Interventions targeting loneliness and social isolation among the older people: An update systematic review
Introduction
The demographic shifting and ageing of the world population are considered a major issue urging for a comprehensive public health action (Poscia et al., 2015). Various strategies have been suggested to tackle the challenges older generations face, and one of the most promising ones is considered to be so called “Healthy Ageing”, namely, the process of developing and maintaining the functional ability that enables well-being in older age (European Commission - Directorate-General for Economic and Financial Affairs, 2014). The ability to maintain relationships is frequently regarded as important to the well-being and social relations in general are an essential component of healthy ageing (WHO | World report on ageing and health, 2016). Several studies reported that people with adequate social relationships have a greater likelihood of survival compared to those with poor or insufficient social relationships (Ellwardt et al., 2015, Holt-Lunstad et al., 2010, Tabue Teguo et al., 2016).
Social isolation and loneliness are distinct but interrelated concepts, that are linked to numerous negative consequences among the older individuals, including health behavioural, psychological and physiological outcomes (Nicholson, 2012). Social isolation is usually characterized as an objective lack of meaningful and sustained communication, while loneliness is more referred to the way people perceive and experience the lack of interaction. Although both are associated with decreases in health status and quality of life, recent literature suggests that the two terms ought to be regarded as distinct characteristics, since they may have independent impacts on health (Dickens et al., 2011). For instance, social isolation is associated with higher mortality in older men and women, but this effect is considered to be independent of the emotional experience of loneliness (Steptoe et al., 2013).
When prevalence of loneliness and social isolation among older generations is concerned, research reports quite inconsistent figures. It has been suggested that loneliness in older adults is most prevalent in the “oldest old”, referring to individuals aged 80 and over. Seven percent of middle-aged and older adults report feeling intense or persistent loneliness (Skingley, 2013), with a range of 5–16% reported across the literature (Windle et al., 2011). In addition, the review of Dickens et al. (Dickens et al., 2011) reported prevalence figures of social isolation among older people around 7–17%, depending on the definition and outcome measure used.
Recently, interventions targeting loneliness and social isolation among older individuals have been extensively studied in the literature. Indeed, several reviews tried to summarize the effects of these interventions, implementing various approaches and incorporating diverse inclusion criteria. Many of them, however, did not include a systematic approach and reached indefinite conclusions, stressing the need for further research (Stojanovic et al., 2017). One of the most recent systematic reviews on this topic evaluated the utility of loneliness interventions among the older generations and covered all primary studies published up to year 2011(Cohen-Mansfield and Perach, 2015). With this premise in mind, our systematic review aims to summarize and update the current knowledge on the effectiveness of the existing interventions for alleviating loneliness and social isolation among older persons.
Section snippets
Search strategy
We performed a systematic search of PubMed, ISI Web of science, SCOPUS, The Cochrane Library, and CINAHL databases in order to identify potentially eligible papers not included in previously published review of Cohen-Mansfield et al. (Cohen-Mansfield and Perach, 2015). Two investigators were independently involved in this process (AP and JS). Our search terminology derived from the scoping review of Prohealth 65 + Project (“65 + PRO-HEALTH - Home page,”, n.d.) and it included a broad initial
Study selection
At the beginning, 1815 potential articles were identified and 429 duplicate papers were excluded. 1386 articles were title screened and 441 abstracts were assessed afterwards. According to the inclusion criteria outlined in the Materials and methods section, 15 quantitative and 5 qualitative studies were ultimately included in the qualitative synthesis (Fig. 1).
Study characteristics
Out of 15 studies providing outcome measures (Alaviani et al., 2015, Bartlett et al., 2013, Bøen et al., 2012, Davidson et al., 2014,
Discussion
The purpose of this systematic review was to update the current knowledge on the effectiveness of interventions aimed at alleviating loneliness and social isolation among the older people. Our search yielded 15 quantitative and 5 qualitative studies, which had incorporated various approaches. The results suggested that six out of 11 group interventions (55%), one out of four mixed interventions (25%) and three out of three individual interventions (100%) reported at least one significant
Conclusion
Although the number of studies on interventions targeting loneliness and social isolation among the older people is constantly increasing, our review did not reach solid conclusions. Some interventions have brought promising results, even though their generalizability is questionable. This review identified new technologies as a promising tool for tackling social isolation and loneliness among the older individuals along with community engaged arts, which brought positive results especially
Authors contributions
Study conception and design: Andrea Poscia, Nicola Magnavita, Mariusz Duplaga.
Acquisition of data: Stojanovic Jovana, Andrea Poscia, Daniele Ignazio La Milia, Agnese Collamati.
Analysis and interpretation of data: Stojanovic Jovana, Andrea Poscia, Nicola Magnavita, Umberto Moscato, Onder Graziano, Agnese Collamati, Walter Ricciardi.
Drafting of manuscript: Stojanovic Jovana, Andrea Poscia, Agnese Collamati, Daniele Ignazio La Milia, Nicola Magnavita.
Critical revision: Mariusz Duplaga, Marcin
Funding
“This publication arises from the project Pro-Health 65 + which has received funding from the European Union (2013 12 10 Pro Health 65+), in the framework of the Health Programme (2008–2013).
The content of this publication represents the views of the author and it is his sole responsibility; it can in no way be taken to reflect the views of the European Commission and/or the Executive Agency for Health and Consumers or any other body of the European Union. The European Commission and/or the
Conflicts of interest
None declared.
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