As a social animal, man has a continuing need for human interaction for developing and maintaining social relatedness, for personal validation, and for meeting other biopsychosocial needs. Acting in ways to meet the need for social interaction is one aspect of self-care. Normally this need is met through such natural support systems as the fàmily and other social groups.
For the elderly in our society, however, these support systems may no longer be viable. Retirement, death of family and friends, illness and limited mobility, and relocation in age-graded housing all contribute to support system deterioration, resulting in less opportunity to interact with others. Loss of this basic psychosocial supply coupled with such accidental crises as death of significant others, loss of home, or loss of health make the elderly a population at risk for the development of mental illness.1'2
Promotion of mental health and prevention of mental illness associated with aging is a concern which nursing has been negligent in addressing.3 This discussion reviews the relevant research in nursing and related fields with respect to one aspect of mental health promotion with the elderly, that of meeting the need for social interaction, and suggests implications for further research and nursing practice.
At each stage of the life cycle a person is concerned with performing those health-related practices which maintain life and promote health and well-being. Universally there is a need to develop self-care practices that meet one's own continuing requirements for: air, food, and water; elimination; activity and rest; solitude and social interaction; protection from hazards; and normalcy.4 One ordinarily adjusts the ways of meeting these requirements to age, developmental state, and health state. These are necessities that one recognizes when a need exists; then one will identify and examine alternative solutions, select and act on one solution, and finally, evaluate the results. This type of deliberate action is always conditioned by factors such as requisite knowledge and skills, motivation and physical energy, and a sense of well-being which permits decisionmaking and action. When an individual lacks knowledge about or is otherwise unable to perform those behaviors necessary for health promoting self-care, a need for nursing exists.
With regard to social interaction, the elderly are required to act deliberately to adjust their social interaction patterns to their changing life space. Loss of social support systems as sources of social interaction as well as buffers against social stress5 may place the elderly in double jeopardy.
Review of Related Research
Several findings from Lowe-ndial's6 research in San Francisco in the 1960's are pertinent. Studying a stratified random sample of 600 elderly community residents and nearly 600 aged hospitalized with psychiatric disorders, the elderly who were mentally ill were found to be far more socially isolated than the healthy. Becoming isolated in late life was associated with mental illness, but was thought to be more of a consequence than a cause. In fact, physical illness appeared to be the critical antecedent to both isolation and mental illness.7 Also significant is the finding that the presence of a confidente, an intimate relationship, does serve as a buffer against such social losses as that of role or amount of social interaction.8 Clark and Anderson's9 findings in the same study series support the close association between the lack of relatedness and mental illness in old age.
Later studies have found positive correlations between social interaction and mental health.10-12 The NIMH longitudinal study of 47 men over the age of 60 showed relative stability in relationships over the 11year study period. The findings also indicated that being married was associated with survival and that the amount of losses of close relationships had the most significant influence on behavior and attitudes.13 In fact, "an intact and supportive intimate social environment was one important sociopsychological factor in resisting assaults in old age and thus a significant factor in survival."14
Little nursing research has been published in the area of adapting social interaction patterns to aging. The findings of a few studies do, however, seem to bear some relationship to the problem. In a study of the aged in nursing homes, for example, Dominick et al15 found that the more successfully adjusted aged patients were those who had special friends in the home and those who knew and liked their roommates.
Schwartz's16 classic study of the nursing and psychosocial needs of the elderly ambulatory patient documented that people with many interpersonal contacts were nearly free of symptoms of "senility," whereas those who lived alone had a more difficult time and were generally less satisfied. The investigators concluded that people with sparse contacts lack a buffer.
Francis Thomas17 examined the relationship between social involvement and mental health status of 600 older noninstitutionalized persons. She found that those with more social interaction had a higher mental health status and that even with the impact of physical health, "social involvement remained an independent factor in the maintenance of mental well-being among the study respondants."
Managan et al18 surveyed the health needs of 1,466 elderly community residents. Persons who lived with others, primarily the homebound, had more health problems and were actually more socially isolated than those living alone. Those over 75 years old had more health problems and were more disabled and socially isolated.
Implications for Nursing Research and Practice
For nursing's utility, however, the current research findings are lacking. Sociopsychological research has linked social interaction among the elderly with health. What has not been studied is how the adaptive elderly maintain interaction systems or respond to their loss. From a self-care perspective the questions have yet to be asked. Do the elderly perceive a need for continued social interaction? Do they perceive the existance of alternate sources of social interaction when their own support systems begin to dwindle? Do they perceive themselves as having any control over meeting the requirements for social interaction? What ar&me ways elderly persons deliberately act to-hïcfease social interaction opportunities? Do they need to learn how to develop new relationships? Answers to these questions would stimulate the development of more appropriate methods of nursing assistance.
In the interim, practitioners of nursing who are cognizant of the need for human interaction could assist the elderly in the following ways.
1. During assessment, be alert for loss of social interaction sources. In the history guide include the question, "Have you experienced any recent losses?" For clients whose disability may have limited their mobility, pursue how this has interferred with their usual social activities. And listen for clues that clients are depressed, lonely, or grieving. The comment "Since Henry's been gone I just haven't felt much like cooking" in response to a question about nutrition stimulates an alert nurse to explore not only nutritional status but social interaction needs as well. __
2. Help the elderly person become aware of social interaction needs. At the level of the individual, skillful interviewing can reveal these needs to the client as well as to the nurse. Validating the loss and loneliness as real, and therefore important, will help the elderly person accept the need for social interaction as normal and one which can be addressed. From a broader perspective, through pamphlets, posters, discussion groups, and mass media the nurse can contribute to recognition by the elderly of the continuing need fox social interaction.
3. Assist the client to identify realistic and acceptable solutions. Suggesting that a homebound woman join a seniors club may not be realistic, but offering a friendly visitor or telephone service may be. By listening to how adaptive elderly are managing this problem, the nurse can expand her repertoire of alternatives.
4. Support the person to select and try out one solution and to evaluate its effectiveness. Since feelings of helpfulness and" hopelessness may be present, supporting the person to make his own choice from among the alternatives will be an important motivator. Unless the current situation is hazardous to the individuars health state, he should be permitted and encouraged to make his own decision about new ways to meet his need for social interaction. Continued interest in how the action is meeting the person's goals will reinforce his sense of control over his decision and behavior as well as encourage him to evaluate and make new choices as necessary.
5. Identify and utilize ways in practice settings in, which interaction between and among elderly clients could be facilitated. In neighborhood health centers and in residential settings, the nurse might offer the opportunity to meet regularly in small discussion groups. Sharing ways of adjusting self-care practices to aging as well as related concerns such as loneliness, grief, and isolation can provide an opportunity for social interaction. These groups may have the potential for becoming continuing support systems for members.
Summary and Conclusions
Social interaction is a basic human need throughout the life cycle. As a self-care requirement, the practices associated with meeting the need for social interaction must be adjusted to age, developmental state, and health state. An intact social support system is positively correlated with mental health. The elderly are a population at risk to lose the usual sources of social interaction through ill health and loss of the natural support systems. Isolated elderly have more physical and mental health problems. Little research has been done which describes how the elderly perceive their need for social interaction and how adaptive elderly change their ways of meeting this requirement. We need answers to these questions in order to more adequately assist the elderly to anticipate and manage their self-care requirement for social interaction in ways which promote mental health in the final years.
- 1. Giordano J. Giordano GP: Ethniciiy and community mental health. Community Ment Health Rev l(l):4-I4, 26, 1976.
- 2. Caplan G: Principles of Preventive Psychiatry. New York, Basic Books, 1964.
- 3. Gunter LM. Miller JC: Toward a nursing gerontology. Nurs Res 26:208-221, 1977.
- 4. Orem DE: Nursing: Concepts of Practice. New York. McGraw Hill Book Co, 1971.
- 5. Caplan G: Support Systems. New York, Behavioral Publications. 1974.
- 6. Lowenthal M. et al: Aging and Mental Disorder in San Francisco. San Francisco, Jossey-Bass, 1967.
- 7. Lowenthal MF: Social isolation and mental illness in old age. In Neu gar ten B (ed): Middle Age and Aging. Chicago, University of Chicago Press, 1968.
- 8. Lowenthal MF, Haven C: Interaction and adaptation: Intimacy as a critical variable. In Neugarten B (ed): Middle Age and Aging. Chicago, University of Chicago Press. 1968.
- 9. Clark M. Anderson BG: Culture and Aging. Springfield, Illinois. Charles C.Thomas Pubs, 1967.
- 10. Maddox GL: Persistence of life style among the elderly: A longitudinal study of patterns of social activity in relation to life satisfaction. In Neugarten B (ed): Middle Age and Aging. Chicago. University of Chicago Press, 1968.
- 11. Rupp C. Duffy ET, Danish M: Successful adaptation to aging: Psychological, social and psychiatric aspects. J Am Geriatr Soc 15:1137-1143,1967.
- 12. DeCarlo TJ: Recreation participation patterns and successful aging. J Geriatr 29:416-422, 1974.
- 13. Granick S, Patterson RD: Introduction. In Human Aging II. Washington, D.C., Government Printing Office (DHEW Pub No 71-9037), 1970.
- 14. Youmans EG. Yarrow M: Aging and social adaptation: A longitudinal study of healthy old men. In Human Aging II. Washington, D.G., Government Printing Office (DHEW Pub No 71-9037), 1970, p 102.
- 15. Dominick JR, Greenblatt D, Stotsky BA: Adjustment of aged persons in nursing homes: The patient's report. J Am Geriatr Soc 16:63-71, 1968,
- 16. Schwartz D, Henley D, Zeitz L: The Elderly Ambulatory Patient. New York, Macmillan Publishing Co, Inc, 1964.
- 17. Thomas FJ: Social involvement of elderly studied in relation to mental health status. Nurs Res Rep 5:1-6, 1970.
- 18. Managan D, ei al: Older adults: A community survey of health needs. Nurs Res 23:426-432, 1974.