"It's not just loneliness": cognitive-emotional-behavioral signatures of social isolation in residential aged care.

BACKGROUND AND

OBJECTIVES

Social isolation is a common and serious problem among nursing home residents, negatively impacting their physical and mental health. Despite this, it is often misunderstood as loneliness, and the specific manifestations of social isolation in this population remain unclear. This study aimed to explore perceptions and experiences of social isolation among nursing home residents from the cognitive-behavioral perspective.

RESEARCH DESIGN AND

METHODS

Semistructured, face-to-face interviews were conducted with 18 purposively sampled socially isolated residents from nursing homes in 2023. Data were analyzed using deductive content analysis informed by the cognitive-behavioral model of social isolation.

RESULTS

Three key themes emerged: (1) social cognitive biases, including retreating from social life, heightened perception of social risks, being a burden in social settings, viewing social interaction as meaningless performance, and perceiving the nursing home as impersonal; (2) emotional dysregulation, characterized by persistent loneliness, suppression of emotional expression, emotional conformity under cultural norms, emotional rumination, and eventual emotional numbness; (3) behavioral social withdrawal, characterized by tokenistic participation, establishing safety through boundaries and avoidance. Institutional constraints and feelings of alienation further reduced residents' motivation for meaningful social engagement.

DISCUSSION AND IMPLICATIONS: Findings suggest that social isolation among nursing home residents involves more than emotional loneliness, encompassing social cognitive biases, emotional dysregulation, and behavioral withdrawal. Addressing these cognitive and behavioral processes may be critical for designing interventions that more effectively reduce social isolation in institutional settings.