Loneliness and isolation in the elderly: Improving care provision

Helen Fuller, Managing Director at Care 4 Quality, discusses loneliness and isolation in the elderly, highlighting how care homes can improve care provision in this area

It is well documented that feelings of loneliness and isolation within the elderly population very often leads to depression and further escalation of other more serious physical and mental health issues. Naturally, one might assume that this issue would occur more frequently in elderly people who live alone in their own homes, but often the reverse is true.

In fact, growing numbers of elderly people living within a care home setting will commonly express the same feelings of loneliness and isolation. Regular visits to care homes across the country has also revealed that despite being surrounded by people all day, many elderly residents have no one close (family or staff) who can spare the time simply to chat.

It is of course perfectly natural that the significant, personal life-changing experience of transitioning from independence and familiar surroundings into a more dependent and unfamiliar care home environment will have a dramatic impact on the mental wellbeing of an individual. There is also the added challenge of adjusting to communal living and suddenly being physically separated from loved ones or community roots.

The dangers of becoming a ‘patient’ first

Once an individual is living within a care setting, there is a tendency for the provider to focus primarily on physical health care needs, managing risks and identifying the level of intervention required to help that person with day to day mobility and routine. Consequently, there is a high risk that ‘people’ simply become ‘patients’ ahead of anything else and this can put them in danger of losing their personal identity.

Spotting the warning signs that someone may be suffering with loneliness or isolation is key and this is where the right training and education within the sector becomes vital. Care providers often use assessment tools that cover various factors such as depression scoring, pre-determined risk factors, and observation of self-exclusion. However, the most effective way of identifying loneliness in the elderly is by raising awareness of the issue at the outset and giving carers, families and visitors some key signs to look out for when spending time with people. Providing further information about what actions staff, relatives can take if they notice any signs, is also useful.

Fluid communication means removing physical barriers

Care providers can help to manage this more effectively by removing as many physical barriers as possible and to facilitate greater, more fluid communication with people on a regular basis. Ensuring that staff are equipped with the right skills and understand how to support and encourage people based on what they enjoy doing, is important. This way providers can ensure they create an interactive environment that relevant to a person’s past hobbies and activities.

People who are nursed and cared for in bed can often feel even more isolated from the rest of the home environment as they will spend the majority of their time in one room. This can sometimes be addressed by using adapted mobility equipment to enable individuals to move around the service and join in with communal activities. If this is not feasible, providers can look into other options to boost inclusion for those who are bed-bound, such as bringing certain activities or hobbies to their bedside, where possible. It is important that these more isolated residents still get to experience the same as those who are more mobile.

Training and awareness around isolation, loneliness and positive mental wellbeing in care homes must be incorporated into the induction programme for care staff and should form part of the pre-admission process with relatives. Care and support plans can then be developed in a more person-centric way to keep individuals’ mental wellbeing at the core and ensuring that meaningful occupational and relevant activities are provided.

Duty of care

Of course, there is also an inspection element to this too. Regulation 10 of the Health & Social Care Act (Regulated Activities) Regulations 2009 – Dignity and Respect states that care providers have a duty to support the ‘autonomy, independence and involvement in the community of the service user’. Often the regulator, on inspections, focus on the length of time that ‘service users’ are left alone for, particularly in communal areas however there has been a shift in CQC reporting about the quality of this staff support time particularly for people who are cared for in bed.

The good news is many care providers are taking positive steps to address the issues surrounding isolation and loneliness in the elderly. Good examples include a ‘buddying’ system where resident’s hobbies and interests are matched and on admission, they are allocated a resident buddy. Regulation and Inspection in the Isle of Man actually require all care services to carry out a ‘compatibility assessment’ to ensure that people are being placed in communal settings appropriately and that they are near like-minded people.

Bring the outside in

Bringing the community into the care service is a great way to develop and maintain those community circles that are so important. There has also been a recent trial where a number of care services have used video calling to help ease loneliness and isolation in the elderly in care.

The key is to make our contact with people in care services more meaningful and genuine. As a sector, we have to remember that it is not about the amount of time but the quality of that time that one spends with an individual. Whether that is a relative, friend, carer, manager, provider or a visiting professional, we can all make a difference in the nurture of care settings to become the inclusive and empowering environments they need to be.