By: Elizabeth Townsend, RN
People are social beings. With COVID-19 introducing social distancing guidelines and restrictions on visitations, social isolation and loneliness are increasing. A report referenced by JAMA discussed the need for solutions for social isolation and loneliness in older adults. There is significant documentation that social isolation and loneliness are related to a higher rate of major mental and physical illnesses, including:
- Cardiovascular and cerebrovascular risks
- More depression and anxiety
- An increased risk of dementia
According to the National Institute on Aging, people who participate in worthwhile activities with others tend to live longer and have a sense of purpose.
Assessing seniors for isolation and loneliness
COVID-19 has made it difficult for seniors to participate in:
- Social gatherings
- Communal dining
- Exercising in groups
- Social programs at senior centers
Home health clinicians assess patients for social isolation and loneliness. Asking patients about their social needs is important to identify who needs assistance, easing isolation and loneliness. The home health agency provides tools or guidelines with questions for the clinicians to ask. Examples of questions to ask:
- Do you feel you have no friends or loved ones?
- Are you lonely?
- How are you staying active?
5 ways to relieve isolation and loneliness
After assessing and finding that your patient is suffering from social isolation, consult with their caregivers and healthcare team —specifically the agency’s social worker—to find ways to relieve their isolation. Daily Caregiving suggests some ways to help:
- Encourage a sense of purpose. Suggest activities such as knitting blankets and caps for newborns at a local hospital, making masks for healthcare workers or family members, or writing letters to their grandchildren to encourage them. Allow the patient to have a responsibility, such as taking care of a plant or dog. This would be giving them a meaningful purpose.
- Encourage interaction. Encourage interaction with others via phone, computer, or if in person, socially distant, wearing a mask.
- Encourage physical activity. Take Into account the patient’s physical ability. They can do gentle exercises such as walking, stair-climbing, yoga, or group exercises via computer. If they cannot get out of bed or are not able to walk, find appropriate activities. Consult with the physical therapy team who can provide resources for exercises for those with limitations.
- Assess the food they are eating. Encourage fiber-rich foods like fruit, vegetables, whole grains, and lean proteins. Consult with community services such as food banks, churches, or meal delivery services.
- Show them they are loved. Find ways to show that they are loved and needed. Listen to what they have to say. Encourage family members, if they are in the home also, to hug the patient and talk and listen to them.
Social workers can help seniors with social isolation and loneliness
Social workers can ensure that patients have access to available resources. Local churches may have “shut-in” outreach for those unable to leave their homes. They may provide phone calls, run errands, provide food baskets, and communicate by mail with the seniors. Local library programs have online programs and can arrange to have books available for the patient to check out. The social worker can also refer the patient to transportation programs that take seniors to doctor appointments.
Encourage virtual connections for seniors
Advancing States created a resource to help reduce social isolation and loneliness.
- If the patient can use a smartphone, show them how to google Earth National Park Tours so they can “visit” the parks and talk about what they saw with others via telephone or with you when you visit.
- Patients can meditate through Journey Meditation.
- Put the patient in contact with Well Connected by Covia, who will help them participate in virtual classes, conversations, and activities by phone and computer.
There are helplines for mental and emotional support, which include:
- Friendship Line by Institute on Aging- 1(800)971-0016
- Happy– a free app that provides emotional support 24/7
- National Alliance on Mental Illness Helpline- 1(800)950-6264
- Substance Abuse and Mental Health Services Administration National Helpline- 1(800)662-4357
Grief. It’s a small word with a big effect. At worst it is crippling. At best it is nagging. And holidays seem to magnify the heartache that follows grief, regardless of when the loss took place.
For some, pushing through the holidays and honoring time old traditions can be the perfect way to memorialize a loved one. But for others, creating and celebrating new traditions or skipping the holiday festivities altogether might be easier to bare.
There’s no right or wrong way to grieve during the holidays. Even two people who experienced the same loss will grieve differently. Many factors, such as the relationship to the deceased; the surviving individual’s belief and spirituality; past experiences with loss; and the survivor’s willingness and ability to express their grief can impact each survivor differently.
Regardless of how you choose to celebrate or not celebrate the holidays, the following steps can help you feel more prepared to handle your grief:
- Acknowledge that the holidays will be different.
- Acknowledge that the holidays will be tough.
- Communicate your holiday plans with family and friends so that they will know what to expect.
- Recognize that even family and friends within your own grief circle may have different plans for how they wish to spend the holidays. Seek to find common ground, establish your plan should the holidays become too much for either party, or choose to celebrate separately if their plans conflict with your level of comfort.
- Seek help from a friend that you trust who can be there for you without offering advice or trying to “fix” your grief.
- Say “yes” to help if you need the support.
Our wish for you this holiday season, and always, is that you can find joy amid sorrow as you remember your loved one.
By: Wilma Peterson, RN
According to the American Lung Association, Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. Living with the distress and panic caused by difficulty in breathing with COPD can induce stress for both the patient and the family. Due to this, Doctors are beginning to call for earlier hospice referrals for patients with COPD. If accessed at the right time, hospice care can assist with symptom management, prevent unnecessary hospitalizations, and help patients achieve a better quality of life.
Patients with advanced COPD are eligible for hospice care, which is fully covered by Medicare, some private insurances, as well as assistance from Veterans Affairs. When the hospice benefit is elected, patients have access to the appropriate care and medications, allowing for more restful periods and easier breathing. Identifying these factors early can relieve symptoms such as anxiety, panic, labored breathing, and intractable coughing that are uncontrolled with regular medications and traditional therapies.
Factors to consider when discussing the appropriateness of a hospice referral for a COPD patient include:
- The patient has a projected life expectancy of 6 months or less
- All therapies, including medications and rehabilitation, have been exhausted
- The patient has frequent emergency room visits and hospitalizations due to exacerbation of COPD
At this point, the patient is considered to be in the advanced stages of COPD, and the discussion for hospice and end-of-life care should begin.
Eight benefits of early hospice referral for those with COPD
Electing the hospice benefit early allows for the expertise of a focused team of professionals:
- Social worker
- Ancillary services
Hospice services are available 24/7/365. The hospice care team will provide medical, emotional, psychological, and spiritual support to the patient and family. Here are eight benefits of early hospice referral:
- Early intervention. The earlier the referral is made, the more time it gives the patient and their family to choose the right hospice company and be a part of the care plan.
- Managed care. A physician leads the hospice care team and can order the appropriate medications and therapies and cater to an individualized care plan for each patient.
- Skilled Nurses. A registered nurse will meet with the patient and family, and can admit the same day. The nurse will also reconcile all medications, put together a plan that focuses on managing symptoms, and provide relief of pain and respiratory distress.
- Hospice Aides. Health aides assist with normal daily activities:
- Ambulating safely
- Other household chores
- Medical Social Worker. A social worker will assist with accessing support in the community, such as respite care and other services.
- Chaplain. Clergy to meet the patient and their family’s psychological and spiritual needs, assisting them through the end-of-life and grieving process.
- Ancillary services. Other ancillary services like physical therapy and occupational therapy, strengthen muscles to assist with safety and allow for a sense of independence.
- Respite Care. Allows time for self-care and rest, which can help with a change in attitude and mindset in caring for your loved one.
Living easier with hospice care
Early hospice referrals means early management of symptoms by:
- Having the appropriate therapy and staff when needed
- Avoiding the stress of emergency exacerbations and unnecessary hospital visits
- Providing a more individualized approach to the patient and caregiver
- Alleviating stress to allow time for future planning or ability to spend quality time
An early hospice referral can provide extra support for both the caregiver and the patient. If you or a loved one is struggling with COPD, consider the benefit of hospice services.