Loneliness in nursing homes: A serious challenge requiring action

Loneliness is a problem that not only affects older people in society but also residents in nursing homes. For many elderly people, the nursing home is their home where they expect to have a safe and social environment. Unfortunately, reality is sometimes different, and there are residents who feel lonely and isolated.

Loneliness in nursing homes can depend on various factors. Lack of staff or engagement can lead to activities and social gatherings not being offered to a sufficient extent. This leads to residents spending most of their time in their rooms without the opportunity for social interaction. For the elderly who have difficulty moving or who lack family and friends who can visit them, the loneliness becomes even more palpable.

Loneliness has both psychological and physical consequences for the elderly. Studies show that older people who feel lonely are at higher risk of developing depression, anxiety and other mental illnesses. In addition, physical health can deteriorate as social interaction can promote physical activity and eating, which is important for the well-being of the elderly.

To combat loneliness in nursing homes, a holistic perspective and commitment from both staff and society are required. One way to reduce the risk of loneliness is to encourage volunteering in nursing homes. By engaging volunteers who can visit the elderly and participate in various activities, the opportunity for social interaction can be increased and the feeling of loneliness can be reduced. It can also be rewarding for volunteers to have the opportunity to share their time and experience.

Finally, it is important that nursing homes strive to create a culture of inclusion and openness. By encouraging residents to participate in decisions about activities and decor, they can feel more engaged and involved in their new home environment. Having common spaces where residents can meet and socialize is also important to promote social interaction.

Loneliness in nursing homes is a serious challenge that must be taken seriously. By allowing the elderly to continue being an active part of society and giving them the opportunity to interact and participate in various activities, we can help alleviate the feeling of loneliness and isolation. Every individual deserves to experience security and social contact, regardless of age and place of residence.

Loneliness affects health

Loneliness is a public health problem and a general problem for older people. There are people who feel lonely even in the nursing home. When the operation is forced to work with cohort care to reduce the risk of infection, the operation must plan conversations and social interaction for the resident.

Involuntary loneliness and isolation can lead to anxiety, depression, premature aging, and eventually death. Other consequences can be reduced appetite and activity which can contribute to fall injuries and more. Social distancing has been a slogan. Physical distance but social proximity would be a better slogan.

In the past, isolation or exclusion from community was the greatest punishment a person could get. Since a lonely person rarely could support himself and survive in the long run, it often led to. In nursing homes, there has been talk of isolating those suspected of being carriers of infection and quarantining them. Quarantine is a measure under the Infectious Diseases Act decided by the infection control doctor, but there are operations that have regularly used quarantine in practice.

In emergency situations where there is ongoing spread of infection, the operation can switch to providing cohort care. This means that everything is done to reduce the risk of infection spreading between the residents. It is then particularly important to give those who stay in their room more attention and time for conversation.

For the person left alone, the risk of existential anxiety is great. It is alleviated in the meeting with other people and being the focus of others' care. We need to be confirmed during the time in cohort care, as well as feel closeness and be able to talk about thoughts and feelings. The "good conversation" must be the main tool for us who care for our elderly, a way for the elderly to be confirmed. A salutogenic perspective facilitates. Even older people must have "A sense of coherence" where life is meaningful, manageable and understandable.

When the operation takes such measures, a health plan should be established that ensures that the resident receives adequate care for both body and soul.

Anxiety

Extensive use of anxiety-suppressing medication can be a sign of deficiencies in care. By consciously working to create a harmonious environment and getting to know the resident, it is often possible to find alternatives to medication as needed against worry. If individual individuals use medication against anxiety and sleep disorders, it says nothing in itself, but if a large proportion of the residents medicate with such drugs, it can indicate that the care environment does not function satisfactorily.

Treatment for anxiety and worry is common among our elderly. Some anxiety medications cause anxiety as the treatment effect decreases after some time of use. The elderly person ends up in a vicious cycle and then takes an extra tablet to reduce his anxiety. Many times, a dedicated staff and a sensible activity that is adapted to the individual can make the need for calming medication decrease. Then it can be possible to phase out addictive drugs and reduce side effects and fall risk.

Staff treatment affects the climate. The staffing obviously matters. Unfortunately, tenders for elderly care sometimes lead to staff cuts, which hits the elderly who receive worse care and less opportunity to maintain their functions and health. Often it is more anxious in the evening when the staff need to go and help residents in each person's apartment to change for the night, while the rest are left alone.

On units for people with dementia, regular supervision is a source of security. Peace and quiet in the evening, as well as subdued lighting can help the elderly to unwind. In the care of people with dementia, it is important that TV sets do not interfere. Instead, quiet music can be preferred. Many of those suffering from dementia cannot make use of TV programs and the noise from the TV causes worry. TV viewing can take place in the room for those who wish.

Employees can tell how restless it can get when new employees arrive. Some substitutes lack education and knowledge about dementia and how it affects the individual. Good introductory training in connection with new hires is important.

Depression

There is often sadness and depression in the elderly, but there is much to do beyond drug treatment. Exercise, conversation, social activities and outdoor activities are important aspects of lifestyle. Often, the relationship with loved ones suffers from the elderly being sad and ruminating negative thoughts.

Aging itself is not the cause of depression. There are several reasons why depressive disorders are more common at a high age. Grief, loss, loneliness, physical illness, understimulation and certain drug treatments can contribute to depression. Anxiety in the elderly often depends on underlying depression. Somatic illness often lies behind "worry" in the elderly.

Older people commit suicide to a greater extent than younger people. It is possible to treat suicidal thoughts, but it is important to pay attention to these and take them seriously. There are good tools for assessing depression in older people. Always inform the doctor if you suspect that a person has suicidal thoughts.

There was a man in a nursing home who was deeply depressed. He had received very good care and really appreciated the staff. One day he couldn't take it anymore and asked to be admitted to a psychiatric ward. He managed to take his life a few days after he was admitted. For the staff at the nursing home, it was reassuring to know that they had done what they could to help him.

Depression and anxiety can be different expressions of the same underlying disease where individual differences determine which image appears most clearly. It is rarely classic depression symptoms. The elderly often complain of "ill health", unwillingness and similar diffuse symptoms. Fatigue, insomnia, increased worry, irritation, cognitive impairment and physical symptoms such as pain rather than sadness. Dizziness is common and they may ask to see the doctor often. Hypochondriasis and paranoid symptoms are common. The anxiety often settles in the body with heart problems, gastrointestinal problems, sleep problems, pain and aches.

Complements to drug treatment.

• Regularity in lifestyle including sleep and exercise.
• Exercise has proven antidepressant effect in itself - at least 3 sessions of 30 min. walk/week.
• To meet daylight.
• Adequate lighting in the residence and the unit.
• Social activation and conversation.
• Moderate with alcohol.

Reflection - mental well-being
Care staff:
• How do you maintain the mental well-being of the residents when you find yourself in situations where contacts between the residents and the close relatives are limited?
• Do you have many who eat anxiety-suppressing drugs regularly?
• What can you do instead of giving anxiety-suppressing?
• How do you work with those who are depressed?

Manager, nurse, occupational therapist and physiotherapist:
• How do you work to plan care so that the individual is not isolated in a situation where you provide cohort care?
• Do you have any form of standard health plan to ensure that the resident gets extra much personal time in such situations?
• Do you keep track of the extent to which you use anxiety-suppressing drugs as needed medication in relation to other nursing homes?
• How do you work with residents who suffer from mental illness?
• Do you motivate residents to participate in activities and outdoor activities?

Resident and relative:
• Does the unit feel restless or calm?
• Do you and your relative have the opportunity to talk about anxiety, depression and other mental illness?
 

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day