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Ageing & Society 23, 2003, 647–658. f 2003 Cambridge University Press DOI: 10.

1017/S0144686X03001296 Printed in the United Kingdom


Interventions to reduce social isolation amongst older people : where is the evidence ?
ABSTRACT As the population ages and more people are living alone, social isolation amongst older people is emerging as one of the major issues facing the industrialised world because of the adverse impact it can have on health and wellbeing. This article reviews the empirical literature published over the last 20 years on the effectiveness of interventions that target social isolation amongst older people. The results reveal that although numerous such interventions have been implemented worldwide, there is very little evidence to show that they work. It is concluded that future intervention programmes aimed at reducing social isolation should have evaluation built into them at inception, and that the results of the evaluation studies, whether positive or negative, should be widely disseminated. Where possible, as a cost-effective measure, pilot or demonstration projects should precede these interventions. Some key elements of successful interventions to counter social isolation amongst older people are presented. KEY WORDS – social isolation, intervention, evaluation, review, older people, ageing.


As the proportion of older people in the population increases and more live alone (World Health Organisation 2002), the problem of social isolation among the age group is of growing concern. In a survey of the empirical literature published between 1948 and 1991, Victor et al. (2000) found that between two and 20 per cent of people over the age of 65 years were socially isolated. In Australia, a study of 2000 veterans found that approximately 10 per cent were socially isolated and a further 12 per cent were at risk of social isolation (Gardner et al. 1999). Another Australian study by Edelbrock et al. (2001) found similar results for the general population. In the United Kingdom, a study of loneliness and isolation
* Australasian Centre on Ageing, University of Queensland, Australia.

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Van Baarsen et al.79. being a carer.84 . but the question is. Wenger et al. Many of these factors are often beyond the socially isolated person’s control and are therefore ‘not obviously susceptible to amelioration’ (Wenger et al. Moyer et al. On the other hand. considered interventions that targeted social isolation and/or loneliness . and suicide (Centres for Disease Control and Prevention 1996 . 2000. rural stress (Monk 2000) .18. geographic location. Numerous interventions have been implemented worldwide to address the problem of social isolation amongst older people. and/or that the limited contact had adverse personal consequences for them. Victor et al. Cattan and White 1998. Conwell 1997. 1996: 345–6). communication and transport difficulties (Brennan. Moore and Smyth 1995. http://journals. elevated blood pressure (Bower 1997) . 1999. People who had only poor or limited social contact were considered as ‘ at risk ’ of social isolation: some older people prefer to be alone and suffer no adverse effects on their quality of life. Social isolation has been defined in myriad ways in the literature. the subjective expression of dissatisfaction with a low number of social contacts. most research indicates that engagement in social interaction is far more beneficial for health and wellbeing of older people (Bower 1997 . Silveira and Allebeck 2001. 2001. Hall and Havens 1999 . mental illness. Warner 1998) . Some studies (e. 1996). 1999 . (1999) combined these two constructs into a single definition. low morale. designing effective interventions to address the problem is difficult. Gardner et al. Gardner et al. The inclusion criteria for the studies in their review were that they: related to older people. Edelbrock et al. increased propensity to dementia (Fratiglioni 2000) .g. Fratiglioni 2000 . Pennington 1992 . depression (Gutzmann 2000.cambridge. and social loneliness or emotional isolation. 2001) have differentiated between two constructs: social isolation. in a report to the Australian Department of Veteran Affairs. Factors contributing to social isolation include loss (in its many forms). Furthermore. social isolation has been linked with increased mortality rates for people aged over 65 years (Bower 1997) . 1960). Thus. Hall and Havens 2001. Although the proponents of disengagement theory contend that psychological adjustment to ageing comes through a reduction of activity and social contact (Cumming et al.648 Robyn A. do the interventions work? There has been one systematic review of the evaluation of the effectiveness of interventions to address social isolation amongst older people (Cattan and White 1998). an objective measure of social interaction. Russell and Schofield 1999). Rapagnani 2002). Findlay by Owen (2001) revealed that over 12 per cent of people aged 65 and more years felt socially isolated. They defined people as socially isolated if they had poor or limited contact with others and they perceived this level of contact as inadequate. poor physical Downloaded: 29 Apr 2012 IP address: 114.

Social isolation interventions 649 T A B L E 1. . Cattan and White (1998) have never publicly documented the references for the studies that they uncovered. loneliness. Group activities: for example. bereavement support Target specific groups: for example. It is therefore impossible to know from their work exactly what types of interventions (other than the categorical programme type. Characteristics of effective interventions . ageing or aging . Issue: social isolation. . Methodology The current review used the same inclusion criteria as Cattan and White (1998) except that only studies published in English between 1982 and 2002 were included. The current research sought to address this shortcoming. . and were published between 1970 and 1997 in any language. Cattan and White’s review identified 21 studies. or quasi-experimental studies (1). before-and-after studies (2). the Cochrane Library. described interventions intended to achieve health gain. PsychInfo. promotion. the widowed Use more than one method and are effective across a broad range of outcomes The evaluation fits the intervention and includes a process evaluation Allow participants some level of control Source : Cattan and White (1998). Search terms were categorised under : . elder.cambridge. social activation. and the remainder were categorised as either nonRCTs (8). Strategy : intervention. discussion. Infotrac. and Ageline. Hand searches were also conducted to scan relevant journals or backdated issues not available online. or whole community) are likely to be more effective than others. Ten of the 21 studies were randomised control trials (RCTs). recorded outcome measures. such as group. community intervention/programme.79. Unfortunately. Type of article : evaluation. social support. . . Internet searches were conducted through Medline. . In Downloaded: 29 Apr 2012 IP address: 114. one-to-one. health promotion. women.1 the Campbell Collaboration Library. review. senior. Cattan and White identified a set of characteristics of effective interventions (Table 1).84 . study. Target group : older. self help. Sociological Abstracts. 11 of which were published in the United States. Cattan and White identified nine surveys of various designs and 25 purely descriptive articles.2 Proquest.18. service provision. Based on their review. . http://journals.

The Tele-Help. Almost half the published studies (8) were conducted in the United States. the programme utilises non-traditional referral sources to identify ‘ at risk ’ older people who typically do not come to the attention of support services. Canada (2).org Downloaded: 29 Apr 2012 IP address: 114. Italy (1) and Sweden (1). Two were evaluations of service provision and four were evaluations of the use of the Internet. recruits and trains employees and volunteers and promotes their links to service systems. The Netherlands (2).79. The following summary of the effectiveness of particular types of interventions. of which three involved telephone support services and two gatekeeper programmes. Six were group interventions. The Link Plus programme and the telephone dyads identified here were ineffective in reducing feelings of social isolation. Only six of the 17 evaluations were RCTs.3 The gatekeeper model has successfully identified socially isolated http://journals. Tele-Check programme that targeted older people at risk of suicide by virtue of their social isolation was effective in reducing rates of suicide. and four considered discussion or support groups. The programme has spread across the USA and is now having success in Canada. Gatekeeper programme : The original gatekeeper programme was established at the Spokane Mental Health Centre in Washington State in 1978.650 Robyn A. of which two involved tele-conferencing. Very little can be deduced about the effectiveness of interventions when so few evaluations of each type of intervention have been conducted. and the others in Australia (3). Essentially. see Florio et al. In the interest of future directions in the field. The 17 relevant studies are listed in Table 2. this summary is offered as a tentative guide until a more substantial database of evaluated interventions becomes available. Further research is needed on all types of interventions to determine whether they actually achieve their purpose. Findlay Results Seventeen relevant studies were identified as well as numerous purely descriptive articles.18. One-to-one interventions Telephone support services : Telephone support services generally involve ‘at risk ’ people being contacted by a trained counsellor or support person on a regular basis.84 . Five out of the 17 relevant studies were one-to-one interventions. must therefore be treated with caution. however. (1996) or visit the Niagara gatekeepers’ website. based on the studies presented in Table 2.cambridge. For a full description of the programme. It promotes. but the former had some success in connecting people ‘at risk ’ with support services.

(2001) Canada Shanley (2001) Australia Tele-conferencing: groups met once a week via tele-conferencing for 12 weeks PPI Tele-conferencing – Adaptation QE of Homereach (programme to raise carers’ awareness of self-care and available resources) Decreased support needs. (1995) Tele-Check (contacted twice Italy weekly re : needs and emotional support) service for older people Florio et al. Studies that have evaluated interventions to address social isolation amongst older people Programme type and target group One-to-one Seniors ‘at risk’ of suicide Isolated older women. training and support of peer and professional leaders and member control of discussions were important ingredients of the successful support groups.18. No significant effects on social isolation. Social isolation interventions Stewart. The project produced Getting in Touch: A Carer Support Model using Teleconferencing. (1996) Gatekeeper programme USA (comparison with other types of referral) Florio et al. (Selection. After eight months. Reduced rate of suicide.T A B L E 2. low income Seniors ‘at risk’ of suicide (84 %=women) Clients referred to services for older people Clients referred to services for older people Group intervention Isolated seniors with disabilities Isolated carers Study and country Morrow-Howell et al. amount of personal contact Downloaded: 29 Apr 2012 IP address: 114. (1998) Gatekeeper programme USA RCT QE CSS Effective for identification of socially isolated older people. (1998) USA Intervention components Study design RCT Effect After four months. social isolation drops in those referred by gatekeepers. unmet needs reduced slightly.) A cost-effective strategy for bringing people together especially from geographically isolated areas. NRPT After referral to support. (1991) Telephone dyads: 10 weeks of USA telephone staff contact designed to increase friend support De Leo et al.cambridge.84 . diminished loneliness and enhanced coping. No significant effect on satisfaction with socialisation or loneliness. Mann. Link-Plus programme: clinical case management and supportive therapy using traditional crisis intervention Heller et al. 651 (Table 2 continued overleaf ) http://journals. Jackson et al. Tele-Help (alarm system). Effective in attaining referrals of ‘at risk’ elderly to health services.79.

RCT Six months post-intervention. but no change in the availability of a close friend or confidante. but the average loneliness score remained within the range of the moderately Downloaded: 29 Apr 2012 IP address: 114. Topics such as leisure activities and the neighbourhood Educational programme on friendship enrichment – 12 weekly sessions to groups of 8 to 12 women Same as above Study design PPI Effect Robyn A. Note: Beneficial effects may not appear unless there is a lengthy intervention period.652 TA B L E 2.cambridge. Findlay Group intervention (cont.5 hrs/wk for maximum 20 weeks). (The results may be an artefact of subject self-selection. Extremely socially isolated older women were three times more likely than non-isolated women to die within the 5-year period. Qualitative data : many interviewees reported being able to cope better. participants demonstrated more frequent social contacts. RCT Use of community support services did impact on mortality rates. (1997) USA Buys (2001) Australia Retirement village residents Community senior support – Effect of extreme social isolation and utilisation of community senior support services Retirement village living QE http://journals.79. NRPT Reduced loneliness during the year following the intervention. Co-led by peer and trained facilitator Discussion groups led by home health aides. There was a trend toward decreased social isolation and emotional loneliness.) Widowed seniors Stewart et al.) Programme type and target group Study and country Intervention components Four face-to-face discussion groups (1–1. The education group also developed new friendships of varying degrees of closeness. (Cont. an increase in participation in organised activities and a decline in loneliness. (2001) Canada Senior women on housing waiting list Lonely older women Andersson (1985) cited in Stevens (2001) Sweden Stevens (2001) The Netherlands Senior women Stevens and van Tilburg (2000) The Netherlands Enhanced support satisfaction. Decreased social isolation and loneliness if actively seeking to make more contact. diminished support needs and increased positive affect.84 . but lonely’: see De Jong Gierveld 1984.) NRMC Twice as many women who completed the friendship course had reduced loneliness and feelings of isolation compared with the controls. Service provision Senior women LaVeist et al. of the ‘socially active.18. and their friendship networks were more complex.

Observation and interview. (1999) SeniorNet. communication USA and decision-support functions Ito et al. Older people who are regular users of SeniorNet reported positively on the medium’s potential for social interaction and individual empowerment.Internet usage Caregivers of persons with Alzheimer’s disease Adults 50+ years All older people Congregate housing and nursing facility residents Brennan. OI. Non-randomised matched control trial. Australia Intellectually challenging 8-week online courses for isolated older persons White et al. (2002) Provision of Internet and USA electronic mail access RCT OI Although ComputerLink improved caregivers’ decision-making confidence. RCT. RCT Internet usage led to a trend in decreased loneliness (small sample). QE. 12 (75 %) felt that U3A Online had helped to alleviate the isolation and loneliness. NRMC. NRPT 47 per cent experienced some feelings of isolation. NRPT. Moore ComputerLink : provides and Smyth (1995) information.cambridge. Social isolation interventions 653 http://journals. a non-profit website USA that provides adults aged 50+ years access to and education about computer technology and the Internet Swindell (2001) Isolated Bytes (U3A Online). Quasi-experimental.79. it did not enhance their decision-making skill nor did it reduce their social isolation. Key to study designs : CSS. Randomised controlled trial.84 . Pre-post intervention Downloaded: 29 Apr 2012 IP address: 114. PPI. Of this ‘isolated’ group. Cross-sectional survey. Non-randomised post-treatment/test survey.

especially in geographically isolated areas. . It may be that support groups are more effective interventions for women. It can be adapted to any community setting including rural areas and could deal with issues other than social Downloaded: 29 Apr 2012 IP address: 114. Service provision The research indicates that the use of community support services is beneficial to health and wellbeing. Ad Hoc Working Group 2000). . it may be that support groups are only effective for people who already have the necessary social skills to join them.79.654 Robyn A. It mobilises and trains non-traditional referral sources – a unique quality. connected them with support services and reduced social isolation among those referred to services. and that moving to retirement-village living can have beneficial effects for those actively wanting to become less socially isolated. . In addition. and therefore might not work for the severely socially isolated. This model may prove to be one of the most successful for dealing with social isolation and has several worthwhile features : . and the results do not necessarily apply to males. The research shows that support groups can have a positive effect on social isolation if they have an implementation period of at least five months. .84 . Internet usage Computer-based functions such as Email that encourage interactive dialogue may be the most beneficial types of programme for reducing http://journals. Support groups : The types of support groups that have been evaluated include educational and friendship enrichment or empowerment programmes and discussion groups. Findlay older people. It opens lines of communication between agencies and builds community capacity – the community-driven approach being crucial to its future (Niagara Gatekeepers Program. Group interventions Tele-conferencing : Tele-conferencing appears to be a cost-effective strategy for reducing loneliness and bringing people together. Most of the evaluative research on support groups has however targeted females. It allows the general public to take action on behalf of vulnerable adults without getting too involved – it promotes anonymity.cambridge. It is cost-effective.

First. In addition.cambridge. governments. Consequently. Although there are several evaluative studies on the effectiveness of specific types of interventions.Social isolation interventions 655 feelings of social isolation. the existing Downloaded: 29 Apr 2012 IP address: 114. as a cost-effective measure. Evaluations of interventions. interventions have a greater chance of success if they utilise existing community resources and aim to build community capacity – the gatekeeper programme being a prime example. but the research evidence in support of this belief is almost non-existent. financial support and technical expertise necessary for thorough evaluations of the interventions. the private sector and researchers is essential to provide the target-group input. implementation and evaluation stages (Cattan and White 1998. It is essential that future programmes aimed at reducing social isolation have evaluation built into them at inception. Third. provides some guidelines for future development. time and manpower may be wasted on interventions for which little evidence of their effectiveness is available. very few have specifically examined the impact on older people. http://journals. while less attention has been paid to evaluating their sustainability and long-term benefits. Networking between communities. Discussion There is a belief that interventions can counteract social isolation and its adverse effects on older people.84 . The dearth of evidence highlights the need for further rigorous research. including the descriptive articles. Most of the existing evaluations have been conducted on interventions that have explicit short-term objectives. including their sustainability and long-term benefits. Where possible. a lower proportion than the 10 out of 21 found by Cattan and White (1998). pilot or demonstration projects should precede these interventions.18. whether positive or negative. interventions are more likely to be successful if they involve older people in the planning. training and support of the facilitators or co-ordinators of the interventions appear to be one of the most important factors underpinning successful interventions. It is equally essential that the results of the evaluation studies. an enormous amount of public money. Of the few existing evaluations of effectiveness. Despite the shortcomings. such as use of the Internet. Second.79. Joseph Rowntree Foundation 1999). specially designed websites such as SeniorNet 4 and U3A Online5 seem to alleviate feelings of social isolation and loneliness. are widely disseminated. high quality approaches to the selection. should be promoted and adequately funded. Only six of the 17 studies in the current review were RCTs. many are flawed by weak methodologies.

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