Author
CATTAN Mima; et al;
Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions.
Journal citation/publication details
Aging and Society, 25(1), January 2005, pp.41-67.
Summary
A systematic review of health promotion interventions to prevent social isolation and loneliness among older people found 30 quantitative studies published 1970 and 2002. A meta-analysis was not possible, and the studies were examined by type and quality of intervention. Ten studies were considered to report effective interventions, of which nine were group activities with an educational or social support input. Six of the ineffective interventions provided one-to-one support, advice or information. The analysis suggests that involving older people in planning, developing and delivering group activities can alleviate their social isolation and loneliness.
Context
While national guidelines, including the UK National Service Framework for Older People, highlight the prevention and alleviation of social isolation and loneliness among older people as an important area of policy and practice, there is a lack of evidence for the effectiveness of health promotion interventions in this area.
Methods
What sources were used?
Searches were carried out on: Medline; Social Science Citation Index; Science Citation Index; Embase (Excerpta Medica); PsycINFO; ASSIA (Applied Social Science Index and Abstracts); CINAHL (Cumulated Index to Nursing and Allied Health Literature); SweMed (Nordic journals); FirstSearch (OCLC collection of databases); Academic Search Elite (EBSCO journals); SIGLE (System of Information on Grey Literature in Europe); the Cochrane Library; and LILACS (Latin American and Caribbean health science literature). Manual searches of 'relevant' books and journals were also conducted.
What search terms/strategies were used?
An 'extensive' search strategy relating to population/target group; problem area; prevention/promotion topic; intervention/method; and type of article was used. Studies published between 1970 and 2002 in any language were included.
What criteria were used to decide on which studies to include?
Studies were included if they assessed the evidence of a change in social isolation and/or loneliness. They were rated as inconclusive, effective, ineffective or partially effective depending on the outcomes.
Who decided on their relevance and quality?
Initial decisions concerning relevance were made by two of the authors, and disagreements resolved by discussions with a third author. The lead author examined all of the studies.
How many studies were included and where were they from?
Six hundred and eighty articles matched the initial search strategy, of which 184 were examined in full, with 76 (representing 42 studies) meeting the inclusion criteria. Thirty quantitative outcome studies were included in the review, with 12 qualitative studies and surveys excluded. Bibliographical details of all reviewed studies are available via http://www.lmu.ac.uk/health/healthpromotion/people/cattan.htm and these were conducted in the USA (16) and the UK (2), with the remainder from Canada , Sweden , Denmark and the Netherlands .
How were the study findings combined?
A meta-analysis was not possible and a qualitative synthesis was conducted by classifying the studies into four categories: group intervention; one-to-one interventions; concerning services; and community development. These were then subdivided by the method of intervention.
Findings of the review
The reviewed studies included 16 randomised controlled trials and ten non-randomised controlled trials. Seventeen were group interventions, ten one-to-one interventions and three examined the impact of service provision on loneliness. One study encompassed three components, including an RCT and a community development approach.
Tabulated details of study design and effectiveness are accessible via http://www.lmu.ac.uk/health/healthpromotion/people/cattan.htm . Ten interventions were assessed as effective, of which six were of high study quality. Nine of these were group interventions with a focused educational input or targeted support activities. Other effective interventions included those: which targeted specific groups; in which the experimental samples were representative of the intended target group; which enabled some level of participant and/or facilitator control, or consulted with the intended target group before the intervention; which evaluated an existing service or activity; and in which participants were identified from agency lists, obituaries, or through the mass media. The majority characteristic of the eight 'ineffective' interventions (conducted using generally moderate quality study designs) was that they were one-to-one interventions conducted in people's own homes. The remaining interventions (generally using moderate or low quality designs) were judged to be 'partially effective' (5) or the results of studies (7) were 'inconclusive'.
Authors' conclusions
'The findings provide clear evidence that a few interventions are effective, namely group interventions involving some form of educational or training input, and social activities that targeted specific groups of people', 'but that the effectiveness of one-to-one interventions to alleviate social isolation and loneliness among older people remains unclear.' Further research is needed to determine which other interventions may be effective and to determine with certainty which interventions do not work.
Implications for policy or practice
'Of importance to policy and practice it appears that programmes that enable older people to be involved in planning, development and delivering of activities are most likely to be effective'.