Social isolation has major mental health and physical impacts on older people, yet limited funding and a prioritising of the physical needs of community care clients act as significant barriers to addressing the social wellbeing of individuals.
Every Wednesday in the old Council Hall in Red Hill, a small rural community located in the hinterland of the Mornington Peninsula, Keith O’Brien leads a small group of men in a woodworking session.
Using the timber cut by O’Brien, who is a retired builder, the group of six to eight men works together to assemble an outdoor chair or craft a model yacht.
“The group is focused on men who are frail, dependent on wheelie walkers for their mobility and who need that extra support not always found in a Community Men’s Shed,” says Michael Hillier who runs the social inclusion program at the Brotherhood of St Laurence.
The Red Hill Men’s Shed is facilitated by volunteers and designed by the men who attend the program.
“It’s an intimate space where they play cards, darts, try their hand at some creative art projects and enjoy one another’s company,” Hillier tells Community Care Review.
The big drawcard, he says, is the vintage Porsche that some of the men get a lift in by the volunteer driver.
The Brotherhood of St Laurence has been running a social inclusion program since 2003. What started out as monthly lunch groups has since grown to include a range of activities including the Men’s Shed and ‘iCoffee iChat’ sessions, where individuals share their favourite iPad apps and connect around a shared interest in technology.
Establishing small activity groups in their local communities supports older people to feel connected to their community and promotes their talents, says Hillier.
“It takes a significant amount of bravery for most people to join an activity group if they have been socially isolated. ‘Will I be liked?’ and ‘Will I fit in’ are common questions that people ask when attending new groups,” he says.
“It’s important for activity staff to be sensitive around issues such as hearing loss, poor eyesight, poor balance and incontinence, which are some of the biggest barriers that prevent people from socialising.
“One small thing that works is the friendly phone call each week from our staff inviting people to come. It’s nice to be invited and know that you would be missed if you didn’t come.”
However, he says one of the biggest challenges in running the leisure and social programs is funding.
For many consumers, their home care package is not sufficient to cover the costs of both personal and home care, as well as attending social activities. Hillier says the costs of community transport such as taxis can make the program expensive.
In a research report produced in March 2014 by The Benevolent Society on the wellbeing of community clients, the issue of cost was also identified as an important concern.
The report Your Life Your Wellbeing said: “While guidelines for home care packages include social support and transport to social activities, in practice these may be difficult to provide within the funding or hours available to someone who also needs assistance with, say, personal care and household tasks.”
While community care worker visits were valued as a form of companionship, the report’s authors argued that increased funding should be available to offer substantial social support to clients and carers, if needed, in a way that allows them to connect with their wider community.
The study of 265 Benevolent Society clients revealed that some clients and carers had deep seated psychosocial needs and goals that were sometimes unacknowledged by care staff.
For example, despite domestic assistance clients showing broadly similar levels of loneliness and higher levels of psychological distress as other clients, case managers were much less likely to classify them as being socially isolated.
Social isolation among culturally and linguistically diverse (CALD) clients was also not as well identified, which could be linked to staff overestimating the social support networks of CALD clients.
In its recommendations, the report called for holistic, comprehensive assessment of clients’ psycho-social needs to be built into community care services and for case managers and coordinators to explore issues of social connection and inclusion more fully during care planning.
To evaluate the effectiveness of various intervention strategies, the University of Adelaide is leading a national project to study what works to reduce social isolation amongst older people.
Dr Debbie Faulkner, deputy director of the Centre for Housing, Urban and Regional Planning at the University of Adelaide, says that anecdotal evidence suggests around 30 per cent of aged care clients are lonely or isolated and studies have shown the mental and physical health effects of this can be dramatic.
In 2010, a review of 148 studies covering around 300,000 people concluded the absence of supportive social relationships was equivalent to the health effects of smoking 15 cigarettes a day or drinking more than six alcoholic drinks daily. The review said that social isolation was more harmful than not exercising and twice as harmful as obesity.
In Australia, the ‘Emerging from the Shadows’ project is currently tracking a group of 80 people receiving a community care service over six months to measure the impact on their social connectedness and sense of belonging. The clients are receiving a mix of targeted social inclusion programs, as well as a home support or home care service in order to draw comparisons.
Preliminary findings suggest that any sort of contact on a regular basis may be having an influence on a person’s wellbeing, a finding supported in the results of the Benevolent Society research.
Faulkner says she has been shocked to realise that many of the study’s participants have reported feeling socially isolated for years, or say they cannot remember a time when they did not feel lonely.
The study is a collaborative project between a number of universities (the University of Adelaide, Melbourne University, Queensland University of Technology, Curtin University and King’s College London), and industry partners (ECH, Anglicare SA, Benetas, Silver Chain, Resthaven, IRT and COTA Queensland.)
In the second phase of the project, a national survey will capture the prevalence of social isolation and loneliness among a wider sample of Australia’s older population.
Twenty people in each state will then be interviewed to compare the life histories of those who are well-connected with those who report having poor quality social relationships.
“We want to understand what have been the factors in their life that led up to where they are now,” says Faullkner. “Is their loneliness the result of a major life event in late life such the death of a partner or close friend, the loss of their driver’s license or downsizing into an unfamiliar neighbourhood? Or are there lifetime factors that may have made them more susceptible to becoming socially isolated in old age?
Faulkner says the ultimate goal is to enable the planning of appropriate services for this cohort and to understand how to design and target aged care services to make a difference to the social wellbeing of older people.
Alone in a crowd
Supporting the conclusions of the Benevolent Society research, Faulkner agrees it can be difficult to identify who is at risk of social isolation and she says it is important to note that it is the quality not the quantity of our relationships that matters most.
She tells the story of Margaret*, a woman in her early 90s who, despite living in a retirement village surrounded by people, felt deeply alone. As years went by, her fellow residents passed away and were replaced with new residents 20 years younger, who shared vastly different interests.
Margaret felt increasingly socially disconnected, despite on the surface appearing to have access to large community networks. “You think they are surrounded by people that they must be ok, but it’s a bit like that saying, ‘you can be alone in a crowd’,” says Faulkner.
The findings of this large, national project will help shed light on this common but under-researched problem.
For more information or to participate in the Emerging from the Shadows study contact Dr Debbie Faulkner on (08) 8313 3230 or email email@example.com.
This article first appeared in January 2015 Community Care Review