Apr 1, 2020
MDedge Psychcast host Lorenzo Norris, MD, interviews Steven
Wengel, MD, about the challenges of loneliness in geriatric
populations in nursing homes, especially during the current
Norris also discusses potential interventions with Dr.
Wengel, who is a geriatric psychiatrist at the University of
Nebraska Medical Center in Omaha.
And later, in the “Dr. RK” segment, Renee Kohanski, MD, talks about how,
in the midst of the pandemic, we are slowing down while we’re
speeding up … and are learning how to use – and not abuse –
- Loneliness has been defined as a form of social pain; it is
more than sadness or a “state of mind.”
- Loneliness and being alone are separate issues suggesting that
loneliness is more of an emotional state and being alone is often a
choice. Loneliness can be characterized as deficits in authentic
interactions and connection because you can be surrounded by people
and still feel lonely.
- Loneliness has been studied as a predictor of health problems
and is identified as a risk factor for early mortality and dementia
and as a predictor of chronic illnesses such as depression.
- When it comes to treating loneliness in the geriatric
population, favor any type of intervention over none and avoid
chalking up symptoms as “just loneliness.” Basic interventions
include providing structure and routine, pushing someone to engage
with others through volunteerism, or having a low index of
suspicion to treat depressive type symptoms with an SSRI.
- In a study of nursing-home patients, 9% report loneliness often
or always and 25% report loneliness sometimes; older adults are
more susceptible to loneliness secondary to frailty and limited
- Loneliness is an independent risk factor for early mortality
and a predictor for other chronic diseases including dementia,
hypertension, depression, and overall poor health.
- During the COVID-19 pandemic, most nursing homes are under
lockdown, and all visitors are barred to minimize the introduction
of COVID-19 to the facilities. This means residents are unable to
see family and loved ones. This necessary intervention brings up
the question of quality of life over quantity of life for older
individuals. Isolation and social distancing have also taken away
group activities like communal meals and games with socializing.
Children of institutionalized patients might also feel a sense of
loss and guilt as they are not allowed to see their loved ones.
Particular to geriatrics, physical touch is essential to healing
emotional pain, for example, a gentle touch or massage to relieve
anxiety or physical redirection to ease agitation secondary to
- Two primary means of addressing loneliness for the geriatric
population include providing structure and finding opportunities
for volunteerism such as helping other residents or completing
simple tasks within the institution.
- Loneliness and major depressive disorder are difficult to
differentiate in the older population. Dr. Wengel recommends
favoring intervention over none. This means using basic
interventions like providing structure and routine, pushing someone
to engage with others through volunteerism, or having a low index
of suspicion to treat depressive symptoms with an SSRI.
Jansson AH et al. Loneliness in nursing homes and assisted
living facilities: Prevalence, associated factors and prognosis.
Jour Nursing Home Res. 2017;3:43-9.
Social isolation, loneliness in older people pose health risks.
National Institute on Aging.
Loneliness: Human Nature and the Need for Social Connection.
New York: W.W. Norton and Company, 2008.
Show notes by Jacqueline Posada, MD, associate producer of the
Psychcast and consultation-liaison psychiatry fellow with the Inova
Fairfax Hospital/George Washington University program in Falls
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