A Review of Social Isolation

An Important but Underassessed Condition in Older Adults

Nicholas R. Nicholson

J Prim Prev. 2012;33(2-3):137-152.

Conclusion

According to the Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care, social isolation is an official nursing diagnosis (Ackley & Ladwig, 2010). There are both objective and subjective characteristics of an individual who is socially isolated, many of which are outlined above. These characteristics can be used to holistically assess an older adult for social isolation or risk of social isolation. Social isolation is a diagnosis that nurses are expected to be aware of and to use in their practice.

Nursing practice needs to be supported by evidence from ongoing research efforts. The evidence presented in this review article highlights the significance of the numerous negative health outcomes related to social isolation. There is also evidence to support various factors that could be used to identify which community-dwelling older adults may be at high risk of social isolation. However, despite this substantial evidence, social isolation is rarely assessed in primary care settings, such as during home visits from community health nurses. By knowing these factors, public health professionals have the opportunity to assess and identify at-risk older adults using the techniques described herein. Once identified, at-risk older adults can be referred to appropriate resources to prevent social isolation. Use of appropriate intervention strategies can be implemented in order to alleviate social isolation and its many associated detrimental health effects, and future plans of care should focus on prevention of future social isolation.

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Table 1. Predictors of social isolation from studies examining it as an outcome
Author(s), year	Sample age, years	Sample size	Predictor variables for increased social isolation	Cross-sectional versus longitudinal	Controlled for
Havens and Hall (2001)	72+	n = 1, 868	Female gender Older age	Cross-sectional	Not stated
Havens et al. (2004)	72+ 72–84 = 66 % 85+ = 34 %	n = 1, 868	Living alone Far distance from relatives Low life satisfaction Declining cognition Difficulty with activities of daily living Older age	Cross-sectional	Not stated
Howat et al. (2004)	60+	n = 38 focus groups n = 13 interview n = 8 in-depth interview	Health/disability Transportation Few relatives/none living close by Few friends Loss of partner/friends Financial concerns Fear of being attacked Shyness	Cross-sectional	N/A—qualitative interviews
Iliffe et al. (2007)	65+ Mean age for at risk for Social Isolation (SI) = 76.6 (SD = 6.85) Mean age for not at risk for SI = 74.2 (SD = 6.04)	n = 2, 641	Male gender Living alone Mood or cognition problems	Cross-sectional	Age, gender (female), education and income
Luggen and Rini (1995)	65–72 = 27.4 % 72–78 = 30.6 % 78+ = 41.9 %	n = 62	Increased age Having no children	Cross-sectional	Not stated
Wenger and Burholt (2004)	65+ Mean age = 93	n = 47	Recent death of spouse Death of relatives and friends/close neighbors Deteriorating health Impairment of mobility/vision/hearing At home alone for increasingly longer periods of time	Longitudinal	Not stated
Smith and Hirdes (2009)	65+ Mean age = 75 (range = 65–99)	n = 848	Marital status (NOT married or widowed) Mood disorder (NOT having one) Personality disorder History of institutionalization Early initial admission to a psychiatric hospital for first admission	Cross-sectional	Age

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A Review of Social Isolation

An Important but Underassessed Condition in Older Adults

Conclusion

Tables

References

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