Emotional Exile. Frontline Workers and Professionals Coping Inside the Loneliness Epidemic.

“… it should never be taken lightly, the essential loneliness of people …that gaping darkness…” (from Olive Again, a 2019 novel by Elizabeth Strout). This passage jumped out at me and pulled hard on my heartstrings. Frontline workers and professionals in senior healthcare are surrounded by people who face this gaping darkness every day. These workers have been described as “taking an emotional journey with older adults during these last chapters of life”.

Is it realistic to expect that senior healthcare workers would know how to intervene in the lives of older adults experiencing such an emotional burden as loneliness and social isolation? Chances are, these workers are not equipped (and maybe not encouraged) to be looking out for and act on the warning signs for social isolation and loneliness that, we now know, result in devastating and negative health outcomes (including increased mortality and morbidity, and decreased recovery from illness and depression). Yet, because workers in healthcare regularly interact with older adults in the most intimate of work settings, they can observe and provide support to those facing their own gaping darkness of social isolation and loneliness, if they are trained to do so.

Workers not only expend their physical and mental energy to engage and connect with older adults, these are jobs also that require what is known as emotional labor. In senior healthcare, emotional labor asks that workers balance and manage feelings and expressions and regulate emotions during interactions. To expend emotional labor in settings where people require connection, empathy and interpersonal support requires emotional resilience and lots of energy.

Intervention as a staff person can be a daunting task without the right resources. If we want to maximize a worker’s success in identifying and intervening when they know a person is experiencing social isolation and loneliness, we have to help them develop knowledge, communication skills and emotional intelligence (and other resources) to be effective. All of this begs the question, how do we develop a sustainable and effective workforce in healthcare that can make an impact on the loneliness and social isolation epidemic?

The National Academies of Sciences, Engineering and Medicine recently published a Report on Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System.

Researchers state that relatively little attention has been paid by public health officials and other medical professionals to the importance of loneliness and social isolation. This report uncovers the acute need to strengthen ongoing education and training for members of the health care professions and direct care workers.

Recommendations include:
• Prepare the workforce with tools to recognize social isolation and loneliness and ameliorate it.
• Improve knowledge and focus on solutions and practices across healthcare disciplines.
• Look at risks of social isolation and loneliness as part of the biology of aging, the psychology of aging, and the sociology of aging.
• Include content related to social isolation and loneliness in educational programs across all health professions including programs aimed at practicing clinicians and other professionals who care for older adults.
• Create a holistic, consistent, and collaborative framework of education and training including experiential learning and continuing professional development.

That training and education about social isolation and loneliness is being considered as a systemic solution is good news. Foundational knowledge and best practices for healthcare workers on this issue is critical. It is also probable that educational and professional development and training programs in social engagement can bring out more of the humanity in the healthcare industry.

Imagine a world where staff/client boundaries can be broken down in appropriate and significant ways; where strategies for connection and belonging are embedded into the operational plans of senior healthcare organizations. Imagine that identifying and resolving the root causes of isolation and loneliness is part of a senior healthcare worker’s job description. More people (and those best suited for the work) will choose healthcare careers because they know they are being set up for personal and professional growth.

May this be the first of many steps in returning to our original motivations in supporting people in the aging space – creating positive moments of social interaction and human connection.

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