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- Why wards are isolated by the courts
- The impact of isolation on the ward’s health
- The impact of isolation on family
- How isolation worsens all aspects of health
- How isolation harms the brain
- How loss, ageing and over medication multiply the effects of isolation
- How to prevent isolation of wards
Known Negative Health Consequences of Social Isolation
Isolation of the Elderly in Guardianship
The abuse heaped on victims of guardianship is reprehensible. The financial and emotional damage done to families by predator Guardians is reprehensible. But perhaps the most egregious crime that can be committed against an elderly ward is forced social isolation and removal of the elderly person from his environment, loved ones, family and residence at into a substandard, unpleasant, unfamiliar, unfriendly forced confinement. Moreover, denied access to their loved ones and denied the ability to even communicate with friends is an under recognized and devastating trauma that affects all aspects of an elderly person’s health.
Despite clear legislative intent to minimize Guardianship generated elderly isolation, Florida has been slow to recognize the magnitude of this disastrous problem. In other states isolation of the elderly has been added to the legal definition of elder abuse, and violations of this prohibition carry significant penalties. But Florida statute 825.102 falls short of the California standard and does not specifically refer to isolation as a serious issue worthy of being considered clear-cut elder abuse. Without a clear-cut directive from the legislature at what little or no oversight in the guardianship process, and especially in plenary guardianship, the abusive guardian can literally begin the murder of his ward and the utter defeat and humiliation of anyone who stands in their way.
There is a spectrum of Guardianship related elderly isolation. Naturally individuals who are violent or otherwise uncontrollable may require occasional isolation of their own protection and the protection of others. But the vast majority of cases of court ordered isolation of the elderly in guardianship are the direct result of the guardianship apparatus wanting to exert absolute total control over an individual and his assets even when it is not necessary to isolate them.
Indeed isolating a ward is a potent weapon. The anguish it causes family is disarming . Removing the ability to communicate with a parent who is clearly in distress and under siege from powerful strangers will bring even the strongest family to its knees.
That social isolation is enormously destructive and harmful is indisputable.
There is a wealth of evidence regarding the negative health outcomes predicted by social isolation. Social isolation impacts health downstream through three pathways:
(1) health behavioral,
(2) psychological, and
Social isolation negatively and profoundly impacts the health and behavioral habits of older adults. Without the positive influence of social network members, older adults who are socially isolated are at risk for many negative behaviors such as heavy drinking , smoking, and being sedentary (Eng et al., 2002). Older adults who are socially isolated also have an increased nutritional risk (Locher et al., 2005).
Social isolation has been demonstrated to impact the psychological and cognitive well-being of older adults. Those who have poor social connections and do not participate in social activities are at an increased risk of cognitive decline (Beland, Zunzunegui, Alvarado, Otero, & Del Ser, 2005). Less socially connected men are at a significantly increased risk of death from suicide, as well as from other causes (Eng et al., 2002). Conversely, older adults who have an extensive social network are more protected against dementia (Fratiglioni et al., 2004; Wang, Karp, Winblad, & Fratiglioni, 2002).
The physiological effects of social isolation in the geriatric population are well documented. It is striking how much evidence exists on social isolation as a predictor of mortality from coronary heart disease/stroke (Boden-Albala, Litwak, Elkind, Rundek, & Sacco, 2005). Other physiological afflictions resulting from social isolation, such as contracting common colds (Cohen, Doyle, Skoner, Rabin, & Gwaltney, 1997), have also been documented.
The brains of lonely people react differently than those with strong social networks. University of Chicago researchers showed lonely and non-lonely subjects photographs of people in both pleasant settings and unpleasant settings. When viewing the pleasant pictures, non-lonely subjects showed much more activity in a section of the brain known as the ventral striatum than the lonely subjects. The ventral striatum plays an important role in learning. It’s also part of the brain’s reward center, and can be stimulated by rewards like food and love. The lonely subjects displayed far less activity in this region while viewing pleasant pictures, and they also had less brain activity when shown the unpleasant pictures. When non-lonely subjects viewed the unpleasant pictures, they demonstrated activity in the temporoparietal junction, an area of the brain associated with empathy; the non-lonely subjects had a lesser response [source: University of Chicago].
These include all-cause mortality, falls, re-hospitalization, and institutionalization. Socially isolated individuals are at an increased risk for all-cause mortality (Berkman, 1984; Eng et al., 2002), which is defined as “the annual death rate or mortality rate from all causes” (Gordis, 2009, p. 62). Conversely, it has been suggested that social networks with greater numbers of friends are protective against mortality (Giles, Glonek, Luszcz, & Andrews, 2005). Social isolation among older adults has also been associated with an increased number of falls (Faulkner et al., 2003). Those older individuals who are socially isolated are also four to five times more likely to be re-hospitalized within one year of original admittance (Mistry et al., 2001). In addition, social isolation is a major predictor of institutionalization (Brock & O’Sullivan 1985); conversely, larger social networks are associated with a lower risk of institutionalization (Colantonio, Kasl, Osfeld, & Berkman, 1993).
Potential Risk Factors of Social Isolation: Associated Variables
Numerous variables have been associated with social isolation. The individual-level variables found to be potential risk factors for social isolation in cross-sectional studies are summarized below in categories outlined by Howat et al. (2004). The categories include: (1) physical; (2) psychological; (3) economic; (4) work/family changes; and (5) environmental. In addition to these categories, pertinent demographic variables were added as a category of risk factors for social isolation.
Older adults who are more socially engaged report less functional disability ( OR = 0.84, 95 % CI [0.75, 0.95]) (Mendes de Leon, Glass, & Berkman, 2003), and those who are a strong part of a social network have been found to have reduced risk of functional disability ( β = −0.009, p < .01) (Mendes de Leon et al., 1999).
There are many studies touting the link between increased levels of social support and increased quality of life (Gallicchio, Hoffman, & Helzlsouer, 2007). However, there are fewer studies examining the relationship between social isolation and quality of life. It has been suggested that being socially isolated impacts quality of life (Lim & Zebrack, 2006). In one study, it was found that the social network structures (including network size and reliance on formal and informal social ties) were associated with quality of life in long-term cancer survivors (Lim & Zebrack, 2006). In another study, women who were socially isolated prior to their cancer diagnosis were more adversely impacted by breast cancer (Michael, Berkman, Colditz, Holmes, & Kawachi, 2002). The authors concluded that prediagnosis level of social integration is an important factor in future health-related quality of life among breast cancer survivors (Michael et al., 2002).
Religious engagement also appears to be an important aspect of the social networks of older persons. In the social network index, church membership was part of the scoring structure used to determine if an individual was socially isolated or not (Berkman & Syme, 1979). Little research has been published in the literature regarding the number of people that an individual knows in their church and its relationship to social networks or social isolation. Most available research pertains to the number of times an individual attended church. An older study found that religious background protected against mortality among older adults with poor health (Zuckerman, Kasl, & Ostfeld, 1984). Those older adults who were not religious were 2.32 times more likely to die (Zuckerman et al., 1984). Conversely, those frequently attending religious services have been found to have lower mortality rates than those with infrequent attendance (Strawbridge, Cohen, Shema, & Kaplan, 1997). In that study, a Cox proportional hazards model showed that those who were frequent attendees of religious services had a lower mortality rate than those who were infrequent attendees (relative hazard = 0.64, 95 % CI [0.53, 0.77]) (Strawbridge et al., 1997).
There are also a number of studies that discuss the relationship between social isolation and cognitive decline in older persons (Bassuk, Glass, & Berkman, 1999; Havens et al., 2004). A decrease in social engagement may have a negative effect on older adults’ cognition (Zunzunegui, Alvarado, Del Ser, & Otero, 2003), and not participating in leisure activities has been found to be an antecedent to lower cognition (Wang et al., 2002). Lack of a robust social network is also a significant precursor to cognitive decline (Wang et al., 2002). Conversely, an active and socially integrated lifestyle has been found to protect against dementia (Fratiglioni et al., 2004).
Changes in Work and Family Roles
It has been demonstrated that the loss of a relative, friend, or close neighbor may lead to an increase in social isolation among older people (Wenger & Burholt, 2004). A stressful negative life event, such as forced guadianship, may prevent older adults from engaging their social networks, therefore placing them at an increased risk for social isolation.
Older adults who live in neighborhoods where safety is a concern may be at an increased risk of becoming socially isolated (Ross & Jang, 2000). There is a significant association between neighborhood disorder and social ties (Ross & Jang, 2000). Communities with high levels of social disorder are characterized as having poor safety, high levels of vandalism, and increased incivilities (Lewis & Salem, 1986).
A large number of older adults in the United States, about 30 % of the elderly population (or 10.9 million people), lives alone (Fowles & Greenberg, 2009). Living alone has been found to be a risk factor for a decrease in social networks or an increase of social isolation (Berkman, 2000; Havens et al., 2004; Howat et al., 2004; Iliffe et al., 2007; Lubben & Gironda, 2003). A study of older adults living alone in China found that they did not need any help solving problems and they learned to be flexible in order to reduce the need of being dependent on others (Tsai & Tsai, 2007). Thus, older adults who do not depend on others for resources may be more likely to get their social needs met, which is in direct contrast with the majority of research articles found in the literature.
When isolation is heaped on top of improper and overmedication the results are horrifying.
Within three months of admission, a team of University of South Florida researchers determined, 71 percent of Medicaid residents in Florida nursing homes were receiving a psychoactive medication — an antidepressant or anti-psychotic, say, or dementia drugs — even though most were not taking such drugs in the months before they moved in and didn’t have psychiatric diagnoses. Fifteen percent of residents were taking four or more such medications. But only 12 percent were getting nondrug treatments like behavioral therapy.
Imagine the terror of awakening in a foreign environment with no one to help you. So at 3 a.m. you start yelling in your bed. A stranger aide tries to calm you down and can’t, so the nurse calls the consulting physician (who has never examined or treated you before) and gets you on a tranquilizer — and you then stay on it, whether or not you need it. And this starts a long string of medications to make you quiet and not be disruptive. Ultimately these powerful drugs like Zyprexa and Respirdol—which should NEVER be given to the elderly—reduce you to a drooling vegetable in just a few days.
In 2010 the Justice Department brought criminal charges against Eli Lilly, accusing the big pharmaceutical firm of illegally marketing its anti-psychotic Zyprexa to doctors who work in nursing homes and assisted living facilities, and encouraging them to prescribe it for sleep disorders and dementia. Its approved use is to treat schizophrenia and bipolar disorder [pdf]. Lilly agreed to pay $1.4 billion in a related civil settlement.)
Especially in Guardianship, these drugs are being used as chemical restraints.
With no one allowed attend team treatment meetings or participate in treatment plans, the guardianship can turn a functional human being into a living corpse.
Wards have the right not to be isolated. This right is violated by abusive guardians routinely.
Rights of persons determined incapacitated.—
(1) A person who has been determined to be incapacitated retains the right:
(a) To have an annual review of the guardianship report and plan.
(b) To have continuing review of the need for restriction of his or her rights.
(c) To be restored to capacity at the earliest possible time.
(d) To be treated humanely, with dignity and respect, and to be protected against abuse, neglect, and exploitation.
(e) To have a qualified guardian.
(f) To remain as independent as possible, including having his or her preference as to place and standard of living honored, either as he or she expressed or demonstrated his or her preference prior to the determination of his or her incapacity or as he or she currently expresses his or her preference, insofar as such request is reasonable.
(g) To be properly educated.
(h) To receive prudent financial management for his or her property and to be informed how his or her property is being managed, if he or she has lost the right to manage property.
(i) To receive services and rehabilitation necessary to maximize the quality of life.
(j) To be free from discrimination because of his or her incapacity.
(k) To have access to the courts.
(l) To counsel.
(m) To receive visitors and communicate with others.
(n) To notice of all proceedings related to determination of capacity and guardianship, unless the court finds the incapacitated person lacks the ability to comprehend the notice.
(o) To privacy.
As has been previously demonstrated, the Agencies charged with enforcing this and other pertinent statutes have failed to do so for decades.
The authors of this document propose that no ward should ever be denied t0 choose or consort with his visitors. No guardian should the power to isolate an elderly citizen. We propose
- Enforcement of existing legislation by the state agencies empowered to do so
- Passage of a bill of clarification of the existing statute to stop its continued impotence
- That all wards have unrestricted visitation with family members unless there can be shown an imminent likelihood of severe physical harm documented by law enforcement.