Research On Curbing Loneliness In Care Homes Through Virtual Technologies

Abstract

Loneliness in care homes poses critical challenges for residents by impacting their mental and physical well-being. The declining number in visitors in care settings has been further aggravated by the pandemic thereby, highlighting the importance of fostering inter-home social networks among residents of care homes. This research proposes the implementation of a three-tiered activity based virtual intervention to help establish social connectedness between residents in care settings to curb loneliness. Residents scoring more than 25 on the UCLA Loneliness Scale will be selected to voluntarily participate in the study and will be assigned with a virtual activity from the category of games, singing and reading. Data will be collected through an ethnographic approach and analyzed through NVivo version 11. The intervention is expected to aid in the reduction of loneliness scores among participants and evoke feelings of positivity. It will aid in leveraging the potential of low-cost virtual technologies to address loneliness in care homes.

keywords: Loneliness, Ageing, Care-Settings, Technology, Intervention

Introduction

Background

The demographic characteristics of the population in the UK is characterized by the presence of individuals who are aged 60 or above. This is indicative of the presence of an ageing population as people now have a longer life expectancy due to advancements in medicine and improvements in living conditions. Close to 1/4^th of the UK’s population is aged 60 and above – which comprises of 15.5 million people. Accordingly, more than 600,000 residents in the UK are aged 90 and above while more than 3 million individuals are aged 80 or over. The Office of National Statistics reports that by the year 2041, the number of individuals who are aged 85 or above will stand at more than twice of the present figure.

Given the present dynamics of the UK’s population, the proportion of older individuals that reside in care home is comparatively low. As of 2016, more than 400,000 individuals resided in care homes. 40% of the individuals residing in these homes are receiving treatment for dementia. In 2018, it was reported that the UK had greater than 11,000 caring homes out of which approximately 42% were nursing homes.

Elderly individuals experience challenges during their day-to-day life at care homes. One of these issues is that of loneliness which has an adverse impact on the quality of life, well-being, and health of the older population. Sustained feelings of loneliness are linked with a general dissatisfaction towards the quantity and quality of social relationships and interactions that individuals experience. It is also associated with the feeling of being socially isolated due to a lack or absence of social ties (Hanratty et al., 2018).

According to a research conducted by Gardiner et al. (2020), the level of moderate and severe loneliness experienced by residents of care homes is alarming. The study found that on an average, 61% of care home residents reported to have experienced loneliness whereas 35% reported that they suffered from severe loneliness.

Previous Literature

Literature on age and ageing has addressed several key challenges faced by individuals residing in care homes. The prevalent themes in this area include studies on neglect in care homes and the distinct needs of an aging population. In their research, Neves, Sanders and Kokanovic (2019) examined the dimensions of loneliness and social isolation the setting of care homes. The study showcased the significance of identifying the differences between loneliness and social isolation whereby the latter was recognized as a self-imposed phenomenon whereas loneliness was deemed to be a private and rather stigmatizing experience. The study design was based on a qualitative methodology which was categorized into two stages. Moreover, data collection methods included recording 101 hours of observation and conducting semi-structured interviews from 22 participants. The research presented recommendations for devising interventions and coping strategies that adhered to an individualistic and social perspectives while offering prospects for social connectedness.

The work of Wijesiri, Samarasinghe and Edberg (2019), examined the phenomenon of loneliness in care home settings in Sri Lanka. The sample size of for the study comprised of 75 individuals aged 65 and above residing in three distinct care home settings in the country. The researchers administered R-UCLA Loneliness Scale on the participants and respondents with high score were shortlisted for interviews. The findings of the research indicated that coping strategies against loneliness varied from individual to individual. Some respondents preferred to address loneliness by becoming closer to their faith and taking part in social gatherings. The findings of the study recommended that the adoption a person-centred strategy would prove to be most effective for coping with loneliness.

Zamir et al. (2018) examined the efficacy of executing a video call intervention strategy for curbing loneliness in care home residents. The study was based on the implementation of ‘Skype on Wheels’ (SoW). The program featured the use of a moveable device which carried an iPhone that had Skype installed in it. The SoW program improved the accessibility of video calls and allowed residents of the care home to stay in touch with their family members. The findings of the research indicated that even though the program was beneficial for care home residents, a lack of family commitment towards video calls and high staff turnover were a barrier towards its long-term implementation.

The technological intervention model of ‘Skype of Wheels’ was further implemented in a similar study conducted by Zamir et al. (2020) which utilized the medium to hold quiz sessions via Skype for care home residents. The intervention proved to be effective in addressing feelings of loneliness by allowing residents to engage with other residents. The research found that the creation of strong inter-home connections through the execution of video calls is beneficial for enhancing social engagement and curbing the onset of loneliness, especially in the current pandemic.

Research Context

The experience of loneliness has notable adverse outcomes. Research indicates that individuals who undergo feelings of loneliness are at a higher risk of developing anxiety and depression. Moreover, they are also more prone to suicidal thoughts and alcoholism (Simard and Volicer, 2020). Studies have also shown that apart from psychological consequences, loneliness can also lead to physical ailments such as high blood pressure and obesity. Individuals who experience prolonged loneliness also have a higher chance of developing Alzheimer’s disease and suffer from gradual cognitive decline (Simard and Volicer, 2020). Newall et al. (2013) note that loneliness is also a risk factor for declined physical activity and mortality.

Given the challenges posed by COVID-19, whereby social distancing measures have increased the reliance on technology to practice safe communication and engagement, this research aims to explore the efficacy of launching remote interactive activities in care home settings through the platform of Zoom. These activities will be divided into the categories of games, singing, and reading and will be administered in a care home setting based in the UK.

The assigned care home supervisors will link each resident with a designated activity based on their age, cognitive ability, preferences, and loneliness score. The primary objective of the intervention is to increase the social connectedness of participants, curb their feelings of loneliness and help them connect with likeminded residents in the care home setting.

The research will assess how inter-home connections between residents of care homes can be fostered in the long-run to address barriers such as a lack of time commitment from family members and the existing restrictions on visitors in care homes due to the onset of COVID-19.

Research Aim

The proposal presents the following research questions which will be addressed as a part of the study:

• How can the development of inter-home connections curb the feelings of loneliness among care home residents?
• How do older people respond to the use of technology to address the onset of loneliness?
• What are the barriers in the implementation of technology-based interventions to promote social engagement in care homes?

Methodology

Design

The design of the study will be based on the action research design process which comprises of planning, acting, observing, and reflecting. This research process is specifically designed to improve outcomes and practices in multiple settings. Once an initiative is executed, the results of the framework are critically evaluated to inform changes in practice, based on the collected data and evidence. Action research is also particular to a given context and has a narrow focus which supports the goal of enhancing existing practice, improving outcomes, and benefiting groups that are targeted by the action research. Moreover, this process is highly collaborative and enables the exchange of ideas for problem-solving.

The planning phase would be based on thoroughly assessing the care home setting based in the UK and exploring avenues for implementing the intervention. This will involve an assessment of the residents of the care home as well as the staff members and supervisors that are present in the setting. The planning phase would also involve selecting the residents who will participant in the intervention. These individuals will be shortlisted by corresponding with the supervisors of the care home and assessing suitable candidates based on various parameters such as their willingness to participate, level of loneliness and suitability with reference to various social engagement activities. The recruitment of participants will also be based on the administration of the UCLA Loneliness Scale. Participants with a score of more than 25 will be shortlisted for the purposes of the research.

As noted previously, the three social engagement categories defined under the intervention are that of games, singing and reading. The first category consists of virtual games which participants can play with care givers on a tablet. These games will be administered through a free application known as ‘Better Visit’.

The second category will involve the creation of a virtual choir among the residents of the care home. The activity will be led by an assigned supervisor who will direct participants through several songs on a weekly basis. In the third category, care home residents will be divided into reading groups through the creation of a virtual book club. The book for discussion will be selected based on the comments and feedback of the participants. Accordingly, the book club will gather on a bi-weekly basis to participate in a virtual reading and subsequently discuss the progress of the plot.

The researcher will engage in a continuous observation of the participants during the study. The observations will be gathered in a journal and will help generate insights regarding the feasibility of the intervention, the response of participants and ongoing barriers in the implementation of the intervention.

In the last phase, the researcher will acquire feedback from respondents and supervisors regarding the intervention. Accordingly, the UCLA Loneliness Score will be readministered among the shortlisted participants to record any decline in the score following the execution of the intervention. The virtual Zoom sessions for each category will be implemented for a span of 3 months – twice per week. The researcher will administer the UCLA Loneliness Scale before the commencement of the study and after the end of the research.

Possible challenges which may arise during the project include budgetary constraints, unwillingness of participants to continue with the intervention, high supervisor turnover and lack of encouragement or interest from family members. The researcher will also conduct unstructured interviews with selected participants at the end of every two weeks to note their experiences and opinions of the intervention.

Participants

The participants of the study will consist of individuals aged between 65 and 80 residing in a long-term care home facility with a score of 25 or higher on the UCLA Loneliness Scale. The participants will be selected based on their voluntary participation. Once individuals who meet the criteria have been identified for the study, the sample will be selected through a random sampling strategy. The supervisors and staff members in the care home will provide information and insights about the suitable intervention for each participant. Individuals participating in the study will be encouraged to share their feedback regarding the intervention and whether the implementation of the program has improved their level of social engagement and inter-home connectedness.

Materials

The materials used for the different categories of activities are free resources that are readily available online. For the games module of the intervention, an application known as A Better Visit will be utilized. A Better Visit is an application which encourages social interaction between residents of long-term care homes and their supervisors or visitors. Owing to the restrictions on visitors entering care homes due to COVID-19, the application will be administered by a care giver or supervisor who can play games with a participant on a tablet. The application has been designed to stimulate engagement and interaction through multiple activities which are easy navigate.

For the second category of the intervention, the study will utilize the ‘Singing for Health’ playlist which is available on YouTube [https://www.youtube.com/playlist?list=PL-IiTbuZ7zr1F4jZYocKQ5pALmBH_1FEg]. This resource comprises of several song renditions that participants will be able to sing along in choirs through virtual Zoom sessions.

The third category of the intervention is based on the creation of a virtual book club. The researcher will obtain book recommendations from the participants and books for each week will be decided prior to the launch of the club. The book club will be moderated through a virtual Zoom session which will last 2 hours each.

Data Collection

The data collection process for this study will be based on the adoption of an ethnographic approach which will involve interviews and observation. The researcher will conduct unstructured interviews with participants to understand their feelings and experiences about loneliness and social interaction. The researcher will maintain a log of this information. Data on the level of loneliness experienced by the participants will be gathered using the UCLA Loneliness Scale. This data will be collected at the start and end of the study.

Analysis

The data will be analysed through the implementation of thematic analysis. NVivo version 11 will be used as the software for managing extensive qualitative data. The researcher will establish persistent themes within the data in addition to analysing the results of the UCLA Loneliness Scale.

Ethical Issues

Written consent will be received from participants and care givers before the commencement of the study. Moreover, participants will also be required to provide their written feedback about the intervention through feedback forms. Any participant who wishes to withdraw from the study at any point in time will have complete authority to do so. The ethical approval will be obtained from the University’s Ethics Board. All participants will be provided with the contact information of the researcher to address any concerns or questions about the study.

Potential Outcomes

The launch of the intervention will improve the social experience of residents in care home settings by focusing on the aspect of inter-home connectedness and developing networks with residents. The study aims to integrate virtual technologies to address the issue of loneliness care homes. It is expected that through the launch of the proposed interventions, participants will experience a reduction in their loneliness levels as identified by the UCLA Loneliness Scale. The intervention will prove to be an effective solution to address the issue of low visitors in care home settings and promote the mental and physical well-being of residents. The integration of technologies will aid in managing the workload of staff members. The intervention will be remodelled through the integration of alternative virtual activities in case it is unable to meet the expected outcomes.

Research Significance

The research will prove to be effective for devising low-cost strategies for addressing loneliness in care homes during COVID-19 which has led to the introduction of visitor restrictions. Moreover, the research will also highlight the importance of inter-home connections and social networks to promote the well-being of residents that receive no visitors. Accordingly, the research will also help in improving the scalability of comparable interventions in care homes across the globe that continue to face challenges triggered by residents’ loneliness. Virtual activities can also stimulate the cognitive function of residents and aid in managing the time commitment of care givers and supervisors.

References

Gardiner, C., Laud, P., Heaton, T., & Gott, M. (2020). What is the prevalence of loneliness amongst older people living in residential and nursing care homes? A systematic review and meta-analysis. Age and Ageing.

Hanratty, B., Stow, D., Collingridge Moore, D., Valtorta, N. K., & Matthews, F. (2018). Loneliness as a risk factor for care home admission in the English Longitudinal Study of Ageing. Age and ageing, 47(6), 896-900.

Neves, B. B., Sanders, A., & Kokanović, R. (2019). “It’s the worst bloody feeling in the world”: Experiences of loneliness and social isolation among older people living in care homes. Journal of Aging Studies, 49, 74-84.

Newall, N. E., Chipperfield, J. G., Bailis, D. S., & Stewart, T. L. (2013). Consequences of loneliness on physical activity and mortality in older adults and the power of positive emotions. Health Psychology, 32(8), 921.

Simard, J., & Volicer, L. (2020). Loneliness and Isolation in Long-term Care and the Covid-19 pandemic. Journal of the American Medical Directors Association.

Wijesiri, H. M. S., Samarasinghe, K., & Edberg, A. K. (2019). Loneliness among older people living in care homes in Sri Lanka. International journal of older people nursing, 14(4), e12253.

Zamir, S., Hennessy, C. H., Taylor, A. H., & Jones, R. B. (2018). Video-calls to reduce loneliness and social isolation within care environments for older people: an implementation study using collaborative action research. BMC geriatrics, 18(1), 62.

Zamir, S., Hennessy, C., Taylor, A., & Jones, R. (2020). Intergroup ‘Skype’Quiz Sessions in Care Homes to Reduce Loneliness and Social Isolation in Older People. Geriatrics, 5(4), 90.