Exploring the use of social network analysis to measure social integration among older adults in assisted living

"I make myself get busy": Resilience and social connection among low-income older adults living in subsidized housing

BACKGROUND

Social isolation and loneliness are pervasive issues among older adults in the United States, carrying significant health risks. Low-income older adults are particularly vulnerable to these challenges compared with their higher-income counterparts due to their limited access to resources and social networks. Many low-income older adults live in subsidized housing, which has the potential to offer unique support tailored to their needs. The intersection of aging and the unique social circumstances faced by low-income older adults significantly influences how they navigate crises.

METHODS

We conducted semi-structured interviews with 24 older adults aged 63-86 residing in subsidized housing communities in the United States. The data were collected from August 2021 to November 2022 and subsequently analyzed using a thematic constant comparison analysis approach.

RESULTS

Many participants felt connected to their housing community. Participants reported that their lives changed substantially due to the pandemic: communal activities ceased leading to isolation and feelings of loneliness. Amid this challenge, participants were resourceful and found creative ways to manage. Many emphasized the crucial role of technology in maintaining emotional support despite physical separation.

CONCLUSIONS

Participants in subsidized housing shared their experiences before and during this unique crisis highlighting the challenges they face, as well as their resilience and adaptability when facing challenges. Our findings underscore the significance of community activation, demonstrating that activities motivated older adults to improve their well-being. Additionally, the role of technology in maintaining connections proved to be crucial.

Objectively Measured Physical Activity and Sedentary Behaviors Among Older Adults in Assisted Living Facilities: A Scoping Review

Older adults in assisted living facilities (ALF) are at risk for low physical activity (PA) and high sedentary behavior (SB), both of which place them at risk for negative health outcomes. The purpose of this scoping review was to synthesize evidence describing the volume of device-measured PA/SB, factors associated with PA/SB, and interventions designed to change PA/SB in older adults living in ALF. Twenty articles representing 15 unique studies were identified from eight electronic databases and grey literature. Residents in ALF spent 96-201 min/day in light PA (n = 2 studies), 1-9.74 min/day in moderate to vigorous PA (n = 2 studies), and 8.5-11.01 hr/day of SB during waking hours (n = 3 studies). Factors associated with PA included 16 personal factors (n = 6 articles), one social factor (n = 2 articles), and two environmental factors (n = 2 articles). Factors associated with SB included 14 personal factors (n = 4 articles) and one social factor (n = 1 article). No intervention successfully changed PA/SB.

Associations between social networks, cognitive function, and quality of life among older adults in long-term care

BACKGROUND

Having rich social networks is associated with better physical and cognitive health, however older adults entering long-term care may experience an increased risk of social isolation and consequent negative impacts on cognitive function. Our study aimed to identify if there is an association between accessing specific types of services or activities within long-term care on social networks and cognition.

METHODS

A cross-sectional study of 96 residents from 2 aged care providers in New South Wales, Australia. Residents were given a battery of assessments measuring social network structure (Lubben Social Network Scale, LSNS-12), quality of life (EuroQol 5D, Eq. 5D5L) and cognitive function (Montreal Cognitive Assessment, MoCA). Demographic factors and service use factors were also collected from aged care providers' electronic records. Independent sample t-test, ANOVA and linear regression analyses were used to explore associated factors for cognition.

RESULTS

Residents had a mean age of 82.7 ± 9.4 years (median = 81) and 64.6% were women. Most residents had cognitive impairment (70.8%) and reported moderate sized social networks (26.7/60) (Lubben Social Network Scale, LSNS-12). Residents who had larger social networks of both family and friends had significantly better cognitive performance. Service type and frequency of attendance were not associated with cognitive function.

CONCLUSIONS

Among individuals most at risk of social isolation, having supportive and fulfilling social networks was associated with preserved cognitive function. The relationship between service provision and social interactions that offer psychosocial support within long-term facilities and its impact over time on cognitive function requires further exploration.

Measuring the Impact of Bedroom Privacy on Social Networks in a Long-Term Care Facility for Hong Kong Older Adults: A Spatio-Social Network Analysis Approach

This study aims to measure the impact of bedroom privacy on residents' social networks in a long-term care (LTC) facility for older adults. Little is known about how the architectural design of bedrooms affects residents' social networks in compact LTC facilities. Five design factors affecting privacy were examined: bedroom occupancy, visual privacy, visibility, bedroom adjacency, and transitional space. We present a spatio-social network analysis approach to analyse the social network structures of 48 residents. Results show that residents with the highest bedroom privacy had comparatively smaller yet stronger groups of network partners in their own bedrooms. Further, residents who lived along short corridors interacted frequently with non-roommates in one another's bedrooms. In contrast, residents who had the least privacy had relatively diverse network partners, however, with weak social ties. Clustering analyses also identified five distinct social clusters among residents of different bedrooms, ranging from diverse to restricted. Multiple regressions showed that these architectural factors are significantly associated with residents' network structures. The findings have methodological implications for the study of physical environment and social networks which are useful for LTC service providers. We argue that our findings could inform current policies to develop LTC facilities aimed at improving residents' well-being.

Social Networks in Retirement and Assisted Living Communities: A Literature Review

Research has substantiated that social isolation and loneliness are linked to poorer health, earlier death, and reduced quality of life among older adults. Although there has been research focusing on social networks of nursing home residents and interventions to decrease loneliness and improve social interactions for older adults in varied settings, there is a gap in research relating to social networks of older adults in assisted living and retirement communities. The goal of the current review was to summarize relevant research findings related to this topic published in the past 5 years. The literature review included searching three electronic databases (CINAHL, EBSCOhost, and PubMed) for research articles published between January 2015 and March 2020. A total of 475 articles were identified, which was narrowed to 16 articles included for full review after inclusion and exclusion criteria were applied. Following analysis, three themes were identified in the literature: Social Connections Within an Assisted Living Community, Social Networks Between Residents and Their Adult Children, and Influence of Physical Structure on Social Networks of Residents. [Journal of Gerontological Nursing, 48(1), 42-46.].

A scoping review of approaches for measuring 'interdependent' collaborative performances

INTRODUCTION

Individual assessment disregards the team aspect of clinical work. Team assessment collapses the individual into the group. Neither is sufficient for medical education, where measures need to attend to the individual while also accounting for interactions with others. Valid and reliable measures of interdependence are critical within medical education given the collaborative manner in which patient care is provided. Medical education currently lacks a consistent approach to measuring the performance between individuals working together as part of larger healthcare team. This review's objective was to identify existing approaches to measuring this interdependence.

METHODS

Following Arksey & O'Malley's methodology, we conducted a scoping review in 2018 and updated it to 2020. A search strategy involving five databases located >12 000 citations. At least two reviewers independently screened titles and abstracts, screened full texts (n = 161) and performed data extraction on twenty-seven included articles. Interviews were also conducted with key informants to check if any literature was missing and assess that our interpretations made sense.

RESULTS

Eighteen of the twenty-seven articles were empirical; nine conceptual with an empirical illustration. Eighteen were quantitative; nine used mixed methods. The articles spanned five disciplines and various application contexts, from online learning to sports performance. Only two of the included articles were from the field of Medical Education. The articles conceptualised interdependence of a group, using theoretical constructs such as collaboration synergy; of a network, using constructs such as degree centrality; and of a dyad, using constructs such as synchrony. Both descriptive (eg social network analysis) and inferential (eg multi-level modelling) approaches were described.

CONCLUSION

Efforts to measure interdependence are scarce and scattered across disciplines. Multiple theoretical concepts and inconsistent terminology may be limiting programmatic work. This review motivates the need for further study of measurement techniques, particularly those combining multiple approaches, to capture interdependence in medical education.

Associations between social network characteristics, cognitive function, and quality of life among residents in a dementia special care unit: A pilot study

Social integration has a significant influence on physical and mental health. Older adults experience an increased risk of social isolation as their social networks contract. The purpose of this study is to examine associations between dementia special care unit residents' overall well-being and cognition with structural aspects of their coresident relationships. Design and Methods Measures of social network structure were calculated from self-reported social contact data within three cohorts of residents in one dementia special care unit. Pearson correlations were used to describe associations between overall quality of life and cognition, with network characteristics indicative of social integration. Results Approximately half the ties sent or received were reciprocated and positive associations were found between social integration and quality of life. However, inconsistent associations were found between social integration and cognitive function. Friendship ties were more frequent between people of adjacent cognitive status categories. In addition, comparing across personal networks, residents tended to be tied to residents of higher quality of life status (43.3%, n = 13 personal networks) as opposed to lower (30%, n = 9 networks) or same (26.7%, n = 8 networks). There is a strong positive correlation between quality of life and respondent's betweenness centrality, suggesting that individuals with high quality of life tend to be important intermediaries between others in the community. Implications Among the "oldest old," quality of life and cognitive function are unevenly distributed, yet these health indicators tend to cluster in social networks. This reinforces that while quality of life may be highly individual, it is in part linked to relationships with others.

Social-Professional Networks in Long-Term Care Settings With People With Dementia: An Approach to Better Care? A Systematic Review

BACKGROUND

Dementia is a syndrome associated with stigma and social isolation. Forty-two percent of people with dementia in the United States and almost 40% in the United Kingdom live in assisted living and residential care facilities. Up to 90% of residents with dementia experience behavioral and psychological symptoms of dementia (BPSD). Currently psychotropic drugs are often used to manage BPSD, despite the drugs' limited efficacy and adverse effects. Even though psychosocial approaches are as effective as medical ones without side effects, their uptake has been slow. Social networks that investigate the structure of relationships among residents and staff may represent an important resource to increase the uptake of psychosocial approaches and facilitate improvements in care.

OBJECTIVES

To conduct a systematic review of social network studies set in long-term care (LTC), including residents with dementia, and identify network factors influencing the care available to residents.

METHOD

Peer-reviewed articles across CINAHL, EMBASE, IBSS, Medline, PsychInfo, Scopus, and Web of Science were searched from January 1994 to December 2014 inclusive, using PRISMA guidelines. Studies included those examining social networks of residents or staff in LTC.

RESULTS

Nine articles from studies in the United States, Europe, Asia, and Australia met search criteria. Resident networks had few social connections. One study proposed that residents with high centrality be encouraged to welcome new residents and disseminate information. The high density in 2 staff network studies was associated with the cooperation needed to provide care to residents with dementia. Staff's boundary-spanning led to higher-status nurses becoming more involved in decision-making and problem-solving in one study. In another, the outcome was staff treating residents with more respect and actively caring for them.

CONCLUSION

These studies suggest interventions using a network approach may improve care services in LTC.

Development of a Multidimensional Scale of Social Integration in Later Life

Social integration is increasingly recognized as key to successful aging; however, definitions and assessments vary greatly across gerontological studies. This study describes the development of and provides preliminary evidence for the multidimensional Social Integration in Later Life Scale (SILLS). A review of previous measures led to the development of a 30-item questionnaire, which was given to a community-based sample of 399 older adults (ages 60–100). Factor analysis was used to determine a four-factor structure that included dimensions of frequency–social ties, frequency–social activities, satisfaction–social ties, and satisfaction–social activities. The overall scale Cronbach’s α was .86 (subscales ranged from .72 to .84), demonstrating good internal consistency. Preliminary results suggest that the SILLS has adequate concurrent and convergent validity. By assessing enacted and perceived integration across social ties and activities, this comprehensive measure is a useful tool for understanding social integration in later life.

A systematic review of nurse-related social network analysis studies

BACKGROUND

Nurses frequently work as part of both uni- and multidisciplinary teams. Communication between team members is critical in the delivery of quality care. Social network analysis is increasingly being used to explore such communication.

AIM

To explore the use of social network analysis involving nurses either as subjects of the study or as researchers.

METHODS

Standard systematic review procedures were applied to identify nurse-related studies that utilize social network analysis. A comparative thematic approach to synthesis was used. Both published and grey literature written in English, Spanish and Portuguese between January 1965 and December 2013 were identified via a structured search of CINAHL, SciELO and PubMed. In addition, Google and Yahoo search engines were used to identify additional grey literature using the same search strategy.

RESULTS

Forty-three primary studies were identified with literature from North America dominating the published work. So far it would appear that no author or group of authors have developed a programme of research in the nursing field using the social network analysis approach although several authors may be in the process of doing so.

LIMITATIONS

The dominance of literature from North America may be viewed as problematic as the underlying structures and themes may be an artefact of cultural communication norms from this region.

CONCLUSIONS

The use of social network analysis in relation to nursing and by nurse researchers has increased rapidly over the past two decades. The lack of longitudinal studies and the absence of replication across multiple sites should be seen as an opportunity for further research.

IMPLICATION FOR NURSING AND HEALTH POLICY

This analytical approach is relatively new in the field of nursing but does show considerable promise in offering insights into the way information flows between individuals, teams, institutions and other structures. An understanding of these structures provides a means of improving communication.

The feasibility of measuring social networks among older adults in assisted living and dementia special care units

BACKGROUND

Studies indicate that social integration has a significant influence on physical and mental health. Older adults experience an increased risk of social isolation as their social networks decline with fewer traditional opportunities to add new social relationships. Deaths of similar aged friends, cognitive and functional impairments, and relocating to a nursing home (NH) or assisted-living (AL) facility contribute to difficulties in maintaining one's social network. Due to the paucity of research examining the social networks of people residing in AL and NH, this study was designed to develop and test the feasibility of using a combination of methodological approaches to capture social network data among older adults living in AL and a dementia special care unit NH.

METHODS

Social network analysis of both egocentric and sociocentric networks was conducted to visualize the social networks of 15 residents of an AL neighborhood and 12 residents of a dementia special care unit NH and to calculate measures network size, centrality, and reciprocity.

RESULTS

The combined egocentric and sociocentric method was feasible and provided a robust indicator of resident social networks highlighting individuals who were socially integrated as well as isolated.