Social isolation in community-dwelling seniors

Abstract
In early August 2007, the Medical Advisory Secretariat began work on the Aging in the Community project, an evidence-based review of the literature surrounding healthy aging in the community. The Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the ministry's newly released Aging at Home Strategy.After a broad literature review and consultation with experts, the secretariat identified 4 key areas that strongly predict an elderly person's transition from independent community living to a long-term care home. Evidence-based analyses have been prepared for each of these 4 areas: falls and fall-related injuries, urinary incontinence, dementia, and social isolation. For the first area, falls and fall-related injuries, an economic model is described in a separate report.Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html, to review these titles within the Aging in the Community series.AGING IN THE COMMUNITY: Summary of Evidence-Based AnalysesPrevention of Falls and Fall-Related Injuries in Community-Dwelling Seniors: An Evidence-Based AnalysisBehavioural Interventions for Urinary Incontinence in Community-Dwelling Seniors: An Evidence-Based AnalysisCaregiver- and Patient-Directed Interventions for Dementia: An Evidence-Based AnalysisSocial Isolation in Community-Dwelling Seniors: An Evidence-Based AnalysisThe Falls/Fractures Economic Model in Ontario Residents Aged 65 Years and Over (FEMOR) OBJECTIVE OF THE EVIDENCE-BASED ANALYSIS: The objective was to systematically review interventions aimed at preventing or reducing social isolation and loneliness in community-dwelling seniors, that is, persons ≥ 65 years of age who are not living in long-term care institutions. The analyses focused on the following questions: Are interventions to reduce social isolation and/or loneliness effective?Do these interventions improve health, well-being, and/or quality of life?Do these interventions impact on independent community living by delaying or preventing functional decline or disability?Do the interventions impact on health care utilization, such as physician visits, emergency visits, hospitalization, or admission to long-term care?
BACKGROUND:
TARGET POPULATION AND CONDITION Social and family relationships are a core element of quality of life for seniors, and these relationships have been ranked second, next to health, as the most important area of life. Several related concepts-reduced social contact, being alone, isolation, and feelings of loneliness-have all been associated with a reduced quality of life in older people. Social isolation and loneliness have also been associated with a number of negative outcomes such as poor health, maladaptive behaviour, and depressed mood. Higher levels of loneliness have also been associated with increased likelihood of institutionalization. NOTE: It is recognized that the terms "senior" and "elderly" carry a range of meanings for different audiences; this report generally uses the former, but the terms are treated here as essentially interchangeable. METHODS OF THE EVIDENCE-BASED ANALYSIS: The scientific evidence base was evaluated through a systematic literature review. The literature searches were conducted with several computerized bibliographic databases for literature published between January 1980 and February 2008. The search was restricted to English-language reports on human studies and excluded letters, comments and editorials, and case reports. Journal articles eligible for inclusion in the review included those that reported on single, focused interventions directed towards or evaluating social isolation or loneliness; included, in whole or in part, community-dwelling seniors (≥ 65 years); included some quantitative outcome measure on social isolation or loneliness; and included a comparative group. Assessments of current practices were obtained through consultations with various individuals and agencies including the Ontario Community Care Access Centres and the Ontario Assistive Devices Program. An Ontario-based budget impact was also assessed for the identified effective interventions for social isolation.
FINDINGS:
A systematic review of the published literature focusing on interventions for social isolation and loneliness in community-dwelling seniors identified 11 quantitative studies. The studies involved European or American populations with diverse recruitment strategies, intervention objectives, and limited follow-up, with cohorts from 10 to 15 years ago involving mainly elderly women less than 75 years of age. The studies involved 2 classes of interventions: in-person group support activities and technology-assisted interventions. These were delivered to diverse targeted groups of seniors such as those with mental distress, physically inactive seniors, low-income groups, and informal caregivers. The interventions were primarily focused on behaviour-based change. Modifying factors (client attitude or preference) and process issues (targeting methods of at-risk subjects, delivery methods, and settings) influenced intervention participation and outcomes. Both classes of interventions were found to reduce social isolation and loneliness in seniors. Social support groups were found to effectively decrease social isolation for seniors on wait lists for senior apartments and those living in senior citizen apartments. Community-based exercise programs featuring health and wellness for physically inactive community-dwelling seniors also effectively reduced loneliness. Rehabilitation for mild/moderate hearing loss was effective in improving communication disabilities and reducing loneliness in seniors. Interventions evaluated for informal caregivers of seniors with dementia, however, had limited effectiveness for social isolation or loneliness. Research into interventions for social isolation in seniors has not been broadly based, relative to the diverse personal, social, health, economic, and environmentally interrelated factors potentially affecting isolation. Although rehabilitation for hearing-related disability was evaluated, the systematic review did not locate research on interventions for other common causes of aging-related disability and loneliness, such as vision loss or mobility declines. Despite recent technological advances in e-health or telehealth, controlled studies evaluating technology-assisted interventions for social isolation have examined only basic technologies such as phone- or computer-mediated support groups.
CONCLUSIONS:
Although effective interventions were identified for social isolation and loneliness in community-dwelling seniors, they were directed at specifically targeted groups and involved only a few of the many potential causes of social isolation. Little research has been directed at identifying effective interventions that influence the social isolation and other burdens imposed upon caregivers, in spite of the key role that caregivers assume in caring for seniors. The evidence on technology-assisted interventions and their effects on the social health and well-being of seniors and their caregivers is limited, but increasing demand for home health care and the need for efficiencies warrant further exploration. Interventions for social isolation in community-dwelling seniors need to be researched more broadly in order to develop effective, appropriate, and comprehensive strategies for at-risk populations.

Racial Discrimination in Colonial India

The growth of Western education and India's contact with the West awakened the Indian mind to the evils of social and religious practices. It led to the religious and social movements of the 19th century.
The leaders of these socio-religious movements like Raja Rammohan Roy, Swami Dayananda Saraswati, Swami Vivekananda and Mrs. Annie Besant, launched a crusade against the abuses and evils of the Hindu Society and religion. They emphasized that no political regeneration and freedom could be possible without social and religious reformation. Indians become aware of their motherland. Dayananda said, "India for Indians" Tilak said, "Swaraj is my birth right and I shall have it."
Indians were discriminated on grounds of color. An attitude of contempt towards Indians was developed by the Anglo-Indian bureaucracy. They looked upon the Indians as half Negroes and half guarillas who could effectively work under force only. The white Europeans always considered the Indians as people of an inferior race.
The British Government openly displayed social antagonism by adopting certain measures and laws which discriminated the brown Indians from the white Europeans. The British administrators in India used to exploit the Indians who remained as humble servants to them. The subordinate Indian officials were leading a very poor and wrenched life whereas the British officers were rolling in luxury.
It annoyed the educated Indians who could not relish the over bearing attitude of the Britishers in India. They came forward to raise their voice against the racial discrimination of the British. It fostered a sense of nationalism in the minds of the conscious Indians.
The British policy of racial discrimination was further revealed in what is known as the llbert Bill Controversy. Lord Ripon, the Viceroy of India got a draft bill prepared through his law member Sir IIbert. The Bill was aimed at removing certain racial inequalities by putting Indian judges at partnership with the European judges in dealing with all cases in Bengal Presidency. Hitherto the Europeans could only be tried by special court consisting of European judges.
The IIbert Bill was approved by Lord Ripon's executive council as well as by all the provincial Governments. The Bill brought the Indian and European Judges on the same footing. The Bill was about to abolish the criminal procedure code of 1873 according to which no Indian Magistrate or Sessions Judge could try a case in which an European was involved. The European culprits were tried only by European judges, because the European considered it beyond their dignity to be prosecuted and punished by the Indians.
The European community in India reacted violently against the bill. They criticized Ripon vehemently; Ripon was ultimately forced to bring about some changes in the Bill in order to avoid an unhealthy situation. The educated Indian was highly influenced by this incident. Their dissatisfaction against the British grew in intensity. A sense of keen patriotism began to gain ground in their minds. This patriotism and national awakening finally led to the establishment of Indian National Congress in 1885.