“The perceived meaningfulness of life is strongly linked to the degree to which a person maintains social relationships.”
Addressing issues related to geropsychiatry and the well-being of older adults
Social isolation is an underrecognized risk for poor health outcomes in the older adult population (Cudjoe et al., 2020). In the midst of the COVID-19 pandemic, effective disease prevention relies on limited physical, and by extension, social contact. Mandated social distancing and stay-at-home orders attempt to protect those most vulnerable. The need for physical distancing can result in negative psychological and psychosocial health outcomes for the older adult population. However, physical distancing need not result in social isolation when nurses provide a holistic approach to care.
Protecting Older Adults' Physical Health
Preventing the spread of COVID-19 has been largely addressed through federal health directives. According to the Centers for Disease Control and Prevention (2020), COVID-19 poses the highest risk for severe illness in adults age 65 and older as well as those with chronic, comorbid conditions. As a result, community-dwelling older adults are encouraged to remain at home without visitors. Senior centers, social gatherings, and churches that were once a source of meals and socialization for older adults are now closed. Residents of long-term care facilities are no longer permitted to spend time together. They may not receive visitors, including family members; participate in public dining; or engage in facility activities and outings. Restrictions such as these are not insignificant and we cannot underestimate their effect on the overall health of older adults.
Protecting Older Adults' Psychological and Psychosocial Health
Although protecting physical health is of great importance, we must not forget the psychological and psychosocial health of older adults during this turbulent time. Increased chronic disease burden, decline in cognitive function, and increased mortality are all associated with social isolation in older adults (Courtin & Knapp, 2017; Kobayashi & Steptoe, 2018). Psychological effects of social isolation include anxiety and depression, increased risk for substance use, and suicidal ideation (Kobayashi & Steptoe, 2018; Straßner et al., 2019).
Erikson described the psychosocial development stage for older adults as ego integrity versus despair (Perry et al., 2015). To achieve ego integrity, older adults must reminisce, impart wisdom, and recognize their purpose in life (Perry et al., 2015). Without meeting these psychosocial tasks, older adults will experience feelings of powerlessness, hopelessness, and a decreased quality of life. The COVID-19 pandemic magnifies the ways in which social isolation pervades every aspect of health.
Protecting Older Adults Holistically
The nursing role in holistic care is to attain and maintain wellness by supporting not only physiological needs, but the psychological and psychosocial needs of the individual. Neuman theorized, in the Neuman System Model, that wellness is an optimal state of interaction between the individual's physiological, psychological, and sociocultural variables (Reed, 1993). The individual is a dynamic blend of variables and achieving balance within these variables increases resiliency to environmental change (Reed, 1993). Expertise in nursing is the ability to view a patient's overall health as a system of variables and to prioritize nursing interventions that reflect this perspective.
Adopting a holistic approach to care in the context of the COVID-19 pandemic means that nurses must counteract the psychological and psychosocial effects of social isolation with creative solutions. Technology-based resources are an excellent option to facilitate social networking and virtual meetings with friends and family (Gardiner et al., 2018). Online meeting platforms and videoconferencing software on a computer, tablet, or smartphone provide real-time interactions from a distance. Long-term care facilities provide iPads® or other devices with videoconferencing capabilities to residents, providing the device is able to be sanitized between uses. Email, telephone calls, and telehealth visits with family, friends, and health care providers may also be beneficial for community-dwelling older adults to maintain connectedness.
In addition to socializing through technology, engaging in purposeful activities, pastimes, and regular daily routines provides an outlet for feelings of isolation and depression. Routine activities, such as cooking, gardening, and household chores, provide daily structure, whereas leisure activities, such as reading, puzzles, and arts and crafts, provide a creative outlet. These activities are potential options for community-dwelling older adults and older adults in residential care facilities. Nursing staff can obtain magazines, coloring pages, and crossword puzzles and deliver these single-use items to residents in long-term care facilities. Families can send gardening, cleaning, and craft supplies to older adults in the community.
Creative possibilities for connectedness increase exponentially with interprofessional collaboration. For example, a long-term care facility in rural Pennsylvania has a daily broadcast for all residents on a facility television channel. The television channel has live recordings of Bingo so residents can play in their rooms on paper scorecards while staff deliver prizes. Residents view live broadcasts of church services, exercise classes, and music performances. These meaningful activities provide an outlet, encourage engagement, and decrease the likelihood of depression in older adults during social distancing.
Activities that allow older adults to share memories and find meaning in life experiences promote ego integrity. Celebrating birthdays and anniversaries may be difficult during social distancing. Family members of community-dwelling older adults and nursing staff in long-term care facilities can decorate the older adult's door or window and celebrate from outside the door. Nurses and family members can provide a journal or notebook so older adults can record thoughts or words of wisdom to share with family. Recorded videos or voice recordings are other options for older adults to share stories and reminisce with others. Family and friends of community-dwelling older adults can provide printed or digital photographs to recall favorite memories. Nursing staff or family members can supply educational resources to help older adults explore a skill they have always wanted to learn, thereby providing a purpose during this time of isolation (O'Rourke et al., 2018).
Although the negative effects of social isolation are considerable, there are many creative ways to address them through nursing interventions. As much as older adults require physical protection during this time, they also require psychological and psychosocial protection. Preserving the health of older adults is accomplished by cultivating ego integrity and building resiliency to cope with the current need for social distancing. Holistic nursing practices are vital in mitigating the effects of social isolation, especially during the COVID-19 pandemic.
- Centers for Disease Control and Prevention. (2020). Coronavirus disease 2019 (COVID-19): Older adults. https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications/older-adults.html
- Courtin, E. & Knapp, M. (2017). Social isolation, loneliness and health in old age: A scoping review. Health & Social Care in the Community, 25, 799–812 doi:10.1111/hsc.12311 [CrossRef] PMID:26712585
- Cudjoe, T. K. M., Roth, D. L., Szanton, S. L., Wolff, J. L., Boyd, C. M. & Thorpe, R. J. Jr. . (2020). The epidemiology of social isolation: National health and aging trends study. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 75(1), 107–113 doi:10.1093/geronb/gby037 [CrossRef] PMID:29590462
- Gardiner, C., Geldenhuys, G. & Gott, M. (2018). Interventions to reduce social isolation and loneliness among older people: An integrative review. Health & Social Care in the Community, 26, 147–157 doi:10.1111/hsc.12367 [CrossRef] PMID:27413007
- Kobayashi, L. C. & Steptoe, A. (2018). Social isolation, loneliness, and health behaviors at older ages: Longitudinal cohort study. Annals of Behavioral Medicine, 52, 582–593 doi:10.1093/abm/kax033 [CrossRef] PMID:29860361
- O'Rourke, H. M., Collins, L. & Sidani, S. (2018). Interventions to address social connectedness and loneliness for older adults: A scoping review. BMC Geriatrics, 18(1), 214 doi:10.1186/s12877-018-0897-x [CrossRef] PMID:30219034
- Perry, T. E., Ruggiano, N., Shtompel, N. & Hassevoort, L. (2015). Applying Erikson's wisdom to self-management practices of older adults: Findings from two field studies. Research on Aging, 37, 253–274 doi:10.1177/0164027514527974 [CrossRef] PMID:25651571
- Reed, K. S. (1993). Betty Neuman: The Neuman systems model. Sage. doi:10.4135/9781483326566 [CrossRef]
- Straßner, C., Frick, E., Stotz-Ingenlath, G., Buhlinger-Göpfarth, N., Szecsenyi, J., Krisam, J., Schalhorn, F., Valentini, J., Stolz, R. & Joos, S. (2019). Holistic care program for elderly patients to integrate spiritual needs, social activity, and self-care into disease management in primary care (HoPES3): Study protocol for a cluster-randomized trial. Trials, 20(1), 364 doi:10.1186/s13063-019-3435-z [CrossRef] PMID:31215468