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Open Access Article << Previous     |     Next >>   Contents Vol 37(2)

The role of social isolation in frequent and/or avoidable hospitalisation: rural community-based service providers’ perspectives

Jo Longman A B , Megan Passey A , Judy Singer A and Geoff Morgan A

A University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. Email: megan.passey@ucrh.edu.au; judy.singer@ucrh.edu.au; geoff.morgan@ucrh.edu.au
B Corresponding author. Email: jo.longman@ucrh.edu.au

Australian Health Review 37(2) 223-231 http://dx.doi.org/10.1071/AH12152
Submitted: 1 March 2012  Accepted: 13 September 2012   Published: 15 March 2013

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Background. Research on frequent or avoidable hospital admission has not focussed on the perspectives of service providers or rural settings. The link between social isolation and admission is not well explored, although social isolation is known to have negative health effects.

Objective. This paper reports further analysis from a study investigating service providers’ perspectives on factors influencing frequent hospital admission in older patients with chronic disease, and explores the perceived role of social isolation.

Methods. Semi-structured interviews with 15 purposively sampled community-based service providers in rural New South Wales, Australia were thematically analysed.

Results. Social isolation was repeatedly identified as an important contributory factor in frequent and/or avoidable admission. Patients were described as socially isolated in three broad and interrelating ways: living alone, not socialising and being isolated from family. Social isolation was perceived to contribute to admission by limiting opportunities offered by social interaction, including opportunities for: improving mental health, pain tolerance and nutritional status; facilitating access to services; reinforcing healthful behaviours; and providing a monitoring role.

Conclusions. Social isolation is perceived to contribute to admission in ways that may be amenable to intervention. Further research is needed to understand patients’ perspectives on the role of social isolation in admission, in order to inform policy and programs aimed at reducing hospitalisation among older people with chronic disease.

What is known about the topic? Social isolation has been shown to adversely affect physical health and mental health and wellbeing across a range of populations. However, less is known about the influence of social isolation on hospital admission among older people with chronic disease, and in particular in instances where admission might have been avoided.

What does this paper add? This paper adds to our understanding of the ways in which social isolation might link to hospital admission among older people with chronic conditions. It does this by reporting the perspectives of community-based service providers with many years’ experience of working with this patient group.

What are the implications for practitioners? Practitioners need to consider the wider determinants of hospital admission among older patients with chronic disease, including social structures and support. For policy makers the implications are to review support for such patients and explore the possible impact of reducing social isolation on hospital admission.


[1]  Winterton R, Warburton J. Models of care for socially isolated older rural carers: barriers and implications. Rural Remote Health 2011; 11: .
| CAS |

[2]  Owen T. Working with socially isolated older people. Br J Community Nurs 2007; 12: 115–16.

[3]  Nilsson CJ, Avlund K, Lund R. Onset of mobility limitations in old age: the combined effect of socioeconomic position and social relations. Age Ageing 2011; 40: 607–14.
CrossRef |

[4]  Arthur HM. Depression, isolation, social support, and cardiovascular disease in older adults. J Cardiovasc Nurs 2006; 21: S2–S7.

[5]  Grenade L, Boldy D. Social isolation and loneliness among older people: issues and future challenges in community and residential settings. Aust Health Rev 2008; 32: 468–78.
CrossRef |

[6]  Mookadam F, Arthur HM. Social support and its relationship to morbidity and mortality after acute myocardial infarction: systematic overview. Arch Intern Med 2004; 164: 1514–8.
CrossRef |

[7]  Cacioppo JT, Hawkley LC, Norman GJ, Berntson GG. Social isolation. Ann N Y Acad Sci 2011; 1231: 17–22.

[8]  Rodríguez-Artalejo F, Guallar-Castillón P, Herrera MC, Otero CM, Chiva MO, Ochoa CC, et al Social network as a predictor of hospital readmission and mortality among older patients with heart failure. J Card Fail 2006; 12: 621–7.
CrossRef |

[9]  Molloy GJ, McGee HM, O’Neill D, Conroy RM. Loneliness and emergency and planned hospitalizations in a community sample of older adults. J Am Geriatr Soc 2010; 58: 1538–41.
CrossRef |

[10]  National Center for Biotechnology Information. Social Isolation – MeSH - NCBI. 2011 [cited 2011 24 November]; Available from: http://www.ncbi.nlm.nih.gov/mesh?term=social%20isolation [verified 24 November 2011].

[11]  Pachana NA, Smith N, Watson M, McLaughlin D, Dobson A. Responsiveness of the Duke Social Support sub-scales in older women. Age Ageing 2008; 37: 666–72.
CrossRef |

[12]  Jordan RE, Hawker JI, Ayres JG, Adab P, Tunnicliffe W, Olowokure B, et al Effect of social factors on winter hospital admission for respiratory disease: a case-control study of older people in the UK. Br J Gen Pract 2008; 58: e1–e9.
CrossRef |

[13]  Victor C, Bowling A, Bond J, Scambler S. Loneliness, social isolation and living alone in later life. ESRC Growing Old Programme, Research Findings 17. Sheffield: Economic and Social Research Council; 2003.

[14]  De Jong Gierveld J, Van Tilburg T. The De Jong Gierveld short scales for emotional and social loneliness: tested on data from 7 countries in the UN generations and gender surveys. Eur J Ageing 2010; 7: 121–30.
CrossRef |

[15]  Page AC, Ambrose SJ, Glover JD, Hetzel D. Atlas of Avoidable Hospitalisations in Australia: ambulatory care-sensitive conditions. Adelaide: Public Health Information Development Unit, The University of Adelaide; 2007.

[16]  Nolte E, Knai C, McKee M. Managing Chronic Conditions: Experience in eight countries. Brussels: World Health Organization on behalf of European Observatory on Health Systems and Policies; 2009.

[17]  Muenchberger H, Kendall E. Determinants of Avoidable Hospitalization in Chronic Disease: Development of a Predictor Matrix. Meadowbrook: Griffith University; 2008.

[18]  Siggins Miller. Unnecessary and avoidable hospital admissions for older people. Canberra: Department of Health and Ageing; 2003.

[19]  Australian Institute of Health and Welfare. Australian hospital statistics 2006–07. Canberra: AIHW; 2008.

[20]  Dunn T. Readmission for ambulatory care sensitive conditions North Coast Area Health Service 2001–2006. Lismore, NSW: Population Health, Planning and Performance Directorate North coast Area Health Service; 2009.

[21]  Clancy CM. The persistent challenge of avoidable hospitalizations. Health Serv Res 2005; 40: 953–6.
CrossRef |

[22]  Kirby S, Dennis S, Jayasinghe U, Harris M. Patient related factors in frequent readmissions: the influence of condition, access to services and patient choice. BMC Health Serv Res 2010; 10: .
CrossRef |

[23]  Resar R, Griffin F. Rethinking emergency department visits. J Ambul Care Manage 2010; 33: 290–95.

[24]  Masso M, Bezzina AJ, Siminski P, Middleton R, Eagar K. Why patients attend emergency departments for conditions potentially appropriate for primary care: reasons given by patients and clinicians differ. Emerg Med Australas 2007; 19: 333–40.
CrossRef |

[25]  Longman J, Singer J, Gao Y, Barclay L, Passey M, Pirotta J, et al Community based service providers’ perspectives on frequent and/or avoidable admission of older people with chronic disease in rural NSW: a qualitative study. BMC Health Serv Res 2011; 11: .
CrossRef |

[26]  Ritchie J, Lewis J, eds. Qualitative research practice: A guide for social science students and researchers. London: Sage; 2003.

[27]  QSR International. NVivo 9. Melbourne: QSR International; 2009.

[28]  Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77–101.
CrossRef |

[29]  Cacioppo JT, Patrick W. Loneliness: Human nature and the need for social connection. New York: WW Norton & Company; 2008.

[30]  Beal C. Loneliness in older women: a review of the literature. Issues Ment Health Nurs 2006; 27: 795–813.
CrossRef |

[31]  Theeke L, Goins R, Moore J, Campbell H. Loneliness, depression, social support, and quality of life in older chronically ill Appalachians. J Psychol 2012; 146: 155–71.
CrossRef |

[32]  Hawkley LC, Cacioppo JT. Aging and loneliness downhill quickly? Curr Dir Psychol Sci 2007; 16: 187–91.
CrossRef |

[33]  de Jong Gierveld J, Havens B. Cross-national comparisons of social isolation and loneliness: introduction and overview. Can J Aging 2004; 23: 109–13.

[34]  Luck GW, Race D, Black R, eds. Demographic Change in Australia’s Rural Landscapes: Implications for Society and the Environment. Collingwood: Springer; 2011.

[35]  Dykstra PA. Older adult loneliness: myths and realities. Eur J Ageing 2009; 6: 91–100.
CrossRef |

[36]  Hawton A, Green C, Dickens A, Richards S, Taylor R, Edwards R, et al The impact of social isolation on the health status and health-related quality of life of older people. Qual Life Res 2010; 20: 57–67.

[37]  Boldy D, Grenade L. Loneliness and social isolation among older people: the views of community organisations and groups. Aust N Z J Public Health 2011; 35: 583.
CrossRef |

[38]  Canadian Institute for Health Information. The role of social support in reducing psychological distress. Canadian Institute for Health Information; 2012. Available from: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1714 [verified 20 April 2012].

[39]  Kirby SE, Dennis SM, Bazeley P, Harris MF. What distinguishes clinicians who better support patients for chronic disease self-management? Aust J Primary Health 2012; 18: 220–227.
CrossRef |

[40]  Dickens A, Richards S, Greaves C, Campbell J. Interventions targeting social isolation in older people: a systematic review. BMC Public Health 2011; 11: 647.
CrossRef |


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