Every month, the leadership team at the Gerontological Advanced Practice Nurses Association (GAPNA) highlights the most important published literature that impacts geriatric practice. This month, GAPNA President-Elect Natalie R. Baker, DNP, ANP-BC, GNP-BC, CNE, GS-C, FAANP, discusses essential factors in successful aging, reducing loneliness in older adults, and the benefits of a geriatric walking clinic for older patients with diabetes.

Factors associated with successful aging in Brazilian community-dwelling older adults: when physical health is not enough
Geriatric Nursing. 2021;42(2):372-378

Physical factors, although important, are not the main factors involved in successful aging, concluded the authors of this study.1 Instead, they found that factors such as resilience, meaning, quality of life, loneliness, and religiosity played an important role in successful aging. The researchers urged for a broader model of successful aging expanding from the objective measurement proposed by Rowe and Kahn into the subjective appraisals.

Commentary by Dr Baker:

Successful aging is often thought of only within the context of physical functioning or absence of disease. Previous studies have refuted this concept, recognizing multidimensional factors that affect an older adult’s satisfaction with the aging process.


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A cross-sectional study of 534 community dwellers 60 years or older residing in Brazil was conducted to evaluate successful aging. The study findings suggested that while physical factors are important, they are not the main factors associated with successful aging. Instead, factors such as resilience, meaning of life, quality of life, religiosity, and loneliness were significant influencers of successful aging.

Personal resilience is a trait frequently associated with overcoming obstacles that ultimately result in contentment. Likewise, those who report satisfaction with their self-described positive meaning and quality of life are prone to be labeled as successfully aging.

The researchers found a link between organized religion and successful aging. Previous literature has reported that regardless of faith beliefs, those who are engaged in religious rituals within the community experience greater longevity.

Loneliness, which is different from social isolation, was reported as being more important than an older adult’s social support system. The subjective feeling of loneliness is not always present in the absence of social engagement and should be assessed with validated instruments such as the UCLA Loneliness Scale.

This study highlights the need to promote engagement in activities that older adults find enjoyable and observe for behaviors that might indicate dissatisfaction with life. Advanced practice providers should incorporate thorough psychosocial evaluations into all geriatric patient encounters.

Meeting the social needs of older adults in rural area
JAMA Health Forum. 2020;1(11):e201411

The unique risks for social isolation and loneliness faced by older adults in rural America were examined in this study.2 Prior to the COVID-19 pandemic, research showed that more than 60% of US adults were lonely. The events of the past year have exacerbated the risk for loneliness. Living in a rural community also places older adults at higher risk of morbidity and mortality, including higher rates of suicide. The author discusses ways to lessen social isolation in rural older adults.

Commentary by Dr Baker:

Loneliness and isolation have been shown to affect one’s health and mortality risk. Changes in health or functional ability, retirement, living alone, and death of spouse/partner or other loved ones are examples of experienced events that can increase loneliness episodes.

Older adults residing in rural areas exhibit higher levels of loneliness than those living in urban communities. Social engagement barriers within the rural setting include decreased broadband Internet access, cellular phone connectivity disruptions, less access to health care providers, and transportation concerns. Additionally, rural residents have higher suicide rates and decreased access to mental health services.

Screening is the first step to identifying loneliness, followed by development of interpersonal interventions to connect older adults with others within their community. Telephone calls, friendly visits, home-delivered meals, and participating in community senior center activities are often effective in decreasing loneliness feelings. Through education about loneliness identification and the potential negative consequences on older adults, health care providers can engage community partners. Mail carriers, bank tellers, grocery store clerks, and faith-based leaders frequently interact with older adults and often are the first to detect a change in mood. These individuals are vital in initiating meaningful social engagement activities.

Structural determinants of social engagement such as lack of adequate transportation, broadband internet, and cellular phone connectivity are also important factors that should be addressed.

Advanced practice providers and interprofessional team members must advocate for health in all policies that increase social connections and educate patients, families, and caregivers about available community resources.