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

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.