Social Isolation - The Best Kept Secret in Healthcare
In my many years as a clinical speech language pathologist, I worked in many types of settings and had the privilege to serve so many different people needing my assistance.
These included seniors within hospitals, rehabilitation units, skilled nursing facilities; the severely physically disabled and those with mental health disorders, persons in group homes with developmental disabilities, those who were legally blind and other challenges..
Of all of these groups , and others I served in 20 to 25 years, there was the common thread of vulnerability. In the 1980s and 1990s it appeared to me, the more ‘disabled you looked or acted’, the more vulnerable, and feared by those who were unfamiliar with their condition and often treated as outcasts.
I dare say, it continues today in some settings due to lack of staff, resources and lack of education. I had experienced it personally, growing up with spastic cerebral palsy.
Vulnerability and lack of a support system with chronic medical conditions seem to predispose a person to social isolation, among other reasons.
Social Isolation in Plain Sight
It was a common sight to see many residents of skilled nursing homes
‘lined up in a row’ in their wheelchairs, directly in front of the nurses station, with a beverage. Typically those with complex medical conditions such as stroke, heart and pulmonary disease, Parkinson’s were lined up.
The reasons may have been- to ‘keep an eye on them’, to try to prevent social isolation’, to decrease liability if they stayed in their rooms alone and as a temporary solution to short staffing when passing medications.
Rarely, did I see any social engagement or interaction from anyone.
It was just the way it was done. There were usually about half a dozen or more residents in a row. They all had blank looks, alone in a crowd, sad and vulnerable. This stark example is vividly etched in my mind as well as my heart with sadness.
However, in reality, we must understand that social isolation has gone on for centuries, in all kinds of settings.
In 2025, there are many forms of social isolation and many reasons for it to occur. SI can occur in institutional and community settings, in private homes, personally imposed isolation and when a person perceives and feels isolated even though they may be surrounded by others.
The Beginnings of Recognizing Social Isolation
It was not until the late 1970’s that professionals began identifying SI as a potential health risk. As physicians identified loneliness among elderly residents, the shift to recognize more social interaction began in the mid- 1980’s and subsequently may have included it in a care plan.
(For purposes of this blog, information was gleaned with the benefit from research and podcast information I was fortunate to do during COVID with Nick Nicholson, Ph.D Professor in Nursing, Quinnipiac University in Connecticut. (His expertise in social isolation is well known throughout the country and beyond.)
Social Isolation can be defined in a few ways…
A state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts which are deficient in fulfilling, quality relationships
…the distancing of an individual, psychological and/or physically from their network of desired or needed relationships with other persons.
SI can be voluntary or involuntary. It is all inclusive and not only relates to the loss of number of social contacts, but also the perceived quality of the relationships.
However, there are also distinct differences between the terms solitude, aloneness and loneliness which the general public, and healthcare professionals can easily confuse or misinterpret, in home and long term care settings.
Solitude- Voluntarily distancing yourself from your social network with a positive feeling. (Such as a walk in the woods on a fall day).
Loneliness is subjective and often has a negative connotation -
It implies a need for another person or group that has been disrupted.
(Such as a grandparent really missing a grandchild)
Aloneness- Can be positive and evidence of self-healing or negative with the feeling of losing control.
(Such as, “It was wonderful to explore on my own” or-
“Nobody understands what I’m going through”)
The Nuts and Bolts of Social Isolation-
Dr. Nicholson states that, what is critical to understand about social isolation is that it exists because of the situation imposed on them, people perceive themselves as disconnected from meaningful people important to them.
Risk Factors Present with Social Isolation in the Elderly-
Cognitive decline; Dementia; People who do not participate in social activities; Increase in falls and malnutrition; Suicide;
Two Types of Socially Isolated Older Adults-
Situational- Occurs rapidly as a result of after a specific traumatic event (ie- sudden death of spouse; loss of housing, sensory deficits (ie hearing vision, taste, smell), family/friends, a decrease in income);
Structural -Occurs over time with no single event triggering the isolation (ie- chronic illness or disability)
The Social Isolation Scale- (2020) The SIS is a six-item instrument, divided into two distinct sections- one section focusing on connectedness and the other focusing on belonging. The questions are easy to understand, taking just 3 minutes to administer. They have been tested thoroughly and can be repeated to assess change over time. It is a good starting point for intervention.
Five Attributes of Social Isolation-
The number of contacts one has - Connectedness;
Feelings of belonging;
The presence of fulfilling relationships;
Engagement with others;
The quality of network members
***In order to effectively address social isolation, the duration of isolation, the motivation and coping strategies all must be considered.
In order for health care professionals to help change the situation of social isolation in long term care settings, goals should include -
To increase the resident’s ability to make ethical decisions based on internal right and wrong and freedom of choice;
To increase the resident’s social interaction at a level acceptable to them;
To develop strategies that can be recognized and repeated by the resident to decrease social isolation.
AND YES, IT TAKES A VILLAGE OF THOSE WHO CARE…
There is much information to learn about social isolation as a component of the fear of retaliation when living in long term care settings.
This detailed document,was a collaborative, multi-state research report on FEAR OF RETALIATION on the part of residents in long term care settings- (December 1, 2024), Entitled, “A Bridge Over Scary Water” (By Researcher Elon Capsi, Mairead Painter, Connecticut State Long Term Care Ombudsman, and others ) Link- https://portal.ct.gov/-/media/ltcop/pdf/report---a-bridge-over-scary-water---december-1-2024---pdf---final_compressed.pdf
Quote from an Ombudsman-
“When a State Long Term Care Ombudsman from another state was asked whether she sees a difference in residents’ fear of retaliation in rural versus urban areas, she said,
‘I think my concern is...whether it’s urban or rural, … when a facility is more isolated and closed off from the outer world and residents do not have family members coming to visit...because maybe they don’t have them, there is room for instilling fear in residents and that fear of retaliation that that creates for residents because they’re isolated, they’re alone, they don’t have anybody...they may only have us as Ombudsmen...and so when you have those circumstances, I think it’s ripe for an increase in fear of retaliation, retaliation, threats, and actual abuse.’
The Scope of Social Isolation Globally- Current global estimates suggest that 1 in 4 older adults experience social isolation and between 5 and 15 percent of adolescents experience loneliness.Rates in low- and middle-income countries are comparable or higher than in high-income countries.
The World Health Organization Commission on Social Connection (2024–2026) aims to see the issue recognised and resourced as a global public health priority. The Commission will propose a global agenda on social connection, working with high-level Commissioners to make the case for action, marshal support to scale up proven solutions and measure progress.
The Advocacy Brief- The brief summarizes the scale, impact, and harms of social isolation and loneliness among older people; it outlines solutions to reduce them, describe policies and proposes a three-point global strategy for tackling these issues. (682.5KBs)
CONCLUSION- It is not enough to just recognize the problem of social isolation that spans the globe…or in our own backyards. For the sake of humanity and a better quality of life for those we care about and love, we individually must be proactive, ‘be good detectives and advocates’ to assist others on an individual basis and insist that it is a resident’s right to have the best quality of life - free from the psychological and physical harm that social isolation. We must take responsibility and be the agent for change when others fail.
nicholas.nicholson@quinnipiac.edu; Tel- 203-582-6542.
Other blogs you might enjoy-
!) https://donnagore.com/blog/beyond-health-and-safety-person-centered-care-is-your-right;
2)https://donnagore.com/blog/caregivers-for-better-or-for-worse-in-sickness-and-in-health
Thank you for reading. Please share your comments!
Donn