How to Treat Social Isolation

Health Risks of Older Adults: Social Isolation
Social isolation is a major health risk for older adults (Landeiro, Barrows, Musson, Gray & Leal, 2017). It can cause symptoms of depression, loneliness and withdrawal for older persons who lack connectivity to the community outside their living quarters. These symptoms can impact both the mental and physical health of older adults and drastically reduce their quality of life. Primary risk factors of isolation include (Elder & Retrum, 2012):
· Living alone
· Mobility or sensory impairment
· Major life transitions
· Socioeconomic status (low income, limited resources)
· Being a caregiver for someone with severe impairment
· Psychological or cognitive vulnerabilities
· Location: rural, unsafe or inaccessible neighborhood/community
· Small social network and/or inadequate social support
· Language (non-English speaking); and
· Membership in a vulnerable group
A registered nurse (RN) can assess this problem by obtaining a health history and physical examination of the patient. Specifically the RN would look for symptoms of listlessness, detachment, and disinterest in the person’s surroundings. The individual might demonstrate a lack of communicativeness and a lack of a desire to talk, if withdrawal or depression is the primary symptom. On the other hand, if loneliness is the primary symptom, the older person might demonstrate a desire to talk at length about anything and not be willing to end a conversation. These two extremes can actually be symptoms of the same problem of social isolation.
One way to effectively measure for the problem of social isolation in older adults would be to utilize The National Social Life, Health, and Aging Project (NSHAP) data, which “contain multiple indicators of social connectedness, social participation, social support, and loneliness among older adults” (Cornwell & Waite, 2009, p. 38).  Cornwell and Waite (2009) state that using the NSHAP data, an RN could assess this problem in a patient by measuring “social disconnectedness (i.e., physical separation from others) and perceived isolation (i.e., feelings of loneliness and a lack of social support)” (p. 38). A scale can be applied to this measurement of variables including social network size and range, percentage of social network who lives in the same house as the patient, frequency of interaction, closeness with network members, living arrangements, number of friends and family members, number of children, attendance at social services, and so on (Cornwell & Waite, 2009).
Three specific interventions would be one-on-one visits, service provision—such as reminiscence group therapy, animal-assisted therapy, teaching the patient how to use the Internet, or gardening therapy (Liu, Lin, Chen & Huang, 2007; Tse, 2010; White et al., 1999; Woo, 2017). Reminiscence group therapy is something that older persons can engage in with others of their generation as they tell and share stories about their past, which allows them to open up, socialize and create new friends and relationships while enjoying their reminiscences on the past. Animal-assisted therapy is the process of bringing an animal such as a dog into the patient’s life to reduce loneliness. Teaching the patient to use the Internet is an intervention that allows the patient to begin virtual relationships online with other online users. Gardening therapy is the process by which the individual participates in nature, which can help to reduce feelings of loneliness and isolation.
Two community resources that could be used to address this problem would be the local Community Action Center and the Community-Based Care Facility, both of which are engaged in providing outreach and support to older persons, by conducting phone calls with that patients to give them more socialization, making home visits, and running a Virtual Senior Center.  Specific interventions that could be utilized by the community resources to address this problem include community-based care of the type already described above: volunteers making home visits, teaching new skills or hobbies to the older persons, or providing them with access to new social situations that the older person can enjoy.
In conclusion, social isolation is an issue that older persons can face and that can cause depression, loneliness and withdrawal. Those at risk for isolation include older people suffering from a language barrier, living in unsafe neighborhoods, living alone, suffering from a disability, having a low socio-economic statues or being a member of a vulnerable group. A scale based on NSHAP data could be used to measure the extent to which the patient is suffering from social isolation. Specific interventions include making home visits, teaching the person to use the Internet, or engaging in reminiscence group therapy. Community resources like the Community Action Center and the Community-Based Care Facility would be useful community resources for addressing this problem.

References
Cornwell, E. Y., & Waite, L. J. (2009). Measuring social isolation among older adults
using multiple indicators from the NSHAP study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 64(suppl_1), i38-i46.
Elder, K., & Retrum, J. (2012). Framework for isolation in adults over 50. AARP
Foundation. Retrieved from
https://www.aarp.org/content/dam/aarp/aarp_foundation/2012_PDFs/AARP-Foundation-Isolation-Framework-Report.pdf
Landeiro, F., Barrows, P., Musson, E. N., Gray, A. M., & Leal, J. (2017). Reducing social
isolation and loneliness in older people: a systematic review protocol. BMJ Open, 7(5), e013778.
Liu, S. J., Lin, C. J., Chen, Y. M., & Huang, X. Y. (2007). The effects of reminiscence
group therapy on self-esteem, depression, loneliness and life satisfaction of elderly people living alone. Mid-Taiwan Journal of Medicine, 12(3), 133-142.
Tse, M. M. Y. (2010). Therapeutic effects of an indoor gardening programme for older
people living in nursing homes. Journal of Clinical Nursing, 19(7?8), 949-958.
White, H., McConnell, E., Clipp, E., Bynum, L., Teague, C., Navas, L., ... & Halbrecht,
H. (1999). Surfing the net in later life: A review of the literature and pilot study of computer use and quality of life. Journal of Applied Gerontology, 18(3), 358-378.
Woo, J. (2017). Designing fit for purpose health and social services for ageing
populations. International Journal of Environmental Research and Public Health, 14(5), 457.