Social contact and interaction have been identified as important predictors

of morbidity and mortality in older populations. Older adults, older women in

particular, may be especially vulnerable to low social contact, due to spousal
death, loss of other companions through death or institutionalization, and the
departure of adult children. Restricted finances and poor health and disability may
further limit opportunities for social participation. Social interaction has been
conceptualized in various ways. We focus on two indicators, contact with
persons outside the immediate household and home confinement, as
important dimensions of social interaction. Although persons living with
others are not typically considered isolated, if they have limited contact with
a broader social world, they may have insufficient social interaction. Relations
with cohabitating family members have been characterized as more
obligatory than those with friends, neighbors and more distant relatives. Just as
evidence exists for a positive impact of social support on health, there is reason to
believe that social isolation may have a negative impact on health. Social isolation
is considered a risk factor for morbidity, mortality, and mental disorders. Lack of
social support and limited social networks reflect two dimensions of social
isolation: perceived isolation and social disconnectedness, respectively.

Communication involves the reciprocal process in which messages are

sent and received between two or more people. Communication is a fundamental
requirement for all human beings. It gives substance to individuals’ lives, is
essential for survival and growth, and enhances a sense of belonging. Cognitive
impairment in people with dementia may limit their ability to communicate
effectively. At a basic level, communication is an activity of daily living. It is vital
that nurses are good communicators, allowing them to be more sensitive to
patients’ needs and therefore engage them on a therapeutic level. The term
‘therapeutic’ relates to the art of healing, the effective treatment of medical
disorders, the eradication of ill health and the improvement of general wellbeing.
Establishing a therapeutic relationship with patients will enable them to feel
comfortable enough to express their needs. It is only through good
communication and the development of the therapeutic relationship that nurses
can truly identify and meet the unique needs of the people they are caring for.
A separate literature suggests that reduced late-life social participation
may be mediated by social identity, i.e., the self-conceptualisations that
individuals derive from their group memberships (e.g., woman, teacher, hill-
walker, Christian). There is evidence for strong links between social identity and
utilisation of healthcare; for example, healthcare is more readily accepted when a
receiver shares a preferred social identity with a provider, and a lack of shared
social identity may lead to service refusal. This suggests that an older man may
not wish to attend a group populated by mainly women because this would
contradict his male identity. Alternatively, an older person who identifies as a
“care-provider” may not want to attend a support group for fear that he/she would
become a “care-recipient”. Moreover, widespread ageism, may lead individuals to
avoid groups for older people in case they become identified as “old” and thus
stigmatised. Loss of self is a persistent notion when thinking about dementia,
predominantly stemming from western philosophical understandings of identity in
which the mind is held as superior to and separate from the body and from
medical understandings of dementia, which view it in terms of inevitable loss and
decline. Despite the person-centred agenda in which we are urged to see the
individuality of the person before the label of dementia (Kitwood, 1997), these
ideas continue to have a strong influence on how people understand and make
sense of dementia and therefore on the experiences of people with dementia
themselves.