Age & Social Isolation
In older populations, the term social isolation refers to a lack of companionship, health care, and daily activities. For most of the aging population, social isolation is not an issue. Social isolation tends to occur among a minority of single women, aged 80 years old or older, whose yearly income level places them below the poverty line. Research noted here illustrates that social isolation in the elderly is correlated with depression, anxiety, and decreased longevity. Various sociological theories are discussed, as are specific examples of isolation. In addition, federal nutrition programs are also discussed.
Keywords: Fitness and Arthritis in Seniors Trial (FAST); General Social Survey (GSS); Reciprocity (Theory of); Social Contract Theory; Social Integration; Social Isolation; Social Relations; Social Support; Substitution Theory; Differential Primary-group Theory
Most people have heard that it is possible to feel lonely when in the company of others. Similarly, it is possible to feel content when completely alone; much of that contentment, though, is based on choice, as one can usually choose to be without company. However, choosing to be alone is very different from being isolated from opportunities to socialize. Additionally, when socialization means talking on the telephone, experiencing companionship, receiving formal or informal health care, or being transported to an appointment, it can seem like a necessity rather than an option. For most of the aging population, social isolation is not an issue. For others, however, social isolation can cause inconvenience. For example, an elderly person might find themselves unable to get to the grocery store when they run out of food. Being isolated and older can result in increased anxiety and depression, and a decrease in longevity.
According to the Administration of Aging’s Profile of Older Americans: 2012 there are more than 41.4 million people aged 65 or older in the United States. Approximately 28 percent of those people live alone. “For all older persons reporting income in 2011 (40.2 million), 17.8% reported less than $10,000. About 40% reported $25,000 or more. [Furthermore, approximately] 3.6 million elderly persons (8.7%) were below the poverty level in 2011." The profile also notes that almost three-quarters (72%) of the male population over 65 years old are married, whereas less than half of the women (45%) in the same age group are married. The people most negatively affected by social isolation are those over 65 who are single females, living alone, and who report an income below the poverty level.
According to Guyatt, Feeny, and Patrick (1991), health-related quality of life (HRQL) is defined as a "patient-centered assessment of overall health and wellbeing" (as cited in Sherman et al, 2006, p. 464). Naughton and Shumaker (1995) note that HRQL "is a multidimensional construct that assesses both physical (e.g., pain, disability, health perceptions) and psychosocial dimensions (e.g., mood, life satisfaction, social roles)" (as cited in Sherman, et al., 2006, p. 464). In trying to measure HRQL, Sherman, et al. conducted a study called Fitness and Arthritis in Seniors Trial (FAST), which uses physical exercise and various social measures to determine a person's HRQL. Sherman and his colleagues assessed data at the beginning of the trial (baseline) and in a follow-up study 18 months after the initial FAST was completed (p. 464).
During the FAST study, a sequence of "resistance training and aerobic exercise interventions" was completed by 439 participants ranging in age from 59 to 87 (p. 467-468). No social support intervention was included during the 18-months of the FAST trial, and participant functioning (at baseline and at follow-up) was measured based on a combination of FAST results and the following constructs (p. 467).
• Social support (the perception of having supportive relationships)
• Social integration (the quantity [rather than the quality] of social interactions)
• Observed physical functioning
• General health
• Depressive symptomatology
• Life satisfaction
• Social functioning (Sherman et al., 2006, pp. 468-469)
FAST results show a correlation between social support (the perception of having adequate social interactions) and enhanced physical functioning—both at the baseline trial and at the 18-month follow-up (Sherman et al., p. 470). Indeed, simply thinking that one has supportive relationships can be beneficial to one's health.
In addition to these findings, baseline social support scores were associated with better baseline functioning in all measured areas of HRQL. At the end of the FAST trial, baseline perceived support significantly predicted psychosocial functioning, but was not predictive ofperceived health or observed physical functioning measures (Sherman et al., pp. 474-475).
What is most significant to Sherman and his colleagues is that "social support remained a significant predictor of improved psychosocial well-being after 18-months" (p. 475). However, while the psychosocial well-being of a person remains intact with the perception of social support, physical functioning does not, according to this data (p. 475). In actuality, these researchers note that a person's physical health and "exercise treatment are the best predictors of follow-up physical functioning" (p. 477). For psychosocial well-being to continue, a person in this age group needs social interaction; however, social support is not correlated to physical functioning.
Much of a person's social interaction is of a personal nature and often includes one's immediate family. To determine the quality of care giving social support by family members, Sanders, Pittman & Montgomery (1986) conducted interviews with 91 caregivers of people 80 years of age and older. According to their data, approximately
Approximately 80% of the caregivers were offspring of the centenarians or spouses of the offspring, and their mean age was 70.2 years. Nearly 30% of the caregivers lived with a centenarian. Almost all of the caregivers lived within a 70-minute drive of the centenarian, 65% saw him or her daily and 90% rated the quality of their relationship as excellent or very good.[In addition], there was a statistically significant relationship between the amount of social and emotional support provided and relationship quality" (as cited in MacDonald, 2007, p. 113).
There appears to be a cyclical relationship between the provision of care and social support. Additionally, it is possible that quality care - and the sense of social support stemming from it - would equate to a lengthier life for the recipient of that care. Poon et al. (2000) conducted a longitudinal study to measure whether or not there was a correlation between social support and length of life (as cited in MacDonald, p. 121). Sampling over one-hundred thirty people ranging in age from 99 to 110 years old, Poon et al. noted that
Men, Whites, and those with greater physical ADL [activities of daily living] limitations had higher risks of mortality…At the level of simple, bivariate correlations, social support (talking on the phone, having someone to help, and having a caregiver) was related to survival length, as was family longevity (as cited in MacDonald, 2007, p. 121).
This is noteworthy information, as the provision of quality social support is not difficult to achieve between two people. Further, if members of a particular family tend to live longer than those in other families, it is not unrealistic to encourage efforts toward securing quality social relationships in an attempt to continue a pattern of longevity.
Many people interact on a daily basis with people whom they do not like. It is important to consider whether or not negative interactions have an effect on mood. Rook (2001) investigated the social interactions of 129 people at least 70 years of age to find a link - if any - between types of exchanges (i.e.: positive versus negative) and the participants' mood. Rock's findings cover two separate collections of daily checklists from participants. At twelve-month intervals, participants completed daily checklists describing their social interactions for fourteen days. The results are summarized below:
Negative exchanges occurred less often but were related more consistently to daily mood than were positive exchanges [with both] positive and negative exchanges exhibiting distinctive associations with loneliness and depression. Positive exchanges also appeared to influence emotional health by offsetting the adverse effects of negative exchanges. [Furthermore, the] increase in day-to-day negative exchanges over a 1-year period was associated with an increase in depression (Rook, 2001, abstract).
In addition to this overall data, Rook noted some important information for future use. First, while more positive exchanges were correlated with participants feeling less lonely, the opposite was not striking in this study, as more negative exchanges were only minimally correlated to feeling lonely. Second, the lack of positive social exchanges had a stronger effect on feelings of loneliness than did an increase in negative exchanges. Clearly, being socially active is more important than having those social interactions be positive in nature when loneliness is at issue. Finally, an increase in negative exchanges does have a negative effect with regard to reported increases in depression and a lack of well-being (Rook, 2001). In 2013, the Journal of Poverty & Social Justice published a study (Lelkes, 2013) suggesting that regular internet use by the elderly can help reduce social isolation and its attendant challenges. An analysis of internet users among older age groups found that those who communicated with others by way of the internet reported being less lonely and isolated. According to the study, the relationship between internet use and a decrease in feelings of isolation was stronger among individuals with low education. The study did not examine the nature of the particular virtual interactions, who factor in specifics regarding who the internet-based conversation took place with. Nevertheless, as the study notes, the findings suggest that increased internet access may have positive social effects.
Social Isolation in Nursing Homes
What is important to consider is the status of social interaction from the perspective of participant inclination. Many of the participants in the Rook (2001) study noted talking on the telephone as being a social exchange. What happens, though, when the telephone rings and the person being called doesn't feel like talking? According to Carstensen & Fremouw (1988), when considering the population of elderly in nursing homes, social isolation can be related to feelings of anxiety or inadequacy just as much as it can be related to not having available social situations (p. 78).
The effects of social isolation on an elderly person's well-being have been studied for years.
Among the elderly, social isolation is related to entrance to nursing homes (Ross and Kedward, 1970), poor physical health (Blumenthal, 1979), psychological pathology (Roth & Kay, 1962; Saltzman, 1971), and suicide (Pelizza, 1979). Perhaps most compelling are recent epidemiological findings linking social isolation among the elderly to mortality (Berkman & Symer, 1979; Blazer, 1982) (as cited in Carstensen & Fremouw, 1988, p. 64).
Social isolation has been linked to three clinical disorders that Carstensen & Fremouw studied within a nursing home setting:
• Depression is usually demonstrated by behaviors like withdrawal and inactivity - both features of social isolation (p. 64).
• Social anxiety has been identified in situations in which high population density is a factor, like within nursing home settings (Freedman, 1972; Zlutnick & Altman, 1972, as cited in Cartensen & Fremouw, 1988, p. 64) or at rock concerts.
• Social competence (feeling confident in social situations) is also related to social isolation in that if a resident has a hearing loss, is introverted, or views himself as a social misfit, isolating himself socially may be a means of...
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