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Housebound Elderly Benefit from Early Social Care Intervention

September 23, 2002

New research shows that older people who have become housebound can benefit from social care services even when they find it hard to acknowledge that they need them. Contact with care services, even when relatively unwelcome, appears to have positive effects on levels of self-esteem and on morale.

Researchers in the 'Growing Older' programme funded by the Economic and Social Research Council suggest that care services managers should intervene as quickly as possible to help people who have recently suffered a decline in their autonomy through ill-health or an accident, such as a fall, rather than delay in order to spend more time matching services to the person. Despite better targeting of home care services on people most in need over the last 10 years, some very frail older people still live on their own with little or no help.

The research found that older people are not always the best judges of their immediate needs. The newly housebound often find it difficult to welcome the help offered. When they do agree, service users may deny, or at least play down, the impact of help. But the evidence in this research points to benefits even where the help is judged less than ideal. Over a six-month period, older people who received services enjoyed higher self-esteem than those who did not. The services can involve using a home help or care assistant, attending at a day centre, or even a move to sheltered housing. A key effect of all these is the making of new contacts and friends.

Some older people reject help because it is not appropriate, in their view, to their needs and circumstances. Some older people feel that residential and nursing homes are not for them but for others who are confused, or without a caring family, and suggest that day care is for a different type of person to themselves. Some suggested that care services are for those too poor to pay for themselves, others said it was too expensive an option.

The research shows that becoming housebound initially leads to sharp falls in self-esteem and confidence. But two thirds of the sample managed to feel better as they adjusted to the change in their situation. They often explained their adjustment in emotional and spiritual terms. The extent of support from their families was an important factor where it was available.

The sample was of 35 people (26 women, nine men). Aged 75 or over, they lived alone in the community, represented a range of incomes and educational backgrounds, faced broadly the same health and social care environment, and had, within the last three months, developed a physical disability which meant they could no longer go out of the house without help. They were followed closely over six months. The people in the sample lived in a partly urban, partly rural area in south east England.

Economic and Social Research Council (ESRC)

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