The PEARLS to Ending Loneliness in Older Adults

In today’s society, couples are having less children or because of the death of their counterparts, they no longer have the network of loved ones that live nearby for support. Thus, those who develop an acute illness, may not have a close support system around to aide in recovery. In addition to these findings, a study using data from the National Social Life, Health, and Aging Project revealed that seniors experiencing loneliness can have a decline in their physical and mental status (Stevenson, 2017). This decline can lead to an increased risk of the development of loneliness, depression and dementia.

There have been multiple studies conducted in North America, Central America, and Europe that have denoted that social isolation impacts a person’s quality of life and can contribute to depressive symptoms (Cho, Choi, & Irwin, 2015). Research has also shown that older adults engaging in cogitative stimulating programs have preserved mental capacity, increased social support and a decrease in loneliness. An example of this type of a program is known as PEARLS. PEARLS stand for a Program to Encourage Active Rewarding Lives for Seniors. It is an intervention that consists of a “problem-solving treatment, social and physical activation, and potential recommendations to patients' physicians regarding antidepressant medications” (Ciechanowski et al., 2004, p. 1569). They were developed in “partnership with community-based aging organizations and designed for delivery outside of traditional mental health settings [and it] resulted in significantly lower severity and greater remission of late-life depression” (Steinman, et al., 2012, p. 9). It was also found that the intervention resulted in at least a 50% reduction in depressive symptoms (Cristofalo, Snowden, & Steinman, 2012). In addition to alleviating these symptoms, PEARLS programs have been credited with other benefits, such as increasing clients' physical and pleasurable activities, social support, quality of life, function, physical health, and ability to live independently (Cristofalo, Snowden, & Steinman, 2012).

Practice-focused Question

The PICOT question for this project is: Do older adults (P) who have symptoms of loneliness (I) and participate in a wellness program (PEARLS) (C) experience less loneliness (O) after engaging in the program (T) for a three-month period?

Impact/Context of Project

This Doctor of Nursing Practice (DNP) will be a quality improvement project centered around a collaboration with a home health company that has identified the issue of loneliness in the population that they serve. Research has shown that older adults enjoy different varieties of PEARLS programs and has been noted that this particular type of program has allowed them to have a better emotional state after involvement (Cristofalo, Snowden, & Steinman, 2012). As a part of the center’s PEARLS program they will implement a computer program geared towards engaging participants in activities that will encourage decreasing loneliness in older adults. There will also be telephonic follow up using motivational interviewing with the participants to evaluate if there was a response to the intervention. The role of the advance practice nurse in the project will be to evaluate the effectiveness of the program using the De Jong Gierveld Loneliness Scale (De Jong Gierveld, 2010) at the start of the program and three months after participation.