Overview of the Grading System
The GRADE approach will be utilized to gauge the value and likely effectiveness of the recommendations made. The system allows for the classification of recommendations as either strong or weak, based on the balance achieved between risks, benefits, cost and burden, as well as the degree of confidence that can be inferred from the estimates of benefits, burdens and risks provided. Furthermore, the system classifies evidence provided as high, moderate or low (Grades A, B, and C respectively), depending on the consistency of the results, the precision of estimates, the risk of bias and the directness of the evidence provided (Schmidt & Brown, 2009/2012). Based on the findings, when a tradeoff between the risks and benefits is made, a recommendation can then be considered for implementation as an intervention.
Practice Recommendation #1
The first practice recommendation, would be to try and strengthen the quality of relationships between the elderly and their spouses as well as with their children, in cases where either or both exist. In most cases, the elderly normally find themselves abandoned, neglected, or simply become lonely after their children move away, a factor that greatly contributes to their loneliness. This is especially true for elderly persons who also happen to be widows or widowers.
Strength of recommendation
The recommendation is quite strong, because the risks involved are quite minimal, while the costs are negligible. In addition, helping to rekindle family relationships can lead to the creation of lifelong relationships and support systems.
Strength and quality of evidence
The evidence can be classified as high due to the high number of studies that identify the loss of a spouse or the moving away of children as causes of loneliness (Fiorillo & Sabatini, 2008; WRVS, 2011).
Practice Recommendation #2
The second recommendation would be to enhance social networking, either through the establishment of support groups that can easily offer the required level of companionship. As an alternative, or to augment the support group approach, activities that encourage socializing and interaction between the elderly can be organized by the nursing homes or by the hospitals to reduce loneliness.
Strength of recommendation
The recommendation is strong because the benefits will certainly outweigh the risks and costs. For instance, by eliminating the risk of loneliness amongst the elderly, the system will also reduce the number of senior citizens in need of medical attention due to conditions that co-occur with loneliness. Furthermore, social networking events or support groups would cost considerably less to organize compared to any medical costs (Windle, Francis, & Coomber, 2011).
Strength and quality of evidence
The evidence can be graded as low, because there are few studies that explore the effect of social networking on loneliness, especially amongst the elderly; the evidence can be graded as low
Practice Recommendation #3
In order to ensure constant monitoring of the wellbeing of the elderly, a community based health worker can be tasked with making regular home visits to select vulnerable individuals. Such visits, in addition to allowing for the assessment of their state of mind, would also allow for the assessment of the quality of relationships such individuals are engaged in.
Strength of recommendation
The recommendation is strong, more so because it falls well within the concept of holistic care and encourages the adoption of a proactive approach. The potential benefits of such an approach would certainly outweigh the risks and costs. Furthermore, research findings on the cost effectiveness of such visits is quite encouraging (Sahlen, Lofgren, Helllner, &. Lindholm, 2008).
Strength and quality of the evidence
The evidence provided can be graded as moderate, especially due to the risk of bias in such studies.
References
Fiorillo, D., & Sabatini, F. (2011). Quality and quantity: the role of social interactions in individual health. Social Science and Medicine, 73, 1644-1652.
Sahlen, K., Lofgren, B., Helllner, M., &. Lindholm, L. (2008). Preventive home visits to older people are cost-effective. Scandinavian Journal of Public Health, 36(3), 265-271.
Schmidt, N. A. & Brown, J. M. (2009/2012). Evidence-based practice for nurses: Appraisal and application of research. Boston: Jones and Bartlett Publishers.
Windle, K., Francis, J., & Coomber, C. (2011). Preventing loneliness and social isolation: interventions and outcomes. Research Briefing 39. Web.
WRVS (2011). Loneliness amongst older people and the impact of family connections. Web.