Primary care-based interventions addressing social isolation and loneliness in older people: a scoping review

Abstract

ObjectivesPrimary care is well positioned to identify and address loneliness and social isolation in older adults, given its gatekeeper function in many healthcare systems. We aimed to identify and characterise loneliness and social isolation interventions and detect factors influencing implementation in primary care.DesignScoping review using the five-step Arksey and O’Malley Framework.Data sourcesMEDLINE, CINAHL, EMBASE, COCHRANE databases and grey literature were searched from inception to June 2021.Eligibility criteriaEmpirical studies in English and Spanish focusing on interventions addressing social isolation and loneliness in older adults involving primary care services or professionals.Data extraction and synthesisWe extracted data on loneliness and social isolation identification strategies and the professionals involved, networks and characteristics of the interventions and barriers to and facilitators of implementation. We conducted a thematic content analysis to integrate the information extracted.Results32 documents were included in the review. Only seven articles (22%) reported primary care professionals screening of older adults’ loneliness or social isolation, mainly through questionnaires. Several interventions showed networks between primary care, health and non-healthcare sectors, with a dominance of referral pathways (n=17). Two-thirds of reports did not provide clear theoretical frameworks, and one-third described lengths under 6 months. Workload, lack of interest and ageing-related barriers affected implementation outcomes. In contrast, well-defined pathways, collaborative designs, long-lasting and accessible interventions acted as facilitators.ConclusionsThere is an apparent lack of consistency in strategies to identify lonely and socially isolated older adults. This might lead to conflicts between intervention content and participant needs. We also identified a predominance of schemes linking primary care and non-healthcare sectors. However, although professionals and participants reported the need for long-lasting interventions to create meaningful social networks, durable interventions were scarce. Sustainability should be a core outcome when implementing loneliness and social isolation interventions in primary care.

Sensor-based assessment of social isolation in community-dwelling older adults: a scoping review

“…Despite the negative health and social consequences of SI, it is not adequately managed in primary care settings [ 15 , 16 ]. SI is not routinely assessed in primary care settings and there is a lack of established best practices for assessment in the community [ 15 , 17 ].…”

“…Despite the negative health and social consequences of SI, it is not adequately managed in primary care settings [ 15 , 16 ]. SI is not routinely assessed in primary care settings and there is a lack of established best practices for assessment in the community [ 15 , 17 ]. One reason may be that primary care clinicians feel that their main responsibilities are to address biomedical issues rather than social issues.…”

“…Novel features can then be extracted from this rich multimodal dataset and fed to machine learning models that can detect and predict the onset of or changes in SI. The need for an automated longitudinal approach is not just because patients do not self-report or that they are unreliable or biased, but also that clinicians are failing to help as well because they do not have the time, resources and awareness to do it and that a longitudinal approach would be beneficial to identify the onset of SI [ 15 , 16 ].…”

The effect of positive thinking on resilience and life satisfaction of older adults: a randomized controlled trial

“…New positive approaches have focused on the importance and role of individual components and skills, including resiliency, and increased emphasis on ideal or successful aging 6 . Several features of resilience, including physical, mental, and social features, have been well-known among older people 7 – 9 , representing the multi-dimensionality of this feature. High resilience during later years of life has been accompanied by ideal outcomes, such as reduced depression and anxiety, increased quality of life, and improved lifestyle behaviors 10 – 12 .…”

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

“…Analyses of interventions tackling loneliness and social isolation in older people have previously been published [12][13][14]. More recently, this issue has received increased research attention [4,[15][16][17][18]. The disciplinary lens of the practitioner or researcher may influence the choice of intervention as does their understanding of the causes and consequences of loneliness and/or social isolation and how this might be changed.…”