Isolation In Older Adults Research Articles

The Double Burden of Depression and Social Isolation in Older Adults during the COVID-19 Pandemic

<h3>Introduction</h3> We are living in a global pandemic of SARS-CoV-2 (COVID-19) that has infected over 63 million people across the world to date. Even though social-distancing is recommended as a key method of reducing risk, such measures disproportionately impact older adults (OA) whose social contacts are often outside their home. Thus, it is both timely and critical to examine the impact of pandemic-related social isolation on OA's mental health. Also, it is unclear whether OAs experiencing depressive symptoms have increased risk of being adversely impacted by social isolation. The current ongoing study utilizes a combination of remotely conducted interviews and online questionnaires to investigate how OA's mental health has been impacted by pandemic-related social isolation. We present preliminary findings from the first wave of our study. We hypothesized that OAs who report higher degrees of reduced quality and frequency in social relationships and communication will be at greater risk of depression, anxiety, and loneliness. Furthermore, we predicted that OAs who endorse depressive symptoms in the recent past will show a stronger association between adverse changes resulting from limited social activity and mental health. <h3>Methods</h3> We recruited 143 OA participants aged 55 years or older (Mean age=64.9, SD=5.3, 87% female). Prospective participants were excluded for self-reported history of neurological disorders, cognitive impairment, or changes in dosage of any psychotropic medications within the past 4 weeks. Otherwise, individuals with current and/or past history of depression or anxiety were included. Following informed consent, participants were screened for cognitive impairment using the MoCA-mini. Participants then filled out a series of questionnaires related to a self-reported diagnostic screen (SAGE-SR), current symptoms of stress (Perceived Stress Scale), depression (Center for Epidemiologic Studies Depression Scale), anxiety (Geriatric Anxiety Scale), loneliness (UCLA-Loneliness), perceived social support (Multidimensional Scale of Perceived Social Support), and perceived social contribution (Social Contribution subscale of the Social Well-being scale). Moreover, we obtained participants' self-reported appraisal regarding the magnitude of adverse impact caused by COVID-19 pandemic-related social isolation on the quality of their personal social relationships and communication frequency with their loved ones. <h3>Results</h3> Overall, participants who reported greater detriment to social relationships and communication frequency also indicated higher degrees of depressive symptoms (r=.32, p<.001), and loneliness (r=.26, p<.005). Interestingly, frequency of using remote forms of communication with friends and family outside the home were inversely related to pathological mental health symptoms. In other words, those who report frequently keeping in touch with loved ones outside their homes also indicated having lower symptoms of depression (r=-.18, p<.05), anxiety (r=-.18, p<.05), and loneliness (r=-.24, p<.005). Notably, household size was not predictive of the above-mentioned symptoms, but was predictive of stress, such that greater household size was associated with higher levels of stress (r=.21, p<.05). We then separately examined two groups of OAs – those who reported having experienced at least some DSM-5 depressive disorders symptoms in the past 30 days, and those who did not. Self-reported magnitude of pandemic-related detriment to social behavior significantly predicted the severity of loneliness, but only in OAs who report some depressive disorder symptoms (r=.24, p<.05). Similarly, in this group, lower perceived social support significantly predicted higher stress (r=-.46, p<.0001) and lower self-reported social contribution predicted higher loneliness (r=-.33, p<.01) respectively. <h3>Conclusions</h3> The preliminary data from our study suggest that greater levels of pandemic-related social isolation are associated with higher severity of symptoms of depression, anxiety, and loneliness. Importantly, OAs with depressive symptoms appear to be at risk of adversely being impacted by loss of social support and absence of meaningful outlet for social contributions during prolonged social isolation. Conversely, our data suggest utilizing psychosocial interventions designed to shore up social support and greater agency in social contribution may be particularly beneficial to OAs who experience depressive symptoms. The correlational nature of our current data is a limitation that will be addressed by our future work gathering responses from the same group of participants who are expected to resume social activity outside the context of pandemic-related social isolation (i.e., Wave 2). Our future work will also address how social isolation relates to day-to-day experience and control of emotions, which is a significant dimensional predictor of functional impairment and distress across multiple psychopathologies. <h3>Funding</h3> Funding <i>support from</i> <b>Special Emphasis: Emerging COVID-19/SARS-CoV-2 Research</b> seed grant awarded to J. Kim, <i>through the Immunology, Inflammation and Infectious Diseases Initiative</i> and the Office of the Vice President for Research at the University of Utah

The Loneliness of Aging

Isolation and loneliness have become buzz words when discussing older adults during the coronavirus disease pandemic; yet, these are age-old problems. Both have been studied extensively, yet there currently is no rapid or succinct tool that can be used in the emergency department to screen for either, or a consensus of evidence-based ways to correct these issues. This is of concern because both loneliness and social isolation have been linked to poor health. Poor health, in turn, can lead to worse isolation and loneliness. These health problems may lead to the older adult seeking care in the emergency department where screening and initial treatment could be initiated. Suggestions for questions that emergency nurses can ask to identify an older adult who is lonely or suffers from social isolation, as well as steps to consider when encountering the older adult with complaints of loneliness and/or social isolation, are provided, with the realization that these are only the first steps of many that would need to be taken. The purpose of this article is to bring forward updated information that discusses loneliness and social isolation in older adults, a timely priority during the coronavirus disease pandemic and often listed as a factor in older adult deaths. A review of relevant screening tools for use in the emergency department are provided.

The art hive as a ‘frame of belonging’ for older adults

ABSTRACT Community leisure spaces play a critical role in supporting belonging, which, in turn, has a buffering effect on loneliness and social isolation for older adults. This study explored the role of art hives in contributing to belonging for older adults. Typically located in storefronts, subsidized housing, libraries, and museums, art hives are community spaces where everyone, particularly individuals prone to exclusion, are welcomed to make art and connect with others. Findings highlight participants’ need for welcoming social spaces where they connect with people who care about them and suggest the value of such spaces extends beyond leisure activities happening within. The democratic nature of art hives contributed to participants’ feelings of shared ownership and collective responsibility for hospitality. These findings advance our thinking about belonging and provide support for the creation of community leisure spaces that support older adults to engage in regular and meaningful social interactions around shared interests.

Covid and the Elderly What are the Lessons We´ve Learned?

Older people are disproportionately affected by the COVID-19 pandemic; although it is not the most affected age group, it is the one with the most serious forms and the highest fatality. This may be related to several issues: higher proportion of comorbidities such as hypertension, diabetes mellitus, cardiovascular disease, chronic obstructive pulmonary disease, etc, all of which are associated with both a higher frequency of infection and a higher fatality rate; less psychological and biological reserves, and finally immune senescence: immunological changes associated with aging. The pandemic presents itself, evolves diversely and impacts in different ways in the lives of young adults and elderly. In this brief review we try to explore diagnosis and evolvement of COVID-19 and impact of isolation in older adults.

The Effect of Technology Use in Reducing Social Isolation or Loneliness in Older Adults: A Systematic Review

The US population over 65 is projected to increase to 21% by 2050. Given mobility issues arising from health concerns, economic status changes, loss of friends and partners, older people are at a higher risk for social isolation and loneliness. Since the declaration of national emergency for COVID-19 on March 13, 2020, many older adults have not been able to connect with others in traditional ways. Instead, activities and contacts have been facilitated virtually via videoconferencing or phone calls to maintain physical and social distance. Amidst COVID-19, the transition to using technologies to connect socially and reduce loneliness has been a critical factor in preventing social isolation and loneliness. Identifying effective strategies involving the use of technology, designing new ways to deliver services virtually, and developing educational programs to promote technology is vitally necessary. This systematic review explored the relationship between technology use and social isolation or loneliness, and examined interventions that reduced social isolation in older adults. A unified strategy was used to systematically search seven databases (MEDLINE, PubMed, Embase, CINAHL, Web of Science, PsycInfo, and AgeLine) to examine qualitative and quantitative studies published in English between 2010 and 2020. Preliminary results indicate that technology can alleviate social isolation and loneliness in older adults despite some mixed results. The findings of this study will provide a foundation for policymakers and practitioners to shape policies and design programs that help older adults to alleviate social isolation and loneliness, particularly amidst the COVID-19 pandemic.

COVID-19 pandemic lockdown responses from an emotional perspective: Family function as a differential pattern

Family can be an essential resource at times of loss or vital crisis. Loneliness and isolation in older adults might have serious negative consequences for their mental health. For this reason, this research aims to analyze the role of family function in the anxiety and depression experienced by older adults during the COVID-19 crisis. Participants were 882 Spanish community-dwelling adults over 60 years of age. Sociodemographic characteristics, characteristics related to the coronavirus, self-perceived health, family function, avoidance, depression and anxiety were analyzed. Data suggest a buffering effect of family function on anxiety and depression during the pandemic. Furthermore, being unmarried or a female, greater fear of COVID-19, worse self-perceived health, greater avoidance, and worse family function were associated with higher levels of anxiety. Likewise, greater fear of COVID-19, poorer self-perceived health, greater avoidance, and poorer family function, were associated with greater depression. These results point out that family dysfunction is a predisposing factor for the development of the emotional problems of anxiety and depression in older people in potentially stressful and loss situations.

Moderating Effect of Race and Ethnicity Between Technology Use and Social Isolation

Social isolation among older adults has brought about poor outcomes of their health and well-being. Information and Communication technology (ICT) is known to alleviate social isolation of older adults. However, it is unknown how ICT access and use are associated with social isolation by race. This study examined the association of ICT and social isolation from the National Health and Aging Trends Study (NHATS), estimating moderating effects of race and ethnicity. The sample for this study was community dwelling Medicare beneficiaries aged 65+ (n=5,567). An index for ICT was formed from five domains: social network websites, email and texting, working cellphone, tablet devices and online computer use (range 1-5, mean=3.96, SD=0.927), and social isolation was derived from responses to five areas: living arrangement, attending religious activities, numbers of important people to talk with, attending other activities such as club participation and volunteer work (range=0-2, mean=1.74, SD=0.927). Race and ethnicity included White (69.6%), African-American (20.7%), Hispanic (5.5%) and Asian/Pacific Islander (2.5%). Multiple linear regression was used using a moderating effect of race/ethnicity, including relevant covariates. Findings revealed increased ICT use was associated with lower social isolation (b=0.05, p<0.05), and race/ethnicity was a significant moderator in the association between ICT and social isolation for African-Americans (b=0.08, p<0.05) and Hispanics (b=0.15, p<0.05) compared to White older adults. The findings indicate that racial differences should be considered when applying technology use to reduce older adults’ social isolation. Practitioners can provide racially competent ICT services for older adults interested in tech-based communication.

“Doing the Impossible with the Inadequate”: COVID-19 Response in U.S. Assisted Living Settings

The COVID-19 pandemic has disproportionately affected long-term care operators, staff, residents and their families; although much attention has been given to nursing homes, largely lost in the discourse are assisted living, residential care, and dementia care (AL) communities. As part of a broader, ongoing study assessing states’ AL regulations regarding medical and mental health care for residents with Alzheimer’s and related dementias (ADRD), stakeholders across the United States were recruited in July and August 2020 for semi-structured interviews to provide their perspectives on AL policies and practices specific to COVID-19 response. Stakeholders (n=32) consisted of state healthcare and trade association representatives, clinical practitioners, operators, researchers, and dementia care experts experienced in AL-related operational, healthcare, and regulatory affairs. Using thematic analysis, we describe several emerging topics regarding the opportunities, challenges, and innovations of responding to COVID-19 within the unique context of AL. States’ public health responses to COVID-19 lacked an understanding of the broader long-term care system, especially AL’s scope and purpose, workforce, capacity to implement infection control practices and policies, and unintended consequences of social isolation for older adults, specifically residents living in dementia care units. Despite these challenges, stakeholders described opportunities to expand telehealth infrastructure, communication and collaboration across states and among operators, and several innovations to mitigate the effects of social isolation. It is imperative for policymakers to understand the nuances of the AL context and design regulations and public health responses grounded in a whole-person perspective and in partnership with operators during, and beyond, pandemic circumstances.

Automatic Detection of Social Isolation based on Human behavior Analysis

Social isolation is a problem that is accentuated in the stage of old age. This condition puts the physical and mental integrity of older adults at risk. This paper presents a predictive model for the automatic detection of social isolation in older adults. The predictive model was implemented in a mobile application that monitors communication and mobility activities performed by an older adult. The mobile application was also generated for a caregiver who is responsible for receiving notifications about the specific level of social isolation of the older adult. The predictive model was evaluated using an experimental group of older adults.

Scaling Our Impact: Emerging Human Factors Applications Addressing Societal Challenges

There is an increasing need and interest for Human Factors and Ergonomics (HFE) professionals to apply our discipline to a larger context. HFE researchers are starting to conduct research outside of traditional settings, focusing their efforts on complex societal challenges; however, this type of work is still in its infancy and there is a need to define how HFE can be used in broader contexts, outside of formal institutions. In this panel, we begin a formalized conversation of how our field can scale its impact. Each panelist will introduce a societal challenge they are addressing and discuss how HFE can be adapted to this context. The topics of this panel will span elections technology, sustainability and climate change, universal access to mental healthcare, social isolation in older adults, and food insecurity. This session will conclude with a moderated discussion between the panelists and audience to brainstorm specific societal challenges that HFE can address as well as how methods can be adapted to this context.

The Healthy Meal Program: A food insecurity screening and referral program for urban dwelling older adults.

To describe the Healthy Meal Program (HMP), a community-academic partnership that aims to address the food insecurity and social isolation in older adults living in an urban setting. Low-income older adults were screened for food insecurity and social isolation. A partnership with the food bank and a farm-based organization helped provide a weekly congregate or home-delivered meal, pilot a cooking class, and offer a mobile market selling fresh vegetables at discounted prices. Overall, 339 individuals agreed to participate in the screening process. Sixty-eight percent (n=230) screened positive for food insecurity and 41% (n=139) screened positive for social isolation. Among individuals who were food insecure, 159 were referred to a food commodity program, 31 to meals on wheels, 23 to Supplemental Nutrition Assistance Program benefits, and 28 to emergency food pantries. The mobile market served 75 participants weekly and 15 individuals took part in cooking classes. Screening for food insecurity and social isolation in the HMP helped to assess the prevalence of these social determinants of health in low-income older adults. Weekly congregate meals, home visits, and group cooking classes were initiatives taken to decrease the impact of food insecurity and social isolation in this vulnerable population.

Video calls for reducing social isolation and loneliness in older people: a rapid review.

Video calls for reducing social isolation and loneliness in older people: a rapid review.

Achieving Safe, Effective, and Compassionate Quarantine or Isolation of Older Adults With Dementia in Nursing Homes

Nursing homes are facing the rapid spread of COVID-19 among residents and staff and are at the centre of the public health emergency due to the COVID-19 pandemic. As policy changes and interventions designed to support nursing homes are put into place, there are barriers to implementing a fundamental, highly effective element of infection control, namely the isolation of suspected or confirmed cases. Many nursing home residents have dementia, associated with impairments in memory, language, insight, and judgment that impact their ability to understand and appreciate the necessity of isolation and to voluntarily comply with isolation procedures. While there is a clear ethical and legal basis for the involuntary confinement of people with dementia, the potential for unintended harm with these interventions is high, and there is little guidance for nursing homes on how to isolate safely, while maintaining the human dignity and personhood of the individual with dementia. In this commentary, we discuss strategies for effective, safe, and compassionate isolation care planning, and present a case vignette of a person with dementia who is placed in quarantine on a dementia unit.

Editorial: Loneliness and Social Isolation in Older Adults during the COVID-19 Pandemic: Implications for Gerontological Social Work.

Editorial: Loneliness and Social Isolation in Older Adults during the COVID-19 Pandemic: Implications for Gerontological Social Work.

Factors associated with social isolation in community-dwelling older adults: a cross-sectional study.

Social isolation in older adults is a major public health problem and associated with increased morbidity and mortality. There are limited data on the association between social isolation and physical function including gait speed. Hence, this study is to determine the prevalence of social isolation and its association with gait speed, frailty, cognition, depression and comorbidities amongst community-dwelling older adults. Social isolation, depression, frailty and perceived general health were assessed using 6-item Lubben Social Network Scale (LSNS-6), Geriatric Depression Scale (GDS), FRAIL scale and EuroQol EQ-5D-5L questionnaire which includes EQ Visual Analogue Scale (EQ-VAS), respectively. Cognition was assessed using the Chinese Mini Mental State Examination (cMMSE), while physical performance test included gait speed and short physical performance battery test. Binary logistic regression was performed to determine the influence of socio-demographic, medical, functional and cognitive variables on social isolation. Out of 202 participants, 27.7% were robust, 66.8% of participants were pre-frail, and 5.4% of participants were frail. Almost half (45.5%, n = 92) of the participants were found to be at risk of social isolation. A poor social network was negatively associated with mean gait speed (OR = 0.674, CI 0.464-0.979, p = 0.039), EQ-VAS (OR = 0.561, CI 0.390-0.806, p < 0.01) and cMMSE (OR = 0.630, 95% CI 0.413-0.960, p = 0.032). Almost half of older adults in the community are at risk of social isolation with a very significant association with gait speed, cMMSE and EQ-VAS scores.

PROTOCOL: Friendly visiting by a volunteer for reducing loneliness and social isolation in older adults.

Loneliness and social isolation are reaching epidemic proportions in both children and adults, despite the increasing connectedness in our twenty-first century world. As a growing number of studies reveal their detrimental impact on physical and mental health, identifying and investing in feasible and sustainable interventions to alleviate social isolation and feelings of loneliness is of prime importance. Friendly visiting, a befriending intervention whereby older persons are matched with someone who visits them on a regular basis, seems to be a realistic and sustainable option for providing social support. However, until this day, it remains unclear if friendly visiting by a volunteer is effective at reducing loneliness and social isolation. Therefore, this systematic review aims to answer the following research question: what is the effect of friendly visiting by a volunteer on feelings of loneliness and social isolation (primary outcomes) and wellbeing (i.e. life satisfaction, depressive symptom experiencing and mental health; secondary outcomes) in older adults? The results of this review may provide useful information to policy-makers that are preparing to take on one the most challenging social issues facing our ageing society.

Hearing Loss, Loneliness, and Social Isolation: A Systematic Review.

Social isolation and loneliness are associated with increased mortality and higher health care spending in older adults. Hearing loss is a common condition in older adults and impairs communication and social interactions. The objective of this review is to summarize the current state of the literature exploring the association between hearing loss and social isolation and/or loneliness. PubMed, Embase, CINAHL Plus, PsycINFO, and the Cochrane Library. Articles were screened for inclusion by 2 independent reviewers, with a third reviewer for adjudication. English-language studies of older adults with hearing loss that used a validated measure of social isolation or loneliness were included. A modified Newcastle-Ottawa Scale was used to assess the quality of the studies included in the review. Of the 2495 identified studies, 14 were included in the review. Most of the studies (12/14) were cross-sectional. Despite the heterogeneity of assessment methods for hearing status (self-report or objective audiometry), loneliness, and social isolation, most multivariable-adjusted studies found that hearing loss was associated with higher risk of loneliness and social isolation. Several studies found an effect modification of gender such that among women, hearing loss was more strongly associated with loneliness and social isolation than among men. Our findings that hearing loss is associated with loneliness and social isolation have important implications for the cognitive and psychosocial health of older adults. Future studies should investigate whether treating hearing loss can decrease loneliness and social isolation in older adults.

Risk factors for social isolation in post-hospitalized older adults

IntroductionSocial isolation in older adults is associated with high rates of adverse health outcomes. Older adults who have had a recent significant health event are likely to be at risk of social isolation following hospitalization. This study aims to identify risk factors amongst older adults at hospital discharge that are associated with social isolation at three months post-hospitalization. MethodsOlder adults were surveyed at hospital discharge and three months post-hospitalization. Baseline data including demographics, self-reported quality of life, physical activity and capacity levels, lifestyle factors, symptoms of depression and anxiety were collected at discharge. Social isolation was measured using the Friendship Scale at the three-month follow-up. Regression analyses were used to examine the relationship between baseline characteristics and social isolation at three months post-hospitalization. ResultsOlder adults (n = 311) participated in the baseline survey, of whom 241 (78 %) completed the three-month survey. Higher depressive and anxiety symptoms at hospital discharge, comorbidity of cancer, history of cigarette smoking, prior access to community and respite service, and arrangement for shopping assistance post-discharge were factors independently associated with an increased risk of social isolation at three months post-hospitalization. DiscussionThis study identified risk factors for social isolation that are unique to older post-hospitalized adults. These findings can help clinicians identify individuals at risk of social isolation and to target interventions that address these risk factors for the prevention of social isolation in older adults after hospitalization.

Is Sedentary Behavior or Physical Activity Associated With Loneliness in Older Adults? Results of the European-Wide SITLESS Study.

Research has found that social relationships are central to the health and well-being of an aging population. Evidence exploring the association between physical activity (PA) and sedentary behavior (SB) with social isolation and loneliness is limited. This study uses objectively measured PA and SB (ActiGraph®) and self-reported measures of loneliness (the De Jong Gierveld Loneliness Scale) and social engagement (the Lubben Social Network Scale) from the SITLESS study, a European-wide study of community-dwelling older adults. Social isolation was associated with SB where higher levels of SB were associated with an increase in the level of social isolation, controlling for age, sex, living arrangements, employment status, body mass index, educational background, marital status, and self-reported general health. In contrast, PA was not associated with social isolation, and neither SB nor PA was a statistically significant predictor of loneliness. SB may be linked to social isolation in older adults, but PA and SB are not necessarily linked to loneliness in older community-dwelling adults.

ADDRESSING SOCIAL ISOLATION OF OLDER ADULTS: THE COMMUNITY PERSPECTIVE AND CONTRIBUTION

This presentation will discuss the Reducing Isolation of Seniors Collective (RISC), a collaboration of three organizations that have implemented nine projects to address social isolation for rural and urban older adults in Saskatchewan, Canada. A survey was completed with the purpose of identifying community-level awareness, knowledge and perspectives on the extent of social isolation of older adults in their communities. Key variables of interest included contributors to social isolation of older adults, barriers to overcoming social isolation, and community efforts and promising assets for addressing social isolation of older adults in their own communities. To develop an understanding of the extent to which respondents are involved with older adults, the survey asked respondents to report how often they supported, observed, advocated for, and/or interacted with seniors. The 271 respondents identified their roles in the community as human service professionals, healthcare professionals, program facilitators, community leaders, organization members, and community volunteers. Three-quarters of respondents reported that they were involved with seniors at least daily or weekly. While 75.3% believed that social isolation of older adults was “somewhat” or “very” common, almost one-half (41.2%) of respondents believed there was not general awareness of social isolation of older adults by other members in their community. Over one-half of the respondents mentioned community programming (55.7%), friends and neighbours (63.1%), and volunteers (57.2%) as community assets that can reduce isolation of older adults. Respondents reported examples of promising interventions in their communities: church support, library programs, transportation service, visiting programs, advocacy groups, and information sessions.