Welcome Wisdom

Constructive Conversations: Understanding Isolation and Promoting Engagement

by Felicia Juntunen, MA, CMC, Director of Care Management

Continuing with our series on turning difficult topics in aging families into constructive conversations, this month we focus our attention on the problem of social isolation in older adults. Aging Life Care professionals have long recognized the profound impact of social isolation on the elderly- a reality that was sadly compounded by the Covid pandemic- but which shed light on its significance. Studies indicate that social isolation is equated with the same level of health risk as hypertension, obesity, and smoking. Social isolation also increases the risk of disability, depression, dementia, hospitalization, falls, neglect, and exploitation. Families are rightly motivated to understand causes and responses to isolation in their aging members.

 

Understanding the Causes of Isolation

Social isolation doesn’t emerge overnight—it’s often the result of accumulating challenges.

Common contributors to social isolation include:

• Physical decline
• Sensory or functional impairments
• Shrinking social networks
• Difficulty using modern technology

Many older adults experience isolation after the loss of a spouse or partner. Or, in caring for a partner the caregiver becomes isolated. Previous social networks may shrink as families relocate at a distance, and friends die or move. Seniors may experience vision and hearing loss, which can restrict driving and participation in preferred activities, and interfere with the use of technology. Incontinence issues may keep them close to home- fearful to be too far from a restroom. Management of medication and side effects may preclude other engagements. Poor balance and fear of falls or dependence on equipment like a walker may further compound isolation. Families who understand the potential causes of isolation can respond compassionately as they pursue conversation with their loved ones.

 

How to Respond with Compassion

A compassionate response in a conversation about the impact of isolation can include rephrasing or repeating what is shared without any judgement, allowing the older adult to know they were heard. For example, if they express that they no longer want to attend social activities because of hearing loss, avoid answering that hearing aids are the solution and instead reply that impaired hearing can make one feel lost in conversation. An empathetic response is more likely to draw out the conversation, reveal more reasons, and lead to more opportunities to work toward some kind of resolution. Isolation doesn’t usually occur suddenly, so conversations geared toward change are best given time to develop.

 

Care Managers as a catalyst for improved social engagement

Aging Life Care professionals, with their personal approach to client services, are poised to recognize social isolation and suggest interventions. ECM client, Harriet*, had lived in a quiet cul-de-sac for 10 years after her husband’s death. As her social circle of support also decreased, she began venturing out less frequently, often only to get groceries. Neighbors noticed she stopped attending community functions. Her son and daughter both lived in other cities, and although they talked on the phone with her regularly, she declined video calls, claiming it was confusing to use a cell phone or computer. They introduced a care manager who visited Harriet and gradually developed a rapport with her. Harriet enjoyed the one-on-one interaction, and the care manger was able to confirm concerns to her children– it was evident she was not eating properly, was suffering from depression, and possibly cognitive decline. The care manager was eventually able to introduce the idea of a move to an assisted living community, helping Harriet to accept the move in exchange for the value of spending time with others. Overall, her condition improved as she had access to better nutrition, more physical activity, and regular social contact.

*names have been changed to protect client identities