The issue: Loneliness and social isolation among older adults.
Social isolation and loneliness are two issues that have been identified as common among older adults, including those living in long-term care (LTC) or retirement homes (Theurer et al., 2015). Indeed, estimates may be as high as half of all residents feeling lonely (Drageset, Kirkevold, & Espehaug, 2011). While loneliness is a subjective feeling often entailing a sense of despair, social isolation can be more objectively measured, for example by taking into account the frequency with which someone has contact with another person. However, both loneliness and social isolation can have negative impacts on health and well-being. Social isolation has been associated with lower life satisfaction (Hawthorne, 2006). Likewise, loneliness has been linked to higher levels of depression and even increased rates of mortality (Holt-Lunstad, Smith, & Layton, 2010).
One way to reduce social isolation and loneliness is through intervention programs that aim to help older adults build peer supports and social relationships, which in turn, can foster social engagement and social group identification. Some examples of such interventions are support groups, music-based interventions, reminiscence therapy, and video-conferencing (Landeiro, Barrows, Nuttall Musson, Gray, & Leal, 2017; Theurer et al., 2015). In contrast, passive care (i.e., activities that do not require residents to actively engage but instead solely be recipients of care) may be associated with increased feelings of loneliness and depression in older adults (Theurer et al., 2015). Indeed, a study conducted with socially isolated, older adults demonstrated that peer support—provided by the other residents and facilitated by a trained activities director—helped to improve physical health, lowered rates of depression, and increased social functioning (Kim, 2012). Another recent study also suggested that peer support may be associated with reducing the number of hospital readmissions among older adults with chronic medical illnesses and depression (Conner et al., 2018). Taken together, this research suggests that there are numerous benefits of setting up peer support programs for older adults who may be lonely and/or socially isolated.
My experience: The perspective of a 20-year-old.
This past summer I had the opportunity to work as a Research Assistant with Dr. Renate Ysseldyk in the Department of Health Sciences at Carleton University. One of the projects I worked on was a community-based research collaboration with the Ontario Centre for Learning, Research and Innovation in Long-Term Care (CLRI) at Bruyère, Riverstone Retirement Communities, and the Java Group Programs1. The Java Music Club is a weekly peer support group that encourages residents to socialize and to build meaningful connections with each other; it was created by Kristine Theurer, to help combat social isolation in long-term care and retirement homes. The program provides peer support in the form of conversation with other residents based on themes (e.g., gratitude) and coordinated music selections (e.g., “What a Wonderful World”). By talking about a different theme each week, the residents are able to form new connections and relate to each other about shared struggles or accomplishments. Every Tuesday morning this summer, I attended one of the Java Music Club group sessions with a lively group of seniors at Riverstone Retirement Communities.
Being 20, I don’t often think about what my life will be like when I’m older and retired. Right now, it’s hard to picture myself as 80 or 90 something and living in a retirement home. However, since all of us will eventually grow older, it is important to consider the social environments in which we will live as we age. As I have observed through this project, there are many activities available to residents who are living in residential care settings, but all activities are optional—thus, social interaction is also optional. Differences in personality dispositions (e.g., introversion vs. extraversion) notwithstanding, social isolation and loneliness can result among those who choose not to participate. Indeed, despite the busy activity calendars in many care homes, it is often the same few people who engage in those activities. Giving all residents the opportunity to participate in activities in which they feel comfortable is important, given previous research demonstrating that the quantity and quality of one’s social support networks are key social determinants of health. “Social determinants of health are factors that are influenced by where people live, such as income and social status, social support networks, education, gender, housing, and working conditions” (Raphael & Mikkonen, 2010).Maximizing residents’ opportunities to have supportive social networks within retirement homes is critical to maintaining health and well-being. This is important because many residents of LTC and retirement homes experience loneliness, which might be mitigated for some by increasing social support and building meaningful social networks. Social support, in turn, has also been shown to decrease morbidity and mortality rates(Uchino, 2006).
I do not have any mobility issues (and I am grateful for that), but many older (and some younger) people do. If my social network revolved around daily walks in the park with a group of my friends and then one day I fell and could no longer go on walks, I imagine I would feel quite lonely and isolated. The Java Music Club does not require a large amount of physical exertion, which is a plus. Members of the club meet once a week for an hour. They choose a theme for each week, coffee is served with a snack, and they talk and sing along to songs. Choosing a theme helps the residents to reminisce and share their emotions. Some of the themes have included creativity, grief, gratitude, and resentment. Sometimes they laugh; sometimes they cry. From what I have observed during meetings of the Java Music Club, the group has become quite close—they trust each other and know that if someone needs help they can count on their fellow group members.
The importance of social group identities.
Group memberships are important. Following in the tradition of social identity theory—which emphasizes the social, emotional, and cognitive value of being part of a group (Haslam et al., 2014;Tajfel & Turner, 1979)—much research has shown that sharing strong bonds with other group members can have a positive effect on well-being, including reduced loneliness and depression (Cruwys, Haslam, Dingle, Haslam, & Jetten, 2014; Jung, Gruenewald, Seeman, & Sarkisian, 2010; Ysseldyk, Haslam, & Haslam, 2013). One of the things that I looked forward to each week was listening to some of the members informally discuss the theme for the week as I helped to set up the materials for the group. Their shared experiences and common bond is what makes the program so great, giving them multiple opportunities to connect and relate even outside of the weekly Java Music Club sessions.
As a young person I’ve never really given much thought to the reasons many people in retirement and LTC homes may experience loneliness; however, working on this project has shown me some of them. In general, older adults tend to experience a decline in total energy levels (Manini, 2011).The Java Music Club is a great way to re-energize. Listening to music and engaging in social time is a wonderful way to start a morning. Others have lost a spouse, as is often the case as people get older. Suddenly, the person you have had by your side for decades is gone. Indeed, many older adults may experience an array of losses, especially as they move into retirement or LTC; they may also lose friends, experience a general decline in health, lose siblings, their independence, and their neighbors and community, all of which are important aspect of one’s life. The Java Music Club gives residents an opportunity to talk to others who may have experienced the same things. Indeed, some of the themes discussed during the Java Music Club were quite sensitive (e.g., loss) and brought up strong emotions, but this gave the group members a chance to be vulnerable with their emotions and to build trust with one another. By creating a supportive environment, the Java Music Club aims to increase emotional support from peers, which in turn strengthens social identity and can increase life satisfaction (Holt-Lunstad et al., 2010; Theurer et al., 2015).
Looking ahead
There are many ways that loneliness and social isolation can be alleviated in retirement and LTC homes. As mentioned above, the Java Music Club is one of the ways that peer support can be increased. However, there are also other intervention programs, of course, that also address these issues. The key to incorporating these programs appears to be involving the residents and encouraging active participation versus having residents simply participate passively (Theurer et al., 2015). Some of the health benefits of peer support are improved physical health, lower rates of depression, increased social identity, and increased quality of life (Holt-Lunstad et al., 2010; Kim, 2012). Indeed, there are many benefits of peer support, of which retirement and LTC homes can take advantage.
The main thing that I have learned from working on this project is that there is a lot more to think about as you grow older than seems obvious. Honestly, when I think about aging, I get scared that my body won’t work the way I want it to or that I won’t remember things as well. I don’t think about how I might be lonely or how easy it could be for me to become socially isolated. Social support and social interactions are important at every stage in life but can be even more important as we age. I only hope that when I get older I will be fortunate enough to have a strong social network of friends and family that I can count on. And no better time to start building those support networks than the present.
Written by Sarah Bickley-Gardner, Department of Health Sciences
1This project formed the basis of a group capstone project in the Health: Science, Technology, and Policy program, led by MSc students Victoria Bond, Edna Tehranzadeh, Margot Wallace, and Connie Wu. This project was also funded by a Knowledge Mobilization Partnership Grant from the Centre for Aging + Brain Health Innovation, and was supported by additional funding from Carleton University and the Government of Ontario through the Ontario CLRI.
References
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