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Headshot of author Kendra KuehnAnyone Can Be Lonely: Addressing Social Isolation & Loneliness in APS

by Kendra Kuehn, MSW, National Adult Protective Services Association

As we move into the holidays and new year with a continuing pandemic, social isolation and loneliness are frequent topics. Ongoing loss of not only loved ones but traditions and normal routines are also heightened for many. These “ambiguous losses” can add to the challenges of loneliness and isolation. To close the year, we are taking another look at the impact of these issues on those served by Adult Protective Services (APS).

What is Social Isolation & Loneliness?

In a 2020 report, the National Academies of Sciences, Engineering, and Medicine (NASEM) highlighted that social isolation and loneliness are separate ideas and don’t necessarily correlate with each other.

  • Social Isolation is the “objective lack of (or limited) social contact with others.” It is typically measured by looking at an individual’s contacts and relationships. Not all people who are socially isolated are lonely.
  • Loneliness is the “perception of social isolation” and if the person feels their relationships meet their needs. It is typically measured using a scale. A person who is objectively not socially isolated may still experience deep loneliness.

The Impact of Social Isolation & Loneliness

Anyone can be lonely, in a 2018 Kaiser Family Foundation study 22% of U.S. adults reported often or always feeling lonely. But NASEM notes there are risk factors that increase the likelihood of loneliness. Health factors include chronic health conditions, hearing and vision impairments, and mental health diagnoses. People with disabilities, particularly those with greater mobility or functional limitations, also identify with greater feelings of loneliness. Even external factors such as transportation access and community safety can impact risk for loneliness. These and other cited risk factors are frequently present in APS clients.

The report notes that social isolation is associated with increased risk of premature death, potentially at the same levels of the impact of smoking or obesity. It may also contribute to cognitive decline. NASEM also highlights that isolation and loneliness increase older adults’ susceptibility to abuse, neglect, self-neglect, and exploitation. They also note that there is need for more research on elder abuse.

In March 2020, Congress also recognized the challenges of social isolation among older adults within the Supporting Older Americans Act of 2020. This reauthorization of the Older Americans Act (OAA) tasks the United States Administration for Community Living’s Administration on Aging with developing a long-term plan to help address the impact of social isolation and authorizes greater screenings and pilot projects to address it. Input from aging organizations, the disability community, and professionals like APS help guide these efforts.

Addressing Social Isolation & Loneliness -
APS Clients & the Community

We know and see the negative impact of social isolation and loneliness. But what ideas and resources are out there to address it, especially when approaching the holidays in a pandemic? Some resources and tip sheets for public awareness may need some tweaks to account for pandemic precautions but overall remain relevant (check out the National Center on Elder Abuse’s Home for the Holidays). This year the National Association of Area Agencies on Aging’s (n4a) annual Home for the Holidays consumer brochure focuses on addressing isolation and staying connected during the COVID-19 pandemic.

Other practices have come out of pandemic challenges. Coalitions and other teams have moved to virtual meetings, with some noting this option has increased participation. The Orange County, New York Elder Abuse Awareness: Virtual Coalition was launched in the Spring of 2020 as fully virtual and has focused much of its work on social isolation. It includes The Center on Aging and Disability Policy at Mount Saint Mary College, Orange County APS, and other professionals. The Virtual Coalition has hosted a series of podcasts each focusing on a different topic related to elder abuse and including direct connections to resources for older adults and the community. Their kick-off podcast is The Significance of Human Interaction.

Earlier this year, Congress passed emergency funding for Area Agencies on Aging (AAA), long-term care ombudsman programs, and other OAA programs to support operations during the COVID-19 pandemic. APS programs should be aware of continuing and new supports that would benefit clients and help address self-neglect or other challenges. The National Resource Center for Engaging Older Adults (engAGED) highlights several AAAs that have started telephone reassurance and wellness check programs. In Hastings, Nebraska the Midland AAA has developed a Friendship Network program to pair socially isolated older adults with volunteers for phone calls, grocery pickup, or other needs. APS should make sure these programs also know that APS is open and how typical APS work and investigations may look different in the pandemic.

Addressing Social Isolation & Loneliness – APS Staff

As the research notes, social isolation and loneliness can affect anyone and this includes APS staff. The loss of routines and everyday conversations can exacerbate this for those used to working in the office or the field. Throughout these past few months, APS professionals from investigators to administrators have noted the need to promote connections, work-life boundaries, and support for the variety of work from home environments. In a recent committee meeting, one attendee noted how supportive it felt to start with a check-in of attendees. A simple round of “how are you doing today?” does not need to be long but can be a significant connection.

The Centers for Disease Control and Prevention (CDC) has a full website addressing Coronavirus (COVID-19) includes both a general coping with stress section and a section on coping with stress and building resilience in the workplace. Both sections highlight what staff may be feeling and resources for support. These tips as well as the continually updated Administration for Community Living’s Coronavirus Disease 2019 (COVID-19) can encourage staff to recognize their own feelings of social isolation and loneliness.

Keeping staff engaged and connected can also help address isolation, particularly when traditional routines like office holiday parties are cancelled. During the COVID-19 pandemic North Dakota’s Vulnerable Adult Protective Services has embraced icebreakers like bingo at the beginning of staff meetings. Holiday icebreakers could include naming a favorite tradition or a new pandemic-era tradition that might be carried forward. The program also did a successful self-care goody basket exchange. A price limit was set and interested staff completed a survey of their likes and enjoyments such as favorite smell, candy, something they have wanted to do but haven’t, etc. To facilitate cross-state connection, the staff member coordinating the exchange worked to ensure that recipients weren’t paired with others in the same city or locality. Participants noted that learning more about each other’s likes and interests fostered greater connections. Exchanges can even be built around ideas like sharing a favorite holiday recipe. Overall, the goal is to decrease isolation and loneliness while making sure staff know what resources are available to them.

Wrapping It Up

As we all know social isolation and loneliness place older adults and people with disabilities at particular risk for abuse, neglect, self-neglect, and exploitation. We also need to be aware of its impact on APS professionals during the pandemic and after. These are just a few of the resources and innovations happening throughout the country. Let us know how you are addressing social isolation and loneliness during the pandemic, holidays, and in the new year.

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