Addressing loneliness in a retirement village community: A pilot test of a print-delivered intervention
Professor Wendy Moyle, Griffith Institute of Health and Medical Research, Griffith University. Email: firstname.lastname@example.org
Aim: To explore perceptions of a self-help print-delivered intervention aimed at encouraging social well-being and addressing loneliness in a retirement village community.
Method: A total of 58 residents of an Australian retirement village received a series of five factsheets addressing various dimensions of loneliness.
Results: The factsheets raised awareness of the importance of social well-being and loneliness. However, the approach was considered difficult to update and was not appropriate for those from a non-English speaking background or with vision impairments. The non-face-to-face approach also was unable to address issues of loneliness associated with bereavement.
Conclusion: This form of intervention offers a cost-effective way to raise awareness of loneliness and social well-being in a retirement village community when issues of updating and presentation of information are taken into consideration.
Over the last five decades, the number of Australians living in age-segregated retirement communities has grown significantly, with this number anticipated to increase threefold by midcentury . Retirement villages have become a popular accommodation option for those seeking independent living with access to amenities, security and health-care support  while increasing social networks and reducing loneliness [3,4]. However, a move into a retirement village can exacerbate loneliness as residents can feel lonely when they move away from former homes, neighbourhoods, friends and extended family .
Although the term loneliness is often used interchangeably with social isolation, the two concepts are distinct in that social isolation is an objective absence in a social network, as opposed to the subjective unpleasant experience of being alone or lonely . People who are socially isolated are not necessarily lonely , just as those who have many social contacts may still experience loneliness .
Addressing loneliness in retirement villages is important not only for the health and well-being of individuals [9,10], but also carries financial implications for health and aged care providers . However, there remains little consensus on how to translate research into practice and the best strategies to reduce loneliness in retirement village settings [12,13]. A mediated intervention is a cost-effective way of distributing health promoting information . Print-delivered material in the form of booklets or pamphlets have been previously used with success to encourage physical health [14,15], help-seeking behaviour  and medication compliance  in older people.
This pilot study drew from findings of a larger study, which investigated perceptions of loneliness through in-depth interviews with older individuals (n= 60) and eight focus groups with service and support providers (n= 75) across Queensland and South Australia. The larger study identified positive and negative aspects of loneliness, which then provided five significant ways of understanding loneliness (Table 1). The pilot explored retirement village residents' perceptions of a self-help print resource developed using the five dimensions of loneliness.
Table 1. Dimensions of understanding loneliness and the factsheets addressing each dimension
|1 Loneliness as relational: influenced by whether older people are able to maintain quality relationships with others.||1 Staying in touch with people and making new friends: contained information on transport, accessing the committee newsletter, village groups, ideas for village events and a neighbourhood watch program.|
|2 Loneliness as connectedness: influenced by whether older people feel like they are connected to the wider community.||2 Connecting to your local community: suggested opportunities to connect with local community groups, events and the benefits of volunteering.|
|3 Loneliness as readjustment: influenced by older peoples' ability to adapt to losses and changes in life.||3 Adjusting to lifestyle changes: aimed at providing information on University of the Third Age, accessing local and village libraries and writing competitions.|
|4 Loneliness as private: it is a personal experience, stigmatised and often kept secret from others.||4 Dealing with the personal side of loneliness: offered educational information on prevalence and characteristics of loneliness and social isolation.|
|5 Loneliness as temporal: influenced by time, be it the time of day or the time of life.||5 Time as a factor in loneliness: outlined information on sleep hygiene, relaxation and time management strategies.|
Setting and participants
The pilot was conducted in one Queensland retirement village, which volunteered to participate after information was sent to several managers. Independent living residents (n= 58, women = 34 and men = 24) were aged between 69 and 91 years, with four residents from a non-English speaking background (7%). All residents were sent a letter informing them of the pilot; and all interviewed residents provided informed consent. The University Human Research Ethics Committee granted ethics approval for the study.
An audiotaped focus group lasting 45 minutes with members of the village residents' committee (n= 7) identified loneliness as a community issue; and the value of the proposed resource can be seen in the following quotation:
There are people we have never met, never seen . . . There are people we identify as being lonely. It's an issue and it's come up, but we've been more tied up in the day-to-day running . . . rather than with this loneliness issue.
The content and layout of the factsheets was then developed in collaboration with the residents' committee during five informal fortnightly meetings. At the end of the 10-week consultation period, the factsheet content was finalised and checked for context specific vocabulary.
The factsheets contained self-help information, education and strategies that specifically aimed to address one of the five dimensions of understanding loneliness (Table 1). Factsheets were colour printed double-sided on A4 paper with a minimum of size 14 font. Factsheets were mailed with a display folder, one a week for five consecutive weeks, to all independent living unit residents (n= 58) with the exception of the first factsheet, which was hand delivered to the participants' residence to enable an explanation of the study.
A resource manual with information supplementary to the brief factsheets was provided to the resident committee members (n= 10) with the intention that residents would use committee members as an additional resource.
Perceptions of piloted resource
One month after the final factsheet distribution, village residents were mailed an invite to provide feedback during two 45-minute focus group sessions, one with resident committee members only (n= 8) and one with independent living residents (n= 14). Those who volunteered to participate were aged between 69 and 91 years; one-third were male (36%) and two were from non-English speaking backgrounds (9%). Perceptions of the format and content of the self-help factsheets and supplementary manual were audiotaped, transcribed verbatim and thematically analysed into two themes. Opinions of the residents' committee and general residents were similar and are therefore presented together.
Theme 1) Relevance of print-delivered approach
Analysis revealed that the factsheets were generally well received and seen as an informative resource that had raised awareness and provided community and individual strategies for addressing loneliness in the village now and in the future:
I think they came as a reminder of what we can do and what we should do and what we normally don't do.
Residents raised certain instances of increased participation in village activities. In particular, residents reportedly used the factsheets to organise a takeout meal eaten as a group in the recreation hall. As one resident recounts:
There seemed to be close to 40 people there, probably about 75% of the village. And we didn't need to have any organised entertainment, because we just entertained ourselves, because we don't all get together regularly.
Committee members felt that they had the capacity to continue distributing the factsheets as part of the orientation of new residents:
I think it will be up to the committee to carry on. I think [the research team's] job will be done . . . [I]t can just be put on the monthly meeting agenda.
Residents reported a lack of information on the role of bereavement in the experience of loneliness, and highlighted a need for information on grief:
. . . also about grief, about the path that you've suffered yourself, . . . also maybe about how we can help each other. A lot of us don't know how to treat each other when somebody goes.
Residents felt that content of the factsheets would be better received if delivered during information or orientation evenings, as this would also offer the opportunity for residents new to the community to meet other residents.
Theme 2) Strengths and weaknesses of print media
Several residents commented that they could not recall reading the factsheets. Many residents felt that, like print material posted by management, factsheets were often left unread in mailboxes, or were discarded and forgotten about.
People see written words and they think ‘oh I'll read that when I've got my glasses’ and it's forgotten.
Other residents said they particularly enjoyed receiving the factsheets in the mail each week rather than in one large bundle:
They came out often enough that you didn't get bored. You wouldn't want the whole lot together . . . one a week was ideal.
Concerns were made about the challenges of keeping factsheets up to date. A small number of residents reported difficulties reading the information because of ailing vision. Furthermore, non-English speaking residents (n= 4) were unable to read the information.
Print-delivered interventions offer a cost-effective way of delivering an intervention to a large group in a brief period of time. Although raising awareness in a cost-effective manner is one of the strengths of the print material approach , the factsheets also enabled organisation of activities and encouraged social participation.
Nonetheless, for print interventions to have successful outcomes, participants must be able to read and understand the material. Ailing vision, cognitive decline associated with dementia, as well as lower literacy and understanding of the English language are all drawbacks of using a print-delivered approach in a retirement community .
Furthermore, print interventions do not allow for complex issues such as bereavement to be addressed, despite evidence of a need in this community group. The impact of desolation on the mental and social well-being of older people is an important, and often overlooked, issue in age-segregated environments where the experience of death and bereavement is common . A more personal approach such as combined phone and mail interventions, or information evenings, would enable further opportunities for residents to get out and meet others.
The print-delivered intervention has the potential to be a sustainable approach to social well-being providing information is updated on a regular basis. To enable a committee led resource, alternatives such as an in-house television channel, or a DVD would allow for factsheets to be more easily and regularly updated.
Although the pilot appears to have highlighted the suitability, sustainability and cost-effectiveness of a print-delivered approach to loneliness, the findings are limited by the small sample size restricted to one Australian retirement village, and the small percentage (38%) of participating residents. It is important to note processes in the pilot that could serve to alleviate loneliness, such as regular contact with researchers and focus groups. Further trials are needed to test the efficacy of print to reduce loneliness in a retirement village. These points considered, the factsheets enabled a self-help resident-directed approach that allowed for a relatively simple intervention to address loneliness and encourage social well-being.
The authors acknowledge the ARC Funded Project: Alone in a Crowd; Supporting Older Australians Managing Loneliness (LP0774983 2007–2010; Stanley M, Moyle W, Ballantyne A, Corliss M and Oxlade D), RSL Care and the retirement village participants.
- • Print-delivered interventions offer a cost-effective way to raise awareness of loneliness and encourage social well-being in retirement communities.
- • It is important to consider readability, outdating of information and the experience of bereavement when developing print-delivered loneliness information.