Date of Project Completion

Spring 2-23-2021

Document Type

Project Paper

Degree Name

Doctor of Nursing Practice



First Advisor

Julie Ponto


Purpose and Rationale

The aim of the evidence-based practice (EBP) project is to improve psychological outcomes for socially isolated older adults enrolled in a Homebound Program (HP) through the implementation of an EBP intervention. Social isolation has a multitude of negative consequences, including impacting the psychological health (e.g. depression, loneliness, anxiety) of the older adult population.

Synthesis of Evidence

Meta-analyses, systematic reviews, and randomized controlled trials addressing the clinical problem of social isolation were identified. Through critical appraisal of the evidence, physical activity, psychotherapy, and socialization interventions have shown to decrease depression and loneliness in older adults. There were mixed findings of these interventions effect on anxiety.

Practice Change and Implementation Strategies

Based on the evidence, four interventions were proposed to the project team (a) reminiscent therapy, (b) physical activity, (c) cognitive behavioral therapy, and (d) mindfulness. After further evaluation of the utility and feasibility of each intervention, the two proposed interventions for implementation are reminiscent therapy and mindfulness. The Iowa EBP Model will be utilized for successful implementation.


Three outcome measures of interest will be examined. The primary outcome of loneliness will be measured with the Three-Item UCLA Loneliness Scale. Secondary outcomes include depression (GDS-15) and anxiety (GAD-7). Data collection will take place at baseline and post intervention.

Conclusions and Implications for Practice

Social isolation is a significant clinical problem impacting many older adults. HP patients are at increased risk as a result of their homebound status and risk for severe COVID-19 disease. Evidence supports the effectiveness of reminiscent therapy and mindfulness in reducing the psychosocial outcomes of social isolation. The quality improvement project aims to address psychological outcomes of social isolation, while considering feasibility and sustainability of such interventions in the HP practice.


Molly DiTomasso DNP, AGPCNP-BC was a crucial part of the development of this project, acting as the DNP mentor who guided the DNP students through the HP practice.