Following the launch of the program, Age UK commissioned the Centre for Health Promotion Research at Leeds Metropolitan University to undertake an evaluation of the programme and to measure and identify the effectiveness of telephone befriending services for older people with regards to their mental and physical wellbeing and their quality of life. The programme also examined the component parts of each model of telephone befriending to identify “models of good practice”.
The study showed that the best structure would be a combination of telephone calls, face-to-face visiting and telephone clubs with emphasis on friendship rather than befriending. It also admits to little time and not enough resources to administer the service. Supportive network with regular input from Age UK manager and regular training for project co-ordinators would be necessary for the smooth provision of the service, together with continual record keeping and monitoring system.
The service can only be sustained by a sufficient number of trained volunteers, matched with clients on the basis of shared interests rather than age or gender. A well-established referral network is required as well as collaboration with referral agencies and other related service agencies, targeting professionals who work directly with the client group. Project coordinators bear the most important local promotion responsibility, as they are aware of local needs and networks within their area, and they know who and where to target in order to maximise effectiveness. Currently, there is no formalised procedure in place for promotion and publicity. This tends to happen on an ad hoc basis utilising whatever means are available in the local area. Financing of promotional materials is assured by Age UK.
Health and social care policies and their influence on telephone befriending
Various international policies and national health strategies recognise the importance of reducing social isolation and loneliness to improve older people’s well-being and quality of life (Department of Health 2001; World Health Organisation 2002). In the United Kingdom, the NHS National Service Frameworks for Mental Health and for Older People have provided local incentives to address loneliness and isolation (Department of Health 1999, 2001).
The development of such strategies to increase older people’s engagement in social life has been a key component of recent UK government policies. The delivery of health and social care and the tackling of social inequalities still remains a soaring Public Health concern. The number of older people gradually increases in the UK, and this calls for better regulations to support their health, mobility and care. Data from the Health Survey for England (DoH, 2000) show that 43 per cent of those over the age of 65 years lived with a moderate or severe disability. The tendencies are rising to 74 per cent of those aged 85 and over (Kellard et al, 2006).
In order to effectively address the needs of older people, health and social care need to be better coordinated with an increase in service provision and most importantly, a greater focus on those services of preventive value (Wanless, 2006). It is over a decade since Wistow and Lewis (1997) argued that a national policy framework, which recognises the value of preventive strategies such as befriending services, is needed. The literature review of mentoring and befriending initiatives undertaken by the Scottish Executive (Wood, 2003) also highlights the need for such services to be firmly integrated within the wider context of service provision. Findings from research conducted by the Joseph Rowntree Foundation (2004) consistently reinforce the idea that befriending services need to be an integral part of a preventive strategy, one which is centered on planning for an ageing society.
A Sure Start in Later Life: Ending Inequalities for Older People includes the main policy thrust for delivering appropriate, joint community services in England (SEU, 2006). It’s focused on providing a range of appropriate services for older people under one roof in local communities, piloted by the Department for Work and Pensions through the Link Age Plus programme and the Partnerships for Older People pilot projects. The wide range of services include health and social care, housing and environment, finance and benefits, lifelong learning, volunteering, advocacy and specialist advice, transport and social activities.
Older people who don’t suffer from isolation and loneliness may still require support in other different areas of their lives, and thus must be protected as to their human rights and entitlements to health and social services. The Human Rights Act is one of the legislations that influences the way public services are delivered to older people. One of the aspects of older people’s human rights is to have the right to make decisions about their private life, including participation in community life (British Institute of Human Rights, 2006). Older people also have the right to feel safe and secure in their local environment and to be able to access the services that are appropriate for their needs (SEU, 2006).
Restricting people in their rights or neglecting their needs in any ways raises the issue of adult abuse and is regulated by the Adult Safeguarding policies, which define adult abuse as a single or repeated act or lack of appropriate actions, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. Abuse is currently recognised as a growing and significant problem by all agencies providing care for older people (DoH, 2011).
The UK Government has introduced a number of other policies to assist older people living in the community. Although the detail of policies differs, the tendency is to focus on the provision of coordinated and integrated health and community services for older people.
Appropriateness, accessibility and effectiveness of the service in meeting the social care needs of older people
One in seven people aged 65 and over in England live alone (DoH, 2003). Coping with health decline is often difficult for them. They feel anxious about being a burden to others, either their children or members of the wider family. Older people, particularly those who live alone, often find it difficult to cope with restricted health and mobility, both practically (not being able to get around) and emotionally (being restrained to the home for long periods of time with little or no company) (Hill et al, 2007).
The use of assistive technology, focused on increasing communication and widening participation, is of a great value for helping older people to stay socially connected and can help increase the independence and quality of life. In particular, the telephone provides many opportunities for reconnecting people to the community and preventing social isolation. The value of the telephone befriending service is the opportunity it affords for human contact (Mann et al, 2008; Blythe et al, 2005 and Monk et al, 2005).
Andrews et al (2003) and McNeil (1994) argue that even when an older person has regular contact with relatives it is also important for an older person’s sense of well-being and happiness to maintain some kind of nonfamily social interaction. This is reiterated in research conducted by Lillyman and Land (2007) who state that one way of reducing social isolation among older people is through befriending schemes where the emphasis is on one-to-one relationships rather than large social gatherings. It is worth noting that a growing body of research evidence refers to the value that older people themselves place on such preventative services (Lewis et al, 1999; Wistow and Lewis, 1997).
Morrow-Howell et al (1998) investigated the impact of a telephone support-therapy service for older people at risk of suicide that was provided by the local social service agency, and found that apart from a “marginally significant difference” (p=0.04) in depressive symptomatology at four months, the intervention was not effective in reducing loneliness and only partially effective in reducing social isolation. The authors implied that the validity of the social isolation measures was ambiguous because of the small sample size (n=60). In addition, the transferability of the intervention was debatable as it was relatively labour intensive with, on average, three calls per client each week.
There is little evidence in the research literature of the acceptability and appropriateness of telephone befriending services for older people in terms of their mental and physical health and quality of life and which takes into account the diversity of older people in relation to age, ethnicity, gender, social class and geography. In light of this apparent gap in research, a systematic review was undertaken, which concluded that educational and social activity group interventions that target specific groups could alleviate social isolation and loneliness among older people, but the effectiveness of home visiting and befriending remained unclear (Cattan et al, 2005).
In a later study conducted by Cattan et al (2008) results suggest that telephone befriending has a significant impact on older people’s lives. During the interviews the participants stated that they could not imagine life without it. They considered their relationship with the befriender to be crucial to their quality of life and the maintenance of their physical and psychological health. A measure of how much the interviewees valued the telephone befriending service and felt a part of it was the fact that they wanted more calls and said they would welcome the opportunity to train as a volunteer so they could make telephone calls.
Age UK’s Call in Time telephone befriending service has been proven to be of a great help to many of its service users. Mrs. B.’s experience gives an example of how the service works: “My husband passed away 4 years ago. On the same day my daughter was diagnosed with cancer, so I was immediately caring for her. That lasted 3 years, then it went to her kidneys, and she passed away in a hospice. I think the worst thing was the loneliness. I was very, very, very lonely, and very, very, very sad” (Age UK, 2012).
This lady was referred to Age UK’s Call in Time telephone befriending service by social services, through which she was partnered up with her own befriender, who she shortly built up a rapport with: “They called me every day initially, then once a week. I still get that weekly phone call. The support I’ve been given has been constant and extremely helpful as I’ve had no one to talk to, so I could offload. It’s something to look forward to. The Call in Time service has helped me dramatically, because I know that that call is coming. If I’m upset I’ve got someone to talk to me, and if I’m happy I’ve got someone to share that with. And as time passes, I’m feeling much better, but I couldn’t have coped without the support I got from the Call in Time team” (Age UK, 2012).
The health promoting role of the nurse in accessing the telephone befriending service
Effective health promotion for older people should focus on reducing their functional disability and improving their general wellbeing, resulting in longer and healthier life. One of the main roles of the nurse is to be able to promote this healthier life for older people, which encounters being aware of the most current health related issues and gaining more knowledge and new skills continuously, which is a lifelong learning process.
Since ageing can be characterized as a process of increasing physical, mental and social vulnerability, caring for older people means encountering different forms of vulnerability. Vulnerability is thus an important resource in nursing. Nurses and patients develop a connection through this vulnerability, which involves a mutual sensitivity. In nurses this sensitivity is necessary for understanding patients. It helps nurses to tune into the atmosphere of the surroundings and to pick up weak messages from patients (Stenbock-Hult and Sarvimaki, 2011).
Both community and hospital based nurses have to develop this kind of sensitivity towards the needs of all patients, and especially towards older people’s physiological, psychological and social needs. Loneliness and social isolation makes people highly vulnerable and the role of the nurse in this is to reduce this vulnerability by providing support and advocacy for patients, referring them for appropriate services available for them locally.
Several studies show the correlation between loneliness, isolation and the pathology of various diseases. Recent studies showed that social network size impacted on the connection between pathology and cognitive function in Alzheimer’s disease, where a larger social network size was linked to better cognitive function (Bennett et al, 2006). Loneliness and/or lack of network support have also been proven to result in lower levels of cognitive function and higher rates of cognitive decline (Tilvis et al, 2004 and Blazer, 2002). Also, Fratiglioni and Paillard-Borg (2004) stated that the onset of different types of dementia may be somewhat delayed by an active and socially satisfactory lifestyle.
One of the most significant skills in nursing is to realize this biological-psychological-social connection and see the consequential link between the biopsychosocial need, the pathology and the appropriate treatment of certain conditions. Within the telephone befriending service, the nurse’s role lies within noticing the need for it, explaining how the service works and making a referral through applicable pathways for those who would benefit from it.
It is also necessary to mention here the importance of interprofessional working among health professionals, as it is paramount in caring for older people. Its value becomes evident in every aspect of health care, as the biopsychosocial needs of every person are strongly interlinked in nature. The quality of holistic care could be improved by asking older people about their own views on themselves, their conditions and circumstances, about the situations they feel vulnerable in and also by concentrating team efforts on addressing these issues.
Conclusion
The above work has summarised the findings about telephone befriending as a service to alleviate older people’s loneliness and feeling of social isolation, focusing on the evaluation of the service, its effectiveness, and its place within Public Health and the field of social policy. The literature available at this time suggests that telephone befriending schemes have an important role to play in the community care of a varied group of service users, although the effectiveness of the service to combat social isolation and loneliness among older people is not clear.
Altogether the telephone befriending service appears to be making a difference to the lives of the older people asked in recent studies. It becomes obvious from the interviews that having a telephone befriender provides a sense of security and belonging for older people, which can mediate the effects of social isolation and loneliness. Knowing they have a friend whom they can talk with, someone who cares about their welfare and whom they can rely on gives people confidence, which results in a noticeable improvement in their general well-being.
Still, there is a need for further research to measure the specific outcomes of befriending. This means focusing on the effectiveness of such services in terms of their influence on older people’s quality of life and their overall preventive value. Research needs to be carried out which investigates different models of telephone befriending, drawing on current understanding as to why certain types of services might or might not be effective. Further work is required to identify appropriate methods for public health and health-promotion evaluation.
Even though there is an apparent lack of peer reviewed published research that examines the effectiveness of befriending services for older people, there is a variety of information from the grey literature. Much of the literature produced on behalf of voluntary organisations and charitable foundations supports the move towards befriending services as a sustainable solution for reducing social isolation because of their longer-term preventive value.
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Social isolation and loneliness among older people – the effectiveness of telephone befriending services
Introduction
The chosen vulnerable group for this work is older people, as one of the soaring public health issues the NHS is facing these days is the aging population. As we age we will inevitably find ourselves having to tackle certain biological, psychological and social difficulties that occur as a consequence of poorer health and retirement from work, making us vulnerable in many areas of life. This annotated bibliography focuses on the need for social interactions and involvement, discussing the benefits of the telephone befriending service in particular. An opinion article and two research papers have been chosen from evidence-based sources to investigate the growing public health issue of social isolation and loneliness.
Learner, S. (2011). Sick of feeling lonely. Nursing Standard, 26(2), 18-19.
This opinion article discusses the causes and signs of loneliness, also its impact on older people’s health and well-being. It focuses on the social aspect of vulnerability experienced by older people living in the community as well as within residential settings. Health care professionals of various backgrounds express their opinion and experience as to loneliness. Loneliness is stated to be a public health threat: “more than half of people over 75 live alone and about one in ten say they suffer from ‘intense’ loneliness” (18). Emphasised is the fact that social isolation can lead to depression and alcoholism and “can also trigger high blood pressure, affect the immune and cardiovascular systems and has been linked to the onset of Alzheimer’s disease” (18).
The nurses’ role is seen to be vital in alleviating loneliness among older people in the community and in care homes as they can “put people in touch with befrienders, day centres or activity clubs” and “help people keep in touch using the internet” (19). The limitation of the article is that there are not many references or sources of information listed, making its evidence-based reliability debateable. Although the article mentions befrienders, it does not contain specific information about telephone befriending.
Cattan, M., Kime, N. and Bagnall, A.-M. (2010). The use of telephone befriending in low level support for socially isolated older people – an evaluation. Health and Social Care in the Community, 19(2), 198–206, retrieved December 16, 2011, from Wiley Online Library Web site:
This research study evaluates the impact of telephone befriending for isolated older people, involving eight project sites across the UK in 2007–2008. The authors are well-known experts in the field of healthcare and health promotion, having published numerous public health related articles in the past few years, providing an exceptionally valuable evidence-based source of information. Participants’ opinion on the telephone befriending service is quoted throughout the study, making it not only scientifically reliable but also emotionally expressive: “You’d just rot otherwise without having a talk once a week on the phone and it makes a big difference when you can’t go out. Sometimes I long for the phone to ring (Female, 77)” (203).
It is hardly an arguable fact that telephone befriending could be one of the best options for socially isolated older people, making their lives “worth living” (198). The authors of the article clearly state that “telephone befriending provides low cost means to help isolated older people gain confidence, develop self-respect and re-engage with the community” (198). These findings have also been backed up by Cattan et al (2009) in the study “Low level support for socially isolated people – An evaluation of telephone befriending” published by Age UK.
Cant, B. and Taket, A. (2005). Promoting social support and social networks among Irish pensioners in South London, UK. Changes in Diversity in Health and Social Care, 2, 263–70.
This qualitative study explores the nature and extent of unmet mental health needs of Irish pensioners. The article is supported by a literature review drew on sources about the Irish community in the UK and paints a picture of social isolation through case studies of individual participants of the Irish Pensioners’ Project. The project details the use of different forms of social support through the help of volunteers and befriending services. Telephone contact is mentioned as “particularly valuable in the evenings and at the weekends, when people were more liable to feel isolated, depressed and, occasionally, suicidal” (267).
The question arising from this topic is whether the co-operation between service providing agencies can be further improved and if so, what action could be taken to provide preventative activities to socially isolated older people. The usefulness of the article comes from it being “an example of a voluntary organisation providing low-cost services to reduce social isolation” and “offering insights into the value of multidisciplinary partnership working among providers” (269). The limitation of the study is that it focuses on the mental health needs of a specific minority ethnic group of the community whereas the two previous articles cover all groups of older people in general.
Conclusion
The above articles helped me to understand that loneliness can become a huge health risk to older people. A holistic approach towards healthcare has to be followed by nurses so that the focus is on the social and psychological aspects of health as much as the biological needs of patients. Exploring the topic also made me realise that in order to maintain good mental health people need to be given the opportunity to engage in culturally appropriate social activities of their individual choice. Telecommunication is one of the best means of social support as it is widely available and accessible for everyone and not restricted to time or place.
References
Cattan, M., Kime, N. and Bagnall, A.-M. (2009) Low-level support for socially
isolated older people - An evaluation of telephone befriending. [Online] Available from: [accessed on: 03.01.2012].