Spend More Time Outside to Combat COVID Isolation

Quarantine restrictions due to COVID-19 and the resultant isolation have caused a myriad of negative effects, especially on the elderly who are dependent on others for both mental and physical support.

The year 2020 brought about not only a staggering death toll across the world due to COVID-19, but also “a year of accelerated unraveling” for fragile older adults living with dementia, according to a Feb. 21 report in the New York Times Sunday Review.

Quarantine restrictions limiting family visits except through windows, social distancing prohibiting congregate meals and physical contact, a lack of re-orienting routines such as physical and mental exercises and exposure to the arts, in addition to keeping people locked in their rooms, likely caused an uptick of emotional and physical problems, including agitation, depression, de-conditioning, and overall failure to thrive.

Tanya Carey, education and Eden coordinator at the Windsor Elms Village in Falmouth, Nova Scotia, observed an increase in challenging behaviors in residents when the home was in strict lockdown at the beginning of the pandemic. “Residents were not able to walk throughout the home and burn off energy,” she said. “There was little spontaneity.”

The residents missed their families and pet therapy. Previous group activities became one-on-one visits with little to no interaction among residents. The garden was no longer used for fun or a place of solace.” Stacey Flint, Montessori community relations coordinator of WindSong Memory Care Communities in Oregon, Washington, and Colorado, noted “significant challenges to adhering to strict lockdown, including more dehydration and weight loss in residents.”

Mental and physical problems also can occur in socially isolated adults living in their homes. The U.S. Centers for Disease Control and Prevention website cites evidence that isolation is associated with a 50 percent increased risk of dementia and other serious medical conditions in community-dwelling older adults.

Antidotes to loneliness and isolation and strategies to increase resilience during the current pandemic have been challenging for adults of all ages, regardless of where they live. Researchers from Spain, Saudi Arabia, the United Kingdom, Norway, and Austria recently revealed evidence for a powerful mental health intervention that is free and readily available to most: contact with nature.

The study found that increasing contact with blue-green spaces in nature was associated with mitigating the negative impacts of COVID isolation, increasing individuals’ resilience, and maintaining positive mental health. Access to private outdoor spaces such as a garden or patio were perceived as most beneficial. The results, published in the November Science of the Total Environment journal, were based on more than 5,000 responses from adults age 26 to over 65 in nine countries during lockdown from the pandemic.

increasing contact with blue-green spaces in nature was associated with mitigating the negative impacts of social isolation

Scientific evidence that spending time outdoors can improve wellbeing is not new. In an email interview, Richard Louv, author of books such as The Nature Principle, Vitamin N, and Our Wild Calling, said there was a paucity of solid studies 15 years ago about the benefits of nature. But the Children & Nature Network that he co-founded in 2006 has compiled a library with summaries of more than 1,000 studies and reports on nature’s impact on children and adults.

Architect Margaret Calkins, PhD, EDAC, FGSA, a nationally recognized trainer and researcher in the field of environments for elders, recently wrote a white paper, Designing Gardens to Attract Activity, to convince administrators, healthcare providers, family members and older adults living in residential homes of the benefits of spaces that help residents get outside regularly.

She cited evidence that individuals in residential settings who go outdoors regularly exhibit less depression. Time spent outdoors reduces stress in nursing home staff as well. Calkins reviewed a horticulture study of older adults in a three-month program of passive and active gardening activities. Depression was reduced and remained lower three months after the program ended. Additional improvements included quality of sleep and ability to concentrate.

Marsha Stamm Gayl, a registered horticultural therapist with a private practice north of Philadelphia, said she conducted nature-based activities for the past nine years in 20 long-term care facilities, working with approximately 200 individuals per month. Beginning in March 2020, she was not allowed into the facilities. “Most long-term care facilities are not allowing their residents to even leave their rooms at this time, let alone be outside in a secure location,” Gayl said. “A lot of it has to do with staffing and the idea that lockdown is interpreted as isolation from the outside, including the outdoors even on their own campus.”

According to Calkins, “There is clear evidence that people are at lower risk of infection when spending time outdoors, practicing social distancing and wearing masks than when following the same precautions indoors. The movement of fresh air dramatically dissipates the density of the number of particles, reducing the risk of infection.”

Susan Rebillet, PhD, who provides psychotherapy for long-term care patients in Dallas, said nature exposure is not encouraged in the facility where she works. “All of the rooms have a view of some sort but because the home is in an urban area, few trees are visible. There is a courtyard with plantings which residents can view but not spend time there due to COVID.”

Pivoting During the Pandemic

Some residential homes have found creative ways to encourage contact with nature during the pandemic, including the Montessori-based communities where Flint works. Residents received individual bucket gardens to tend. For those unable to go outdoors, the buckets are brought to their rooms so they can smell, touch, and feel the plants. The facilities also have enclosed courtyards with planter beds, with two people assigned per planter, and held balance classes in the courtyards in good weather.

Last spring, residents planted flowers in ceramic pots they painted to sell in a drive-through event as a fundraiser. Daily outdoor walking groups are allowed, with social distancing enforced, as well as occasional food truck meals outdoors. The facilities also had outdoor seating for art activities and residents could build snowmen in the winter. Visits to parks and pet therapy still are not allowed, but staff brought their own dogs into the facility for visits.

The Windsor Elms Village in Nova Scotia brought nature indoors prior to the pandemic, with live plants placed throughout the home and a cat and budgie bird (aka parakeet) taking up residence in different homes. Therapy pets still are not allowed, but the home allows family pets during visits.

Resources for Increasing Access to Nature

Susan Rodiek, PhD, professor emerita in the Department of Architecture at Texas A&M University and an expert in therapeutic design for senior living facilities, said three factors make it more likely older adults will access nature:

  1. An outdoor area with easy-to-open doors and thresholds that are easy to cross.
  2. Comfortable seating.
  3. Heaters in winter and devices to reduce humidity in hot weather.

Rodiek created a three-DVD set, Access to Nature, Planning Outdoor Space for Aging, to help providers, policymakers, designers, and advocates create healthy, inviting outdoor environments for seniors in residential settings. She recommends the Seniors’ Outdoor Survey tool as an easy way to evaluate outdoor areas. Based on residents’ preferences and usage, it can help residential care home staff decide what to install or improve. It is free to download through the website: http://accesstonature.org/resources.html

Nature’s Healing Impact

Widow Virginia Davis, who moved from her Ohio home to a retirement community in New Mexico nine months before the pandemic, participated in a virtual expressive writing workshop last fall. On Zoom, she described severe loneliness because she could not visit with new friends due to lockdowns. But, she said, nature got her through. “I coped with the COVID isolation by going out on my balcony every evening to watch the Albuquerque sunset followed by the starry night sky. Without the beauty and constancy of nature, I could not have managed,” she said.


This article is an excerpt from the online continuing education (CE) course:

Therapy Tidbits – Spring 2021 is a 1-hour online continuing education (CE) course comprised of select articles from the Spring 2021 issue of The National Psychologist, a private, independent, quarterly newspaper intended to keep psychologists informed about practice issues.

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. Professional Development Resources maintains responsibility for this program and its content. Professional Development Resources is also approved by the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the Continuing Education Board of the American Speech-Language-Hearing Association (ASHA Provider #AAUM); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Arizona Board of Occupational Therapy Examiners; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Georgia State Board of Occupational Therapy; the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors (#MHC-0135); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678); and is CE Broker compliant (all courses are reported within a few days of completion).

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Social Isolation Concerns Amid COVID-19

The psychological effects of a pandemic are widespread. From the expected anxiety, fear, and uncertainty of not knowing how long the pandemic will last, or how damaging it will be, to the challenges of coping with social, vocational, and economic shifts, people’s lives have broadly been affected. Adding to this, social isolation removes the typical psychological resources that we expect during times of crisis and can lead to physical challenges which, of course, influence psychological functioning.

Social isolation removes the typical psychological resources that we expect during times of crisis, so be sure to check in on loved ones.

Humans, like all mammals, are meant to be social. Removing this fundamental component of life, not surprisingly, leads to many debilitating effects on mental health. In humans, it is often associated with post-traumatic stress disorder and depression – two outcomes that can be argued are related to an overly reactive alert system, feelings of lack of safety, and ultimately, adrenal exhaustion.

The Lancet published a review in February 2020 of 24 studies documenting the psychological impact of quarantine, offering a glimpse into what has been brewing in hundreds of millions of households around the world.

The review found that people who are quarantined are highly likely to develop a wide range of psychological symptoms, including low mood, insomnia, stress, anxiety, anger, irritability, emotional exhaustion, depression and post-traumatic stress symptoms. Low mood and irritability specifically stood out as being “very common.”

In cases where parents were quarantined with children, the mental health toll became even steeper. In one study, no less than 28% of quarantined parents warranted a diagnosis of “trauma-related mental health disorder.”

Among quarantined hospital staff, having been quarantined was the factor most predictive of symptoms of acute stress disorder and “quarantined staff were significantly more likely to report exhaustion, detachment from others, anxiety when dealing with febrile patients, irritability, insomnia, poor concentration and indecisiveness, deteriorating work performance, and reluctance to work or consideration of resignation.” It is also noteworthy that “health-care workers who had been quarantined had more severe symptoms of post-traumatic stress than members of the general public who had been quarantined, scoring significantly higher on all dimensions.”

It is this lack of interpersonal connection that should be considered as a mortality risk factor, much like physical inactivity, smoking, obesity, and lack of healthcare access. Research presented at the 125th Annual Convention of the American Psychological Association found that loneliness and social isolation may now represent a greater public health hazard than obesity.

With the increase in social isolation and loneliness during this time, it’s more important than ever to check in our friends and loved ones, however we can – a quick phone call, video chat, dropping off food, etc. We need to look out for one another. 🙂

Course excerpt from:

COVID-19: Picking Up the Pieces is a 2-hour online continuing education (CE) course that examines the effects of the pandemic and the challenges we face moving forward.

This course will discuss the many aspects of COVID-19 that have affected us all, physically, psychologically, and economically. It will begin with a discussion of what pandemics are, and what differentiates COVID-19 from previous pandemics. We will then turn our attention to the psychological effects of a pandemic – from anxiety, fear, and uncertainty, economic and vocational challenges, to social isolation and the physical challenges that further compromise psychological adjustment. We will then look at the effects of starting over – from re-entry and reorganization to chronic anxiety, triggering, and even the stigma of being infected by or exposed to the virus.

Next, we will explore the ways in which the clinician can help the client. We will learn how shifting the client’s attitude toward adversity, introducing them to post-traumatic growth, and encouraging insight and reflection can promote psychological growth, even in times of psychological distress. The last section of this course consists of specific exercises the clinician can use with the client coping with COVID-19. Course #21-42 | 2020 | 39 pages | 15 posttest questions

Click here to learn more.


Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. Professional Development Resources maintains responsibility for this program and its content. Professional Development Resources is also approved by the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Georgia State Board of Occupational Therapy; the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors (#MHC-0135); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678); and is CE Broker compliant (all courses are reported within a few days of completion).

Enjoy 20% off all online continuing education (CE/CEU) courses @pdresources.orgClick here for details.

Earn CE Wherever YOU Love to Be!

The Psychological Effects of Social Isolation

Increased aggressiveness towards unfamiliar others, persistent fear, and hypersensitivity to threatening stimuli. These are some of the effects of social isolation described in a study done by Moriel Zelikowsky and colleagues at the California Institute of Technology (Zelikowsky et al., 2018).

Social Isolation

In another meta-analysis done at University of Surrey and Brunel University London, researchers found that social isolation could be linked to increased inflammation in the body (Smith et al., 2020).

As Kimberley Smith, a lecturer in Health Psychology at the University of Surrey, explains, “Loneliness and social isolation have been shown to increase our risk of poorer health. Many researchers propose that part of the reason for this is because they influence the body’s inflammatory response.”

Another study found that social isolation is linked to increased risk of mortality (Alcaraz et al., 2018).

Social isolation, while it might have been something we spoke about rather infrequently in the past, now seems like it is a new normal. It is necessary. We need to do everything we can to stop the spread of the coronavirus, COVID-19.

But just how this affects us mentally and physically is another matter altogether. While it is important to stop the spread of the coronavirus, social isolation is not good for our health – mentally or physically. And even before quarantine orders were put in place, social isolation was a growing problem. In the United States, for example, about half of people older than 85 live alone, and decreased mobility or ability to drive may cut opportunities for other socialization (Brown et al., 2017).

Social Isolation is a “Silent Killer”

Moreover, during a U.S. Senate hearing on aging issues in the spring of 2018, a representative for the Gerontological Society of America urged lawmakers to support programs that help older adults stay connected to their communities, stating that social isolation is a “silent killer that places people at higher risk for a variety of poor health outcomes.”

Now, more than ever, the effects of social isolation will be felt, and more so by those already at risk, as the coronavirus is much more deadly to the elderly population.

There is hope, however. In a study that appeared in the American Journal of Epidemiology, in 2018, the authors concluded that most detrimental were “the lack of interpersonal connections.” When people were able to develop and maintain more interpersonal connections – remotely or otherwise – the effects of social isolation were not nearly as powerful (Alcaraz et al., 2018).

So where does this leave us? Now, more than ever, is the time to pick up the phone, send an email, text, or message, reach out, and stay connected. Your brain and body will thank you.

Related Online Continuing Education (CE) Courses:

Managing Anger & Aggressive Behavior is a 3-hour online continuing education (CE) course that provides strategies for dealing with anger and aggression in clinical practice. Click here to learn more.

Psychological Effects of Media Exposure is a 2-hour online continuing education (CE/CEU) course that explores the psychological effects that media exposure has on both the witnesses and victims of traumatic events. Click here to learn more.

Psychological Effects of Ostracism is a 2-hour online continuing education (CE/CEU) course that explores the effects of ostracism and social exclusion in both children and adults – in the real world, and online. Click here to learn more.

Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Georgia State Board of Occupational Therapy; the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors (#MHC-0135); the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

Professional Development Resources is approved by the American Psychological Association to sponsor continuing education for psychologists. Professional Development Resources maintains responsibility for this program and its content.

PDR offers over 150 accredited online CE courses for healthcare professionals. 

Target AudiencePsychologistsSchool PsychologistsCounselorsSocial WorkersMarriage & Family Therapists (MFTs)Speech-Language Pathologists (SLPs)Occupational Therapists (OTs)Registered Dietitian Nutritionists (RDNs), and Teachers

Enjoy 20% off all online continuing education (CE/CEU) courses @pdresources.orgClick here for details.

Earn CE Wherever YOU Love to Be!