HOW SOCIAL ISOLATION AND LONELINESS AFFECT SOCIAL FUNCTIONING IN THE ELDERLY
A Project
Presented to the faculty of the Division of Social Work California State University, Sacramento
Submitted in partial satisfaction of the requirements for the degree of
MASTER OF SOCIAL WORK
by Serim Kang
ii © 2019 Serim Kang
iii
HOW SOCIAL ISOLATION AND LONELINESS AFFECT SOCIAL FUNCTIONING IN THE ELDERLY
iv Student: Serim Kang
I certify that this student has met the requirements for format contained in the University format manual, and that this project is suitable for shelving in the Library and credit is to be awarded for the project.
__________________________, Graduate Program Director ___________________ Serge Lee, Ph.D. Date
v Abstract
of
HOW SOCIAL ISOLATION AND LONELINESS AFFECT SOCIAL
FUNCTIONING IN THE ELDERLY by
Serim Kang
There is a significant gap in the current research showing the correlation between both social isolation and loneliness with the social functioning in elderly. In order to fill such a gap, the current study explored the question what is the relationship between objective social isolation and perceived isolation, loneliness, on the social functioning and health outcomes in elderly? A secondary analysis of the Sacramento Area Latino Study on Aging showed there is a statistically significant negative relationship between one’s level of social isolation and loneliness and their overall social functioning and health
outcomes. Social isolation and loneliness both have a negative impact in similar and different ways on the overall social functioning and health outcomes in the elderly. Such findings provide direction for future policies aimed to help the elderly, which should focus on reducing both social isolation and loneliness.
_______________________, Committee Chair Kisun Nam, Ph.D., MSSW
vi DEDICATION
vii
ACKNOWLEDGEMENTS
viii TABLE OF CONTENTS Page Dedication ... vi Acknowledgements ... vii List of Tables ...x Chapter 1. INTRODUCTION ...……… 1
Background of the Problem ... 3
Study Purpose ... 6
Theoretical Paradigms ... 8
Definition of Terms... 9
2. LITERATURE REVIEW ... 11
Conceptual Distinction between Social Isolation versus Loneliness ... 12
Overview of Social Isolation ... 12
Overview of Loneliness ... 13
Race/ Ethnicity Differences in Social Isolation and Loneliness ... 14
Impact of Social Isolation and Loneliness ...19
Summary ...32
3. METHODOLOGY ...33
Study Design ... 33
Sampling Procedures ... 36
ix
Instrument ... 38
Data Analysis ... 41
Protection of Human Subjects ... 42
Summary ... 43
4. STUDY FINDINGS AND DISCUSSIONS ...44
Demographics. ... 44
Statistically Significant Relationship between Social Isolation and Social Functioning ... 48
Statistically Significant Relationship between Loneliness and Social Functioning ... 50
Summary ... 53
5. CONCLUSIONS AND RECOMMENDATIONS ...54
Summary of Study ... 54
Implications for Social Work ...56
Limitations ...60
Recommendations for Future Research ...62
Conclusions ...64
x LIST OF TABLES Tables Page 1. Demographic Characteristics……… .. .………. 45 2. Independent Variables……….… ……….46 3. Dependent Variables……… .. ………….………. 48
Chapter 1 INTRODUCTION
As human beings, feeling connected to others through social interaction is
significant to our emotional, mental and physical well-being. Physical and mental health risks linked with social isolation are comparable to the harmful effects of smoking cigarettes and obesity. Such health risks may be even greater for the elderly who face challenges of transitioning into a life stage where connecting to people becomes increasingly difficult. With greater social isolation due to factors such as declining health, loss of spouse, decreasing mobility and much more, the effects of isolation are essential to research further to better understand and develop ways to reduce the negative outcomes. Compared to health behaviors such as smoking, much less is understood about how and why social isolation and loneliness affects one’s health (Cacioppo & Hawkley, 2009). Such a lack of studies is a challenge in fully understanding the impact of social isolation and loneliness with the elderly population.
isolation and loneliness impact elderly in comparable or different ways. Although research has shown the association between lifestyle or health factors such as smoking with reduced health in the elderly, there is still a lack of studies demonstrating how social isolation and loneliness both have an impact on the physical and cognitive functioning in the elderly population. Even when concepts of loneliness and social isolation are
included and compared with one another in a study, they are largely examined separately (Newall & Menec, 2017).
Background of the Problem
The importance of social interaction for humans is widely understood yet the effects of a lack of social interaction and feelings of loneliness are not as clearly
understood or addressed in society. Specifically, for the elderly, the effects of a lack of connection to others can have a significant implication that society needs to further address. With increasing social isolation and life expectancy among the elderly
population, there are reports of a high level of social isolation and loneliness. In the 2017 Profile of Older Americans presented by the U.D Department of Health and Human Services, nearly twenty eight percent or 13.8 million of all non-institutionalized older individuals in 2017 lived alone and among those, 9.3 million were women and 4.5 million were men (Profile of, 2018). The proportion of those living alone increases with advanced age, where for women age 75 and over, over 45% lived alone (Profile of, 2018). Thirty five percent of older individuals surveyed in a study involving a
community population reported that they had no confidant, a confidant being defined as someone to discuss serious problems with, who was readily available, and had at least monthly contact with (Institute, 1992). In a national survey, over 35% of older adults over the age of 45 reported being lonely (Wilson & Moulton, 2010).
Social isolation and loneliness among the elderly population has been shown to have a critical negative impact on one’s longevity, mental and physical health (Choi, Erwin & Cho, 2015). One’s mental and physical health is critical in one’s social
studies consisting of 308,849 participants, individuals with strong social ties had a 50% greater likelihood of survival compared with those who have poor social relationships (Valtorta & Hanratty, 2012). Seventeen-year mortality data from the Alameda County Study demonstrated the significance of social ties as predictors of survival at different ages, where compared to those aged less than 60 years, ties with close friends or relatives assumed greater importance for those aged 60 and older (Institute, 1992). A study of 331 persons aged 65 and older indicated a higher death rate among persons who were socially deprived and such an effect on mortality occurred over a shorter period of 30 months (Institute, 1992). Research from the National Social Life, Health and Aging Project indicate that those who felt lonely and isolated were more likely to report having poor physical and mental health (Cornwell & Waite, 2009). A lack of social connections not only negatively impact one’s emotional and brain health, but also has been linked to poor cognitive performance (Cacioppo & Hawkley, 2009).
and loneliness are associated with worse physical health, which is an issue that needs to be further studied. Elderly who are not socially isolated or perceive high levels of support from others have a nearly 70 percent chance of reporting very good or excellent health compared to those who report social isolation or loneliness have only a 40 percent chance of reporting very good or great health (Cornwell & Waite, 2009).
With a better understanding of how social isolation and loneliness affects the social functioning in the elderly, there can be policies that are more effective and services to decrease both social isolation and loneliness while increasing both social
connectedness and the perceived availability of social resources. As the elderly
population will continue to increase, developing a greater understanding of the challenges they face will become an essential task for society. Over the past 10 years, the population age 65 and over increased from 37.2 million in 2006 to 49.2 million in 2016, a 33% increase, and is projected to almost double to 98 million in 2060 (Profile of, 2018). With a rapidly increasing aging population, a better understanding of the impact of social isolation and loneliness is crucial for more effective policies improving elderly health care to form and can generate greater benefits in reducing mortality among elderly in society (Saxon, Etten & Perkins, 2010).
intervention programs that can better assist the elderly and modify the factors that affect their health, quality of life and mortality rates. Such valuable research will not only provide a better understanding of how to help the elderly live a healthier and longer life, but also help create a fundamental change in the current society’s ability to fulfill the duty to care for the aging population.
Study Purpose
This study aims to research the correlation between social isolation, loneliness and overall social functioning of elderly. The objective of the study is to determine the impact that social isolation and loneliness has on one’s social functioning including cognitive, emotional and physical functioning. This study will examine social isolation and loneliness together to determine whether objective and perceived isolation,
admission to nursing homes and ability to maintain a physical mobility are the essential factors examined as one’s social functioning. The research study will analyze the
correlation between one’s social interaction such as attending religious services or talking on the phone to their social functioning.
Theoretical Paradigms
The ecological systems theory helps describe and understand how social isolation has a negative impact on the social functioning in the elderly. The challenges elderly face is better examined in relationship with other environmental forces such as the family, the group, the organization, the community, the economy and the culture, in which one’s social environment has a great impact on one’s ability to thrive or not (Anderson, 1988). The ecological systems theory refers to a conceptual system about one’s mind, body and environment in transactional relationships. With an incorporation of the exchange principle, the well-functioning of a system is the result of mutual need meeting relationships, between sub-systems, and between the ecosystem and its
environment. Through this theory, one’s dysfunction in social functioning can be explained by one’s lack of social connection and inadequate resources from the external environment. The theory therefore helps to explain and understand how a declining ability to stay connected to others and the environment relates to one’s reduced social functioning in the elderly.
People and their physical-social-cultural environment are understood to interact in processes of mutual reciprocity and complementary exchanges of resources, where the systemic functional requirements are met and a balance of exchanges between the person and environment can be achieved (Siporin, 1980). Social functioning refers to a system's integrated, harmonized application of capacities, within basic social relationships,
and perform life roles. For the elderly who have challenges in maintaining basic social relationships and difficulty utilizing both internal and external resources, their ability to maintain effective social functioning is also increasingly challenging. The theory explains how each subsystem such as an individual, family or organization requires the access to and the use of adequate and well-matched internal and external demands, to cope with life tasks and stresses, in effective and satisfying ways, to attain development and self-fulfillment (Siporin, 1980).
When such demands are not met and create dysfunction such as in a physical illness, there is a disparity and lack of fit between the sub-systems and between the ecosystem and its environment. An individual person can function well only if he has mature internal abilities and competencies, and has access to needed social resources in the way of positive, nurturing supports and demands. For the elderly who are socially isolated and experience loneliness, their ability to match their internal and external needs is negatively affected, and their capacity to function and achieve self-fulfillment is also hindered, which needs to be further addressed.
Definition of Terms
participation in social activity (Choi, Irwin & Cho, 2015). Social isolation is also the inadequate quality and quantity of social relations with others in various backgrounds where human interaction takes place, such as interaction with another individual, group, community or the broader social environment (Durcan & Bell, 2015).
Chapter 2
LITERATURE REVIEW
Over the past 10 years, the population age 65 and over increased from 37.2 million in 2006 to 49.2 million in 2016, a 33% increase and is projected to almost double to 98 million in 2060 (Profile of, 2018). The age 85 and over population is projected to more than double from 6.4 million in 2016 to 14.6 million in 2040, a 129% increase (Profile of, 2018). About one in every 7, or 15.2%, of the population is an older
American. Persons reaching age 65 have an average life expectancy of an additional 19.4 years, with an additional 20.6 years for females and 18 years for males (Profile of, 2018). With an elderly population that is continuing to rise, there is a greater need to address the issues of social isolation and loneliness among the elderly. Although social isolation and loneliness affect one’s physical and cognitive health across all age groups, the effect may be especially severe for older adults since they are more likely to experience stressful life transitions and health complications. Both objective and perceived state of isolation, loneliness, negatively impact the physical and cognitive health of the elderly.
and studies that study potential interaction effects relate to the lack of effective programs and services aimed to reducing both social isolation and loneliness.
Conceptual Distinction between Social Isolation versus Loneliness
While many studies do not make a clear distinction between social isolation and loneliness, there are clear differences between the two variables. Social isolation is the objective indicators such as having a small social network, being unmarried, participating in few activities with others or some combination of these conditions (Wilson, Krueger, Arnold, Schneider, Kelly, Barnes, Tang & Bennett, 2007). Loneliness on the other hand is one’s perceived isolation such as feeling disconnected to others, and feeling a sense of dissatisfaction with social interactions rather than the absence of it (Wilson, Krueger, Arnold, Schneider, Kelly, Barnes, Tang & Bennett, 2007). Social isolation overall is an objective measure and defined as a deprivation of social contacts whereas loneliness is people's subjective feelings of isolation (Miyawaki, 2015). Although researchers often use the terms social isolation and loneliness interchangeably, there is a need to
differentiate and examine how objective versus subjective isolation impact elderly in different ways.
Overview of Social Isolation
living alone since census data collection began and also likely have the highest rates in human history, with rates projected to increase (Euromonitor International, 2014).
Social isolation has a negative impact on the physical and cognitive health of elderly in numerous ways. Social isolation is associated with an increased risk of all-cause mortality, including mortality from coronary heart disease/strokes,
re-hospitalization, death from suicide, Dementia and more. Social isolation is also associated with a decline in cognitive functioning and overall physical functioning. Although there are variations in association patterns among different ethnicities such as Hispanic, African American or Caucasian, social isolation overall was associated with negative health outcomes in the elderly (Miyawaki, 2015).
Overview of Loneliness
In recent predictions, loneliness will reach epidemic proportions by 2030 (Linehan, Bottery, Kaye, Millar, Sinclair, & Watson, 2014). There is a significant prevalence of loneliness among seniors where in a Health and Retirement Study of 2002 showed that over 19 percent of noninstitutionalized adults over the age of sixty five reported feeling lonely for the majority of the time in any given week (Ong et al., 2016). A Loneliness scale also indicated that twenty-nine percent of respondents over seventy-five years of age or older showed they were lonely (Ong et al., 2016). Despite
been reported in studies in different countries such as areas in Europe and Asia. Loneliness is also significantly associated with a decline in cognitive functioning and physical functioning, in similar and different ways as social isolation.
Research utilizing population based data from the National Social Life, Health, and Aging Project combined multiple indicators of social isolation into scales assessing social isolation such as a limited amount of social networks, limited participation in social activities and perceived isolation such as feelings of loneliness and perceived lack of social support (Cornwell & Waite, 2009). Individuals ranging from fifty seven to eighty five were interviewed in their homes. Objective social isolation and perceived isolation are independently associated with lower levels of self-rated physical health, in which both objective and perceived isolation is associated with worse physical health (Cornwell & Waite, 2009). The association between social isolation and mental health may operate through the strong relationship between loneliness and mental health, in which both social isolation and loneliness should be researched simultaneously.
Individuals who lack social connections objectively, report frequent feelings of loneliness tend to suffer higher rates of morbidity and mortality, infection, depression and cognitive decline (Cornwell & Waite, 2009).
Race/Ethnicity Differences in Social Isolation and Loneliness
residing adults aged 57 to 85 from the National Social Life, Health, and Aging Project indicated that social isolation has negative associations with health across racial and ethnic groups. Social isolation negatively affects both physical and mental health among non-Hispanic Black, non-Hispanic White and Hispanic older adults, with different
patterns of associations found across these racial and ethnic groups (Miyawaki, 2015). Both loneliness and social isolation had a significant negative association with physical and mental health among elderly White individuals. For Blacks, social isolation is negatively associated with their physical health while loneliness had a negative association with mental health. In elderly individuals who are Hispanic, there was no association between social isolation and physical health, but a significant negative association was found with their mental health (Miyawaki, 2015). Despite various associated patterns, however, social isolation overall was associated with health outcomes that were similar across three elder groups. Such findings suggest the need to examine the association of social isolation and physical and mental health that is inclusive of all racial and ethnic groups of older adults.
As part of a health and needs assessment project conducted by the Center for Aging at the University of Texas, a study examined relations among social isolation and loneliness to health outcomes in a randomly selected population of southwestern
arthritis and stroke. Higher objective social isolation was also associated with diabetes, hypertension, arthritis, and emphysema and liver disease (Tomaka, Thompson &
Palacios, 2006). The overall pattern of correlations suggests that isolation and loneliness were positively related to disease, where the more one is objectively isolated from others and also feels more lonely, the more likely they are to have a disease, compared to those who have less social isolation and loneliness.
For both Hispanics and Caucasian participants there were impacts of social isolation and loneliness on their health but in different ways. For Hispanics, family support predicted diabetes, kidney disease and arthritis, where high family support was associated with more favorable and lower disease outcomes (Tomaka, Thompson & Palacios, 2006). Loneliness was also a consistent predictor of cardiovascular disease outcomes for Hispanics, with high levels of loneliness predicting hypertension, heart disease, and stroke. Grater family support was associated with more favorable disease outcomes for both Caucasians and Hispanics. For Caucasians, belonging support continued to predict diabetes, hypertension and liver disease in the same way as for the entire sample. Also consistent with analyses for the entire sample, for Caucasians, living alone was negatively related to heart disease. In addition to heart disease, family support also predicted emphysema and stroke.
diabetes, kidney disease, and arthritis and belongingness support predicting arthritis and asthma, particularly when compared to the full sample analyses (Tomaka, Thompson & Palacios, 2006). Among Caucasians, loneliness predicted only emphysema but family support was also important among Caucasians, negatively predicting emphysema and stroke but positively predicting heart disease. Finally, social isolation continued to predict diabetes, hypertension, and liver disease in Caucasians. Overall the study indicated that loneliness and the amount of objective support play important roles in the health of the aging population, including aging among Hispanics and Caucasians in different ways. The ethnic group analyses demonstrated significant patterns, where loneliness predicted disease outcomes more consistently in the Hispanic sample compared with the Caucasian sample. Such a pattern may suggest that the negative effects of loneliness may be especially significant among this group and needs further research. The Caucasian subgroup analyses for heart disease showed that living alone was negatively associated with heart disease, whereas objective family support was positively related to heart disease.
participants indicated that perception of aging and life is affected by the level and quality of social support. Interviews of the Latino elderly showed they were most concerned about loneliness and the prospect of living in nursing homes (Beyene, Becker, & Mayen, 2002).
A qualitative study assessing the need for mental health services among Latino older adults in San Diego, California showed that besides Depression, challenges
reported included the need for socialization and social support (Barrio, Palinkas, Yamada, Fuentes, Criado, Garcia & Jeste, 2007). The Latino participants in the study expressed that elderly in general and those with mental illness in particular were socially isolated. Consumers and family members emphasized that much of the depression and negative thoughts experienced by Latino older adults were a result of social isolation (Barrio et al., 2007). Latino older adults were thought to be even more isolated than most non-Latino older adults because of their inability to speak English. Additionally, many Latino older adults spent much of their day alone in the house because their children worked long hours and were often absent. Underlying the loneliness and social isolation expressed by Latino individuals was a cultural expectation that family members should meet their needs for companionship aligning with the customs of their culture (Barrio et al., 2007). Subsequently many Latino older adults felt abandoned by their children, which led to greater distress and isolation, which was in contrast to the perspective of service
providers who viewed the Latino family as cohesive and supportive of the needs of older adults. Latino participants also complained of a great need for more community
studies indicate how despite perceptions in society, Latino elderly report a great amount of both objective isolation and loneliness.
An examination of the prevalence of loneliness and its influences among community-dwelling older Mexican Americans, a highly familistic segment of the American population, indicated how the average scores on a Three-Item Loneliness scale were higher for Mexican Americans compared to the general population (Gerst-Emerson, Shovali, & Markides, 2014). Such scores indicate how Hispanic elderly may be at a higher risk for the negative effects of loneliness. Such information is also seen as a valuable result to help facilitate the development of interventions to address loneliness in this rapidly growing population of Mexican Americans (Gerst-Emerson, Shovali, & Markides, 2014). The higher rates in elderly Mexican Americans may reflect the nature of Mexican American culture, where individuals in a highly familistic culture have higher expectations for social interactions and the changes of aging such as death of relatives may be a greater challenge for Hispanic elderly to overcome.
IMPACT OF SOCIAL ISOLATION AND LONELINESS Admission to Nursing Home/Hospitalization
Research also indicates that seniors who report greater social isolation and loneliness are more likely than those who are not to face early admission into nursing or residential care facilities (Valtorta & Hanratty, 2012). Such early admissions can have an effect on their future ability to remain healthy both physically and cognitive
2016). Hospital admissions may not only be due to issues with physical health, but also due to their declining cognitive functioning. Loneliness is associated with higher health care utilization among older adults in the United States. An analysis of panel data from the Health and Retirement Study from 2008 and 2012 helped examine the long-term impact of loneliness on health care use of community-dwelling individuals in the United States aged 60 years and older. Binomial regression models were utilized to determine the impact of loneliness on physician visits and hospitalizations. Although an experience of loneliness at one time did not predict health care utilization, chronic loneliness,
defined here as reporting loneliness both at baseline and at 4-year follow-up, was significantly associated with increased number of doctor visits (Gerst-Emerson &
Jayawardhana, 2015). This study supports previous research indicating that loneliness is a significant public health issue, especially among older adults. In addition to the potential quality-of-life implications, the results from this study show that chronic loneliness contributes to a cycle of illness and health care utilization.
fewer social relationships and higher rates of readmission to the hospital (Valtorta, Moore, Barron, Stow & Hanratty, 2018).
Self Report of Health Status
Elderly who report a lower level of social support also report worse status of their general health. An analysis of two subsamples from the full samples of the National Health and Nutrition Examination Survey of 1999 to 2002 analyzed whether a
representative national probability sample of US community-dwelling older adults who reported less social support also reported poorer general health status, which is a robust predictor of prospective mortality among elders. After controlling for age, race, gender, and educational attainment, elderly individuals across all analytic samples who reported a need for more social support also reported having worse health compared to those who were satisfied with the support available to them (White, Philogene, Fine & Sinha 2009). Such results indicated how in the United States, elderly’s satisfaction with the emotional and social support is associated with better self-reported health status.
Morbidity
analysis demonstrated how deficiencies in social relationships are associated with an increased risk of developing both CHD and stroke and the association is comparable to other psychosocial risk factors (Valtorta, Kanaan, Golbody, Ronzi & Hanratty, 2016). Social isolation is associated with a higher risk of being diagnosed with chronic illnesses because of a decrease in social relations for elderly Europeans. In the survey on Health, Ageing and Retirement in Europe, results indicate that people who participate in social activities have fewer probability of suffering from chronic diseases, while those who are socially isolated and live alone the opposite is true, where they experience a greater probability of suffering from chronic diseases (Prieto, Saez & Fernandez, 2018).
cohort. Particularly among Hispanic elderly individuals, social isolation was significantly associated with greater left ventricular mass.
Seniors who experience social isolation or loneliness also are at a greater risk for increased morbidity. Both social isolation and loneliness have been linked with the development of numerous diseases, such as cardiovascular disease. Inflammation is a potential pathway through which loneliness might impact health and overall
cardiovascular functioning (Hackett, Hamer, Endrighi, Brydon & Steptoe, 2012). Older adults who reported being lonely were twice as more likely to develop Alzheimer’s Disease than those who did not report loneliness, according to a study in Chicago of over 800 older adults (Valtorta & Hanratty, 2012). Research also indicates that seniors who report greater social isolation and loneliness are more likely than those who are not to face early admission into nursing or residential care facilities (Valtorta & Hanratty, 2012). Senior who report as being lonely have a 30 percent higher hospital admission rates than seniors who do not report loneliness (Sibley, Thompson & Edwardh, 2016).
uniform measures of loneliness, possible effects of unmeasured variables and the use of analytic processes that do not take into account survival time. Nevertheless, there are clear indications that loneliness is associated with overall diminished health due to adverse health behaviors such as diminished sleep, poor nutrition, greater fatigue etc (Ong et al., 2016). Both loneliness and social isolation can lead to other negative health behaviors such as smoking, overconsumption of alcohol and a decrease in physical activity and exercise (Sibley, Thompson & Edwardh, 2016).
Cognitive Functioning
Older adults who reported being lonely were twice as more likely to develop Alzheimer’s Disease than those who did not report loneliness, according to a study in Chicago of over 800 older adults (Valtorta & Hanratty, 2012). Accumulating evidence suggests that both humans and mice have a higher risk of developing Alzheimer’s
Disease if they are feeling lonely or are living isolated (Hsiao, Chang, & Gean, 2018). A lack of social connection with family and friends increases the risk of Alzheimer’s Disease or Dementia (Poey, J., Burr, J., Roberts, J. S., 2017). However, social isolation along is not necessarily sufficient to be able to predict the risk of developing dementia related symptoms (Holwerda, T. J., et al, 2013). Rather, a more accurate predictor is the perceived isolation, feelings of loneliness.
2014). In the Amsterdam Study of the Elderly, risk factors were examined for
depression, dementia, and higher than expected death rates among the elderly, through a tracking of more than 2000 participants with no signs of dementia for a period of three years. Among those who lived alone, around one in 10, around 9.3% had developed dementia after three years compared with one in 20, around 5.6% of those who lived with others (Holwerda et al., 2014). However among those without social support, one in 20 had developed dementia compared with around one in 10, or 11.4% of those who did have support. For participants who stated they felt lonely, more than twice as many of them developed dementia after three years compared with those who did not feel lonely, around 13.4%. Those who lived alone were between 70% and 80% more likely to develop dementia than those who lived with others. Participants who stated they felt lonely were more than 2.5 times as likely to develop the disease. In a multivariate analysis, controlling for other factors such as demography or psychiatric risks,
individuals who felt lonely were 1.64 times more likely to develop clinical dementia than those who did not feel lonely, while those with an objective state of social isolation did not show such effects (Holwerda et al., 2014). Feelings of loneliness independently contribute to the risk of dementia in later life, unlike social isolation that does not, in which one’s perceived rather than the objective absence of social attachments increases the risk of cognitive decline (Holwerda et al., 2014).
controlling for covariates such as marital status, demographic characteristics, social isolation and psychosocial risk factors (Courtin & Knapp, 2017). However, causal links and mechanisms were still shown difficult to demonstrate and further research is needed to support causality. The negative effect of loneliness on health is also shown in how the effects accumulate to produce greater increases in systolic blood pressure over a 4 year period than are observed in less lonely individuals (Hawkley, Thisted, Masi & Cacioppo, 2010). Such findings were based on 229 individuals ranging from 50 to 68 years of age that included ethnicities such as Caucasian, African American and Hispanic men and women in Chicago’s Health, Aging, and Social Relations Study, who were tested annually for each of five consecutive years (Hawkley et al., 2010). Such a population based sample was able to indicate that the effect of loneliness on one’s systolic blood pressure was independent of age, gender, race or ethnicity along with other factors such as medications, health conditions, effects of depressive symptoms etc (Hawkley et al., 2010).
with other people but also on how much a person is satisfied with the connections. The study reveals how expressed dissatisfaction with available relationships is a stronger indicator of loneliness. Nevertheless, the study is limited and more longitudinal studies on a larger group of elderly individuals are needed in the future.
Although longitudinal studies have been limited, research has indicated that loneliness is a risk factor for, and may contribute to, poorer overall cognitive
performance, faster cognitive decline and poorer executive functioning. Higher rates of loneliness is also associated with increased negativity and depressive cognition,
heightened sensitivity to social threats, a confirmatory bias in social cognition that is self-protective and paradoxically self-defeating, heightened anthropomorphism and contagion that threatens social cohesion and much more (Cacioppo & Hawkley, 2009). A cross sectional of 4,993 elderly city residents over the age of 65 showed that two out of four measures of social support, marital status and perceived positive support from friends, were statistically significant (Yeh & Liu, 2003). The findings showed that social support is an indicator of cognitive function in community dwelling older adults. The study suggested that interventions or activities that enhance social support would improve cognitive functions in the elderly (Yeh & Liu, 2003).
cognitive measures to assess global cognition, episodic, semantic and working memory, perceptual speed, etc. A total of 76 individuals developed dementia during the 65 month study period and the risk of clinical Alzheimer’s was more than doubled in lonely persons compared with persons who were not lonely (Cacioppo & Hawkley, 2009). Results of the study indicated that the lonelier were the participants, the poorer the cognitive
performance within each of these domains at baseline, and loneliness was associated with greater cognitive declines in every domain except working memory and episodic
performance (Wilson et al., 2007). Loneliness significantly increased the risk of clinical Alzheimer’s, and this association was not affected with covariates such as objective social isolation and other demographic and health related factors.
lifestyle throughout the later years in life may enhance cognitive reserve and benefit cognitive function.
Mortality
The association between loneliness and social isolation and the harmful effects on elderly’s physical health is shown in the effects on their mortality and morbidity rates. The risk for mortality from a lack of social relationships is greater than that from obesity. With other factors controlled, the risk from social isolation and loneliness is equivalent to the risks associated with Grades 2 and 3 obesity (Holt- Lunstad, Smith, Baker, Harris, & Stephenson, 2015). Despite a need for more extensive longitudinal studies, a meta-analysis of 148 longitudinal studies with 308,849 participants followed for an average of 7.5 years showed that individuals with strong social connections have a fifty percent greater likelihood of survival compared to those with less social relationships (Valtorta & Hanratty, 2012). Social isolation results in higher likelihood of mortality, whether
measured objectively or subjectively. Cumulative data from 70 independent prospective studies, with 3,407,134 participants followed for an average of 7 years, showed a
significant effect of social isolation, loneliness, and living alone on odds of mortality. With multiple covariates accounted for, the increased likelihood of death is 26% for reported loneliness, 29% for social isolation and 32% for living alone (Holt- Lunstad et al., 2015). Such findings demonstrate the negative impact of both social isolation and loneliness on elderly’s mortality rates.
Demakakos & Wardle, 2013). In the English Longitudinal Study measuring loneliness and social isolation among 6,500 men and women over 52 years old, although both social isolation and loneliness showed association with increased mortality, social isolation, which is the objective state of isolation in the elderly, indicated a greater association with mortality rates (Steptoe et al., 2013). Such additional findings can help provide a
direction for more effective social programs that can help improve not only the perceived isolation such as loneliness, but also the objective amount of social interaction they have with others.
Suicide Risk
One’s amount of social isolation is a critical factor in determining an individual’s risk for committing suicide and may be especially important when understanding suicide among the elderly. The Centers for Disease Control has identified, as a key strategy for preventing suicide is the promotion and strengthening of connectedness at personal, family, and community levels. In a meta-analytic review of 148 studies, there was a 50 percent increased likelihood of survival for participants with stronger social relationships (Conwell, Orden & Caine, 2011). Such findings indicate how social connectedness rather than isolation is important to one’s survival rate. Older adults who commit suicide are significantly less likely to have had a close person, more likely to live alone than their peers in the community, and less likely to participate in community activities.
Caine, 2011). In such findings, both the objective and subjective state of isolation has an impact on the suicide risk among elderly.
Analysis of data in the Established Populations’ for Epidemiologic Studies of the Elderly database showed that having a greater number of friends and relatives with whom to confide was associated with significantly reduced suicide risk in older adults (Conwell & Thompson, 2008). The study indicated how a greater amount of social support and less social isolation is a protective factor in elderly’s risk of committing suicide. Census data also indicated that elderly who commit suicide were more likely to live alone than their peers in the community (Conwell & Thompson, 2008). Such findings demonstrate that, comparable to psychological and medical factors, social stressors such as social isolation place the elderly at risk for suicide, whereas social supports seem to help reduce the risks of suicide.
Summary
Social isolation and loneliness both have a significant impact on the physical and cognitive health of elderly in various ways. Social isolation is associated with an
increased risk of all-cause mortality, re-hospitalization, and decline in cognitive functioning and overall physical functioning. Loneliness has also shown to predict dementia progression, admissions to nursing homes and disease outcomes such as heart disease and strokes. Both social isolation and loneliness have an impact on elderly morbidity and mortality rates. Compared to social isolation, the impact of loneliness on one’s likeliness to develop Alzheimer’s disease is known to a greater extent.
Although there are variations in association patterns among different ethnicities such as Hispanic, African American or Caucasian, both social isolation and loneliness overall was associated with negative health outcomes in the elderly in different ways. Loneliness however was a better predictor of physical health among Hispanics than other ethnicities, predicting hypertension, heart disease, and stroke. Social isolation such as the objective amount of family support was also a significant factor for Hispanics by
predicting diabetes, kidney disease, and arthritis, compared to other ethnicities.
I hypothesize that social isolation and loneliness both have a significant negative impact in similar and different ways on the overall social functioning and health
Chapter 3 METHODOLOGY
My research question explored is what is the relationship between objective social isolation and perceived isolation, loneliness, on the social functioning in elderly, specifically on their physical and cognitive health outcomes? My hypothesis is that social isolation and loneliness both have a negative impact in similar and different ways on the overall social functioning and health outcomes in the elderly.
Study Design
The study design for my research question and hypothesis, which is whether there is a correlation between social isolation and loneliness with negative outcomes in the elderly’s social functioning, was a quantitative secondary data analysis of an existing study. The present study was a secondary analysis of the existing Sacramento Area Latino Study on Aging (SALSA) study data acquired from ICPSR. From 1996 to 2008, the SALSA Study tracked the incidence of physical and cognitive impairment, dementia and cardiovascular diseases in elderly Latinos in the Sacramento region. The study inspected the effects of cultural, nutritional, social and cardiovascular risk factors on overall health and dementia in the participants, and examined the association between diabetes and functional status. The research design for the SALSA study is an
The data from the SALSA study was suitable for my research question as the original questionnaire utilized to obtain the baseline data measured variables related to my independent variables including social isolation and loneliness and also my dependent variable social functioning and health outcomes. Questions such as one’s employment status in the SALSA study served as a measure for social isolation in the current study. Questions measuring one’s level of Depression served as measures of loneliness in the current study. Since the original SALSA study measured participant’s physical and cognitive impairment as well as dementia and cardiovascular diseases, the data contained information that relates to one’s overall social functioning.
Secondary analysis is analysis of data that was collected by others for another primary purpose and is an empirical exercise that applies the same basic research principles as studies utilizing primary data and has steps to be followed just as any research method. While secondary data analysis is a flexible approach and can be utilized in several ways, it is also an empirical exercise with procedural and evaluative steps, similar to collecting and evaluating primary data (Johnston, 2014). Finding that this data would adequately address my research questions and that the primary method of data collection was appropriately suited my research, I utilized existing survey data to find the answers to different research questions than were asked in the original research.
secondary data is available, researchers can obtain access to and utilize high quality larger datasets, such as those collected by funded studies or agencies that involve larger samples and contain substantial breadth, such as the SALSA study. The larger samples of the SALSA study are also more representative of the target population and allow for greater validity and more generalizable findings (Smith, Ayanian, Covinsky, Landon, McCarthy, Wee & Steinman, 2011).
Despite various advantages to performing secondary data analysis to existing data, there are also disadvantages to this type of analysis. Inherent to the nature of the secondary analysis of existing data, the available data are not collected to address the particular research question or to test the particular hypothesis of the secondary research, which is whether social isolation and loneliness have a negative impact on the social functioning in elderly (Cheng & Phillips, 2014). Additionally, the data in the original research may not be collected for all population subgroups of interest or for all
geographic regions of interest of the secondary research. Another difficulty of using secondary data is that the secondary researcher did not participate in the data collection process and may not know exactly how it was conducted in which there may be
qualitative methods, utilizing a quantitative method enabled generalization, where findings from the samples of this study can be applied to better understand a larger population, the elderly as a whole in society. With such generalizability, the findings can potentially help generate future programs that help the elderly.
Original survey research rarely uses all of the data collected and this unused data can provide answers or different perspectives to other questions or issues (Johnston, 2014). In order to utilize data that may not have been used fully in the original research in the SALSA study, this current study conducted a secondary data analysis of data from the study. The key to using existing survey data effectively to discover meaningful responses is a good fit between the research question and the dataset (Johnston, 2014). To utilize survey data effectively, data was located in the current study that corresponded with the research question of whether there is a correlation between social isolation and loneliness with social functioning in the elderly.
Sampling Procedures
In the original SALSA study, participants were randomly selected from a larger pool of prospective participants and by doing so, each participant in the large pool of people had an equal chance of being selected to participate (Dudley, 2011). A probability sampling was utilized where every person in the population had an equal chance of being selected, in which it is possible that any individual in the population could be selected in the study (Dudley, 2011). A probability sampling, specifically a systematic random sampling was used, where each person has an equal chance of being selected by systematic choice rather than random chance. With a probability sampling, the sample can be considered a representative sample that allows for generalization to the
population. Since the intent of the study is to generalize the findings to the population which is the Latino elderly population, utilizing a probability sampling was essential.
Data Collection Procedures
Instrument
The baseline questionnaire of the SALSA study contained categorical variables with multiple answer choices, with a range of answers to questions from never, little of the time, some of the time, most of the time, unable to answer, N/A, don’t know and refuse. For my study, the responses were re-coded into dichotomous variables, and responses were either a yes or no. To create my independent and dependent variables, the questions measuring one’s social isolation and loneliness and one’s social functioning were re-categorized into either a yes or no answer from the multiple answer choices in the SALSA questionnaire.
To measure my independent variables social isolation and loneliness, specific questions from the baseline questionnaire were selected to measure each. The
changed to a yes or no response, where one’s response not at all became no, and responses from not very often to almost always became yes. The answer yes to this question indicates that one is not socially isolated while no means they are. The responses from unable to answer to refused were treated as missing values.
The second independent variable loneliness, one’s perceived isolation, was measured by responses to the question “Did you feel like you could not shake off the blues even with help from your family or friends?” (Haan, Aiello, Gonzalez, Hinton, Jagust, Miller, Moore, Blythe, Mungas, & Seavey ((1996-2008)). This question also had a wide range of answer choices from never, little of the time, some of the time, most of the time, unable to answer, N/A, don’t know and refused. For this study, the responses were also changed to a yes or no response, where one’s response of never became no, while
responses from little to most of the time became yes. A response of yes indicates that one is lonely, while answer no means one is not lonely.
was measured by the question “How would you say your health compares to other
persons your age?” In the original study the responses included better than your age with the value of 1, about the same as others your age was 2 and worse than others your age was 3. In the current study, better than age remained as value 1, about the same as others your age became 0 and worse than others your age became -1. For this question,
therefore a positive score means one has a higher social functioning and negative score indicates the respondents consider their health is worse than others.
original responses there were response choices of either 0 or the number of days. For the current study, if an answer is 0 days, the numeric value became 0 and if the answer contained a number of days from 1 to 14 days, the answer became 1. For this question, a lower score indicated no days of staying in bed, meaning one has a higher social
functioning, while a score of 1 means yes and that one has a lower social functioning. The fifth variable whether one was ever hospitalized was measured with the question “Have you ever been hospitalized for any reason?” The original responses were yes as 1 and no as 2. For the current study, yes remains 1 while no becomes 0 and a lower score indicates a higher social functioning. For the sixth variable whether one was ever admitted to nursing home, the question used was “Have you ever stayed overnight as a patient in a nursing home or other long term care hospital?” For this question the responses were also yes as value 1 and no as 2. For the current study, the answer yes remains 1 while no becomes 0, where a lower score indicates a higher social functioning.
Dependent variables DV-1 DV-2 DV-3 DV-4 DV-5 DV-6
“Higher social
functioning” (+) (+) (–) (–) (–) (–)
Note:
DV-1: Self-perception of overall health (1 through 5)
DV-2: Health perception compared to others (–1 through +1) DV-3: Difficulties in mobility (0 through 6)
DV-4: Stayed in bed past two weeks (0 and 1) DV-5: Ever hospitalized (0 and 1)
DV-6: Ever admitted to nursing home (0 and 1)
Data Analysis
means of two independent groups that answered each of the questions measuring one’s level of social isolation, loneliness and social functioning. Missing values such as participants who did not answer a question remained missing in the current analysis. The purpose of the current study was to test the primary hypothesis, that there will be a correlation of higher social isolation and loneliness to lower social functioning.
Specifically I conducted an independent samples t-test to test the means of two groups to test the relationship between independent and dependent variables. An independent samples t-test was used to determine whether there was a correlation between participant’s responses related to social isolation such as employment status to their responses that measured social functioning, such as their number of hospitalizations, and admission to nursing homes. Independent samples t-test allowed me to compare two groups whose means are not dependent on one another. In the present study, the means of two groups are not dependent. Two samples are independent if the sample values selected from one population are not related or somehow paired or matched with the sample values selected from the other population (Banda, 2018). An independent sample t-test tells the researcher whether there is a statistically significant difference in the mean scores for the two groups or not.
Protection of Human Subjects
Summary
The purpose of the current study was to test the primary hypothesis, that social isolation and loneliness have a negative impact on one’s social functioning. Specifically, that there is a correlation of higher social isolation and loneliness to lower social
Chapter 4
STUDY FINDINGS AND DISCUSSIONS
The current study explored the question what is the relationship between objective social isolation and perceived isolation, loneliness, on the social functioning and health outcomes in elderly? Social isolation and loneliness both have a negative impact in similar and different ways on the overall social functioning and health outcomes in the elderly. An independent samples t-test was performed to test whether social isolation and loneliness negatively affect elderly’s social functioning. Social isolation was measured by multiple variables such as whether one was employed, volunteered, traveled to
Mexico or to another Latin country while loneliness was measured by whether one could not shake off the blues. Social functioning was measured by multiple variables including one’s self perception of own health, health perception comparison with others, difficulties in mobility, whether one stayed in bed past two weeks, ever hospitalized or ever admitted into a nursing home.
Demographics
is 2.9% single/never married, 58% is married, 24.9% is widowed, 10.5% is divorced, 2.9% is separated and .8% is living with someone as a spouse. Table 1 also lists the income of participants, where 44.8% is less than 1000, 20.5% is 1000 to 1499, 11.4% is 1500 to 1999, 9.3% is 2000 to 2499 and 14.1% is 2500 or more. Among the participants, 87.2% had attended school while 12.8% had not.
Table 1: Demographic Characteristics Mean SD % Age 7.64 7.128 Gender Male 41.60 Female 58.40 Marital Status
Single/ Never Married 2.9
Married 58
Widowed 24.9
Divorced 10.5
Separated 2.9
Living with Someone as a Spouse 0.8
Income Less than 1000 44.8 1000 to 1499 20.5 1500 to 1999 11.4 2000 to 2499 9.3 2500 or more 14.1 Education Yes 87.2 No 12.8
fourth independent variable measuring loneliness, 36.2% of participants could not shake off the blues while 63.8% could.
Table 2 Independent Variables IV 1- Employed Y 17% N 83% IV 2 – Ever Volunteered 17.2% 82.7%
IV 3- Ever traveled to Mexico 49.8% 50.1% IV 4- Could Not Shake off Blues 36.2% 63.8%
difficulty in mobility. The mean score for DV 3 difficulties in mobility is .7 with a standard deviation of 3.221.
Table 3 Dependent Variables DV1 -Self Perception of Health Mean 3.33 SD 1.036 DV 2- Health Perception Compared to Others .54 .638 DV 3-Difficulties in mobility .7 3.221
DV 4- Stayed in Bed Past 2 Weeks .17 .207 DV 5- Ever Hospitalized .74 .441 DV 6- Ever Admitted to Nursing Home .04 .199
Statistically Significant Relationship between Social Isolation and Social Functioning
Those who answered yes to employment also had a higher health perception compared to others with a mean of .65 significant at less than .001, compared to those who answered no, of .52. Those who answered yes to employment had a lower difficulty in mobility with a lower mean of .10 significant at less than .001 compared to those who answered no, of .37. For those who answered yes to employment and less socially isolated had a lower rate of staying in bed over the past two weeks with a mean of .20 significant at less than .01, compared to those who are more socially isolated, a mean of .5. A yes response also related to higher social functioning where there was a less likelihood of ever being admitted to nursing home with a mean of .01 significant at less than .01 compared to those who answered no, a mean of .35. However, the variable ever being hospitalized did not have a statistically significant relationship with one’s employment status.
to staying in bed the past two weeks, ever being hospitalized and ever admitted to nursing home.
I hypothesized that higher health outcomes would be observed from those answering yes to whether they have ever traveled to Mexico, and therefore less socially isolated. My analysis results support my hypothesis with statistical significance of a p value less than .001, where those who answered yes to ever traveled to Mexico had a higher health perception of health compared to others with a mean of .58 significant at less than .05 compared to those who answered no, of .51. Those who were less socially isolated also had a lower difficulty in mobility with a mean of .27 compared significant at less than .01 compared to .45 of those who were more socially isolated. Those who answered yes to ever traveling to Mexico also had a lower rate of stayed in bed for past two weeks with a mean of 3% significant at less than .05 compared to those who answered no, 6%. Ever being hospitalized also had a lower mean of 71% significant at less than .01 for those who answered yes to have ever traveled compared to those who have not at 76%. Analysis results did not show statistical significance for the variable travel predicting one’s self perception of own health and ever being admitted to nursing home.
self-perception of overall health with a mean of 2.36 compared to those who answered no, of 2.85. Those who answered yes to could not shake off the blues and lonelier had a less health perception compared to others with a mean of .39 significant at less than .001 compared to those who answered no, of .63.
Table 4
Independent Samples T-Test
Social Isolation Loneliness
DV 6- Ever Admitted to Nursing Home 1%** 3% 2.00% 3.10% 41% 42 % 27% 35% Summary
significant association with self perception of own health, health perception compared to others, difficulties in mobility and stayed in bed.
Chapter 5
CONCLUSIONS AND RECOMMENDATIONS Summary of Study
A secondary analysis of the Sacramento Area Latino Study on Aging showed the association between one’s social isolation and loneliness and overall social functioning in the elderly. My hypothesis that there would be a negative relationship between one’s level of social isolation and loneliness and their social functioning and health outcomes was supported, generating implications for future research in social work. Social isolation was measured by multiple variables such as whether one was employed, volunteered, traveled to Mexico or to another Latin country while loneliness was measured by whether one could not shake off the blues. Social functioning was measured by multiple variables including one’s self perception of own health, health perception comparison with others, difficulties in mobility, whether one stayed in bed past two weeks, ever hospitalized or ever admitted into a nursing home. An independent samples t-test showed that social isolation and loneliness negatively affect elderly’s social functioning with statistical significance.
statistically significant difference between social isolation and loneliness with health outcomes indicate that there is a considerable association between one’s level of social isolation and loneliness to their social functioning, which provides important
implications. With an independent samples t-test, this study showed how there are differences in one’s social functioning depending on one’s level of social isolation and loneliness. Essentially, social isolation and loneliness were a statistically significant indicator of one’s functioning and health outcomes among the participants.
One’s level of social isolation measured by one’s employment, volunteer and travel experience had a significant connection to one’s social functioning, specifically in the areas of one’s self perception of health, health perception compared to others,
difficulties in mobility, staying in bed, hospitalization and admission to nursing home. Among the variables measuring social isolation, there were differences in their
association to one’s social functioning. One’s employment status and volunteer experience did not have a statistically significant association to one’s hospitalization. However, the dependent variable of one’s travel experience did, where an individual who has traveled has a significantly less likelihood for hospitalization than someone who has not traveled. Such results may be due to the likelihood that if one travels, they are likely to also have a better functioning and hospitalization than someone who does not travel.
there are differences in their association to one’s social functioning and health outcomes. One’s travel experience did not have a significant association to one’s self perception of health, while employment and volunteer experience did. Such findings may suggest that the ability to work and volunteer has a greater effect on one’s self perception of their health, as they are completing tasks and helping others compared to traveling where such does not likely occur.
One’s level of loneliness measured by responses to the question whether one could not shake off the blues, also had different outcomes in its association to social functioning. Specifically one’s loneliness did not have a statistically significant association with one’s hospitalization or one’s admission to nursing home. Such outcomes may indicate that compared to objective social isolation, loneliness may not have as much of a significant impact on one’s functioning related to one’s hospitalization and nursing home admission. This finding does not support my hypothesis that a greater amount of loneliness is associated with a higher rate of hospitalization and nursing home admission. Such results may be due to a limitation of the variable that is used to measure loneliness, in which more measures that represent one’s loneliness can show a more significant correlation between one’s loneliness and social functioning such as
hospitalization and nursing home admission. However, similar to social isolation, one’s loneliness also had a statistically significant association to one’s self perception of health, health compared to others, difficulties in mobility and staying in bed.
Several implications for social work and practice can be proposed from this research study. As the current study indicates, one’s level of social isolation and loneliness in elderly have a significant impact on their overall functioning and such an issue must be further addressed in the social work field. This study suggests the
importance of social workers helping to reduce the overall social isolation and loneliness among elderly who are increasingly isolated and experience greater loneliness. This study suggests specific intervention strategies such as assisting seniors in obtaining employment if able and wanted, encourage ing the elderly to volunteer at community centers or neighborhood programs, and overall reduce the barriers for travel by
connecting to transportation resources such as Dial-A-Ride services and other programs. Social workers can overall work to enhance elderly’s amount of social interaction to help reduce the negative impacts of social isolation.
doctor's visits. By building rapport with minority elders, they may be able to better assess and screen their risk of social isolation and loneliness.
There are micro, mezzo and macro implications for social work practice from my study results. A micro level implication for social work practice is that with an
understanding of the negative impacts of both social isolation and loneliness on one’s social functioning, there can be a greater emphasis on reducing social isolation and loneliness in elderly individuals. Despite studies showing the impact of social isolation and loneliness on the overall health of elderly, there is still not a sufficient discussion of how such issues can be improved. Enhancing one’s ability for social interaction and reducing one’s level of loneliness will help in one’s overall social functioning. Such improvements can lead to positive changes in many aspects of their lives. With a study that shows the negative impact of social isolation on one’s social functioning and health outcomes, there will be increased awareness of how both objective and perceived isolation, loneliness, has a negative effect one’s functioning. With such knowledge, individuals can become more motivated to increase their social interaction and
connection with other people. Although many obstacles such as declining health, less family contacts, and more hinder such interactions, individuals can still become more aware of how their isolation is directly affecting their functioning and become motivated to make a change.
perceived isolation, loneliness, and the negative impact they have on elderly’s
functioning. By specifically assessing for the individual’s level of social isolation and loneliness, a clinician or staff can better intervene and make a recommendation and linkage to service when needed. Therefore, no matter the setting of the assessment, whether it is at a hospital, nursing home, day care or assisted living facility, the clinician can better intervene and prevent further impairment. Progress in this area will likely depend on healthcare providers, including nurses and social workers, to recognize loneliness and social isolation among patients (MacLeod, Musich, Parikh, Hawkins, Keown, K, 2018). Another mezzo level implication is that with more services geared towards assessing social isolation and loneliness in the elderly, there can be constructive changes in families that experience challenges with declining functioning of a family member. With a better understanding of the effects of social isolation and loneliness, family members can play a crucial role in increasing one’s level of objective social connection. For example, a daughter can encourage her elderly mother to begin volunteering as a community gardener, which can help improve the mother’s self-perception of her own health, health self-perception compared to others and reduce the amount of difficulties in mobility.
restrictions in budgets, funding etc. With more research that can support the issue that social isolation and loneliness negatively influences one’s health outcomes, there can be greater opportunities for such programs to receive funding. With more funding and development of programs, more individuals can receive assistance through programs that help reduce social isolation and loneliness. Such programs may include senior
community centers in rural communities, transportation assistance services, peer support programs, in-home counseling services and much more. Specifically, from the results of my study, individuals can benefit from greater senior volunteer programs, travel
opportunities and assistance and employment search assistance for those who are able to work.
Limitations
