The need for social distancing during the coronavirus pandemic has exacerbated the adverse impacts of isolation on hospice patients’ quality of life. Protecting the seriously ill at highest risk of COVID-19’s impacts has come at the cost of human touch and hands-on care so integral to hospice patients in their final life stages. Hospice and palliative care providers have turned an increased focus on addressing isolation issues and connecting with patients from afar.
“As palliative care providers, I think social isolation is much more concerning than we have been aware of in the past,” said Daniel Hoefer, M.D., chief medical officer for Sharp HealthCare’s outpatient palliative care program, in a National Hospice and Palliative Care Organization (NHPCO) podcast. “It’s a physical-chemical manifestation and a complicated process that I don’t think we fully understand yet.”
Research has indicated significant links between the impacts of social isolation and increased risk of early mortality among older and seriously ill patients. Not only is a patient’s mental health impacted with greater risk of depression, anxiety and loneliness, but isolation also poses increased physical risks for those in the home without strong family and caregiver support and raises potential for hospitalizations and emergency room visits.
“Research shows that social isolation increases risk of heart disease, diabetes, mortality, cancer, suicide, accidents — virtually all aspects of health care,” said Hoeffer. “Who are the most vulnerable people for these consequences? It’s our advanced elderly, hospice, palliative populations, especially in the community-based population. When you look at the research regarding social isolation in the elderly, the hazard’s ratio for mortality of people who are truly socially isolated is as bad as smoking a pack of cigarettes every day.”
The pandemic has further complicated issues of social isolation with the need to protect hospice and palliative care patients from exposure to COVID-19, as well as keep those who have been exposed or contracted the virus quarantined to prevent its spread. As states reopen, the stress and fear of protecting those most vulnerable has prolonged isolation periods, with patients spending months away from social activities, family, friends and care teams. Many have said goodbye to loved ones through glass windows or electronic screens, unable to be physically present the final hours of life.
“Families of patients with COVID-19 face a significant psychological burden,” according to recent research. “The quality of the dying experience and lack of preparation for the death are both predictors of complicated grief. Health professionals should communicate with families regularly and, where possible, facilitate communication between patients and their families utilizing virtual technology. Information leaflets should be provided for both patients and family members.”
With many events and activities cancelled during the outbreak, hospice and palliative care patients are heavily reliant on virtual interactions to maintain socialization. Providers have leveraged telehealth flexibilities during the national health emergency to address social needs, linking patients to various online activities and social events, virtual spiritual support, and video therapies to reduce anxiety and depression such as arts, crafts and relaxation exercises. Recent research has reflected positive patient perception of telehealth services during the pandemic.
Several hospices have additionally ramped up outreach and increasingly collaborated with community partners to develop volunteer programs and provide direct social interaction for patients.
Patients have reported that social calls and visits made a difference to them, according to Lori Bishop, NHPCO’s vice president of palliative and advanced care. “There’s value in socialization in terms of patient satisfaction, with success rates going up dramatically for patients who had a set time of day and social interaction with family, friends or caregivers,” Bishop said.
Ongoing and regular social interaction can improve a patient’s quality of life, giving a sense of purpose and structure, according to Hoefer. Providers can work to better address social isolation by integrating this topic more into conversations during medical visits and sharing this information among interdisciplinary care teams.
“Social components of care can be just as vital to a patient’s well-being as their medical care,” said Hoefer. “The more structured and regulated social integration becomes into your practice, those are things that will definitely help our patients in the long run. Make sure patients have structure in their day. People who have purpose live the longest. Keeping people properly stimulated, keeping them in good habits of integration, are very important for the overall health of the patient, beyond just their psychosocial needs. Structured socialization helps people to maintain that meaning and purpose in their lives to get through this [pandemic]. It’s not the same as touching their hands or hugging your patient, but it’s remarkable how quickly people get withdrawn without it.”