title: Models of care for socially isolated older rural carers: barriers and implications.
abstract: BACKGROUND
  In response to population ageing, the numbers of older carers residing in rural areas are increasing. However, rural older carers are at risk of social isolation due to the decreased social networks associated with ageing and caring responsibilities, and the geographical isolation associated with rurality. This broad, systematic review of the literature was undertaken to: (1) identify barriers to social participation for rural older carers; and (2) summarise features of interventions that were effective in reducing social isolation for rural and/or older carers.
  
  
  METHODS
  Literature was obtained through systematic searches of selected electronic databases; selected Australian and international government and research based websites and Google Scholar. Searches were limited to material published from 1999 to 2009, and literature was included which either identified barriers to social participation, or outlined interventions that were effective in reducing social isolation and increasing social support in rural and/or older carers.
  
  
  RESULTS
  67 articles, book chapters and reports identified which addressed the review objectives. Findings indicate that rural older carers experience considerable barriers to socialisation, and six dimensions are identified that are effective in reducing barriers, decreasing social isolation and increasing social participation. Interventions must address individual needs; incorporate a dual carer-care recipient focus and/or an educational component; facilitate informal social interaction; utilise existing networks and experienced personnel; and be both sustainable and long term.
  
  
  CONCLUSIONS
  Reducing social isolation in rural older carers is a two-stage process. First, barriers to attendance, both logistical and perceived, must be addressed, and the focus of the intervention must be relevant to the carer. Second, opportunities for informal social interaction must be maximised within the intervention. However, a secondary focus may be necessary to ensure attendance, and the provision of education is also integral to achieving long-term outcomes. Integration of service providers in an informal capacity is also important in providing long-term support options. Addressing these issues will assist in developing interventions for rural older carers that are both appropriate and sustainable.
authors.affiliation: John Richards Initiative, La Trobe University, Wodonga, Victoria, Australia. r.winterton@latrobe.edu.au
authors.forename: R
authors.initials: R
authors.lastname: Winterton
authors.forename: J
authors.initials: J
authors.lastname: Warburton
mesh_terms: D000368:Aged; D017028:Caregivers / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D012934:Social Isolation; D058992:Social Participation; D012944:Social Support