Loneliness as Collateral Damage from COVID-19 Isolation

Once again the resident says: “I am lonely and afraid. Where is my daughter?”  As caregivers, we know the answers, and the consequences of loneliness, but we also know that visitors can bring COVID into the nursing home.

How did we make the decision to turn the nursing home into patient prisons?

    • Experts in virus transmission recommended restricting contact with residents
    • Nursing home patients were dying in record numbers
    • Do something quick – let’s protect them and keep their visitors away

What have we learned about COVID-19 since this order to quarantine?

    • Asymptomatic carriers (facility staff) can transmit the virus if not in PPE
    • PPE and testing/tracing are key to mitigation

What have we learned about separation and loneliness for our residents?

    • “Frail older adults are at increased risk of mortality, but this risk is even higher for those who are also lonely or socially isolated.” Hoogendijk 2020

Now what?

    • Nursing home professionals understand the risks and long to end the isolation
    • Facilities are finding creative patient-centered ways for family involvement

Reference: Frailty Combined with Loneliness or Social Isolation: An Elevated Risk for Mortality in Later Life by Emiel O. Hoogendijk PhDAnnelot P. Smit BScCarmen van Dam MDNoah A. Schuster MSc  et al. First published: 23 July 2020 https://doi.org/10.1111/jgs.16716

 

Stories from The Field

Harry was very sociable on Unit 3 and his sense of humor kept us all entertained. When visitors were restricted and he was confined to his room it was good for infection control but detrimental to his spirit and well-being.

Early on in the quarantine there was adequate PPE and staff so at meal time Harry got the help he needed to eat and a few minutes of socialization and visiting with the dietary aide and the personal care aide helping him eat. His family was also able to stand in the parking lot and talk through the open window with their father. They explained what was happening on every visit.

By the end of week two, the PPE was not always available so the dietary aide could not enter the room and the personal care aide often wore a garbage bag for protection which was quite disturbing to Harry. When there were fewer caregivers, as several had become sick, the meal tray was often delivered to him but no one was able to help him eat. 

The family, from outside Harry’s window, could see their father getting quieter, sitting down more, and looking thinner in the face. He asked often when his family could come in to see him and if they could bring his favorite cookies, and why he could not leave his room. 

This story does not have a good ending for Harry, moderately frail at the outset, and declined further from social isolation and inadequate oral intake. He lost weight and became COVID-19 positive and did not recover. 

Harry’s demise was sadly not unique and continues in some facilities today. Families and caregivers alike would like to see the end of isolation and restricted visitors and are working to provide other ways of audio-visual communication until such time as the coronavirus abates or adequate staff and protective gear are available to allow for some visitation from families.