Diagnosing Social Isolation And Loneliness In Older Adults And Its Effects On Mental Health
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Social isolation can happen when an individual withdraws from society to the point that they rarely or never have contact with other human beings. This type of isolation can contribute to physical and mental health challenges such as depression, impaired immunity, poor sleep quality, and accelerated cognitive decline. A variety of situations may cause a person to become socially isolated, potentially including adverse childhood experiences, grief, unemployment, substance use disorder, and transportation challenges. Social media often contributes to the isolation many feel today. Therapy, whether online or in person, can be one way to effectively address social isolation and begin to reintegrate into society.
What is social isolation?
Social isolation can affect people of all ages, but it often seems to affect those with a lifelong pattern of being isolated or having very few friends. When someone is isolated from most of society, they may confine themself to their home and minimize contact with family or friends. This can become a pattern in the face of potentially stressful or overwhelming social or environmental situations, so an individual may learn to avoid interaction as it can become uncomfortable over time.
Social isolation can be a chronic condition that may affect a person's general perspective and potentially every aspect of their existence. Personality disorders or traits of such disorders can appear, including the need to avoid others, low self-esteem, and suicidal thoughts and actions*. Recently, social isolation may be as risky for overall health as obesity or smoking.
*If you or someone you know is experiencing suicidal thoughts, help is available. You can contact the 988 Suicide & Crisis Lifeline 24/7 at 988.
Effects of social isolation and loneliness in older adults
According to research, loneliness can be a serious health risk, and people who live in perpetual social isolation may be twice as likely to die prematurely. The risk can be heightened when an isolated individual is elderly. Loneliness may be more harmful to health than obesity, in terms of statistics, and it may be as harmful as smoking tobacco.
Physical ailments and other mental health issues can stem from isolation.
Effects of social isolation and loneliness on mental health
- Depression
- Poor sleep quality
- Impaired executive function
- Accelerated cognitive decline
- Poor cardiovascular function
- Impaired immunity
- Increased risk of premature death
What are the causes of social isolation?
Social isolation can be caused for many genetic and environmental reasons. For example, in an abusive relationship*, it’s possible that partners who want full control may isolate the other person from everyone they know.
Aside from willful isolation (including the potentially unhealthy desire to avoid people, which is sometimes indicative of Avoidant Personality Disorder), other causes of isolation may include:
- Childhood trauma and verbally or emotionally abusive parenting
- Personality disorders
- Autism spectrum disorder (ASD)
- Loss of a spouse
- Transportation challenges (i.e., no car or no driver’s license)
- Unemployment
- Substance use disorder
How can living alone contribute to social isolation?
Living alone can contribute to social isolation, and statistics seem to agree that more people are generally living alone these days, which can mean that more people may be experiencing the effects of social isolation. Missing events, even if it's by accident, can have a negative effect on a person and potentially cause a chain reaction of avoiding other events.
Diagnosing social isolation in older adults in nursing homes
A social isolation in nursing diagnosis generally refers to attitudes that can develop because of poor nursing home care. When patients are admitted to a nursing home or assisted living facility and lack a strong community of friends and family to interact with, they may deteriorate quickly. Not only does visiting with family often help to keep them mentally and physically healthy, but the nursing home community can institute a social isolation care plan to make sure each resident gets plenty of association and emotional stimulation.
Lastly, someone may deliberately avoid people because of the discomfort they may feel, the perceived level of danger involved, or the emotional labor that can come from being around people. This attitude often develops following negative encounters in which other people are rude, hostile, or critical. Social isolation, while it may be unpleasant, can be viewed as less stressful than trying to coexist with others.
Social media’s effects on isolation
The internet and social media seem to have permanently changed the ways people interact with one another in society. Now we may have what could be referred to as “surrogate emotional connections”. In other words, we tend to engage virtually via technology without necessarily connecting with in person.
Social interaction stimulated by mobile phones may not be genuine
Mobile phones and tablets may simulate interaction thanks to webcams and microphones, but do these interactions qualify as genuine human connections? Many psychologists may say no and quote rising rates of social isolation and depression. Tests quoted in Science Direct revealed that even “socially active” web users often felt socially isolated. In many cases, the more addicted a person is to social media, the higher their degree of unhappiness may be.
Social media can still make individuals feel unhappy and isolated
Social media content often preys upon the common need to fit in, promotes certain brands and social causes, and can leave many individuals feeling abandoned. Individuals may only get the attention they crave when they refer to popular topics or even express unpopular, controversial ideas.
Social networking can cause stress and misunderstandings
For many people, social networking can cause great stress, even among family. One reason for this could be that we are usually more likely to misread statements or say things we wouldn't say face-to-face over an electronic device.
If people feel they are not conforming to cultural standards of acceptable interaction, they may ostracize themselves to avoid further pain and rejection. Ostracism can lead to physical pain and increase stress hormones. This can eventually affect the sleeping cycle and wreak havoc on a person’s physical health, especially if that person is elderly, since they may be more susceptible to physical and cognitive decline after retirement age.
When we are socially active, we typically use most of our resources to process external stimuli. However, when our surroundings and environments become routine, these processes may be turned inward. We might become introspective and dwell on upsetting thoughts. Some even speculate that social isolation could enhance anxiety and paranoia.
Social media can expose a person to potentially disturbing posts
Technology and social isolation may not be the perfect match they’re often depicted to be in the media. An addiction to virtual companionship may enhance social isolation symptoms in some people. Social media sites like Tumblr and Instagram can feature potentially disturbing posts from users who may hyper-focus on themes involving depression and suicide. New social phenomena, like cyberbullying, can lead to tragic consequences, sometimes even including teen suicide.
While positive online interactions can enhance someone’s self-concept, a surrogate community on its own may not be an acceptable substitute for real, in-person interaction. It can be overwhelming to think about venturing outside of one’s comfort zone and into the “real world,” but the risks of doing so may provide more benefits than remaining indoors and untethered to the outside community.
Therapy can address social isolation and improve mental health
Getting professional help from a licensed therapist may save someone's life, or at the very least, help them break away from depressive habits.
The first step can be reaching out to someone. The advantage of an online therapy platform may be that you can decide the days and hours that are best for you. Online chat, video chat, and phone call options may be available for you. If you have a hard time socializing and communicating with others, you may initially feel more comfortable speaking to a therapist by typing out your thoughts and feelings.
Online therapy can be an effective method for treating social isolation and other symptoms of loneliness. In one study of older adults during the COVID-19 pandemic, online interventions were found beneficial in helping the adults overcome social isolation. In addition, online therapy is generally shown to have the same efficacy rate as traditional in-office therapy.
Takeaway
How can you assist someone showing signs of social isolation or loneliness?
One of the most significant ways to help someone showing signs of loneliness is to engage them in positive social contact. It is important to notice that loneliness and social isolation are not the same thing. Social isolation is objective and measurable, defined as the number of social encounters a person has had within a given timeframe in everyday life. On the other hand, loneliness is subjective and refers to a person’s dissatisfaction with the quality or quantity of their social relationships.
Social isolation can be remedied if a person engages in social encounters with others, but that won’t necessarily help loneliness. The person needs to experience positive interactions where they feel listened to, accepted, and reassured. Therefore, helping someone showing signs of loneliness not only means interacting with them but also ensuring that the interaction is positive and supportive. Helping a person expand their support system and have more positive social interactions is likely to reduce their feelings of loneliness and social isolation.
How are social isolation and health linked to one another?
According to the Centers for Disease Control and Prevention, loneliness increases a person’s risk of premature death from all causes. It is a risk that is on par with smoking cigarettes, being severely overweight, or being physically inactive. Evidence suggests that heart disease and stroke risk substantially increase in lonely people. In the elderly, social isolation is associated with around a 50% increased risk of dementia. Mental health is also affected; loneliness is associated with a heightened risk of depression, anxiety, and suicide.
What is the Nanda nursing diagnosis “risk for loneliness?”
The Nanda diagnosis “risk for loneliness,” diagnostic code 00054, states: “At risk for experiencing a decreased sense of connectedness with self and/or others, which may lead to negative effects on emotional and physical well-being.” This social isolation nursing diagnosis is made when a patient’s feelings are disturbed due to the emotional weight of loneliness. Nursing interventions include providing supportive care, encouraging socialization, teaching positive coping skills, and encouraging self-exploration. Nurses are in an ideal position to enhance their therapeutic relationship with their patients by encouraging them to combat their lonely feelings.
How can social isolation or loneliness affect mental health?
Evidence suggests that most humans have a fundamental “need to belong” that is closely related to mental health. Loneliness is often defined as an absence of belonging or a sense of isolation, even if a person experiences a typical amount of social encounters. One study investigating the mental health impact of loneliness found that the adverse effects can be substantial. Participants were split into two groups: one reporting significant loneliness and the other reporting no loneliness.
Results suggested that more than half of the participants reporting loneliness became depressed, compared to 5% in the non-lonely group. The lonely group also experienced a steep rise in suicidal ideation, with 42% of lonely participants reporting some type of suicidal thoughts during the study. Anxiety and panic symptoms also increased substantially.
What interventions and strategies reduce social isolation and loneliness?
The primary intervention for loneliness is positive social interaction. Healthcare professionals also encourage using positive coping strategies and self-exploration to reduce the severity of the impact of loneliness. It is important to remember that the major risks come from loneliness, not necessarily from social isolation, and reducing social isolation may not eliminate feelings of loneliness.
Loneliness is subjective, while social isolation is objective. One can objectively increase the number of social encounters they experience, but that alone may not reduce negative feelings associated with loneliness. Combatting loneliness typically requires close connections and strong social connections, and it may be helpful to introduce social skill development strategies and interventions for communication skills to aid in developing meaningful relationships. Support groups and other group-driven interventions are also likely to be beneficial.
Are people who experience social isolation more susceptible to physical and mental illnesses?
Social isolation and loneliness increase the risk of physical and mental illness significantly. Facts from the Centers for Disease Control and Prevention indicate that social isolation increases the risk of heart disease, type 2 diabetes, addiction, dementia, and premature death. Evidence suggests that health risks are on par with smoking cigarettes, a sedentary lifestyle, or severe obesity.
The mental health risks of isolation and loneliness are also significant. Evidence suggests that loneliness increases the risk of anxiety, panic disorders, depression, and suicidal ideation. Those who are lonely tend to struggle with socializing, and they may benefit from interventions for social skills that allow them to build meaningful relationships with others.
What is the correlation between social isolation and loneliness?
Loneliness and social isolation are commonly used interchangeably but are not synonymous. Social isolation refers to the amount of social encounters a person experiences within a certain timeframe. It is objective and readily measured. Loneliness, on the other hand, refers to a person’s internal impressions about the quality and quantity of their social relationships. It is highly subjective and personal; some people may feel fulfilled with very few social interactions, and others might struggle with feelings of loneliness even if they have many social encounters.
How is diagnosing social isolation and loneliness done?
To diagnose someone's emotional well-being and tell whether he is socially isolated, health professionals will use several tools such as interviews and questionnaires. They will also assess the person’s behavior and check for other mental health conditions like depression or anxiety.
How to tell if older adults are isolating themselves?
There are several ways to tell if someone is isolating themselves. Watch out for some signs like suddenly avoiding friends not having conversation like they used to. You will also notice other changes in how they act, like spending too much time by themselves, skipping hobbies they used to love, or not caring about social events.
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