Older people often identify social inclusion as important to their quality of life and independence. They want to have good relationships with family and friends, to have a role, to feel useful and to be treated with respect. Opportunities to participate and make a positive contribution to community and society are integral to autonomy and therefore dignity. Scie’s Dignity in Care practice guide identifies the factors that cause social isolation and provides practical guidance to support service providers and practitioners in the development of their practice.
Risk factors that may lead to social exclusion include bereavement, loss of work and poor health. Age discrimination, sometimes alongside other forms of discrimination, can also contribute to the social isolation of older people. The very elderly are particularly likely to experience isolation.
Although older people living alone are most likely to experience social isolation, those who live in residential care are also at risk, especially if they lack opportunities to participate in the community outside the residential home. Care home residents can be encouraged to develop social connections through contact with local community centres, schools and volunteer organisations. A person-centred approach to activity planning should help to ensure that older people feel that they are valued members of their local communities.
The promotion of social inclusion features prominently in current policy across government departments. The white paper Our Health, Our Care, Our Say acknowledges that social exclusion, isolation and loneliness contribute to the incidence of mental illness, particularly depression. The report emphasises the need for a universal approach to inclusion from services such as transport, health and housing.
The English Longitudinal Study of Ageing looks particularly at social isolation in older people and uses seven measurement criteria to assess the extent to which an older person may be experiencing isolation. These are:
● Social relationships.
● Cultural trips (cinema/theatre/concerts).
● Civic activities (such as being a member of a local interest group, undertaking volunteering or voting).
● Access to basic services (shops and health).
● Neighbourhood exclusion (feeling safe in your local area).
● Financial products (banking, savings).
● Material consumption (being able to afford household utilities and annual holiday).
The Department of Health has established the Dignity Challenge as part of its Dignity in Care campaign. The challenge lays out the national expectations of what constitutes a service that respects dignity and focuses on 10 different aspects of dignity, including social inclusion. A series of “dignity tests” under each of the 10 headings sets standards for meeting the expectations of the Dignity Challenge. The tests can be accessed on Scie’s practice guide.
The involvement of older people at all levels of service planning and delivery is key to social inclusion. Participation will, in itself, provide meaningful activity and a role in the community for those service users who become involved. The inclusion of older people from diverse communities will ensure that they can contribute their own knowledge and expertise and that their needs will not be overlooked. Local authorities need to ensure that support is available to local communities to enable individuals and groups to develop the skills and confidence to facilitate active participation.
Scie’s practice guide has been developed to ensure all people who receive health and social care services are treated with dignity and respect. It will be of interest to people who use services and their carers, as well as those working in social care, because they will be able to find information on what they can expect from services.
The guide has recently been updated to include information for those working in mental health services and mental health service users, following the DH’s extension of its Dignity in Care campaign to cover other groups of vulnerable adults.
● Promote access to social networks for older people.
● Address transport issues that act as barriers to community participation.
● Interlink community projects, community centres and schools to increase levels of intergenerational social contact.
● Identify and respect the skills of older people, including those gained in previous employment.
● Ensure people are given ordinary opportunities to participate in the wider community through person-centred care planning.
Research Abstracts: Age Discrimination
● Practice Guide 9: Dignity in Care
● Practice Guide 11: The participation of adult service users in developing social care
● English Longitudinal Study on Ageing
● Age Concern
● Help the Aged
● Minimum standards for domiciliary care and care homes standards