Breaking the loneliness cycle in aged care

Aged care facilities should be well placed to tackle social isolation yet research shows seniors who live in residential care report feeling lonelier than those in the community, write Peter Birkett, Andrea Dunlop and David Edvardsson.

It’s inevitable that as we age there will be a social cost. Factors such as retirement from meaningful employment, health limitations, the loss of spousal companionship and diminished friendship networks arising from death and disability mean that opportunities for social engagement decline.

Social connectedness is well regarded as a key determinant of health.

Whilst recent aged care reforms place increased importance on living longer at home to maintain health and independence, the unintended consequence may be increased social isolation and loneliness.

Residential aged care facilities should be well placed to tackle issues of loneliness and isolation due to communal living, availability of caregivers to support health needs, unrestricted timeframes for visitors and leisure, recreation and lifestyle programs.

However, research in 2012 found that older people in residential care report feeling more lonely than those living in the community.

Minister for Aged Care Ken Wyatt last year quoted figures of up to 40 per cent of people living in residential aged care do not receive any visitors at all.

The solution to tackling loneliness for those living in residential facilities must not rely upon maintaining diminishing family connections once present in former lives.

Facilities and aged care providers must also accept some responsibility to tackle this complex issue. It must be said, however, that not all people living in residential care are lonely. Alone perhaps, but not lonely necessarily.

Breaking the cycle

Delivering care that is person centred has been both an expectation, and a flagship of, many aged care providers. But are we really delivering care that meets the physical health as well as the social, emotional and psychological needs of the residents we care for?

Have you been to an aged care facility where residents are congregated in comfortable lounge chairs in communal spaces for long periods of the day? Have we ever asked them if that makes them happy? Have we ever asked them what they would prefer to be doing or if they are lonely? Or are we too afraid of the answers that they might give?

Statistics from the end Loneliness Campaign in the UK reveal that 90 per cent of us find it difficult to tell others that we are lonely. It follows then that aged care residents may also find this hard to admit.

So how do we find out? Very simply we must observe, ask, listen, connect and explore ideas and possibilities to facilitate important social connections that may break, even temporarily, the loneliness cycle.

Then we must share what we learn. The daily handover should not be limited to addressing issues of health status it should also be used to share information that holds meaning to that resident; something about their life history, interests, values and their view of the world.

It might be equally valuable to share that you noticed them tapping their foot along to a certain song or that they laughed when a joke was made or that their eyes lit up when they shared a snippet of their life.

Staff commonly report that making a difference to others is what drives them to work in residential aged care, yet the skills of enquiry and observation about social factors are not necessarily intuitive. The workforce requires education about how to do this, what to ask, how to ask, when to ask and importantly how to share the information with their colleagues.

New international initiative

An international study currently underway in Norway, Sweden and Australia may reveal some of the answers. Using a Scandinavian developed Thriving in Older Persons Assessment Scale, the study surveyed residents, families and staff in nursing homes about perceptions of person centred care and then provided a 12-month education program to care staff within three domains of

• giving a little extra
• developing a caring environment, and
• assessing highly prioritised psychosocial needs.

Using alternative facilities in each country as control sites, the staff, residents and families will be resurveyed after the education program to see if it has made a difference.

Disney and Pixar has made a fortune out of movies like Shrek and Beauty and the Beast highlighting issues of loneliness and the benefits of acceptance and social inclusion. They do so because these are issues that resonate.

Loneliness will affect us all, sooner or later, so let’s work to make residential aged care a place where older people do not simply survive but also where they thrive.

Follow AAA online for updates on the study’s outcomes. Don’t miss the forthcoming March-April issue of AAA magazine for more on tackling loneliness in residential aged care.

Peter Birkett is CEO and Andrea Dunlop is manager of workforce and service development at Hesse Rural Health Service. Professor David Edvardsson is director of Austin Health Clinical School of Nursing at La Trobe University.