Social Isolation in the Older Adult

Social Isolation in the Elderly

Introduction

When considering community health nursing, the nurse is responsible for addressing multiple issues and concerns of the population at risk (PAR). The nurse must consider multiple facets of the community including the individual, the environment, the availability of education to the PAR, religion, communication, and social problems among other areas.

The PAR the writer will focus on is the older adult, male or female, 75 years and older, living in a residential facility who is at risk for social isolation. According to Alspach (2013), social isolation is a continual lack of sense of belonging, as well as the individual lacking social engagement with others, having very little social contacts, and lacking fulfilling and meaningful relationships with family and friends. Landeiro, Barrows, Nuttall-Munson, Gray, and Leal (2016), reported that up to 50% of those aged over 60 are at risk for social isolation and one-third of the older adult population will experience some level of loneliness (pg. 1).

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The older adult population is growing substantially and will continue to do so over time. As the population ages, more people will experience physical and cognitive changes that could result in detrimental results (Crewdson, 2016). The PAR affected by physical and cognitive changes transition to residential living facilities either by choice or by encouragement from family (Singer, 2018). The transitioning older adult may begin to experience social isolation and loneliness early on or as time goes by.

The PAR being addressed is at risk for social isolation related to the physical and cognitive changes that occur. Older adults may isolate themselves after transitioning to residential living facilities because the older adult does not know anyone and may be unsure of the new living environment. Many health conditions, including but not limited to, hearing loss, cognitive impairment, mood disorders, and vision problems contribute to social isolation (Dury, 2014). The ability of the community health nurse to implement interventions to prevent social isolation is imperative to the overall wellbeing and quality of life to the older adult living in the residential living facility.

Community Assessment

The geography of the PAR is in a residential living facility in Saint Clair Shores (SCS) Michigan. The facility provides services to older adults with a medical diagnosis of a cognitive impairment including Alzheimer’s disease and dementia. The older adults vary from ages 70 years to 99 years old, male and female.  In 2018, the United States Census Bureau (USCB) reported the PAR made up 19.9% of the census for the city (USCB, 2018). The facility currently houses 22 older adults in private suites.

The PAR identified is visible in the social setting, some participating in social activities while others are disengaged, experiencing challenging behaviors or are asleep in the common gathering room. The writer observed the most common race among the PAR includes Caucasian females, making up approximately 95% of the facility census, with the remaining five percent consisting of Caucasian males.

During the writer’s observations of the PAR, approximately 50% are observed malnourished and underweight. The individuals in the facility appear clean and appropriately dressed for the occasion. The writer observed 11 individuals in wheelchairs, six individuals with a four-wheel walker, and five individuals ambulating without the use of an assistive device. The facility itself appears clean with minimal staining of the carpet. The private apartments are a studio layout with hardwood flooring and private, handicap accessible bathrooms. The private apartments are clean and clutter free.

The residential living facility is clean and well maintained on the outside as well, with rows of planter boxes containing red roses lined underneath multiple windows. There are a variety of colored tulips lining the walkways to the entrance. The writer also observed clean walkways circling the facility without cracks or lifting cement, flourishing green grass, and statuesque pillars housing marina style light fixtures.

The community around the facility is clean with multiple variations of housing, stores, and parks for recreation. The roads are well maintained, including those in the subdivisions. The streets are also clean and well maintained with multiple members visible in the community. There are three public high schools in the community, as well as three elementary and middle school buildings. The community spans eight miles along Lake St. Clair (SCSMI, 2018).

During the writer’s observation of the community, there are several walk-in clinics, as well as two hospitals within a five-mile radius of the residential living facility, with one hospital east of the facility and the other west of the facility. Inside the facility itself, the PAR is not required to leave for appointments, as the facility maintains an on-site physician and nurse.

The writer attended an event for the community of SCS at a local park, however the writer did not observe members of the PAR from the facility at the above event. Instead, the writer observed members varying from children to middle aged adults laying blankets in the grass under various trees facing the lake. During the writers travel to the event, churches of varying religious preferences, including Christian, Catholic, and Presbyterian, appeared scattered along the main road opposite the lake.

Evidence of the attitude toward health and health care is well hidden. The writer was unable to make observations of advertisements for clinics or health-related events. There is no visible evidence of botanical and herbal medicine shops within the community. The writer does, however, observe one chiropractor practice in the community.

Community – Based Diagnosis

Using the data collected, the writer is able to ascertain the priority community health problems including, the lack of group – based activities that promote socialization and stimulation, the physical changes related to hearing loss and its effects on the individual desire to socialize, the inability to conduct cognitive-behavioral therapy to determine the inward feeling leading to isolation, and the lack in the use of animals to promote socialization and cognitive stimulation in the older adult.

There is an increased risk for social isolation among older adults residing in residential living facilities related to hearing loss, mood disorders, cognitive impairment, and the lack of stimulation as demonstrated by high rates of depression and a declining quality of life.

Planning

In the planning phase, it is important for the community health nurse to formulate a plan of action that will lead to positive results. The nurse must ensure that interventions put into place are measurable and attainable by the PAR. The writer has established both short- and long-term goals for the PAR to achieve.

When considering group – based activities, the nurse must consider the needs of the PAR. A short term goal includes creating hands – on activities in 10 to 15-minute increments that are planned and developed by the PAR. Activities are more likely to be effective when the individual is able to participate in scheduling activities of their choosing (Gardiner, Geldenhuys, and Gott, 2016). A long-term goal includes maintaining engagement of the PAR for the duration of an activity that presents as challenging and productive. According to Gardiner et al. (2016), activities that present as both a challenge and productive are suggested as being appropriate and lead to lower levels of isolation through keeping the individual occupied (pg. 151).

According to Dawes et al. (2015), hearing loss can have a profound effect on an individual’s desire to socialize, as it is associated with cognitive decline which spirals to the individual isolating oneself (pg. 2). A short – term goal for the nurse includes aiding with routine hearing screenings in the residential facility on a monthly basis. The community health nurse will assist in securing a visiting audiologist who will visit the facility to complete hearing screenings, as well as complete hearing aid fittings and repair if needed. The nurse and audiologist will divide the PAR into groups for evaluation on separate dates. A long-term goal the nurse can develop includes educating the PAR about hearing aid use and continued encouragement to wear the hearing aids daily. According to Dawes et al. (2015), there is evidence that interventions, including the use of hearing aids, can improve quality of life and decrease incidence of social isolation (pg. 2).

Conducting cognitive-behavioral therapy focuses on the inward needs of the person and focuses on the negative thoughts underlying the reason for isolating oneself from others. This type of therapy works best because it allows people to recognize and deal with negative thoughts (Novotney, 2019). A short-term goal the nurse can implement for the PAR includes engaging older adults in social groups in the facility, for example a book club, once weekly for a duration of 30 minutes. A long-term goal the nurse can implement includes engaging the individual with the older adult leading the group book club discussion once weekly for a duration of 30 minutes.

Providing individuals with socialization and stimulation utilizing animals can have a positive effect on feelings of loneliness and isolation. A short-term goal the nurse can implement would include providing periods of visiting animals, including dogs and cats, to the residential facility once weekly for a period of 30 minutes. A long – term goal for the nurse to implement would include providing a facility pet for the PAR who would reside in the facility daily.

Interventions

The first intervention the community health nurse will implement includes group – based activities. Individuals who do not engage in meaningful social activities with others are at risk for a shortened lifespan, mood and behavior changes, and may lose a sense of purpose (NIH, 2019). A primary intervention for the PAR would include providing socialization to the individual upon the older adult’s transition to the residential facility. From the writer’s professional experience with the PAR, it is important to provide socialization immediately upon the older adult’s transition to the living facility. This intervention allows the individual to meet others in the facility and introduces the individual to the multiple activity options available to the PAR.

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A secondary intervention the nurse will implement includes scheduling and participating in the physical exam and screening for depression by the physician. It is important for the clinician to distinguish symptoms of depression and determine the state of the older adult to allow for proper treatment needed. A tertiary intervention would include introducing and implementing a group exercise program in the residential living facility. In a study conducted by Wallace, Lees, Minou, Singleton, and Stratton (2014), the results indicated that individuals in the PAR who participated in a daily exercise program are more likely to feel a sense of enjoyment and improved quality of life.

Intervention one intertwines with Healthy People 2020’s objective older adult (OA) -6. OA-6 objectives goal is to increase the number of older adults with physical and cognitive limitations to engage in more physical and stimulating activities (ODPHP, 2019). Both the objective and intervention aim to achieve active participation from the PAR in stimulating activities that promote socialization.

The second intervention the community health nurse will implement includes educating the PAR on the importance of routine hearing tests. The primary intervention for the PAR would include the nurse conducting a seminar regarding the effects of hearing loss on the cognition of the older adult. According to Dawes et al. (2015), hearing loss has been recognized as contributing to the cognitive decline in older adults.

The secondary intervention would include the nurse scheduling and assisting with conducting routine hearing tests on the PAR. The tertiary intervention the nurse can implement includes educating and demonstrating the application of assistive listening devices and how to use them. In the same study by Dawes et al. (2015), research concluded that the use of assistive listening devices improved social engagement in the older adult due to the ability of the older adult to comprehend the information being given.

Intervention two intertwines with Healthy People 2020s OA-2 objective. Both the objective and the intervention aim to provide further fundamental services to the older adult that would normally be ignored (ODPHP, 2019).  It is important for the PAR to be educated on the importance of receiving routine hearing tests and using assisted hearing devices to prevent cognitive decline and social isolation.

The third intervention the community health nurse can implement in the residential living facility is conducting cognitive-behavioral therapy. The primary intervention would include educating the PAR on the importance of creating social groups and its effects on feelings of loneliness and isolation from others.

The secondary intervention the nurse will implement includes completing routine screenings for feelings of loneliness, depression, and the risk for isolating oneself from others. The tertiary intervention to be implemented includes creating a PAR lead music-making club once weekly in the facility. Rhythm-centered music making has been found to be beneficial in the emotional, psychological, and social states of the older adult by allowing the individual to participate as a group and take the intervention into their own hands (Yap, Kwan, Tan, Ibrahim, and Ang, 2017, pg. 2).

Intervention three intertwines with Healthy People 2020s objective OA-6. Both the objective and the intervention aim to promote both individual and group socialization by utilizing physical and stimulating activity (UDPHP, 2019). By doing so, it allows the older adult to achieve social engagement and the independence to choose to do so.

The fourth, and final, intervention the nurse will implement includes the use of animal therapy in the residential living facility. The primary intervention the community health nurse will implement includes educating the staff of the residential living facility on the benefits of animal therapy on the older adult population with a cognitive impairment.

The secondary intervention being implemented will include utilizing dogs and cats in the facility to provide stimulation and socialization to the PAR. According to Gardiner et al. (2016), pet therapy acts as a coping mechanism for the older adult and therefore can alleviate loneliness and prevent social isolation. The tertiary intervention to be implemented includes providing the facility with a live-in pet for the PAR to socialize with daily. Animals act as a companion for older adults, particularly those with a cognitive impairment. The animal provides a level of stimulation as well as interaction that some miss out with others (Gardiner et al., 2016).

Intervention four intertwines with Healthy People 2020s objective OA-6. Both the objective and the intervention aim to provide stimulating activity options for the older adult that will allow the individual to make independent choices while still offering multiple options for socializing. The use of animals provides stimulation for the PAR, including those with difficulty communicating with others (ODPHP, 2019).

Evaluation

It is critical for the community health nurse to implement an intervention and to ensure the success of the implementation for a positive outcome for the PAR. After completing multiple literature reviews, the writer has concluded that the incidence of social isolation is increasing in the older adult. While it takes many facets of care to prevent isolation from occurring, the writer discusses four interventions with successful outcomes.

The goal of the first intervention is for the community health nurse to create and implement group-based activities for the PAR. The writer believes this is met. The writer created activities in the residential living facility, including an exercise program using exercise balls and pool noodles cut in half. The writer then demonstrated to the PAR how to complete a drumming class with a designated leader, that lasted approximately 25 minutes before losing the attention of the PAR. A music class is also utilized and successful, as the PAR participated with each other for approximately 30 minutes playing the drums, tambourine, and maracas.

The goal of intervention two is to implement routine hearing screenings and the use of an assisted hearing device. The writer believes this is met. The writer researched local audiologists within the community and located a clinician who makes home visits. Consent forms were provided to the individuals guardians for signature and everyone in the PAR received a hearing screening. Individuals with assisted hearing devices received free-of-charge device cleanings and repair if needed. The clinician agreed to make monthly visits to the residential living facility to service the needs of the PAR.

The goal of intervention three is to implement a cognitive-behavioral therapy program within the facility. The writer believes this is met. The focus of cognitive-behavioral therapy is to create small group gatherings to promote individuals to reflect inward and discover internal feelings. The writer created small groups within the PAR including a PAR lead book club and a mens club with assistance from a male member of the facility staff.

The goal of intervention four is to implement an animal therapy program within the facility. The writer believes this is partially met. The writer can provide frequent visits from therapy trained service dogs on a weekly basis from Love on A Leash, however the administrator of the facility is not open to a facility pet at this time. The administrator felt that the demands of an animal would be difficult to meet when needing to meet the needs of the PAR at varying times.

To be successful in the community health nurse role, the nurse must be able to view the PAR as both a whole and as an individual. The nurse must be able to plan and implement various needs of the PAR while considering the needs of the entire community. While some interventions are not completely met, it can be said that the nurse is still successful when making a difference to those being served.

References

• Alspach, J. G. (2013). Loneliness and social isolation: risk factors long overdue for surveillance. Critical Care Nurse, 33(6), 8-13. doi: http://dx.doi.org/10.4037/ccn2013377
• City of St Clair Shores (SCSMI). (2018). City of st clair shores Michigan. Retrieved from: https://www.scsmi.net/414/St-Clair-Shores-At-A-Glance
• Crewdson, J. A. (2016). The effect of loneliness in the elderly population: a review. Healthy Aging & Clinical Care in The Elderly, 8:1-8. doi: 10.4137/HACCE.S35890
• Dawes, P., Emsley, R., Cruickshanks, K. J., Moore, D. R., Fortnum, H., Edmondson-Jones, M.,…Munro, K. J. (2015). Hearing loss and cognition: the role of hearing aids, social isolation and depression. PloS ONE, 10(3). doi: 10.1371/journal.pone.0119616
• Dury, R. (2014). Social isolation and loneliness in the elderly: an exploration of some of the issues. British Journal of Community Nursing, 19(3), 125-128. doi: 10.12968/bjcn.2014.19.3.125
• Gardiner, C., Geldenhuys, G., & Gott, M. (2018). Interventions to reduce social isolation and loneliness among older people: an integrative review. Health and Social Care in the Community, 26(2), 147-157. doi: 10.1111/hsc.12367
• Landeiro, F., Barrows, P., Nuttal Musson, E., Gray, A. M., & Leal, J. (2017). Reducing social isolation and loneliness in older people: a systematic review protocol. BMJ Open Access, 7(5), 1-5. doi: 10.1136/bmjopen-2016-013778
• National Institute of Aging (NIA). (2019). Social isolation, loneliness in older people pose health risks. Retrieved from: https://www.nia.nih.gov/news/social-isolation-loneliness-older people-pose-health-risks
• Novotney, A. (2019). Social isolation: it could kill you. American Psychological Association, 50(5), 32. Retrieved from: https://www.apa.org/monitor/2019/05/ce-corner-isolation
• Office of Disease Prevention and Health Promotion (ODPHP). (2019). Older adult topics and objectives. Healthy People 2020. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults/objectives
• Singer, C. (2018). Health effects of social isolation and loneliness. Journal of Aging Life Care. Retrieved from: https://www.aginglifecarejournal.org/health-effects-of-social-isolation- and-loneliness/
• United States Census Bureau (USCB). (2018). Quick facts st. clair shores city, Michigan. Retrieved from: https://www.census.gov/quickfacts/stclairshorescitymichigan
• Wallace, R., Lees, C., Minou, M., Singleton, D., & Stratton, G. (2014). Effects of a 12-week community exercise program on older people. Nursing Older People, 26(1), 20-26. doi: 10.7748/nop2014.02.26.1.20.e508
• Wong, A., Chau, A. K., Fang, Y., and Woo, J. (2017). Illuminating the psychological experience of elderly loneliness from a societal perspective: a qualitative study of alienation between older people and society. International Journal of Environmental Research and Public Health, 14(824), 1-19. Doi: 10.3390/ijerph14070824
• Yap, A. F., Kwan, Y. H., Tan, C. S., Ibrahim, S., & Ang, S. B. (2017). Rhythm-centered music making in community living elderly: a randomized pilot study. BMC Complementary and Alternative Medicine, 17:311. doi: 10.1186/s12906-017-1825-x