When seniors make the hard decision to leave their lifelong homes and move into a senior living community, one of their driving motivators is avoiding seclusion. Yet many senior living residents still struggle with loneliness and its negative impacts on mental and physical health.
This was true even before the pandemic. A study in 2020 from the National Academies called social isolation “a serious but underappreciated” public health risk for seniors, comparable to factors such as high blood pressure, smoking or obesity and presenting a major risk for premature mortality.
A separate pre-COVID study from researchers at the University of Chicago and the University of California linked loneliness in older adults to depression, pain, fatigue, poorer general health and an increased likelihood of nursing home admissions. That study found that loneliness can lead to cognitive decline, dementia, increased inflammation and increased mortality.
Pandemic lockdowns only exacerbated the problem. Yet the pandemic also raised awareness among caregivers, residents and their families about the importance of identifying residents at risk of isolation, and taking proactive steps to solve it.
“The pandemic brought to light mental health issues in a way that nothing else ever has,” says Jean Fortgang, NP-C, ACHPN, associate director of the UnitedHealthcare® Assisted Living Plan.
Here is a look at how operators are confronting this most urgent of health challenges — and how Optum is creating communities of care.
Small steps by staff can yield big results for residents
The first step in helping residents deal with isolation is, of course, identifying the symptoms. The authors of the 2020 National Academies report noted that approximately 25% of “community-dwelling Americans aged 65 and older” are socially isolated, feelings that present a major risk for premature mortality and are comparable to high blood pressure, smoking or obesity.
“Because this is an older population, there are still some stigmas attached to saying, ‘I’m going to counseling,’ or ‘I’m on medication for anxiety or depression,’” says Dr. Cathy Lipton, national medical director for senior community care at Optum. “I do believe the pandemic allowed a little bit of grace with that, helping people realize it’s okay to say, ‘I’m sad. I’m lonely. I’m not happy with the way things are.’ And then others can help them address that.”
The good news is that as communities have grappled with the many new pandemic-fueled challenges, Optum advanced practice clinicians (APCs) report more staff and family awareness of symptoms of depression and anxiety. More staff members, particularly those without a medical background, are coming to recognize more quickly relevant changes in resident mood and behavior, Fortgang says.
“They are calling out the differences more frequently,” she says. “And I think that goes for all the staff, not just clinical staff. It really is a community, an extended family. So, they may not know to call it mental health, but they know to call out when a behavior is different.”
That enables the Optum team, as part of the community, to provide more education and support to help senior living communities address behavioral health issues. Even small steps can produce big results, such as talking with family members about residents, creating activities that help residents overcome anxiety or using physical therapy to help them regain strength and confidence.
Technology: the social game-changer
The pandemic also spurred innovative, often simple, new programs that have great potential to drive long-term improvements. One of the biggest game-changers: technology.
During lockdowns or restricted visitation, Optum bought tablets for residents and helped them set up those communication channels.
“Such programs helped bridge the digital divide for seniors,” Lipton says.
Besides using technology to see their families, increasingly tech-savvy seniors also learned to tap virtual options for attending everything from grandchildren’s recitals to religious services.
“I don’t think that will go away,” Lipton says. “So that’s a really nice outcome. There are so many ways that they can now participate in social activities that don’t require them going across town.”
The next crucial challenge: building on lessons learned
How the long-term impacts of social isolation during the pandemic will play out for both mental and physical health will no doubt be studied long after COVID-19 fades. In the meantime, it’s important that senior communities continue to build on the momentum achieved in helping residents cope with the mental health challenges of social isolation.
“A lot has been learned,” Lipton says. “Just realizing that, again, there is a risk regardless of how well adapted residents may appear and keeping vigilant and being aware there are situations that can happen even without a pandemic, such as losing an old friend. It’s so important to make sure that everybody involved with the assisted living residents knows that.”
This article is based on an Optum white paper, “Social isolation: The underrated senior health risk.” To download a free copy of the complete white paper, visit info.optum.com/behavioral-health-social-isolation.
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