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每个人的孤老,都值得被定制的关怀 | BMC Public Health |
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论文标题:Loneliness and social isolation interventions for older adults: a scoping review of reviews
期刊:BMC Public Health
作者:Olujoke A. Fakoya, Noleen K. McCorry et al.
发表时间:2020/02/14
DOI:10.1186/s12889-020-8251-6
微信链接:点击此处阅读微信文章
“孤独”和“社会孤立”体验的个体性使实施标准化的干预措施变得困难。2020年2月14日发表在开放获取期刊BMC Public Health 上的一项研究着眼于根据个人需要调整干预措施的必要性。作者Olujoke Fakoya在接下来的分享中将告诉我们更多关于这项研究的信息。
![](/upload/paper/images/2020/3/2020321536319470.jpg)
画作来自本文作者 Olujoke Fakoya
大多数人在一生中的某个时候都会经历孤独,但由于社会上对孤独感普遍的污名化,很多人不会承认这种经历。通常,“孤独”和“社交孤立”这两个词可以互换使用,尽管它们之间存在一些差异。例如,“孤独”被认为是一种主观体验,当一个人只有有限的陪伴,很少或没有情感和社会支持时,孤独就会发生。而“社会孤立”,则被认为是在与家人、朋友或更广泛的社区缺乏社会接触和互动时发生的。因此,一个人有可能有大量的社会联系,但仍然感到孤独;或被孤立,但没有经历孤独。
孤独可能发生在生命周期的任何阶段,如童年、青春期、中年或老年。可能导致孤独和社会孤立的风险因素包括:年龄、性别、家庭搬迁、地理隔离、独居、离婚、守寡、健康状况不佳、行动不便、种族和退休。然而,老年人似乎更容易遭受孤独和社交孤立。根据Age UK (2018),英格兰有140万长期孤独的老年人,整个英国的这个数字更多。
孤独,由于其对健康的负面影响而被广泛宣传为一个主要的健康问题。研究发现,孤独/社交孤立与各种心理和生理健康状况的高风险之间存在联系,包括心脏病、高血压、免疫系统减弱、焦虑、抑郁、认知能力下降,甚至死亡。旨在减轻孤独和社会孤立的干预措施现在被广泛提倡,以期作为这一日益严重的问题的解决办法,尽管这些干预措施在多大程度上是有证据支持的尚不清楚。因此,我们对这个领域进行了综述研究,以绘制这一领域的大量研究证据,并描述针对老年人的孤独/社会孤立干预的范围。
我们(对其他综述的)综述发现,综述作者并不总是为所研究的干预措施提供理论依据或理论基础,而且通常对干预措施及其与孤独的匹配缺乏概念和定义。除了其他方面的不同,据报有效的干预措施似乎具有理论基础。我们的回顾还指出了环境背景的重要性,并强调了缺乏理论基础往往给确定某一特定类别的干预在何种情况下最适当或最有效到来困难,也难以得知这些干预措施是通过何种机制减少孤独感和社会孤立感的。
此外,我们还发现这些综述往往使用了范围广泛的术语来描述旨在减轻孤独和社会孤立的干预措施的特征。虽然它们使用了相同或类似的术语,但这些术语的含义往往不同。改善用于描述这些干预措施的术语的一致性,可能会提高干预措施报告的准确性,并有助于在不同的环境背景中复制干预措施。
我们的研究点明了认识到老年人个体孤独体验的独特性的重要性,因为他们体验孤独和社会隔离的方式或程度可能与其他年龄层的人群不同。鉴于孤独的主观体验以及孤独和社会孤立的不同决定因素,针对孤独和社会孤立的各自原因采取干预措施也很重要。因此,有必要调整干预措施以满足每个人的需求,同时考虑到干预措施在目标、设计和实施方面的多样性和异质性。
明确区分旨在减少孤独和社会孤立的干预措施很重要,因为那些旨在减轻孤独的干预措施可能对感到社会孤立的个人无效,反之亦然。最后,服务计划者和提供者应该将有效的干预与他们的服务环境和目标相匹配,并根据他们的评估需求将个人与干预相匹配。
摘要:
Background
Loneliness and social isolation are growing public health concerns in our ageing society. Whilst these experiences occur across the life span, 50% of individuals aged over 60 are at risk of social isolation and one-third will experience some degree of loneliness later in life. The aim of this scoping review was to describe the range of interventions to reduce loneliness and social isolation among older adults that have been evaluated; in terms of intervention conceptualisation, categorisation, and components.
Methods
Three electronic databases (CINAHL, Embase and Medline) were systematically searched for relevant published reviews of interventions for loneliness and social isolation. Inclusion criteria were: review of any type, published in English, a target population of older people and reported data on the categorisation of loneliness and/or social isolation interventions. Data extracted included: categories of interventions and the reasoning underpinning this categorisation. The methodology framework proposed by Arskey and O’Malley and further developed by Levac, et al. was used to guide the scoping review process.
Results
A total of 33 reviews met the inclusion criteria, evaluating a range of interventions targeted at older people residing in the community or institutionalised settings. Authors of reviews included in this paper often used the same terms to categorise different intervention components and many did not provide a clear definition of these terms. There were inconsistent meanings attributed to intervention characteristics. Overall, interventions were commonly categorised on the basis of: 1) group or one-to-one delivery mode, 2) the goal of the intervention, and 3) the intervention type. Several authors replicated the categorisation system used in previous reviews.
Conclusion
Many interventions have been developed to combat loneliness and social isolation among older people. The individuality of the experience of loneliness and isolation may cause difficulty in the delivery of standardised interventions. There is no one-size-fits-all approach to addressing loneliness or social isolation, and hence the need to tailor interventions to suit the needs of individuals, specific groups or the degree of loneliness experienced. Therefore, future research should be aimed at discerning what intervention works for whom, in what particular context and how.
(来源:科学网)
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