Primary Care Research Group, Peninsula College of Medicine & Dentistry, University of Exeter, Smeall Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK.
BMC Public Health. 2011 Aug 15;11:647. doi: 10.1186/1471-2458-11-647.
Targeting social isolation in older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years. Social isolation is prevalent amongst older people and evidence indicates the detrimental effect that it can have on health and wellbeing. The aim of this review was to assess the effectiveness of interventions designed to alleviate social isolation and loneliness in older people.
Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009. Additional articles were identified through citation tracking. Studies were included if they related to older people, if the intervention aimed to alleviate social isolation and loneliness, if intervention participants were compared against inactive controls and, if treatment effects were reported. Two independent reviewers extracted data using a standardised form. Narrative synthesis and vote-counting methods were used to summarise and interpret study data.
Thirty two studies were included in the review. There was evidence of substantial heterogeneity in the interventions delivered and the overall quality of included studies indicated a medium to high risk of bias. Across the three domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome. Over 80% of participatory interventions produced beneficial effects across the same domains, compared with 44% of those categorised as non-participatory. Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across the three domains compared with 59% of interventions with no evident theoretical foundation. Regarding intervention type, 86% of those providing activities and 80% of those providing support resulted in improved participant outcomes, compared with 60% of home visiting and 25% of internet training interventions. Fifty eight percent of interventions that explicitly targeted socially isolated or lonely older people reported positive outcomes, compared with 80% of studies with no explicit targeting.
More, well-conducted studies of the effectiveness of social interventions for alleviating social isolation are needed to improve the evidence base. However, it appeared that common characteristics of effective interventions were those developed within the context of a theoretical basis, and those offering social activity and/or support within a group format. Interventions in which older people are active participants also appeared more likely to be effective. Future interventions incorporating all of these characteristics may therefore be more successful in targeting social isolation in older people.
针对老年人的社交孤立问题是一个日益受到关注的公共卫生问题。在过去几十年中，社会中的老年人比例有所增加，据估计，在未来 20 到 40 年内，大约 25%的人口将年满 60 岁或以上。老年人中普遍存在社交孤立现象，有证据表明，这种现象对健康和幸福会产生有害影响。本综述的目的是评估旨在缓解老年人社交孤立和孤独感的干预措施的有效性。
系统地检索了相关电子数据库（MEDLINE、EMBASE、ASSIA、IBSS、PsycINFO、PubMed、DARE、Social Care Online、Cochrane 图书馆和 CINAHL），使用广泛的搜索策略，检索 2009 年 5 月以前发表的英文随机对照试验和准实验研究。通过引文追踪确定了其他文章。如果研究涉及老年人，如果干预措施旨在缓解社交孤立和孤独感，如果干预参与者与非活动对照组进行比较，并且如果报告了治疗效果，则将研究纳入。两名独立的审查员使用标准化表格提取数据。使用叙述性综合和投票计数方法来总结和解释研究数据。
综述纳入了 32 项研究。所提供的干预措施存在很大的异质性，纳入研究的整体质量表明存在中等到高度偏倚风险。在社会、心理和身体健康的三个领域中，79%的群体干预和 55%的一对一干预报告了至少一项改善的参与者结局。80%以上的参与式干预在相同的领域产生了有益的效果，而 44%的非参与式干预则没有。在有理论基础的干预中，87%的干预在三个领域报告了有益的效果，而没有明显理论基础的干预则为 59%。关于干预类型，提供活动的干预中有 86%，提供支持的干预中有 80%导致了参与者结局的改善，而家访的干预中有 60%，互联网培训的干预中有 25%。明确针对社交孤立或孤独的老年人的干预措施有 58%报告了积极的结果，而没有明确目标的研究则为 80%。
需要更多设计良好的针对社交孤立的社会干预措施有效性的研究，以改善证据基础。然而，有效的干预措施的共同特征似乎是那些在理论基础上制定的，以及那些在小组形式下提供社交活动和/或支持的。老年人作为积极参与者的干预措施也似乎更有可能有效。因此，未来包含所有这些特征的干预措施可能会更成功地针对老年人的社交孤立问题。
