Every Sunday for five years, my grandma and I went for a delicious, satiating lunch followed by a trip to the grocery store. She was widowed, and I was the only relative who lived nearby. The time frame for lunch was fairly consistent; the waiters kept the meal moving along. However, the time we spent in the grocery store was unpredictable. My grandma inspected each piece of fruit in search of the perfect apple, bunch of bananas, or cantaloupe. Or so I thought. In hindsight, I realized she was searching for a way to prolong our time together to reduce loneliness.

This memory of my grandmother, and the lesson that individuals express their need for social connection in different forms, has come to mind often lately as I conduct psychotherapy sessions via telehealth for skilled nursing facilities. Staff members at the facilities identified several older adults with various mental health conditions who were not leaving their rooms for meals, activities, or socializing with other residents. I began working with these patients to help bring them out of their shells, if possible, by addressing the issues restraining or limiting them.

The Lack of Social Connection
The work came after a recent advisory by Dr. Vivek H. Murphy, United States Surgeon General, declared that loneliness and isolation — a lack of social connection — are an epidemic in our society, especially among older adults. The comprehensive report also highlighted the consequences that social disconnection has on one’s physical and emotional well-being. Those who do not perceive themselves as having quality relationships have an increased likelihood of cardiovascular disease, anxiety, or depression.

Initially, I was ambivalent about the effectiveness of telehealth consulting in tackling these issues. I prefer to meet with individuals in person to better understand their behaviors within their environment. For example, I observe how their room is decorated, their mobility, and how they interact with their roommate, aides, nurses, or doctors. However, a colleague reminded me that, although a screen might only capture a headshot of the resident, I should not underestimate the power of the relationship that psychologists build and develop with their clients, whether conducting a psychotherapy session in person or using technology to help produce behavior change.

It took me a few sessions to realize that I could continue to assess these behaviors, but I needed to employ different strategies. For example, while residents interact with staff members to maneuver the tablet to ensure we can see each other on the screen, I listen to how the resident speaks to the staff and whether they can reposition themselves independently (for example, move the bed up or down, or tray table right or left). During the session, the residents sometimes need more tissues or the blinds closed to avoid a glare on the screen. Some residents immediately press the call bell, some need encouragement, and when neither happens, I text a staff member.

The residents and I use this incident to discuss potential apprehension or obstacles to asking for help. In addition, staff members are receptive to taking me on virtual tours of a resident’s room to see photographs of friends, family, pets, grandchildren, great-grandchildren, and any new artwork that the resident created. I gather a sense of who the residents are, what they enjoy, and what is meaningful to them.

How Technology Has Evolved to Help
Most importantly, I am able to advocate for the resident's needs. One request that initially took me by surprise was their need to wear lipstick. It is easy to forget that not all residents have small compacts — and if they use a wheelchair, they can’t see themselves in the bathroom mirrors that are usually situated above the sinks. The tablet screen allows residents to see their reflections for the length of a session. With the assistance of staff and family members, the residents receive their makeup — an instant pick-me-up — and reminisce about getting dolled up for outings with friends, the bowling alley, dancing, shopping, and spending time with significant others.

On the flip side, many residents are surprised by how technology has evolved and the ease with which we communicate through a miniature screen. After experiencing success connecting in this fashion, residents’ confidence appears to increase. They use technology to connect with friends and family members in this same capacity.

This is critical. Individuals without an adequate support system are at risk of experiencing higher stress levels. For example, older adults who live alone and have physical limitations or lack transportation and easy access to doctors, pharmacies, and shopping can be left feeling overwhelmed and helpless. In this situation, individuals may succumb to these various stressors and stop trying to successfully manage their various physical or mental health conditions.

However, understanding social-support theories may help individuals break this cycle of stress and social disconnection. The direct effect theory of social support suggests that when individuals perceive themselves to be part of trusting, reliable, and caring relationships with individuals, groups, or community organizations, these support systems can effectively prevent stressors from ever surfacing.

The Cushion of Support
Additionally, the stress-buffering theory proposes that when stressors occur, a strong support system can cushion the negative consequences that can potentially result from those stressors. For example, if individuals need assistance following discharge from a hospital, suffer from a chronic health condition, or are diagnosed with COVID-19, their family, neighbors or religious organizations can help with the healing process. Providing help can take different forms, such as bringing mail to a neighbor’s door, picking up medications, delivering prepared meals, providing rides to a doctor’s appointment, taking them grocery shopping, or organizing community support. These encouraging actions allow the individuals to focus on their well-being.

Rumi, a 13th-century Persian poet, wrote, “Life is a balance of holding on and letting go.” When developing and maintaining social connections with others, we may need to let go of our previous ideas of what makes for the perfect family member, friend, or teammate. We might be surprised, as I was during my recent telehealth work at the skilled nursing facility, by how easily social connections can be formed and maintained — and the positive impact these connections have within our personal and professional networks, community, and society.