The Friendship and Relationship Interactions in the Elderly Networks Description (FRIEND) study

Abstract

People living in long-term residential aged care need supportive relationships and positive interactions. However, current evidence suggests that people with cognitive-functional impairment experience few friendships, negative interactions are common and many residents feel completely isolated. This thesis aims to describe the friendships, social relationships, and personal friendship schema of people living in a Sydney residential aged care facility. The research uses multiple social network analysis methods, including semi-structured interviews, standardised survey assessments, and observations. The thesis explores associations between social networks and self-report measures of perceived social support and adult attachment profiles. It describes staff- and observer-perceptions of residents’ multi-valenced relationships and explores associations between relationship characteristics and engagement and social isolation. The thesis introduces a novel psychosocial method for analysis of observational field note data. The novel method is applied to describe patterns and quality of coresident interactions involving residents with dementia and to identify possible personal and environmental factors that influence interactions. Residents experienced few friendships and many residents had no positive relationships. Most residents perceived little support and felt isolated. Residents’ perceptions of support or isolation and difficulty with relationships may have been influenced by their position within the larger network and by environmental factors including care unit location and lack of staff facilitation. The size and quality of resident networks were correlated with personal attributes including residents’ cognitive and physical capacities and attachment style. Most residents were able to articulate friendship clearly. Their views of friendship had likely changed little upon entering residential care as they applied long-held schema within a dramatically different social context. Despite multiple barriers to relationships, residents with dementia wished to reach-out to coresidents to connect in positive and meaningful ways. Only a few had friendships. Moreover, staff- and observer-report indicated negative relationships were common and interactions that began positively often ended in rejection and disconnection. These results indicate a pressing need for individually tailored interventions and a sharper focus on residents’ social health.