Just over a year ago I wrote three blogs on social isolation and loneliness. I looked at how many older people self-identified themselves as being lonely; various ways to measure loneliness and some of the responses which may be effective. Of course, these issues have not gone away; they remain topics of debate among researchers on ageing as well as organisations working to prevent or alleviate loneliness among older people.
I have recently had cause to look back at some of the academic literature in this area and am left with questions about whether we are going the right way to address these important and growing issues. A 2018 paper[1] examined a whole range of responses to social isolation and loneliness, as reported mainly in international journals. An earlier 2013 paper[2] looked at several initiatives in Queensland. In the discussion of the effectiveness of various programmes the terms contradiction and inconsistency keep coming up –
“Despite considerable research effort, evidence regarding the effectiveness of programmes aimed at reducing social isolation in older people remains inconclusive.”
“Disappointingly, the current evaluation did not return any statistically significant changes in social support and loneliness that can be confidently attributed to the interventions used.”
“Little is known about the range and scope of effective interventions, and what aspects of interventions contribute to their success. “
The researchers appear to be seeking systematic approaches to evaluation which will produce results which are recognised as consistent and comparable across a range of programmes and locations. In these terms “good evaluation” appears to be defined as evaluation that incorporates “validated psychological measures”; “clear identification of an intervention effect, and the use of well-validated measures of loneliness and/or social support”. This criticism is directed especially at community-based and government-run programmes.
It seems that the researchers’ aim is to produce measures of loneliness which can be applied anywhere and the results of which can be compared from area to area and programme to programme without uncertainty. But should this be the aim – finding such a magic wand?
I wonder if this approach is over-simplifying the situation. Programmes to combat loneliness are usually complex, encompassing a range of elements. As Gott et al. conclude, it is “unclear which specific aspects of an intervention contributed most strongly to its success.”
So how do we arrive at “validated psychological measures”.
Many recent reviews of loneliness and social isolation interventions have focused almost solely on quantitative outcomes, and without taking account of other forms of evidence. In reality, qualitative research can be more appropriate and valuable when the complexities and ever-changing nature of individual social networks are involved.
The measures suggested by the researchers to improve their results include:
- Increasing sample sizes.
- Standardising sampling, data collection and administration processes across programmes.
- Ensuring that participants do not have pre-existing relationships with people collecting the data.
- Ensuring that data are collected by experienced and anonymous researchers.
- Minimising freedom of participants to join or leave the research at any time.
- Avoiding convenience samples based on participants available through community organisations.
- Inclusion of a control group.
The practicality of such approaches may be questioned in the absence of unlimited resources and recognising the realities of working at the community-level. (How to recruit a perfect control group?)
There appear to me to be some contradictions inherent in this more rigorous and inflexible regime. The use of highly standardised measures may not reflect the particular attributes, or circumstances, of local areas or the nuances of society and culture among sub-groups within the population. On the one hand there are calls for involving older people in research planning, implementation and evaluation, and also in the design and delivery of services through extensive community consultations and provision of training for older volunteers. How will this be reconciled with calls for experienced and anonymous researchers?
This is not intended to be an attack on academic researchers. They have their own objectives and processes. It is simply a call for more thought on how locally relevant, sensitive and meaningful research can be used to improve the wellbeing of older people by combating loneliness and social isolation.
[1] Clare Gardiner, Gideon Geldenhuys and Merryn Gott (2018) Interventions to reduce social isolation and loneliness among older people: an integrative review. Health and Social Care in the Community 26(2), 147–157.
[2] Helen Bartlett, Jeni Warburton, Chi-wai lui, Linda Peach and Matthew Carroll (20143) Preventing social isolation in later life: findings and insights from a pilot Queensland intervention study. Ageing & Society 33, 1167-1189.
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