Dementia Care

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Vol 5 No 5 October/November 2016 Australian Journal of Dementia Care 53
had dementia. It found that a person’s
network (excluding staff) typically
consisted of two women – the person’s
daughters or friends – who visited once
per month (Parmenter 2012).
Additional findings included that the
longer a person lived in care the less
frequent were the visits; people with
more cognitive and physical problems
had fewer social relationships; and
people who lived in care longer were
more likely to have severe dementia.
Similarly, a Hong Kong study
discovered that on average, long-term
care residents had a network of 2.6
people (including staff), most of whom
were women. Frequency of visiting for
non-staff network members was less than
once a month (Cheng 2009). In both
studies, some residents did not have
anyone in their network.
Dutch researchers discovered that
when nursing staff had a connection to a
resident’s family member, friend, or
acquaintance, then staff treated other
people residing in the home with greater
respect, felt more comfortable with them,
and began friendly conversations more
frequently with them (van Beek et al
2013).
Where an external connection existed,
a staff member was more likely to treat
all people residing in the unit better, not
just the person with whom the external
connection existed. The Dutch
researchers proposed that improvements
in care may have been due to these
outside social contacts providing
information, enhancing trust and
providing opportunities for better
control of the person’s care.
Social relationships
between residents
The FRIEND study used SNA to explore
friendships and positive relationships
between residents in a Sydney long-term
care home (see Figures 1 and 2 for
examples of data from this study). These
residents were asked to identify the
people in their care unit with whom they
had friendships and to rate how strong
these relationships were. Residents also
completed surveys assessing how
socially supported they felt (Casey et al
2015).
The size of residents’ networks varied,
ranging from 0 to 18 other residents.
However, these relationships were rarely
‘interconnected’ (shared in common).
The average size of a resident’s care unit
‘network’ was one person, or nil. Less
than a third of interviewed residents
identified other residents as their friend
and over a third of residents were
‘isolates’, ie they said they had no
relationships and they were not named
by anyone else. Residents felt socially
isolated generally, but those who had
mutual friendships with other residents
felt more socially supported (Casey et al
2015).
What we have learnt
A systematic review of SNA research that
involved people with dementia in care
identified that residents in these studies
formed connections with other residents,
staff and visitors during their time in
care. These connections were part of the
larger care home network that offered
support and benefit to residents and
staff, or created constraints.
However, residents’ minimal social
connections placed them at risk of social
isolation, and some residents had no
social connections. On the other hand,
connections between staff and residents’
family and friends, and the flow of
information and trust through their
network, were suggested to have
improved care outcomes.
The results of network analyses of
between-resident relationships in the
Sydney long-term care home indicated
that residents felt they had few positive
relationships with other residents and
true friendships were rare. Many
residents had no positive connections
with the people they lived with every
day. Yet, friendships and positive
relationships did exist and residents who
had mutual relationships benefitted
through feeling more socially supported
(Casey et al 2015).
Implications for practice
The results of our SNA research to date
into residents’ social-professional
networks and relationships between
residents in long-term care – from both
the FRIEND study and multiple
international studies identified in the
SOCIAL literature review – provide
additional insights into the patterns and
importance of human relationships in
everyday practice. Our evidence
highlights the lack of social
connectedness in care and indicates that
care-based social networks are associated
with the social health and well-being of
people with dementia.
Since maintaining positive social
connections and feeling socially
supported are associated with better
mental and physical health, the findings
that people with dementia in residential
care have so few positive connections
and experience profound social isolation
are truly concerning. Residents are
surrounded by people yet feel they live
in a social desert, disconnected from
others.
Appropriate application of evidence-
based interventions to improve social
interactions requires knowledge of
residents’ preferences and assessment of
their individual needs, capacities, and
social experiences in care (Abbott et al
2016; Adams & Blieszner 2015).
Staff can help residents by creating
oases of supportive connections. This
may be done through fostering positive
social interactions among residents’ who
have difficulty doing so themselves, and
reaching out to residents and their
visitors to learn more about the unique
person living in care.
References
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Measuring social integration among residents
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Bradshaw SA, Playford ED, Riazi A (2012) Living
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The Gerontologist 00(00) 1-13. Available at:
DCRC SPEC I AL I SSUE : THE B I G P I CTURE I N DEMENT I A RESEARCH
Residents are
surrounded by
people yet feel they
live in a social desert,
disconnected
from others