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Early Signs of Depression in Older Adults Due to Dementia

older male sitting down thinking

Loneliness and social isolation are strongly associated with several adverse health outcomes in older adults, including death, chronic lung disease, coronary heart disease, stroke, arthritis, impaired mobility, and depressive symptoms (Steptoe et al., 2013). Although loneliness and social isolation frequently occur together, they are distinct and can occur independently of one another.

A research article by Perissinotto et. al (2019) provided the following definitions for these terms:

Loneliness“The subjective feeling of being alone (perceived isolation). It also relates to the distress that results from discrepancies between ideal and perceived social relationships.”
Social Isolation“A complete or near-complete lack of contact with society, and it relates to a quantifiable number of relationships (actual isolation).” Therefore, it is objective with measurable factors.
Social Connectedness“A multifactorial construct that represents the structural (e.g., network size, marital status), functional (e.g., perceived social support), and quality (e.g., positive or negative) aspects of social relationships.”

Assess: With this foundational understanding, the authors recommend providers use standardized assessment tools to evaluate for loneliness and social isolation and then document the results in the EHR. Two noted assessments were the Berkman-Syme Social Network Index (previously recommended by the Institute of Medicine to evaluate social connections and social isolation) and the UCLA three-item loneliness scale.

Act: The interprofessional healthcare team can then tailor interventions based on both the assessment results as well as by asking and listening to the patients and those who care for them. Four intervention categories were recommended to target the identified underlying causes: improvement of social skills, enhance social support, increase opportunities for social interactions, and address maladaptive social cognition. Identifying resources linked to these four categories will then support the interprofessional healthcare team in connecting the older adults to the appropriate services.

Following are additional resources on the topic:

Connection to Hendrich II Fall Risk Model™

Loneliness and isolation can play an integral role in a person who is experiencing depression. This is especially relevant for older adults, who are often more vulnerable to depression given the stressors accompanying getting older, such as loss and grief, role transitions, and physical health changes.

By assessing for depression as a fall risk factor in the Hendrich II Fall Risk Model™, it offers the opportunity to reduce a patient’s fall risk as well as to establish a continuum of care plan with the patient/caregiver and interprofessional care team. This care plan should document the patient’s social and psychological support needs and identify critical resources for the follow-up management of depressive symptoms.

References:

Perissinotto, C., Holt‐Lunstad, J., Periyakoil, V. S. and Covinsky, K., 2019. A Practical Approach to Assessing and Mitigating Loneliness and Isolation in Older Adults. J Am Geriatr Soc, 67: 657-662. DOI: 10.1111/jgs.15746

Steptoe, A., Shankar, A., Demakakos, P., and Wardle, J., Apr 2013. Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences, 110 (15) 5797-5801; DOI: 10.1073/pnas.1219686110

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