Participation of Social Workers in Aged Care Interventions - Research Paper Example

Research Project SWN019 Research Skills for Social Change Name: ID: Lecturer: Date: Word: Project Title: Evidence of Participation of Social Workers’ in Aged Care Interventions for Loneliness Introduction Australians currently receiving aged care services surpass the one million mark and the demand for these services increases due to the growing ageing Australian population (O’Keeffe, 2014). Many aged care studies have traditionally focused on the well-documented challenges such as physical deterioration, cognitive decline, disability and chronic illnesses (CEPAR, 2014). There is a paucity of studies on the management of psychosocial issues. Loneliness is one of the dominant problems for which empirical evidence is scanty (Stanley et al., 2010; Gerst-Emerson & Jayawardhana, 2015). Loneliness and social isolation are closely related and the terms are at times used interchangeably. They refer to the absence of social or interpersonal relationships desired by an individual. Research indicates that loneliness poses higher morbidity and mortality risks than cigarette smoking and obesity (Holt-Lunstad, Smith & Layton, 2010). Among older adults, loneliness is a real challenge resulting from a number of eventualities: sedentary lifestyles, reduced mobility due to physical impairments and the deaths of spouses, age mates or close friends. Loneliness accounts for negative health outcomes such as depression, high blood pressure, disability, cardiovascular diseases and premature deaths (Hawkley et al., 2010). Other related adverse conditions include alcoholism, suicidal ideation and suicide (Lund, Nilsson & Avlund, 2010). In spite of consistent research findings linking loneliness with these critical health consequences, aged care literature on interventions for loneliness remains scarce. Social isolation is a social phenomenon and can be comprehensively addressed through social care. Stanley et al. (2010) reported that care providers had found lack of meaningful relationships, and not the number of social contacts, as the main cause of social isolation among older people. This research project investigates the evidence of the participaton of social workers play in establishing meaningful relationships with a view to combating loneliness among the older people. Understanding this will greatly enhance quality of service delivery in the aged care sector. The Research Question This research project addresses one pertinent question: what is the evidence that social workers intervene in reducing loneliness in aged care? The interventions for combating loneliness among the old are being implemented at three levels: the state, local government and non-governmental agencies (Findlay & Cartwright, 2002). This project, therefore, focuses on the social workers’ input in these agencies. Cattan, White, Bond and Learmonth (2005) propose four types of aged care interventions for loneliness: community-based activities, group-based forums, service provision, and one-to-one interventions. These are good entry points for the research project but the specific aims of this study will identify and describe social workers’ involvement in mitigating loneliness among the older people. Findlay and Cartwright (2002) have noted that those different countries have been channeling resources into aged care programmes but the critical question has been whether they work. It is hoped that the findings of this study will provide a basis for evaluating aged care social services. Top of Form Bottom of Form Literature Review Healthy ageing, reduced mortality rates and increased life expectancy among the older people are primary concerns in aged care in Australia (Pearce, Matthews, & Healthy Ageing Task Force, 2000; Australian Institute of Health and Welfare, 2004). It is estimated that Australians aged above 85 years will increase at the annual average of 30, 032 from 2026 – 2041 (Healthy Ageing Task Force, 2000). By 2026, the population growth rate of Australians aged over 65 years will be thrice the rate of growth of the total population between the age of 15 and 64 years (Department of Health and Ageing, 2006). In 2011, the population of those aged 60 years and above was almost 700 million and the number is projected to rise to two billion by 2050 (United Nations General Assembly, 2011). In Australia, older persons (65 years and above) will comprise over 25% of the population by 2045 (Australian Bureau of Statistics, 2015). As the number of older people increases, their vulnerability increases and so is the demand for aged care services. Meeting this demand has been complicated by the changing socio-demographic trends in the recent past. Immediate family members are getting more and more separated geographically; more women initially providing homecare for older people are getting engaged in formal employment; and family sizes are getting smaller (Newman, 1987). This implies that informal care the older people have been traditionally receiving from the family members is fast declining. Consequently, the role of social workers in aged care service provision is gaining prominence. A report(Social Exclusion Unit, 2005) in the UK revealed that older people suffer economically (live in low income households), socialy (30% of the people are unable to see a friend in a week), psychologically (33% of them suffer depression), from medical conditions (60% suffer from long standing illnesses), indecent shelter (33%), increased fatalities ( more than 20,000S excess deaths among this group) and high mortality rates (nearly half of those admitted in nursing or residential facilities die within 18 months of admission). The report employs the broad term ‘social exclusion’ to encapsulate these adverse experiences of the older people. It gives the definition of social exclusion as the shorthand term for what happens to people suffering from linked problematic conditions such as family breakdown, unemployment, poor skills, bad health, high crime, low incomes and poor housing. Similar concerns are raised in the Closing the Gaps Report tabled in the South Australian Parliament (Lacey, 2012). This author observes a growing number of the Australia’s ageing population experiences divorce, ill-health, poverty, disability, dependency, spousal death, and gender, physical, sexual, social, psychological and financial abuse or neglect. The older people in Australia also suffer from social isolation and ageist assumptions (Australian Human Rights Commission, 2013). Notably occurring in the two reports is the issue of social exclusion. This research project hence identified a narrower version of social exclusion – social isolation or loneliness as the subject of study. Loneliness and social isolation have been often linked with older age and a number of related risk factors (Byles, Harris, Nair & Butler, 1996). European and American studies have extensively considered loneliness as an aged care issue in both residential and non-residential settings (Eldelbrock, Buys, Creasy & Broe, 2001). Limited attention, however, has been given to this problem in Australia (Grenade & Boldy, 2008). Though the two concepts are interrelated, loneliness and social isolation are considered to be different in research. While social isolation can be regarded as an objective assessment of minimal contacts an individual has with others or an individual’s low level of participation in the life of a community (Byles, Harris, Nair & Butler, 1996). As such, social isolation is measured in terms of the number of social network a person has. For example, a researcher would count the frequency and number of contacts in a given span of time. On the other hand, loneliness is generally viewed as a more subjective situation that is usually unwelcome or negative. It has to do with perceptions of someone’s social relationships as well as their level of engagement with others as being insufficient qualitatively and quantitatively (Steel, Boldy, Grenade & Iredell, 2006). This implies that one who has an extensive social network (that is, not socially isolated) can still feel lonely. Conversely, someone can have a very limited network (hence socially isolated) without feeling lonely if they actively and frequently engage the few contacts. This research project applies both concepts to aged care and hence may have to use the terms interchangeably but in an informed sense. Limited research has generated factors that protect older people in Australia from encountering loneliness or social isolation (Victor, Scrambler, Bond & Bowling, 2000; Steel, Boldy, Grenade & Iredell, 2006). These factors include the presence of a friend or confidant, relatives, neighbours, children and pets in that order. Of key importance to this study are the interventions for loneliness in aged care cited by Grenade and Boldy (2008): a) Social connections strategies such as social clubs, befriending, group activities, teleconferencing and home visits b) Personal efficacy strategies like counseling, self-help groups and bereavement support. c) Behavior modification strategies such as modeling d) Skills development strategies like communication skills development This project reviews aged care studies with an aim of identifying and describing the role of the social workers in these interventions. Methodology The social exchange theory emerged from the work of Kelley and Thibaut (1978). and Rusbult (1980). These studies primarily assessed the rationalized self-interest in social relationships. Since then, social researchers have used it in exploring several relationships including parenting (Milkie et al., 2002) and commitment, satisfaction and stability in dating (Sprecher, 2001). At the core of social exchange theory is the economic dimension of social relationships. Its basic principle is that .people in social environments choose to behave in a manner that maximizes their likelihood of deriving self-interests from those situations. The assumptions of this theoretical construct are therefore instrumental in explaining the situations that perpetuate loneliness in the older people and rationalise aged care interventions for loneliness. One key assumption of this theory is that people are generally rational and they consciously calculate the costs and benefits in any social exchange. This implies that individuals in a social exchange exist as rational actors and reactors simultaneously. In this respect, the social isolation in which the older people find themselves is not accidental but a clear case of decision making on the side of former acquaintances. The social networks for the elderly begin to shrink as other players find no benefit engaging them. The relatives and/or friends decide to disengage the older person whose economic advantage has dwindled as their economic and social dependency rises. This tenet can also inform the work of the caregiver in combating loneliness. The older persons, for example can be made to understand that combating loneliness is a matter of choice and deliberate efforts. The second assumption on which the social exchange theory is premised states that individuals engaged in social interactions rationally seek to maximize the benefits accruing those situations particularly those that meet their basic needs. In emphasizing basic needs, the social exchange theory suggests that social exchanges are a means to human survival. In view of this, social exclusion of the older people denies them their basic needs. Lacey (2012) argues that this amounts to cruelty, neglect and elder abuse that should be considered as a human rights issue. The third assumption is that production of rewards or pay offs do pattern social interactions. Patterns of social exchanges not only meet an individual’s needs but they also define how the individual may ultimately seek to meet these needs. Consequently, people will go for relationships that promote their needs and they will also be motivated to accommodate behaviours from others that are desired for meeting their own needs. In this connection, the older people are abandoned and neglected by friends and family for new relations that the latter deem are paying off or rewarding. This precept explains the motivation for adopting behavior patterns that socially isolate the older people. The other tenet of social exchange theory deals with power position. Social interaction is viewed as a goal-oriented enterprise in a social system that is freely competitive. Like in any competition, power in social interaction rests with individuals having greater resources that give them advantage over others. Power and privilege differentiation in social groups mean that those with more resources are in better positions to control and ultimately benefit from the social exchange. From this argument, the older people are the most disadvantaged in the social system since they are often bereft of physical and financial might from which social power may be derived. By implication, economically empowering the older people may increase dependence on them and thus improve their power position and give them an advantage to negotiate interactions in their favour. Closely linked to the principle of power position in social interaction is the concept of the least interest. The individual who gains the least from a social relationship tends to wield more power in that relationship than the one who gains more. In this sense, power originates from less dependency. For example, in a parent-child relationship, a young child stands to gain more from a parent than the vice versa. The parent derives power from this arrangement hence controls it. However, as the child grows and the parents ages, the power structures swop in favour of the child when the older parent stands to gain more from the adult offspring. Figure 1.0: A conceptual framework for combating loneliness in aged care In sum, the social exchange theory views human interactions as being motivated by the desire to seek benefits and avoid costs. Rational choices for beneficial social behavior are made constantly made by individuals. The theory posits that human behavior costs energy and only the interactions that bring rewards or incur the least costs will be likely repeated. This perspective of human social behavior clearly explains the predicament in which the older people find themselves. The younger people put high estimates for the cost of relating with the older people while the estimates for rewards that would accrue from such relationships remain low. This research project, therefore, adopts the principles of the social exchange theory as the motivators for social isolation or exclusion of the older people (see Fig, 1.1 above). The same principles can equally inform the application of the interventions for combating loneliness in older people. Methods The research design for this project is the systematic review. This method is useful for gathering existing corpus of research knowledge irrespective of the primary research methods used in the studies and it can include quantitative and qualitative researches (Holm & Severinsson, 2012). This project will, however, be limited to studies that primarily used qualitative methodology since the themes sought are best studies qualitatively. The purpose of systematic review is to gather the best possible research findings for the development of evidence best practices (Holopainen et al., 2008). For this project, the evidence for the social workers’ participation in interventions for combating loneliness in older people in residential aged care facilities will be sought for. This study will follow the steps outlined by (Holopainen et al., 2008). After formulating the research question and defining the study’s purpose, Holopainen et al. suggest that literature search should be followed by evaluating and analysing data and finally presenting the results. Literature search, being the most critical stage of a systematic review, will be done judiciously to ensure that only high-quality researches are included. Cooper (1998) observes that biased and incomplete studies may result into insufficient data and faulty conclusions. This is one of the criticisms of systematic reviews. The studies to be included in this study will be searched from a variety of electronic databases: PubMed, OVID Medline, EBSCOhost and ProQuest. The Boolean expression “social workers’ participation in aged care interventions for loneliness” will be searched from the databases. Search words will also be used separately or in combination. They include “aged care”, “older people”, “elderly”, “elder care”, “people aged 65 years and above”, “loneliness”, “social isolation”, “social exclusion”, “social workers”, “service providers”, “nurses”, staff” ,“ participation”, “involvement”, “activities” and “interventions”. The limiters will be set for the last 15 years – 2000-2015. These searches will be expected to yield abstracts, review papers and studies. The inclusion criteria will adopt the format: study design, publication type, intervention and participants and settings (Brownie and Nancarrow (2013). The researcher will read through each material to ascertain its eligibility for inclusion. Studies for inclusion must have used qualitative designs and surveys. Publications to be included must be full text peer-reviewed articles found in scholarly and professional journals published in English. The interventions in the studies must address combating loneliness, social isolation or social exclusion among older people. The study participants must be older people and/or social workers residing or working respectively in a residential aged care facility. Relevant articles from the reference lists of the selected articles will be searched in the databases in case the initial searches might have missed them. A distinction will be made between the selected primary studies and secondary studies. The results of literature search will be presented in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram as adapted below. Figure 2.0 Modified PRISMA Flow Diagram (PRISMA, 2009) The methodological quality assessment can be done on the basis of evidence-based practices for what is understood to constitute evidence (Slade & Priebe, 2006). The study results will be categorized as per the rating systems for the hierarchy of evidence put forth by (Melnyk and Fineout-Overholt, 2005). Data analysis will begin with reading each study to gain its overall impression and general understanding. Further reading and manual coding of data is then done. Data extraction and coding will be done manually since qualitative researches yield results that cannot be analysed automatically by the software for statistical pooling. The findings from each study will therefore be manually extracted and presented in narrative form. Results will be grouped according to qualitative methods used, sample sizes and type of intervention. The interventions for loneliness in aged care facilities will be grouped under four main themes cited by Grenade and Boldy (2008). e) Social connections interventions f) Personal efficacy strategies. g) Behavior modification strategies h) Skills development interventions ` The findings are to be concretized in well labeled tables that identify, for example, the study, author(s), date, method, sample size, content, and a summary of its findings. Evidence for these interventions can also be given from the perspective of the social worker or from the older person’s standpoint. A systematic review can incorporate content analysis of its findings. For this study, the content of the findings can be grouped under the four categories: the main theme, themes, subthemes and meaning unit (Holm & Severinsson, 2012). Content analysis for anticipated data for this study can be exemplified thus. Table 1 Content analysis for the aged care loneliness interventions in residential facilities Main theme Social Workers Roles Themes Enhancing social connections Developing Personal efficacy Subthemes Organizing teleconferencing Facilitating self-help group discussions Meaning Unit Older people actively engage Older people get support from their contacts thus combating one another hence they are not isolated loneliness Ethical considerations The projected study, being a systematic review, does not require formal ethical review. However, a number of ethical principles need to guide it. These principles include beneficence, that is, the study should promote good for the older people; nonmaleficence which means avoiding any conclusion that may be harmful to the older people; justice which requires fairness to all parties – in this case, to both the social worker and the older people; autonomy which is a person’s right to choose; and fidelity which entails trustworthiness and honesty. The last principle, fidelity may be shown by peer-reviewers’ comments such as ‘we doubted all the data’ or ‘these results are of substantial interest but they are also questionable in terms of reliability and validity of the studies’ (Shenton, 2004). In view of this, some ethical responsibilities for reviewers have been suggested: thoroughness in searching, checking all details, following up on suspicions arising from conflicting results, inaccuracies, questionable publication ethics and conflicts of interest (O’Mathuna, Fineout-Overholt & Kent 2008). Another ethical question with regard to systematic review confronts the relationship between ethics and evidence: knowing the question, does one go where the evidence leads them? Or, knowing the answer does one look for evidence? Reviewers may also fall into the practice of misrepresenting the primary research. Shenton (2004) raises the issue of honest errors which are indicative of an absence of a meticulous approach to the preparation of research papers for publication. It is reflected in the investigator’s research protocol, laboratory practices and data management. Other ethical issues in systematic review include selective bias whereby only a part of the analyses are included in the report and outcome bias – only a portion of results are reported (O’Mathuna, Fineout-Overholt & Kent 2008). The reviewer should take ethical responsibility by exercising autonomy, thoroughness, accuracy, double-checking, contacting editors and following up on suspicions. The overall goal should be the impact of the study on the subjects, in this case, the older persons. Timeline The research project will take 8 weeks and the following activities will be catered for: a) Planning and design This stage requires time for seeking approval of the proposal from the supervisor. Time is needed for familiarization with search engines and data selection methods. b) Data collection Data collection will be done online and this requires a lot of time c) Data analysis Time is allocated for reading and note making followed by findings analysis. d) Dissemination On getting approval, time for conference presentation, sharing the findings with the policy makers and journal publication will be scheduled. Schedule/Week Nov 2015 Wk 1 Nov 2015 Wk 2 Nov 2015 Wk 3 Nov 2015 Wk4 Dec 2015 Wk1 Dec 2015 Wk2 Dec 2015 Wk3 Dec 2015 Wk4 Approval of research proposal Familiarisation with the search engines Literature search Articles selection Methodological quality assessment Reading of the articles Data analysis Discussions and conclusion Drafting and editing the write-up Approval of the project Dissemination Figure 2.0 Timeframe Resources Data collection instruments that will be required are laptop or PC and source of uninterrupted internet. The researcher will use the facilities in the college. Dissemination The findings of this research will be disseminated in various ways. First it will be presented verbally in the conference. The verbal presentation will be complemented by a projected Powerpoint Presentation. Another avenue for dissemination is the presentation of the findings for publication in a peer-refereed journal for social health or work. The researcher will also wish to share the findings with government and not-for-profit agencies in the aged care industry. Abridged copies of the project will be sent to these agencies in hard and soft copies. References Australian Bureau of Statistics, Population Projections — A Tool for Examining Population Ageing . Australian Human Rights Commission (‘AHRC’), Fact or Fiction? Stereotypes of Older Australians, (Research Report, 2013) . Australian Institute of Health and Welfare. (2004). Australia's health 2004: The ninth biennial health report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare. Brownie, S., & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. CIA, 1. http://dx.doi.org/10.2147/cia.s38589 Byles, J. E., Butler, J. R., Harris, M. A., & Nair, B. R. (August 01, 1996). Preventive health programs for older Australians. Health Promotion Journal of Australia: Official Journal of Australian Association of Health Promotion Cattan M., White M., Bond J. & Learmouth A. (2005) Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions. Ageing and Society 25 (1), 41–67. Department of Health and Ageing (2006), Approved Provider Information, Department of Health and Ageing, Canberra. Edelbrock, D., Buys, L., Creasey H. & Broe, G.A. 2001. Social support, social networks and social isolation: The Sydney older persons’ study. Australas J Ageing. 20, 173-8 . Gerst-Emerson, K., & Jayawardhana, J. (2015). Loneliness as a Public Health Issue: The Impact of Loneliness on Health Care Utilization Among Older Adults. Am J Public Health, 105(5), 1013-1019. http://dx.doi.org/10.2105/ajph.2014.302427 Great Britain., & Great Britain. (2005). Excluded older people: Social Exclusion Unit interim report. London: Office of the Deputy Prime Minister. Grenade, L., & Boldy, D. (2008). Social isolation and loneliness among older people: issues and future challenges in community and residential settings. Aust. Health Review, 32(3), 468. http://dx.doi.org/10.1071/ah080468 Hawkley, L.C., Thisted, R.A., Masi, C.M., Cacioppo J.T. (2010). Loneliness predicts increased blood pressure: 5-year cross-lagged analyses in middle-aged and older adults. Psychol Aging.;25(1):132---141. Holm, A., & Severinsson, E. (2012). Systematic review of the emotional state and self- management of widows. Nursing & Health Sciences, 14(1), 109-120. http://dx.doi.org/10.1111/j.1442-2018.2011.00656.x Holopainen A, Hakulinen-Viitanen T, Tossavainen K. Systematic review – a method for nursing research. Nurse Res. 2008; 16: 72–83. Lacey, W., & Lacey, Wendy. (n.d.). Neglectful to the point of cruelty? : elder abuse and the rights of older persons in Australia. University of Sydney. Lund R, Nilsson CJ, Avlund K. (2010). Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women. Age Ageing. 39(3):319-326. Melnyk BM, Fineout-Overholt E. (2005).. Evidence-Based Practice in Nursing & Healthcare A Guide to Best Practice. Philadelphia, PA: A Wolters Kluwer Company Lippincott Williams & Wilkins. Newman, S.J. (1987), Worlds Apart: Long-term Care in Australian and the United States, The Haworth Press, New York, NY. O’Keeffe, Valerie (2014). Client perceptions of quality care in aged care services. Centre for Work + Life. Milkie, M. A., Bianchi, S. M., Mattingly, M. J., & Robinson, J. P. (2002). Gendered division of childrearing: Ideals, realities, and the relationship to parental well-being. Sex Roles, 47, 21–38. doi:10.1023/A: Top of Form O'Mathúna, D. P., Fineout-Overholt, E., & Kent, B. (January 01, 2008). How systematic reviews can foster evidence-based clinical decisions: part II. Worldviews on Evidence-Based Nursing / Sigma Theta Tau International, Honor Society of Nursing, 5, 2, 102-7. 1020627602889 Pearce, K., Matthews, M., Australia., & Healthy Ageing Task Force (Australia). (2001). National reference guide: Mature-age employment. Canberra: Dept. of Health and Aged Care. PRISMA. (2009). PRISMA checklist (PRISMA transparent reporting of systematic reviews and meta analyses). Available from URL: http://www.prisma-statement.org/ Rusbult, C. E. (1980). Commitment and satisfaction in romantic associations: A test of the investment model. Journal of Experimental Social Psychology,16, 172–186 Shenton, A. K. (January 01, 2004). Strategies for Ensuring Trustworthiness in Qualitative Research Projects. Education for Information, 22, 2, 63-75. Slade M & Priebe S. (2006). Choosing Methods in Mental Health Research Mental Health Research from Theory to Practice. London: Routledge Taylor and Francis Group.. Sprecher, S. (2001). Equity and Social Exchange in Dating Couples: Associations With Satisfaction, Commitment, and Stability. J Marriage And Family, 63(3), 599-613. http://dx.doi.org/10.1111/j.1741-3737.2001.00599.x Stanley, M., Moyle, W., Ballantyne, A., Jaworski, K., Corlis, M., Oxlade, D., Stoll, A., Young, B. (January 01, 2010). 'Nowadays you don't even see your neighbours': loneliness in the everyday lives of older Australians. Health & Social Care in the Community, 18, 4, 407-14. United Nations General Assembly, Follow-up to the Second World Assembly on Ageing, Report of the Secretary-General, A/66/173, 66th sess, agenda item 27(c) (22 July 2011) 3. Victor C., Bowling A., Bond J. & Scambler S. (2003) Loneliness, Social Isolation and Living Alone in Later Life. Economic and Social Research Council (ESRC) Growing Older Programme University of Sheffield, Sheffield, UK. ust. Health Review, 32(3), 468. Read More

These are good entry points for the research project but the specific aims of this study will identify and describe social workers’ involvement in mitigating loneliness among the older people. Findlay and Cartwright (2002) have noted that those different countries have been channeling resources into aged care programmes but the critical question has been whether they work. It is hoped that the findings of this study will provide a basis for evaluating aged care social services. Top of Form Bottom of Form Literature Review Healthy ageing, reduced mortality rates and increased life expectancy among the older people are primary concerns in aged care in Australia (Pearce, Matthews, & Healthy Ageing Task Force, 2000; Australian Institute of Health and Welfare, 2004).

It is estimated that Australians aged above 85 years will increase at the annual average of 30, 032 from 2026 – 2041 (Healthy Ageing Task Force, 2000). By 2026, the population growth rate of Australians aged over 65 years will be thrice the rate of growth of the total population between the age of 15 and 64 years (Department of Health and Ageing, 2006). In 2011, the population of those aged 60 years and above was almost 700 million and the number is projected to rise to two billion by 2050 (United Nations General Assembly, 2011).

In Australia, older persons (65 years and above) will comprise over 25% of the population by 2045 (Australian Bureau of Statistics, 2015). As the number of older people increases, their vulnerability increases and so is the demand for aged care services. Meeting this demand has been complicated by the changing socio-demographic trends in the recent past. Immediate family members are getting more and more separated geographically; more women initially providing homecare for older people are getting engaged in formal employment; and family sizes are getting smaller (Newman, 1987).

This implies that informal care the older people have been traditionally receiving from the family members is fast declining. Consequently, the role of social workers in aged care service provision is gaining prominence. A report(Social Exclusion Unit, 2005) in the UK revealed that older people suffer economically (live in low income households), socialy (30% of the people are unable to see a friend in a week), psychologically (33% of them suffer depression), from medical conditions (60% suffer from long standing illnesses), indecent shelter (33%), increased fatalities ( more than 20,000S excess deaths among this group) and high mortality rates (nearly half of those admitted in nursing or residential facilities die within 18 months of admission).

The report employs the broad term ‘social exclusion’ to encapsulate these adverse experiences of the older people. It gives the definition of social exclusion as the shorthand term for what happens to people suffering from linked problematic conditions such as family breakdown, unemployment, poor skills, bad health, high crime, low incomes and poor housing. Similar concerns are raised in the Closing the Gaps Report tabled in the South Australian Parliament (Lacey, 2012). This author observes a growing number of the Australia’s ageing population experiences divorce, ill-health, poverty, disability, dependency, spousal death, and gender, physical, sexual, social, psychological and financial abuse or neglect.

The older people in Australia also suffer from social isolation and ageist assumptions (Australian Human Rights Commission, 2013). Notably occurring in the two reports is the issue of social exclusion. This research project hence identified a narrower version of social exclusion – social isolation or loneliness as the subject of study. Loneliness and social isolation have been often linked with older age and a number of related risk factors (Byles, Harris, Nair & Butler, 1996). European and American studies have extensively considered loneliness as an aged care issue in both residential and non-residential settings (Eldelbrock, Buys, Creasy & Broe, 2001).

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