Introduction
Prolonged hospital stays are associated with rising levels of loneliness and social isolation, which in turn evolve into depression. Elderly patients are the most vulnerable to these negative psychological effects due to their declining physical and mental capabilities, personal perceptions, as well as social and financial backgrounds. Elderly patients make up for the most numerous population group that is in frequent need of medical help. In the USA alone, the number of elderly people is over 48 million (“FFF,” 2016). Depression is a dangerous and debilitating mental disease that can affect a person’s capability to feel, think, and act (“What is depression,” n.d.). Preventing depression in elders will promote the quality of health and life, as well as reduce the load on the hospital system and the budgets of individual citizens. One of the potential solutions is assigning a nurse to spend time with elderly patients during a prolonged hospital stay, to reduce the feelings of loneliness and social isolation.
Change Plan
Practice Question
To outline the practice question for this paper, we will use the standard PICOT (Patient, Intervention, Comparison, Outcome, Timeframe) plan (Riva, Malik, Burnie, Endicott, & Busse, 2012):
- P (Population): Patients aged 65 years or older, diagnosed with ailments and diseases that solicit a prolonged hospital stay.
- I (Intervention): Regularly and daily-scheduled visits from a nurse during non-treatment hours. The time of the visit is fixed at around 20 minutes.
- C (Comparison): Standard treatment procedures with no dedicated visits from a nurse.
- O (Outcome): The expected outcome is the reduction of feelings of loneliness and social isolation, and general improvement of the perceived quality of life.
- T (Timeframe): The time for the proposed intervention to be taking place is from one week to one month.
The identified major stakeholders to take part in the experiment are the elderly patients aged 65 years or older, and the nursing personnel of a particular hospital setting.
Related Evidence
One factor related to the likelihood of depression in elderly patients is the fact that their bodies are more vulnerable to various diseases and ailments that can leave them bedridden for some time. According to the AARP (American Association of Retired Persons), the main causes of hospitalization in elders are as followed (Foltz-Gray, 2012):
- Cardiac arrhythmia.
- Congestive heart failure.
- Chronic obstructive pulmonary disease.
- Coronary atherosclerosis.
- Diabetes.
- Pneumonia.
- Stroke.
- Bone fracture.
All of these diseases have the potential for rendering an elderly person bedridden for quite some time, meaning a prolonged stay in a medical facility, where they can feel alone and isolated.
The effects of loneliness and social isolation are associated with higher risks of mortality. According to Holt-Lunstad, Smith, and Baker (2015), who has conducted an extended literature search, covering numerous dedicated materials between 1980 and 2014, the increased odds of social isolation, loneliness, and living alone increase the likelihood of mortality by 26-32 percent. Elderly hospital patients are more likely to be reminded of their social isolation as many of them do not have any relatives or living friends to visit them during a hospital stay, which can only amplify the negative effects of their situation.
Numerous specialists in different areas of hospital care reflect on the likelihood of the development of depression due to loneliness and social isolation. Polikandrioti et al. (2015) state that in hospitalized elderly patients with heart failure, the prevalent factors that lead to depression are the disease duration and social isolation associated with lack of human contact due to being single, divorced, or widowed. Besides, out of 190 hospitalized heart failure patients, two-thirds were found to have moderate to high levels of anxiety and depression. The numbers are 24.7% for moderate anxiety, and 32.6% for high anxiety and depression. This shows that in elderly heart failure patients, the possibility of developing depression is very high.
Concerns regarding patient social isolation are not unique to heart resuscitation departments alone. As indicated in the research regarding patient isolation precautions by Spraque, Reynolds, and Brindley (2016), there is evidence that patient isolation, which is a common procedure when receiving patients that have highly contagious diseases, may be causing depression and feelings social isolation among elderly patients. According to their findings, the prevalence of depression among patients subjected to isolation is 40% greater than among those that were not isolated. Also, the researchers found a correlation between levels of depression and nursing visits, which also supports the idea of the proposed intervention.
The idea of dedicated nursing visits is supported by Nicholson (2012), who states that social isolation is a prevalent major health problem among older adults. In his research of the available material on social isolation, collected from various sources, such as Medline, CINAHL, and PsycINFO is that medical workers and healthcare professionals should utilize measures of early social isolation assessments in elder patients, and work with at-risk individuals to prevent further isolation, which is associated with many negative outcomes, such as depression and suicide (Nicholson, 2012).
Aziz and Steffens (2013), in their study of causes of late-life depression, have underlined many potential factors to contribute to the development of the disease, ranging from physical factors such as the feelings of pain and objective helplessness to psychodynamic factors such as life stressors and social support. The important part of this large article that supports the proposed intervention is the importance of perceived support, also called emotional support. According to Aziz and Stephens (2013, p. 508), “a significant relationship exists between social support and depressive signs and symptoms in all dimensions of social support, including social network size, network composition, social contact frequency, the satisfaction of social support, instrumental/emotional support, and helping others.”
Patient Interview
As part of this assignment, we have conducted an interview with a hospitalized elderly patient, who has been in ambulatory care for at least two weeks due to a fall and a fractured limb. The interview used the Revised UCLA loneliness scale, which is a medical questionnaire implemented among elderly patients suspected for depression (“Revised UCLA loneliness scale,” n.d.):
- I feel in tune with the people around me.
- – Rarely.
- I lack companionship.
- – Sometimes.
- There is no one I can turn to.
- – Sometimes.
- I do not feel alone.
- – Sometimes
- I feel part of a group of friends.
- – Rarely.
- I have a lot in common with the people around me.
- – Yes, all of us in this ward have broken limbs. Often.
- I am no longer close to anyone.
- – Sometimes.
- My interests and ideas are not shared by those around me.
- – Often.
- I am an outgoing person.
- – Rarely.
- There are people I feel close to.
- – Rarely.
- I feel left out.
- – Often.
- My social relationships are superficial.
- – Often.
- No one really knows me well.
- – Often.
- I feel isolated from others.
- – Sometimes.
- I can find companionship when I want it.
- Rarely.
- There are people who really understand me.
- – Rarely.
- I am unhappy about being so withdrawn.
- – Sometimes.
- People are around me but not with me.
- – Often.
- There are people I can talk to.
- – Rarely.
- There are people I can turn to.
- – Sometimes.
As it is possible to see from the overall results of the questionnaire, the patient does feel socially isolated.
Translation into Practice
The provided information from peer-reviewed literature sources supports the idea of nursing intervention in order to eliminate the feelings of loneliness and social isolation. The proposed solution is very easy to implement within the parameters of a standard hospital setting – several nurses would need to be assigned to visit elderly hospitalized patients on a daily basis. They should spend at least 20 minutes on average with every patient, engaging in friendly conversation, telling them about the local news and the weather, and talking to them on whatever subject of their preference.
Conclusions
Loneliness, social isolation, and depression present a real danger to hospitalized patients aged 65 or older. Many sources dedicated to various fields of medical expertise make a connection between depression and increased mortality rates. The proposed intervention of providing emotional support to the elderly patients via daily nursing visits is expected to reduce the chances of depression in elderly patients, thus improving medical outcomes and promoting health and quality of life.
References
Aziz, R., & Steffens, D. C. (2013). What are the causes of late-life depression? Psychiatry Clinics of North America, 36(4), 497-516.
Foltz-Gray, D. (2012). Most common causes of hospital admissions for older adults.Web.
FFF: Older Americans month: May 2016.(2016). Web.
Holt-Lunstad, J., Smith, T. B., & Baker, M. (2015). Loneliness and social isolation as risk factors for mortality. Perspectives on psychological science, 10(2), 227-237.
Nicholson, N. R. (2013). A review of social isolation: An important but underassessed condition in older adults. The Journal of Primary Prevention, 33(2-3), 137-152.
Polikandrioti, M., Goudevenos, J., Michalis, L. K., Koutelekos, J., Kyristi, H., Tzialas,D., & Elisaf, M. (2015). Factors associated with depression and anxiety of hospitalized patients with heart failure. Hellenic Journal of Cardiology, 56, 26-35.
Revised UCLA loneliness scale. (n.d.). Web.
Riva, J. J., Malik, K. M. P., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. The Journal of Canadian Chiropractic Association, 56(3), 167-171.
Sprague, E., Reynolds, S., & Brindley, P. (2016). Patient isolation precautions: Are they worth it? Canadian Respiratory Journal, 2016(1), 1-5.
What is depression?(n.d.). Web.