Report on the Social Isolation of Seniors
The Impact of Social Isolation on Seniors’ Quality of Life and Well-being
The social isolation of seniors can cause communities to suffer a lack of social cohesion, higher social costs, and the loss of an unquantifiable wealth of experience that older adults bring to our families, neighbourhoods and communities.
Socially isolated seniors are less able to participate and contribute to their communitiesFootnote 7 . Yet seniors benefitFootnote 8 from volunteering and participating in their communities due to a sense of satisfaction and efficacy, and communities benefit from the services and social capital seniors are providing. A decrease in contributions by seniors is a significant loss to organizations, communities and society at large.
Social isolation can result in reduced social skills. For example, seniors “who develop depression, social anxiety, loneliness, alcoholism, and schizophrenia tend to become socially isolated and uncomfortable around other people. This leads to an atrophy of social skills, partly because of disuse, and partly because of the way that psychological symptoms can disrupt social behaviourFootnote 9.”
Social isolation is considered a risk factor for elder abuseFootnote 10 , including financial abuseFootnote 11 , and may increase fear of crime and theftFootnote 12 ; thus making seniors even less likely to participate in social activitiesFootnote 13.
Furthermore, there is a substantial amount of evidence that describes the relationship between health and social isolation. A senior’s social network can positively influence good health behaviours such as successful smoking cessation or remaining active.
Conversely, socially isolated seniors are more at risk of negative health behaviours including drinking, smoking, being sedentary and not eating well; have a higher likelihood of falls; and, have a four-to-five times greater risk of hospitalization. Research also indicates that social isolation is a predictor of mortality from coronary heart disease/strokeFootnote 14.
Disabilities can further marginalize. According to the 2013 Canadian Survey on Disability, just over a third of Canadians aged 65 and older are living with a disability (rising from 26.3% among individuals aged 65 to 74 to 42.5% among individuals aged 75 and olderFootnote 15). Furthermore, many older adults have to cope with two or more chronic illnesses (multimorbitityFootnote 16): approximately 29.8% of adults 65 to 79 years old and 37.5% of adults 80 years or older report having two or more chronic conditionsFootnote 17.
Social isolation also affects the psychological and cognitive health of seniors. It is associated with higher levels of depression and suicideFootnote 18. According to research, 1 in 4 seniors lives with a mental health problem (e.g. depression, anxiety or dementia) or illnessFootnote 19, and 10 to 15% of adults 65 years or older and living in the community suffer from depression. The percentage of seniors in residential care who have been diagnosed with depression or showed symptoms of depression without diagnosis is higher at 44%. Approximately 50% of people over the age of 80 report feeling lonely; men over the age of 80 have the highest suicide rate of all age groups.
Respondents to the online consultation noted that mental health contributes to social isolation and has an impact on the individual’s quality of life. More specifically, respondents expressed that social isolation increases the risk of developing mental health issues, has an impact on the person’s self-esteem and confidence, which decreases their connection with the community and inhibits them from accessing health care services, thus perpetuating isolation.
Factors Increasing the Risk of Seniors Becoming Socially Isolated, Including Critical Life Transitions
Understanding how seniors become or remain isolated is key to the Council’s reflection. The literature confirms that there is a variety of risk factors that increase the possibility of seniors becoming socially isolated. These include, but are not limited to the following:
- living alone;
- being age 80 or older;
- having compromised health status, including having multiple chronic health problems;
- having no children or contact with family;
- lacking access to transportation;
- living with low income; and,
- changing family structures, younger people migrating for work and leaving seniors behind, and location of residence (e.g. urban, rural and remote).
Critical life transitions such as retirement, death of a spouse, or losing a driver’s license further increase the risk of becoming socially isolatedFootnote 20. The more risk factors seniors face, the more likely they are to be isolated.
The Council solicited the views of stakeholders and seniors to identify some of the most common risk factorsFootnote 21. They were as follows:
- lack of awareness of or access to community services and programs;
- fear, stigma or ageist attitudes (internal and external) that prevent seniors from accessing community services/programs or being socially active in their community;
- lack of accessible and affordable transportation options was mentioned in all regional roundtables as one of the most important issues;
- lack of affordable and suitable housing and care options to meet the varied needs of older adults;
- loss of sense of community;
- lifelong health issues including disabilities;
- late onset or age-related disabling conditions such as incontinence or fear of falling when going to and from venues;
- challenges relating to technology – including access and costs, literacy and comfort with technologies including telephone systems (press “1” for service, etc.), computers, social media, as well as others (e.g. parking meters); and,
- life transitions (death of a spouse, move to long term care facilities or other residence, loss of driver’s licence, etc.).
Specific groups of seniors were also identified as being at greater risk of social isolation, such as:
- seniors with physical and mental health issues (including older adults with Alzheimer’s disease or other related dementia, or multiple chronic illnesses);
- low income seniors;
- seniors who are caregivers;
- Aboriginal seniors;
- seniors who are newcomers to Canada or immigrant seniors (language proficiency issues, separation from family, financial dependence on children, low levels of inter-ethnic contacts, discrimination); and,
- lesbian, gay, bisexual or transgendered seniors.
As many as 44% of seniors living in residential care in CanadaFootnote 22 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 groupsFootnote 23. Therefore, the link between mental health and social isolation cannot be ignored.
Similarly, studies show that the lack of a supportive social network is linked to a 60% increase in the risk of dementia and cognitive decline; while socially-integrated lifestyles protect against dementiaFootnote 24.
In sum, social isolation can have a number of deleterious consequences for seniors that are often difficult to separate from the underlying risk factors associated with isolation. The results of this association can be the development of self-reinforcing and reciprocal patterns of social isolation.
Preventing and/or Reducing Social Isolation of Seniors
Each consultation method used (i.e. regional roundtables, bilateral meetings, online consultation and the national roundtable) was distinct and made a unique contribution to the National Seniors Council’s understanding of the topic. Many of the discussions revolved around what is currently available for seniors and what further measures could be implemented to prevent and/or reduce social isolation.
The following provides an overview of major themes that emerged. Current innovative practices and promising approaches identified by participants have been highlighted using boxes throughout this section.
Societal Awareness and Research
Ageism – The need to dispel myths associated with aging was discussed at each roundtable and continues to be a fundamental issue addressed by the NSC in relation to all of its priority areas. Stereotypes that portray older adults as either weak and frail or extremely vibrant and engaged were cited as inhibitors.
Community environment – Participants in each roundtable were concerned about the link between the social isolation of older adults (particularly those over the age of 65) and fundamental shifts in neighbourhood and community values over the last decades. There was general agreement on the need to recreate a sense of community to encourage interactions and connections among neighbours and the larger community.
Dementia – Seniors report that when their friends learn of a dementia diagnosis, their circle of friends shrinks. While stakeholders discussed anecdotally the effects dementia has on the social interactions of the individual and of their spouse, they also stated there was a need to better understand the causes and social consequences of dementia. Caregivers for individuals diagnosed with dementia are also at risk of social isolation, due to the competing demands of caregiving, work, and other duties.
The Alzheimer Societies of Canada delivers the First Link program which is an early intervention service designed to connect individuals and families affected by Alzheimer's disease or another dementia with services and support as soon as possible after diagnosis. Formal referral from physicians and health professionals allows for proactive contact with individuals and families. First Link ensures that individuals and families are connected early for support throughout their journey. (National)
Intergenerational Relations – Participants made parallels between the social isolation of seniors and that of youth who may be bullied or harassed by others. Intergenerational programming was proposed as a useful approach to help both generations break isolation together.
REACH (Regina Education and Action on Child Hunger) and Street Culture Youth have a partnership to provide delivery service and a REACH food security program for seniors. Street Culture Youth who are learning the job of courier are paid to deliver frozen meals, fresh produce, bread, eggs and other staples to seniors. Seniors receive meals and have a short conversation with youth couriers. The initiative is receiving good feedback from seniors and the couriers are encouraged to call REACH if one of the seniors where they delivered a meal seems unwell. The program helps build respect between seniors and youth. (Saskatchewan)
Leadership on Loneliness – The distinction between social isolation and loneliness was raised in many of the regional roundtables. Social isolation was defined by participants as low quantity and quality of contact with others while loneliness was defined as being more subjective in nature (i.e. rooted in the individual’s perception of the quality of contact).
The Campaign to End Loneliness is a network of over 600 national, regional and local organizations, and people working together through community action, good practice, research and policy to create the right conditions to reduce loneliness in later life in the United Kingdom. Launched in 2011, the network is led by five partner organizations (Age UK Oxfordshire, Independent Age, Manchester City Council, Royal Voluntary Service and Sense). (United Kingdom)
Life Transitions – Discussions at several roundtables stressed the importance of considering life transitions as triggers for social isolation (e.g. children moving away for work; age-onset health issues, relocation, change of residence, or co-residence (including institutionalization or hospitalization); aging past 80 (shrinking of social network); and declines in physical and mental health (functional decline, reduced capacity and resilience).
Promoting Healthy Aging – Health was identified as a determinant for social isolation, so there are benefits to be had from promoting active and healthy aging. Physical activity, eating well, healthy body weight, moderate drinking, not smoking, reduced stress, and good sleeping habits are some of the important health behaviours deemed important for seniors to maintain a healthy lifestyle as they ageFootnote 25.
Access to Information, Services and Programs for Seniors
Access to Information, Services, and Programs – Participants confirmed that older Canadians find “navigating the system” challenging. Awareness of and access to appropriate information, programs or services were also identified as barriers to inclusion or fulfilling basic social needs.
211 is Canada’s source of information on government and community-based health and social services; its telephone help line (2-1-1) and website help connect people to relevant information and services, and to navigate the complex network of human services quickly and easily. (National)
The www.seniors.gc.ca website is a central resource for seniors, their families, caregivers and supporting service organizations. The site provides information for seniors on federal, provincial, territorial and some municipal government benefits and services, including information on finances, housing, health and wellness.
Seniors.gc.ca highlights federal seniors-related initiatives and supports the Government of Canada's ongoing efforts to encourage seniors to stay active, engaged and informed. The website also provides links to other portals such as the McMaster Optimal Aging Portal, created to share evidence-based knowledge with professionals and the general public. (National)
Outreach, Gatekeeper Programs, and Community Registries – Participants confirmed that a “reactive” approach is currently in place to address the needs of socially isolated individuals, many of whom are not identified or supported until after a crisis. Stakeholders believe that more outreach is required: it is important for front line workers to “knock on doors”Footnote 26. Furthermore, programs are more effective when accessible by including transportation services or setting up shop in areas close to seniors. Innovative partnerships, such as gatekeeper programs, were noted as successful approaches.
Sharing Promising Practices – Service providers stressed the importance of learning from others and promoting knowledge transfer around successful practices and initiatives. Participants also asked for support in fostering connections between agencies, for example through conferences or symposia that would allow practitioners to exchange information and learn from others.
Supports, Community Capacity and Inclusion
Aging in Place – As seniors stay home longer, home care services of all types (meals, friendly visits, home upkeep, repairs, health care, etc.) are in high demand. Participants mentioned the role home care professionals can play in identifying socially isolated seniors by recognizing signs of depression, mental health issues and cognitive decline.
HouseCalls, a unique not-for-profit primary health care program, led collaboratively by Dr. Mark Nowaczynski, Clinical Director, and Sprint Senior Care, Lead Administrative Agency, provides frail and homebound seniors with physician-led, interdisciplinary care at home by a highly integrated interprofessional team. HouseCalls provides ongoing comprehensive home-based primary medical care, as well as occupational therapy, physiotherapy, social work and connections to community support services for seniors living at home with physical, cognitive and social frailties – caring for those whose needs cannot be met through traditional office-based primary care delivery. HouseCalls and its partners also work closely with hospitals and other health care providers to foster client-centred continuity of care, especially during transitions between care providers – hence reducing readmissions, hospitalizations, and long-term care admissions while preserving independence at home. (Ontario)
Collaborations and Social Partnerships – Given the complexity and scope of social isolation, participants expressed interest in collaborative approaches that bring together key players, cluster programs and offer a multi-disciplinary approach.
The Niagara Gatekeepers program has two key tools: a referral phone line and public education. Gatekeepers are members of the community including neighbors, friends, family and front line service workers (such as bank tellers, grocery store clerks, pharmacists, postal workers, newspaper delivery services, etc.) who can identify signs of potential isolation or danger. Anyone in the community can call to help connect “at risk” seniors with programs and services. Referrals to the Niagara Gatekeeper phone line are forwarded to one of the partner agencies who in turn contact the senior and help get services in place to help seniors remain safe and independent at home for as long as possible. The program promotes awareness and referrals through public information sessions and by partnering with front line service businesses and organizations. (Ontario)
Community Programming and Funding – Funding programs were lauded as valuable sources of start-up/seed funding for programs aimed at preventing and alleviating social isolation. Participants also recognized the importance of developing and sustaining innovative services and programs as well as sharing information about successful models to inspire other organizations. There was also broad interest in involving seniors in the development of its policies relating to funding programs and community programming.
The Camp Sunshine Program, by Sunshine Centres for Seniors, provides social, recreational and health promotion activities for both frail and active seniors, as well as people with disabilities on Ward’s Island. In the community, there are almost no affordable opportunities for seniors to partake in an outdoor program in a natural environment. Many seniors cannot afford a holiday at a cottage or do not have the transportation available for such a holiday. Seniors in long term care facilities also do not have access to outdoor recreational options in the summer. For many seniors, Camp Sunshine is the only summer holiday they have. (Ontario)
Labour Force Participation of Older Workers – Seniors themselves and society in general, benefit from active aging, which for many includes continued engagement in the labour force. Many still want to work, so it is advantageous to ensure that they are engaged and productive. Unfortunately, barriers do exist that can prevent older workers from participating in the labour forceFootnote 27. Participants confirmed the need to address these barriers, as outlined in the Council’s previous reports.
Intrinsic and Extrinsic Barriers to Participation
Age-Friendly Environments – Participants lauded the value of the age-friendly communities’ initiative currently in place in Canada and across the world. This model, developed by the World Health Organization in collaboration with the Government of Canada, addresses eight key domains of community living that enable seniors with varying needs and capacities to live in security, good health and to participate fully in society. These include: transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication and information; community support and health services; and outdoor spaces and buildings. Age-Friendly communities provide opportunities not just for seniors, but for the whole community.
The title of “Age-Friendly City” (AFC) is given to a city that ensures the well-being of seniors in collaboration with other resources in the community. In 2008, the city of Sherbrooke established an AFC committee to explore new ways of improving the quality of services and promoting a healthy and active lifestyle. In 2009, the city of Sherbrooke and six other municipalities were the very first to be recognized as Age-Friendly Cities in Quebec. To develop a culture of civic-mindedness and caring toward seniors, Sherbrooke’s AFC committee has developed a training kit for the staff of businesses in the city to help them adopt a respectful and caring attitude toward seniors. The values stressed are respect, hospitality, listening and thoughtfulness. (Quebec)
Built Environment – The built environment can itself be a barrier to social participation. Participants noted the reticence of many seniors to go for walks, partake in community activities or even complete routine tasks outside the home because of their physical environment. Even limited access to public washroom facilitiesFootnote 28 can restrict or inhibit some individuals, especially those who suffer from forms of incontinence. Accessible public washrooms could then be a means to enhance social integration and engagement for seniors.
The Great British Public Toilet Map helps people find their nearest public toilet. Introduced by the British Design Research Associate Gail Ramster and Senior Research Fellow Jo-Anne Bichard from the Helen Hamlyn Centre for Design at the Royal College of Art in London, the website was developed as part of the Tackling Ageing Continence through Theory Tools and Technology project. (United Kingdom)
Caregiving – Being a family/friend caregiver residing in the same household as the care recipient was noted as a major factor of social isolation. Seniors providing caregiving services to other seniors or family members can feel isolated. Even if support groups are available to caregivers, the issue is often “who will take care of the person while I attend the support group?” Participants noted the strain caregiving can have on the health of the senior caregiver, on their work lives, and the risks involved if the caregiver becomes ill.
Cultural Barriers – Cultural barriers can also increase the risk of social isolation among older immigrants to Canada, as can the family responsibilities of some immigrant seniors. For example, older immigrants caring for grandchildren can become too busy to integrate culturally, learn a language and/or participate in community life.
The Regina Open Door Society (RODS) offers the Welcoming Community for Newcomers Program which assists newcomers to become familiar with their community, establish supportive social networks and enhance their objectives. The program matches newcomers with community volunteers who are established residents in the community and are familiar with local social, educational, employment and recreational systems. RODS, in partnership with the Regina Public School Board, the Regina Catholic School Board and the Conseil des écoles fransaskoises also hosts the Newcomer Welcome Centre, which is a first-stop/one-stop shop for newcomers in need of settlement-related information, referrals, and assessments. (Saskatchewan)
Language – Language barriers have been identified as inhibiting social inclusion and participation of seniors. Participants identified challenges in finding care facilities and social programming in the individual’s language of choice. It was noted that people who were happy to move in their youth for work or education into official language minority communities may, in their later years, prefer regions where they can receive services in a language of their choice. However, leaving an established network and community can create isolation.
Teslin, a rural community in Yukon, is going to have its own Elders’ complex with smaller apartments and a big common room to encourage socialisation. The Teslin Tlingit Council is involved in all aspects of the development of the Elders’ complex from the development to final approval of the design. (Yukon)
Housing and Homes – Some 85% of Canadians over 55 years old want to remain in their present home for as long as possibleFootnote 29. Others, however, choose or find themselves in housing options that offer some support services. Participants mentioned the impact of housing types on social isolation: people can be isolated or feel lonely even in large apartment complexes, particularly in buildings lacking centralised social hubs.
The shortage of publically funded long-term care beds, the cost of living in private facilities, and the discrepancies in regulations from one jurisdiction to another were some of the other housing concerns raised by participants. Because of shortages or having few affordable options, some seniors may have to accept beds in facilities outside their home community, that don’t accept pets, that may not offer services in the language of their choice or be sensitive to their cultural needs.
Mismatch of needs in care facility options can increase the risk of social isolation and, of particular note, culturally appropriate facilities for First Nations and Métis people are few and far between.
Lesbian, Gay, Bisexual or Transgendered (LGBT) Seniors – Participants in many of the roundtables raised the specific vulnerabilities and needs of older individuals who are lesbian, gay, bisexual or transgendered/transsexual (LGBT). Many of today’s LGBT seniors have not publically disclosed their sexual orientation, but the first “out” generation is nearing retirement. Participants indicated that older homosexuals are faced with a double discrimination—those of age and sexual orientation—in many spheres: health care, home care, legal and recreation.
In partnership with Gai Écoute, Fondation Émergence offers an information and awareness program focusing on the realities faced by lesbian, gay, bisexual and trans identity (LGBT) seniors. Pour que vieillir soit gai seeks to empower those who work or deal with seniors to ensure homophobia-free and transphobia free environments. (Quebec)
Mental Health – One participant summed up the relationship between social isolation and mental health issues as a “vicious cycle”. Isolated seniors can become depressed or develop other mental or physical health problems. In turn, seniors who have mental illnesses or other mental health issues often do not or are unable to seek the help they need, becoming further isolated. The overlapping stigma of mental illness and ageism were raised as magnifying the risk of vulnerability.
The Canadian Mental Health Association leads the Volunteers in Partnership Program, a one on-one program matching volunteers with adults with mental illness, helps them pursue social and leisure goals. This model could be applied and adapted to seniors. (National)
Mobility – Mobility encompasses not only participation in society (e.g. being able to drive or having accessible public transportation) and physical activity of older adults, but also the performance of specific maneuvers such as walking or climbing stairs and carrying out instrumental activities of daily living. An important aspect of mobility within the community can be simply “getting seniors there” through accessible and affordable transportation. This was named as one of the key factors affecting the ability of seniors to participate in community programs. In addition to extrinsic barriers of mobility, aids and physical environments, older adults also cope with intrinsic barriers, such as fear of falling and mobility impairments.
L.I.N.K.S. (Live Independently and Keep Social) is a volunteer group that supports older isolated adults and helps them stay involved in their community. Volunteers are matched with seniors and help them with recreation and social activities, registration and transportation options until they gain confidence to participate independently. Referrals come from individuals, family, friends and the medical community, creating a community safety net for isolated seniors or for those at risk of social isolation. (British Columbia)
Urban vs Rural or Remote Living – Although risk factors for rural and urban older adults are different, participants identified both groups as being at risk for social isolation. For example, Aboriginal seniors who reside in remote areas with specific health issues are at a high risk of social isolation when they have to relocate to receive health treatments. On the other hand, social isolation for urban seniors may be related to housing issues or community environments.
Technology – Technology, while a great tool to help individuals stay connected, is neither accessible to nor adopted by all. Some participants mentioned that the costs associated with a computer, Internet access and even telephone service are not affordable for some seniors. Yet others are not comfortable with communications technologies.
The Technologies for Aging Gracefully Lab (TAGlab) of the University of Toronto, founded in 2008, designs aides, software, systems, and experiences that support aging through the life course with the goal of fostering a sense of community, identity and autonomy for users. The TAGteam believes that carefully designed technology can help improve the quality of life of seniors while, at the same time, addressing common social and psychological issues faced by older adults. (Ontario) (TAGlab) of the University of Toronto, founded in 2008, designs aides, software, systems, and experiences that support aging through the life course with the goal of fostering a sense of community, identity and autonomy for users. The TAGteam believes that carefully designed technology can help improve the quality of life of seniors while, at the same time, addressing common social and psychological issues faced by older adults. (Ontario)
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