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SECG Blog: A focus on social participation of community aged care clients

Dr Lindsey Brett, Prof. Andrew Georgiou, Dr Mikaela Jorgensen and Prof. Johanna Westbrook
Centre for Health Systems and safety Research, Australian Institute of Health Innovation, Macquarie University
August 2018

Many older adults express a desire to stay living in their own home for as long as possible and remain contributing members of their communities.1 To help older Australians achieve this they can access home help through Government-funded community aged care services.2 Along with physical needs, it is important that community aged care services also address the psychosocial needs of older adults. One area of growing concern is social isolation (lack of relationships with others) and loneliness (feelings of lack, or loss of companionship), which effects up to 10% of older Australians.3 Social isolation and loneliness is associated with poorer mental and physical health, and a greater risk of dementia and mortality.4

By assisting older adults to remain engaged and socially active within their communities, aged care services can help to address the issues associated with social isolation and improve quality of life (QoL). A high level of social participation and engagement contributes to lower levels of psychological distress, higher self-rated health, better physical function, and lower risk of future dependence for activities in daily living (ADLs) in community-dwelling adults.5 Due to the physical and psychological benefits associated with social participation, community aged care services may also help to reduce the burden of care by potentially reducing the need to access some health services, such as assistance to complete ADLs or treatment of depression due to social isolation. While there are studies which highlight the presence of social isolation and loneliness in the community,3 there are very few which consider approaches that could be utilised to identify older adults that would benefit from greater social participation and engagement.

The Centre for Health Systems and Safety Research, Australian Institute of Health Innovation at Macquarie University has partnered with a large aged care provider to take on an innovative project to gain insights into social participation levels and experiences of community aged care clients. A Commonwealth Department of Health Dementia and Aged Care Services Fund grant has been awarded for this project. The aims of the project are to ascertain the level of social participation and QoL of a sample of community aged care clients, and utilise the findings to enhance care planning to target social participation and engagement. To gain an understanding of client social participation the Australian Community Participation Questionnaire (ACPQ) will be used.6 Client QoL will be measured using the ICEpop CAPability Measure for Older Adults (ICECAP-O).7 The measures selected for this project will allow for measurement of associations between community care services, social participation and QoL.

The findings collected using the ACPQ and ICECAP-O will be enhanced through information gained from both clients and staff who consent to participate in focus groups as a part of this project. The focus groups will consider client and staff responses to the implementation of the tools, and the impact they had on service provisions and other relevant outcomes. The rich data collected during the focus groups will provide valuable insights that cannot be collected through quantitative measures alone. Consideration of client and staff opinion is also important to help promote consumer-directed care.

This project seeks to tackle the issue of social isolation by adding increased attention during community aged care assessments to clients’ social participation and QoL. The use of the ACPQ and ICECAP-O will assist clients to identify what helps them to bring purpose, meaning and value to their lives. The tools will help staff to identify relevant services that can be utilised by clients to increase social participation and maintain connections with family and friends. An increased utilisation of services by community aged care clients has the potential to benefit the community as a whole through uptake and maintenance of memberships of neighbourhood associations, religious groups or non-governmental organisations. In this project we anticipate, and will measure the extent to which, integration of the ACPQ and ICECAP-O into routine assessment provides clients, staff, and aged care planners with insights into aspects of client wellbeing not previously considered, to inform decisions about the provision of services to improve social participation and QoL for community aged care clients.

Reference List

1. Fleischer S, Roling G, Beutner K, Hanns S, Behrens J, Luck T, et al. Growing old at home – A randomized controlled trial to investigate the effectiveness and cost-effectiveness of preventive home visits to reduce nursing home admissions: study protocol [NCT00644826]. BMC Public Health. 2008;8(1):185.

2. Australian Government. Aged care: a quick guide Canberra: Australian Government; 2016 [updated 24/10/2016. Available from: http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1617/Quick_Guides/Aged_Care_a_quick_guide.

3. Aged and Community Services Australia. Social isolation and loneliness among older Australians. Deakin; 2015. Contract No.: 1.

4. Davidson S, Rodssall P. Age UK Loneliness Evidence Review. Age UK; 2014.

5. Douglas H, Georgiou A, Westbrook J. Social participation as an indicator of successful aging: an overview of concepts and their associations with health. Australian Health Review. 2017;41(4):455-62.

6. Berry HL, Rodgers B, Dear KBG. Preliminary development and validation of an Australian community participation questionnaire: Types of participation and associations with distress in a coastal community. Social Science & Medicine. 2007;64(8):1719-37.

7. Flynn TN, Chan P, Coast J, Peters TJ. Assessing quality of life among British older people using the ICEPOP CAPability (ICECAP-O) measure. Applied Health Economics and Health Policy. 2011;9(5):317-29.

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