Interventions for Social Isolation and Loneliness in Later Life: Considering the Needs of Family Caregivers
摘要
Dementia caregiving can impact all domains of social relationships that are important for health and well-being. In this chapter, we provide a scoping review of the literature on social isolation and loneliness (SIL) in the context of older adults providing informal care for loved ones with dementia. Estimates suggest that up to half of dementia caregivers will experience loneliness while caring for a loved one, and 37% social isolation. This chapter identified aspects of the caregiving experience that impact SIL, including protective relational experiences such as feelings of mastery and competence in the caregiving role and increased closeness in the relationship with the person with dementia. Relational experiences in caregiving that may increase risk for SIL include losses from caregiving, relationship discord among family members, caregiving strain, and changing needs for social support over the course of the illness. The relative balance of these risk and protective factors may play a role in caregivers’ SIL outcomes during caregiving and could also serve as intervention targets for clinicians or in the development of interventions. The Cognitive Behavioral (CBT) model of social connection assumes that, as with emotional states such as depressed mood and anxiety, loneliness and distress (due to isolation) can be conceptualized as being caused and maintained not just by “objective” circumstances (e.g., inability to leave the home) but also by our thoughts, behaviors/actions, and physiological responses surrounding those experiences. This chapter also reviews the literature on interventions for SIL in caregivers. Evidence-based interventions for dementia caregiving frequently include components that may impact relational processes during caregiving (e.g., peer support, connection to resources), but few explicitly target SIL. Those with a specific focus on social support/networks are more likely to have measures of SIL included in clinical trials for effectiveness. Taken together, there is some evidence that evidence-based interventions for dementia caregivers that specifically target social relationships can improve social support. Other aspects of SIL are infrequently studied as outcomes for dementia caregivers. Psychotherapeutic interventions and peer support hold promise, but trials infrequently measure SIL outcomes. Connection Planning, while not developed specifically for caregivers, is a brief, evidence-informed intervention to target SIL that was designed to be brief and easy to learn. Until additional research is conducted to indicate the best interventions to reduce or prevent SIL in older caregivers, Connection Planning holds promise as a means to promote the social health in this at-risk population of older adults and could be added to existing programs without significant additional resources or staff training.