
Supporting older people’s social inclusion and access to care
Written by Dr Grace Krause and edited by Dr Kat Deerfield and Dr Flossie Caerwynt
August 2025
It can be hard for older people in Wales to access the right kind of support. Some older people face different types of exclusion that stop them fully participating in society. This evidence summary looks at what social exclusion in older life looks like and how services can adapt to address these challenges.
Introduction
Older people in Wales often struggle to access the right kind of support (Age Cymru, 2024). Like other parts of the UK, Wales has an ageing society. By 2038, it’s likely that one in four people in Wales will be over 65 (Welsh Government, 2021). There are other changes to the way we live that may affect older people’s needs, now and in the future. For example, more people are living alone, including more older people, and more older people are becoming unpaid carers (Welsh Government, 2021).
We asked social care staff what would help support their work with older people. One thing they asked for was more research on how services can help reduce social isolation for older people and their carers.
People working in social care also told us that there were multiple barriers to older people accessing support. They said that it was hard to avoid gaps in care for older people, especially when they were being discharged from hospital. They said this was because services are not always joined up. They also told us that they were concerned that older people do not always get the right level of support early on, and that people with complex needs often struggle to get all the support they need.
This evidence summary looks at two specific ways people are working to address these issues: joined up working between health and social care and social prescribing. Social prescribing helps connect people to support that’s available within their communities. We look at what the research says about the effectiveness of both approaches and how they can be used to improve well-being in later life.

Exclusion in later life
Many older people face exclusion from different areas of life. Walsh et al. (2021) describe five different ways that older people are often excluded from society. In this section, we discuss these five forms of exclusion, and we’ve also added digital exclusion as an additional theme.
Social exclusion
Research on social exclusion focuses on how a lack or loss of social relationships can negatively impact on many areas of a person’s life.
A lack of social relationships leads to people being disconnected from the social support that they need. Relationships are valuable for general well-being, as well as for the practical support that other people can provide (Burholt and Aartse, 2021). People who are socially excluded also often lack opportunities to participate in society. For example, they may be excluded from taking part in hobbies, political activities, and volunteering or paid work. This means they’re even further isolated from the world around them (Walsh et al., 2021). In the UK, there are also strong links between social exclusion and economic exclusion (Van Regenmortel et al., 2021).
Economic exclusion
Many older people struggle financially. Data from 2024 shows 16 per cent of pensioners in Wales were living in poverty (Welsh Government, 2025). Older people who are single are more likely than couples to live in poverty. In 2022, 24 per cent of single older people were living in poverty, compared to 14 per cent of couples (Older People’s Commissioner for Wales, 2023). Statistics available for the rest of the UK also tell us that older people from some communities may have much higher rates of poverty. For example, in England, more than 40 per cent of people over 50 of Pakistani background live in poverty (Centre for Ageing Better, 2024). The cost of living crisis has also had a significant impact on pensioners. Between 2021 and 2024, consumer goods became 21 per cent more expensive, but pensions have not increased in line with inflation (Centre for Ageing Better, 2025).
Services
Older people sometimes struggle to access the services they need, like health and social care services, transport, and communication technologies (Draulans, 2021). Research shows that several things can form barriers to accessing services. These include (Srakar et al., 2015):
- geographic location (for example, remote or rural areas)
- for-profit care models
- poverty
- one size fits all services that do not take individuals’ needs into account.
Older LGBTQ+ people, older people from Black and minority ethnic backgrounds, and disabled older people especially struggle to access services when the services are not made accessible to these groups. More information on how to make services more accessible to LGBTQ+ people can be found in our evidence summary on supporting older LGBTQ+ people in social care.

Community and spatial exclusion
As it gets harder for older people to get around, they can face more isolation from their community. The accessibility of the built environment around people makes a difference, as does having access to community spaces. Accessibility of the built environment includes resources that are within a comfortable walking distance. For example, accessible public toilets or benches on walking routes (Tournier and Vidovićová, 2021).
There are specific challenges in understanding the support needs of people living in minority ethnic communities. Burholt et al. (2018) note that measures that are used to assess support needs and isolation in majority populations might not work as well on people with varied cultural backgrounds. In particular, they note that some minority ethnic communities tend to be more focused on the collective and on families. This means that support networks will look different and support needs might also look different. This might lead to minority communities receiving inadequate support due to stereotypes about communities “providing for their own” (Burholt et al., 2018).
Civic exclusion
Many older people experience civic exclusion. This means they are often shut off from opportunities to impact or make decisions in their communities and other forms of civic engagement. Civic engagement includes any kind of activity that is focused on working towards a common good. This can mean things like volunteering or engagement in politics and activism (Torres, 2021).
Digital exclusion
Older people are less likely to be able to access the internet or digital resources with confidence than younger people. This leads to difficulties accessing some services and activities. Digital exclusion is linked to other forms of social exclusion, particularly poverty (Bucelli and McKnight, 2022).
Interventions to address digital exclusion were reviewed by Public Health Wales and the Health and Care Research Wales Evidence Centre (Wale et al., 2024). Their broad findings were that overall, older people who took part in interventions were positive about their involvement. However, they did not become significantly more comfortable engaging in online activities. The authors argued that there’s some indication that training can make older people more comfortable with digital technologies. However, the best way to make sure that older people aren’t negatively impacted by digital exclusion is to make sure that people can access everything they need without relying on digital technology (Wale et al., 2024).

The best way to make sure that older people aren’t negatively impacted by digital exclusion is to make sure they can access everything they need without relying on digital technology
These different types of exclusion are all connected, and often older people will be affected by more than one. Economic exclusion, for example, will make it much harder to access services or take part in social events. Living somewhere with poor transport links or without accessible transport makes it harder to access most things.
Social care plays an important role in supporting inclusion for older people. Social care itself provides important services for people and can also help with access to other parts of life including facilitating social connections, supporting access to transport and leisure activities, and helping people to stay in work with the right kind of support.

As people age, they may need to draw on different kinds of support at the same time. The connection between different services plays a vital role in improving care

Joining up logistics
Different cultures and processes can also be a challenge when information systems and administrative procedures are different. While the logistics of sharing information across different systems can be an obstacle, working actively to improve communication can help make joint working more successful (Cameron et al., 2014). Llewellyn et al. (2018) emphasise the importance of looking at the practicalities of joining up care. They found that agreeing on what the best way to communicate is and building trust in the long term played an important role in enabling positive collaboration.
Effective data sharing is one vital aspect of successful collaboration. A review of 24 studies on data sharing between health and social care for older people found that it was important for (de Bell et al., 2024):
- assessing people’s needs
- coordinating the different services a person may need
- supporting people moving from hospital to home
- coordinating care for people living in care homes
- making sure people have good end-of-life care.
The review found that trust was essential for good data sharing, while mistrust between different professionals made data sharing more difficult. They also found that data sharing worked better when there were appropriate policies and procedures in place that meant that everyone could navigate the system effectively. In order to be able to share relevant information, it was helpful for professionals to understand what others needed the data for, highlighting the importance of clear communication (de Bell et al., 2024).

Social prescribing can help older people tackle the challenges of social exclusion. It can include things like helping with travel, access to groups and activities, and confidence building
How does social prescribing work in Wales?
Social prescribing takes different forms across Wales. Researchers charting the different forms of social prescribing across Wales found that in 2021, over 25,000 people used social prescribing (Wallace et al., 2021). The study showed that the term 'social prescribing':
- was used to mean different kinds of work or activity
- was delivered by people with diverse levels of expertise
- involved support for varied groups of people.
This research showed that social prescribers mostly worked for third sector organisations, with some sitting within local authorities or GP practices.

Wallace et al. (2021) also found that social prescribing organisations in Wales had a strong focus on offering holistic, person-centred approaches. Those working in social prescribing saw their role as more than just signposting to support. Rather, they viewed their work as building relationships with people and connecting them to a wide range of local services and networks.
The people accessing social prescribing in the study also described feeling more connected to their communities. Finding confidence to connect with others helped many to get out more. They also reported finding more spaces to talk about their mental health.
The positive effects of using social connectors to combat loneliness in older people also comes out in an evaluation of a project run by Age Cymru Gwynedd and Môn in Anglesey. The project Cadwyn Môn, worked with people on a one-to-one basis to increase their social contacts and connections (Roberts and Windle, 2020). Through the project, people accessing the service were matched with volunteers who supported them to identify their goals and take part in community groups.
Researchers analysed survey responses from 120 people who had completed the programme and found that people reported significant improvements to both their mental health and their quality of life. They reported feeling happier and more confident and having a better outlook on life. They also reported improved physical health and mobility, using public transport more, making new friends or re-kindling old friendships, taking up new hobbies, and learning new skills.

Helping older people connect with their communities can be powerful, but it doesn't replace the need for adequate funding for social care and health services
These approaches also focus on relationships or other resources people already have, including people’s skills and abilities to form new social connections. While those things can be truly transformative for people, Daly and Westwood (2018) note that they cannot be a replacement for looking at people’s material resources. The researchers also raise concerns that asset-based approaches might not work as well for older people who live in poorer areas. While getting better connected to existing resources might offer a lot to people from more affluent areas, it might offer significantly less for people in areas that have been historically disadvantaged. This might also affect people with particularly poor health or with higher support needs. They might not be able to access resources if there isn’t funding to give them personalised support.
Wallace et al. (2021) similarly describe issues around capacity and expertise. They find that the boom in social prescribing has led to many new jobs being created, but that these are often fixed-term contracts with relatively low salaries. The people they talked to also described concerns around resources and the sustainability of programmes.
These concerns are important to keep in mind when supporting older people to access services. Empowering people to connect to their communities and draw on the resources around them can be powerful. However, it’s important to recognise that this is not the right approach for everyone and does not replace the need for adequate funding of social care and health services.
Conclusion
Everyone in Wales deserves to access the support they need to age well. Sometimes there are barriers that lead to unequal access. This evidence summary has presented research around two ways to address social exclusion and difficulties accessing services. It can be easier for people to access the care they need when health and social care services are able to work together effectively. Social inclusion is also an important part of making sure older people can access the right support, and social prescribing can be one way of working toward that goal.
Additional reading
Here’s a list of the five most relevant resources to supporting older people’s social inclusion and access to care that are either open access or freely available on the NHS Wales e-Library.
- Daly, M. and Westwood, S. (2018) ‘Asset-based approaches, older people and social care: an analysis and critique’, Ageing and Society, 38 (6), pp. 1087-1099, doi:10.1017/S0144686X17000071, available at https://doi.org/10.1017/S0144686X17000071.
- Giebel, C., Hassan, S., Harvey, G., Devitt, C., Harper, L. and Simmill-Binning, C. (2022) ‘Enabling middle-aged and older adults accessing community services to reduce social isolation: Community Connectors’, Health and Social Care in the Community, 30, pp. e461-e468, doi:10.1111/hsc.13228, available at https://doi.org/10.1111/hsc.13228.
- Llewellyn, M., Garthwaite, T., Blackmore, H. and McDonald, M. (2018) ‘Working for a shared common purpose - experiences of health and social care integration in Wales’, UNISON Cymru Wales, available at https://uswvarious1.blob.core.windows.net/uswvarious-prod-uploads/documents/UNISON_-_HSC_Integration_Report.pdf.
- Milne, A., Sullivan, M.P., Tanner, D., Richards, S., Ray, M., Lloyd, L., Beech, C. and Phillips, J. (2014) Social work with older people: a vision for the future, The College of Social Work, available at http://www.cpa.org.uk/cpa-lga-evidence/College_of_Social_Work/Milneetal(2014)-Socialworkwitholderpeople-avisionforthefuture.pdf.
- Wallace, C., Davies, M., Elliott, M., Llewellyn, M., Randall, H., Owens, J., Phillips, J., Teichner, L., Sullivan, S., Hannah, V., Jenkins, B. and Jesurasa, A. (2021) ‘Understanding social prescribing in Wales: a mixed methods study’, Wales School for Social Prescribing Research (WSSPR), PRIME Centre Wales, Data Cymru, Public Health Wales, available at https://www.wsspr.wales/ws/media-library/269583bea8a143e18a9d0ae85fdb4314/phw_sp_report_final.pdf.
Reference list -
Age Cymru (2024) Why are we still waiting? Delays in social care in Wales, available at https://www.agecymru.wales/siteassets/documents/why-are-we-still-waiting/why-are-we-still-waiting.pdf (accessed: 7 July 2025).
Asthana, S. and Halliday, J. (2003) ‘Intermediate care: its place in a whole-systems approach’, Journal of Integrated Care, 11 (6), pp. 15-24, doi:10.1108/14769018200300054.
Banerjee, S., Willis, R., Matthews, D., Contell, F., Chan, J. and Murray, J. (2007) ‘Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon memory service model’, International Journal of Geriatric Psychiatry, 22 (8), pp. 782–788, doi:10.1002/gps.1741.
Bucelli, I. and McKnight, A. (2022) ‘Poverty and social exclusion: review of international evidence on digital exclusion’, Wales Centre for Public Policy, available at https://www.wcpp.org.uk/wp-content/uploads/2022/09/211025-WCPP-Poverty-Review-Digital-exclusion.pdf (accessed: 4 April 2025).
Burholt, V. and Aartse, M. ‘Introduction: Framing Exclusion from Social Relations’, in Walsh, K., Scharf, T. Van Regenmortel, S. and Wanka, A. (eds.) (2021) Social Exclusion in Later Life: Interdisciplinary and Policy Perspectives, Cham, Springer International Publishing, pp. 77-82.
Burholt, V., Dobbs, C. and Victor, C. (2018) ‘Social support networks of older migrants in England and Wales: the role of collectivist culture’, Ageing & Society, 38, pp. 1453-1477, doi:10.1017/S0144686X17000034.
Cameron, A., Lart, R., Bostock, L. and Coomber, C. (2014) ‘Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature’, Health and Social Care in the Community, 22 (3), pp. 225-233, doi:10.1111/hsc.12057.
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Clarkson, P., Brand, C., Hughes, J. and Challis, D. (2011) ‘Integrating assessments of older people: examining evidence and impact from a randomised controlled trial’, Age and Ageing, 40 (3), pp. 388-391, doi:10.1093/ageing/afr015.
Daly, M. and Westwood, S. (2018) ‘Asset-based approaches, older people and social care: an analysis and critique’, Ageing and Society 38 (6), pp. 1087-1099, doi:10.1017/S0144686X17000071.
de Bell, S., Zhelev, Z., Bethel, A., Thompson Coon, J. and Anderson, R. (2024) ‘Factors influencing effective data sharing between health care and social care regarding the care of older people: a qualitative evidence synthesis’, Health and Social Care Delivery Research,12 (12), pp. 1-87, doi:10.3310/TTWG4738.
Draulans, V. and Lamura, G. ‘Introduction: Framing Exclusion from Services’, in Walsh, K., Scharf, T. Van Regenmortel, S. and Wanka, A. (eds.) (2021) Social Exclusion in Later Life: Interdisciplinary and Policy Perspectives, Cham, Springer International Publishing, pp. 135-140.
Giebel, C., Hassan, S., Harvey, G., Devitt, C., Harper, L. and Simmill-Binning, C. (2022) ‘Enabling middle-aged and older adults accessing community services to reduce social isolation: Community Connectors’, Health and Social Care in the Community, 30, e461–e468, doi:10.1111/hsc.13228.
Glasby, J., Martin, G., and Regen, E. (2008) ‘Older people and the relationship between hospital services and intermediate care: results from a national evaluation’, Journal of Interprofessional Care, 22(6), pp. 639-649, doi:10.1080/13561820802309729.
Llewellyn, M., Garthwaite, T., Blackmore, H. and McDonald, M. (2018) ‘Working for a shared common purpose - experiences of health and social care integration in Wales’, UNISON Cymru Wales, available at https://uswvarious1.blob.core.windows.net/uswvarious-prod-uploads/documents/UNISON_-_HSC_Integration_Report.pdf (accessed: 3 February 2025).
Melin Emilsson, U., Strid, A.L. and Söderberg, M. (2022) ‘Lack of Coordination between Health Care and Social Care in Multi-Professional Teamwork - the Obstacle for Coherent Care of Older People Suffering from Multi-Morbidity’, Journal of Population Ageing, 15, pp. 319–335, doi:10.1007/s12062-020-09300-8.
Milne, A., Sullivan, M.P., Tanner, D., Richards, S., Ray, M., Lloyd, L., Beech, C. and Phillips, J. (2014) Social work with older people: a vision for the future, The College of Social Work, available at http://www.cpa.org.uk/cpa-lga-evidence/College_of_Social_Work/Milneetal(2014)-Socialworkwitholderpeople-avisionforthefuture.pdf (accessed: 11 July 2025).
Older People’s Commissioner for Wales (2023) Understanding Wales’ ageing population: key statistics, available at https://olderpeople.wales/wp-content/uploads/2023/01/221222-Understanding-Wales-ageing-population-24-November.pdf (accessed: 7 July 2025).
Roberts, J.R. and Windle, G. (2020) ‘Evaluation of an intervention targeting loneliness and isolation for older people in North Wales’, Perspectives in Public Health, 140 (3), pp. 153-161, doi:10.1177/1757913919868752.
Rothera, I., Jones, R., Harwood, R., Avery, A.J., Fisher, K., James, V., Shaw, I. and Waite, J. (2008) ‘An evaluation of a specialist multiagency home support service for older people with dementia using qualitative methods’, International Journal of Geriatric Psychiatry, 23 (1), pp. 65–72.
Srakar, A., Hrast, M.F., Hlebec, V. and Majcen, B. ‘Social exclusion, welfare regime and unmet long-term care need: Evidence from SHARE’, in Börsch-Supan, A, Kneip, T., Litwin, H., Myck, M. and Weber, G. (eds.) (2015) Ageing in Europe: Supporting policies for an inclusive society, Berlin, de Gruyter, pp. 189-198.
Torres, S. ‘Introduction: Framing Social Exclusion’, in Walsh, K., Scharf, T. Van Regenmortel, S. and Wanka, A. (eds.) (2021) Social Exclusion in Later Life: Interdisciplinary and Policy Perspectives, Cham, Springer International Publishing, pp. 239-243.
Tournier, I. and Vidovićová, A. ‘Introduction: Framing Community and Spatial Exclusion’, in Walsh, K., Scharf, T. Van Regenmortel, S. and Wanka, A. (eds.) (2021) Social Exclusion in Later Life: Interdisciplinary and Policy Perspectives, Cham, Springer International Publishing, pp. 185-192.
Van Regenmortel, S., Winter, B., Thelin, A., Burholt, V. and De Donder, L. (2021) ‘Exclusion from Social Relations Among Older People in Rural Britain and Belgium: A Cross-National Exploration Taking a Life-Course and Multilevel Perspective’, in Walsh, K., Scharf, T. Van Regenmortel, S. and Wanka, A. (eds.) (2021) Social Exclusion in Later Life: Interdisciplinary and Policy Perspectives, Cham, Springer International Publishing, pp. 83 -98.
Wale, A., Everitt, J., Ayres, T., Okolie, C., Morgan, H., Shaw, H., Tudor Edwards, R., Davies, J., Lewis, R., Cooper, A. and Edwards, A. (2024) ‘A rapid review of the effectiveness of interventions for addressing digital exclusion in older adults’, Public Health Wales, doi:10.1101/2024.03.21.24304670.
Wallace, C., Davies, M., Elliott, M., Llewellyn, M., Randall, H., Owens, J., Phillips, J., Teichner, L., Sullivan, S., Hannah, V., Jenkins, B. and Jesurasa, A. (2021) ‘Understanding social prescribing in Wales: a mixed methods study’, Wales School for Social Prescribing Research (WSSPR), PRIME Centre Wales, Data Cymru, Public Health Wales, available at https://www.wsspr.wales/ws/media-library/269583bea8a143e18a9d0ae85fdb4314/phw_sp_report_final.pdf (accessed: 4 April 2025).
Walsh, K., Scharf, T., Van Regenmortel, S. and Wanka, A., ‘The Intersection of Ageing and Social Exclusion’, in Walsh, K., Scharf, T. Van Regenmortel, S. and Wanka, A. (eds.) (2021) Social Exclusion in Later Life: Interdisciplinary and Policy Perspectives, Cham, Springer International Publishing, pp. 3-21.
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