Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 119

Older adults are prone to social isolation for a number of reasons. As part of growing older, older adults are more likely to experience widowhood, the loss of friends and family, and physical separation from family due to geographic moves. Hearing and vision loss, cognitive impairment, and physical disability all lead to mobility impairments and a reduced ability to drive, navigate public transportation, or leave the home. Older adults living in rural areas or who face financial insecurity may have limited means to engage with their communities. Risk factors for social isolation and related adverse health effects and possible mitigation factors are summarized in Figure 4.5.

Social isolation is defined as objective physical separation from other people, while loneliness is defined as subjective distress due to feeling separated or alone.⁴³ Although correlated, the two terms are not synonymous. Older adults who are physically isolated may report robust relationships, particularly with online connectivity and/or engagement in meaningful leisure activities. Conversely, adults who live with or near others, even family members, may report loneliness if the quality of these relationships is poor. Both social isolation and loneliness are associated with a number of adverse health effects. Loneliness increases the risk of depression, anxiety, and suicidality. Social isolation increases the risk of cognitive impairment and delayed time to diagnosis. Chronic social isolation and loneliness trigger an increased inflammatory state, leading to increased risk of cardiovascular disease, exacerbations of chronic illnesses, and a suppressed immune system.

Figure 4.5 Risk factors, possible adverse events, and possible treatment options for loneliness in older adults.

Approximately one‐quarter of community‐dwelling older adults in the US were characterized as socially isolated. Lower income, lower educational attainment, unmarried relationship status, and Caucasian race were all correlated with a higher risk of social isolation.⁴⁴ Loneliness is difficult to capture objectively, but various surveys have indicated that 20–45% of adults report feeling lonely some or all of the time. Living alone and dissatisfaction with one's social circle, family, or community increased the risk of loneliness.

Treatment of loneliness must be tailored to individual circumstances to be effective; there is no one‐size‐fits‐all approach. Factors increasing the risk of social isolation, such as impaired hearing, should be addressed, and co‐morbid psychiatric diseases such as anxiety or depression should be appropriately treated. Social workers may be able to help patients establish reliable transportation, join senior centres, or pair at‐risk seniors with volunteer organizations that provide companionship. Patients can engage in volunteer groups or community organizations based on shared language, culture, or interests. Cognitive‐behavioural therapy can be effective for select patients who exhibit maladaptive social cognition, characterized by persistent negative thoughts about themselves and how they are perceived by others.⁴⁵