Social isolation programs may be beneficial for social, mental, and physical health in older adults, but program characteristics could impact effectiveness

Dickens AP, Richards SH, Greaves CJ, et al. Interventions targeting social isolation in older people: A systematic review BMC Public Health. 2011;11:647.

Review question

What is the effectiveness of strategies that aim to reduce social isolation and/or loneliness in older people? What are the possible health benefits of these strategies?

Background

With approximately 22% of the global population being 60 years old or older by the year 2050, issues such as social isolation and loneliness are expected to become increasingly problematic. Social isolation impacts an estimated 7-17% of older people, while loneliness effects around 40%. Although related, these two concepts are distinct. Many definitions of social isolation exist, one of which being that social isolation refers to social support that is minimal in both quantity and quality. On the other hand, loneliness refers to a personal belief that companionship has been lost or is missing. Research has shown that: social isolation is linked to death, poor self-rated physical health, and increased dementia risk in older people.

How the review was done

This was a systematic review of 32 randomized controlled trials and quasi-randomized controlled trials published between 1976 and 2009, including a total of 4,061 participants.

• Participants ranged in mean age from 41 to 85 years old, and varied in background to include: caregivers, people with an illness, housing residents (e.g. in retirement communities, assisted living, government subsided buildings), people living in institutional settings (e.g. nursing homes), and people living in the community. Loneliness and social isolation was either implied based on the participants’ situation or identified through assessment.  
• Study participants received one or more of the following: activity (social or physical programmes), support (e.g. education, counselling, discussion group or therapy); home visits; service provision (e.g. contact with plants/pets/children); or internet training. These varied in-terms of: delivery personnel (e.g. health or social care professionals, instructors, students, counsellors, other professionals), format (e.g. one-on-one, group, or combined), frequency (one or more times a week or over two weeks), duration (generally six weeks - one year), session length, and the inclusion of input from participants.
• Researchers measured changes in the participants’ physical, mental (e.g. depression, mental well-being), and social health (e.g. loneliness, social isolation and social support). 
• Results were compared to people in control groups (e.g. receiving nothing, usual care, on a waiting list etc.); with some studies using more than one control.

What the researchers found

Programs addressing social isolation appear to have the most beneficial impacts on physical and mental health, social support, and loneliness in older people. However, program effectiveness may be tied to certain characteristics, such as whether it is group and theory based, participatory, and/or includes social activity/support. Group based programs appear more effective than one-on-one programs, as are those where participants are able to provide active input through social contact.  Similarly, programs informed by theory may be more effective than those that are not; and programs that include social activity and support may also be more effective than those that do not. The risk of bias was high in 21 studies and moderate in 11 studies. More high quality research with better reporting of outcomes is needed on the effectiveness of social isolation strategies in tackling social isolation.  

Conclusion

Social isolation programs that are theory-based, delivered in a group format, include social activity or support, and promote active participation by older adults show promise as an effective strategy to reduce loneliness and improve social support and mental and physical health.