Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-22T19:32:36.716Z Has data issue: false hasContentIssue false
  • English
  • Français

Interventions to improve the health and wellbeing of older people living alone: a mixed-methods systematic review of effectiveness and accessibility

Published online by Cambridge University Press:  07 January 2020

Georgina Johnstone Open the ORCID record for Georgina Johnstone [Opens in a new window] ,
Marissa Dickins Open the ORCID record for Marissa Dickins [Opens in a new window] ,
Judy Lowthian ,
Emma Renehan ,
Joanne Enticott ,
Duncan Mortimer  and
Rajna Ogrin Open the ORCID record for Rajna Ogrin [Opens in a new window]
Georgina Johnstone*
Affiliation:
Bolton Clarke Research Institute, Melbourne, Australia
Marissa Dickins
Affiliation:
Bolton Clarke Research Institute, Melbourne, Australia Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical School, Monash University, Melbourne, Australia
Judy Lowthian
Affiliation:
Bolton Clarke Research Institute, Melbourne, Australia School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia Institute of Future Environments, Queensland University of Technology, Brisbane, Queensland, Australia
Emma Renehan
Affiliation:
Bolton Clarke Research Institute, Melbourne, Australia Beyond Blue, Hawthorn, Victoria, Australia
Joanne Enticott
Affiliation:
Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical School, Monash University, Melbourne, Australia Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
Duncan Mortimer
Affiliation:
Centre for Health Economics, Monash Business School, Monash University, Clayton, Australia
Rajna Ogrin
Affiliation:
Bolton Clarke Research Institute, Melbourne, Australia Department of International Business and Asian Studies, Griffith University, Brisbane, Australia Biosignals for Affordable Healthcare, Royal Melbourne Institute of Technology University, Melbourne, Australia Austin Health Department of Medicine, University of Melbourne, Melbourne, Australia
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The global population is ageing and the likelihood of living alone increases with age. Services are necessary to help older people living alone to optimise health and wellbeing. This systematic review aimed to summarise the effectiveness and accessibility of interventions to improve the health and wellbeing of older people living alone. Relevant electronic databases (CINAHL, MEDLINE, PsycINFO and Scopus) were searched for all years up to August 2018. Studies were included if they involved older people (aged ⩾55 years) living alone, and an intervention with measured health and wellbeing outcomes. All study types were included. The Theory of Access was used to assess interventions across dimensions of accessibility, availability, acceptability, affordability, adequacy and awareness. Twenty-eight studies met the eligibility criteria; 17 studies focused on ageing safely in place and 11 on psychological and social wellbeing. Studies comprised quantitative (N = 19), qualitative (N = 4) and mixed-methods (N = 5) approaches. Dimensions from the Theory of Access were poorly addressed in the studies, particularly those of higher-quality methodology. Studies were heterogeneous, preliminary in scope and lacked consistent study design, methodology or measurement. Services that do not address user accessibility in design or evaluation may be limited in their uptake and impact. It is recommended that dimensions of access and co-creation principles be integrated into service design processes and be evaluated alongside clinical effectiveness.

Keywords

older adultsliving aloneaccesshealthwellbeingageing in place
Type
Review Article
Information
Ageing & Society , Volume 41 , Issue 7 , July 2021 , pp. 1587 - 1636
Copyright
Copyright © The Authors, 2020. Published by Cambridge University Press.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adams, RG and Blieszner, R (1995) Aging well with friends and family. American Behavioral Scientist 39, 209–224.CrossRefGoogle Scholar
Ahn, J-A, Park, J and Kim, C-J (2018) Effects of an individualised nutritional education and support programme on dietary habits, nutritional knowledge and nutritional status of older adults living alone. Journal of Clinical Nursing 27, 2142–2151.CrossRefGoogle ScholarPubMed
Andersson, L (1985) Intervention against loneliness in a group of elderly women: an impact evaluation. Social Science & Medicine 20, 355–364.CrossRefGoogle Scholar
Andonian, L and MacRae, A (2011) Well older adults within an urban context: strategies to create and maintain social participation. British Journal of Occupational Therapy 74, 2–11.CrossRefGoogle Scholar
Andrews, GJ, Gavin, N, Begley, S and Brodie, D (2003) Assisting friendships, combating loneliness: users’ views on a ‘befriending’ scheme. Ageing & Society 23, 349–362.CrossRefGoogle Scholar
Asakawa, T, Koyano, W, Ando, T and Shibata, H (2000) Effects of functional decline on quality of life among the Japanese elderly. International Journal of Aging & Human Development 50, 319–328.CrossRefGoogle ScholarPubMed
Australian Bureau of Statistics (2006) Future Living Arrangements, Year Book Australia, 2006. Available at http://www.abs.gov.au/ausstats/[email protected]/Previousproducts/1301.0Feature%20Article92006?opendocument&tabname=Summary&prodno=1301.0&issue=2006&num=&view=.Google Scholar
Australian Bureau of Statistics (2015) Household and Family Projections, Australia, 2011 to 2036. Available at http://www.abs.gov.au/ausstats/[email protected]/mf/3236.0.Google Scholar
Australian Bureau of Statistics (2017) Ageing Population, 2016. Available at https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/2071.0~2016~Main%20Features~Ageing%20Population~14.Google Scholar
Australian Institute of Health and Welfare (2013) The Desire to Age in Place Among Older Australians. Available at https://www.aihw.gov.au/reports/older-people/the-desire-to-age-in-place-among-older-australians/contents/table-of-contents.Google Scholar
Australian Institute of Health and Welfare (2018) Older Australia at a Glance. Available at https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/summary.Google Scholar
Bacsu, J, Jeffery, B, Novik, N, Abonyi, S, Oosman, S, Johnson, S and Martz, D (2014) Policy, community and kin: interventions that support rural healthy aging. Activities, Adaptation & Aging 38, 138–155.Google Scholar
Bidonde, M, Goodwin, DL and Drinkwater, DT (2009) Older women's experiences of a fitness program: the importance of social networks. Journal of Applied Sport Psychology 21, S86–S101.CrossRefGoogle Scholar
Bly, JL and Kissick, P (1994) Hospice care for patients living alone: results of a demonstration program. Hospice Journal 9, 9–20.CrossRefGoogle ScholarPubMed
Calsyn, RJ, Munson, M, Peaco, D, Kupferberg, J and Jackson, J (1984) A comparison of the effectiveness of various approaches to visiting isolated community elderly. Journal of Gerontological Social Work 7, 29–42.CrossRefGoogle Scholar
Cattan, M, Kime, N and Bagnall, A-M (2011) The use of telephone befriending in low level support for socially isolated older people – an evaluation. Health & Social Care in the Community 19, 198–206.Google ScholarPubMed
Cattan, M, White, M, Bond, J and Learmouth, A (2005) Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Ageing & Society 25, 41–67.CrossRefGoogle Scholar
Chappell, NL, Dlitt, BH, Hollander, MJ, Miller, JA and McWilliam, C (2004) Comparative costs of home care and residential care. The Gerontologist 44, 389–400.CrossRefGoogle ScholarPubMed
Cheng, S-T, Fung, HH and Chan, ACM (2008) Living status and psychological well-being: social comparison as a moderator in later life. Aging & Mental Health 12, 654–661.CrossRefGoogle ScholarPubMed
Cheung, C-k and Ngan, M-h (2000) Contributions of volunteer networking to isolated seniors in Hong Kong. Journal of Gerontological Social Work 33, 79–100.CrossRefGoogle Scholar
Clarke, M, Clarke, SJ and Jagger, C (1992) Social intervention and the elderly: a randomized controlled trial. American Journal of Epidemiology 136, 1517–1523.CrossRefGoogle ScholarPubMed
Coelho, J and Duarte, C (2015) Socially networked or isolated? Differentiating older adults and the role of tablets and television. In Abascal, J, Barbosa, S, Fetter, M, Gross, T, Palanque, P and Winckler, M (eds), Human–Computer Interaction – INTERACT 2015 (Lecture Notes in Computer Science Vol. 9296). Cham, Switzerland: Springer, pp. 129–146.CrossRefGoogle Scholar
Cohen-Mansfield, J and Perach, R (2015) Interventions for alleviating loneliness among older persons: a critical review. American Journal of Health Promotion 29, e109–e125.CrossRefGoogle ScholarPubMed
de Vaus, D and Qu, L (2015a) Demographics of Living Alone (Australian Family Trends No. 6). Melbourne: Australian Institute of Family Studies.Google Scholar
de Vaus, D and Qu, L (2015b) The Nature of Living Alone in Australia (Australian Family Trends No. 9). Melbourne: Australian Institute of Family Studies.Google Scholar
Department of Social Services (2015) Living Well at Home: CHSP Good Practice Guide. Available at https://agedcare.health.gov.au/sites/default/files/documents/06_2015/good_practice_guide_version_web_accessible_pdf.pdf.Google Scholar
Dickens, AP, Richards, SH, Greaves, CJ and Campbell, JL (2011) Interventions targeting social isolation in older people: a systematic review. BMC Public Health 11, 647.CrossRefGoogle ScholarPubMed
Ensor, T and Cooper, S (2004) Overcoming barriers to health service access: influencing the demand side. Health Policy and Planning 19, 69–79.CrossRefGoogle ScholarPubMed
Findlay, RA (2003) Interventions to reduce social isolation amongst older people: where is the evidence? Ageing & Society 23, 647–658.CrossRefGoogle Scholar
Fokkema, T and Knipscheer, K (2007) Escape loneliness by going digital: a quantitative and qualitative evaluation of a Dutch experiment in using ECT to overcome loneliness among older adults. Aging & Mental Health 11, 496–504.CrossRefGoogle ScholarPubMed
Ganong, LH, Coleman, M, Benson, JJ, Snyder-Rivas, LA, Stowe, JD and Porter, EJ (2013) An intervention to help older adults maintain independence safely. Journal of Family Nursing 19, 146–170.CrossRefGoogle ScholarPubMed
Gardiner, C, Geldenhuys, G and Gott, M (2018) Interventions to reduce social isolation and loneliness among older people: an integrative review. Health & Social Care in the Community 26, 147–157.CrossRefGoogle ScholarPubMed
Goins, RT, Williams, KA, Carter, MW, Spencer, SM and Solovieva, T (2005) Perceived barriers to health care access among rural older adults: a qualitative study. Journal of Rural Health 21, 206–213.CrossRefGoogle ScholarPubMed
Graham, C, Scharlach, AE and Kurtovich, E (2018) Do villages promote aging in place? Results of a longitudinal study. Journal of Applied Gerontology 37, 310–331.CrossRefGoogle ScholarPubMed
Graham, CL, Scharlach, AE and Price Wolf, J (2014) The impact of the ‘Village’ model on health, well-being, service access, and social engagement of older adults. Health Education & Behavior 41, 91S–97S.CrossRefGoogle ScholarPubMed
Graham, CL, Scharlach, AE and Stark, B (2017) Impact of the Village model: results of a national survey. Journal of Gerontological Social Work 60, 335–354.CrossRefGoogle ScholarPubMed
Greaves, M and Rogers-Clark, C (2009) The experience of socially isolated older people in accessing and navigating the health care system. Australian Journal of Advanced Nursing 27, 5–11.Google Scholar
Greenhalgh, T, Jackson, C, Shaw, S and Janamian, T (2016) Achieving research impact through co-creation in community-based health services: literature review and case study. Milbank Quarterly 94, 392–429.CrossRefGoogle ScholarPubMed
Grimmer, K, Kay, D, Foot, J and Pastakia, K (2015) Consumer views about aging-in-place. Clinical Interventions in Aging 10, 1803–1811.Google ScholarPubMed
Gross, HM, Mueller, S, Schroeter, C, Volkhardt, M, Scheidig, A, Debes, K, Richter, K and Doering, N (2015) Robot companion for domestic health assistance: implementation, test and case study under everyday conditions in private apartments. In 2015 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Hamburg, Germany: IEEE, pp. 5992–5999.CrossRefGoogle Scholar
Gurley, RJ, Lum, N, Sande, M, Lo, B and Katz, MH (1996) Persons found in their homes helpless or dead. New England Journal of Medicine 334, 1710–1716.CrossRefGoogle ScholarPubMed
Holland, J and Rodie, AR (2011) Growing old and living alone: perceptions of preventive health services. Journal of Management & Marketing in Healthcare 4, 113–121.CrossRefGoogle Scholar
Huang, C-L, Wu, S-C, Jeng, C-Y and Lin, L-C (2004) The efficacy of a home-based nursing program in diabetic control of elderly people with diabetes mellitus living alone. Public Health Nursing 21, 49–56.CrossRefGoogle ScholarPubMed
Huang, L-H and Lin, Y-C (2002) The health status and needs of community elderly living alone. Journal of Nursing Research 10, 227–236.CrossRefGoogle ScholarPubMed
Iliffe, S, Tai, SS, Haines, A, Gallivan, S, Goldenberg, E, Booroff, A and Morgan, P (1992) Are elderly people living alone an at risk group? British Medical Journal 305, 1001–1004.CrossRefGoogle ScholarPubMed
Jung, H and Lee, J-E (2017) The impact of community-based eHealth self-management intervention among elderly living alone with hypertension. Journal of Telemedicine and Telecare 23, 167–173.CrossRefGoogle ScholarPubMed
Kharicha, K, Iliffe, S, Harari, D, Swift, C, Gillmann, G and Stuck, AE (2007) Health risk appraisal in older people 1: are older people living alone an ‘at-risk’ group? British Journal of General Practice 57, 271–276.Google ScholarPubMed
Klinenberg, E (2016) Social isolation, loneliness, and living alone: identifying the risks for public health. American Journal of Public Health 106, 786–787.CrossRefGoogle ScholarPubMed
Kmet, LM, Lee, RC and Cook, LS (2004) Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Edmonton, Canada: Alberta Heritage Foundation for Medical Research.Google Scholar
Lee, K and Raiz, L (2015) The home-delivered meals program: a promising intervention for suburban older adults living alone. Care Management Journals 16, 195–202.CrossRefGoogle ScholarPubMed
Levine, ME and Crimmins, EM (2018) Is 60 the new 50? Examining changes in biological age over the past two decades. Demography 55, 387–402.CrossRefGoogle ScholarPubMed
Liu, SJ, Lin, CJ, Chen, YM and Huang, XY (2007) The effects of reminiscence group therapy on self-esteem, depression, loneliness and life satisfaction of elderly people living alone. Mid-Taiwan Journal of Medicine 12, 133–142.Google Scholar
Lucas, RE (2007) Adaptation and the set-point model of subjective well-being: does happiness change after major life events? Current Directions in Psychological Science 16, 75–79.CrossRefGoogle Scholar
Mahoney, DF, Mahoney, EL and Liss, E (2009) AT EASE: Automated Technology for Elder Assessment, Safety, and Environmental monitoring. Gerontechnology 8, 11–25.CrossRefGoogle Scholar
Masi, CM, Chen, H-Y, Hawkley, LC and Cacioppo, JT (2011) A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review 15, 219–266.CrossRefGoogle ScholarPubMed
McHugh Power, JE, Lee, O, Aspell, N, McCormack, E, Loftus, M, Connolly, L, Lawlor, B and Brennan, S (2016) RelAte: pilot study of the effects of a mealtime intervention on social cognitive factors and energy intake among older adults living alone. British Journal of Nutrition 116, 1573–1581.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG and Prisma Group (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. PLOS Medicine 6, e1000097.CrossRefGoogle ScholarPubMed
Moore, J, Giesen, J, Weber, JM and Crews, JE (2001) Functional outcomes reported by consumers of the Independent Living Program for Older Individuals Who Are Blind. Journal of Visual Impairment & Blindness 95, 403–417.CrossRefGoogle Scholar
Moore, J, Steinman, B, Giesen, J and Frank, J (2006) Functional outcomes and consumer satisfaction in the Independent Living Program for Older Individuals Who Are Blind. Journal of Visual Impairment & Blindness 100, 285–294.CrossRefGoogle Scholar
Morgenstern, LB, Adelman, EE, Hughes, R, Wing, JJ and Lisabeth, LD (2015) The Women Independently Living Alone with a Medical Alert Device (WILMA) trial. Translational Stroke Research 6, 355–360.CrossRefGoogle ScholarPubMed
National Association of Area Agencies on Aging, National Council on Aging and UnitedHealthcare (2015) The United States of Aging Survey. Available at https://www.unitedhealthgroup.com/newsroom/2015/0708unitedstatesofaging.html.Google Scholar
Ofei-Dodoo, S, Medvene, LJ, Nilsen, KM, Smith, RA and DiLollo, A (2015) Exploring the potential of computers to enrich home and community-based services clients’ social networks. Educational Gerontology 41, 216–225.CrossRefGoogle Scholar
Olsberg, D and Winters, M (2005) Ageing in Place: Intergenerational and Intrafamilial Housing Transfers and Shifts in Later Life (Final Report No. 88). Melbourne: Australian Housing and Urban Research Institute. Available at https://www.ahuri.edu.au/research/final-reports/88.Google Scholar
Orellano-Colón, EM, Mountain, GA, Rosario, M, Colón, ZM, Acevedo, S and Tirado, J (2015) Environmental restrictors to occupational participation in old age: exploring differences across gender in Puerto Rico. International Journal of Environmental Research and Public Health 12, 11288–11303.CrossRefGoogle ScholarPubMed
Penchansky, R and Thomas, JW (1981) The concept of access: definition and relationship to consumer satisfaction. Medical Care 19, 127–140.CrossRefGoogle ScholarPubMed
Popay, J, Roberts, H, Sowden, A, Petticrew, M, Arai, L, Rodgers, M, Britten, N, Roen, K and Duffy, S (2006) Guidance on the Conduct of Narrative Synthesis in Systematic Reviews: A Product from the ESRC Methods Programme. Available at http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.178.3100&rep=rep1&type=pdf.Google Scholar
Pripfl, J, Kortner, T, Batko-Klein, D, Hebesberger, D, Weninger, M and Gisinger, C (2016) Social service robots to support independent living: experiences from a field trial. Zeitschrift für Gerontologie und Geriatrie 49, 282–287.CrossRefGoogle ScholarPubMed
Richard, A, Rohrmann, S, Vandeleur, CL, Schmid, M, Barth, J and Eichholzer, M (2017) Loneliness is adversely associated with physical and mental health and lifestyle factors: results from a Swiss national survey. PLOS ONE 12, e0181442.CrossRefGoogle ScholarPubMed
Rose, MR (2006) The impact of homecare services to the homebound elderly individual living independently alone in the community. Dissertation Abstracts International Section A: Humanities and Social Sciences 67, 340.Google Scholar
Rychetnik, L, Frommer, M, Hawe, P and Shiell, A (2002) Criteria for evaluating evidence on public health interventions. Journal of Epidemiology and Community Health 56, 119–127.CrossRefGoogle ScholarPubMed
Saurman, E (2015) Improving access: modifying Penchansky and Thomas's Theory of Access. Journal of Health Services Research & Policy 21, 36–39.CrossRefGoogle Scholar
Savikko, N, Routasalo, P, Tilvis, RS, Strandberg, TE and Pitkala, KH (2005) Predictors and subjective causes of loneliness in an aged population. Archives of Gerontology and Geriatrics 41, 223–233.CrossRefGoogle Scholar
Schmitt, EM, Sands, LP, Weiss, S, Dowling, G and Covinsky, K (2010) Adult day health center participation and health-related quality of life. The Gerontologist 50, 531–540.CrossRefGoogle Scholar
Stepler, R (2016) Smaller Share of Women Ages 65 and Older are Living Alone. Available at https://www.pewsocialtrends.org/2016/02/18/smaller-share-of-women-ages-65-and-older-are-living-alone/Google Scholar
Stevens, N (2001) Combating loneliness: a friendship enrichment programme for older women. Ageing & Society 21, 183–202.CrossRefGoogle Scholar
Strain, LA and Blandford, AA (2002) Community-based services for the taking but few takers: reasons for nonuse. Journal of Applied Gerontology 21, 220–235.CrossRefGoogle Scholar
Tang, F and Pickard, JG (2008) Aging in place or relocation: perceived awareness of community-based long-term care and services. Journal of Housing for the Elderly 22, 404–422.CrossRefGoogle Scholar
Toien, M, Bjork, IT and Fagerstrom, L (2018) An exploration of factors associated with older persons’ perceptions of the benefits of and satisfaction with a preventive home visit service. Scandinavian Journal of Caring Sciences 32, 1093–1107.CrossRefGoogle ScholarPubMed
United Nations, Department of Economic and Social Affairs and Population Division (2017) Living Arrangements of Older Persons: A Report on an Expanded International Dataset. Available at http://www.un.org/en/development/desa/population/publications/pdf/ageing/LivingArrangements.pdf.Google Scholar
Ware, JE (1997) SF-36 Health Survey: Manual & Interpretation Guide. Boston, MA: Health Institute, New England Medical Center.Google Scholar
World Health Organization (2017) WHO Guidelines on Integrated Care for Older People (ICOPE). Available at https://www.who.int/ageing/publications/guidelines-icope/en/.Google Scholar
Yeh, S-CJ and Lo, SK (2004) Living alone, social support, and feeling lonely among the elderly. Social Behavior and Personality 32, 129–138.Google Scholar
Zingmark, M, Fisher, AG, Rocklov, J and Nilsson, I (2014) Occupation-focused interventions for well older people: an exploratory randomized controlled trial. Scandinavian Journal of Occupational Therapy 21, 447–457.CrossRefGoogle Scholar