Greaves Colin J, Farbus Lou
Peninsula Medical School, Smeall Building, St Luke's Campus, Magdalen Road Exeter EX1 2LU.
J R Soc Promot Health. 2006 May;126(3):134-42. doi: 10.1177/1466424006064303.
Depression and social isolation affect one in seven people over 65 and there is increasing recognition that social isolation adversely affects long-term health. Research indicates that interventions, which promote active social contact, which encourage creativity, and which use mentoring, are more likely to positively affect health and well-being. The purpose of this study was to evaluate a complex intervention for addressing social isolation in older people, embodying these principles: The Upstream Healthy Living Centre. Mentors delivered a series of individually-tailored activities, with support tailing off over time. Two hundred and twenty-nine participants were offered the Geriatric Depression Scale, SF12 Health Quality of Life, and Medical Outcomes Social Support scale at baseline, then 6 months and 12 months post intervention. Semi-structured interviews were conducted with 26 participants, five carers and four referring health professionals to provide a deeper understanding of outcomes. Data were available for 172 (75%) participants at baseline, 72 (53% of those eligible) at 6 months and 51 (55%) at 12 months. Baseline scores indicated social isolation and high morbidity for mental and physical health. The intervention was successful in engaging this population (80% of referrals were engaged in some form of activity). At 6 months, there were significant improvements in SF12 mental component, and depression scores, but not in perceived physical health or social support. At 12 months, there were significant improvements in depression and social support and a marginally significant improvement in SF12 physical component (p = 0.06), but the SF12 mental component change was not maintained. The qualitative data showed that the intervention was well-received by participants. The data indicated a wide range of responses (both physical and emotional), including increased alertness, social activity, self-worth, optimism about life, and positive changes in health behaviour. Stronger, 'transformational' changes were reported by some participants. Individual tailoring seemed to be a key mediator of outcomes, as was overcoming barriers relating to transport and venues. Key processes underlying outcomes were the development of a positive group identity, and building of confidence/self-efficacy. The Upstream model provides a practical way of engaging socially isolated elderly people and generating social networks. The data suggest a range of psychosocial and physical health benefits. Although there are limitations in attributing causality in uncontrolled studies, the data seem to indicate a reversal of the expected downward trends in some aspects of participants' health, and suggest that this approach is worth further investigation.
抑郁症和社交孤立影响着七分之一的65岁以上老人，而且人们越来越认识到社交孤立会对长期健康产生不利影响。研究表明，那些促进积极社交接触、鼓励创造力并采用指导的干预措施，更有可能对健康和幸福产生积极影响。本研究的目的是评估一种针对老年人社交孤立问题的综合干预措施，该措施体现了以下原则：上游健康生活中心。指导者开展了一系列量身定制的活动，并随着时间推移逐渐减少支持。229名参与者在基线时、干预后6个月和12个月时接受了老年抑郁量表、SF12健康生活质量量表和医学结果社会支持量表的测评。对26名参与者、5名护理人员和4名转诊的健康专业人员进行了半结构化访谈，以更深入地了解结果。基线时有172名（75%）参与者的数据可用，6个月时有72名（符合条件者的53%），12个月时有51名（55%）。基线分数表明存在社交孤立以及较高的身心健康发病率。该干预措施成功地吸引了这一人群（80%的转诊者参与了某种形式的活动）。在6个月时，SF12心理成分和抑郁分数有显著改善，但在感知身体健康或社会支持方面没有改善。在12个月时，抑郁和社会支持有显著改善，SF12身体成分有微弱的显著改善（p = 0.06），但SF12心理成分的变化没有维持。定性数据表明该干预措施受到参与者的好评。数据显示了广泛的反应（包括身体和情绪方面），包括警觉性提高、社交活动增加、自我价值感增强、对生活的乐观态度以及健康行为的积极变化。一些参与者报告了更强烈的“转变性”变化。个性化定制似乎是结果的关键调节因素，克服与交通和场所相关的障碍也是如此。结果背后关键的过程是形成积极的群体认同感以及建立信心/自我效能感。上游模式提供了一种让社交孤立的老年人参与并建立社交网络的实用方法。数据表明在心理社会和身体健康方面有一系列益处。尽管在非对照研究中归因因果关系存在局限性，但数据似乎表明参与者健康某些方面预期的下降趋势出现了逆转，并表明这种方法值得进一步研究。
