Over the last three-plus years we have seen the impact social isolation has made on our elders. The recommendation to keep cognitively, physically, and socially active throughout life can aide in helping prevent cognitive loss. The social model of care focuses on a “person-centered” model in providing a more active environment. When the pandemic began, every door was closed including resources for our elders. This led to the decline of the overall health of these individuals.
Social isolation is a self-reported social determinant of health item that will be added to MDS Section D beginning October 1, 2023. Social isolation refers to lack of social contact with others. One-fourth of adults over the age of 65 are socially isolated. The Center for Disease Control and Prevention recently issued a warning that social isolation and loneliness increases serious health risks including early onset dementia, decline in mental health, falls, and incontinence.
There will be other areas of social determinants of health that will be added into the MDS—questions regarding ethnicity, race, language (resident’s preferred language and desire for an interpreter), transportation, health literacy, and social isolation. To determine what the impact is for any specific social determinant, an interview will need to be conducted to collect information on which residents have those social determinants and look at their outcomes. To collect the information on who is impacted by social determinants of health, CMS is adding those areas into the new MDS. It’s not an area of data that is collected currently. Facilities are going to need to think about: Who is going to collect it? How are they going to collect it? When are they going to collect it? And where will it be stored when they do collect it so that others can retrieve it if they are looking to complete any MDS sections with this additional information? Social determinants of health will be a significant change, particularly for social services, who will probably be tasked with collecting this information, this may also impact the CAA (Care Area Assessment) under activities which will include increased documentation needs and care planning for the social determinants of health, to the discharge planning process.
When residents living in skilled nursing facilities self-disclose social isolation, a care plan should be developed to mitigate or eliminate associated risks. Care planning for social isolation requires in-depth analysis of a resident’s experience, contributing factors and associated risks. It is important to consider residents’ social networks, individual relationships’ strengths, and psychosocial functioning. For residents lonely in the facility, it is important to provide activity programs and services that they personally enjoy.
A major source of activity interventions for social isolation includes non-pharmacological approaches to care. More studies are needed on non-pharmacological approaches with using the social engagement model. One study that was conducted in February 2020 (before the pandemic) noted the importance of non-pharmacological approaches with the use of music and personal listening preferences. There have been studies that have investigated the impact of music sessions on expressed positive emotions. Measurement of positive emotions in persons with dementia has to date been captured by proxy ratings of caregivers with self-made questionnaires. Because caregivers offer their observations, the research skewed the results which leads to creating better assessments to note emotions. The Music and Memory program was developed to allow individuals specifically living with dementia the opportunity to express pleasure, alertness, anger, or sadness using personal music interventions. This non-pharmacological approach to care has been used for several years. It was originally not to be used as a crisis intervention but more of a preventive measure. However, during the pandemic this program made an impressive impact on persons who were socially isolated. For more information on music and memory visit: https://musicandmemory.org
Another non-pharmacological approach has been art engagement. There have been several studies noting the importance of this intervention. Art therapy is considered patient centered. Patient-centeredness considers each patient as a unique being whose specific needs, values, and experiences should be reflected in their health care. Patient-centered interventions emphasize the use of holistic, individualized, respectful, and empowering strategies that can be achieved using targeted and/or tailored approaches. Active engagement in something that has a therapeutic outcome can allow for personal expression and the ability to increase social opportunities. During the pandemic, these types of interventions became one-to-one which was challenging with the staffing crisis many senior living communities endured. For more information on the benefits of art check out the following resources: https://hellobream.com and https://neuroartsblueprint.org
Other non-pharmacological interventions include aromatherapy, exercise, and the use of multi-sensory rooms. There are limited studies on these interventions as well. Most of the research has been conducted in other countries. Social isolation from the pandemic has greatly impacted the overall psychosocial well-being of our elderly population. It is crucial to provide holistic measures and interventions that family members and caregivers can understand and possibly benefit from as well. One study on exercise noted that evidence points towards physical activity having a small, beneficial effect on normal cognition, with a possible effect in mild cognitive impairment, mostly due to aerobic exercise. Using the person-centered approach can lead to a more holistic path towards effective therapeutic responses. This research verified the importance of using practical applications to support individuals at risk for social isolation. This research conducted opens the path for further exploration in better understanding the specific needs of individuals living with dementia, and how to customize personalized approaches utilizing these and other engagement interventions. For more information on aromatherapy visit: https://dementiaconnectioninstitute.org for more information on exercise visit: https://strongeruseniorfitness.com and for more information on multi-sensory rooms visit: https://www.snoezelen.info
The best strategy for those at risk of social isolation is to provide non-pharmacological activity interventions. It will be important for activity professionals to work with social services when coding Section D on the MDS. Addressing social isolation will help residents’ with improving mental well-being along with improving physical functioning. Social connection matters for the overall health of the people we serve.
Alisa Tagg, MS ACC/EDU CADDCT CDP CDCS DCS
NAAP Association Director