Systematic Reviews of Randomized Control and Quasi-Experimental Studies suggest that there is moderate evidence demonstrating the success of programs targeting social isolation in seniors. Common characteristics of successful programs and types of programs are listed in the table below.
Figure 3 – Successful ways of combatting social isolation
In terms of characteristics, programs that are based on a coherent theoretical basis of how to address social isolation have a greater chance of being successful, as are those that involve seniors in all programming steps, from planning to implementation, and evaluation. Participatory approaches that involve seniors in decision making and group activities are also important. Programs that target groups of individuals who share common characteristics – such as the various groups of seniors discussed in this review – can be fruitful, as well as those that target loneliness and social isolation directly (as opposed to targeting these indirectly while focusing on another issue). Programs that offer more than one method of intervention – such as group activities or individual support – have greater potential. Providing co-ordinators and frontline providers with good training and support is also important, as are mobilizing community assets to promote innovative approaches that pool resources, and involving nurses or allied health professionals as gatekeepers and advocates.
Jopling’s (2015) study on social isolation programs in the United Kingdom, conducted under the auspices of the UK Campaign to End Loneliness, further identifies the “structural enablers” that help facilitate success. These include designing programs at the neighbourhood level, using asset-based community development approaches – which focuses on identifying and mobilizing individual and community assets – creating opportunities for seniors to volunteer, and promoting age-positive approaches among key organizations and institutions within a local area. Joplin provides several useful descriptions of programs that have adopted these approaches.
In terms of the types of programs that are successful, the literature suggests that many different kinds of interventions can have a positive impact, including group activities, one on-one interventions and support provision (though group activities may have a greater impact according to the World Health Organization, 2015), arts and culture based activities, leisure activities, inter-generational activities, educational activities, friendship programs, telephone support, gatekeeper programs, internet groups, support groups, and religious activities. Thus, a range of different kinds of interventions can yield success – including those that use technology to create new communities – though in-person group activities are frequently mentioned as being particularly impactful.
In one systematic review, the Ministry of Health and Long-Term Care Ontario (2008) examined two different kinds of interventions – in-person group support activities and technology assisted interventions – and found that both showed positive results. Similarly, McDaid et al. (2015) looked at empirical studies testing the effectiveness of multiple programs and found that there was a small evidence base demonstrating that all of them had positive effects. These included arts and culture-based activities, friendship programs, intergenerational activities, and what they referred to as “Third Age” education. Toepoel (2013) examined data from a representative survey in the Netherlands and found that, among adults 65 years of age and older, cultural activities, reading books, and hobbies contribute to decreasing loneliness.
Individual program evaluations demonstrate positive results though they are usually based on small samples. An evaluation of Contact the Elderly (2008), for instance, indicated that a majority of participants felt less lonely as a result of the program. The program, which boasts 320 groups across the United Kingdom, organizes monthly Sunday afternoon teas between volunteers and seniors. Likewise, an evaluation of the Seniors Centre without Walls program, which provides free social and educational programming for older adults via telephone in Manitoba, revealed that the vast majority of participants felt more connected and less isolated (Newall and Menec, 2015). TeleVisit, a California-based non-profit, adopts a similar approach by facilitating group activities among seniors via teleconference and easy to use tablets.
In addition to these studies and evaluations, there is an emerging descriptive literature providing information on programs that tackle social isolation. For example, the World Health Organization (2015) describes several programs in Europe that have adopted innovative approaches, such as the Telephone Rings at 5 in Portugal, Multigenerational Centres in Germany, Cité Seniors in Switzerland, and Men’s Sheds in Australia and Ireland. Beach and Bamford (2015) also provide a useful summary of multiple projects in England including Walking Football, the Culture Club, and the Seafarers Project. The Belgium-based, Fondation Roi Baudouin, which provides funding to community initiatives to address social isolation, describes 20 separate projects that have been undertaken, their successes and challenges. Projects range from collective suppers, groups for cultural outings, and cross-cultural discussion groups to collective pampering sessions, inter-generational groups to promote knowledge exchange, and pen-pal groups between seniors and children (Teller and Dorsselaer, 2007). In France, social cafés have been established in several places where seniors can get together, converse, and participate in different activities, including intergenerational ones (Saci, 2012).
The organization, Pour Que l’Esprit Vive, hosts monthly musical concerts for seniors in care facilities in rural France as a way to encourage socialization and combat isolation. Both contemporary and older forms of music are played (Desjobert, 2012). Social actions centres (clubs du Centre d’Action Sociale), where physical activities are organized for seniors, and open houses (Maison Ouverte), where seniors can drop in to participate in activities, also exist in France (Hallier-Nader, 2011).
The annual reports of organizations tackling social isolation can also be extremely instructive. Les Petits Frères (2016), an organization that is active in 15 regions of Quebec, provides annual updates on its many activities, including inter-generational pairing of older people with young volunteers for social activities (jumelage), holiday celebrations, regional trips, and other ongoing outings and activities.
Finally, there are multiple toolkits that provide useful suggestions on how to start programs to address social isolation, including the Nelson Allan Project Toolkit, which provides practical information for grassroots groups and community organizations (Nelson Allan Project, 2015). Innoweave (2015) also provides practical information on how projects addressing social isolation among seniors can be scaled up and make use of social innovation techniques. Within the context of the UK Campaign to End Loneliness, the Hidden Citizens project provides practical steps to service providers on identifying those who experience loneliness (Goodman et al., 2015). The Campaign has also developed a guide to assist practitioners with evaluation.
AARP Foundation Isolation Framework
This report presents the results of the first phase of the AARP (American Association of Retired People) Foundation Isolation Framework Project by ResearchWorks to develop a cross-disciplinary framework for addressing isolation among seniors. The following objectives were accomplished:
Establish a more thorough understanding of the current state of research related to isolation across multiple disciplines, including the major gaps in our understanding of isolation, with a special focus on research related to adults aged 50+.
- Synthesize the literature, resulting in a unifying definition of isolation.
- Delineate the various measures and indicators of isolation and risk for isolation.
- Identify promising directions and needs for future research.
- Inform future study of isolation within the 50+ population
U.K. Promising Strategies
This report from the UK identifies promising strategies for addressing loneliness, drawing on the expertise and experience of leading figures in the field, as well as on the academic and other available evidence. An expert panel (comprised a range of disciplines, and included older people, academics, leaders of service delivery organisations, policy thinkers, funders, commissioners and government experts), was asked about approaches they felt showed
the most promise in addressing loneliness, and why. Out of the discussions a list was made of approaches most commonly identified as showing promise. Extensive literature searches were then conducted to examine what hard evidence backs these approaches. A wide variety of case studies are provided, some for specific or marginalized populations.
Extracted from: Promising Approaches to Reducing Loneliness and Isolation in Later Life (Jopling, K for AgeUK, 2015)
The McMaster Optimal Ageing Portal
Provides evidence based information about healthy aging. Topics include social isolation for which examples of programs that are effective at reducing social isolation and/or loneliness in older adults are identified: these include psychosocial activity groups involving art, therapeutic writing, group therapy, & exercise that lead to new friendships.
Older adults are especially at risk of experiencing social isolation and loneliness. The characteristics of strategies tackling these issues are important factors in determining whether or not they work.
For Vulnerable / Marginalized of Seniors:
In terms of the evaluation literature on programs addressing social isolation among specific groups of seniors, the literature is mostly suggestive. The following illustrates some potential promising interventions, however as previously stated, the evidence-base for some of these is still very much in its early stages, and this is not meant to be an exhaustive list:
Social Isolation in Canadian Older Adults
Review of social isolation in Canada: prevalence, risk and protective factors, and evidence informed interventions: