Report on the Social Isolation of Seniors

Consultation Highlights

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.