Ageing population is rising rapidly as the years goes by. Estimated total number of elderlies aged 65 years old and above will be about 900,000 by the year 2030 (Budget 2018, 2019). Elderlies are identified as the vulnerable group due to impairment of their physical health, the death of spouses and partners, being more likely to live alone and having fewer confiding relationships (Victor & Bowling, 2012).
Madam D.S, 86 years old widow who was diagnosed with Alzheimer’s disease more than 5 years ago. She has multiple past medical history including a surgical history of right hip arthroplasty done 11 years ago. Despite her age, she is still able to ambulate with a walking stick, with minimal to moderate assistance. She lives with her eight son and family in a 4-room purchased HDB flat. However most of the time client is usually left alone in the day at home. Several problems gathered from the interview conducted with Madam D.S and Social Isolation is one out of the six problems identified. Social isolation refers to the quality and quantity of the social relationships a person has at individual, group, community and societal levels (Scottish Government, 2018). According to Landeiro, Barrows, Musson, Gray & Leal (2017) Social isolation and loneliness affect about one-third to one-half of the elderly population and have a negative impact on their physical and mental health.
There are several risk factors for social isolation among the elderly which includes disabilities, reduced social networks, aging, transportation issues and low self-esteem (Valtorta & Hanratty, 2012).
Despite being able to ambulate with a walking stick with minimal assistance, Madam D.S tends to experience unsteady gait after walking around for quite a while. She will always need to sit and rest in between thus she may feel it to be burdensome for the family. Functional limitations may create hindrance for the client from having to go out and stay home. Physical disabilities may cause functional barriers thus decrease the opportunities to create new social interactions among others like neighbours, friends and the society (Savikko, Routasalo, Tilvis, Strandberg & Pitkälä 2005).
Study done by Crooks, Lubben, Petitti, Little, & Chiu (2008) mentioned that larger social networks shows some positive outcomes on the cognitive function among elderly women. It decreases the risk of developing dementia. Madam D.S does not have the ability to use the electronic gadgets such as the hand phone and computers. Therefore, she is unable to communicate with others. By making use of the electronic devices could allow the client to call her friends over the house and gather together since she is most of time alone in the day.
Lack of transportation increases the effect of social isolation (Community Living Solutions, 2017) Madam D.S has phobia of taking the public transport especially the bus as there were an incident whereby she almost fell in the bus due to the ignorance of the bus driver. Knowing that the caregiver’s family does not have a car, they would need to travel with the public transport. As told by the family, they had suggested to take a taxi instead however, Madam D.S refused. This contributes to the reason on why she does not want to go out often. Client’s family would rent a car occasionally to go out as a family. Lack of confidence is also one of the factor which refrains Madam D.S, to go out of the house. She has fear of walking along the corridor as she is afraid of falling off the height from level eight. She tends to hold on onto the neighbours’ house gates while walking to avoid looking down to the ground.
There are several interventions for social isolation such as, animal interventions, befriending interventions and social facilitation (Gardiner, Geldenhuys & Gott, 2018). According to Krause-Parello (2012) Pets can play a positive role in the both the physical and psychological health of older adults. It also helps in lessening feelings of social isolation and aid in emotional support. Based on Madam D.S, she has a panda soft toy which she treats it like her child. She will communicate with it as though it is a living thing. Patting it to sleep while singing a lullaby. Client’s granddaughter had mention that she had once hide the soft toy keeping it away from client’s sight. Client gotten restless and went around the house searching for it. When client finally managed to find the soft toy, she hugged it tight while tears rolling down her cheeks. This shows a positive signs that client had treated the soft toy as a close companion which she unable to let go. Evidence shows that animal associated activities increased life satisfaction for everyone including those with dementia or cognitive deficits (Olsen, Pedersen, Bergland, Enders-Slegers, Patil and Ihlebaek, 2016). Animals are unable to communicate like how human beings does however it able to provide a nonhuman social support (Krause-Parello, 2012).
Befriending interventions are usually one-to-one interaction which involves the volunteers (Gardiner, Geldenhuys & Gott, 2018). Madam D.S will be home alone most of the time in the day while the other family members goes to work. She would often just sleep, walking aimlessly at home, lazing on the sofa staring into space. She is not capable of switching on the television nor is she able to use the electronic devices such as phone or hand phone. Madam D.S loves to talk people. During the interview done with her, she seems very enthusiastic in telling stories. Therefore, having volunteers to keep her company at home may imposed a good intervention for her as she would not feel lonely. These volunteers reaches out to seniors who are at risk of social isolation. There are several resources which provides befriending services such as the Lions Befrienders Service Association and Singapore Silver Pages where it allows to take care of the emotional and psychological wellbeing of the elderly by keeping them company and providing them with listening ears (Lions Befrienders Service Association, 2019; Singapore Silver Pages, 2011).
The main aim for social facilitation is to facilitates social interaction between friends and the society. It usually involves group based instead of an individual activities. This allows the elderly to make friends. Activities such as charity funded friendship clubs (Hemingway & Jack 2013), shared interest groups (Cohen-Mansfield, Parpura-Gill, Kotler, Vass, MacLennan & Rosenberg, 2007) and day care centres (Iecovich & Biderman 2012). Suggested to client’s family on bringing Madam D.S to the day care centres during the day to avoid her from staying home alone however they verbalised that they were unable to get a subsidy for it due to the family’s total income. Apart from that, client herself is not keen on going to the day care centres. The reason was that no one understands her and she has no freedom. Madam D.S speaks Malay, Hindi and Bengali. She may understand minimal English but unable to speak this may be a hindrance on why she refuses to go day care centres. Few blocks away from client’s black there is a Senior citizen’s corner whereby it is located at the void decks, it is actually a free space for the elderly to gather together and interact with each other. There are several facilities provided such as kitchen, toilet, television corner just like a home. Client’s family may consider bringing client there to widen her social circle (National Heritage Board, 2018).
At this stage, it is essential for people of these aged group to already have an Advanced Care Planning (ACP) initiated as in the event where they become very ill and unable to make any decisions for themselves, their spokesperson will be the ones making the decisions on their behalf (Living Matters, 2019). A study done by Detering, Hancock, Reade & Silvester (2010) Advance care planning improves end of life care and patient and family satisfaction thus reduces stress, anxiety, and depression for the surviving loved ones. However, as for our client, Madam D.S, ACP was not done before and it is not applicable for her to do it now due to her cognitive impairment. She was diagnosed with Alzheimer’s diseases for more than five years ago. However, there is a high possibility whereby Lasting Power of Attorney (LPA) has already been done years ago with client’s third son being the appointed donee. LPA works similarly as ACP but LPA is a legal document which donees has the rights in client’s personal welfare, property and affair matters in the event where the client loses her mental capacity (Public Guardian, 2017).
Elderly population are vulnerable and social isolation is part of an ageing process. It is essential to identify social isolation in elderly to prevent further cognitive decline. By implementing the interventions mentioned above, it allows Madam D.S to widen her social circle. Engaging in group activities with the peers and others keeps her mentally active thus would delay her progression of Alzheimer’s which she already has. Attending day care centres in the day would also allow client’s family members to have a peace of mind while they are at work as she will not be alone at home.
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