Social distancing, shelter-in-place, self-isolation, stay-at-home orders: these are all terms with which we have become painfully familiar since the global COVID-19 pandemic began and are becoming a part of the general human condition. Of course, we want to do what is necessary to stay safe and prevent the spread of the virus. Regardless of pandemics, isolation and loneliness can be a part of everyday life for the elderly and can have devastating effects on their physical and emotional health.
Much contributes to loneliness in the elderly; this population cohort is most likely to have lost a partner, close friend or family member. They are most likely to have health issues that need long-term care or have underlying co-morbidities that concern them. Social isolation can be a significant contributing factor, combined with adult children and grandchildren living remotely and, perhaps, the deterioration of hearing, eyesight or mobility. These stressors can contribute to loneliness and the overwhelming feeling that there is no one to turn to for support.
In a quarantined societal situation, external contributors can severely exacerbate the feeling of isolation and loneliness. External contributors to feelings of loneliness can be:
- Food insecurity
- Loss of meaningful employment
- Lack of ready transportation
- Limited opportunity to socially engage with others
- Lower individual income
- Accessibility of a primary professional caregiver
- Minimized participation in organized groups such as church
- Lack of technology such as telephones or television
Loneliness in our elderly population has been proven to contribute to physical and mental health issues. In a variety of university and private studies, loneliness has been shown to:
- Be a significant indicator of poor physical and mental health
- Increase the rate of mortality
- Be as damaging as smoking or obesity
- Increase one’s chance of developing clinical dementia
- Contribute significantly to individual Medicare healthcare spending
It can be argued that loneliness is perhaps the most prevalent “disease” in our elderly population. It can also be argued that it is perhaps the most overlooked disorder in that population and one that, if addressed properly and continually, could provide a significant difference in the quality of life, health and financial well-being of the elderly. In order to address loneliness, we must first understand how to recognize it.
Signs and Symptoms of Loneliness
There are distinct signs in a person’s everyday actions, discussions and physical appearances that point to their loneliness. Recognizing these signs is the first step in combating this disease and providing assistance and care. Here are just a few symptoms of loneliness:
- Decrease in appetite and nutrition intake
- Lack of energy or remaining in bed longer than usual
- Significant increase in watching television
- Noticeable decrease in communication with peers
- Increased anxiety levels or change in temperament
- Increased complaints of aches and pains
- Expressed feelings of depression, hopelessness or suicide
Person Centered Design Solutions
As designers and care providers, there are several ways we can work together to combat loneliness in our elderly population, particularly within a group living situation such as assisted living or skilled nursing. Often these efficacies involve the care program and care givers’ intervention, but the built environment can contribute to relieving loneliness either by providing tools for the care givers’ use or designs that vicariously encourage resident social interaction.
Designing senior living residences with person-centered care in mind is a major first step. In coordination with staff empowerment, it becomes easier for staff to understand resident personalities, daily routines, social connections within the household and dietary habits. Staffing consistency also provides residents with familiar faces and opportunity to welcome staff members into their social connectiveness. Person-centered care design requires the designer to fully understand the relationship between the small household layout, amenities and function, thus requiring a thoroughly considered process of how residents and staff react to one another and how residents react socially with others.
Simple design inclusions can make a big difference and are only limited by the imagination of the designer. If, for example, we inset a resident room entry by about three feet along a major portion of the width of the apartment, we can create a small seating area just outside the resident apartment. This serves not only as a transitional area between the corridor and the resident room but can be a place where the resident can relax in the morning with a cup of coffee and a friend sharing a friendly conversation. It can also serve as a place where a caregiver and resident can discuss, with at least a shred of privacy, changes in resident behavior that may have become concerning.
Small House Design Solutions
Within that same small household layout, resident rooms can be a bit larger in order to accommodate more than simply a bed and dresser. If the room size permits personal furniture such as a small table and two side chairs, the resident can invite others into their “home” for a friendly card game or a simple neighborly visit. The additional benefit provided by allowing resident furniture reinforces familiarity of personal items which can contribute to decreased anxiety particularly at move-in and shortly thereafter. Care providers should be allowed to take a few minutes to sit down with the residents in these small social areas to simply converse about how their day is progressing, getting to know them personally.
Another easy design approach is to make sure the dining room is large enough to accommodate a variety of seating arrangements. This allows residents to choose their level of social interaction during mealtimes. Care providers should encourage residents to occasionally modify their seating choices in order to elevate their social interaction with a variety of residents.
Design Solutions that Encourage Social Interaction
In small house and person-centered designs, the often-included open kitchen area can be the center of social interaction just as the kitchens in our own homes. If designed sensibly, perhaps with a counter bar area where residents can sit to watch meal preparation or a cooking demonstration, there is a natural level of interaction, both active and vicariously. The countertop height should be at a level such that residents don’t have to climb into a bar stool but should also be available for easy physical participation to do such things as mixing ingredients or kneading bread dough. Care providers should regularly schedule cooking and baking activities so that it becomes a regular event that the residents look forward to.
Design solutions should also consider the need for residents to socially interact with family visitors. This may not occur as often as desired, but when it does it is very important in the minimization of loneliness for the resident. Large living rooms are great for use by the residents, but not necessarily for family visits. A smaller sitting area with furniture enough to accommodate four to six people that is set aside from the daily activity of the household serves this purpose much better. Here, conversations can take place among the family members without disruption from other residents. Care providers can serve coffee and snacks and discourage other residents from imposing themselves on the family gathering.
Including a meditation room can be a way to minimize loneliness. The room does not need to be large and could double as the family gathering space. Providing an area where residents can quietly consider and celebrate the rewards and accomplishments of their life or where, they can work through a grieving period, may allow the avoidance of a period of deep depression. Care providers should be aware of residents who utilize this space by themselves too often and of their demeanor as they enter and leave the space.
Loneliness for many may be a product of the COVID-19 pandemic that required social distancing, lack of hugs and isolation but there will be a time when this pandemic will subside, and society will begin to normalize. Loneliness, however, is an epidemic which will almost certainly be with us forever. We need to understand the symptoms and provide mitigation for those symptoms in order to assure the quality of life the elderly population deserve. As designers of residences for the elderly, we need to sensibly include solutions that assist care providers and residents to combat loneliness. Together, these approaches can help minimize the loneliness that is prevalent in the elderly and stem the health and financial issues that arise from it.