The aim of this essay is to investigate telephone befriending as a service from the point of view of the current Health and Social Care Policy and to explore how beneficial the service is in alleviating the feelings of loneliness and social isolation.

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SN 21099928

Telephone befriending service for older people

Introduction

The percentage of older people in the UK has increased in recent years and social isolation in older people has become a soaring public health issue. Evidence indicates that social isolation and loneliness can have a major effect on the health and wellbeing of people of all ages, especially older people. The aim of this essay is to investigate telephone befriending as a service from the point of view of the current Health and Social Care Policy and to explore how beneficial the service is in alleviating the feelings of loneliness and social isolation.

To determine the effectiveness of telephone befriending, the following topics were studied in detail: the definition of vulnerability; what makes older people vulnerable; telephone befriending service to combat loneliness; social policy and law on the service and its effectiveness; and the role of the nurse in promoting and accessing this service.

Electronic searches were run through databases like Medline, EBSCOhost, PsychInfo, CINAHL, Academic Search Elite and the Cochrane Library, looking at these five categories: the term “vulnerability”; population/target group; law/health promotion topic; effectiveness/ineffectiveness of telephone befriending service; and the role of the nurse in promoting the service. Additional literature was examined online and manually. Names and places were kept confidential in this work.

Definition of vulnerability and older people as a vulnerable group

The term “vulnerable” is often used to describe people or groups that are poor, disadvantaged, dependent, frail and/or isolated (Delor and Hubert, 2000). National policy on adult protection defines a vulnerable adult as a “person who is, or may be, in need of community care by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation” (Department of Health, 2000).

Research suggests that vulnerability comprises two distinct concepts: one of which is etic vulnerability, linked to externally evaluated risk, determined by an outsider and measurable; while the other is emic vulnerability, concerning an individual’s personal understanding of vulnerability and based on their own “experience of exposure to harm through challenges to their integrity” (Spiers, 2000, p. 718).

When applying the term “vulnerability” to the aspects of social exclusion or low quality of life, factors like gender and ethnic inequalities, cultural patterns, political and welfare systems have to be equally considered (Hilhorst and Bankoff, 2004).  On the other hand, people sometimes end up being in some ways “vulnerable” as the result of their own life histories, for example, being unmarried or childless can lead to loneliness and poverty in later life, making the individual dependent on social support and thus highly vulnerable (Grundy, 2006).

Societal issues, such as ageism and age discrimination also contributes to people’s exposure to harm (Office of the Deputy Prime Minister, 2005). It is well documented that ageism is widespread in every society (Nelson, 2002; Palmore, 2005 and Ray et al, 2006), and older people are often labeled to be boring, grumpy, weak, irritable, and cognitively impaired (Scholl and Sabat, 2008). Older people can sometimes see themselves as “deserving” these negative stereotypes (Kruse and Schmitt, 2006) and this view is also widespread among professional caregivers (Cowan et al, 2004).  

Recent studies on social exclusion also pinpoint the fact that environmental factors play a significant role in older people’s vulnerability. Scharf et al (2002) states that people living in deprived areas of the UK face serious risks of experiencing crime and social isolation and tend to be disadvantaged because of the lack of availability of public and private services.

Vulnerability evolves from different life experiences of a certain individual accumulated over time. Nevertheless, it is difficult to distinguish those who are vulnerable from those who are not by taking into account only exposure factors or common threats. The outcomes of threats and negative factors mainly depend on the ways in which individuals succeed or fail to use social, material and public resources to their advantages.

When defining the term “vulnerable” it is also important to mention that labelling people as vulnerable and in need of protection carries the dangers of overriding their priorities or their disempowerment (Lloyd-Sherlock, 2002). Russell (1999) suggests that there is an obvious difference between the public perception of certain older people as highly vulnerable and in need of services, and the older people’s own perception of vulnerability. To older people, being offered services may often feel like undermining their independence.

Reduced health and physical strength, disability, retirement, loss of a spouse arise from the biological and social processes of ageing and will shape older people’s views on their own vulnerability (Schroder-Butterfill and Marianti, 2006). Research  shows that he way individuals see their own difficulties and disabilities can be significant in coping with the challenges of old life, although relational resources like social networks (relatives, friends and neighbours) and formal social sources (community institutions like religious and voluntary associations) are usually more important (Grundy, 2003).

For the above reasons, vulnerability is a difficult phenomenon to study. Different outcomes in life are never perfectly predictable. There’s further need for formal welfare provisions, like pensions and health and social services (Lowenstein and Ogg, 2003). The UK is facing a future in which the needs of increasing numbers of people who on average will live longer will have to be met, and this calls for new initiatives to support their health, mobility and care, to promote their general wellbeing in later life.

The purpose of telephone befriending and its intended client group

According to national statistics, Britain’s older people are living in isolation, with those over the age of 65 twice as likely as other age groups to spend over 21 hours of the day alone. Reportedly, in 2002 29% of women aged between 60 and 74 years lived alone compared with 16% of men of the same age (Office for National Statistics, 2005). This trend is set to continue over the next twenty years, with an increase of nearly 50% in the number of people aged 85 years and over, expected to be living alone, who are likely to suffer from some form of disability or debilitating illness (Hersey, 2005).

A wide range of factors may affect older people as to their sense of social isolation and loneliness (Victor et al, 2006). For example, as a result of retirement or relocation older people may be unable to maintain their social connections and their social environment. They may lose connections to members of the extended family, and friends/ex-colleagues may be lost through illness or death. As a result, there may be no companion to interact and share social activities with. In addition, there may not be enough availability or accessibility to referred activities. A number of personal factors may encroach on the ability of older people to engage in social activities (Mott and Riggs, 1992).

Ill health, poor mobility, financial difficulties, adverse side effects of medications, problems with transportation, caring for a significant other and needing assistance may all lead to reduced social activity, lack of interaction with others and eventually social isolation (Victor et al, 2006). Mental illness, low morale, poor rehabilitation and admission to residential care have all been found to be correlated with either social isolation or loneliness or both (Wenger et al, 1996). Seemingly, older people are more at risk of developing mental illness, such as dementia and Alzheimer’s disease, as well as physical ill health caused by social isolation and loneliness.

Telephone befriending is just one of the numerous low-support services that can be useful for combating older people’s loneliness and social isolation. In May 2005 Age UK (formerly Age Concern and Help the Aged) and Zurich Community Trust launched a two year national programme “A Call in Time”, to provide a telephone befriending service, which consists of a regular daily or weekly phone call by a volunteer befriender, who makes the call at a regular pre-agreed time. The target client group of the service is older people, who, for a variety of reasons, suffer from the apparent lack of companionship, which results in them feeling lonely and socially isolated.

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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 ...

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