The contribution of primary care practitioners to interventions reducing loneliness and social isolation in older people-An integrative review

Monitoring utilisation patterns of home- and community-based services for healthy ageing: a cross-sectional study

BACKGROUND

The home- and community-based care model has been developed to enable older people healthy ageing in place. However, few studies have investigated how well particular home- and community-based services (HCBS) have reached older people. This is crucial to address the issue of inequity in healthcare for seniors living independently. This study aims to examine the utilisation of the overall HCBS as well as its three main categories: life care services (LCS), medical health services (MHS) and spiritual comfort services (SCS). It will compare various predictors influencing the uptake of these services and highlight broader policy implications for building an integrated care system that promotes ageing within communities.

METHODS

The research adopted a cross-sectional research design with a comparative analysis approach. A questionnaire survey was carried out with 1246 older adults in Zhejiang province, yielding 1171 valid responses and an overall response rate of 93.98%. Descriptive statistics and binary logistic regression analyses were applied to identify differences in service utilisation and key determinants.

RESULTS

The research findings showed that overall HCBS utilisation was relatively low, influenced by factors such as age, family support, self-assessed economic status, community type, type of social security benefits, awareness of regular HCBS, self-care capability and self-rated health. Substantial variations were observed in the utilisation rates of LCS, MHS and SCS. The young-old population was less likely to use LCS and MHS, whereas individuals with family support and chronic diseases were more inclined to utilise MHS and SCS. Economic condition and community type emerged as key determinants affecting the use of all three services.

CONCLUSIONS

This study highlights that HCBS have not been fully utilised and are influenced by various factors. Moving forward, it is crucial to address the care needs of different income groups, with particular attention to the unique challenges faced by rural older adults. Targeted policies and interventions are necessary to enhance accessibility for those with chronic illnesses and limited family support. Local governments should work in partnership with families to develop higher-quality, place-based integrated care services, ensuring that both medical care and spiritual well-being services are effectively delivered to meet the evovling needs of an ageing population.

Loneliness among older adults in Europe: time to integrate health and social care

Loneliness is a major concern for public health in contemporary societies. Older adults are particularly vulnerable to loneliness because of their reduced social connections following life changes, such as retirement. Loneliness is often investigated and discussed together with social isolation. While social isolation implies an actual lack of social connections, loneliness implies a perceived deficit of social relations regardless of the real amount of social contacts. However, since living alone may lead to loneliness, individuals can experience both loneliness and social isolation together. Loneliness is not an inevitable consequence of aging and can be tackled with various interventions that can be classified into individual- and group-based formats and can be conducted either in-person or online. In terms of contents, interventions for lonely older adults vary widely, from psychological therapies to contacts with nature and pet company. Although many lonely patients are seen in primary care settings, they are often hospitalized through emergency departments. Social prescriptions, which are more and more perceived as an important add-on to clinical treatments, are non-medical interventions designed to help patients to improve their health by linking traditional clinical practice with social activities and support services within the community. Health- and social-integrated care in the community has become a major priority among older adults to ensure their continuity and quality of care. A European model for welfare systems should be framed by a full integration of care across health and social services. Investing in integrated community care should improve the broad efficiency of the European welfare systems.

Mobilizing community health assets through intersectoral collaboration for social connection: Associations with social support and well-being in a nationwide population-based study in Catalonia

BACKGROUND

Limited social connection among older adults poses a global public health challenge, reducing sources of support and affecting health and well-being. National public health strategies that leverage local intersectoral collaboration between key sectors such as primary and social care, community organizations, and society, have been advocated, yet their impact remains underexplored.

OBJECTIVE

This study examines the regional variability in the uptake of a public health strategy in Catalonia that mobilizes community health assets, such as social clubs and leisure activities, through intersectoral collaboration and its associations with social support and mental well-being in older adults.

METHODS

We conducted a population-based cross-sectional study using the Catalan Health Survey (2017-2021) with 6011 adults aged ≥ 60 years across 31 Health Sectors. Survey data were linked with area-level uptake metrics, generated using data analytic techniques. Individuals were categorized into three uptake groups based on the number and territorial distribution of asset-based initiatives within their area of residence. Multilevel regressions tested associations with social support (OSSS-3) and mental well-being (SWEMWBS), controlling for individual, contextual, and temporal factors.

RESULTS

Participants' average age was 74.1 years ±  10.0 with 53.3% women. From 2017 to 2021, 2312 asset-based initiatives were registered across Health Sectors, ranging from 0 to 342 per sector. Residing in sectors with the highest uptake of initiatives (>15 initiatives per 10,000 population) was associated with higher social support (β = .34, p < .01) and mental well-being scores (β =  1.11, p < .01).

CONCLUSION

Residing in areas with greater health assets mobilized through intersectoral collaboration was associated with higher social support and well-being among older adults. This study represents one of the first national evaluations of an intersectoral strategy aimed at mitigating the mental health impacts of limited social networks. Future public health strategies should prioritize equitable access for inclusive benefits.

Factors associated with social isolation in stroke patients: a systematic review and meta-analysis

OBJECTIVE

Systematic evaluation of factors influencing social isolation in stroke patients for further intervention studies.

METHODS

We searched for observational studies in 7 databases from inception to January 2024. Two researchers performed literature screening, quality assessment, and data extraction independently according to inclusion and exclusion criteria, and meta-analysis was performed using R4.3.1 software.

RESULTS

A total of 10 studies with a total sample size of 4162 cases were included. Meta-analysis showed that social isolation in stroke patients was associated with economic status (β'=-0.21, 95%CI:0.39, -0.02; P=0.0261), degree of education (β'=-0.16, 95%CI:0.29, -0.03; P=0.0171), marital status (β'=0.13, 95%CI:0.04, 0.23; P=0.0069), social support (β'=-0.37, 95%CI;-0.50, -0.25; P<0.0001), stigma(β'=0.48, 95%CI:0.25, 0.72; P<0.0001), symptom burden (β'=0.25, 95%CI:0.18, 0.31; P<0.0001), course of disease (β'=0.23, 95%CI:0.08, 0.37; P=0.0021), combined chronic diseases (β'=0.14, 95%CI:0.04, 0.24; P=0.0057), and limb function (β'=0.33, 95%CI:0.23, 0.43; P<0.0001) were associated. Meta-regression and subgroup analyses showed that disease stage and sample source were sources of heterogeneity.

CONCLUSION

There are many factors influencing the social isolation of stroke patients, and healthcare professionals should take timely and targeted measures to prevent and intervene effectively, with a view to improving the social participation of stroke patients and reducing their social isolation.

Interventions in ambulatory healthcare settings to reduce social isolation among adults aged 18-64: a systematic review

BACKGROUND

Social isolation is associated with increased all-cause and premature mortality, poor chronic disease management, and mental health concerns. Limited research exists on interventions addressing social isolation among individuals under 65 despite its increasing prevalence among young and middle-aged adults.

AIM

To identify interventions from the extant literature that address social isolation and loneliness in ambulatory healthcare settings in adults aged 18-64 and to identify elements of successful studies for future intervention design.

DESIGN & SETTING

Systematic review of interventions targeting social isolation in community-dwelling adults aged 18-64 within ambulatory healthcare settings.

METHOD

A search strategy was developed to identify relevant articles in the following databases: Ovid MEDLINE, Embase, EBM Reviews, Scopus, CINAHL, and PsychInfo. Data were extracted on study design and setting, intervention type, outcome related to social isolation/loneliness, and scale of measure used.

RESULTS

25 078 citations were identified and underwent title and abstract screening. 75 articles met our inclusion criteria and were synthesised, including an assessment of bias. Effective interventions were delivered in community health settings, incorporated a group component, and used digital technologies. They also addressed the association between mental health and social isolation using cognitive-behavioural therapy (CBT) approaches and enhanced self-management and coping strategies for chronic conditions through psycho-educational interventions.

CONCLUSION

Future research should prioritise adults living in low-income and middle-income countries, racialised individuals, as well as those with fewer educational opportunities. There is also a need to advance research in primary care settings, where longitudinal patient-provider relationships would facilitate the success of interventions.

Telehealth memory clinics in primary healthcare: real-world experiences from low-resource settings in Greece

Background

The role of primary healthcare is pivotal in the management of the surge of dementia prevalence particularly in low-resource areas. In this study, two telehealth-based memory clinics in primary healthcare operating within the frames of the INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) are presented.

Methods

The first clinic, which is led by a general practitioner, operates at a primary healthcare center in a semi-mountainous area and closely collaborates with the geriatric psychiatry outpatient clinic of the Patras University General Hospital via a telehealth medicine platform. The second clinic is embedded at the General Hospital Center for Interconnected Psychiatric Support on the island of Syros, is led by registered nurses, and is interconnected with the geriatric psychiatry unit at the Eginition University Hospital in Athens.

Results

Both memory clinics are in their infancy. At the general practitioner-led memory clinic, 13 beneficiaries were assessed and treated during the first 6 months of its operation. Cognitive decline and depressive and/or anxiety symptoms were detected in 10 and eight individuals, respectively. In 9 of the 27 beneficiaries of the registered nurse-led memory clinic, either mild cognitive impairment or dementia was diagnosed, while affective and/or anxiety symptoms were detected in almost all of them. Of note, only 14 beneficiaries of both clinics had received a diagnosis of a mental or neurocognitive disorder prior to their assessment at the memory clinics.

Conclusion

Developing memory clinics in primary healthcare may be a pragmatic strategy to improve access of older adults living in low-resource areas to cognitive healthcare services.

Ageing with chronic conditions and older persons' experience of social connections: a qualitative descriptive study

Background Chronic conditions may limit older peoples' social engagement and wellbeing. Reduced social connections can result in loneliness and social isolation. This study aimed to explore the experience of social connection in older people living with chronic conditions, and the factors influencing their social participation. Methods A purposive sample of 19 community-dwelling older Australians (mean age 75.5years) with one or more chronic conditions participated in a qualitative descriptive study. Semi-structured interviews explored participants' perceptions of their social connections and the potential impact of their chronic conditions. Views about the role of general practice in supporting older persons' wellbeing were discussed. Data were analysed inductively using thematic analysis. Results Five themes were identified: (1) the experience of loneliness, (2) managing diminishing social contacts, (3) living with chronic conditions, (4) barriers to social connection, and (5) facilitators of social connection. Participants felt that ageing with chronic conditions contributed to loss of function and independence, which limited social connections, and increased loneliness and social isolation. Barriers to social connections included issues with mobility, transport and forming new networks. Families were a primary support, with continued community engagement and general practice support crucial to staying well and socially connected. Conclusions Understanding older peoples' experiences, and the barriers and facilitators of social connections can guide clinicians' interventions. General practice is a promising intervention point because of its high use by those with chronic conditions to stay well. General practice nurses are well-placed to collaboratively address the barriers older people face in maintaining social connections.

Exploring the relationship between perceived loneliness and subjective cognitive decline in older individuals

OBJECTIVE

Loneliness has been associated to a greater risk of cognitive decline and dementia in older individuals. However, evidence on whether this association also exists for older individuals who complain of cognitive problems is limited. We conducted a survey to examine the association between subjective cognitive decline in the working memory domain, perceived loneliness, depression, anxiety, and stress in older individuals with different profiles.

METHODS

A total of 302 healthy, old individuals completed 3 questionnaires to assess subjective cognitive problems in attention, executive functions, storage, depression, anxiety, stress, and perceived loneliness.

RESULTS

We conducted a cluster analysis and 3 clusters of individuals with different profiles emerged. Individuals with greater subjective cognitive problems (cluster 1) in the attention and storage domains, reported higher perceived loneliness and stress but not depression. In contrast, individuals with the least subjective cognitive problems (cluster 3) in the storage domain, reported lower perceived loneliness.

CONCLUSIONS

Individuals with higher subjective cognitive decline also report higher levels of perceived loneliness but not more depression than their peers. However, this correlation is present only for individuals with mild subjective cognitive decline (cluster 2). The implications for future research and interventions are discussed.

Loneliness and depression in older adults with multimorbidity: the role of self-efficacy and social support

Introduction

As relatively little is known about self-efficacy and social support in individuals aged 65 years and older and whether they are facing a decline in life due to multimorbidity and previous COVID-19 infection, this study investigated hypotheses based on Social Cognitive Theory.

Methods

It was tested whether depressive symptoms in multimorbid patients who were hospitalized for COVID-19 infection, and recover post infection during their hospital stay, do not differ from those of multimorbid patients hospitalized for other conditions. Furthermore, we tested whether depressive symptoms are associated with increased loneliness scores, low self-efficacy beliefs, and poorly perceived social support. Additionally, it was investigated whether self-efficacy is a mediator variable, and social support is a moderator variable between loneliness and depression. N = 135 patients with or without previous COVID-19 infection (mean age 64.76) were recruited. Paper questionnaires were collected at the time of inpatient hospital admission in the year 2021 and in a cross-sectional study design. The study compared n = 45 multimorbid patients who survived COVID-19 infection with those n = 90 who were not infected before.

Results

No significant difference in depressive symptomology between these two groups revealed [t(133) = 130, p = 0.90, d = 0.024); F(3, 122) = 0.255, p = 0.86]. The study found a positive correlation between loneliness and anxiety and depression in both groups (rdepression = 0.419 and ranxiety = 0.496). Self-efficacy mediated the relation between loneliness and depression. The completely standardized indirect effect was β = 0.111, percentile Bootstrap 95% CI 0.027-0.201.

Discussion

The research findings suggest the importance of self-efficacy, and loneliness in the development of depressive symptoms, and have several practical implications for improving the mental health of multimorbid patients: Prospectively, treatment should not only focus on physical and cognitive health, but also on promoting self-efficacy and perceived social support, as well as address loneliness with psychoeducational interventions. Replication of the findings and conducting interventional research also employing lifestyle components should follow up, as this study tested associations but no causal relationships.