Reducing social isolation and loneliness

I had the pleasure of chairing the fourth in The Institution of Engineering and Technology’s (IET) series on Healthy Living and Housing.  The focus for this session was on reducing social isolation and loneliness.

You can access the session by clicking the link here and registering to watch on demand.

Speakers for this session included

1. Smriti Kotiyal, Research Assistant, University of Bradford
2. Marianne Wanstall, CEO, The Brendoncare Foundation
3. Heather Claridge, Principal Design Officer, Architecture & Design Scotland

COVID-19 and the role of technology

Smriti began by discussing the significant role that technology, including communication technologies, has played in managing COVID-19.  COVID-19 is often compared to the 1918 Spanish Flu and 2009 H1N1 outbreak. Today we have improved capacity, diagnostic tools and communications. For example, current global internet usage sits at 53.6% compared to 25.8% in 2009. This has very much facilitated improved knowledge sharing and better use of technological advancements.

The use of technology to reduce the spread of COVID-19 has not been without controversy. China is one country that has adopted a fully fledged tech driven approach – with the use of drones, cameras in the streets and mandatory requirements for scanning QR codes when for instance entering a grocery store. India have introduced their own contract tracing App, Aarogya Setu (Health Bridge). The approach in Western countries has been different given data privacy requirements. Such technologies have been important to reducing the spread of infection.

And COVID-19 is having a dramatic impact on psychosocial health. With it, we’re seeing increased anxiety, insomnia and social distress. Communication technologies have played an important role in keeping people connected. And other technologies such as robots have increasingly come into play including

• ElliQ – a personalised companion for the elderly using AI; and
• PARO – a therapeutic robot to give the benefit of animal therapy

The impact of COVID-19 and lockdown has also had a dramatic impact of levels of domestic violence with a reported 22% increase in cases. Smriti was part of a team taking place at an UKBlacktech AI for Good hackathon sponsored by PWC in June 2020. The team won the hackathon with the development of Auxilium – a camouflage App that can be used by victims of domestic violence to help understand what is going on and hear other people’s stories. The App can effectively be ‘hidden’ on a phone, critical for user safety. The team is also aiming to build in psychological support and resources. It can also be used to track users’ moods over time.

In terms of next steps for Auxilium, it is at prototype stage with a focus on research on how to implement and the resources that will be required. Work will begin shortly on how to develop it further.

Addressing social isolation and loneliness is challenge. For Smriti, as an international student she was effectively isolated after March for about 6 months. Communication tools such as FaceTime, WhatsAPP, and Zoom, have been critical for staying in touch with friends and family.

Reducing social isolation and loneliness in care homes and supported environments

Marianne began by outlining the background to Brendoncare. The charity provides care home living, supported care and clubs in the South East of England. Their focus is person-centred care to facilitate independence, and building inclusive communities.

For Marianne, a key challenge is to move away from the type of care home environments where residents are in effect isolated from the rest of community life. This is becoming increasingly important given that in the UK it’s expected that there will be 8 million people more over the age of 65 over the next few decades. It’s also worth noting that the volunteer base is also getting older.

In terms of what we’ve learned over the last six months, Marianne highlighted the following points:

• Face to face contact remains essential for residents’ health and wellbeing;
• For certain groups, for example for some residents living with dementia, the need to isolate and socially distance can be problematic due to a lack of understanding;
• There are significant issues with the wearing of masks and people’s ability to communicate well ie. lack of facial cues; where hearing might be limited etc;
• While there have been some great developments in technology, there remain some gaps, namely lack of wifi and mobile phones for many, no access to tools like online banking and so on;
• Significant issues with training people to use online tools and services when it’s not in person. On the flipside, where there is training and support, there is a high degree of receptiveness to using digital tools; and,
• digital skills are not linked to age and lack of access remains an issue across age groups.

On what works well, Marianne flagged the following:

• Dementia friendly environments are critical in terms of design, colours and so on;
• It’s important to ensure that community living is connected to care; and,
• Technologies that support residents including digital toys such as Paro which is indicative of people still needing physical contact.

However, there remain some real concerns during COVID including:

• Tight restrictions for residents on access to friends and families, particularly for those who are bed bound;
• Speed of adaptations needed within buildings to keep staff and residents safe and well;
• Ventilation and infection control i.e. care homes are warm environments so issues with managing ventilation to reduce the risk of infection;
• Providing safe spaces for staff, for instance to be able to change clothes and put on and take off PPE; and,
• Lack of transport as much of it is not accessible at the moment.

Brendoncare also use acoustic monitoring which is a tool that allows distance monitoring from somebody who may need support. It can be used to identify for instance if someone has had a fall. It is monitoring from a distance. They are also exploring the use of circadian lighting and sensor technologies.

In terms of the future, there’s a real need to build care homes as part of and connected to communities. There’s also a real need for developing built environments that support people with dementia. In terms of technology, Marianne highlighted that not only does it need to be built in and intuitive to use, but we also need to get the balance right with having it in place and personal control. It will also be important to utilise technologies that can collect and analyse data in a way that requires less manual input from staff.

Caring places

Heather discussed the report, A Caring Place, which is part of the town centre living work from Architecture & Design Scotland (ADS). The work focuses on how town centres can be more supportive environments to live in with a particular focus on ageing and the provision of care. The rationale for the work is that we know there’s a major issue around the ageing population. In Scotland, it’s estimated that the population over 75 will increase by 85% over the next 25 years.

In Scotland, there is a government commitment to the Town Centre First Principle which prioritises investment in a network of centres to ensure they support better services and outcomes. More recently in response to COVID-19 has been the inclusion of the concept of the 20 minute city – that everyday facilities are within a 20 minute walk of where people live and can support healthier lives.

In designing for an ageing population, what’s needed is a person centred approach to understand the issues involved. ADS have engaged with experts in policy, people and place, and identified four key things needed for a more caring environment – a sense of place, purpose, support, and worth. Two areas of focus emerged from this work – housing choice including location, and ‘in-between’ spaces which includes the quality of journeys and their interactions.

This work resulted in the development of a set of 10 principles to be used when working on a project. These explore:

• how places work with people;
• how we can make more of our town centres; and
• how can we connect things up to support people.

Heather highlighted a number of the principles.

The first principle focuses on the provision of friendly and accessible transport which is an efficient, cost effective and encourages social interactions. One such example is Cycling Without Age Scotland which connects people interested in cycling with residents in care settings and socially isolated individuals.

Principle 2 involves providing accessible and quality external environments – inclusive spaces and networks that support intergenerational engagement such as barrier free spaces. Principle 3 is digital and physical connectivity. And Principle 5 is developing intelligent systems and designing for the re-purposing and integrating of technology.

To develop a narrative on town planning, ADS use personas to consider people, place and care. They apply the 10 principles to look at specific locations through the lens of the various personas – each with unique needs and wants. The location is then considered in terms of housing, green, community, and transport and digital infrastructure.

COVID-19 has brought into sharp focus many of the issues considered in the report. For Heather, we need to consider town centres if we want to create resilient and mixed communities. Collaboration is key, with technologists and engineers working with planners, town centre managers, users and others. A place led approach is important. It’s also important to understand how places work across time and seasons. Spaces also need to be made pleasurable to be in. Heather’s final point was the importance of examining how we can create caring places that are environmentally sound and can support a green recovery.

Key discussion points on reducing social isolation and loneliness

How has India managed to deal with reducing the impact of COVID-19 when only about half of the population uses mobile phones?

• Digitalization and the use of digital technologies has increased significantly over the last 2 years.
• Improved and effective usage of the mobile phone App and sharing messaging through other communication channels including social media. Much of this would not have been possible a few years ago.

Did the UK government get the balance right in locking down care homes to reduce the spread of COVID-19 in terms of protecting health and the impact on residents’ lives?

• Difficult balance to find
• Continued challenge with social distancing in care settings
• Requirement for rapid testing, testing to be done on a larger scale, and test results to be returned quickly

What needs to be done to improve digital infrastructure in a range of settings?

• Building in technologies to the home so it is not a case of having to seek them out
• Systems that can be personalised for people with different needs and requirements
• Clear identification of plans to address gaps in provision between urban and rural settings
• Integration of digital infrastructure as a co-benefit in planning and development of mixed communities
• Effective knowledge transfer to users to understand what is available

What are the key links to working life? Social isolation and loneliness are not just an issue for older people.

• We need good urban design principles for public spaces and places with a focus on localism. This has been greater attention with COVID-19.
• Technology can play a significant role for those living alone i.e. robot technologies, tech to support memory loss etc
• Understanding the experiences of different people and different levels of need

Final thoughts on building inclusive and connected communities

• Connecting people and places will be key and that we use the space we have intelligently and in a supportive way i.e. how people move around, connect to services in relation to location etc.
• Development of collaborations with people that understand place, engineers, technologists, communities and individuals, carers and so on
• We need to look beyond COVID in terms of planning spaces that reduce social isolation and loneliness
• Continue building digital platforms and systems that support online engagement.

As part of The IET’s series on Responding to COVID-19: Healthy Living and the home

1. Healthy living and housing
2. Community care and care homes
3. Monitoring vulnerable patients and remote diagnostics
4. Reducing social isolation and loneliness
5. Smart home tech to support people’s needs
6. The future of Intelligent homes to support health