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Slide 1: Loneliness in Community Dwelling Older Adults Andrea Yevchak, GCNS-BC, RN Nursing 597C Geriatric Assessment Fall 2008
Slide 2: Objectives By the end of this presentation, participants will be able to: 2.Assess for loneliness in older adult using a measurement tool. 3.Develop a plan of care for older adults experiencing loneliness and/or related conditions. 4.Be able to discuss factors that contribute to loneliness in older adults, especially community dwelling older adults.
Slide 3: Health Care Setting  Community dwelling older adults can be present, but not limited to, the following settings:  Acute Care  Post-Acute Care  Primary Care Providers Offices  Retirement Communities  Senior Centers  Specialty Clinics
Slide 4: Loneliness Includes emotional and social components that can have negative health consequences Loneliness is a subjective experience, often best described and not defined
Slide 5: Risk Factors of Loneliness  Aging as a Process  Illness  Chronic Conditions  Lack of Independence  Decreased Social Support and Networks  Death of significant others, family, friends  Reduced social activity  Rural Dwelling Older Adults  Older Adults with less education
Slide 6: Loneliness and Health
Slide 7: Depression Loneliness is a component of depression An individual may be lonely without being depressed and may be depressed without being lonely
Slide 8: Loneliness  Interpersonal Depression  Global concerns about dissatisfaction  Often shorter in duration  Guilt is less likely to be present  There may be no or little changes in sleeping and eating patterns dissatisfaction with life  Longer duration  Guilt is often associated with depression  Vegetative Symptoms are often present, insomnia and decreased appetite http://www.medscape.com/viewarticle/430545_8
Slide 9: Additional Terms
Slide 10: Short-form UCLA Loneliness Scale (ULS-8) 7 Question, 4 Point Likert Scale with values ranging from “never” to “always” “I lack no companionship” “There is no one I can turn to” “I am an outgoing person” “I feel left out” “I feel isolation from others” “I can find companionship when I want it” “I am unhappy being so withdrawn” “Peoples are around me but not with me” Russell, 1996
Slide 11: Satisfaction with Life Scale 5 Question, 7 Point Likert Scale Ranging from 7 Extremely Satisfied to 1 Extremely Dissatisfied “In most ways my life is close to my ideal” “The conditions of my life are excellent” “I am satisfied with my life” “So far I have gotten the important things I want in life” “If I could live my life over, I would change almost nothing” 35 - 31 Extremely satisfied 26 - 30 Satisfied 21 - 25 Slightly satisfied 20        Neutral 15 - 19 Slightly dissatisfied 10 - 14 Dissatisfied  5 -  9   Extremely dissatisfied Pavot and Diener, 1993
Slide 12: Research Articles Grading Schema Used to make recommendations for evidence-based practice: A1= Evidence from well-designed meta-analysis or well-done systematic review with results that consistently support a specific action A2= Evidence from one or more randomized controlled trials with consistent results B1= Evidence form high quality evidence-based practice guideline B2= Evidence from one or more quasi experimental studies with consistent results C1= Evidence from observational studies with consistent results (e.g. correlational, descriptive studies) C2= Inconsistent evidence from observational studies or controlled trials D= Evidence from expert opinion, multiple case reports or national consensus reports
Slide 13: Loneliness i n Older Chinese Ad ults: A R isk Factor for Eld er Mis treat ment (2007) Dong et . Al . and depression in Twainese rural communit y-dwelling elders (2001) Wang et. Al. Grade= C1 Grade= C1 H ealth risk apprais al in older Peopl e 1: Are Older Peopl e Living Alone an ‘at Ris k’ Group? (2007) Kharicha et . Grade= A2 Al. Assessment of a Short Sca le to Measure Social Support Among Older People (1999) Goodger et . Al. Grade= B1
Slide 14: Enha nce Ins tituti onaliz ed Older Ad ults ’ Social Support Networks and Decr eas e Loneliness (2006) Winningham & Pike Independent Living Retirement Communities: Risk and Resilience Factors (2004) Adams et. Al. Grade= A2 Grade= B2
Slide 15: Predictors and subjective Causes of Loneliness i n an Aged Popula tion (2005) Savikko et. Al. St ress, Loneliness, and Depression in Taiwanese R ural Community-Dwelling Elders (2000) Wang et. Al. Grade= C1 Changes in Older Adult Loneliness: Results from a Seven-Year Longitud inal Study (2005) Dykstra et . Grade= C1 Al. Grade= C1
Slide 16: Case Study 1 Julie is a 99 year widow in good physical and mental health, being aided by her 75 year old son. Her son’s wife suddenly experiences a massive stroke. Julie’s son is now her primary caregiver, changing the focus of his attention from his mother to his ailing wife. Julie reports to you as her primary caregiver. Her blood pressure is elevated and she states that she has not been sleeping as well as normal. She is also quite talkative today, chatting with you about the weather and about her newest plans to start a knitting project.
Slide 17: Case Study 1 Attributes of Julie Difficulties in Adjustment Affects on Julie’s Health Possible Interventions
Slide 18: Case Study 2 Edith is a 70 year old recent widow who moved into a local continuing care retirement community to be closer to her daughter. She previously resided in a another retirement community, had a close group of friends, was involved in exercise program, and well liked throughout the community. Edith is an active 70 year old woman, still participating in physical activity programs and other events as offered at her new “home”, but she states that it is difficult for her to feel any connection. As the gerontological clinical nurse specialist at this facility, Edith comes to you in tears not understanding why she is having such a difficult time.
Slide 19: Case Study 2 Attributes of Edith Difficulties in Adjustment Affects on Edith’s Health Possible Interventions
Slide 20: Thank You!!!