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Reducing Loneliness and Depression: The Power of Peer Mentoring in Long-term Care

Open AccessPublished:October 17, 2019DOI:https://doi.org/10.1016/j.jamda.2019.08.011
      To the Editor:
      Moving into a long-term care home can be accompanied by negative psychosocial effects. Loneliness and depression are common,
      • Elias S.M.S.
      Prevalence of loneliness, anxiety, and depression among older people living in long-term care: A review.
      and residents complain about superficial social connections in these settings.
      • Knight T.
      • Mellor D.
      Social inclusion of older adults in care: Is it just a question of providing activities?.
      Despite a desire among residents for more purposeful activities, recreational programming provided overall tends toward entertainment and distraction, rather than opportunities for meaningful contributions or connections.
      • Theurer K.
      • Mortenson W.B.
      • Stone R.I.
      • et al.
      The need for a social revolution in residential care.
      Peer mentoring may allow residents to reshape their social worlds in ways that reflect their agency. Peer mentoring is a supportive relationship between 2 individuals who share a common experience or characteristic.
      • Joo J.H.
      • Hwang S.
      • Abu H.
      • Gallo J.J.
      An innovative model of depression care delivery: Peer mentors in collaboration with a mental health professional to relieve depression in older adults.
      Given the success of this approach in other settings,
      • Raymond J.M.
      • Sheppard K.
      Effects of peer mentoring on nursing students' perceived stress, sense of belonging, self-efficacy and loneliness.
      • Cooper K.
      • Schofield P.
      • Klein S.
      • et al.
      Exploring peer-mentoring for community dwelling older adults with chronic low back pain: A qualitative study.
      we developed a peer mentoring program for use in long-term care, called Java Mentorship. The program involved resident and community volunteer mentors who met weekly for a team meeting and education. The program was facilitated by a recreation therapist or volunteer coordinator who used standardized education modules and a training manual. The 26 education modules included learning on how to be a mentor, for example, how to engage passive mentees who did not speak much or how to support someone who was grieving. After each team meeting/education session, resident mentors and community volunteers paired up to visit isolated residents. During mentor visits, emotional support was provided, educational materials were shared, and mentees were encouraged to attend other relevant programs that were offered. This article focuses on the scientific outcomes of a feasibility study on the program implementation in 10 Canadian homes.

      Methods

      We evaluated the program using a mixed-methods, pre-post design. To act as mentors, residents needed to be able to speak English and understand simple instructions. Surrogate decision makers provided consent for resident mentors who were not cognitively competent (n = 9). Outcome data on the resident mentors were collected at baseline and at 3 and 6 months. We assessed depression (primary outcome) using the Geriatric Depression Scale Short Form
      • Sheikh J.I.
      • Yesavage J.A.
      Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version.
      and loneliness using the 6-question UCLA Loneliness Scale.
      • Neto F.
      Psychometric analysis of the short-form UCLA Loneliness Scale (ULS-6) in older adults.
      Purpose in life was assessed by the Life Engagement Test, social identity with the Single-item Measure of Social Identification, and sense of belonging by a psychological subscale of the Sense of Belonging Scale. A post-study survey used open- and closed-ended questions to evaluate mentors' experiences. The study was approved by the university and local institutional research ethics boards.

      Results

      We enrolled 48 resident mentors in 10 of the 13 invited long-term care homes. The intervention was implemented as outlined in the training manual in 8 homes. The mean age of the mentors was 80 years, and 88% were female. At 6 months compared to baseline, we retained 28 mentors and observed significant decreases in the depression and loneliness scores (Table 1).
      Table 1Results of Linear Mixed-Model Analysis
      MeasureLinear Mixed Model (LMM) Results (Baseline vs 6 mo)
      BSEP ValueEffect Size, d
      Geriatric Depression Scale−0.970.49.0480.30
      Loneliness scale−1.660.62<.010.23
      Life Engagement Test−0.650.67.330.14
      Social Identity Measure0.510.43.240.18
      Sense of Belonging Scale3.272.36.170.21
      B, regression model coefficient; SE, standard error.
      Effect size is reported as Cohen d.
      In the post-study surveys, mentors described increases in confidence due to the training provided. They also described some challenges encountered, for example, visiting with less verbal residents. They rated highly the camaraderie and the ease of use of the program materials. The importance of making a difference in the lives of their peers was reflected in their interviews. One mentor described the personal impact of helping others: “It's changed my life. It makes me feel like I am needed.”

      Discussion

      These novel findings suggest the potential of peer mentoring as an approach to improve mental health in long-term care. Although we had issues with retention, which is not surprising given the frailty of this population, the scientific outcomes are promising, especially considering the recalcitrant nature of loneliness and depression in these settings.
      • de Jong Gierveld J.
      • Van Tilburg T.G.
      • Dykstra P.A.
      New ways of theorizing and conducting research in the field of loneliness and social isolation.
      • Snowden J.
      Depression in nursing homes.
      There are several possible explanations for the lack of significant changes in other measures. Given the modest effect sizes, the study may have been underpowered. Alternatively, a longer duration of follow-up may be required to observe changes in these constructs.
      As this was a pre-post study, there are several limitations, including the lack of a control group and a potential Hawthorne effect. Furthermore, in the absence of responsiveness data, we are unable to determine if the changes would be considered clinically significant. Experimental research exploring the role of mentoring in these settings is warranted.

      Conclusions

      To our knowledge, this is the first study to examine the delivery of peer mentoring using a team approach within long-term care homes. In these settings, residents are typically considered passive recipients of care and much time and energy are devoted to coping with illness rather than cultivating strengths. Resident mentoring has the potential to destabilize these practices. Although the concept of offering residents volunteering opportunities is not new, a formal role that includes extensive mentoring education and team support is unique. Developing quality relationships is difficult, despite the available social programs and support from staff. Residents who are lonely may benefit from the meaningful connections made through helping others. Peer mentoring may provide an opportunity for people living in long-term care homes to contribute in a purposeful way and improve their mental health and quality of life.

      Acknowledgments

      A special thank-you to Kaylen Pfisterer, Amy Matharu, Josie d’Avernas and the late Dr Michael Sharratt from the Schlegel-UW Research Institute for Aging, and Melanie James, residents, staff, and volunteers at Schlegel Villages

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