key: cord-354105-lgkfnmcm
authors: Office, Emma E.; Rodenstein, Marissa S.; Merchant, Tazim S.; Pendergrast, Tricia Rae; Lindquist, Lee A.
title: Reducing Social Isolation of Seniors during COVID-19 through Medical Student Telephone Contact
date: 2020-06-05
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2020.06.003
sha: 
doc_id: 354105
cord_uid: lgkfnmcm

Abstract Social isolation has been associated with many adverse health outcomes in older adults. We describe a phone call outreach program in which health care professional student volunteers phoned older adults, living in long-term care facilities and the community, at risk of social isolation during the COVID-19 pandemic. Conversation topics were related to coping, including fears/insecurities, isolation, and sources of support; health; and personal topics such as family and friends, hobbies, and life experiences. Student volunteers felt the calls were impactful both for the students and for the seniors, and call recipients expressed appreciation for receiving the calls and for the physicians who referred them for a call. This phone outreach strategy is easily generalizable, and can be adopted by medical schools to leverage students to connect to socially-isolated seniors in numerous settings.

Social isolation has been associated with many adverse health outcomes in older adults. We 2 describe a phone call outreach program in which health care professional student volunteers 3 phoned older adults, living in long-term care facilities and the community, at risk of social 4 isolation during the COVID-19 pandemic. Conversation topics were related to coping, including 5 fears/insecurities, isolation, and sources of support; health; and personal topics such as family 6 and friends, hobbies, and life experiences. Student volunteers felt the calls were impactful both 7 for the students and for the seniors, and call recipients expressed appreciation for receiving the 8 calls and for the physicians who referred them for a call. This phone outreach strategy is easily 9 generalizable, and can be adopted by medical schools to leverage students to connect to 10 socially-isolated seniors in numerous settings. Social isolation, a quantitative loss in a person's social relationships, is common in older adults, 27 with 27% of adults over 60 y/o living alone. 1, 2 During the COVID-19 pandemic, social distancing 28 has been an essential public health strategy. 3 While many older adults entered independent 29 living communities for activities and socialization, they have been advised to remain in their own 30 apartments or room. Meals are delivered to doors, activities have stopped, exercise rooms 31 closed, and visitors are restricted. These necessary stay-at-home measures unfortunately 32 increase social isolation. 33

Social isolation has been associated with adverse health outcomes including increased risk of 34 falls, all-cause mortality, hospitalizations, and cognitive decline, as well as unhealthy behaviors 35 like physical inactivity and poor diet. 4,5 Additionally, in the previous SARS pandemic, isolating 36 infection control practices were associated with increased depression and traumatic stress 37 response symptoms. 6 Social isolation has been associated with less infection resistance, more 38 emergency admissions to hospital, and extended length of stay, factors which may lead to 39 worse outcomes during the COVID-19 pandemic. 7-10 40

Given the effects on the mental and physical health of the elderly, interventions targeting social 41 isolation are necessary to mitigate risk of increased morbidity and of infection from COVID-19. Social Isolation Calls during COVID-19 -3

We created a phone call outreach program, Seniors Overcoming Social Isolation (SOS), in 48 which medical and health professions student volunteers (e.g. MD, MD/PhD, Neuroscience, 49

Genetic Counseling) called older adults, living in long-term-care facilities (LTCF) and the 50 community, at risk of social isolation during COVID-19. The SOS program entailed providers 51 identifying at-risk older adults and then referring the contact information to coordinators who 52 would then pass the info to student volunteers. Student volunteers were provided with an 53 introduction script and a series of conversation starters, general social history questions, and 54

well-being questions (e.g. resource needs, groceries) to ask the older adult. Students then 55 phoned the older adults when they had available free time. The goals were (1) to provide 56 companionship and resources for unmet needs of older adults, while (2) fostering health 57 professional students' skills in communicating and understanding the needs of older adults in 58 their community. We propose that social phone calls to older adults may reduce social isolation 59 while providing meaningful engagement with the community and a learning experience for 60 students. perspectives and resolving any identified discrepancies through discussion. In no cases were 80 the coders unable to reach consensus. The coders organized the content into relevant themes. 81

Descriptive statistics were used to analyze participant surveys. 82

Fourteen volunteers made 25 phone calls, averaging a length of 8.3 min (SD 4.0). Nearly all 85 volunteers (85.7%) were in medical school (MD or MD/PhD program), and most of those 86 students were in their first year of medical school (75%). There was 2 graduate health program 87 students (e.g. medical geneticist and neuroscientist programs) who heard about program 88 through word-of-mouth. Volunteers were predominantly female (92.9%), and identified as Asian 89

or White (50% and 43%, respectively). 90

Both conversational and COVID-19-related themes were discussed during calls (Table 1) . 91

Topics related to COVID-19 included health, fears, isolation, coping, and sources of support, 92 while other prominent topics ranged from family and friends, to hobbies, to the older adult's past. In addition to providing social connection, several students assisted in addressing unmet 94 needs by referring the older adults to sources of support. 95

Most students felt that the calls were well-received; recipients expressed appreciation both for 97 the calls/callers and for those who referred them. (Table 2 ) Some students felt that the call was 98 less impactful, while one felt that they had disrupted the older adult by calling. Student 99 volunteers indicated they had plans to contact a little over a third of older adults (36%) again. 100

We do not have data about follow-up phone-calls. 101

After the telephone contact, many students felt positive and empowered; one described feeling 103 inspired by the older adult's story, and several reflected on the senior's appreciation. Other 104 students acknowledged challenges, such as needing patience and talking about different topics 105 than normally discussed with younger adults (Table 3) . 106 107

During the COVID-19 pandemic, requisite social isolation is a critical problem among older 109 adults living in assisted and independent living communities. There is ample evidence that this 110 is an important problem desperately needing intervention. 111

To reduce social isolation, we present a practical intervention leveraging health professions 112 graduate students contacting older adults and residents of independent and assisted living by 113 phone. Our results show that it is feasible and has bi-directional benefit to both student callers 114 and older adult residents. Students felt empowered and that they were able to make a difference in the lives of socially isolated seniors. Results also showed that they were learning 116 how to be patient and slowdown in conversations with hearing-impaired seniors, specifically 117 learning important tenets of geriatrics in the process. Older adults appreciated and enjoyed 118 receiving calls, likely as they were interrupting their social isolation. 119

Limitations of this study include the small sample size, single location, and referral of older 120 adults by a provider. While conducted in a single location (Chicago), COVID-19 was widespread 121 and existed in most of the area's long-term-care communities necessitating isolation. Several 122 students struggled to contact their assigned older adults, potentially due to illness or 123

hospitalizations. This intervention depends on student volunteerism; as classes resume, fewer 124 students may have time to participate. Moreover, this requires coordination of providers in 125 identifying appropriate older adults, student volunteering, and a coordinator assigning seniors to 126 call. While online sign-ups limit some of the workload, a dedicated volunteer student coordinator 127 is necessary. 128

Seniors Overcoming Social Isolation calls are easily generalizable and can be adopted by most 129 medical schools to connect students to socially isolated seniors in multiple settings. For further 130 generalization, student volunteer groups do not need to be in the same area as those being 131 contacted. Medical schools can partner with rural communities or low income areas who do not 132 have direct academic partnerships to reduce isolation in hard-to-reach areas. During COVID-19 133 pandemic, this simple innovation has been shown to be a feasible route of improving the lives of 134 both older adults and students. 135 

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Health risks associated with social isolation in general and in young, 147 middle and old age

SARS Control and Psychological Effects of Quarantine

Social Ties and Susceptibility to the Common Cold

Social Disconnectedness, Perceived Isolation, and 154 Health among Older Adults

Does lack of social support lead to more ED visits for older 157 adults?

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Social distancing in covid-19: what are the 163 mental health implications?

The Effect of Information Communication 165

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The authors wish to thank their families and loved ones for support while in medical school and the health care profession. The authors also wish to thank the volunteers who assisted with the telephone contact of the older adults.
