The art of medicine encompasses healing of both the body and the mind, and thus, an understanding of the complex relationship between a patient’s mental well-being and physical disease state. This psychological and physical interplay is even more important in the elderly population, as they are more susceptible to physical disease, and more vulnerable to preventable, psychological neglect. Providing comprehensive care to our large elderly population is a public health necessity.
A recent study showed that one of the things that the elderly are most afraid of, and are increasingly facing, is becoming isolated and lonely as a result of sickness or age. These social behaviors additionally lead to negative physical manifestations and thus pose a severe threat to treating elderly patients. Some authors define isolation and loneliness broadly as the “absence of social ties or relationships,” while others argue that isolation is better defined as a lack of “intimate relationships and friendships.” Moreover, it was found that loneliness is not a result of the frequency of contact with family, friends or one’s own children, but rather a lack of social support. Thus, while the true definition of social isolation is not concrete within health care, it is evident that some form of meaningful social support is necessary, no matter what form that support comes.
Unfortunately, social isolation and loneliness stem from a variety of factors, and unless corrected, lead to a downward spiraling prognosis. One study states that isolation comes from either a choice by the part of the patient to not connect with others or, more frequently, as a result of life events such as sickness or lack of transportation that consequently diminishes a patient’s access to human interaction. Factors like transportation, access to quality health care, and proactive social services all contribute to the development of isolation. An elderly woman describes the process as follows: “You do build a cocoon around yourself. Sometimes you draw back and you don’t know why you’re drawing back but you just do. You look at the situation and say ‘No, I’m not gonna go through the process.’ But you do build something around yourself after a few years of being on your own.” This exemplifies how once an elderly patient decides to, or is forced into withdrawing from society, they make decisions that lead to further isolation.
Understanding what isolation and loneliness is, and where they stem from, one can now begin to understand why the elderly community is particularly at high risk. For example, the elderly are more likely to have lost a significant other, may be living alone or in a nursing home away from their friends and family, or may develop conditions which may perpetuate feelings of isolation. Grief and loneliness accompany the former two, which may cause patients to become reclusive, while the latter may prevent them from engaging in activities that they used to participate in. Patients with chronic conditions like hearing loss may find it difficult to engage in conversations, which will further isolate them from human contact. Reduced strength and difficulty traveling strand the elderly in their homes, whether it is in the community or in a nursing home, further cutting them off from hobbies or social events. Lastly, living in non-urban areas makes it even more difficult to travel because public transportation is limited, and often requires individuals to travel great distances to and from, and in between stops. These predispositions to isolation and loneliness are so great that 17 percent of older people are socially isolated and 56 percent of those individuals in nursing homes are socially isolated. Worse, elderly people who have a negative outlook on aging — those who associate aging with inevitable sickness — are found to be more likely to develop destructive and isolating behaviors. Because of the greater likelihood of being separated from close friends and family, the development of chronic conditions, and limited mobility, the elderly are predisposed to becoming isolated and lonely.
The long-term sequelae of isolation and loneliness has been well studied, and are in fact both independent risk factors for depression, Alzheimer’s disease, and cardiovascular problems. Another study found that poor social structure, including a lack of participation in social activities led to a decline in physical and mental function. This decline leads to further isolation, as discussed earlier. For example, an individual who loses their sight might not be able to read the newspaper and might therefore feel disconnected from the rest of the world. Isolation also leads to symptoms like fatigue, tension, and muscle weakness. Thus, not only do these patients begin to lose what makes us human — our interaction with the world and others — but they begin to lose their physical and mental health.
Health care providers can play a large role in improving the quality of life of their elderly patients. Evidence has shown that having a good social structure can curve feelings of isolation and loneliness; having close friends increases satisfaction with life, and decreases the likelihood of developing the negative health effects associated with isolation. Thus, planning social events and entertainment at nursing homes and in the public that appeal to the elderly can help build a sense of community. Currently, valuable resources are spent creating programs and events that providers think the elderly would be interested in; however, results are poor because of a lack of attendance. Rather, institutions should poll residents and the older population to directly target their interests, such as gardening, exercise classes, and art programs. Group therapy sessions are another great way to build mentorships and community within the elderly population. These mentoring and group sessions can help the elderly develop meaningful relationships within the new environment they are in. Another great program is to have educational intervention about the effects of isolation to one’s health, as it will motivate more of the elderly to come to social events and be proactive about their attitude towards their own health and condition. Education should also include technology, teaching the elderly and providing them with tools like online video chatting and email. Such technologies can aid the elderly in keeping contact and maintaining meaningful relationships from their past despite having moved somewhere else. Furthermore, nursing homes and community groups should arrange for public volunteer programs where other members of the community can be paired with an elderly individual. Through programs like this, elderly patients can find meaning and purpose through mentoring the youth and establishing relationships. Moreover, cities should provide public transportation at a discounted rate so that the elderly can safely get around the community. In the event that the individual lives in a nursing home, the institution should provide easy and effective transportation services to their patients. Lastly, in nursing homes, a great administrative change that helps prevent isolation is to have each patient be seen by a primary nurse. Through this structure, patients see the same familiar face and it helps to build rapport and build a connection. Further, nurses provide care on a personal level, and so this helps them to notice changes in behavior and get help much quicker if someone is slipping into isolation. There is much that can be done to ensure that no member of the older community feels isolated or lonely.
All in all, the elderly population in America is a large and growing subset of the community. However, they are at risk of becoming isolated and lonely as a result of ageism, physical isolation and health problems. Unfortunately, there is a direct correlation between feelings of isolation and loneliness with negative health manifestations. Nonetheless, there are many methods — having better programming, access to transportation, screening and health care — which can be implemented to ensure that isolation and loneliness is not a problem that our elderly have to deal with.
Former Editor-in-Chief (2016) and Former Medical Student Editor (2014-2015)
Drexel University College of Medicine
Vikas is a Class of 2017 medical student at Drexel University College of Medicine. He joined in-Training in 2014 as a medical student editor and served as the Editor-in-Chief and a writer's-in-training mentor. Vikas' interests include public health and advocacy.
