Person-centred Gerontological Care In Context Essay Sample

INTRODUCTION

People are social beings who desire long-lasting and fulfilling relationships (Savage et al., 2021). Individual's connection with others enables them to thrive and survive; however, as people age, the majority of them are alone more often than when they were younger, leaving them more vulnerable to social isolation and loneliness and related physical and mental health problems such as depression, cognitive decline and heart disease (Gardiner et al., 2018). Donovan & Blazer (2020) defined loneliness as a subjective negative feeling linked to a perceived lack of a wider social network (social isolation or absence of a given desired companion (emotional loneliness). On the other hand, social isolation entails an objective lack of social contacts and interactions with friends, family members, and the community. Over 1.4 million older people in the United Kingdom are lonely and socially isolated (Age UK, 2022). The picture above illustrates the emotions of an older man who is sad and lonely after the passing of his wife. He reminisces the beautiful time they shared as a family and feels emotionally and physically drained from his current state. According to Dury (2014), old adulthood allows people to break off from the daily pressures of work and family responsibilities, often perceived as an opportunity to rest and reflect on their lives. However, these moments could also lead to a more taunting past and further emotional and physical health issues. The essay will demonstrate an understanding of older adults' mental and physical health in relation to loneliness and social isolation.

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THE SOCIAL AND GENETIC PROPONENTS OF LONELINESS

World Health Organization (WHO) (2021) asserted that the primary causes of loneliness are social and genetic factors. According to Freedman & Nicolle (2020), the study of identical and non-identical twins confirmed that loneliness is 50% inherited, and 50% results from external social factors. The social factors entail past experiences with or from one's social settings. For instance, bereavement. Contrarily, genetic factors emerge as a result of the individual's unique qualities based on the personal traits they portray to the world around them (Poscia et al., 2018). Gardiner et al. (2018) affirmed that an individual's level of loneliness is influenced by their personal characteristics, including gender, chronic disease, and functional impairment, among others. Dury (2014) outlined that the social factors influencing loneliness include:

1. Bereavement:

According to Donovan & Blazer (2020), losing a loved one is the major course of intimate and relational loneliness. One may experience temporary or chronic loneliness depending on their levels of grief. Poscia et al., 2018) also affirmed that loneliness is a normal part of grief and is the most common aspect of losing a loved one. The death of a loved one often leaves a hole in people's hearts that can never be filled. The intense grief could lead to social withdrawal or isolation from the wider social networks. One could be in a room full of people but still, feel lonely; the feeling of loneliness due to bereavement is intense, unknown, and painful.

WHO (2021) argued that everyone will die at some point, and as people grow older, they will likely lose a loved one. However, people have different ways of overcoming their grief. This is mostly influenced by their age. For instance, a middle-aged widow or widower could overcome the loss of an intimate loved one by re-marrying; however, older people have difficulty overcoming their loss (Freedman & Nicolle, 2020). This is often because the majority of people within their social cycle or age group may have died, thus left with no one to confide in. in addition, old age is associated with failing organs and mobility issues, making it challenging for bereaved older people to perform activities which could support their efforts to alleviate the pain of losing a loved one (Cotterell et al., 2018). Furthermore, like grief, the loss could also emanate from separation, divorce, and mental illness, leading to loneliness and social isolation.

2. Life circumstances:

According to Poscia et al. (2018), humans could experience certain challenges or trauma that make them self-isolate and feel lonely. These life circumstances comprise poverty, remote location, unemployment, past abusive relationships, and lack of a constant place to call home. WHO (2021) indicated a direct correlation between low income and loneliness. People with low income often feel more excluded. Besides, other factors such as poor health, reduced mobility, sensory impairment, and cognitive impairment could increase the risk of loneliness.

Moreover, Beam & Kim (2020) added that besides genetics and social factors, certain structural factors could impede socialisation, leading to loneliness. For instance, a person living in a community full of crimes could choose social isolation and loneliness over the need for socialisation. Thus, the structural factors could include limited access to essential services, distrust of neighbours, and fear of criminals (Freedman & Nicolle, 2020). Social groups such as ethnic minorities, people with physical and learning disabilities, and long-term conditions are often poorly served by mainstream services, thus, increasing the risk of loneliness and social isolation. Furthermore, immigrants risk low social integration due to language and communication difficulties. Donovan & Blazer (2020) also pointed out that communities and societies that lack socio-economic resources, inadequate transport, limited education, poor housing, lack of access to digital technology, marginalisation, and ageism contribute to loneliness and social isolation.

3. Social media:

According to Savage et al. (2021), excessive use of social media is linked to loneliness. People spending most of their time on social media have inadequate time to associate with people in their physical spheres. Donovan & Blazer (2020) cited that older people feel lonely and socially isolated due to a lack of visitors and low-quality relationships with others. Age UK (2022) reported that about 12% of people aged over 65 do not spend time with their family, and about 17% of older people in the UK have less than weekly contact with friends, family, and neighbours. Loneliness exists across age groups, though not much prevalent among people below 65 years. The continued use of social media could lead to low self-esteem as one watches the lives of others, leading to more loneliness; however, older people with physical conditions such as blindness can hardly use social media to connect with their friends, while those of them that can use social media may feel low when seeing the lives of others (Dury, 2014). Hence, loneliness mostly affects the older generation and results from various social and genetic factors.

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THE IMPACTS OF LONELINESS ON THE WELL-BEING OF OLDER PEOPLE

Beam & Kim (2020) highlighted that social isolation is associated with elevated blood pressure, vascular resistance, impaired sleep, progression of Alzheimer's disease, alcoholism, depression, anxiety, cognitive decline, weakened immune system, obesity, poor physical health, and death.

According to WHO (2021), loneliness and social isolation are linked to about 30% increased mortality risk. However, Age UK (2022) argued that middle-aged adults experiencing loneliness and social isolation are at greater risk of premature mortality than older adults. Social isolation and loneliness are associated with risk factors for mental and physical health, such as lack of physical activity, obesity, smoothing and substance abuse, and poor access to health care services. Freedman & Nicolle (2020) reiterated that risk factors for premature mortality, such as obesity and smoking, are extensive in people experiencing loneliness and social isolation. According to Beam & Kim (2020), the components of social connections such as network participation, marital status, and network size affect the feeling of loneliness, thus, improving the quality of life.

Moreover, low-social connectedness is linked to higher healthcare utilisation and progression for patients with long-term conditions such as dementia (Savage et al., 2021). Fakoya et al. (2020) cited that low social support is also associated with increased hospital readmission rates and myocardial infarction mortality. Loneliness and social isolation in patients with heart failure are linked with frequent ambulatory and emergency room visits to the onset and disease course of other late-life health conditions such as neurocognitive disorders and depression (Newall & Menec, 2019).

Additionally, social isolation and loneliness impair older people's health and quality of life. Fakoya et al. (2020) claimed that loneliness and social isolation increase older adults' risk for physical health conditions such as stroke and cardiovascular disease and mental health conditions such as suicidal ideation and suicide, anxiety, cognitive decline, depression, and dementia. Steptoe et al. (2013) added that social isolation and loneliness could contribute to health conditions such as type-2 diabetes and high cholesterol and limit mobility and activities of daily living. It also increases the risk of abuse and violence against older people, thus worsening their quality of life.

The older man portrayed in the image above has a history of chronic heart disease and the death of his wife; after being married for 40 years found himself in chronic loneliness. This resulted from the high level of grief he feels and his inability to confide in anyone. He had also lost close friends before his wife died. These cumulatively increased his risk of developing physical and mental health conditions associated with loneliness, such as depression, organ failure, and cognitive decline. According to Savage et al. (2021), about 75% of older people have weak organs due to deterioration over the years. This makes them prone to severe chronic diseases, including social isolation and loneliness.

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REMEDIES TO THE SITUATION

The findings have demonstrated adverse physical and mental impacts of loneliness and social isolation along older adults, particularly people with chronic loneliness. Hence, various interventions could address and improve older people's health and well-being. Firstly, there are various activities and meet-ups that older people could be encouraged to attend to improve their involvement in society (WHO, 2021). These include classes and day centres, particularly tailored to meet the needs of people with dementia. In addition, older people should be aware of what is happening in their community. Since they are not avid internet or social media users, alternative approaches such as advertisements in local newspapers and direct mail marketing could be adopted to reach them (Beam & Kim, 2020). This will help improve their knowledge and access to medical and professional care immediately after they notice the likelihood of experiencing loneliness.

The health promotion programmes targeting members of the public could be used to help spot the warning signs of loneliness and social isolation and introduce older people to services available in their community, such as grief counselling groups (National Institute on Aging, 2019). Besides, the health sector is vital in identifying and directing older people at risk of or experiencing loneliness and social isolation. This allows the connector services to understand an individual's predicament and increase access to relevant services and interventions (Centres for Disease Control and Prevention (CDC), 2020).

Additionally, discussions should be encouraged among the public about loneliness and social isolation in people over 65 years who feel cut from society. According to Donovan & Blazer (2020), such discussions will encourage people to visit their elderly friends and family members frequently and direct them to safe places where they can socialise. Talking about the incidents, such as grief and family support, could help alleviate the feeling of loneliness. The Age UK has created a telephone befriending service, "Call in Time," for companionships (Beam & Kim, 2020). This allows older people to talk, listen, and share information and gain a feeling of belonging.

CONCLUSION

Retrospectively, working with older adults with mental health needs in a ward setting is enlightening. During my placement, I realised the negative impact of loneliness and social isolation on older adults. I noticed the need to develop therapeutic relationships with older adults, treat them with dignity and promote their safety and comfort. In addition, the reflection has enhanced my understanding of the need for a more collaborative approach to working with older adults with diverse physical and mental health needs,  with in-depth consideration of social interventions. In my future practice, I will enhance my language and communication skills to effectively recognise and assess loneliness in older adults and promote individuality when working with older adults. I will also be keen to identify and escalate care for conditions such as depression, anxiety, heart attack, dementia, and suicide ideation emanating from loneliness and social isolation.

References

Age UK. (2022). Loneliness research and resources. Available at: https://www.ageuk.org.uk/our-impact/policy-research/loneliness-research-and-resources/

Beam, C. R., & Kim, A. J. (2020). Psychological sequelae of social isolation and loneliness might be a larger problem in young adults than in older adults. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S58.

Centres for Disease Control and Prevention. (2020). Loneliness and social isolation linked to serious health conditions: Alzheimer's Disease and Healthy Aging.

Cotterell, N., Buffel, T., & Phillipson, C. (2018). Preventing social isolation in older people. Maturitas, 113, 80-84.

Donovan, N. J., & Blazer, D. (2020). Social isolation and loneliness in older adults: review and commentary of a National Academies report. The American Journal of Geriatric Psychiatry, 28(12), 1233-1244.

Dury, R. (2014). Social isolation and loneliness in the elderly: an exploration of some issues. British journal of community nursing, 19(3), 125-128.

Fakoya, O. A., McCorry, N. K., & Donnelly, M. (2020). Loneliness and social isolation interventions for older adults: a scoping review of reviews. BMC public health, 20(1), 1-14.

Freedman, A., & Nicolle, J. (2020). Social isolation and loneliness: The new geriatric giants: Approach for primary care. Canadian Family Physician, 66(3), 176-182.

Gardiner, C., Geldenhuys, G., & Gott, M. (2018). Interventions to reduce social isolation and loneliness among older people: an integrative review. Health & social care in the community, 26(2), 147-157.

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Newall, N. E., & Menec, V. H. (2019). Loneliness and social isolation of older adults: Why it is important to examine these social aspects together. Journal of Social and Personal Relationships, 36(3), 925-939.

Poscia, A., Stojanovic, J., La Milia, D. I., Duplaga, M., Grysztar, M., Moscato, U., ... & Magnavita, N. (2018). Interventions targeting loneliness and social isolation among the older people: An updated systematic review. Experimental gerontology, 102, 133-144.

Savage, R. D., Wu, W., Li, J., Lawson, A., Bronskill, S. E., Chamberlain, S. A., ... & Rochon, P. A. (2021). Loneliness among older adults in the community during COVID-19: a cross-sectional survey in Canada. BMJ Open, 11(4), e044517.

Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences, 110(15), 5797-5801.

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