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How Senior Living Directors Can Reduce Social Isolation Among Residents

Published On 6.2.21

By Irene Blumenthal, PT, MHA
Director of Senior Living Partnerships
and Dr. Sarah Morgenstein, OTR/L, CDP, CAPS
Regional Director

Since the start of the COVID-19 pandemic, older adults have experienced loneliness and social isolation more than ever. As COVID-19 restrictions lift and life returns to “normal,” what lessons have we learned about how to best keep older adults connected when the unimaginable happens? Even as we resume daily activities without the restrictions that were in place throughout 2020, senior living operators can take the lessons they learned from the past year to better prepare for the future.

First, we must define the difference between social isolation and loneliness — two experiences that we all, not just older adults, felt over the past year. Social isolation is the objective physical separation from other people, while loneliness is the subjective feeling of being alone or separated. In the last year, more than 1/3 of older adults aged 65 and older have felt lonely and socially isolated. Experiencing loneliness comes with health risks that rival obesity and a sedentary lifestyle, including premature death, heart disease, stroke, depression, and anxiety. Prolonged feelings of loneliness can change a person’s physiology and put them into a near-constant state of fight-or-flight, triggering their biological defenses. This can increase inflammation in the body and weaken the immune system.

During a global pandemic, a weakened immune system is the last thing we want for older adults. But there are many ways to keep older adults from feeling lonely and strengthen their immune system, all while keeping them safe from illnesses.

Senior living operators have recognized how imperative it is to keep older adults engaged and connected to combat the negative effects of loneliness. Over the last year, we have seen senior living communities get creative in coming up with ways to do this while keeping residents and families safe. Furthermore, CDC officials state that another pandemic is not a question of “if” but rather “when,” meaning it is imperative to reflect on the past year to identify what was done well, and what could be better to best keep older adults safe and engaged, no matter the circumstances.

Seniors Are a Lot More Sedentary Than You Think

Ponder this: On average, how many minutes of moderate-intensity physical activity do your residents need each week to maintain their strength and function?

The answer is 150 minutes.

Now, how many minutes do you think they are currently getting?

The answer is three minutes. Three! That is unimaginable, right? No. Unfortunately, this is in fact the average amount of time older adults spend on physical activity per week.

In addition to the negative physiological and psychological effects loneliness has on older adults, it can also be detrimental to their physical well-being. The sedentary lifestyle associated with loneliness and isolation can present as great of a risk as contracting COVID-19. Without adequate engagement, stimulation, and exercise, older adults are weaker, more fragile, and at higher risk for falls and subsequent hospitalizations.

To avoid these risks, SLCs have devised creative solutions to allow for more physical activity, even during a pandemic. For example, exercise can be completed in person, socially distanced, or virtually, and the recipients receive the same benefit. 150 minutes per week of moderate-intensity activity can help reverse the effects of a sedentary lifestyle, release endorphins, improve mood, and strengthen the immune system.

What counts as moderate-intensity exercise? While engaging in moderate-intensity activity, your heart rate should begin to rise, you can talk but can’t sing, and you may perspire a bit. If your residents are not getting this level and amount of activity a week, rethink your programming to include higher intensity exercise programs; because chair yoga is not enough—especially for higher functioning and active residents.

No One Is Too Old to Benefit From Exercise

In my clinical experience, patients often ask if there is a “magic pill” they can take to decrease pain or fall risk. My answer is always, “Exercise,” because the benefits of physical activity are nearly endless. It can positively impact nearly every body system, improve sleep, appetite, and psychological well-being.

Let’s meet Ruth: Ruth is an 89-year-old who has been living in a senior living community throughout the COVID-19 pandemic. While following precautions, I could only see Ruth in her apartment. She hadn’t seen her family in person since she began therapy four months earlier. She was depressed, anxious, deconditioned, and at very high risk for falls. Ruth and her family knew that a fall and hospitalization could be devastating during a pandemic. I was able to work with Ruth three days per week in 1-hour sessions each. Our therapy visits became the highlight of her week, and she was motivated to get stronger so she could visit her daughter again.

Her balance and mood improved. In our sessions, we focused on functional strength and balance to make sure she was safe in her apartment and staying as active as possible. On initial evaluation, Ruth completed standardized outcome measures that compared her performance to normative data of other older adults in her age range. She completed a Timed Up and Go (TUG), a functional test that assesses a resident’s ability to stand up from a chair, walk 10 feet, turn around, walk back, and sit back down in the chair. The results of this outcome measure can identify the need for assistance during mobility and the likelihood of falls. Ruth completed this test in 47 seconds. However, for her age range, she should have been able to complete this test in 12 seconds or less.

Through intensive prescribed exercise with a physical therapist, Ruth was able to increase her strength, walk to the dining room without losing her breath, and become less fearful of falling. When her community’s gym reopened, she was able to continue her home exercise program and get even stronger. At her therapy discharge, Ruth completed the TUG in 13 seconds, a 34-second improvement! For the first time in nearly a year, Ruth felt strong, confident, and safe.

Does Your Senior Living Community Offer Enough Physical and Social Engagement Opportunities?

Communities that only offered group activities and classes found themselves in a tough spot last year. With restrictions eliminating most, if not all, group activities, senior living communities were left with zero opportunities for their residents. This resulted in residents being more susceptible to a sedentary life and the health risks associated with it.

FOX Rehabilitation provides senior living partners with skilled physical therapy, occupational therapy, and speech-language pathology services to engage residents physically, socially, and mentally through a variety of evidence-based programs and interventions. Therapy services are vital to not only improving and maintaining physical wellness and stamina but are also critical for mental well-being. Communities can think of ways to offer more reduced-size group activities in addition to large group gatherings. Additionally, services and visits can be delivered in residents’ apartments to reduce risk while keeping them engaged and preventing loneliness and social isolation. Activities can be planned outdoors to allow more residents a chance to safely socialize. And although some residents may not be physically comfortable navigating outdoor terrains such as grass and steps, this is yet another reason to have an evaluation by your clinician. Maximizing your residents’ physical abilities outdoors as well as indoors will help improve their functional wellness and quality of life.

Sometime in the near future, we hope to put this experience far behind us. But we can all learn from it. Keeping older adult residents physically and socially active and engaged is the key to keeping them healthy during a pandemic and long after.

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