Social isolation and the perceived importance of in-person care amongst rural older adults with chronic pain: a review and emerging research agenda

Rural older adults with chronic pain may be physically and socially isolated as their pain makes it difficult to interact with others in and outside the home. For some older adults, their only regular in-person interaction may be with health and social care staff who visit them at home. However, there are concerns that the introduction of healthcare technology into the home (i.e. telehealth and telecare) may disrupt this valued opportunity for interaction. The use of such technology forms a key component of ‘extitution’ strategies of care – the opposite of the more traditional institutionalisation – which are being promoted by policy makers as one way of metering the rising cost of caring for our ageing population. The underlying theory is that if older adults are monitored more frequently then any changes in health status could be identified earlier, potentially preventing unnecessary stressful transport and emergency admission to expensive hospital facilities. Despite this, the available evidence indicates that traditional home healthcare technology does not enhance patient well-being overall, and the interruption of face-to-face interaction has been posited as one reason for this. It would seem that an entirely new breed of technology is now required that has patient communication needs at its core. This narrative review paper considers intersections between social isolation, chronic pain, health and social care and technology in order to present an emerging research agenda, with a focus on opportunities for research on chronic pain in rural communities to be undertaken.