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Caregivers of 'high need' elders require support, validation.

CHICAGO -- Research on the psychology of loneliness is helping a large nonprofit organization better address the needs of socially isolated elders living in the community and, indirectly, reduce stress and burnout among the staff and volunteers who serve them.

Anna M. Walters, R.N., program director for the Chicago chapter of Little Brothers-Friends of the Elderly, explained that just over a year ago, Dr. John T. Cacioppo spoke to the organization about his work in the emerging field of social neuroscience. Ms. Walters reviewed the impact of that talk on her organization in a session she led with Dr. Cacioppo.

Dr. Cacioppo asserted that the feeling of loneliness is a "pain signal" that tells an individual that he or she is becoming disconnected from others. Biologically, the signal has helped the human species survive by motivating people to maintain contact.

People who fail to respond to the loneliness signal by finding meaningful connections risk a host of psychological and physical consequences, said Dr. Cacioppo, who is the director of the center for cognitive and social neuroscience at the University of Chicago. His and other studies have shown loneliness to be a major risk factor for morbidity and mortality, he added.

Ms. Walters said that Dr. Cacioppo's work led her to understand why some elders seem to be impervious to the support, friendship, and social opportunities offered to them through Little Brothers, whose mission is to relieve isolation and loneliness in adults older than age 70. "I had assumed we were making an impact with all our elders who met our criteria," she said.

But she described "high need" elders as "intrinsically lonely" people who tend to maximize the negative and minimize the positive aspects of their lives. Their behavior can include lying, rudeness, and manipulation.

"Regardless of their level of isolation, regardless of how much we do for them, we can never do enough," she said.

These individuals are on high alert for the danger of social rejection, and that state of fear becomes a self-fulfilling prophecy, Ms. Walters said. Some of these individuals also may be suffering from depression or bipolar disorder.

She contrasted these individuals with the "extrinsically lonely" whose loneliness is primarily situational; for example, those for whom transportation is a problem or those who have outlived all of their friends. When friendship is offered to them, such extrinisically lonely individuals typically blossom.

"I began to think ... that when we cannot do enough [for high-need elders], one of the most important things I can do is to acknowledge and validate the staff and the volunteers," Ms. Walters said. Knowing that dealing with these elders can be emotionally draining, Ms. Walters now makes a point of telling the caregivers that their difficulty in connecting is not their own failing. Realizing that, the caregivers develop more realistic expectations.

Ms. Walters also has begun to provide training programs on issues such as depression, hoarding, cultural and generational differences, and undeveloped relationship skills. Monthly support groups help staff and volunteers cope with stress, anxiety, and grief.

The program also offers guidance on maintaining healthy boundaries with elders who persistently focus on the negative and make unreasonable demands.

Ms. Walters counsels her staff to communicate compassionately but clearly with these high-need individuals about reasonable expectations. The overall message she tries to give to staff and volunteers is that "you are doing everything you can do. There are some issues we cannot fix, and that's okay," she said.

The Chicago chapter of Little Brothers-Friends of the Elderly served 1,100 elders in 2009 (mean age, 83 years).

More information about LBFE is available at


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Author:Birk, Susan
Publication:Clinical Psychiatry News
Date:Nov 1, 2010
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