Social Withdrawal and Dementia

As human beings, socialization is a vital part of our existence. Numerous studies have shown the importance of connecting with others and engaging in activities that keep us both mentally and physically stimulated.  According to the Centers for Disease Control and Prevention (CDC) Social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity. Social isolation was associated with about a 50% increased risk of dementia.

For people living with dementia, social withdrawal and isolation is extremely common and should be addressed whenever possible. To the untrained care partner, this is often simply considered part of the disease process and is therefore often accepted as normal. However, allowing a person to become isolated and withdrawn may speed the cognitive decline and cause other problematic expressions such as hallucinations, wandering, anxiety, and repetition. 

In this article, we will help care partners to identify signs of social withdrawal and offer some tips on things that can be done to help these individuals live a more fulfilled and enjoyable life. 

A few clues that a person may be withdrawing may include:

• Avoiding social situations: Individuals who are socially withdrawn may actively avoid social situations, events, or gatherings. They may make excuses not to attend or become isolated from others.
• Spending excessive time alone: Those who are socially withdrawn may spend a significant amount of time alone and may seem to prefer their own company over that of others.
• Lack of interest in social activities: Individuals who are socially withdrawn may show little interest in participating in social activities or may not enjoy participating in social activities. Of particular note is the reduced interest in activities that were formerly a big part of the individual’s life. 
• Limited social interactions: Those who are socially withdrawn may have limited social interactions with others, including family, friends, or coworkers.
• Reduced communication: Individuals may have reduced communication with others.
• Appearing disinterested or detached: Individuals may seem disinterested or detached when engaging with others, showing little emotion or engagement in conversations.

It is important to note that social withdrawal can sometimes be a sign of a mental health condition, such as depression, anxiety, or trauma. It can also be a sign of physical decline such as cardiovascular health, vision and hearing loss. Therefore, it is important to approach individuals who display social withdrawal with empathy and care, and consider speaking with a mental health professional and the person’s primary physician  if necessary.

Additionally, it is important to note that social withdrawal can also be caused by the progression of dementia itself. Individuals may become more withdrawn, have difficulty remembering people and places, and have a decreased ability to communicate. 

Below are few things to consider: 

• While it is easy to simply blame the isolation or withdrawal on the cognitive impairment, there may be root causes for their action. Could the person be bored, could they have a physical ailment but are simply unable to communicate the issue.
• If there is a history of depression or other mental health concerns, make sure the individual is taking their medication as prescribed.
• Helping a person living with dementia to participate in activities is a skill. Simply asking or suggesting may not work. Learn how to “Sell” the activity.  Ask the person living with dementia to “help you”, they will be less likely to say “no” when presented in this manner.  Provide purposeful and meaningful activities that match the person’s interests, abilities and strengths.

Steps you can take: 

Managing social withdrawal in individuals with dementia can help improve their quality of life and overall well-being. Here are some strategies that may be helpful:

• Encourage social engagement: Encourage individuals living with dementia to participate in social activities that they enjoy. It is important to always remember that the individual living with dementia has a physical illness on the inside. Their brain is dying and if frontal lobe damage has occurred, it can cause a loss in initiative. Just getting the individual started is often the biggest challenge. Once engagement begins, there is often no further assistance needed.Activities could include spending time with family and friends, attending religious or community events, or participating in recreational activities. Music and dance are great tools when trying to encourage engagement. Music sits in a part of the brain that seems to be unaffected by dementia until very, very late in the process. Find music they like and sing along.
• Create a safe and supportive environment: Individuals living with dementia may feel overwhelmed or anxious in social situations, so it is important to create a safe and supportive environment that helps them feel comfortable and at ease. This may include minimizing distractions and noise, providing familiar objects and photos, and using calming music or aromatherapy.
• Provide social cues and prompts: Using cues such as large calendars, pictures and signs can help to trigger reminders of activities.
• Modify social activities: Individuals living with dementia may have difficulty with certain activities, so modifying activities to better suit their abilities can be helpful. For example, simplifying games or activities or providing step-by-step instructions can help them participate in social activities and feel more engaged.  Ask a dementia specialist or recreation therapist to assist in adaptations of favorite activities.
• Provide emotional support: Individuals living with dementia may feel isolated or withdrawn due to changes in their cognitive function and behavior. Providing emotional support and reassurance can help them feel valued and included. Additionally, it is important to acknowledge their feelings and listen to their concerns and needs.  Be aware of non-verbal cues and behavioral expressions that suggest unmet needs.
• Consider review of medications: Never adjust medications without the assistance of a knowledgeable healthcare professional. Some medications such as antipsychotics may influence the way a person acts, including social withdrawal. Make sure to work with a healthcare professional who understands the affects certain medications can have on a person living with dementia. 

Overall, managing social withdrawal in individuals with dementia requires a person-centered and individualized approach that addresses their unique needs and preferences. With patience, empathy, and support, individuals with dementia can maintain social connections and a sense of purpose and meaning in their lives.