Scoping Review of the Literature Social Isolation of Seniors 2013-2014

Risk factors

The literature confirms that a variety of risk factors increase the likelihood of seniors becoming socially isolated. These have been grouped under five themes: life transitions, economics, health/mental health, caregiving and social.

Life transitions

Critical life transitions such as retirement (Hall et al., 2003; Winningham & Pike, 2007; Cotten, Anderson & McCullough, 2013), death of a spouse (North Sky Consulting Group Ltd., 2013; O’Luanaigh & Lawlor, 2008; Cloutier-Fisher et al., 2006; Wenger & Burholt, 2004; Stewart, Craig, MacPherson & Alexander, 2001; Hall et al., 2003; AQCCA, 2007; Truchon, 2012), inability to drive (Winningham & Pike, 2007), or moving to a long term care facility or other residence (Winningham & Pike, 2007; Cotten et al., 2013) increase the risk of becoming socially isolated (Keefe et al., 2006). Changing family structures, such as younger family members migrating for work, and smaller social networks in later-life also have an impact on social isolation (Keefe et al., 2006; Butler, 2006; AQCCA, 2012; Cotten et al., 2013). The more critical life transitions and associated risk factors seniors face, the more likely they are to experience episodic or chronic social isolation.

Economic

Economic factors, such as living with low income (North Sky Consulting Group Ltd., 2013; Raymond, Gagné, Sévigny, & Tourigny, 2008; Truchon, 2011; Truchon, 2012), lacking accessible and affordable transportation options (North Sky Consulting Group Ltd., 2013; Hall et al., 2003; Abbott & Sapsford, 2005; AQCCA, 2007; Raymond et al., 2008; Sherman & Lacarte, 2012), the absence of affordable and suitable housing (Hall et al., 2003), and limited access to primary health care services (Abbott & Sapsford, 2005) to meet the varied needs of seniors are also known risk factors for social isolation. These economic factors may also have a cumulative effect on social isolation, for instance, seniors with low income and living in a rural or remote area with few transportation options may be significantly isolated even if they would like to become more engaged with their local community.

Health and mental health

Studies show that the lack of a good social network is linked to a 60% risk increase in dementia and cognitive decline; while socially-integrated lifestyles protect against dementia (Fratiglioni, Wang, Ericsson, Maytan & Windblad, 2000). It is likely that mental health affects the likelihood of social isolation, and that persons experiencing social isolation are more prone to mental health issues. As many as 44% of seniors living in residential care in Canada have been diagnosed with depression or show symptoms of depression without diagnosis, and men over the age of 80 have among the highest suicide rate of all age groups (Canadian Institute for Health Research, 2010; Public Health Agency of Canada, 2010). Therefore, the link between mental health and social isolation, while complex and likely bi-directional in nature, cannot be ignored.

Similarly, having a compromised health status (Cloutier-Fisher et al., 2006; Paul, Ayis & Ebrahim, 2006; Raymond et al., 2008; AQCCA, 2011; Truchon, 2012; Cotten et al., 2013), whether it is physical (Butler, 2006; Truchon, 2011) or mental health issues (AQCCA, 2007; Truchon, 2011) has been identified as a risk factor for increased social isolation (O’Luanaigh & Lawlor, 2008). Health problems include but are not limited to: dementia, multi-morbidity (Keefe et al., 2006; Hall et al., 2003), addiction (AQCCA, 2007; Truchon, 2011), and vision or hearing issues (Wenger & Burholt, 2004; Hall et al., 2003). Other late onset or age-related disabling conditions, such as incontinence, frailty, fear of falling when going to and from venues, or general loss of independence (AQCCA, 2007) have also been identified as risk factors for social isolation (Ramage-Morin & Gilmour, 2013).

Caregiving

Another group that is at a higher risk of social isolation are seniors who are caregivers for parents, siblings, or other relatives (Sherman & Lacarte, 2012; North Sky Consulting Group Ltd., 2013; O’Luanaigh & Lawlor, 2008). High levels of caregiving, especially when providing long hours and/or intensive caregiving to someone with significant physical and/or mental challenges, can result in disconnecting from others, and can result in caregiver burden, stress, and depression, all of which are associated with social isolation (Cloutier-Fisher et al., 2006; MacCourt, 2007).

Social

Specific groups of seniors were also identified as being at greater risk of social isolation, such as Aboriginal seniors (Health Canada, 2009), seniors who are newcomers to Canada or immigrant seniors, especially those with language barriers, seniors who are caregivers (Wenger & Burholt, 2004; MacCourt, 2007; Cotten et al., 2013), as well as lesbian, gay, bisexual or transgendered seniors (Guasp, 2011).

Older immigrants (Cloutier-Fisher et al., 2006; Senate Committee on Social Affairs, Science and Technology, 2013; Li, 2010; Truchon, 2011; Social Planning and Research Council of British Columbia, 2011), minority groups and lower income seniors, such as older women living alone (Senate Committee on Social Affairs, Science and Technology, 2013; Truchon, 2011), experience higher risks of loneliness and limited social interaction for a number of reasons, such as language barriers (Li, 2010; Truchon, 2011), literacy, discrimination, lack of sense of community and limited social interactions in their new communities (North Sky Consulting Group Ltd., 2013). Aboriginal seniors face similar issues including language and cultural barriers, socio-economic disadvantages and regional differences, such as living in rural or remote areas (Health Canada, 2009; Cotten et al., 2013).

As per a report published by the Stonewall organization in the UK, older lesbian, gay and bisexual people, when compared to heterosexual groups, are more likely to be single, live alone, have a smaller social network, see their family less frequently, drink more alcohol and are more likely to take drugs, have a history of mental illness, and have more barriers to accessing necessary health care (Guasp, 2011). As these factors are associated with social isolation, older lesbian, gay and bisexual people are more at risk of becoming socially isolated (Guasp, 2011; Truchon, 2011).

Living alone, increasing age (Keefe et al., 2006; Wenger & Burholt, 2004), low education (Cloutier-Fisher et al., 2006; Raymond et al., 2008), rural vs urban living (Raymond et al., 2008), ageism (Truchon, 2011) as well as having no children or limited contact with family (Wenger & Burholt, 2004) have also been identified as factors that increase risks of social isolation. Some older adults also fear leaving their dwelling because of concerns of physical safety in public places due to higher crime rate or perceived higher crime rate (Abbott & Sapsford, 2005; Sherman & Lacarte, 2012), lack of information or awareness to access community services and programs (Raymond et al., 2008; AQCCA, 2011) or being reluctant to form new relationships, or not wanting to go alone to activities (North Sky Consulting Group Ltd., 2013; Gilmour, 2012).

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