XXVth ESRS Congress
1
29 July – 1 August 2013 in Florence, Italy
Personal and social interaction amongst the
older rural population with chronic pain: can
ICT support resilience?
Lorna Philip, Anne Roberts, Margaret Currie and Alasdair Mort 1
Abstract – Demographic ageing is pronounced in rural
areas, creating considerable challenges for the delivery of health and social care services. New and existing technologies are already playing a role in the
delivery of health and social care services. Could
technology supplement (or even replace) the need for
home visits for older rural residents suffering from
chronic medical conditions? This paper will illustrate
the importance of in-person care, and highlight the
benefits of home visits. Patients and care professionals believe in-person care promotes the general wellbeing of older people with chronic pain. Although
technology cannot replace all in-person interaction,
our findings suggest that there are ways in which it
may provide opportunities to sustain and enhance
these interactions which are often made challenging
by the experience of chronic pain.1
INTRODUCTION
Demographic ageing is a worldwide phenomenon. By
2083 about 1 in 3 people in the UK are likely to be
aged 60+ (ONS, 2009). Most older adults live active,
independent lives but demographic ageing is increasing the absolute number of older adults requiring health and social care services. Age UK (2013:
6) noted "An estimated 4 million older people in the
UK (36% of people aged 65-74 and 47% of those
aged 75+) have a limiting longstanding illness". It is
reasonable to infer that a considerable proportion of
these 4 million will make regular demands upon
health and social care services.
Across Europe many rural areas have older demographic profiles than urban areas and are forecast
to age faster in the foreseeable future (Philip et al,
2012). To cater for an ageing population public sector service delivery in rural areas must overcome
challenging demographic and settlement characteristics (low population numbers and density, limited
public transport and distance from major service
centres) and, in the case of specialist services such
as health care, the additional challenges of attracting
and retaining suitably qualified staff (Wilson et al,
2009; Cleland et al 2012).
Chronic pain (continuous, long-term pain lasting
for more than 12 weeks) is estimated to affect 14%
of the UK population (Health Improvement Scotland,
1 Lorna Philip, Department of Geography and Environment, University
of Aberdeen, Scotland, UK (l.philip@abdn.ac.uk)
Anne Roberts and Alasdair Mort, Centre for Rural Health, University of Aberdeen, Scotland, UK (a.roberts@abdn.ac.uk)
Mags Currie James Hutton Institute, Scotland, UK
(Margaret.Currie@jhi.ac.uk).
2012): the prevalence increases with age. It affects
physical and psychological health, is associated with
increased social isolation (Clarke and Iphofen, 2008)
and the incidence is reportedly higher in rural than
urban areas (Hoffman et al, 2002).
Maintaining social networks and promoting social
interaction is important for active ageing. The social
networks of older adults tend to contract with age
(Lansford et al, 1998) and older people can experience loneliness and depression, particularly if friends
and families live at a distance (Gierveld, 1998). The
dispersed settlement structure of many rural communities, accessibility challenges and long-term
migration trends (close family members may no
longer live nearby) could increase the likelihood of
older rural adults having small social networks, in
particular small numbers in a social network that are
seen, in-person, on a regular basis. This situation
will be exacerbated for older rural adults living with
chronic pain whose ability to get out and about and
to maintain social contact is impeded by their medical condition. For many older rural adults with
chronic pain the only regular in-person social interaction they have is with a health or social care provider.
Information and Communication Technology (ICT)
developments in health have been posited as offering innovative and potentially cheaper means of
delivering a range of health and social care services
(e.g. UK Government’s 3millionlives initiative). They
may lead to in-person contact between older adults
and health and social care providers being reduced.
THE TOPS PROJECT
Intersections between social isolation, chronic pain,
health and social care and new technology are the
context for the TOPS project which seeks to examine
interaction between older people and their health
and social care providers and which considers how
technology could play a part in enhancing the life
experiences of older people with chronic pain living
in rural areas. Findings from one work stream are
presented below.
METHODOLOGY
In-person home visit observations and semistructured interviews with older adults and their
health or social care provider were undertaken in a
remote island location in Scotland. Inclusion criteria
for the study are that participants should be aged
XXVth ESRS Congress
2
29 July – 1 August 2013 in Florence, Italy
60-79, experience chronic pain, receive regular
home visits from health and/or or social care staff,
live in a remote rural location and not be users of
telehealth technology to manage their pain. With
NHS ethical approval participants were recruited
through GP Practice Managers and the Community
Nursing and Social Care Teams. 6 home visits were
observed and 7 older adults and 5 professionals
were interviewed. Three research questions structured the qualitative data collection. RQ1. What
types of interaction may be observed between older
adults with chronic pain and their health and social
care providers during home visits?; RQ2. what aspects of personal and social interaction do rural older
adults with chronic pain value?; and RQ3. how might
technology have a role to play in future delivery of
health and social care services?
KEY FINDINGS
Various professional activities were undertaken during home visits but we also observed polite social
interaction, exchanges of gossip and verbal and
physical expressions of compassion and companionship. The health or care provider was the only person seen by the older adult that day apart from a
spouse / family member. The home visit thus encompasses an element of social opportunity, very
important when socialising with friends can often be
limited due to degree of mobility, levels of pain or
tiredness. Professionals coming to the home bring
news of the outside world and allow older adults to
retain feelings of connection with and belonging to
their community. Professionals also monitor the
older adult's condition and are able to spot deterioration or improvements in health and adapt the care
provided accordingly. Some older adults were using
ICT at home (e.g. email, Skype), but were not using
it to manage their chronic pain. Although receptive
to the idea of using ICT to both maintain and sustain
social connections and to make use of telecare and
telehealth technologies, ergonomic challenges older
patients can have with using ICT were identified.
These included difficulties holding a device, typing or
using a mouse or tracker pad. Impaired hearing or
vision, which may mean the software through which
a service is delivered is unsuitable, are further challenges. The cost of devices such as laptops or tablets means ICT is off-putting to some older adults
and rural broadband infrastructure issues (low speed
and unreliable services) must be overcome.
CONCLUSIONS
The interactions between older adults with chronic
pain and their health and social care professionals
during home visits are a powerful tool for maintaining feelings of social connection with the wider
community. Home visits contribute to wider wellbeing: they provide social opportunities which are
valued by patients whose opportunities to socialise
can be limited due to pain, tiredness and shortened
concentration spans.
All participants had limited pain management options available. The nearest pain management clinic
was a 3 hour journey away. There is scope for technology to contribute to a flexible approach to pain
management in the home. Physiotherapy services,
pain clinics and self-management courses (cognitive
behavioural therapy) could be offered remotely but
the delivery method must take into account the
ergonomic and other practical needs of older rural
adults.
Our findings suggest that older rural adults with
chronic pain and their health and social care providers are receptive to the use of ICT as part of an
overall care package but the well-being aspects of
in-person care mean that ICT should not replace inperson care in service delivery restructuring.
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ACKNOWLEDGEMENT
The TOPS project is supported by an award made by
the RCUK Digital Economy programme to the
dot.rural Digital Economy Hub, award reference
EP/G066051/1.