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Loneliness is as lethal as smoking 15 cigarettes a day

By Kelly Klund, LPN
Resourse Nurse, Empira

You have held on through this pandemic and tried to do the right things: you get eight hours of sleep a night, you eat your bright green and orange vegetables, you drink eight glasses of water a day, and you hold doors open for strangers and then POW!!!!!!! You read a blog and learn that loneliness is as lethal as smoking 15 cigarettes a day. As a former smoker I can tell you that smoking 15 cigarettes a day makes you feel like garbage. As a person who was separated from many of the people who are important to me during the height of the Covid-19 pandemic I can tell you that felt like “garbage” too. I get the parallel, but I don’t think that you need me to tell you that the loneliness we have all suffered over the last year because of the lockdowns and quarantines has taken its toll on our mind, body and spirits.

Empira dug into the effects of loneliness and learned some startling facts about the price we pay when we are lonely. The biology of loneliness can accelerate the buildup of plaques in our arteries, help cancer cells grow and spread, and promotes inflammation in the brain leading to Alzheimer’s disease (Social isolation, loneliness in older people pose health risks, 2019). If we experience prolonged periods of loneliness we are more at risk for poor decision making, depression, anxiety, at a higher risk for stroke, we have higher rates cardiovascular impairment, more complaints of chronic pain, and a tendency to fatigue more easily. There is a 50% increased risk to develop dementia and a 26% increase in mortality. Loneliness can kill us, loneliness is just as lethal as smoking 15 cigarettes a day!

Here is the interesting thing about loneliness, it is subjective. Alone ≠ loneliness. According to Cacioppo, loneliness is defined as a state of mind characterized by a dissociation between what an individual wants or expects from a relationship and what that individual experiences in that relationship.

Before we can understand the totality of the impact that loneliness has had on us it is important that we understand the different types of loneliness that we may have been feeling:

  • Personal or intimate loneliness is the absence of a significant person (spouse/ partner, pet) who provides emotional support and affirms one’s value as a person. Did you have to quarantine in your home away from your loved ones? Was it hard?
  • Relational loneliness is the absence of a sympathy group. This is usually about 15-50 people who regularly interact with one another. Examples: Card group, prayer group, immediate family, coworkers. This is a group that you meet with who are going through the same things that you are. Did you cancel family gatherings or suddenly start working from home?
  • Collective loneliness is the absence of a network. Your network is made up of 150-1500 people, who provide support just by being together as part of the same group. Examples: Church family, extended family, organizational memberships. Did your church stop in-person services, did your concert or sporting event tickets get cancelled?

In order to avoid some of the negative mind, body and spirit risks associated with loneliness we must first do some quiet, introspective evaluation. Where in our lives have our expectations about our relationships not been met, either because of forced distance from lockdown or quarantine, or because of other factors in our lives that may have existed or been exacerbated because of Covid?

Knowledge is power, and now that we have learned about the different types of loneliness we may be experiencing it is important that we see some ways that we may respond to address them.

  • Personal or intimate loneliness – what is the “Next best thing”? Can you hug a pillow with your loved ones perfume or cologne?
  • Relational loneliness – Zoom happy hours have replaced the after work get together, and many movie streaming companies have develop the ability to have “watch parties” so people can watch movies together, but from their separate homes. With the CDC relaxing guidelines, is there are small group of your friends and family that can now safely gather?
  • Collective loneliness – Can you join in online events? Most of our Church services are now streamed, many community organizations have moved their meetings to ZOOM or “live” broadcasts. I personally, am much more likely to attend services at home, on the couch in my PJ’s than I was before Covid when services were in person. Some of my favorite performers have hosted free online concerts that can be cast to your living room television and although not in person, I can watch along with other people like we were all together in an arena, without the long drive home.

Addressing your loneliness may require a bit of creativity. Just like many smokers ditched that nasty habit to better their health, I challenge you to take care of your mind, body and spirit and tap into your creativity to connect with the things and people that are important to you.

References:
Cacioppo, S., Grippo, A. J., London, S., Goossens, L., & Cacioppo, J. T. (2015). Loneliness. Perspectives on Psychological Science, 10(2), 238-249. https://doi.org/10.1177/1745691615570616
Galambos, C., & Lubben, J. (2020). Social isolation and loneliness in older adults: A national academies of sciences, engineering, and medicine report. Innovation in Aging, 4(Supplement_1), 713-713. https://doi.org/10.1093/geroni/igaa057.2511
Holt-Lunstad, J., Smith, T., & Layton, J. (2010). Social relationships and mortality risk: A meta-analytic review. SciVee. https://doi.org/10.4016/19865.01
O’Donnell, E. [Woman on window ledge with cigarette]. Pexels.com. https://www.pexels.com/photo/photo-of-woman-holding-cigarette-3185099/
Social isolation, loneliness in older people pose health risks. (2019). US Department of Health and Human Services – NIH National Institute on Aging. https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks
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Maybe Christmas, perhaps, means a little bit more

Written by Kelly Klund, LPN
Resource Nurse, Empira

Most of us know the story of the Grinch, a crabby green creature who has lived a lonely spiteful life. He has a deep dislike for the people who live in the town of Whoville and detests their love of Christmas. He hatches a plot to sneak into Whoville on Christmas Eve and steal the decorations, gifts and food. In the middle of his attempt to ruin Christmas he comes across Cindy Lou Who, an innocent child who has the beauty and magic of Christmas in her heart.

The Grinch continues with his plan and once he gets back to his home with all of the town’s Christmas swag he is amazed to learn that all the Whos in Whoville have not had their Christmas ruined, but instead are anchored in the value of being together and sharing Christmas love. Seeing this, the Grinch’s icy heart grows three sizes and he returns “Christmas” to Whoville and celebrates all the beauty and love with the Whos on Christmas.

“Then the Grinch thought of something he hadn’t before! Maybe Christmas, he thought, doesn’t come from a store. Maybe Christmas, perhaps, means a little bit more.”

DR. SEUSS GEISEL, 1957

When we hear the story of the Grinch we often think of that little bit more as generosity, family, the gift of giving or the celebration of Christ’s birth if you are a Christian.

This year most of the ways we traditionally celebrate the Christmas holiday are likely to be turned upside down. Like at Thanksgiving, we were being asked not to gather in our large family and friend groups. The prevalence of unemployment may make gift giving a source of tension for some families. Church services are not likely to look like they have in years past. Getting together with our friends for holiday baking or cookie exchanges will have to be reinvented and gathering at the knee of Grandma or Grandpa to hear our families’ Christmas stories is a much loved tradition we will likely have to forego.

In normal times 46.9% of people report some sort of grief during the holiday season with social isolation being one of the biggest factors in that grief. In addition to holiday grief, according to the CDC, U.S. adults reported considerably elevated adverse mental health conditions in relation to COVID-19. Compound the impact that COVID-19 has had on our mental health with the holiday grief that is normal and we are ripe for a holiday season that is lacking holiday cheer.

But what if we thought about it differently?

What if this year’s little bit more was about the gift we could give to ourselves; the gift of time for self-reflection and the gift of exploring what matters most.

In Empira’s ResoLute grant we explore something we’ve titled Work of Aging. This work begins when people start to reflect on their life and confront their own mortality. Work of Aging is used to describe conversations or actions that support one in reaching wisdom recognizing what matters most in living and dying.
When we explore our Work of Aging we are looking into seven domains that can cause us despair or be a source of peace and joy in our lives:

• Life story – What role does our story play in who we are today?
• Condition – How does your health affect your quality of life
• Purpose – Why do you wake up in the morning?
• Relationships – What relationships do you want to honor or reconcile?
• Spirituality – Do you feel connected to something bigger than yourself?
• End of Life – Have you prepared for the end of your life?
• Legacy – What do you want others to think when they hear your name?

What if this year’s little bit more is about taking advantage of the time we have alone or with a smaller group of loved ones to reflect on recognizing what matters most and sharing those conversations with the people closest to us?

Was the Grinch crabby and bitter because he needed to explore his Work of Aging? Did seeing the Whos in Whoville singing on Christmas morning open his eyes to being connected to something bigger than himself? Did returning Christmas to Whoville empower him to shape his legacy?

This Christmas we will all have decisions to make about if and how we celebrate and as we are making those decisions I invite you to also explore your own Work of Aging.

For more information on a tool that guides Work of Aging conversations check out the Work of Aging Reflection Journal.

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We wish you a Merry Christmas and a much better New Year!

If you are struggling with mental health or addition and need assistance there are many resources available including the Substance Abuse and Mental Health Serves Administration National Helpline 1-800 – 622-HELP (4357)

“Dr. Seuss” Geisel, T. (1957). How the Grinch Stole Christmas! Random House.

Wirz-Justice, A., Ajdacic, V., Rössler, W., Steinhausen, H., & Angst, J. (2018). Prevalence of seasonal depression in a prospective cohort study. European Archives of Psychiatry and Clinical Neuroscience, 269(7), 833-839. doi:10.1007/s00406-018-0921-3

Mental health, substance use, and suicidal ideation during the … (2020, August 13). Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

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4th of July Traditions

Written by Birttni Peterson, RN
Resource Nurse, Empira

There is no doubt, that for many people, Independence Day is one of the most looked forward to days of the summer. What’s not to love? Time spent with family and friends, fireworks, tasty food, bonfires, and if we are lucky, as Minnesotans, nice weather. I’m pretty sure that most people understand the symbolism of the fireworks, like it says in the Star-Spangled Banner: And the rocket’s red glare, the bombs bursting in air. But for many people the 4th of July is like many other holidays; a perfect reason to get together and celebrate with family. Many of those families have traditions and unfortunately with this COVID virus right now most will not be able to celebrate as they would like.

Vintage American Flag With Sparklers And Smoke On Rustic Wooden Background - Independence Day Celebration ConceptWhat is the reason we celebrate with fireworks, parades, and red white and blue on the 4th day of July? Well, here’s a brief history on it.

The Revolutionary War began in 1775 and ended in 1783. The cause of this war was due to growing tension between Great Britain’s 13 colonies and the Colonial Government. On July 2nd of 1776, there was a vote to gain their Independence, it wasn’t until two days later that representatives from the 13 colonies and Continental Congress officially adopted the Declaration of Independence.

“Fun fact, John Adams thought that July 2nd would be the date that Americans would celebrate their independence.”

Now, I’m not much of a history buff… but do you know who is? Our good friend Andy Griffith.

A family tradition of mine is adventuring to my Grandparent’s house in Deerwood Minnesota. We would attend the Crosby-Ironton parade during the day. Our parade spot was right across from a Dairy Queen, so of course we always bought a treat before the parade started… even if it was only 10 o’clock in the morning. The parades have been getting shorter and shorter each year, but average to be a little over an hour. Which for a kid looking to fill her bag with candy, it wasn’t long enough. We would then make the drive home to grill hamburgers and hot dogs for lunch and if my parents were lucky, us kids would let them take a nap before our evening festivities. We would finish our 4th of July day off by being mesmerized by fireworks in the evening. What are your family traditions for Independence Day?

Like I said earlier, the 4th of July, 2020, for most Americans, is going to be celebrated differently this year. Those most affected are the residents of long term care facilities. A lack of togetherness with their families will only be amplified during this holiday. Although recently the MN Department of Health has put out guidance for long term care facilities to have outdoor visitations, it just won’t be the same.

But there are a few other ways that you can celebrate with your loved ones this 4th of July.

Bring the tradition to them. Since visitors are not allowed in nursing communities and we don’t know how the outdoor visitations will work, bringing the tradition to them may be a bit more difficult this year. A way you can still celebrate with your loved one is by decorating the outside of their window with an American Flag, window decals, and/or flowers.

Cute American Kids watching Fourth of July ParadeCall and Reminisce. If you aren’t able to carry out your normal family traditions, call and reminisce about what you have done in the years past. Take it one step further by writing down your 4th of July memories and make it into a keepsake for you and your loved one(s).

Just remember that the biggest thing for people facing tough times, especially around holidays, is that they know you are here for them and that they are cared for.

Firework and bokeh lights at night in the colors of the flag from the united states of america (blue, white and red)Resources
https://www.history.com/topics/american-revolution/american-revolution-history
https://www.timeanddate.com/holidays/us/independence-day

Click to access ltcoutdoor.pdf

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Why I Don’t Hate COVID 19

Written By Kelly Klund, LPN
Resource Nurse, Empira

Now that I have your attention let me explain.


I do hate that people are dying. I do hate that people are sick. I do hate that people are separated from their families. I do hate that people are losing their jobs. I do hate that our economy is crashing. I do hate that we don’t have a perfect health care infrastructure. I do hate that small businesses are suffering and some may not survive, and I do hate that our children’s education has been disrupted.

Where there is tragedy there is also triumph, and somewhere on the other end of this unprecedented time we will see that there may be things that are better because of what we have been through.

I think about the poem “I miss September 12th” by Elizabeth Gray.

I miss September 12, 2001. I would never want another 9/11, but I miss the America of 9/12. Stores ran out of flags to sell because they were being flown everywhere. People were Americans before they were upper or lower class, Jewish or Christian, Republican or Democrat. We hugged people without caring if they ate at Chick-fil-A or wore Nikes. On 9/12 what mattered more was what was uniting us than what divided us.

Elizabeth S. Gray

In a study completed in 2015 Pollak and Wilson found Advance Care Planning (ACP) conversations to be uncommon. The category of frail elderly patients was identified as a population with limited or no meaningful engagement in ACP. COVID 19 is forcing all of us to have hard, but necessary conversations about our health care wishes. This is a positive that has come from COVID19.

In 2017 Walmsley and McCormack published a study that showed the difficulty that family members encounter when trying to stay engaged. We all know of someone who visits their loved one in a nursing home every Sunday because it is the right thing to do, but they often don’t know what to talk about. With the strict visitor restrictions aging services has appropriately imposed many of those families have had to embrace technology as a way to stay connected. My hope is that when this is over those families continue with their meaningful good night or good morning video chats, as opposed to their weekly obligatory visits. That would be a positive that came from COVID 19.

I have a friend who hosts daily what’s for supper video chats with her girlfriends who struggle in the kitchen. Whether eating curbside pick-up or home cooked meals, people are congregating around the dinner table. This is a positive from COVID19.

I live in a small town in Wisconsin and our main street cafe posted on their Facebook page that they have had some of their busiest days ever. People are pulling together to support local businesses differently than before. This is a positive from COVID 19.
I don’t hate that COVID 19 cancelled my large family Easter celebration. Instead of the hustle and bustle of a house full of people, my husband, college aged daughter, adult son and I had a lovely family dinner at home. The belly laughs were abundant and the memories are priceless. This is a positive from COVID 19.

In the article “Forget Happiness, find Meaning” the author, Kaufmann, says that we should focus on empathy, compassion and gratitude when faced with challenges. There is meaning in COVID 19 for all of us, the challenge is for us to embrace that meaning and grow from it.
I am finding meaning in community, family and appreciation and that is why I don’t hate COVID 19, it is about perspective. I wouldn’t want this new way of life to last forever, but I can find the gifts.

In this time when everyone’s world has been upended where can you find opportunities for empathy, compassion and gratitude? I challenge you to find the September 12th moments in your life.

Kristian Pollock, Eleanor Wilson. Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: a qualitative study of care at the end of life. Health Services and Delivery Research. 2015;(31). doi:10.3310/hsdr03310.
Kaufman SB. Forget Happiness, Find Meaning. Scientific American Mind. 2019;30(6):21. https://search-ebscohost-com.ezproxy.umuc.edu/login.aspx?direct=true&db=f5h&AN=139129444&site=eds-live&scope=site. Accessed April 13, 2020.
Walmsley B, McCormack L. Severe dementia: relational social engagement (RSE) during family visits. Aging & Mental Health. 2017;21(12):1262-1271. doi:10.1080/13607863.2016.1220923.

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Social Distancing & Emotional Health

Written by Heather Johnson, RN
Resource Nurse, Empira

How are you doing? Stressed? Anxious? Worried? Fearful?

It’s natural to feel this way under the current circumstances. The pandemic of COVID-19 is being broadcast everywhere on everything. As humans we also need to recognize and accept that everyone reacts differently. These reactions are based on your current circumstances, your mental health and your own feelings. Just know you are not alone. Or are you?

In a previous post I wrote about the need for social connectedness. This undeniable need for social connection is scribed into our DNA, it’s an innate part of our human existence. We need one another, and yet we are living in a time where social distancing is our new norm. This all seems counterintuitive to our nature.

So how do we balance the need for social distancing while preserving and supporting emotional health and our need for human connectedness at the same time?

The reality of it is, for most of us this is uncharted territory and we are unsure.

Emotional connectedness is subjective and is created when two or more people come together and create a bond over similar emotions. It’s a tie with someone who you share a particular set of emotions even if those emotions and feelings are anger, sadness, sorrow, joy, love or a thousand or more emotions that humans experience. The sharing of our emotions with one another provides us with the opportunity to create relationships. It allows us to bond over and to process what is happening while creating an understanding that we are not alone.

As a society we are bombarded with information about precautionary hygiene practices and social distancing, and as a nurse, I can fully embrace the heightened awareness and education to support physical health. As a late life care nurse, a mother, a daughter, a wife, a sister, a niece, a community member, and a friend, I also think about the added need for individuals to understand just how important our emotional health is. It is crucial in maintaining our physical health. Our physical and emotional health are intertwined and you need to take care of both to be healthy.

How then do we move forward in the coming days and weeks following social distancing guidelines without compromising emotional connectedness?

Here are a few strategies to support emotional connectedness while keeping your distance.
• Make and maintain eye contact with those around you.
• Use a hand wave to say hello or goodbye.
• Nod your head as you walk by one another.
• Listen to what others are sharing, and pay attention to their emotion.
• Put yourself in their shoes, empathize with what they may be feeling.
• Have genuine conversations. Make a phone or video call to a friend or family member. (Your grandparents need you now more than ever!)
• Email or write a letter.
• Share a simple smile with someone. (Did you know that the more you smile, the more intelligent (and better looking) the other person will perceive you as? And, chances are they will smile back!)

Remember: Emotional connections are the one thing that connects us all!

Please be safe and stay healthy!