UW ECHO in Geriatrics - www.uwyo.edu/wycoa - University of Wyoming

UW ECHO in Geriatrics

        wycoa@uwyo.edu
        www.uwyo.edu/wycoa

Effects of Social Isolation:
Considerations for Nursing Home Care
during the Pandemic Era

Maya Pignatore, PhD
       Omaha VAMC Psychologist

Goals

                       Current
  Known sequalae                      Methods to
                     research of
     of social                          combat
                   isolation during
     isolation                         isolations
                    the pandemic

Social Isolation

• Social isolation is defined as having a low quantity and quality of contact with
  others; it is objective and can be measured using observations of an individual's
  social network. 6

• Social Isolation does not always beget loneliness. Loneliness does not require
  social isolation, but the two can have similar effects.

• Various studies show that 25% or more of the older adult population may
  experience loneliness as baseline. 7, 8, 9

• Social isolation and loneliness were perceived to be considerable risks for older
  adults during the COVID-19 pandemic, as many precautionary measures involve
  isolating this higher risk population.

Current Research on Social Isolation

Social isolation can
• increase mortality 29%, similar to smoking 15 cigarettes per day 6, 28, 30
• increase rates of high blood pressure, cognitive decline, Alzheimer's disease,
  coronary heart disease, obesity, anxiety, depression 6, 7, 28

• Why?
   •   Peers might encourage health behaviors28, 29
   •   Depression as a cardiovascular risk factor28
   •   Impacts on nervous system, inflammation, or sleep disturbace28, 7, 6
   •   Dysregulation in the metabolic system 28, 6, 7
   •   Changes to immune system functioning6, 28

General assumption that
COVID-19 restrictions would
     worsen MH outcomes.
                  But did it?

What actually happened during Covid-19?
• There is research from numerous countries showing older adults coping well
  during the pandemic. 1

• Data from ongoing study using the UCLA Loneliness Scale down a DECREASE in
  loneliness scores during lockdown in Spain compares to 2 years prior22
   • Possible short-term feelings of connectedness during lockdown d/t social media and
     news campaigns

• John Hopkins study, comparing results April 2020 to 2018 study, found increase
  in negative MH symptoms reported by US population overall, though lowest
  distress rates among adults age 55+23

• CDC study conducted in June 2020 showed that older adults (age 65+) had the
  lowest level of negative MH symptoms as compared to other age groups2
   • Example: 6.2% reported anxiety disorder symptoms, as compared to 35.2% of those age
     25-44 reporting anxiety symptoms

Suicide rates during Covid-19 Pandemic

• Suicide rates in advanced (high to middle income) countries remained the same
  or declined in the early months of the pandemic. 14

• Increase in US ER visits for suicide attempts and overdoses in 2020 (January-
  September) compared to 2019.15
   • Wyoming and Hawaii excluded from study

• Loneliness and COVID-19 related stress correlated with suicidal thoughts.16

• Greater social support inversely related to suicidality; financial struggles and
  unemployment directly related to suicidality. 16

Holland KM, Jones C, Vivolo-Kantor AM, et al. Trends in US Emergency Department Visits for Mental Health,
Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic. JAMA Psychiatry. 2021;78(4):372–379.
doi:10.1001/jamapsychiatry.2020.4402.

Bray et al. (2021) show
differing trends in suicide
rates in Maryland based
on race.

Suggest further research
of suicide rates during
pandemic looking at racial
and economic
demographic data.13

Manitoba Study18

• Telephone interviews with 25 seniors living in rural areas.
   • 20% of participants lonely before COVID and continued to be lonely after restrictions
     lifted
   • For most individuals, loneliness increased within the first the first few months of
     COVID-19 restrictions
   • Factors such as other mobility impairments may increase sense of isolation
   • Individuals who can reflect on how they coped with isolation in the past (growing up
     on farm) were more able to successfully manage isolation
   • Most individuals returned to pre-COVID levels of loneliness within 6-7 months from
     beginning of pandemic

First interview in May-June. Second interview in July-August 2020.18

Israeli Retirement Community20

• Interviews with 24 residents at 13 different facilitates

• Themes Identified:
   • ‘Us vs. them: Others are worse off’. Older residents engaged in
     constant attempts to compare their situation to that of others. The overall
     message behind these downward comparisons was that the situation is not so
     bad, as others are in a worse predicament;
   • ‘Us vs. them: Power imbalance’. This comparison emphasized the
     unbalanced power-relations between older adults and the staff and
     management in the setting and
   • ‘We have become prisoners of our own age’. Negative MH
     consequences increased when the rest of society lowered restrictions and
     facilities did not.

US and UK study21

• 200 participants, age 65+ recruited online.

• Looked at preference for isolation as a modulator of negative MH consequences.

• Theory not proven—baseline preferences for isolation did not help people cope
  better with COVID-19 social contact restrictions.

• Worries about health and acute stressors (job and food insecurities) more likely
  predictors of poor MH outcomes.

Resiliency

“an ability to recover from or
adjust easily to adversity or
change.”
- Merriam-Webster Dictionary

Resiliency Among Older Adults

• Internal factors (stress response, cognitive skills, ego integrity) and
  external factors (social status, financial stability) might contribute to Older
  Adults successful coping3, 10

• Inverse relationship between wisdom, specifically compassion, and
  loneliness regardless of age 4

Coping with Isolation

Meta-Analysis by Williams et al.5:
-Analyzed prior research on interventions to reduce loneliness,
considering what could be feasibly done during COVID-19
pandemic
    Mindfulness
    Movement therapy (Tai Chi, Qi-gong)
    Laughter Therapy

   •   Visual Art Discussions
   •   Robot-based Animal Therapy
   •   Wii-gaming
   •   Mixed Results for Reminiscence and CBT
   •   Education focused on social skills building and facilitated social
       interactions also shown to improve loneliness

Coping with Isolation

• Helplines to connect older adults with healthcare,
  welfare, and social services 11

• Telephone outreach may be one of the best ways to
  help nursing home residents maintain
  connectedness.27, 28
    • Video telehealth might not be accepted by all
      older adults and may not be more effective than
      care as usual.19, 24
    • Focus on accessible solutions and consider low-
      tech options where available.25

Coping with Isolation: Use of
Technology
• Increase digital literacy and improve access to virtual
  communication11, 17

• Augmented Reality or Virtual Reality systems17

• Social Robots or Companion Robots: Paro, Sophia17,
  Vector12

• One study found statistically deceased loneliness among
  hospitalized individuals with use of robots. Results for
  nursing home residents did not reach significance, but
  general response was still positive.26

Conclusions

• Older adults overall likely to cope well during COVID-19, but still
  vulnerable to loneliness and negative MH symptoms when socially
  isolated.

• Economic status or race may moderate how people are impacted by
  the pandemic.

• No studies yet specifically showing coping during winter months.

• Care as usually is recommended, with focus on preventative MH
  measures.

Questions/Discussion

Citations

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