Download
loneliness n.
Skip this Video
Loading SlideShow in 5 Seconds..
Loneliness PowerPoint Presentation

Loneliness

272 Views Download Presentation
Download Presentation

Loneliness

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Loneliness An introductory module for clinicians David Ryan, Ph.D. C. Psych Director of Education and Knowledge Processes, Regional Geriatric Program of Toronto

  2. This module is part of the sfCare approach Patient Handout 8.5 x 11 Poster PowerPoint Presentation

  3. Objectives Identify 5 negative health outcomes that are associated with loneliness Detect loneliness using a structured approach Apply general strategies to limit loneliness Apply a senior friendly approach to loneliness Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources

  4. What is loneliness? Classroom Poll Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources • Lack of social contact with others • Feeling of being alone • Having a small number of social connections • Fear of living alone

  5. What is loneliness? • Feeling of being alone Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources • The subjective feeling of being alone (perceived isolation) • The distress that results from discrepancies between ideal and perceived social relationships • Loneliness and social isolation are related but not the same Perissinotto et al. 2019

  6. Loneliness and health Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources Why a clinical module on loneliness in older adults? • Evidence suggests that loneliness may have a direct negative impact on health outcomes • Because of the complexity of an older adult’s loneliness, an accurate assessment and a prescriptive approach is needed • Healthcare providers have a unique opportunity to identify and address loneliness in older adults

  7. Loneliness and older adults in Canada Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources • 1.4 million older adults (25% of men and 40% of women) say they are lonely • Living alone is a risk factor for loneliness and almost half of older adults who live alone report feeling lonely • Bereavement is a common cause of loneliness and its impact might be compounded by grief Statistics Canada, Catalogue no. 82-003-X

  8. More on loneliness and health Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources • Loneliness is as bad for health as smoking 15 cigarettes a day • Loneliness increases risk of mortality by 29% • Loneliness is associated with dementia, heart disease, and depression Holt-Lunstad, PLoS Med. 2010;7(7):e1000316 Holt-Lunstad, Perspectives on Psychological Science. 2015;10(2) 227–237 Fratiglioni, 2000. Lancet. 355(9212): 1315-9

  9. Let’s lessen loneliness in 7 steps Three-Item Loneliness Scale • How often do you feel that you lack companionship? • 1 – Hardly ever • 2 – Some of the time • 3 – Often • How often do you feel left out? • 1 – Hardly ever • 2 – Some of the time • 3 – Often • How often do you feel isolated from others? • 1 – Hardly ever • 2 – Some of the time • 3 – Often Step 1 Screen for loneliness Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources Score = sum of all items (max 9) Higher scores indicate greater loneliness. Hughes, 2004. Research on Aging.26(6):655-72

  10. Let’s lessen loneliness in 7 steps Step 2 Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources • Take a moment to tell the older adult your name • Let the older adult know that you remembered their earlier comments • Allow time for silence and reflection • If the conversation turns to the past it can be helpful to think about the functions of reminiscence If loneliness is identified, use active listening skills

  11. Let’s lessen loneliness in 7 steps Step 2 (cont.) Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources Narrative Integrative Side note: What are the functions of reminiscence? Evidence suggests that reminiscence can be helpful for alleviating loneliness. Instrumental Transmissive Escapist Obsessive Syed Elias Geriatr Nurs. 2015 Sep-Oct;36(5):372-80

  12. Let’s lessen loneliness in 7 steps • Incontinence • Mobility • Sensory impairments • Etc. Physical factors Step 3 Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources Look for factors that may be contributing to loneliness • Cognitive impairments • Depression • Grief • Etc. Mental factors • Social identity • Isolation • Etc. Social factors Statistics Canada, Catalogue no. 82-003-X Boss L. Int Psychogeriatr. 2015 Apr;27(4):541-53 Hoogendijk EO. Maturitas. 2016 Jan;83:45-50

  13. Let’s lessen loneliness in 7 steps Step 3 (cont.) Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources Side note: What is meant by social identity? An older adult may experience loneliness because of their place or position in history or society. Example: An older adult who is a newcomer to Canada and has English as a second language may have a unique experience of loneliness. Henslin, J. M., & Nelson, A. (1997). Essentials of sociology

  14. Let’s lessen loneliness in 7 steps • Physical Factors • Interventions for incontinence • Tailored exercise regimen to enhance mobility • Sensory aids • For more resources visit: https://www.rgptoronto.ca/resources/ • Mental Factors • Treatment for depression • Referral to grief support groups Step 4 Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources Create a care plan to treat physical and mental factors

  15. Let’s lessen loneliness in 7 steps • Social Factors • Referral to culturally appropriate community social programs • Consider activities for both outside and inside the home Step 5 Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources Write a social prescription to address social factors Complete a “social prescription” together with the older adult rgptoronto.ca/resources

  16. Let’s lessen loneliness in 7 steps Step 6 Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources • Actively involve the older adult in creating their plan of care; allowing them choice / control over the treatment options that meet their preferences. • Allowing for control over the type and duration of social activity as well as finding ways to optimize predictability of the social activity is especially important. Find ways to optimize predictability and control Schulz R J Pers Soc Psychol. 1976 May;33(5):563-73 Priddy (1982) Educational Gerontology, 8 (5), pp. 507-518

  17. Let’s lessen loneliness in 7 steps Step 7 Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources • Follow up the next time you see the older adult • Use the Three-Item Loneliness Scale again • Reassess for the factors that may be contributing to persistent loneliness • Consider referrals to counseling or psychotherapy if loneliness continues Reassess after a period of time

  18. Case study • Anna is an 83 year old who emigrated from her home country as a young adult, during a time of social unrest • Speaks very little English • Lost her husband 20 years ago, and has lived alone since • Does not drive but walks to church every week • Has a large and close knit family who check in on her regularly • Enjoys reminiscing about “the old country” before things turned badly there • Has hypertension which is controlled with diuretics. Experiences urgency incontinence. Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources

  19. Case study Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources Anna has told you she is very lonely and sometimes cries herself to sleep. Her daughter who has accompanied her to her appointment is surprised to hear this. How can we lessen Anna’s loneliness?

  20. Case study Assess for factors that contribute to Anna’s loneliness Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources • Physical factors: urinary incontinence • Mental factors: unresolved grief • Social factors: • Language barriers contributing to cultural isolation • Extroverted personality and craves more interaction with people than she is getting

  21. Case study Strategies to mitigate Anna’s loneliness Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources • Active listening and supporting narrative reminiscence • Assess and treat urinary incontinence • Suggest grief counselling • Inquire if the family can visit more often, do longer visits, and create a visiting schedule based on Anna’s preferences • Consider alternative living arrangements

  22. Case study Follow up about Anna’s loneliness Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources • Anna appreciated being listened to every time she told her stories • The care plan for her urinary incontinence has shown excellent results • She declined grief counselling – she said that God is her counsellor • A teenage grandchild moved in with her, which provided a relationship that they both very much needed

  23. The senior friendly approach How all healthcare providers can address loneliness using a senior friendly care approach Ask leaders to remove barriers to care, and provide education for staff, patients and caregivers. Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources Organizational Support Organizational Support Loneliness is not due to age! Address this symptom as a health issue. Emotional & Behavioural Environment Emotional & Behavioural Environment Processes of Care Processes of Care Loneliness is linked to poor health outcomes. Not addressing this health issue may be unethical. Ethics in Clinical Care and Research Ethics in Clinical Care and Research Remove physical barriers and add supports for social engagement (e.g. transportation, the use of technology) Physical Environment Physical Environment

  24. Discussion questions • What is one thing you can do differently in your practice as a result of reviewing this module? • What are your barriers to creating a care plan for loneliness? • What strategies have you used to lessen loneliness in your patients? Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources

  25. References Perissinotto C, Holt-Lunstad J, Vyjeyanthi S, Convinsky K. A Practical Approach to Assessing and Mitigating Loneliness and Isolation in Older Adults. JAGS. 2019 Feb 14. doi: 10.1111/jgs.15746. Urinary incontinence and loneliness in Canadian seniors. Health Reports, Vol. 24, no. 10, pp. 3-10, October 2013 • Statistics Canada, Catalogue no. 82-003-X Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316. Holt-Lunstad J, Smith TB, Baker M. Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review. Perspectives on Psychological Science. 2015;10(2) 227–237. Fratiglioni, L., Wang, H.X., Ericsson, K., Maytan, M. & Windblad, B. (2000). Influence of Social Network on Occurrence of Dementia: A Community-based Longitudinal Study. Lancet. 355(9212): 1315-9 “A Short Scale for Measuring Loneliness in Large Surveys: Results from Two Population-Based Studies” by Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT, 2004. Research on Aging.26(6):655-72 Syed Elias SM, Neville C, Scott T.. The effectiveness of group reminiscence therapy for loneliness, anxiety and depression in older adults in long-term care: a systematic review. Geriatr Nurs. 2015 Sep-Oct;36(5):372-80. Boss L, Kang DH, Branson S. Loneliness and cognitive function in the older adult: a systematic review. Int Psychogeriatr. 2015 Apr;27(4):541-53. Hoogendijk EO, Suanet B, Dent E, Deeg DJ, Aartsen MJ. Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam. Maturitas. 2016 Jan;83:45-50. Henslin, J. M., & Nelson, A. (1997). Essentials of sociology: A down-to-earth approach. Scarborough, Ont: Allyn and Bacon. Schulz R. Effects of control and predictability on the physical and psychological well-being of the institutionalized aged. J Pers Soc Psychol. 1976 May;33(5):563-73. https://www.ncbi.nlm.nih.gov/pubmed/1271225 Priddy, J., Teitelman, J.L., Kivlighan, D.M., Fuhrmann, B.S. Overcoming learned helplessness in elderly clients: Skills training for service providers (1982) Educational Gerontology, 8 (5), pp. 507-518. Objectives What is loneliness? Loneliness and health Case study Senior friendly approach Discussion questions Resources

  26. The sfCare Learning Series received support from the Regional Geriatric Programs of Ontario, through funding provided by the Ministry of Health and Long-Term Care. V1 July 2019