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Fostering Connection to Prevent Loneliness in LTC

Solution Providers

Article contributed by AAPACN Solution Provider MED-PASS

By Bradley Slye, MPH, and Stacy Yale, RN, BSN

Did you know that more than half of nursing home residents report feeling lonely? Loneliness can be completely invisible, regardless of the number of activities hosted by your facility, the flash of a polite smile, or a room full of people.

While nursing home caregivers provide essential care, they can unintentionally foster social isolation and emotional disconnection by over-emphasizing clinical outcomes. Loneliness is associated with poor physical and mental-health outcomes.

Recognizing and responding to loneliness is not just a compassionate act, but a critical step in promoting whole-person care, preserving dignity, and protecting health.  In addition, staff satisfaction and retention are directly tied to resident well-being and positive experiences. In other words, by spending more time with residents, caregivers can improve the lives of seniors while boosting overall morale.

What is Loneliness?

Loneliness is a deep and subjective sense of disconnection felt when the social interaction a person desires does not match their experiences. This gap can be unique to each resident. Where one resident may feel satiated with their interactions, another may have the same quantity or even quality of interactions but feel a deep longing for more.

Some researchers characterize loneliness as emotional, social, or existential, or any combination of these. Emotional (or personal) loneliness may occur when mourning a significant loss, like a spouse or dear friend. Social loneliness may be felt when an individual is disconnected from a group they have been a part of. Existential loneliness may be the result of struggling with questions about one’s roles and value at a particular stage of life.

Loneliness should not be considered a “mood” or taken lightly. The Centers for Disease Control and Prevention (CDC) and U.S. Surgeon General have called loneliness a critical health risk and a public health crisis, comparable in impact to smoking, obesity, or physical inactivity. In nursing homes, unaddressed loneliness can undermine recovery and diminish quality of life.

The Toll of Loneliness

Loneliness and social isolation pose serious threats to the health and well-being of elderly people, with overwhelmingly negative consequences. The more loneliness a resident experiences, the lower their quality of life. And although experiencing occasional loneliness is part of the human condition, some estimates suggest that those over 65 experience loneliness at double the frequency of younger adults.

The lowered quality of life experienced by lonely residents can manifest as sleep disturbances, depression, cognitive decline, and fatigue – often stemming from the absence of social networks and the deep sense of loneliness that accompanies isolation. Loneliness is also associated with a range of chronic conditions, including kidney disease, liver disease, cancer, arthritis, emphysema, asthma, and stroke. Abuse and exploitation of lonely residents has also prompted organizations like AARP to advocate for greater awareness and intervention research.

Residents new to care facilities may be particularly disoriented by new, institutionalized schedules, sharing space with strangers, or loss of autonomy. Other residents with a history of trauma or those belonging to marginalized groups may feel their loneliness is compounded by stigma, exclusion, and structural barriers.

Understanding Context

It is important to consider the emotional context of admission into a nursing home. Many residents enter care following a major health event, cognitive decline, or the loss of a spouse or home. This transition can be traumatic, stirring grief, disorientation, or a sense of abandonment. If unacknowledged, these feelings can deepen into sustained loneliness.

Other residents may have interpersonal histories and past traumas that shape how they engage with others. Some may be reluctant to trust staff or peers due to earlier experiences with neglect, discrimination, or institutionalization.

For LGBTQ+ elders, for example, care environments may stir fears of judgment or exclusion, especially if they’ve previously concealed their identities for safety. Veterans may carry deeply personal experiences that may intensify feelings of loneliness. While some struggle with post-traumatic stress, survivor’s guilt, or lasting effects of injuries, others may feel dissatisfied with group settings where the camaraderie they once felt feels absent. The loss of their tight-knit social network and clear sense of mission may lead to a loss of identity and structure, which makes fostering meaningful connection difficult.

Understanding these complex contexts may allow caregivers to approach loneliness with greater empathy and insight, along with a better understanding that loneliness is not simply a matter of needing more activities or visitors. Rather, it is a reflection of whether residents feel safe, valued, known, and free to be themselves in the place they now call home.

Why Recognition Matters

Nurses and other staff members are consistently being asked to give more of themselves. From delivering increasingly complex clinical care, managing medications, and ensuring regulatory compliance, addressing loneliness may seem frivolous. Plus, amid the pressures of staffing shortages and turnover, it might be easy to overlook signs of loneliness.

Signs of loneliness may include lingering in shared spaces, declining participation in activities they once enjoyed, or frequently requesting care or support with non-urgent issues/activities of daily living that the resident is physically and mentally capable of completing independently. These residents may just want to engage with someone.

Recognizing loneliness means tuning into those subtle signs and being emotionally attuned to residents. It requires intentional listening, building trust, and understanding each resident’s unique social and emotional needs. When caregivers identify loneliness as a legitimate and urgent health concern, they can prioritize meaningful interactions, personalized programming, or mental health support before deeper issues take root.

Building Connection

Addressing loneliness does not require grand gestures, unlimited activities budgets, or tripling the clinical staff. Small, consistent, and compassionate acts of connection can make a profound difference in the lives of residents. Those acts may include:

  • Establishing consistent staff-resident assignments to build stronger relationships and familiarity.
  • Creating space for storytelling that honors a resident’s past, helping staff understand their preferences, interests, and identities.
  • Validating the resident’s lived experiences.
  • Facilitating peer support groups or buddy systems that promote friendship and mutual support among residents.
  • Promoting family engagement using virtual visits, letters, or storytelling projects when in-person visits aren’t feasible.
  • Establishing inclusive environments for LGBTQ+ residents, veterans, and/or culturally diverse populations, where they feel seen and valued.

Every team member (clinical and non-clinical, at all levels) should be empowered and encouraged to engage meaningfully with residents, making social connection a shared responsibility.

Sharing Responsibility

Recognizing and reducing loneliness requires systemic change from leadership. Leaders and decision makers must prioritize psychosocial health, communication, and trauma-informed care training among staff. Leaders should also establish a culture in which staff are empowered to slow down for meaningful connections in their interactions with residents.

Families, too, play a vital role in addressing the loneliness problem. For many residents, the loss of regular family visits can deepen feelings of abandonment. Administration can support greater connection by offering flexible visiting hours, technology access and support for video calls, and family education on recognizing the symptoms and effects of loneliness, and more.

Conclusion

While loneliness and social isolation may look different from resident-to-resident, the signs and symptoms are detectable. Caregivers should be alert to changes in behavior, affect, routine, sleep cycle, and overall well-being of the resident. In nursing homes, where residents are at higher risk of isolation, recognizing loneliness is a moral, clinical, and public health imperative. When staff is attuned to the expressions of resident needs, care is delivered with compassion, creativity, and connection.

To recognize loneliness is to affirm humanity, and to address loneliness is to address dignity.

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