David Ryan PhD C Psych Director of Education and Knowledge Processes Regional Geriatric Program of Toronto This module is part of the sfCare approach 2 PowerPoint Presentation 85 x 11 Poster ID: 929802
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Slide1
Loneliness
An introductory module for clinicians
David Ryan
, Ph.D. C. Psych
Director of Education and Knowledge
Processes,
Regional Geriatric Program of Toronto
Slide2This module is part of the sfCare approach
2
PowerPoint Presentation
8.5 x 11 Poster
Patient Handout
Slide3Identify 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
ObjectivesWhat is loneliness?
Loneliness and healthCase studySenior friendly approachDiscussion questions
ResourcesObjectives
Slide4What is loneliness?
Objectives
What is loneliness?
Loneliness and healthCase study
Senior friendly approachDiscussion
questionsResources
Classroom Poll
Lack of social contact with others
Feeling of being alone
Having a small number of social connections
Fear of living alone
Slide5What is loneliness?
ObjectivesWhat is loneliness?
Loneliness and health
Case studySenior friendly approach
Discussion questionsResources
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
Feeling
of being
alone
Perissinotto et al. 2019
Slide6Loneliness and health
Objectives
What is loneliness?Loneliness and health
Case studySenior friendly approach
Discussion questionsResources
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
Slide7Loneliness and older adults in Canada
ObjectivesWhat is loneliness?
Loneliness and healthCase study
Senior friendly approachDiscussion
questionsResources
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
Slide8More on loneliness and health
ObjectivesWhat is loneliness?
Loneliness and healthCase study
Senior friendly approachDiscussion
questionsResources
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
Slide9Let’s lessen loneliness in
7 steps
Objectives
What is loneliness?Loneliness and healthCase study
Senior friendly approach
Discussion questionsResources
Step 1 Screen for loneliness
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
Score
= sum
of all
items (max 9)
Higher
scores indicate greater
loneliness
.
Three-Item Loneliness
Scale
Hughes,
2004. Research on Aging.26(6):655-72
Slide10Let’s lessen loneliness in 7 steps
ObjectivesWhat is loneliness?
Loneliness and healthCase study
Senior friendly approachDiscussion
questionsResources
Step 2
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
Slide11Let’s lessen loneliness in 7 steps
ObjectivesWhat is loneliness?
Loneliness and healthCase study
Senior friendly approachDiscussion
questionsResources
Step
2 (cont.)
Side note:
What are the functions of reminiscence?
Evidence
suggests that reminiscence can be helpful for alleviating loneliness.
Narrative
Integrative
Instrumental
Transmissive
Escapist
Obsessive
Syed Elias Geriatr Nurs. 2015 Sep-Oct;36(5):372-80
Slide12Let’s lessen loneliness in 7 steps
Objectives
What is loneliness?
Loneliness
and health
Case studySenior friendly approachDiscussion questionsResources
Step 3
Look for factors that may be contributing to loneliness
Incontinence
Mobility
Sensory impairments
Etc.
Physical factors
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
Slide13Let’s lessen loneliness in 7 steps
ObjectivesWhat is loneliness?
Loneliness and healthCase study
Senior friendly approachDiscussion
questionsResources
Step
3 (cont.)
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
Slide14Let’s lessen loneliness in 7 steps
Physical Factors
Interventions for incontinenceTailored exercise regimen to enhance mobility
Sensory aidsFor more resources visit:
https://www.rgptoronto.ca/resources/
Mental FactorsTreatment for depression Referral to grief support groups
ObjectivesWhat is loneliness?Loneliness and healthCase studySenior friendly
approach
Discussion
questions
Resources
Step 4
Create a care plan to treat
physical and mental factors
Slide15Let’s lessen loneliness in 7 steps
ObjectivesWhat is loneliness?
Loneliness and healthCase study
Senior friendly approachDiscussion
questionsResources
Step
5
Write a social prescription to address social
factors
Social Factors
Referral to culturally appropriate community social programs
Consider activities for both outside and inside the
home
Complete a “
social
prescription” together with the older adult
rgptoronto.ca/resources
Slide16Let’s lessen loneliness in 7 steps
ObjectivesWhat is loneliness?
Loneliness and healthCase study
Senior friendly approachDiscussion
questionsResources
Step 6
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
Slide17Let’s lessen loneliness in 7 steps
ObjectivesWhat is loneliness?
Loneliness and healthCase study
Senior friendly approachDiscussion
questionsResources
Step 7
Follow up
the next time you see the older adult
Use the
Three-Item
L
oneliness
S
cale
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
Slide18Case study
Objectives
What is loneliness?Loneliness and healthCase study
Senior friendly approach
Discussion questionsResources
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
E
njoys
reminiscing about “the old country” before things turned badly
there
Has hypertension which is controlled with diuretics. Experiences urgency incontinence.
Slide19Case study
ObjectivesWhat is loneliness?
Loneliness and healthCase study
Senior friendly approachDiscussion
questionsResources
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?
Slide20Case study
Physical factors: urinary incontinence
Mental factors: unresolved grief
Social factors:
Language barriers contributing to cultural isolationExtroverted personality and craves more interaction with people than she is getting
ObjectivesWhat is loneliness?Loneliness and healthCase study
Senior friendly approachDiscussion questionsResources
Assess for factors that contribute to Anna’s loneliness
Slide21Case study
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 preferencesConsider alternative living arrangements
ObjectivesWhat is loneliness?Loneliness and healthCase studySenior friendly
approach
Discussion
questions
Resources
Strategies to mitigate Anna’s
loneliness
Slide22Case study
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 neededObjectivesWhat is loneliness?
Loneliness and healthCase studySenior friendly approach
Discussion
questions
Resources
Follow up about Anna’s
loneliness
Slide23The senior friendly approach
Ask leaders to remove barriers to care, and provide education for staff, patients and caregivers.
Loneliness is not due to age! Address this symptom as a health
issue.
Loneliness is linked to poor health outcomes. Not addressing this health issue may be unethical.
Remove physical barriers and add supports for social engagement (e.g. transportation, the use of technology)How all healthcare providers can address loneliness using a
senior friendly care approachObjectivesWhat is loneliness?
Loneliness
and health
Case study
Senior friendly
approach
Discussion
questions
Resources
Organizational Support
Emotional &
Behavioural
Environment
Ethics in Clinical Care and Research
Physical Environment
Processes
of Care
Organizational Support
Ethics in Clinical Care and Research
Processes
of Care
Emotional &
Behavioural Environment
Physical Environment
Slide24Discussion 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 healthCase studySenior friendly approach
Discussion questionsResources
Slide25References
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-XHolt-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.ObjectivesWhat is loneliness?Loneliness
and healthCase studySenior friendly approachDiscussion questionsResources
Slide26The 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