Nurse’s Understanding of Loneliness Among the Elderly Population:
Nurses have a significant responsibility providing quality healthcare to their patients. Similarly, nurses have a responsibility to ensure that the elderly population under their care is in an excellent psychosocial situation. The elderly group under the care of nurses often find themselves lonely due to their substantial dependence caused by their mental or physical impairment (Drageset et al., 2015).
For various people, aging is associated with the loss of fundamental aspects of life, such as friends, family members, physical functions, and many others. The effects of such losses and how they are managed can result in feelings of loneliness. This scoping review fulfills the need for further exploration to improve the understanding of loneliness under the context of healthcare (Harris, 2015).
Though loneliness is a problem for all age groups, the rate at which the elderly population is affected by the issue is very high. Various loneliness cases have been reported in the past in different elderly nursing ho mes. Socialization is an essential aspect of a healthy aging process, and nurses represent one of the dominant teams that provide services to the elderly and lonely populations. The primary purpose of this scoping review is to examine the nurses’ understanding of loneliness among the elderly.
The Rationale for the Review
To ensure the effective wellbeing of elderly adults, healthcare providers at different levels of service and care contexts should meet their respective direct needs. Previous studies reveal that nurses are willing to concentrate on first-hand problems among the elderly which leads to loneliness. Existing research shows that it is a great challenge to spare enough time and space for the elderly populations under their care (Barakat et al., 2019). Therefore, nurses are often compelled to concentrate on other practice duties while neglecting their relationship with the elderly patient which leads to loneliness. The issue of loneliness among the elderly populations covers both the aspects of suffering from either subjective or objective loneliness. This review is a starting point in examining the concept of loneliness among the elderly, the perception of loneliness among nurses, and the necessary approaches to improving elderly healthcare (Sundler et al., 2016)
In this scoping review based on relevant literature, the primary research question is: How do nurses understand the concept of loneliness among the elderly?
Loneliness is a problem prevalent in all age groups but most rampant among the elderly. The elderly group, under the care of nurses, often find themselves lonely due to their substantial dependence caused by their mental or physical impairment (Drageset et al., 2015 ). Nurses should avail themselves to the older adults in their care irrespective of the challenges that come with their line of work. Technically, nurses should be able to assess loneliness among their elderly patients, and their perception of loneliness is vital in assisting the elderly with loneliness.
A quick scoping review was employed in a systematic article search process through different steps. As the search process continued, the review methods, criteria, and analyses were documented and predetermined. The step-by-step method was applied. All the references obtained through the search strategy were screened, selected, and scored based on their relevance to the research study topic. The system identified the top-quality, evidence-based research articles in a highly organized and ranked way.
Moreover, the system identified applicable research and evidence that the organization produced outside the gray literature. Various factors determined the research paper’s eligibility, which included establishing if the title meets the criteria of the study, and whether the entire text meets the eligibility criteria. Articles that did not fulfill such criteria were excluded from the study. Only peer-reviewed articles were used.
The studies used in this scoping review paper were obtained through an online search of databases such as Medline, CINAHL, PubMed, and Cochrane. To ensure that only updated information was used in the study, articles published between 2014 and 2020 were used. Moreover, only English language articles were utilized since the researcher is a native English speaker who understands English better than other languages . During the screening process, only articles whose title, abstract, and year of publication met the eligibility screening process were involved. Articles that did not match any of the above elements of the eligibility criteria were excluded from the study. All the articles included in the study were chosen based on their relevance to the research study question.
Numerous information sources were used in this research study. To have access to various articles concerning the research study, PubMed, Medline, CINAHL, Cochrane databases, and many others were searched. Only the best databases were chosen for quality research work. In addition, a few nursing and emergency journals published in the last five years were also reviewed to ensure more research was obtained.
Different data items were used in this research study. Special focus was on different variables for which the research data was sought, including nurses, loneliness, elderly or older patients, understanding, and awareness. This research study mainly focused on nurses other than other healthcare providers such as doctors, healthcare managers, therapists, and many others. Particular focus was out on only the elderly patient groups or populations; hence, eliminating other age groups. The working definition of loneliness was an individual’s state of sadness caused by the fact that one lacks the company of friends. An assumption was made that all nurses had an idea about the concept of loneliness among the elderly population since they often spend more time taking care of them.
The scoping review was conducted in a systematic review based on the PRISMA statement of transport reporting on meta-analysis and systemic reviews. For the selected engines, various strings were combine d. Among these included Hospitals [Mesh] OR healthcare facility OR “nursing healthcare service” [Mesh] OR “healthcare” OR “nursing homes” OR nurse OR nurses OR nursing teams [Mesh] OR role OR nurses understanding of loneliness among the elderly population[MESH]OR “loneliness” OR lonely elderly in nursing homes or healthcare department, “healthcare facilities”[Mesh] OR “health facility” OR “health facilities” and OR hospitals. OR: understanding or awareness or knowledge.”
Data were extracted from these reports using the piloted forms or the data extraction forms. Two different individuals used the data extraction form in collecting data from the systematic reviews. Such a procedure is intended to allow the pre-testing of data extraction form. Based on experience, all the issues or problems found in the form were fixed, and their interrater reliability was checked to understand the form’s validity. For all the studies, the revised data extraction was used. The data extraction form included the bias evaluation or evidence grading and was done in a separate form where two independent individuals were involved in data extraction to reduce the bias of the research data used.
The research revealed that nurses play a vital role in improving the quality of life for the elderly. All the studies showed a need for the nurses to offer a helping hand to elderly patients who were most vulnerable to depression. Sundler et al. (2016) noted that there is a need to explore communicative issues in encounters between nurse assistants and older persons in times of home care visits. When nurses establish friendly relations with their elderly patients through constant communication, the elderly are less prone to loneliness. Forging friendships between the nurses and elderly patients improves the quality of life of older adults.
Chapter 3: Results
To establish what it means to be an individual living through an illness trajectory of MND n=375 No The life word approach is essential in healthcare. Existential loss associated with MND is a loss of spatiality, embodiment, and the future. Healthcare professionals are tasked with taking care of and paying close attention to individuals living through an illness trajectory of MND from the time of diagnosis onwards. The findings from the study may prompt healthcare workers to put much focus on patients living through existential loss and their various existential concerns. The conclusions of the study encourage a lifeworld approach in regards to healthcare. The concept of “existential loss” in the study was limited only to people diagnosed with MND.
Arslantas, Adan, Ergin, Kayar, & Acar 2015. Arslan Arslantas, H., Adana, F., Ergin, F. A., Kayar, D., & Acar, G. (2015). Loneliness in Elderly People, Associated Factors and Its Correlation with Quality of Life. A Field Study from Western Turkey. Iran J Public Health, 44(1), 43–50. pmid:26060775; PubMed Central PMCID: PMC4450013.
The main aim of the research is to examine the factors that influence older people’s loneliness and their relationships with the type of life they live n=174 UCLA Loneliness Scale/
Quality of Life (QOL) Short Form (SF-36) Older adults should be encouraged to participate in social activities to improve their healthy wellbeing. Loneliness has adverse effects on QOL in elderly patients. The older adults living alone were found to be a high-risk group, and this should prompt policymakers and healthcare workers to be aware of the factors that bring about loneliness. Supportive social and physical environments should be provided to the elderly to improve their quality of life. Findings from the study show that the maintenance of QOL should be prioritized during the provision of healthcare services, given the increasing number of elderly people. Only 83.2% (n=174) of the target group was reached.
Barakat, Elattar, & Zaki, 2019. Barakat, M. M., Elattar, N. F., & Zaki, H. N. (2019). Depression, Anxiety, and Loneliness among Elderly Living in Geriatric Homes. American Journal of Nursing Research, 7(4), 400-411. doi: 10.12691/ajnr-7-4-1 The study’s main aim is to assess anxiety, depression, and loneliness among older adults living in nursing homes n=50 Geriatric Anxiety Scale (GAS)/
UCLA Loneliness Scale/
Structured Interview Questionnaire/
Beck’s Depression Inventory Intervention measures or programs for managing anxiety, loneliness depression among elderly staying in geriatric homes are necessary. Older adults staying in geriatrics homes have higher depression levels, loneliness, and anxiety. There is a need for further studies evaluating the psychosocial factors that are largely involved in depressed elders to prevent depression and promote mental health in elders who have been institutionalized. There is a need to address depression, which is the most common psychiatric disorder among the elderly. The findings should prompt the healthcare providers in nursing homes to help the elderly cope with their loneliness and depression. All patients were over the age of 65.
Gardiner, Geldenhuys, & Gott, 2018. Gardiner, C., Geldenhuys, G., & Gott, M. (2018). Interventions to reduce social isolation and loneliness among older people: an integrative review. Health Soc Care Community 1–11. doi:10.1111/hsc.12367
To carry out an integrative review to establish the range and scope of approaches targeting social isolation and loneliness among elderly populations n=50 No It is essential to develop further a theoretical understanding of how successful interventions mediate social isolation and loneliness. Loneliness and social isolation are significant issues affecting the elderly. Interventions and engagement in activities are widely advocated to help older adults cope with social isolation and loneliness, a growing problem. The use of a community development approach and productive engagement proved useful in tackling social isolation and loneliness amongst the elderly. The development of such approaches may prompt healthcare providers to adopt such measures to help elderly adults cope with loneliness and social isolation. The study should have encompassed a higher number of elderly adults.
Elias, Neville, & Scott, 2015. Elias, S. M. S., Neville, C., & Scott, T. (2015). The effectiveness of group reminiscence therapy for loneliness, anxiety, and depression in older adults in long-term care: A systematic review. Geriatric Nursing, 36(5), 372–380. doi:10.1016/j.gerinurse.2015.05.004
To establish the role of group reminiscence therapy in dealing with loneliness and depression. N=37
No Group reminiscence therapy is good for the wellbeing of elderly patients. Group reminiscence therapy for loneliness improved their quality of life. The adoption of group reminiscence therapy is beneficial given the resource strains in delivering long term care and may prompt essential health care providers to adopt group reminiscence therapy in place of individual reminiscence therapy. The findings from the study showed that group reminiscence therapy was effective, and there is a need to adopt this type of therapy in regards to helping the older adults deal with depression. The study showed limited research regarding the benefits of group reminiscence therapy in helping the elderly deal with depression. There is a need for further research to help establish an evidence base and provide a better understanding of the effectiveness of group reminiscence therapy. Group therapy could have been for a more extended period.
Heidari, Ghodusi, & Shirvani,2016. Heidari, M., Ghodusi, M., & Shirvani, M. (2016). Loneliness in elderly and non-elderly residents of nursing homes. International Journal of Nursing Education, 8, 71–76.
To examine the concept of leadership among elderly and non-elderly residents in nursing homes. N=60
UCLA Loneliness Scale Therapy is essential for improving the wellbeing of the elderly population. Loneliness is a severe problem in elderly populations. The study’s findings may prompt healthcare workers to disregard the common notion that loneliness is mainly associated with older age. Also, the study may prompt research on nursing homes, given that most studies regarding loneliness are among the community-dwelling people. Therefore, the factors that contribute to loneliness among the elderly in nursing homes are vastly unknown. Residents of nursing homes are at a higher risk for loneliness, which should prompt healthcare providers to provide a helping hand. There was an imbalance in the number of elderly and non-elderly patients incorporated into the study.
Farshid, Fatemeh, Ravanbakhsh, & Javad, 2014. Farshid, S., Fatemeh, C., Ravanbakhsh, E., & Javad, M. (2014). Explanation of loneliness in the elderly and comparison with psychosocial development theory: a quantitative study. J Educ Community Health, 1(2), 30-8.
Comparison of loneliness among the older adults with the Psychosocial Development Theory n-60 No Loneliness is still a severe problem among elderly populations. Loneliness results from the feeling of lacking people to communicate within their hard times . The study’s findings may prompt the various healthcare providers to assist the elderly in experiencing loneliness, given that it is prevalent among the elderly. There is also an increased chance that healthcare providers may adopt Erikson’s theory as a strategy to reduce isolation to help improve the quality of life amongst the elderly. The studies may also prompt further studies on the adverse health consequences of loneliness on the physical and mental health of the elderly. All patients were aged between 65-85 years.
Nikmat, Hashim, Omar, & Razali, 2015. Nikmat, A. W., Hashim, N. A., Omar, S. A., & Razali, S. (2015). Depression and loneliness/social isolation among patients with cognitive impairment in a nursing home. ASEAN Journal of Psychiatry,16(2):222-31.
To establish the prevalence of loneliness or social isolation and aspects of late-life depression in the elderly population. N=188 Beck’s Depression Inventory/
UCLA Loneliness Scale Depression and loneliness/social isolation related concepts, and they should be addressed to improve the quality of life live lived by elderly populations. There are high prevalence levels of depression or loneliness among elderly populations. The study may prompt further research on the impact of significant changes in lifestyle in regards to the elevation of stress levels among the elderly. Also, the study is more likely to illuminate on the self-perception of health deficits among the elderly. Simultaneously, the society is informed on the increased prevalence of depression among the elderly due to institutionalization. The study only encompassed patients with cognitive impairment.
Sundler, Eide, Van Dulmen,& Holmström, 2016. Sundler A. J., Eide H., Van Dulmen S., & Holmström I. K. (2016). Communicative challenges in the home care of older persons: A qualitative exploration. Journal of Advanced Nursing, 1–10. doi:10.1111/jan.12996
The study’s main aim is to explore communicative issues in encounters for nurse assistants and older persons in times of home care visits. N=100 No Communication training should concentrate on addressing the existential issues and needs faced by older persons.
Communication is a central aspect of the facilitation of person-based home care. The study’s findings may encourage the continued shift of care for the elderly institutional care to home care. It may also encourage the various challenges, including the complexity of communication, while providing home care to be addressed. The findings from the study encourage a home-based care approach. The data consisted of audio recordings of real-life encounters during home care visits.
Drageset, Eide, Dysvik, Furnes, Hauge, 2015 Drageset J, Eide GE, Dysvik E, Furnes B, Hauge S. (2015). Loneliness, loss, and social support among cognitively intact older people with cancer, living in nursing homes–a mixed-methods study. Clinical Interventions in Aging 10:1529-1536
The aim is to investigate loneliness and social support among nursing homes. N=60 one-item Loneliness Scale/
Social Provisions Scale Loneliness was minimized through engaging activities. The study may prompt the healthcare providers to screen all their elderly residents in the nursing homes for early detection of loneliness. The study also sheds light on the need to determine the factors that contribute or reduce loneliness to improve the quality of life for the elderly. In addition, the study may prompt the various healthcare providers to attend to the elderly experiences of loneliness in an individualized manner to improve their quality of life. The review was exclusively for older adults in a skilled nursing facility.
Based on the chapter’s findings , there is a close relationship between aging and the loss of significant aspects and functions of life. Aging has a close association with the loss of fundamental functions and aspects of life, including physical performance and fitness, loss of friends, family, and other aspects, leading to a feeling of loneliness (Barakat et al., 2019). The separation from family and friends, including the inability to engage in activities, could lead to anxiety, frustration, and stress. Caring for such patients is an ethical and responsible concept demanded by the nursing profession.
Summary of Evidence
From the scoping review findings, nursing practice has much usefulness in understanding and managing the concept of loneliness among the elderly population. Nurses are responsible for encouraging the elderly to participate in social activities with family and friends to improve their healthy wellbeing as a strategy for avoiding thoughts of loneliness and depression (Drageset et al., 2018). The implementation of intervention measures or programs meant to manage depression, anxiety, and loneliness among the elderly living in geriatric homes is necessary and spearheaded by nurses.
Nursing practice should inform the process of the establishment of further theoretical sharing of understandings of the different ways to mediate social isolation and loneliness successfully (Borhani et al., 2017). One proven approach is the group reminiscence therapy, a structured intervention where the elderly adults use their past life histories to improve phycological well-being. The therapy has proved effective in reducing depression and anxiety in institutionalized adults. Evidence from the review shows that therapy is essential for improving the wellbeing of the elderly population. Engaging activities involving the elderly in terms of participation and communication minimizes loneliness and any forms of anxiety experienced by the selected population (Woods et al., 2018). Nursing practice is useful in the described context, and communication training on the practice should focus on addressing existential needs and issues that the elderly adults in institution care face .
Chapter 5: Preliminary Study
Elderly adults in geriatric institutions suffer from loneliness, which leads to depression and anxiety if they fail to engage in physical and social activities. One of the core reasons for the high prevalence of depression and loneliness in thought is dementia, a common condition associated with the aged population (Gonzalez et al., 2015). At an advanced age, the elderly may fail to remember events, places, and people from their past lives. An overlooked element in nursing practice when caring for elderly adults in geriatric institutions is the effect of dementia on loneliness and depression (Gonzalez et al., 2015). The elderly may fail to recognize their children and feel lonely and desperate, as they perceive that they are on their own and that there is no one to take care of them (Woods et al., 2018). The effect is isolation and a feeling of loneliness, with the situation worsening among people who lose their sense of touch, taste, sound, and smell. The scoping review identified several gaps: the contribution of dementia to loneliness among the aged in institutionalized care, and the role of nursing practice in helping such patients.
Reminiscence therapy (RT) forms a part of the nursing practice protocols in taking care of the aged population and helping them deal with loneliness, whether at home or under institutionalized care. According to Woods et al. (2018), RT in nursing practice involves discussing events and experiences from the past between the nurse and the elderly adults. RT aims to evoke memories, improve health wellbeing, and stimulate mental activity to engage the elderly adults in social activities and connect with the past as a strategy to reduce loneliness and anxiety. Gonzalez et al. (2015) also argue that props such as pictures depicting memories, attachment objects, and videos are an essential part of RT in nursing practice. According to the authors, the therapeutic strategy creates a continuous string of events and stories to socially engage the adults and remind them of who they are within their immediate space (Tomstad et al., 2017).
On the other hand, Li et al. (2017) argue that apart from loneliness, RT helps older adults in institutionalized care with depression and anxiety. Although the amount of research and data on the prevalence of anxiety and depression among aged adults with dementia is limited, existing studies show a positive relationship between RT and depression. According to Li et al. (2017), the nursing practice improves cognition and mood in people with dementia, enabling them to talk and associate freely with family, friends, and healthcare workers. The benefits of RT in dealing with dementia and loneliness are significant.
The research will use a randomized parallel-designed controlled trial, where 90 patients from geriatric institutions and home care will be used. The research subjects will be recruited and randomized into two significant groups (n=45 per group). The research participants will be men and women between 65 and 89 years, with a distribution pattern to ensure half of the participants in institutionalized care and other in-home care. The study will obtain informed consent from the participants directly or through their caregivers. An exclusion criterion of patients with severe Alzheimer’s disease will be used to ensure all dementia cases are incorporated into the study.
Generally, the scoping review provided more insight on nurses understanding of loneliness among the elderly population. The articles in the review illustrated the role of nurses in elderly patients being comforted in the hospital. An individual study article illustrated the productivity and engagement triage of nurses and how it would ultimately affect a decreased loneliness of the elderly in hospitals (Hoeksem a et al. 2017). According to Grady P. A. (2016), the article stated nurses’ perception of the understanding of loneliness, which is an inadequate description of nurse roles and how they deal with the elderly .
It is worth noting that nurses might be conditioned to a biased mind of only healthcare, which is risky for the elderly. The review examined the causes of loneliness and recommended efforts to be employed but did not indicate identification if poor health was related to the contribution ; this gives a biased alternative to nurses’ work and roles. Also, the studies do not directly discuss the role nurses should play in caring for the elderly sick population; this leaves the role of nurses in this issue unsolved, which is a bias risk to the nurses understanding loneliness of the sick elderly.
Nursing practice should inform the process of the establishment of further theoretical understandings of the different ways to mediate successfully social isolation and loneliness. For instance, the use of group reminiscence therapy, a structured intervention where the elderly share their past events with peers in geriatric homes. The therapy has proved effective in reducing depression and anxiety in institutionalized adults. (Woods et al., 2018). Nursing practice is useful in the described context, and communication training on the practice should focus on addressing existential needs and issues that the elderly adults in institution care face.