# Situation: The public health nurse of a municipality leads the health program for older persons in a farming barangay, working with the barangay health workers (BHWs) and the senior citizens' association. A 78-year-old widow who lives alone has stopped going to church and seldom talks to her neighbors. She says she feels lonely. Her depression screen is negative, and she is independent in daily activities. Which intervention is BEST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627072  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse of a municipality leads the health program for older persons in a farming barangay, working with the barangay health workers (BHWs) and the senior citizens' association.

A 78-year-old widow who lives alone has stopped going to church and seldom talks to her neighbors. She says she feels lonely. Her depression screen is negative, and she is independent in daily activities. Which intervention is BEST?

## 보기

1. Schedule monthly home visits by the nurse to check her blood pressure
2. Advise her to move to a home for the aged where staff can watch her
3. Refer her to the municipal health officer for medication evaluation
4. Link her to the seniors' association and arrange peer visits **✔ 정답**

**정답: 4**

## 해설

Her problem is social isolation, not illness or dependency. The most direct intervention is to build social connection through the senior citizens' association, peer visiting, and regular contact, while her health continues to be monitored. This also supports her independence and social participation, which are aims of healthy ageing.

## 심화 해설

Core clinical picture

This client is a 78-year-old widow who lives alone, has withdrawn from church and neighbor contact, and reports feeling lonely. Her depression screen is negative and she remains independent in ADLs. The problem is therefore social isolation with subjective loneliness, not a mood disorder, functional decline, or unstable medical condition. The best intervention must directly rebuild social connection while preserving her autonomy.

Why option 4 is the best answer

Linking her to the seniors’ association and arranging peer visits targets the actual problem—social disconnection—through structured, community-based social contact. This approach is consistent with healthy ageing principles: it supports participation, maintains independence, and uses existing community resources rather than moving the client or medicalizing a social issue.

Why the other options are less appropriate

| Option | Main limitation |
| --- | --- |
| 1. Monthly BP checks | Addresses physical monitoring, not loneliness; does not build social connection |
| 2. Move to a home for the aged | Premature and restrictive; she is independent and does not require supervised care |
| 3. Medication evaluation | Inappropriate because depression screening is negative; loneliness is not a pharmacologic indication |

Evidence from the literature

A cluster-randomized trial found that a multicomponent intervention using 6 home-based face-to-face sessions intercalated with 5 telephone calls reduced social isolation and loneliness in community-dwelling older adults [1]. This supports the value of repeated, structured social contact delivered in the person’s own environment.

A systematic review and meta-analysis concluded that interventions targeting loneliness in community-living older adults can be effective, although the evidence base has historically been heterogeneous [2]. The key implication is that active social-support interventions—not passive monitoring or relocation—are the appropriate first-line response for loneliness without depression or dependency.

A network meta-analysis of non-pharmacological interventions identified that certain structured approaches produce meaningful reductions in late-life loneliness [3]. While the abstract does not specify a single superior modality, it reinforces that psychosocial and social-participation strategies are the relevant category of intervention for this client.

A rapid review on goal setting for social connection highlights that interventions often incorporate goal setting and goal attainment as components to promote social connection in older adults [4]. This aligns with linking the client to a peer network where she can set small, achievable social goals—such as attending one association activity or receiving one peer visit per week—rather than imposing a care plan on her.

Nursing process application

Key point! The nursing diagnosis is Impaired Social Interaction or Risk for Loneliness, not Ineffective Coping or Depression.

Watch out! A negative depression screen does not mean the loneliness is unimportant—loneliness independently increases morbidity and mortality risk, so it still requires a nursing intervention.

Key point! The intervention should be least restrictive and community-integrated. Peer visits through the seniors’ association preserve autonomy, use existing social infrastructure, and avoid unnecessary institutionalization or medicalization.

Examination focus

For licensure exams, questions like this test whether the candidate can distinguish a social need from a medical or psychiatric need. When a client is independent, has a negative depression screen, and reports loneliness with behavioral withdrawal, the priority is facilitating social connection through community resources and peer support, not referral for medication, relocation, or isolated physical monitoring. The correct answer is the one that directly addresses the stated problem while maintaining the client’s independence and dignity.References (research sources)

- [1]Effectiveness of a multicomponent intervention to reduce social isolation and loneliness in community-dwelling elders: A randomized clinical trial.RCT/clinical trialHernández-Ascanio J, Perula-de Torres LÁ, Rich-Ruiz M, González-Santos J, Mielgo-Ayuso J, González-Bernal J (2023) · DOI: 10.1002/nop2.1277

- [2]Interventions to Reduce Loneliness in Community-Living Older Adults: a Systematic Review and Meta-analysis.Meta-analysis/systematic reviewShekelle PG, Miake-Lye IM, Begashaw MM, Booth MS, Myers B, Lowery N (2024) · DOI: 10.1007/s11606-023-08517-5

- [3]Effects of non-pharmacological interventions on loneliness among community-dwelling older adults: A systematic review, network meta-analysis, and meta-regression.Meta-analysis/systematic reviewYu DS, Li PW, Lin RS, Kee F, Chiu A, Wu W (2023) · DOI: 10.1016/j.ijnurstu.2023.104524

- [4]Supporting goal setting to promote social connection in older adults: a rapid review.Research articleChen P, Fineberg D, Ogrin R. (2026) · DOI: 10.1136/bmjopen-2026-120085

## 임상 시나리오

Community Response to Late-Life LonelinessRebuilding social connection without medicalizing isolation
For an older adult who is independent in ADLs and has a negative depression screen, reported loneliness points to social isolation rather than disease. The priority is to restore social participation through existing community structures.

Link the client to the senior citizens' association and arrange peer visits. This provides structured, face-to-face contact while preserving autonomy and avoiding unnecessary relocation or medication.

CautionDo not move an independent older person to a supervised facility or start medication solely for loneliness. Reserve those steps for functional decline, safety risk, or confirmed depression.

## 핵심 개념

- **Social isolation** — An objective lack of social contacts or interaction with family, friends, or community.
- **Loneliness** — A subjective distressing feeling of being alone or disconnected, which can occur even when others are present.
- **Healthy ageing** — The process of developing and maintaining functional ability that enables well-being in older age, including social participation.
- **Peer support** — Emotional and practical help provided by individuals with shared experiences or backgrounds, often used in community settings.
- **ADLs** — Activities of Daily Living such as bathing, dressing, eating, and mobility; independence in ADLs indicates functional capacity.

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