliness amongst older adults. The aim of this study was to describe and understand healthcare professionals’ perceptions of loneliness amongst older adults. Methods: A descriptive qualitative study. Twenty-six Spanish healthcare professionals with experience caring for older adults participated in the study. Data were collected between November 2019 and September 2020 using focus groups and in-depth interviews. Data were analysed following a content analysis method using ATLAS.ti software. Results: Healthcare professionals’ perceptions of loneliness amongst older adults is represented by three themes: (1) “when one’s personal life and social context lead to loneliness”; (2) “from abandonment to personal growth: the two faces of loneli...
International psychogeriatrics, 2018
ABSTRACTObjectives:To (i) systematically identify and review strategies employed by community dwelling lonely older people to manage their loneliness and (ii) develop a model for managing loneliness. A narrative synthesis review of English-language qualitative evidence, following Economic and Social Research Council guidance. Seven electronic databases were searched (1990-January 2017). The narrative synthesis included tabulation, thematic analysis, and conceptual model development. All co-authors assessed eligibility of final papers and reached a consensus on analytic themes. From 3,043 records, 11 studies were eligible including a total of 502 older people. Strategies employed to manage loneliness can be described by a model with two overarching dimensions, one related to the context of coping (alone or with/in reference to others), the other related to strategy type (prevention/action or acceptance/endurance of loneliness). The dynamic and subjective nature of loneliness is refle...
Healthcare
Aims: To identify the factors conditioning the feasibility of an intervention to reduce social isolation and loneliness in noninstitutionalized older adults from the perspective of the intervention agents. Design: A Dimensional Grounded Theory study conducted from December 2019 to January 2020. Methods: Twelve participants were recruited from an experimental study developed in a health district of a southern Spanish city. Data were collected through focus group meetings, individual interviews, biograms, anecdote notebooks, and the field diaries of two participants not included in the other techniques. Transcripts were analyzed using thematic analysis. Findings: Findings were divided into three themes: (a) the elderly between the walls of loneliness, economic difficulties, losses, and the past; (b) intervention agents/volunteers between the walls of inexperience in the management of psychological/emotional processes, lack of moral authority, and difficulty in planning results adapted...
Loneliness as an unresolved issue in social inclusion programmes
Journal of social inclusion, 2022
Loneliness, social isolation and exclusion are worldwide social problems with negative effects which are exacerbated in marginalised groups and communities. From a qualitative perspective, this paper examines the approach to loneliness in 62 community-based social inclusion centres and programs for people experiencing exclusion in the Basque Country (Spain). The aim of the study was to identify good practice in dealing with loneliness in centres and programs and to understand the main challenges in providing support from the perspective of practitioners. The results show that best practices focus on individualised or person-centred interventions, the generation of interaction spaces that promote social relations, accompaniment as an intervention tool, empowerment and community participation, and employment and socio-professional training. The main challenges and difficulties are grouped into four levels. These include the users' own individual difficulties (lack of motivation, progressive deterioration and poor social skills, etc.). To a lesser extent, insufficient professionalisation of inclusion services, insufficient resources (lack of human and material means) and social problems such as stigma and social rejection are mentioned. Intervention implications that practitioners can take into account to mitigate the loneliness of people at risk and/or socially excluded are discussed.
Loneliness, older people and a proposed social work response
Journal of Social Work, 2020
SummaryThis article is based upon a scoping review of literature about older people and loneliness.FindingsIncreasingly in the UK, older people’s experience of loneliness is conceptualised as a public health concern. Social workers will wish to respond appropriately to older adults reporting loneliness but may react on the basis of keenly held assumptions about loneliness in later life, with scant regard to distinct subcategorisation of the construct. Exploring what an appropriate social work response may be, this article first sets out four misconceptions related to older people’s loneliness: that older people are especially lonely, loneliness correlates with living alone, strengthening family networks is best for alleviating loneliness, and loneliness interventions should tackle the issue directly.ApplicationsA proposed model is introduced regarding social work intervention, focusing upon direct assessment of needs, the maintenance of meaningful existing relationships and, if requ...
Aging & Mental Health, 2013
Objectives: Loneliness is an important influence on quality of life in old age and has been conceptualised as consisting of two dimensions, social and emotional. This article describes analyses that sought to produce models of social and emotional loneliness in older people, using demographic, psychological and health, and social variables. Method: Older people (aged 65þ, n ¼ 1255) from the Barnsley metropolitan area of the United Kingdom were recruited randomly from within a stratified sampling frame and received a questionnaire-based interview (response rate: 68.1%). The questionnaire contained items and scales on demographic, psychological and health, and social characteristics, and a validated measure of loneliness that assesses both social and emotional loneliness. Results: Of the respondents, 7.7% were found to be severely or very severely lonely, while another 38.3% were moderately lonely. Social and emotional loneliness shared 19.36% variance. Being male, being widowed, low well-being, low selfesteem, low-income comfort, low contact with family, low contact with friends, low activity, low perceived community integration, and receipt of community care were significant predictors of social loneliness (R ¼ 0.50, R 2 ¼ 0.25, F(18, 979) ¼ 18.17, p < 0.001). Being widowed, low well-being, low self-esteem, high activity restriction, low-income comfort, and non-receipt of informal care were significant predictors of emotional loneliness (R ¼ 0.55, R 2 ¼ 0.30, F (18, 973) ¼ 23.00, p < 0.001). Conclusion: This study provides further empirical support for the conceptual separation of emotional and social loneliness. Consequently, policy on loneliness in older people should be directed to developing a range of divergent intervention strategies if both emotional and social loneliness are to be reduced.
A realist evaluation of loneliness interventions for older people
Age and Ageing, 2021
Introduction the aim of this study was to develop a programme theory to inform the design of loneliness interventions and guide any future evaluations. Methods we undertook a mixed-method evaluation, informed by the realist approach, of different approaches to loneliness in one health and social care system in the East Midlands, UK. We used a combination of documentary analysis, interviews/focus groups with service providers and users and quantitative analysis to develop an initial programme theory. Results common aims of local interventions included enhancing social connectivity, providing emotional support and advice/information; recurring interventions included social activities, emotional support, advice and information, lunch clubs, learning new skills and practical support. None were robustly evaluated. Fifty-six service user or providers were involved in interviews or focus groups, which highlighted the causes of loneliness, preferred services, access to services, thoughts ab...
Health & Social Care in The Community, 2020
Loneliness is increasingly recognised as a global public health concern associated with a range of negative health outcomes (Cacioppo & Cacioppo, 2018; Holt-Lunstad, Smith, Baker, Harris, & Stephenson, 2015). Comparable in terms of seriousness to obesity and smoking (Hawkley & Cacioppo, 2010), loneliness has been linked to increased risk of coronary heart disease and stroke, depression, cognitive decline and Alzheimer's disease (Valtorta, Kanaan, Gilbody, Ronzi, & Hanratty, 2016). Globally, numerous studies have been undertaken to predict the extent of loneliness with research in the United Kingdom (UK) suggesting that 5% of adults in England report feeling lonely 'often' or 'always' (Office for National Statistics, 2018), while international reports suggest that one-third of adults in industrialised countries is affected by loneliness (Cacioppo & Cacioppo, 2018). This highlights the highly subjective and personal nature of