Social isolation and loneliness among older adults is a serious issue certain to grow with the population. Successful programs to combat it must employ multiple interventions to maximize the chances of social reintegration. One facility’s methods are described.
social isolation, loneliness, older adults, befriending intervention, health and social care provision, COVID-19, phone techniques
Social isolation and loneliness among older adults is a serious phenomenon affecting the fastest growing segment of the United States population. Causes of isolation are plentiful and well-documented, but a cure can be extremely elusive.
Most people have encountered a relative or colleague who has become increasingly socially isolated as they age, and whose health status has declined as a result. The reasons for increased social isolation can be the loss of a spouse; shrinking social circles that are common with aging; an injury that has caused self-consciousness or embarrassment; or even a pandemic, where social isolation is mandated. Regardless of the reason, a downward spiral set into motion by social isolation can gain momentum and cause serious health problems that could be difficult to overcome if the cycle is not broken.
Breaking this cycle does not have a “one size fits all” solution. Successful programs must be designed at the outset to employ multiple interventions seamlessly and naturally to maximize the chances of successful social reintegration and improved health.
One example of a successful multiple-intervention approach is the case of “John” in Virginia. John was lonely, depressed and socially self-isolated. He spent most days in bed, which further contributed to his existing sarcopenia (age-related muscle weakness) and balance issues. John was referred by his medical provider to a balance- and strength-training program run by physical therapists and kinesiologists. It is one of several common social isolation and loneliness interventions also known as a health and social care provision program (Gardiner, Geldenhuys, and Gott, 2018).
At the start, John was self-conscious and had low self-esteem; he dreaded leaving his house, so he did not schedule an appointment to go into the facility as recommended. This is not an uncommon occurrence when dealing with an older, lonely clientele. The staff at the facility began to call him regularly and carefully and slowly develop a friendly relationship, using befriending intervention techniques (Gardiner, Geldenhuys, and Gott, 2018).
‘With the strength and confidence he had developed, John has begun antique shopping at local galleries.’
Employees at this facility are carefully selected and trained in communication methods with older, socially isolated adults. Eventually the employees developed a relationship with John and convinced him to come into the facility to spend time with the friendly staff that he had met on the phone, with no commitments or expectations beyond socialization.
John had spoken with several staff members over the phone by this time, with conversations ranging from television program likes and dislikes to sports and family. Finding some commonality is important in this early phase. While John was at the facility, the staff continued to further develop their budding relationship. Staff then began to introduce John to several other program participants with whom staff had identified pre-existing commonalities. Eventually additional friendships developed through this social facilitation (Gardiner, Geldenhuys, and Gott, 2018).
This facility also uses incentive techniques—in which members receive prizes for attaining specific goals—to induce members to build healthy habits (such as regular attendance) and participate in various programs available at the facility. This is done to identify other potential interests in the hopes of assisting participants with leisure activity and skills development (Gardiner, Geldenhuys, and Gott, 2018).
Potential interests include dance, social media, movies, yoga, Tai Chi, and Pilates, among others. John rapidly became fully involved with several programs and other offerings at the facility. He also began to develop an interest in antiques, with the encouragement of his new friends. And, while John was involved with activities at the facility, he completed the balance- and strength-training program to which he was originally referred. With the strength and confidence he has developed, John has begun antique shopping at local galleries. He illustrates successful social reintegration and the need to use multiple interventions to attain that success.
This period of social distancing due to COVID-19 has only exacerbated the problems of social isolation and loneliness. Many avenues of social interaction and connection have been cut off out of necessity. Finding ways to reduce social isolation while social distancing has created new challenges. Adapting phone techniques to include befriending intervention has shown to be an effective way to bridge the physical distancing gap. These adapted phone calls have been employed with much success, as demonstrated by our ability to establish recurring phone calls with clients, engaging them in meaningful discussion.
These phone calls are extremely helpful in keeping people socially connected, but offer much more than just socialization. They can be used to identify those who cannot get out of the house to shop for food, and then arrangements can be made for food delivery. They can be used to help transfer prescriptions to mail-order options or convert healthcare appointments to telehealth visits. These calls can literally be lifesaving.Social isolation can have lasting and devastating effects, particularly in the older adult population, but employing multiple-intervention approaches as explained above has proven to be effective in reversing those effects, both physically and mentally. Mandated social distancing has made the need for this kind of innovative socialization even more vital.
Sheldon Zinberg, MD, is chairman emeritus and senior wellness advisor at Encore Wellness, and Mike Merino is president and CEO of Encore Wellness in Fullerton, California.
Gardiner, C., Geldenhuys, G., and Gott, M. 2018. “Interventions to Reduce Social Isolation and Loneliness Among Older People: An Integrative Review.” Health & Social Care in the Community 26(2): 147–57.