Tailoring interventions for social isolation and loneliness

The individuality of experiences of loneliness and social isolation makes it difficult to deliver standardized interventions. A study published today in BMC Public Health looks at the need to tailor interventions to suit the needs of individuals. Author Olujoke Fakoya tells us more about the study in this blog.

Most individuals experience loneliness at some point in their lifetime but many will not admit to this experience due to the stigma surrounding it. Often, the terms ‘loneliness’ and ‘social isolation’ are used interchangeably even though there are some differences. For example, loneliness is viewed as a subjective experience that tends to occur when an individual has limited companionship and little or no emotional and social support. Social isolation, on the other hand, is considered to occur when there is lack of social contact and interaction with family, friends or the wider community. Hence, it is possible for an individual to have a large number of social connections and still feel lonely, or to be isolated but not experience loneliness.

Loneliness may occur at any point in a life cycle, e.g. during childhood, adolescence, middle-age or older age; and risk factors that can cause loneliness and social isolation include: age, gender, home relocation, geographic isolation, living alone, divorce, widowhood, poor health, limited mobility, ethnicity, and retirement. However, older people appear to be more vulnerable to experiencing loneliness and social isolation. According to Age UK (2018), there are 1.4 million chronically lonely older people in England and many more across the UK. Loneliness is widely publicized as a major health concern due to its negative impact on health.

Research has identified links between loneliness/social isolation and a higher risk for a variety of mental and physical health conditions including heart disease, high blood pressure, weakened immune system, anxiety, depression, cognitive decline, and even death. Interventions aimed at alleviating loneliness and social isolation are now advocated widely as solutions to this growing problem, although the extent to which these interventions are evidence-informed is unclear. Hence, we conducted a scoping review to map the large body of research evidence in this area and to describe the range of loneliness/social isolation interventions targeted at older populations.

Our review (of reviews) identified that review authors do not always provide a rationale or theoretical underpinning for the interventions studied, and that generally the intervention and its match with loneliness is poorly conceptualized and defined. Interventions reported to be effective appeared to be characterized by, among other aspects, a theoretical underpinning. Moreover, our review points to the importance of context and highlights that a lack of theoretical underpinning tends to pose difficulties in terms of ascertaining which context(s) a particular category of intervention would be most appropriate or effective, and also by which mechanisms these interventions work to reduce loneliness and social isolation.

Furthermore, a broad range of terms were used to describe the characteristics of interventions that were designed to alleviate loneliness and social isolation. Although the same or similar terms were used, often, their meanings were different. Improving the consistency of terminology that is used to describe these interventions is likely to increase accuracy and improve the reporting of an intervention as well as aid in the process of replicating interventions across different contexts.

Our research also points to the importance of recognizing the uniqueness of the individual experience of loneliness among older people who may not experience loneliness and social isolation in the same way or to the same degree. Given the subjective experience of loneliness, and the varying determinants of loneliness and social isolation, it is also important to target interventions at the respective causes of loneliness and social isolation. Hence, there is a need to tailor interventions to meet the requirements of each individual whilst taking account of the diversity and heterogeneity across interventions in terms of goals, design and implementation.

Distinguishing clearly between interventions targeted at reducing loneliness and social isolation is important as those interventions targeted at alleviating loneliness might not work for individuals who feel socially isolated and vice versa. Finally, service planners and providers should match effective interventions to their service context and goals, and also match individuals to interventions based on their assessed needs.

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