The worldwide increase of the older population in the 21st century has become an important demographic trend due to the decline in birth rates and the increase in living standards. According to the United Nations’ 2022 report, individuals aged 65 and over constitute 10.5% of the world population, and this percentage is expected to increase to 25.5% by 2050. Aging is defined as a physiological process that develops through the interaction of biological, psychological, and social factors, and social aging brings many issues such as health problems, economic difficulties, and social isolation.

This study examines the problems caused by loneliness and social isolation in older individuals. Social isolation is defined as an individual feeling excluded from society and experiencing limited social interactions. This situation can cause various issues for older individuals such as health problems, depression, and low quality of life. Homecare services are an important support system that aims to improve the quality of life of older people and reduce social isolation. However, social isolation can negatively impact the effectiveness of these services and make the care process more difficult.

The main problems caused by social isolation include increased health problems, psychological effects such as depression and loneliness, failure to meet care needs, and decreased quality of life. The increase in physical health problems in old age, lack of social support, and transportation challenges can trigger social isolation. The feeling of loneliness is also associated with individual and environmental factors such as loss of a spouse, chronic diseases, and sensory losses.

Homecare services are critical for older people to lead an independent and safe life in their own homes. These services aim to meet the physical and mental health needs of older people while focusing on strengthening social support systems and optimizing environmental factors. Gerontologists play an important role in planning and implementing services to improve the quality of life of older individuals in this process.

The study analyzes the status of an individual living alone and in need of care and the reasons for the lack of necessary interventions by focusing on a case discovered by chance within the scope of the One from Home Project (Evden Biri Projesi). The study uses this case to discuss the shortcomings of the current system regarding old age, care processes, and the aspects that need to be improved.

Method

This study uses the qualitative research method in order to understand in depth the problems older individuals experience related to homecare services. The reason for preferring the qualitative method is that it provides data that will provide a detailed understanding of older individuals’ life experiences. The research has adopted a case  study design due to it being an effective approach for analyzing specific situations and making generalizations about common situations. The case of M.S. represents a concrete example of older individuals’ common issues such as social isolation and health problems and can be a guide for similar studies in the future.

The participant of the study is an 82-year-old woman named M.S., who was identified within the scope of the Evden Biri Project carried out by Süleyman Demirel University Eğirdir Vocational School of Health Services. M.S. was selected as a typical example representing problems specific to old age such as chronic health problems, social isolation, and care needs. The typical case sampling technique was used to identify the participant.

The Evden Biri Project is a voluntary initiative that aims to increase older individuals’ access to homecare services and to improve their quality of life. Within the scope of the project, elderly individuals are visited in their homes; their health status, social needs, and care requirements are assessed, and regular support is provided.

Observation and in-depth interview techniques were used for collecting the data. The observation technique is used to analyze the living conditions, health status, and social support systems in M.S.’s home. The observations revealed that inadequate personal hygiene, neglected home maintenance, and long-term bed dependency have led to health problems. The in-depth interviews were used to provide a detailed analysis of M.S.’s health history, activities regarding daily life, food consumption habits, and social support systems.

When analyzing the data, the study used qualitative data analysis methods to evaluate the data obtained from the observations and interviews and then classified and analyzed the findings under themes. Notable connections were established, especially between themes such as social isolation and health problems.

The research was conducted in accordance with ethical guidelines, and approval was obtained from M.S. The study adheres to the principle of confidentiality and obtained the necessary permissions from the Eğirdir District Social Service Center.

Case

 The 82-year-old female patient, M.S., was treated during the evaluation carried out in the Eğirdir District of Isparta Province within the scope of the Evden Biri Project carried out by Süleyman Demirel University Eğirdir Vocational School of Health Services, Department of Health Care Services. This project is a voluntary initiative that organizes the care services provided in older individuals’ homes. Within the framework of the project, M.S.’s health status and living conditions were meticulously examined, and several critical health problems were identified.

 With regard to M.S., she is lonely, comorbid, and in need of care. She had previously been visited at her home through a notice, but because no official guardian could be appointed, she had practically been abandoned to her fate.

Assessment and Intervention

 During her general status assessment, the project team observed M.S. to be asleep, her living space to be dirty with rotten bread, stool in a bag, and some money brought by her tenants next to her bed.

M.S.’s health data were reported as follows

:- Blood pressure: 90/60 mmHg

- Fasting Blood Glucose: 53 mg/dL

- Pulse rate: 64 bpm

- Sats: 90 mmHg

Grade 2 pressure sores were detected on the hips and elbows due to long-term bed dependence. A significant decrease in daily living activities was observed, and the patient’s first intervention involved her being given a glass of sugar water, a bed bath, and wound care and dressing and her living area was cleaned. Due to the unusable condition of the patient’s kitchen and the risk of infection, soup was brought from a restaurant, and the team helped the patient eat.

Social Services and Legal Aspects

 This section discusses the legal and social services aspects encountered while placing M.S. in a care center. During the interviews with the Eğirdir District Social Service Centre, M.S. was inadmissible to the care center due to the lack of her own consent and the absence of a guardian. However, Article 83 of Social Service Law No. 2828 emphasizes the responsibilities mukhtars (village headmen) and other individuals have to notify about persons in need of protection and care. As a result, M.S.’s consent was obtained, and the placement process was initiated.

According to the Regulation on Nursing Homes and Elderly Care and Rehabilitation Centers (Official Gazette No. 24325, February 21, 2001), older individuals in emergency situations can be admitted with the approval of the local administrative authority. Accordingly, M.S. was first placed in a health institution and then in a care center. During this process, gerontologists holistically assessed her health and social and environmental needs and developed a sustainable care plan. Gerontologists also facilitated her placement in the care center by providing information and support about the legal processes.

Such interventions aim to improve the quality of life of older individuals by taking into account their needs in all areas of life. The role of gerontologists is critical in the planning and implementation of care processes. 

Discussion and Conclusion

 Loneliness and lack of care in old age can create serious problems at both the individual and social levels. The case of M.S. provides a concrete example of how these issues can turn into larger problems. Complications due to late intervention, especially dehydration and malnutrition leading to loss of consciousness, worsened the effects of social isolation. Social isolation is defined as an individual being disconnected from social connections and having limited social interactions, and this negatively affects older individuals’ social and psychological status.

The consequences of loneliness include health problems, hygiene deficiencies, and malnutrition. Hygiene issues for older persons who live alone can negatively affect their general health by increasing the risk of infection. Similarly, malnutrition can lead to a weakened immune system and increased health problems. These situations both reduce their quality of life and create an additional burden on the health system.

The case of M.S. illustrates the consequences of lack of care and late intervention. The legal and social service problems encountered during her care process at the center disrupted her care services for reasons such as lack of consent and lack of a guardian. However, legal regulations have been enacted on admitting older individuals to care  centers in emergency situations. During this process, gerontologists created an effective care plan by holistically assessing her health and social needs.

The study emphasizes the importance of care needs and social services in old age and draws attention to the need for early intervention systems for high-risk individuals. The case of M.S. shows that the effectiveness of social services should be increased and that the timely provision of care services directly affects older people’s quality of life.

Society needs to develop stronger social policies and care services to support older persons. Legal barriers and cultural factors such as the refusal to appoint mukhtars as guardians can disrupt care services. To deal with such problems, flexible and holistic approaches should be adopted, and social services and legal regulations should be made more effective.

The case of M.S. demonstrates that meeting one’s care needs in old age in a timely and effective manner contributes to human rights and social solidarity. Improving social services and legal support also plays a critical role in improving older individuals’ quality of life.