Author
EVANS Simon; VALLELLY Sarah;
Title
Best practice in promoting social well-being in extra care housing: a literature review.
Journal citation/publication details
York: Joseph Rowntree Foundation, 2007. 35p.
Summary
This mapping review of empirical evidence covers 141 documents and looks at six themes: social interaction; gender, marital status and parenthood; the environment and well-being; purpose, religion and spirituality; exercise, activity and well-being’ and the philosophy of care.
Context
This review was carried out to set the context for a larger research project exploring the social well-being of frail older people in extra care housing. This in turn was prompted by growing policy interest in the benefits of promoting well-being, and an increase in the number of research studies being conducted.
Methods
What sources were used?
Fifteen databases and some 50 websites are listed in an appendix. References in relevant studies were checked.
What search terms/strategies were used?
The terms used in three categories (person, quality of life, setting) are specified in Table 1. All searching was carried out in September 2006.
What criteria were used to decide on which studies to include?
This review is essentially a mapping exercise but does focus on empirical studies with an explicit methodology, description of sample and data collection, and defined outcome. Other inclusion criteria, if any, are not specified beyond those evident from the search strategy. The introductory chapter describes how the authors progressively widened the ‘setting’ element of the searches from extra care housing (where there is little literature) to cover ‘a broad spectrum of housing, health and social care.’ They also discuss terminological difficulties, in particular the difficulty of distinguishing between ‘social well-being’ and ‘quality of life’, and note that they took a liberal approach ‘in order to provide a comprehensive and useful overview’.
Who decided on their relevance and quality?
This is not discussed, but it is clear that strict methodological quality criteria were not employed. The authors report that the review includes a mix of peer reviewed journal papers, grey literature and literature reviews.
How many studies were included and where were they from?
The review covers 141 documents, all listed in the references. The authors note that much of the evidence comes from outside the UK, including the USA, Canada, European countries, Israel and Japan. This has been included, ‘while acknowledging the possible difficulties associated with cross-cultural comparisons’, on the grounds that approaches with similar underpinning values and philosophies may be transferable to UK settings.
How were the study findings combined?
The review is narrative and covers ‘a broad range of overlapping themes’, which are treated in turn: social interaction; gender, marital status and parenthood; the environment and well-being; purpose, religion and spirituality; exercise, activity and well-being’ and the philosophy of care.
Findings of the review
Social interaction
There is widespread agreement on the importance of social networks and social interaction to well-being. Organised social and creative activities provide the main opportunity for social interaction in housing with care settings, and some activities (e.g. reminiscence groups) and approaches (group, rather than one-to-one) have been shown to be more effective than others. However, there is little evidence on what works to reduce social isolation, and it is also important to remember that some residents actively seek solitude. In residential care settings those with physical or cognitive impairments tend to have lower levels of social interaction than other residents, and non-intimate relationships with staff are less conducive to well-being than those with family and friends outside the housing setting.
Gender, marital status and parenthood
The evidence on the relationship between gender and well-being is contradictory, partly because of the different nature of male and female social networks and the greater reluctance of men to take part in organised social activity. However, some studies suggest that significant negative life events such as widowhood have a more damaging effect on men. The evidence on marital status is clearer, with married people reporting lower levels of stress and higher levels of happiness than the unmarried, especially among older age groups. There is little evidence about the impact of parenthood, and studies are inconclusive. However, there is considerable evidence that family carers provide extremely high levels of support across a range of housing with care settings, and ‘it would seem logical to suppose that those without such support might have lower levels of well-being.’
The built environment
There is a broad literature acknowledging the importance of the built environment, especially for those in residential settings who may rely on it to compensate for physical and/or cognitive impairments. The provision of a range of venues for social interaction, such as a restaurant or communal eating area, garden and shop, is important, although for some they may have a negative effect by reinforcing the sense of an institutional environment. The stringent application of health and safety regulations may also have negative effects, for example in relation to access to gardens and other outdoor spaces, which are increasingly seen as important to well-being.
Purpose, religion and spirituality
There is a considerable literature on the potential benefits of spirituality or religion, with some studies suggesting that these are more important indicators of well-being than traditional measures such as social resources, physical health or negative life events. Other studies argue that a sense of purpose is more important than extrinsic or intrinsic religious orientation, but that this can be difficult to maintain in the face of negative life events including the perceived loss of control represented by entry into residential care.
Exercise and activity
Although there is significant evidence that exercise is effective in building muscle strength and in guarding against falls and further disability, the impact on well-being is less clear. Overall, it seems likely that exercise is more beneficial for the physically frail than the healthy, potentially increasing their ability to perform activities of daily living and thus maintaining life satisfaction. Exercise may also help to guard against depression, while rehabilitative activities can be helpful for people with cognitive impairment. Many housing with care settings also provide social activities and there is evidence that those who take part (women, generally, rather than men) receive benefit. Specific activities conferring benefit include singing, gardening and music. However, the number and range of activities provided by housing with care schemes vary greatly and there is a particular dearth of provision for people in specialist dementia units who may remain unoccupied for most of the time, with little meaningful social interaction.
Philosophy of care
The values and philosophy espoused by housing with care settings ‘impact greatly on the social environment and therefore on levels of well-being’, and a person-centred or relationship-centred approach is increasingly advocated. However, in long term care settings the focus tends to be the provision of personal care and the meeting of ‘minimum universal needs’, which can lead to a lack of stimulation and low levels of patient-staff interaction. Restrictive attitudes towards health and safety, and a failure to provide residents with opportunities for involvement in decisions about care delivery and service development can also have a negative effect.
Authors' conclusions
‘Overall, this review has highlighted some key factors in promoting social well-being for older people’ but also demonstrates the complex nature of the interaction between these factors, and the contradictory nature of the evidence in some areas. In part this is a product of the lack of consensus on what is meant by terms such as ‘well-being’ and ‘frailty. There are considerable gaps in the literature although ‘it is likely that much of the best practice highlighted is relevant to extra care and other housing with care settings’.
Implications for policy or practice
Particular aspects of good practice are highlighted in each chapter, where appropriate.