Social isolation and loneliness may seem like an insignificant problem but it has the potential to be debilitating to patients and reduce their quality of life. While all patients for a multitude of reasons can be at risk for isolation, older adults have the highest risk due to their loss of spouses and friends, living alone, and chronic illnesses. While social isolation may not be an acute concern, research shows that isolation increases the risk of dementia, heart disease, and stroke as well as depression and suicide.
For patients who are socially isolated, nurses and other healthcare professionals may be some of the main contacts and social interactions for these patients. Nurses must be attuned to the barriers these patients face and may have to tread lightly as patients may not be forthcoming with their feelings of loneliness. Nurses can offer nonjudgmental suggestions, be supportive advocates, or simply be a listening friend to patients feeling alone.
Causes of Social Isolation (Related to)
- Developmental delays
- Impaired cognitive functioning
- Abnormalities in physical appearance
- Inappropriate social behavior
- Inability to engage in or maintain relationships
- Traumatic experiences causing psychological or emotional pain
- Disabilities (motor, speech, cognition)
- Frequent illnesses, hospitalizations, or complex treatments
- Living alone
- Lack of a support system
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Feelings of loneliness and rejection
- Insecurity in relationships
- Fear and anxiety
- Interests, values, or behavior are viewed as socially or culturally different or unacceptable
- Prefers to be alone
Objective: (Nurse assesses)
- Absence of support through family or friends
- Diagnosis of mental disorder that affects relationships (PTSD, schizophrenia)
- Flat or dull affect
- Irritable or hostile demeanor
- Physical handicap that prevents social interaction (bedridden, paralysis)
- Nonverbal or poor ability to communicate; speech impediment
- Inappropriate social cues or behavior (autism)
Expected Outcomes:
- Patient will express a desire to interact with others and will seek social engagement
- Patient will learn social and communication skills to improve relationships
- Patient will express a feeling of improved self-worth and confidence
- Patient will participate in activities with others that align with their interests and mental/physical capabilities
Nursing Assessment for Social Isolation
1. Determine physical and mental limitations.
Developmental disabilities such as cerebral palsy or physical constraints such as tetraplegia that will not improve will limit the activities and interactions the patient can participate in.
2. Assess the patient’s feelings and perceptions.
It can be embarrassing to admit to feeling lonely. The nurse can assess if the patient has hobbies or interests and if they have friends to enjoy them with or if they prefer to be alone.
3. Recognize signs of isolation due to low self-esteem.
Patients with disfigurements such as a loss of a limb or burns or other abnormalities such as a speech impediment may have low self-worth and may feel embarrassed attempting to socialize.
4. Assess for resource barriers.
A lack of adaptive equipment or transportation may make socialization difficult.
5. Note unusual social behaviors or missing social cues.
The nurse can observe for inconsistent communication, lack of understanding of humor or sarcasm, or a dislike of being touched as barriers to adequate socialization.
6. Identify strained relationships or missing support systems.
Patients often divulge information about an estranged spouse or children, living far away from family, or difficulties in personal relationships. Listen closely for these statements as they may be a way of the patient wanting to discuss feelings of loneliness or abandonment.
Nursing Interventions for Social Isolation
1. Offer yourself as a nonjudgmental listener.
Patients who may feel isolated due to rejection or a feeling of not belonging may not feel safe to open up. They may respond with hostility or short answers as a defense mechanism. Establishing a therapeutic relationship promotes trust and a safe space for the patient to discuss sensitive matters.
2. Utilize multidisciplinary support for assistance with social skills.
Those with autism may benefit from behavioral therapists to assist with teaching social and communication skills. Those with a stutter can work with a speech therapist. Physical and motor impairments can benefit from PT and OT care.
3. Encourage support groups.
Patients may feel isolated due to a chronic health condition such as a colostomy, pain, or autoimmune disease. Speaking with others who are enduring the same challenges can make the patient feel less alone.
4. Use technology.
Socialization isn’t strictly for face-to-face interaction. All patients can benefit from online forums, chat groups, and communication apps, and phone calls to foster relationships.
5. Refer to therapy for deeper issues.
Patients who have experienced deep losses such as an older adult who lost their spouse or other situations where grief is apparent may need counseling to work through their loss and prevent further isolation. Social anxiety and traumatic experiences may need deeper investigating by a trained mental health professional.
6. Offer equipment and resources to improve isolation.
If isolation is related to a lack of transportation, offer free or low-cost transportation options. If a patient is homebound, contact agencies that can provide volunteers for companionship. If a patient feels isolated due to incontinence or another physical impairment, offer supplies or equipment such as a wheelchair to improve confidence.
7. Recommend adult daycare centers or facilities.
The nurse can research centers in the patient’s area that offer activities for older adults. This can also include a local gym that offers exercise classes or a library that offers crafting or book clubs.
8. Encourage volunteering.
A great way to curb loneliness is to help others. This can also be a low-pressure way for someone who is insecure to interact with others. Some examples include volunterring at an animal shelter, assisting with a “clean-up” day at a local park or beach, or helping set up a local event.
9. Offer an outside perspective.
The patient may not be aware of the negativity or inappropriate behaviors they display. The nurse can offer suggestions without sounding rude such as requesting the patient not to use foul language or speaking about more cheerful topics and less about controversial issues.
10. Ideas for the introverted patient.
Even patients who prefer to be alone are at risk for isolation. Simply walking around the neighborhood or a nearby park or enjoying lunch in a cafe allows them to be near others without the pressure to interact. This can be the perfect amount of socialization for an introvert but also offers the opportunity to meet others.
References and Sources
- CDC. (2021, April 29). Loneliness and Social Isolation Linked to Serious Health Conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/aging/publications/features/lonely-older-adults.html
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Henderson, R. (2016, December 28). Social Isolation – How to Help Patients be Less Lonely. Patient. https://patient.info/doctor/social-isolation-how-to-help-patients-be-less-lonely
