MacEwan University Senior Isolation in Long Term Care Presentation

MacEwan University

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I need help with a Social Science question. All explanations and answers will be used to help me learn.

To create a digital story( OR PREZI) about senior isolation in long term care.

>Reading sources to support Digital story as following;

  • Depression in older nursing home residents: The influence of nursing home environmental

stressors, coping, and acceptance of group and individual therapy

(Namkee G. Choia*, Sandy Ransomb and Richard J. Wylliec)

-The effect of Hearing Aid Use on Cognition in Older

Adults: Can We Delay Decline or Even Improve

Cognitive Function?

(Julia Sarant, David Harris, Peter Busby, Paul Maru, Adrian Schembri, Ulrike Lemke and Stefan Launer)

-Engaging with vulnerable seniors (Edited by: JULIE HICKS PATRICK, Ph.D.)




-Incapacitated and Alone: Prevalence of

Unbefriend Residents in Alberta

Long-Term Care Homes

Stephanie A. Chamberlain,Wendy Duggleby, Janet Fast,

Pamela, Teaster, and Carole A. Estabrooks


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Journal of Gerontological Social Work ISSN: 0163-4372 (Print) 1540-4048 (Online) Journal homepage: Depression, Hopelessness, and Suicidal Ideation Among the Elderly A Comparison Between Men and Women Living in Nursing Homes and in the Community Pnina Ron PhD To cite this article: Pnina Ron PhD (2004) Depression, Hopelessness, and Suicidal Ideation Among the Elderly, Journal of Gerontological Social Work, 43:2-3, 97-116, DOI: 10.1300/ J083v43n02_07 To link to this article: Published online: 04 Oct 2008. Submit your article to this journal Article views: 2165 View related articles Citing articles: 37 View citing articles Full Terms & Conditions of access and use can be found at Depression, Hopelessness, and Suicidal Ideation Among the Elderly: A Comparison Between Men and Women Living in Nursing Homes and in the Community Pnina Ron, PhD ABSTRACT. This study attempts to compare levels of depression, hopelessness, and suicidal ideation among elderly males and females, in reference to their living arrangement, i.e., community vs. nursing homes. For many elderly people, old age is characterized by various losses: physiological, functional, social, cognitive, financial, etc. The outcomes of such losses often include, more often than not, environmental isolation, a subjective feeling of loneliness, anxiety, depression, and frequently, loss of motivation to continue living. In light of the rise in life expectancy and the multitude of losses which can be associated with the aging process, it is probable that one out of five elderly persons will spend part of his/her life in a long term care institute. Such living arrangements may have negative effects on the mental health of its residents, because placement is often accompanied by feelings of lack of control over one’s own life, and inability to make decisions regarding daily issues. Elderly persons living in the community (227: 78 men, 149 women) and 91 living in nursing homes (33 men, 58 women), in both independent and frail functional status (ADL), participated in the study. Findings show significantly more hopelessness, helplessness, and dePnina Ron is affiliated with the School of Social Work and Faculty of Social Welfare and Health Studies, University of Haifa. Journal of Gerontological Social Work, Vol. 43(2/3) 2004 © 2004 by The Haworth Press, Inc. All rights reserved. Digital Object Identifier: 10.1300/J083v43n02_07 97 98 JOURNAL OF GERONTOLOGICAL SOCIAL WORK pression among residents of nursing homes compared to those living in the community, differences between men and women living in both environments, and a correlation between other demographic variables and the three dependent variables of the study. The conclusions of the study indicate a need to pay interdisciplinary attention to the mental health of elderly residents of nursing homes, particularly in the preliminary stages of placement and adjustment. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: © 2004 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. Elderly, gender, community, nursing home, depression, hopelessness, suicidal ideation, losses, environmental isolation, loneliness, anxiety BACKGROUND Factors Affecting the Development of Depression Among the Elderly Old age is characterized by various losses. Physiological losses may be due to sickness and functional disabilities; sociological losses include retirement from work, loss of social and family networks; and personal losses are related to personality components, a reduced sense of control over one’s life, diminished self-esteem and self image, and increased difficulty when coping with stress and crisis situations (Goldberg & Huxley, 1992; Jorm, 1995; Lovestone & Howard, 1997). These losses create a dependence on others (in different life aspects and to varying degrees) as well as a subjective sense of loneliness (Achte, 1988). Coping with these losses ad their effects may lead to depressive disturbances. Among the outcomes of losses in old age, we can find different kinds of disturbances including mental, behavioral, emotional, etc. (Bar-Tor & Lomerantz, 1997). Mental disturbances include psychotic symptoms, such as paranoid delusions, the various types of depression, and especially reactive depression (Goldberg & Huxley, 1992; Katona, 1994). Researchers argue that somatic symptoms of depression are more frequent among the aged population because of reduced quality of life, fear of death or dementia, and accumulation of non-channeled anger (Tolchin, 1989; McIntosh, 1992). Because of the multitude of losses experienced in old age, the time elapsed between the adjustment to one loss and the occurrence of another is reduced Pnina Ron 99 substantially. This reduction makes it difficult to distinguish incidences of abnormal depression and normal reactive depression (Rose, 1993). Various research studies have investigated the correlation between depression and cognition, behavior, and suicidal tendencies (Robbins & Regier, 1991; Weyerer et al., 1995). Several researchers suggested five categories of depressive symptoms that indicate suicidal tendency: general appearance and behavior (uncombed, introverted, etc.); cognitive function (disorientation, memory loss, etc.); content of thought patterns (disorganized thought, hopelessness, etc.); mood (sadness, anger, etc.); and somatic function, such as lack of appetite, sleeplessness, etc. (Schmid, Menjee, & Shah, 1994). Other researchers found that hopelessness is the major element in suicidal ideation and tendencies among depressed elderly (Rifai et al., 1994). Lester (1994) reported the hints revealed by the depressed elderly population in regard to suicidal tendencies. These included situational hints, such as frequent negative life events; loss of living environment, personal, and inter-personal losses; hints of a psychological syndrome, such as anxiety and guilt; behavioral hints, such as preparing for death and changes in lifestyle and habits; and verbal hints, such as talk of personal death, suicide threats, and expressions of helplessness and hopelessness. Characteristics of the Elderly Who Are “at Risk” of Suicidal Ideation and Behavior As in younger population groups, there is no “profile” describing the elderly who are “at risk” of suicidal ideation. Nevertheless, there do seem to be several characteristics that are more frequent among those elderly who attempted or committed suicide. Demographic Characteristics White male widowers aged 65 and over are at higher risk than the remaining population groups. Since 1980, the rate of suicide among this group has risen in the U.S. by 23% (Meeham, Saltzman, & Sattin, 1991). Atchley (1991) further defined the population group with the highest potential to commit suicide, arguing that this white male aged 65 and up had also recently lost his spouse and in addition suffers from a terminal illness or deteriorated physical ability. The risk of suicide among these males rises with age and reaches its peak at the age of 80. Other researchers focused on elderly females at risk (Lovestone & Howard, 1997). Most of the researchers dealing with suicide risk factors among the elderly indicate physiological and the functional disabilities as the main reasons for 100 JOURNAL OF GERONTOLOGICAL SOCIAL WORK suicide (McIntosh, 1992; Norris, Snow-Turek, & Blankenship, 1995). Frequent use of medication and sometimes overuse and a combination of different medications can also be a risk factor for suicide. Mental and Inter-Personal Characteristics The feeling of loneliness experienced by the elderly is subjective and may result from lack of social bonds, loss of spouse, and feelings of alienation and emptiness (Lowenstein & Rosen, 1989; Bondevik & Skogstad, 1996). This feeling is accompanied in most cases, with the feeling of depression and low self-esteem (Mullins & McNicholas, 1986), which might lead to the development of suicidal tendencies. Glass and Reed (1993) added that most of the elderly with suicidal tendencies were not characterized by past suicidal attempts or other self-destructive behaviors; rather, these elderly consider ending their lives following a realistic assessment of their situation, in which they identify numerous possible reasons, such as the accumulating effect of loss they have experienced, reduction in job, family and community roles, reduction in income level, a sense of worthlessness and uselessness, functional damage, tendency to develop chronic illnesses accompanied by pain and suffering, placement in nursing home, etc. Achte (1988) argued that it was not evident whether the relatively high rate of suicide among the elderly was the result of loneliness and financial insecurity in modern society or whether it should be attributed to cognitive-pathological processes frequently found in older age, which increase the risk of suicide. Reviewing these suicide risk factors among the elderly, Achte supported the multi-causal etiology composed of loneliness, isolation (withdrawing from the environment), somatic illnesses, and depression. According to Dykstra (1993; 1995), the highest risk of suicide stems from the feeling of failure and lack of support. These feelings usually originate from changes and transitions experienced by the elderly during a time when their adjustment powers are diminished (Osgood, 1991; Peters & Liefbroer, 1997). Findings show that in Israel, only 5% of the elderly aged 65 to 79, 10% of the elderly aged 80 to 84, and 20% of the elderly aged 85 and up live in nursing homes (Bergman, Factor, & Kaplan, 1986). In light of the rise in life expectancy, the number of persons aged 80 and over is constantly increasing; hence, the percent of elderly residing in nursing homes is also rising (Lowenstein & Yakivitz, 1995; Bar-Tor & Lomerantz, 1997). Various research studies have indicated low mental well being among elderly residents of nursing homes (Estes, 1980; Berkowitz, Waxman, & Yabbe, 1988). On the other hand, other research studies have reported an increase in quality of life and personal welfare experienced by the elderly upon placement Pnina Ron 101 in nursing homes (Sherwood, Glassman, Sherwood, & Morris, 1974; Carp, 1997). Bar-Tor and Lomerantz (1997) found that mental and physical expressions of depression are frequent among elderly residents of nursing homes. The mental symptoms included melancholia, lack of general interest in life, fears and isolation, and the physical symptoms included lack of appetite and sleeplessness. Suicidal ideation and tendencies are defined as thoughts and feelings characterized by helplessness, lack of direction and significance in life, and hopelessness. Suicidal behavior is an expression of these feelings and thoughts and includes irregular intake or complete cessation of medication, ceasing to eat leading to drastic weight loss, sleeplessness, activity reduced to a minimum, personal, and hygienic negligence, etc. A large part of these symptoms also characterize depression. In the United Kingdom, the rate of depression among the elderly population residing in the community is about 15%, and it is higher among women than men. The rate of depression rises to 40% among the elderly population residing in nursing homes or geriatric hospitals, in similar states of functionality and health (Lovestone & Howard, 1997). Empirical studies carried out in the United States indicate similar rates of depression (in its various types) among elderly residents in the community and in nursing homes (Lester, 1994). In general, few comparative studies have been made investigating the rate of depression among the elderly residing in nursing homes and in the community. One study addressed the issue of differences in health and functioning levels between the two population groups as research limitations (Stuck et al., 1993). Another study, investigating health background and the consumption of sleep medication and anti-depressive drugs, found that elderly women living in the community consumed more anti-depressive drugs than did men in similar living conditions, whereas in nursing homes, the consumption rate of these drugs is similar among men and women, with only slightly higher usage by men (Rubenstein et al., 1984). In a comparison regarding the frequency and different rates of depression, it is necessary to address the health history of the research participants, which may precede placement in the nursing home (Baldwin & Jolley, 1986; Green et al., 1992). In Israel, no research studies have compared the mental health of elderly residing in the community with that of a similar population group residing in nursing homes. Moreover, there is no data comparing suicidal behavioral expressions, suicidal attempts, or suicides among the two population groups. It is difficult to locate sampling groups of elderly persons living in both types of 102 JOURNAL OF GERONTOLOGICAL SOCIAL WORK environments who also share basic characteristics, such as functional level, marital status, etc. Clearly, the mental state of an elderly person who arrives at a nursing home due to unwillingness to continue living at home after the loss of a spouse does not resemble that of a widowed elderly person who chooses to remain at home. The emotional vulnerability of elderly individuals who chose the nursing home is more intense, as they need to adjust both to the loss of the spouse as well as to the nursing home. The Statistical Almanac does not differentiate between suicides committed by elderly living in the community and in the nursing home (Israel Central Bureau of Statistics, 1986, 1990, 1994). The reasons for this include institutes’ unwillingness to publish data that might damage their image, Judaism’s attitude towards suicide, the religious sanction placed upon those committing suicide in regard to place of burial, commemoration, etc. In an attempt to explain the possible differences between residents of nursing homes and the elderly living in the community, in terms of frequency and levels of depression, Henderson et al. (1994) focused on the change of environment. In addition to separating the elderly individual from his/her physical surroundings, in most cases, a separation forced due to a deteriorated functional-health situation or loss of a spouse is often accompanied by emotional-social separation. This separation causes isolation and seclusion of the elderly individual and, hence, depression. Other researchers indicated that family support was the most effective factor influencing the sense of depression experienced by residents of nursing homes (Burvill et al., 1991; Green et al., 1992; Peters & Liefbroer, 1997). According to their findings, placement in a nursing home creates a sense of alleviated responsibility, since it is henceforth shared among family members, friends, and the nursing home staff. This sense of a lessened burden in turn affects the frequency of visits, and the degree of support provided by the elderly individual’s informal support systems. However, this behavior may be construed by the elderly as a rejection, which leads to feelings of depression. Bar-Tor and Lomerantz (1997) indicated five factors affecting the deteriorated mental welfare of nursing home residents. These factors include negative stereotypes of nursing home staff; society’s negative stereotypical attitude towards nursing home residents; lack of control in a nursing home framework; insecurity and lack of privacy; disconnection from family and friends. Solitary elderly people, as well as those lacking any informal support system, who live in the community but are not in touch with family and friends, express similar high levels of depression, and the rate of attempted suicide among them is high. Pnina Ron 103 METHODS The following research attempted to compare the levels of depression and suicidal behavior between two population groups: frail elderly people residing in nursing homes and those living in the community. An additional point of comparison was between men and women. In the course of the research, a comparison was made between these groups in regard to three dimensions: level of depression, level of hopelessness, and level of suicidal ideation. The contribution of this research lies in its comparison between two parallel populations and in its specific focus on elderly who exhibit high rates of suicide. Identifying the characteristics of these risk groups may enlighten professionals and contribute to the planning, assessment, and application of suicide prevention programs for the elderly in the community and those residing in nursing homes. Research Population The research population consisted of two groups categorized according to living environment: community and nursing homes (see Table 1). 1. The group living in the community consisted of 149 elderly women and 78 elderly men, in frail condition. The participants, insured in the general health insurance fund (Kupat Holim Klalit), defined themselves as in need of partial assistance in their ADL function. All were interviewed while waiting for their appointment at clinics treating a high percentage of elderly patients. The clinics were sampled at random from a list of clinics treating the elderly population, within a certain geographical urban area. In the clinic, the participants were sampled by convenience sampling. Defining characteristics of the two research groups included variables such as knowledge of the Hebrew language, perceived functional situation, and present place of residence. These factors were determined before conducting the interview. 2. The group residing in nursing homes consisted of 91 elderly persons (58 women; 33 men) aged 67-86 living in “independent and frail” quarters at three nursing homes within the same geographical area as the sampled clinics and the community participants. The residents were sampled at random. One of three residents defined was selected from a list of 214 fluent Hebrew speakers corresponding to the research population. One of the nursing homes on the list had only 12 residents, so addi- 104 JOURNAL OF GERONTOLOGICAL SOCIAL WORK tional residents were interviewed by convenience sampling in order to maintain a balance between residents of all three nursing homes. Table 1 shows that most of the demographic variables of the subjects in both groups have a similar distribution. The proportion of men and women in both research groups is similar and closely resembles that of the elderly population in Israel. Most of the participants are European-American (this datum relates to the fact that the majority of participants were Holocaust survivors). Most participants subjectively described their socio-economic status as moderate, and none had attempted suicide in the past. The two groups were not matched on some variables. Most of the elderly living in nursing homes were widowed, whereas most of the participants living in the community were married. It is possible that being widowed constitutes an accelerating factor for TABLE 1. Characteristics of the populations. Elders in the community (N = 227) Elders in nursing homes (N = 91) Gender % Male Female 34.4 65.6 36.3 63.7 Marital Status % Married Widowed 64.8 35.2 17.4 82.6 Country of Origin Israel Asia-Africa Europe-America 3.0 13.6 83.4 3.2 9.8 87.0 Socioeconomic Status % (subjective) Low Medium High 9.6 72.8 17.6 10.9 65.9 23.2 Previous Suicide Attempts Yes No 1.3 98.7 5.4 94.6 Previous Mental Therapy % Yes No 16.2 83.8 13.1 86.9 Holocaust Survivor % Yes No 77.0 23.0 79.1 20.9 Average Ag ...
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Final Answer


Senior Isolation in
Long term care

Student Name:
Institutional Affiliation:


 Senior isolation is the short hand term for social
 It is when one feels isolated in one’s home, removed
from family and friends.
 Some of the contributing factors include; health
conditions, depression, chronic pain, retirement

Circumstances that lead to
isolation of a senior

 Residing far away from family members.
 Having few children thus eliminating the possibility
of living close to a grown child.
 Passing away of spouses and friends.
 Less engagement to hobbies and interests.
 Divorces
 Cultural barriers
 Retirements

Signs and Symptoms of
Senior Isolation

 Loss of interest in socializing
 Dramatic changes in weight or appetite
 Sleep disturbances
 Lethargy
 Neglection of personal hygiene
 Cognitive decline
 Increased use of alcohol and drug use
 Self loathing

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