Guest column: Long-term care/geriatrics
Help elderly clients conquer loneliness
By Ruth Shearer, RN, MS, MSN
Assistant Professor, Division of Nursing
Ruth Davidhizar, RN, DNS, CS, FAAN
Professor and Dean, Division of Nursing
Bethel College, Mishawaka, IN
Everyone experiences occasional bouts of loneliness. Even more common among the elderly, loneliness often contributes to depression and may lead to physical or cognitive decline in elderly clients.
Your elderly clients may experience loneliness in different situations. Many women outlive their spouses, and even when a spouse is alive, loneliness often enters the picture. Feelings of loneliness may occur when a spouse needs hospitalization, nursing home placement, or when a spouse becomes confused and unable to carry on a normal conversation. Similarly, your elderly client may experience loneliness during a hospital stay or during rehabilitation from an illness or injury.
Know the signs
Loneliness also can be a symptom of depression. Even as you consider developing a care plan to alleviate feelings of loneliness in your elderly clients, you must be alert to signs of clinical depression, including refusal to eat, diminished concern about personal appearance, and reluctance to make decisions.
Medical referral for clinical depression is imperative because there are medications and other interventions that effectively alleviate feelings of sadness and despair characteristic of clinical depression. (For a list of articles on depression assessment, see box, p. 67.)
Case managers must determine whether loneliness is a symptom of depression or an emotional state that can be changed. If you have ruled out clinical depression, teaching elderly clients the strategies outlined in this column may help them conquer loneliness and improve their quality of life.
1. Express and work through grief for lost loved ones. Everyone experiences loss. Feelings of loss, depression, anger, and grief must be spoken so that they can be left behind. Encourage your elderly clients to discuss the loss of loved ones. After a period of grieving, encourage your elderly client to reach out for new friendships, fresh experiences, and new kinds of activities.
Suggest community programs and support groups that can provide your elderly client an opportunity to meet other older adults with similar interests.
2. Get involved in new kinds of work and activity. Getting involved in new work and activities, paid or volunteer, opens new horizons for elderly clients. Provide your clients with a list of volunteer opportunities close to home. Encourage them to pursue hobbies, either new activities or ones they have enjoyed in the past. Research data suggest that activities offset the disenchantments that come when jobs are boring or lost, or even when a loved one dies.
3. Get involved in new relationships. Connect ing with others through mentoring, caring about them, and being involved in a meaningful way fosters feelings of contentment. Some suggestions for building meaningful, new relationships include returning to school, starting a new career, rediscovering creative pursuits, and traveling.
4. Learn new patterns of behavior. As individuals age, they experience a number of losses. In addition to the loss of loved ones, disabling illness, and boredom may lead to feelings of loneliness and depression. Learning a new skill provides challenges. It also helps create a positive mind-set in older adults. Ask your elderly clients about interests and suggest adult education classes and other activities that encourage them to master new skills.
5. Learn to live alone and like it. Family members and spouses leave or die throughout life. Each person will live alone at times. Living alone does not have to be lonely. Encourage elderly clients to live near family members and friends so they can be included in activities. Children enjoy interactions with older relatives through letter writing, telephone calling, and visiting.
In addition, suggest that family members send your elderly clients newspaper, clippings, coupons, photographs, and mementos of special events. Your clients may want to save some of these newspaper articles in a scrapbook highlighting family activities and accomplishments.
One of this column’s authors has an elderly aunt who lives alone. The aunt compiled scrapbooks over the years filled with newspaper clippings and other mementos she received from the author. The aunt sent those scrapbooks to the author, who was preparing to apply for a fellowship in the American Academy of Nurses. Many items in the scrapbooks became documentation of professional activities. The aunt was able to provide a unique service that promoted a professional career.
6. Change expectations and goals. Clients with the ability to change their expectations and goals with age are happier in later adulthood. Encourage elderly clients to identify and use qualities that may have lain dormant.
In addition, instead of waiting for children living out of town to visit, encourage elderly clients to regularly visit a homebound neighbor, friend, or member of their religious community. These visits will alleviate your clients’ loneliness and will give them a sense of purpose.
7. Cope creatively with stress. Individuals can choose their subjective mental state. For example, instead of acting devastated by a loss, an individual can choose to view it as a learning experience. That experience can be shared with others, thus turning a loss into something positive. The ability to bounce back following a stressful event and to maintain a positive attitude is an important protection against feelings of loneliness and despair.
8. Use reminiscence to enjoy the past. Reminiscence promotes ego integrity, pleasure, and hope. Personal reminiscence of pleasant memories produces pleasure and is useful in alleviating loneliness. Suggest that your elderly clients surround themselves with items from earlier, happier days.
Special items, such as a desk used by a spouse who has died, can bring pleasant memories into a room. Pictures of family members and friends serve as a symbolic representation of caring, provide meaning to life, and reduce feelings of loneliness. Pictures also stimulate discussion of personal pride that include personal and family accomplishments.
9. Seek help to deal with situational stress and change. Situational stresses, losses, and changes can cause temporary feelings of grief. Encourage elderly clients to seek support from a person who is an active listener, or be an active listener yourself. Simply having someone listen to their concerns may enable your elderly clients to cope more effectively.
Being heard also fosters an expectation of being helped. This expectation of help decreases anxiety, as well as feelings of loneliness. There is therapeutic value in discussing a problem. In addition, telling someone else, such as a case manager, care provider or family member, about a problem also may enable your client to begin solving it.
Case study: Edith
The case of a woman named Edith illustrates how many of the strategies discussed in this column alleviate loneliness in the elderly. Edith lost her husband when she was 70. This loss did not daunt her spirit. She remained active in her church and its women’s group activities.
Edith’s widowed sister moved in with her to provide companionship. The sisters traveled each summer from their home in Florida to a lake cottage in Indiana and then on to Pennsylvania to visit their children and grandchildren. Edith continued to be happy, concerned about others, and persistently invited family and friends to visit her Florida home.
At 78, Edith married a widower named Bill. Bill and Edith spent winters in Florida and summers in Indiana at the lake. They also traveled to Alaska, Hawaii, and across the United States. The couple invited family and friends to visit them in Florida. They made themselves available as hosts and tour guides.
When Edith was 92, her second husband died. The funeral was a celebration of the many positive relationships Bill had developed and the wonderful memories shared by Edith and Bill’s large extended family. At the funeral home, Edith continued to greet friends and family with warmth and enthusiasm and to invite them to visit her when they were in Florida. Edith and Bill conquered loneliness throughout their lives through the warm and positive relationships they maintained.
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