Are Your Older Patients at Risk for Isolation?

  1. Our goal is to ensure elderly patients are healthy enough to return safely home, but what happens once they get there and they’re home alone? Even if they’re physically able to care for themselves, many elderly patients are isolated due to physical limitations and reduced social interaction. This isolation can result in increased physical and mental health risks. Identifying risks and educating elderly patients and their families about available opportunities may help reduce their isolation.

    Are Your Older Patients at Risk for Isolation?

    As we age, most of us experience cognitive and physical losses. This could include chronic health issues that impede our ability to complete everyday tasks, or ones due to sensory issues with hearing, speech, or mobility. As nurses, we're often assessing for losses associated with physical decline that may impede the patient's ability to live independently, although many of our patients may be affected by losses that may not be visible. The loss of family and friends through death or distance, the physical inability to continue with hobbies or activities that once brought joy, or retirement from a career are just a few things that can take a toll on our patient's perception of self-worth, or result in increased isolation.

    Isolation can contribute to poor mental health, cognitive decline, a lower quality of life, and potentially premature death. Studies have discovered links between social isolation and depression and indicated that older patients that suffer from isolation may result in increased significant health risks. Taking the time to ask specific questions, educating family and caregivers, and offering alternate methods of socialization may help identify, or reduce, an older patient's feelings of isolation.

    Isolation vs. Loneliness

    Although studies may not always differentiate the terms isolation and loneliness, and occasionally the terms may be used interchangeably, they're not the same. Someone can be socially isolated but not feel lonely, while someone may not live alone, or live in a personal care home, or have a large social network and still suffer from loneliness. Loneliness is more subjective and can be related to someone's perception, a fear of rejection, or feelings of low self-worth, and can correlate with depression.

    Regardless of whether someone is at risk, or suffering, from social isolation or loneliness, both can contribute to higher risks for mortality. The lack of social relationships has been determined to potentially:

    • Increase mortality risk factors to be comparable to those from smoking, obesity and lack of physical activity
    • Increase risks of elder abuse
    • Result in delayed discharge, or increased costs of care due to lack of family support

    Detecting Feelings of Isolation

    A patient may not admit to feelings of isolation, and their distress may not be obvious. If adult children or caregivers don't live nearby, encourage them to get to know their parent's friends and neighbors. Request that they alert them if they notice changes or unusual behavior in their older loved ones.

    Ask the patient about:

    • Their perception of emotional closeness to family and friends
    • Recent losses
    • Whether they ever feel left out, isolated, or that they lack companionship

    Be sure to be alert for other signs and symptoms of other mental health risks of depression, or suicidal ideation, and treat or refer appropriately.

    Social Solutions

    Educate patients and family about methods to decrease isolation through use of technology to stay in touch through phone calls, email or Skype. Don't assume that all seniors aren't comfortable with using technology. The wide variety of available tools and technology can help to remotely enhance social support for patients.

    Work on changing maladaptive perceptions by encouraging reminiscing about the patient's personal accomplishments, and suggest ways to continue to gain feelings of accomplishment or purpose. Look for ways to highlight, or share their knowledge. Consider the patient's interest and encourage them, or their family, to explore other methods to decrease feelings of isolation or an increased sense of purpose such as by:

    • Adopting a pet that meets the patient's physical capabilities to care for such as a fish, bird, dog, or other animal that can help provide an increased sense of purpose
    • Revive a love of gardening with a small indoor herb garden, or a fairy flower garden
    • Becoming a foster grandparent and serve as a mentor, role model or a friend to children with exceptional needs to share their experience, hobbies, and compassion
    • Volunteering to gain a more positive outlook through their contributions
    • Virtual Senior Centers offer seniors the opportunity to learn, connect and participate online using webcams when they can't physically travel to a senior center
    • Adopt-a-Grandparent is a program where seniors in assisted living facilities or nursing homes are paired with a teenager or college student to experience co-mentoring

    Enhancing Those Golden Years

    We may often speak of the golden years without considering that they may be tarnished with feelings of loneliness or isolation that can result in higher mortality risks. Educating our patients and family about increasing awareness of isolation, and potential ways to decrease this, might help make those golden years a little less lonely.

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    About Maureen Bonatch MSN, BSN, RN

    Maureen Bonatch MSN, RN draws from years of experience in nursing administration, leadership and psychiatric nursing to write healthcare content. Her experience as a fiction author helps her to craft engaging and creative content. Learn more about her freelance writing at and her fiction books at

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  3. by   traumaRUs
    Thanks Maureen!

    As someone who works with chronically ill patients, isolation is real. i work in rural America where sometimes its only caregivers that see a pt. Makes me sad!
  4. by   Maureen Bonatch MSN
    My area is also pretty rural, so we encounter this frequently. It is so sad.