By: Brennan Ninesling BA, BSa, Aum Solanki BA, BSa, Madeline Carney BSa, Ambuj Kumar MD, MPHa, Lucy Guerra MD, MPHa
Corresponding author: Dr. Lucy Guerra MD, MPH, Morsani College of Medicine, University of South Florida. 12901 Bruce B Downs Blvd, Tampa, FL 33612. Email: email@example.com.
“Describe your perfect day” is one of my uncle’s favorite games to play around Christmas time. Taking turns around the circle, my cousins, sister, and I discussed our vacation destinations and incredible meals we had planned for our perfect days. We were all dreaming by the time we circled around to my grandmother. At 82, she is my last living grandparent, surviving her husband by four years now. “On my perfect day, I want all three of my children and their children together at my house. Just for one day.”
Her request sounded simple, but I realized how rare it is for my family members to have time off together. A reminder of how woefully under-equipped our society is to address the many difficulties that come with old age. The population is getting older, and the widely accepted belief that older people are lonelier has gone unchallenged. Prevalence data suggests that nearly one in three older adults (>65) report feelings of loneliness in the United States [1-3]. Social relationships are integral to human well-being, and research has consistently shown that social isolation has negative effects on health outcomes [4-6].
When Madeline, Aum and I enrolled at the University of South Florida Morsani College of Medicine, we quickly realized that our Tampa community was full of older adults with very few social connections. With this in mind, we set out to create a program that would provide social support for this population. Our program’s mission is simple: to decrease feelings of loneliness in our older population through lunch visits with medical student volunteers.
Unfortunately, we realized most of this population had come to terms with the fact that their chance at their “perfect day” has passed. On visits to their homes, we found familiar stories of loved ones passing and children moving away, leading to deleterious mental and physical health effects.
Sara, one of the participants in our program, described her “perfect day” to us at a recent check-in visit. She recalled strolling down Bayshore Boulevard with friends after a day of hunting for bargains at local supermarkets. She loved going to the beach and playing cards with friends before her fall and subsequent hip replacement. Sara’s story shared a common theme with the experiences of many of our participants: the loss of meaningful connections with other people. While the Soul Food Project may not single handedly recreate such perfect days, it can help fulfill the need for social relationships that older adults are lacking.
Through the Soul Food Project, we sought to demonstrate that a weekly meeting with a medical student could reduce feelings of loneliness, depression and anxiety in enrolled lonely adults. We enrolled these participants by sending a three question survey to screen for feelings of loneliness; these surveys were sent to the 900+ individuals that were enrolled with Meals on Wheels of Tampa. Those with a positive screen were given the opportunity to be a part of our program. We measured the change in their depression, anxiety and loneliness by comparing responses to standardized surveys (PHQ-9, GAD-7, and R-UCLA) between older adults that were randomly assigned to either a control or intervention group. We also asked enrolled participants to complete surveys before and after a six-week trial period and compared changes to responses between the two groups.
Unfortunately, enrolling lonely adults was more difficult than we had anticipated. Charles, a potential participant for the Soul Food Project, expressed these sentiments over the phone. “You gotta talk to my landlord,” he said, explaining to us that his landlord did not like strangers on the property. Furthermore, follow up with Charles proved to be difficult as he was in and out of the ER and doctors’ appointments throughout the program.
While this is just one example, it highlights the variety of reasons that people like Charles can become isolated and be difficult to reach consistently. Because of these challenges, we ended up with a smaller sample size of 17 instead of our original target of 66. This small sample size meant that we were not able to make many meaningful conclusions from the survey data we gathered. A larger sample size will be needed to determine whether our lunch program is efficacious in decreasing feelings of loneliness in this population.
Even with these difficulties, our mission stayed focused on building positive connections between medical students and lonely older adults in our community. This was reflected in the 100% satisfaction for the program from our older participants. Many described their excitement for each visit. One particular participant stated that meetings with her medical student “brought her out of herself,” something she was not able to do for a long time.
Medical students also described several conversations that they and their companions had. They told us about how their relationships improved over the six weeks. For instance, one medical student told us how she was enjoying her visits, but was somewhat taken aback by her companion’s unwillingness to let her into her home. For three weeks, they sat on the porch for lunch. The following week, the participant finally opened up, allowing the student into her home, blushing and apologizing for the mess that she was clearly embarrassed by. These moments are key for the Soul Food Project, and this willingness from our older participants to share personal details about their life, past, family and even their health was extremely encouraging.
This willingness to open up to students that participants only meet for an hour every week shows why programs such as this are so valuable, regardless of the challenges we experienced. While one hour each week will not achieve their perfect day, that hour does make a valuable difference.
Conflicts of Interest: Participant identifying details were removed and names were changed to protect privacy. The authors have no potential conflicts of interest to disclose.
Author Contributions: BN is the principal investigator who proposed the project idea, and along with AS and MC, implemented the program and wrote the article. AK played a major role in designing the study and assisted with article preparation. LG also played a major role in study design and program implementation. All authors read and approved the final article.
Sponsor’s Role: No sponsor was used in preparation of this manuscript.
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