Date of Award

Spring 5-23-2020

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Karen Macauley, PhD, DNP, MSN

Abstract

Abstract

Background: Social isolation in the elderly has been identified as a risk factor for poor mental and physical health, as well as higher rates of mortality, depression, and cognitive decline. Loneliness is the unpleasant experience that occurs when a person’s network of social relationships is deficient in some important way, either quantitatively or qualitatively. Depression is a mental condition characterized by feelings of severe despondency and dejection, typically with feelings of inadequacy and guilt, and accompanied by lack of energy and disturbance of appetite and sleep. Physically, lonely people have more disorders, such as sleeping problems, stomach pain, and headaches. Seniors have an elevated rate of loneliness and are at greater risk for social isolation and depression. Given the overwhelming demand for care and the shortage of providers needed to treat this expanding population, telemedicine is considered an innovative way to administer care to patients and decrease feelings of isolation and loneliness. The UCLA Loneliness tool was used to measure feelings of loneliness and has been used in an estimated 80% of all empirical studies on loneliness. The PHQ-2 and PHQ-9 screening tools were used to measure participants feelings of depression. The tools measured the frequency of depressed mood and anhedonia. The PHQ-2 was utilized at every visit. The PHQ-2 has a 97% sensitivity and 67% specificity in adults and is used in primary care settings throughout the United States (Arroll, et al. 2010).

Purpose: The purpose of this EBP project was to implement telehealth senior care visits to reduce social isolation by decreasing feelings of loneliness and depression as measured by the UCLA loneliness and PHQ-2, and PHQ-9 screening tools.

EBP Model: The John Hopkins Model will be used to guide this EBP.

Project Plan Process

  • Obtained Stakeholder and IRB approval
  • Educated stakeholders regarding mental illness, co-morbidities, loneliness, depression, and quality of life.
  • Introduced weekly telehealth visit to reduce loneliness and depression among seniors for 3 months as measured by the UCLA Loneliness Survey and the PHQ-2 and PHQ-9 screening tools.

Screening for loneliness and depression was conducted on patients in a senior living facility in Southern California over a 3-month period. The UCLA Loneliness Scale and PHQ-2 depression scale were utilized to measure the participants feelings’ at baseline (Day 0), 7-, 30-, 60-, and 90 days. Pre and post data were collected using the PHQ-9 scale at Days 0 and 90.

Results: Eighty percent of patients had a decrease in depression and 60% had a decrease in loneliness over this period as measured by the PHQ-9 and UCLA Loneliness Scale. A small minority of patients (20%) had an overall decrease in loneliness and depression for the first 60 days as measured by the PHQ-2 scale and then had a spiked increase in depression and loneliness that coincided with the Christmas holidays.

Implications for Practice/ Conclusions: Loneliness and depression lead to mental as well as physical decline. The utilization of telehealth visits has a potential psychological benefit by dramatically increasing the quality of life for seniors. Additionally, it can decrease the financial burden of emergency department visits or missed appointments with their primary care provider.

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