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Supporting older adults’ social relationships with person-centred care delivery

This article has been written especially for Helping Hands and comes from Snorri Rafnsson’s work at the Geller Institute of Ageing and Memory, School of Biomedical Sciences at the University of West London.

About Snorri Rafnsson

Dr. Snorri Bjorn Rafnsson BSc (Hons.), MSc (Edin), PhD (Edin), PGCHE, FHEA, FRSPH (UK) currently serves as Associate Professor of Ageing and Dementia in the Geller Institute of Ageing and Memory, School of Biomedical Sciences at the University of West London.

His research combines an interest in epidemiology and social gerontology.

The role of person-centred adult care

At its core, person-centred care involves decision-making that takes into account older adults’ preferences, values, lifestyles, and social circumstances. Practitioners of person-centred care view the person as an individual and work together to make sure there is good communication, information, and education. Indeed, an important part of the role of health and social care professionals is to advise and support older adults in making appropriate health and lifestyle choices.

Acknowledging that older adults have unique notions about their care reflects a respect for the individual, an awareness of individual differences, and a sensitivity to the continued importance of choice and autonomy in later life. Allowing individuals to exercise control in their environment and integrating personal preference into their care are ways to enhance older adults’ satisfaction and quality of life. Person-centred care thus also aligns with evidence-based practice by integrating professional knowledge and skills with the best current evidence (including, but not limited to, health and social research), along with service users’ values, to provide the best possible care and support.

The importance of person-centred care

Making sure that older adults are involved in, and central to, their care, is now recognised as a key component of developing high-quality older adult health and social care. Although much work is still needed to facilitate this process, adopting person-centred care practices has become more of a priority over the past years and decades. By placing older adults at the centre of their care, it is hoped that the quality of available care services will improve, and people will receive the care they need when they need it.

With as many as 50% of older adults living with multiple long-term conditions, including diabetes, asthma, and arthritis, empowering older adults to effectively self-manage their conditions has become a key priority for the NHS. But as these numbers are expected to increase over the next years and decades, the challenge to meet their needs for care and support is likely to remain.

Common psychosocial challenges in later life

The number of older adults with unmet care and support needs is increasing, partly due to the strains experienced by formal and informal care systems. Addressing these unmet needs is an urgent priority in health and social care. A recent review found how older adults living with long-term conditions often have multiple unmet care needs related to their physical and psychological health, social life, as well as the environment in which they live and age.

Frequently, social and psychological behaviours and conditions act together to generate negative experiences and feelings among older adults, including that of loneliness, anxiety, fear, grief, loss of confidence, and lack of social and support networks. However, such adverse psychosocial experiences in later life are rarely isolated nor straightforward but are often coupled with broader longer-term health and social support issues. This further highlights the importance of developing person-centred care practices and support services based around the psychosocial needs of older adults.

Social connections, health, and well-being of older adults

There is growing interest among health and social researchers in the changes that occur to adults’ social networks as they age, and specifically in the relationship between older adults’ social networks and their health and wellbeing. Recent research, for example, suggests that different aspects of older adults’ social networks may help sustain well-being levels.

The role of close relationships with friends and family, and frequent contact with others in later life, may be particularly important for older adults’ quality of life. Similarly, studies have found that the risk of developing dementia is related to loneliness and having fewer intimate relationships in later life. Although researchers are still trying to understand the exact nature of these associations, efforts to enhance the quality of older adults’ personal relationships with friends and family may be relevant to lowering dementia risk.

Social relationships depend on having access to social contacts, are important in promoting older adults’ engagement in social activities, such as walking or gardening clubs, and allow valuable social support exchanges, including sharing of information and advice, and expressions of love, empathy, and trust. Importantly, following an extensive evidence review, the Lancet Commission on dementia prevention identified low social contact with others as one of 12 potentially modifiable risk factors (along with more established risk factors such as physical inactivity, high blood pressure and diabetes) for the development of dementia in later life.

Meeting older adults needs for social contact with person-centred care delivery

Addressing unmet psychosocial care and support needs of older adults, and designing appropriate services and solutions centred around what they need or desire, is an urgent health and social care priority. In the spirit of person-centred care, activities and practices that support social network interactions need to be individualised and should consider the older adult, others in their immediate network, and their preferences for social interactions, including a desire for visits with family members, preferred frequency and mode of social contact (e.g. face-to-face interactions, online communication etc.), preferred size of social groups, as well as specific social activities, such as participating in clubs and celebrating holidays and birthdays.

Documenting older adults’ psychosocial preferences could thus assist both formal and informal carers in tailoring interventions and activities that provide individualised support for meaningful and desired social interactions with friends and family. For example, maintaining the home environment, or assigning a home carer to the same residents to provide continuity of care, may facilitate more frequent interactions and enhance the quality of the time older residents spend with each other, care staff, and their close contacts.

Simpler still, providing access to relatively cheap, and easy to use, technology for older residents to actually hear and see their loved ones has proved invaluable for many families in times of lockdown and social distancing during the current coronavirus pandemic.

Sources:

  1. Abdi S, Spann A, Borilovic J. et al. Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatrics. 2019 (19). https://doi.org/10.1186/s12877-019-1189-9.
  2. Carpenter BD, Van Haitsma K, Ruckdeschel K. et al. The Psychosocial Preferences of Older Adults: A Pilot Examination of Content and Structure1. The Gerontologist. 2000 40 (3):335–348. doi: https://doi.org/10.1093/geront/40.3.335
  3. Health Innovation Network. What is person-centred care and why is it important? https://healthinnovationnetwork.com/system/ckeditor_assets/attachments/41/what_is_person-centred_care_and_why_is_it_important.pdf
  4. Hermer L, Bryant NS, Pucciarello M et al. Does comprehensive culture change adoption via the household model enhance nursing home residents’ psychosocial well-being? Innovation in Aging. 2017 1(2). doi:10.1093/geroni/igx033.
  5. Livingston G, Huntley J, Sommerlad A et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug;396(10248):413-446. doi: 10.1016/S0140-6736(20)30367-6.
  6. Rafnsson SB, Orrell M, d’Orsi E et al. Loneliness, Social Integration, and Incident Dementia Over 6 Years: Prospective Findings From the English Longitudinal Study of Ageing. Journal of Gerontology B Psychological Sciences and Social Sciences. 2020 Jan 1;75(1):114-124. doi: 10.1093/geronb/gbx087.
  7. Rafnsson SB, Shankar A, Steptoe A. Longitudinal Influences of Social Network Characteristics on Subjective Well-Being of Older Adults: Findings From the ELSA Study. Journal of Aging and Health. 2015 Aug;27(5):919-34. doi: 10.1177/0898264315572111.

Page reviewed by Snorri Rafnsson, Associate Professor of Ageing and Dementia in the Geller Institute of Ageing and Memory on March 25, 2021

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