Rising to the Occasion: A National Nursing Home Study Documenting Attempts to Address Social Isolation During the COVID-19 Pandemic

ObjectivesCOVID-19–related policies introduced extraordinary social disruption in nursing homes. In response, nursing facilities implemented strategies to alleviate their residents’ loneliness. This study sought to describe interventions nursing homes used, document the perceived effectiveness of efforts, and determine barriers to implementing strategies to mitigate social isolation and loneliness.DesignNational survey of nursing homes sampled in strata defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5).Settings and ParticipantsUS Nursing Home Directors of Nursing/Administrators (n = 1676).MethodsThe survey was conducted between February and May 2022 (response rate: 30%; n = 504, weighted n = 14,506). Weighted analyses provided nationally representative results.ResultsOne-third were extremely concerned about their home's ability to meet residents' medical and social needs during COVID-19 before vaccines were available and 13% after vaccines. Nearly all reported trying to mitigate residents' social isolation during the pandemic. Efforts tried, and perceived as most useful, included using technology (tablets, phones, emails), assigning staff as a family contact, and more staff time with residents. Most frequently cited barriers to implementation were related to staffing issues.Conclusions and ImplicationsDespite multiple challenges, nearly all nursing homes tried to implement many different approaches to address residents’ social needs, with some (eg, having an assigned family contact, use of tablets and phones) perceived as more useful than others. Staffing issues presented barriers for addressing the social needs of nursing home residents. Many strategies for addressing social isolation placed more demands on a workforce already stretched to the limit. While concerns about resident social isolation reduced after vaccine availability, administrators remained extremely concerned about staff burnout and mental health.     

Pilot study of Qigong/Tai Chi Easy acute effects of meditative movement,breath focus and “flow” on blood pressure,mood and oxytocin in older adults

BackgroundOlder adults are increasingly lonely and at risk for hypertension. Endogenous oxytocin levels are associated with lowering blood pressure (BP), suggesting value in increasing oxytocin. Regular practice of Tai Chi improves BP and mood; we explored a single session of Tai Chi Easy (TCE) with older adults and feasibility of measuring oxytocin as a key biomarker.MethodIn a single-arm pre-post design pilot study, 21 older adults (age 55–80) with mild-moderate hypertension practiced a single session (50-min) TCE. BP, psychosocial measures, and saliva samples were collected pre/post to examine feasibility of acute measures of oxytocin and explore effect sizes of outcomes. Participants (N = 21; 19 % Latinx, 76.2 % female, mean age 66.76).ResultsBP systolic: 138.43–134.86; diastolic 78.48–78.00 (p > .05; Cohen’s d −0.23; −0.08 respectively). Total Mood Disturbance (TMD) and Connection (CN) improved [TMD mean pre 41.891 (SD=19.60) to post 35.00 (SD=10.21), p = .01; Cohen’s d − 0.67); CN mean 7.85 (SD=2.01) to post 9.05 (SD=1.00), p = .01; Cohen’s d 0.70]. Baseline oxytocin was positively correlated with baseline loneliness (N = 14, r = .599); pre/post oxytocin changes were negatively correlated with baseline loneliness (N = 14, r = −.585). BP decrease was associated with characteristics of the intervention: “flow” (coef=.=0.58N = 17) and meditative/breath focus (coef=−1.78; N = 17).Discussion/ConclusionMedium to large effect sizes indicating change in mood and connection were found for this single session intervention. Knowing that Tai Chi improves BP when practiced over time, this TCE intervention shows promise for planning a fully powered, randomized controlled study of BP, mood and perceptions of connection in hypertensive older adults. Feasibility of assessing acute salivary oxytocin is less promising. Increase in oxytocin levels occurred for those less lonely, but declined for lonelier participants. With different responses based on baseline loneliness scores, no mean change in oxytocin levels was found. Seemingly unstable levels (possibly related to interaction with study staff) suggests the need for further testing in more controlled study designs. Finally, BP associations with meditative/breath focus and flow could be further explored in future study designs addressing mediation.     

我国60岁及以上老年人孤独感影响因素分析

目的分析我国≥60岁老年人孤独感影响因素。方法使用2018中国老年社会追踪调查资料中≥60岁老年人作为研究对象, 估计样本量为7 953人。孤独感采用孤独感量表进行测量, 运用逐步回归与简单斜率法分析主、客观因素对孤独感的影响及其相互作用。使用SPSS 25.0软件进行统计学分析, 采用PROCESS 3.3宏程序进行简单斜率检验。结果研究对象共8 926人。客观因素中, 家庭网络差的老年人孤独感水平更高(P<0.05)、社区提供养老服务能够降低老年人孤独感(P<0.05)。主观衰老年龄≤60岁、社会适应能力和情绪感知较差的老年人其孤独感水平更高(均P<0.05)。主观衰老年龄在社区提供养老服务对孤独感的影响中发挥负向调节作用(P<0.05), 社会适应和情绪感知在家庭网络对孤独感的影响中发挥负向调节作用(均P<0.05)。结论我国≥60岁老年人孤独感受到主客观因素的共同作用, 其中主观因素在客观因素对老年人孤独感影响作用中发挥重要的调节作用。因此, 在创造良好适老环境为老年人提供有力外部支持的同时, 也应充分调动老年人自身主观能动性, 共同缓解老年人孤独...     

Impact of COVID-19 policies on perceptions of loneliness in people aged 75 years and over in the cognitive function and aging study (CFAS II)

Background

The COVID-19 pandemic and associated social distancing measures have profoundly impacted society and social contact patterns, with older people disproportionately affected. Concerns have been raised about a resulting pandemic of loneliness in older people, although the current evidence is mixed. This study provides a unique perspective on the prevalence of loneliness in a population cohort of older people before the pandemic, followed up after the introduction of social restrictions.

Methods

Data analysis was conducted using Wave 3 of the longitudinal Cognitive Function and Aging Study II (2018–2019) and a sub-study focusing on experiences during the COVID-19 pandemic (2020). The sample comprised 379 adults aged over 75 living in Cambridge, Newcastle, and Nottingham. Multivariable binary logistic regression was conducted to identify correlates of prevalent loneliness, adjusted for confounding covariates, during the pandemic. The prevalence of loneliness during the pandemic was compared to loneliness in 2018–2019.

Results

Prevalence of loneliness in this sample during the pandemic was 25.1% (95% CI 20.9%–29.7%) compared to 17.2% (95% CI 13.7%–21.3%) in 2018–2019 (χ² = 14.1, p < 0.01). Variables associated with increased odds of prevalent loneliness included: prior loneliness, living alone, female gender, living in an area of higher deprivation, frequent pre-pandemic social contact at community groups, and separation from family during the pandemic, adjusted for age and sex. Weekly technology-mediated contact using telephone or video calls was associated with lower odds of loneliness.

Conclusions

COVID-19 recovery plans should address loneliness in older people. Target groups should include those who have previously been lonely, people who live alone, those living in deprived areas, and those who had previously been socially active through community groups.