What is the impact on health and wellbeing of interventions that foster respect and social inclusion in community-residing older adults? A systematic review of quantitative and qualitative studies

Abstract

BackgroundMany interventions have been developed to promote respect and social inclusion among older people, but the evidence on their impacts on health has not been synthesised. This systematic review aims to appraise the state of the evidence across the quantitative and qualitative literature.MethodsEligible studies published between 1990 and 2015 were identified by scanning seven bibliographic databases using a pre-piloted strategy, searching grey literature and contacting experts. Studies were included if they assessed the impact (quantitatively) and/or perceived impact (qualitatively) of an intervention promoting respect and social inclusion on the physical or mental health of community-residing people aged 60 years and older. Titles and abstracts were screened for eligibility by one reviewer. A second reviewer independently screened a 10% random sample. Full texts were screened for eligibility by one reviewer, with verification by another reviewer. Risk of bias was assessed using standardised tools. Findings were summarised using narrative synthesis, harvest plots and logic models to depict the potential pathways to health outcomes.ResultsOf the 27,354 records retrieved, 40 studies (23 quantitative, 6 qualitative, 11 mixed methods) were included. All studies were conducted in high and upper middle-income countries. Interventions involved mentoring, intergenerational and multi-activity programmes, dancing, music and singing, art and culture and information-communication technology. Most studies (n = 24) were at high or moderate risk of bias. Music and singing, intergenerational interventions, art and culture and multi-activity interventions were associated with an overall positive impact on health outcomes. This included depression (n = 3), wellbeing (n = 3), subjective health (n = 2), quality of life (n = 2), perceived stress and mental health (n = 2) and physical health (n = 2). Qualitative studies offered explanations for mediating factors (e.g. improved self-esteem) that may lead to improved health outcomes and contributed to the assessment of causation.ConclusionsWhilst this review suggests that some interventions may positively impact on the health outcomes of older people, and identified mediating factors to health outcomes, the evidence is based on studies with heterogeneous methodologies. Many of the interventions were delivered as projects to selected groups, raising important questions about the feasibility of wider implementation and the potential for population-wide benefits.Systematic review registrationPROSPERO registration number CRD42014010107Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0680-2) contains supplementary material, which is available to authorized users.

Social prescribing: where is the evidence?

“…4 In time, social prescribing principles have been increasingly applied to older populations, with a view to addressing loneliness, improving physical activity levels, and mental wellbeing. 5 Understanding such diversity is important, because relevant outcomes are likely to vary according to different social prescribing schemes. Generally, programmes are aimed at addressing the social determinants of ill health, supporting patients with non-clinical root causes of poor health, or preventing disease.…”

Biopsychological Effects of Social Participation on Aging: The Role of Identity-Affirming Music and the Arts

“…Interview responses from participants in Studies 2 and 3 emphasized these findings, with frequent mentions of connecting with others, sharing personal struggles and triumphs, and feeling joy as a result of this bonding process. These social experiences are often reported in other studies of artistic interventions (Baker et al, 2018;Clark et al, 2018;Dingle et al, 2013) and it is postulated that they help promote the positive health outcomes that are also observed among study participants (Ronzi, Orton, Pope, Valtorta, & Bruce, 2018). This was especially evident in Study 6, when social identification was measured for each group membership reported by participants.…”

“…Social group participation likely operates through multiple pathways to affect well-being. Indeed, other mediators of this relationship have been identified, including self-esteem and positive attitude towards aging (Ronzi et al, 2018). Along with social identity, these factors are important to consider when designing and assessing social interventions for older adults.…”

“…Unfortunately, recruitment efforts of this type can also be biased. Studies of social interventions often naturally attract socially active individuals, instead of those who are more isolated and perhaps in greater need of social programming or support (Ronzi et al, 2018). Recruiting and studying these harder-to-reach individuals is imperative to our understanding of how social groups can function as health interventions (Jetten, Haslam, Haslam, 2011).…”

Loneliness and the letter: Co-developing cross-generational letter writing with higher education students and older people

“…Although one of the studies detailed by Canedo-García involved a lifewriting workshop (Chippendale and Boltz, 2015), none of the interventions involved letter writing between different age groups, despite the dialogical and self-reflective nature of this social practice (Hall et al, 1999). Like the health-related programmes evaluated by Ronzi et al (2018) and Canedo-García et al (2017), letter writing has been found to be associated with 'physical and mental benefits across diverse samples' (Pennebaker andSeagal, 1999: 1252). More specifically, in a 'short [letter] writing campaign' involving 219 people, writing letters of gratitude was found to improve well-being and significantly decrease 'levels of depressive symptoms' (Toepfer et al, 2012: 198).…”