As a social species, we rely heavily on interpersonal interactions that shape our perspectives on life and our personalities as a whole. While it is common for individuals who identify more as introverted to spend more time alone, they relish in a comfortable aloneness as opposed to a forced isolation that stems from loneliness. Social isolation is defined as the lack of having one or more social relationships (Hawthorne, 2008). Social relationships can be broadly defined as filial relationships, being an active participant in community projects/events, essentially any act that involves the socialization of an individual (Hawthorne, 2008).
I chose to study and write about social isolation and its effects because of my past experience working with the elderly in a nursing home. The summer before coming to college I volunteered at a Jewish nursing home in the Bronx where I assisted the recreational activities manager plan programs and events for the elderly in order to keep them from falling into social isolation or feelings of loneliness. Because those elderly people in the nursing home rarely had family visiting them, we made it our mission to keep them entertained, but nonetheless the loneliness still crept in from time to time and I witnessed first hand what affect that can have on not only their mental health, but their physical and emotional health as well. The American psychological association has cited social isolation as “a potentially greater threat to society than obesity”; therefore it is important to understand the causes and mediators of social isolation.
It is undeniably that the lack of a social network, in the form of friends and family is detrimental to ones development. Even individuals who are more introverted in nature have a social network though it may be more refined and smaller than those who are extroverted in nature. Isolation is considered Unhealthy when people spend extended periods of time in isolation, without there being any physical, emotional, or mental benefit from the time spent alone (Hawthorne, 2008). While social isolation in the youth is damaging, social isolation in the elderly has been found to be more detrimental. As one ages the chances of illness, death of oneself or those closest to an individual increase tenfold. Chronic illness and the death of a loved one(s) are all factors that may lead to social deprivation or the lack of desire to have a social network (Berry et al., 2012). Researchers have found that the stresses brought on by Social Deprivation is a trigger for anxiety and depression (Berry et al., 2012).
In the literature review conducted by Dickens et al., (2011) researchers found that social isolation is commonplace in the elderly, and that the overall results of the 32 studies in the review indicate that social isolation is most disadvantageous to the elderly (people over 45) as it has more negative effects on their mental, physical, and emotional well being. Their literature review also sought to Asses which interventions would be most effective in alleviating the factors that may lead to ones social isolation. They found that “across the domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome” (Dickens et al., 2011, p.647), they also found that out of 86% of the 32 studies provided activities as interventions for social isolation and loneliness in the elderly. They found 80% of those providing support (in home support) resulted in fewer reports of social isolation, followed by 60% as a result of nurse home visits and 25% as a of internet training interventions (Dickens et al., 2011)
According to the multi path model of explaining mental disorders there are four factors that may affect a change in ones behavior. Those factors are biological, psychological, social, and sociocultural. While all the factors differ, clinicians employ the multi path model as a means of looking at a patients abnormal behavior in a more holistic manner as opposed to focusing on one factor and discounting others that may be affecting ones behavior simultaneously. The biological aspect of it argues that the change in behavior is genetic and that it was bound to happen based on patients biological make up. Social isolation is usually a condition that develops from the lack of social networks therefore clinicians may rule out the biological factor as an immediate contributing factor, but still a factor nonetheless.
The next step could be to Asses for psychological factors that may be at play. A clinician should inquire about any family history of mental illness, they should assess the patients Personality, level of cognition, emotional responses, learning styles or patterns, any developmental history, self-esteem, and self-efficacy (Bellus, class notes, 2017). This mental health check is great step in in assessing the psychological factors that may be present in a patient who may be suffering from social isolation. If a patient is exposed to a socially sound environment, but were still displaying symptoms of social isolation, then the patient may be facing more malignant mental health issue. In the case of an elderly patient they are most susceptible to forming a mental illness as their bodies deteriorate with age, they are also more likely to face lower self esteem and less self efficacy as they become less self reliant and more reliant on others for support in even the most rudimentary of tasks.
As a clinician using the multi path model the next step would be to assess for social factors that may’ve lead to a patients social isolation. One should inquire on How often the patient lacked companionship How often they feel isolated or experience feelings of being left out (Menec, 2016), To Asses if the patient is suffering from mere loneliness, or if the patient has socially isolated himself or herself from the very human social contact we thrive. To asses the social factors one should check to see if the patient were Living alone, has a lack of access to private transportation, has little to no contact with their social network, family & friends, (Dickens et al., 2011) and/or has experienced major life events such as loss of a spouse have all been identified as risk factors that may lead to feelings of isolation (Menec, 2016). An additional measure that could be effective in discerning if a patient may be suffering from social isolation is a mental health check. If the patient was currently living in a social environment that was thriving with new opportunities to be social on the regular, yet they Persisted to show symptoms of social abnormality, then the patient may be suffering from issues that are more biological and require more specific interventions.
Lastly, the final factor to consider in the multi path model is the sociocultural aspect. Sociocultural factors include but aren’t limited to “Socioeconomic status, race, ethnicity, gender, sexual orientation, religious preference, physical disabilities” (Bellus, class notes, 2017, p.166). Of the literature reviewed, there is growing support for the notion that psychological and sociological factors influence on how well one ages; the research suggests a positive correlation between social, psychological, and sociocultural factors on the elderlies ability to age more successfully (Singh & Misra 2009). Researchers found those low in socioeconomic status, males, and those with disabilities to be more prone, and thus higher in social isolation than their counterparts. Gouda & Okamoto (2012) also noted that physical, psychological, and social factors regarded are associated with social isolation and that previous studies note that being a male, lacking companionship, being of low SES, deterioration in physical and mental functioning are all contributing factors to social isolation. Thus there is evidence that the use of the multi path model is effective in that researchers found nearly all factors influencing social isolation, though some more prevalent than others.
Treatment
Unlike many illnesses social isolation is one that can be alleviated with non-medicinal interventions that only work if treatment is consistent with the needs of the Patient depending on how far gone they would be on a set isolation scale, as these feelings will differ from patient to patient. As a clinician one should make it their business to learn more about the patients through a classical interview. Interviewing the patient alone can shed some light on their likes/ dislikes and that in turn may be helpful in formulating a personalized care plan With the aim of reducing feelings of social Isolation (Saunders, 2012). Another Intervention than can be beneficial in the treatment of social isolation is planning organized family events. By encouraging family members to come and participate actively in ones treatment not only do you strengthen the bonds of that social net work but it also strengthens feelings of love and joy which have been found to counteract feelings of loneliness and even isolation. The implementation of family days could also be proactive for elderly citizens who may be feeling lonely and who may be at risk for developing social isolation.
Lastly, based on the results of the interview collected, ones clinician should then begin extensive research into the benefits of Nursing homes or elderly assisted living facilities. Ones clinician may also consider suggesting a home nurse or a home health aide. Keeping the patient in their home would not only aide their recovery by not removing them from their comfort zone but it also makes it easier and more convenient for the family to come over for organized events. An additional measure that can be taken to restore feelings of independence include booking access a rides for the patient or at least a form of constant transportation so they feel less limited in where they can go or what they can do.
Based on the literature, its undeniable that social isolation has it affects on ones health, most especially the elderly. Thurston notes that even in the healthiest individuals the lack of a properly functioning social network can lead to fatal cardio vascular diseases. Holt-Lunstad et al., (2015 p.227) also note “actual and perceived social isolation are both associated with increased risk for early mortality”. Thus the implications of studying social isolation lie in the benefits it would have of increasing the life span of the elderly. In addition to the interventions aforementioned Findlay (2003) suggests three requirements for effective interventions of social isolation. First that clinicians be highly trained in facilitating the type of support needed by the patient, secondly she suggests that the patients should be active participants in planning their own interventions from beginning to end, lastly she notes that interventions work best when community outreach is employed.
Community outreach can easily come in the form of getting the patient involved in activities at their religious house of choosing. When my grandmother came to America she often complained of being cooped up at home with nothing to do. While my family and I are of the Muslim faith, my grandmother is not, and so to mediate her feelings of loneliness and isolation we found her a church to attend of the denomination of her choosing. My grandmother is now a very involved member of the church as an usher! She often volunteers her time to babysit the children and teach Sunday school. This involvement in something larger than her self has given her a new sense of purpose in life.
Other community out reach programs Clinicians could suggest include activities like Elderly Zumba, weekly Bingo, Participating in water aerobics, Karate for the elderly, paint nights and much more of the activities normally offered in local recreational centers and YMCA’s. The coupling of an independent means of transportation and community involvement that naturally force the development of strong social ties to the community may counteract and even mediate the effects of social isolation in the elderly.