Re-Engagement After Prolonged Isolation
Isolation has been a long-standing issue for many older adults whose physical health has declined and support needs increased. Sadly, in many instances isolation has been normalised as normal part of ageing, along with the assumption that depression too is just part of getting old. In this article we are going to explore latest research on the impact of isolation in late life, particularly related to COVID-19 offer strategies how to gently reintroduce opportunities for better engagement and social connections in late life.
The Problem
Many individuals who experience isolation may subsequently experience loneliness and be at risk of developing mental health condition(s). They are not as active, engaged and well as they once were and may not be able to jump in the car as readily as before, go for a walk or organise a holiday with friends or family. Life is different, their support needs have increased and their losses may be multiple - loss of independence, loss of value, loss of role and loss of meaning. Older adults may feel reluctant to ask for help unless it is essential in fear of inconveniencing others and their schedule.
It is not uncommon to hear
“I am not meaningfully participating or contributing towards my community”
or
“What is the point of going on?”
In day-to-day interactions, many of us have noticed our clients are not as keen to leave the comfort of their chairs, rooms and accommodation. Fear of the unknown environment and new reality can set in and impact the confidence and self-esteem of our elders. For some, it has been it has been a sudden change, perhaps due to a fall or other health setbacks and for others the quieter lifestyle has always been the preference. And, then for a number of them it has been the impact of COVID-19. They have become disengaged over the last two years and this has been normalised. This is not okay and we need to work together to fix it.
Statistics and Research
Isolation and loneliness in late life has drawn attention of many clinicians and researchers over the last decade. For researchers, it has been difficult to capture disengagement, as the uptake on various programs has varied and impacted by the pandemic. How do we measure something if we do not know how many people are impacted by isolation? It has been easier to capture this information in residential care settings where we can track how often people leave their rooms, engage in activities or leave the facility for recreational purposes. We know from residential settings that up to 1 in 2 residents have symptoms of depression (AIHW, 2019).
In community-based settings, client engagement from programs and services has significantly reduced. The update on support has been low with some clients expressing fear of contracting COVID-19, if they allow a service provider to enter their home. Many service providers have continued to deliver welfare check ups over the phone, however after a few phone calls several have reported difficulty in initiating new conversations and keeping the talk going, as clients report not having much to discuss as they are confined to their homes and not experiencing positive emotions.
According to Kryzazanik et al (2021), older adults from residential care settings make up to 65% of all COVID-19 related deaths in Australia. COVID-19 has increased loneliness (41%) and anxiety (33%) in older people in RACF (Brydon et al., 2022) with reduced face-to-face contact with loved ones, less social activities, outings and ability to interact with other residents within the facility. Further, increased community and media scrutiny has been observed with outbreaks and finger pointing and certain individuals labelled as “patient zero”.
So, where to tune our attention and efforts?
- Create opportunities which encourage gentle participation and calm experiences- sharing interests and hobbies may be more appropriate in smaller groups than big loud musical concerts. Quantity is not always better than quality, do not underestimate the power of short bursts of meaningful interactions.
- Allow elders to share the impact of grief and loss over the last two years and how it has impacted them. Being able to relate to those around us can improve the sense of belonging and understanding.
- Focus on strengths of older people - how did they overcome the challenges in their lives before? How can we use those strengths now? This is what I teach in my workshops.
- Engage in reminiscence - even a 5 minute activity can have profound effects on the older person
- Encourage time in nature - sunshine and even rain can be calming and beneficial to our wellbeing
- Be mindful and present in service delivery – allow moments of meaningful engagement
- Be kind and gentle on yourself - working during COVID-19 times has been difficult not just for clients but also for caregivers, sometimes you can feel you have so much of yourself to give, but being just present in the moment may be all that the client needs.
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