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Older Adults in Long-Term Care: Surrounded by Many but Still Alone
Despite older adults living in a long-term care setting and being surrounded by perhaps hundreds of other residents, staff members, and visitors, it is likely that many individuals feel isolated and lonely.
The UCLA Loneliness Scale asks three questions to determine a person’s connectedness to other people:
- How often do you feel you lack companionship?
- How often do you feel left out? and
- How often do you feel isolated?
Kim Tingley wrote in The New York Times, “Social isolation and loneliness tend to go together.” Although you can experience one without the other, and they may not have the same cause, the same intervention may be used in response.
A study reported in February 2020 by the National Academies of Sciences, Engineering and Medicine noted that one-quarter of Americans over the age of 65 responded that they experienced feelings related to social isolation even if they lived in the community rather than a nursing home.
Researchers concluded that this emotional state had a significant impact on the physical health of individuals, predisposing the person to premature death like smoking or the lack of physical exercise. Additionally, the study’s authors linked the increased incidence of dementia to social isolation, higher rates of anxiety, depression, and suicide.
The study included the following interventions:
- Conduct assessments to identify at-risk individuals;
- Include social isolation in electronic health records; and
- Connect patients with social care or community programs.
If people are considered isolated if they have fewer than six confidants, no spouse, and no group affiliation, then nearly all nursing home residents would be defined as being socially isolated. Increasing residents’ links to volunteers, clergy, social workers, activity therapists, and psychologists, as well as giving the nursing staff sufficient time and direction to sit and listen to the residents, may address some of these issues.
Having people willing and able to hear the needs of the resident and respond should be considered an advantage to living in a long-term care facility, not just the skilled care services or activities of daily living (ADL) support we have come to expect.
COVID-19 has compounded social isolation and loneliness in the community and in long-term care facilities. The imposition of restrictions on visitors has likely been the cause of many nursing home residents who died because of COVID-19 but not from the virus itself. Many facilities have responded by using technologies to connect residents to their families; however, some have been less responsive in addressing the day-to-day connectivity needs of residents for more than ADL tasks. Certified nursing assistants need to be viewed (and to understand their role) as more than the caregiver for physical needs, but as the first contact for a resident’s social and emotional well-being.
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