Risk of social isolation and resulting loneliness becomes increasingly more prevalent as we age, lose friends and family, and navigate chronic health conditions. Situational factors including diminished social and familial roles, together with physical limitations increase the incidence of isolation and loneliness. For individuals living with mental health challenges, the impact of loneliness can be devastating. Isolation coupled with mental health challenges may result in loss of social connectedness and purpose, as well as heightened symptoms and subsequent hospitalizations. Additionally, the prevalence of depression, anxiety, and myriad mental health diagnoses common among older adults suggests that we may be positioned for a large-scale crisis as our population’s median age continues to rise (Valtorta & Hanratty, 2012).
Older adults who experience isolation and loneliness are at greater risk for developing symptoms associated with dementia and cognitive decline as well as physical and emotional manifestations. Loneliness is associated with an increase in sleeplessness, eating disorders, suicidal ideations and attempts (Mann et al., 2017) all of which are associated with an increase in morbidity. Isolation places older adults at greater risk for experiencing elder abuse including: physical, emotional, financial abuse, and neglect. Elder abuse occurs less often when individuals are connected to their families, communities and social networks (Bonnie & Wallace, 2002).
Mental and medical health care providers are realizing the value in prescribing social interventions together with traditional therapies as a means to eradicate the symptoms associated with loneliness. Social interventions may include: continuing education, social day programs and supportive, caring friendships that encourage older adults with and without mental health challenges to remain engaged in their communities. Giummarra et al. (2007) interviewed health professionals together with older adults and found that social and emotional connectedness was strongly associated with overall health while the absence of those connections indicated an increase in physical symptoms.
Programs that provide social support, for example, seek to reduce isolation and loneliness for older adults who are living with a mental health diagnosis by providing companionship; supportive, caring friends are uniquely positioned to act as a catalyst between the individual and their community. Evaluations suggest that the supportive friend model holds value for older adults as a conduit for positive change. The supportive relationship claims to promote social connections that extend beyond the relationship and into the community, thus building a sustainable support network for the individual (Drury, 2014, p. 125-28). Additionally, individuals who visit their program friends regularly are likely to notice changes in behavior, health and/or personal hygiene, all of which might indicate that the person is experiencing a mental or physical health crisis. Social support programs, such as these, may provide training so that volunteers are able to identify potential problems, and report back to the organization for appropriate linkage and referrals.
Caring friends are often in a position to help strengthen an individual’s ties to their community by reintroducing them to activities they once enjoyed, or perhaps by sharing new experiences. Activity theory suggests that older adults who remain engaged in activities previously enjoyed, even with modifications, tend to experience full lives into and through late adulthood (R.J. Havighurst, 1961).
Humans need social connections. Whether they are one-to-one, in groups, or via technology, the supportive relationship aims to encourage personal growth and foster feelings of self-worth. As an option to face-to-face friendships, technology has been introduced as an effective means to communicate with isolated individuals. Telephone support, or “befriending” is a cost-effective tool for providing regular contact and encouragement for isolated older adults. A study by Cattan, Kime, and Bagnall (2010), demonstrated that telephone support not only alleviates loneliness but provides a sense of belonging, lowers stress and anxiety, increases confidence and encourages engagement not only with the caller, but with the community at large. Currently some programs are incorporating the telephone connection component as an alternative or bridge to in-person support. Additionally, isolated individuals may choose to provide support to others and experience the benefits of being a caring friend for someone else in need.
As important as meaningful conversation and relationships, continuing education opportunities for isolated older adults have been shown to increase feelings of self-efficacy and boost self-esteem (Merriam & Key, 2014). The authors stress that continuing education is a human right and knowledge empowers individuals to make critical decisions on their own behalf. For individuals who may be isolated, and perhaps living with mental health challenges, the educational experience can significantly reduce feelings of depression, helplessness, and may indeed promote a sense of belongingness. Furthermore, reduced symptoms can lead to a decrease in prescribed medications, fewer visit to the emergency room and fewer medical issues in general, together with a reduction in public expenditures.
How do we move forward and what can be done? We can be mindful and aware. If we identify an individual who may be isolated and lonely, we can call to let them know that we care, are thinking about them and that they matter. We can continue to support programs that provide caring friendships together with other social programs that address issues of loneliness among older adults and individuals living with mental health diagnoses. We can encourage others to volunteer to do the same. We can advocate for policy change and increased funding for all programs that support older adults with mental health diagnoses. By perpetuating the discussion around isolation and loneliness and that of mental health we can lessen the prevalence of isolation and subsequent loneliness among older adults living with mental health challenges.
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