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Developing a Research Program on Social Isolation among Older Adults

in BC--

Établissement d’un Programme de Recherche sur L’isolement Social chez les Aînés de la Colombie-Britannique

Presentation prepared for the Intertic Colloquium, UQAMMay 29, 2008

Karen M. Kobayashi, PhDDenise Cloutier-Fisher, PhD

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Presentation Outline

• Focus on Social Isolation among Older Adults

• Social Isolation Research Program

• Future Research Directions/Areas for Exploration

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Why Focus on the Socially Isolated (SI)?

• Marker of vulnerability • i.e., SI defined as individuals in poor

health and/or with “inappropriate” (overuse or underuse) health service utilization patterns

• F/P/T Ministers Responsible for Seniors (2003) identified SI as an ‘at-risk’ or vulnerable group vis-à-vis health

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The Connection between Social Isolation and Health

• Positive relationship between social integration/support and health status

• Established in the literature (Great Britain, Canada, the US).

• How do intersections of age, gender, and residence (rural/urban geography) mediate social isolation and health, and influence service use?

• What is ‘appropriate care’ for this vulnerable population?

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Person

Person

Social Integration vs Isolation

Individual

•Nature (e.g, rural/urban, ethnocultural)

•Range of services

•Access to amenities

•Health care/social services

Well-being

Ill-health

Individuals/Populations

Family/Friends

CommunityIdentity, beliefs, values, characteristics (age, gender, marital status, income, occupation, health), mobility

Proximity, relationships, degree of closeness, loss of children/friends

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What is Social Isolation and How is it Measured?

Complex social construct• Network size, number of social

contacts, quality of relationships (i.e., LSNS-6)

• Other factors, e.g., live alone, income, marital status, health conditions

• Residence, e.g., urban/rural• Meaning?

• Loneliness and solitude• Resilience and vulnerability• Need for and use of health care

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Social Isolation Research Program

•To develop a comprehensive profile of socially isolated older adults and discuss the research and policy implications for individuals in BC•Joint funding: CIHR/BC Ministry of Health

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Research Program 2005-08

Phase 1

Quantitative Research n=1064

Non-socially isolated

n=883

Socially Isolated

n=181

Phase 2In-depth

Qualitative n=27

Research ObjectiveResearch Objective: : develop profile of social develop profile of social isolation among older isolation among older adults in BCadults in BC

Research ObjectiveResearch Objective: develop insights into the : develop insights into the experience/meaning of social isolation among a experience/meaning of social isolation among a selected group of older adults in BCselected group of older adults in BC

Multi-layered

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Phase I: Differences among Socially Isolated and Non-Socially Isolated Older Adults: T-test results

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•   Socially Non-Socially  • Isolated Isolated• N = 181 N = 883•        • Characteristic Mean Mean Sig.•• Age 76.9 74.3 0.000• # Chronic Conditions 3.4 3.0 0.011• # ADLs that require help 1.2 0.8 0.000• Annual consultations with:

• family physicians 5.5 5.7 0.719• eye specialists 1.1 1.2 0.825• other medical doctors 0.9 1.3 0.379• nurses 0.7 1.0 0.576• dentists 1.1 1.5 0.005• alternative health providers 1.9 1.9 0.653

• Days physical health not good 18.7 13.2 0.000• Days mental health not good 15.0 10.0 0.008• Days health from usual activities 19.0 12.8 0.001• Nights in hospital in last year 9.8 10.5 0.884• Bradburn Positive Affect Scale¹ 10.8 12.0 0.000• Bradburn Negative Affect Scale²7.4 6.6 0.000• Length of Res. in BC (years) 43.5 44.2 0.721• Time in current home (years) 11.5 14.0 0.016

     

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Phase I: Logistic Regression: Predictors of Social Isolation

Variable Odds Ratio

Age 1.04

Gender (males) 1.6

Marital Status – Single

-Wid or Div/Sep

6.0

2.0

Lower (or refused) Income 2.0

Poor Health Status 2.2

Rent rather than own home 1.9

Being from another country (than the US or UK)

2.5

Lower religiosity 2.3

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Identifying those at-risk

• HC workers – need to ask questions about social contacts

• Single older adults (or widowed or separated/divorced persons), those with low income, those who are renters, recent immigrants, and those who have been in the area for shorter periods of time (migrants)

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Phase II

• Qualitative study – in-depth interviews with 27 SI older adults on Vancouver Island

• Objective: to provide further insights into the everyday experiences and meaning of social isolation

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Preliminary Qualitative Insights

• Life course events – the meaning of negative events (e.g., death of a child) and their accumulation over time

• Resilience – life long patterns of smaller networks (gendered?)

• Family Issues – support or burden? • Implications of Restructuring (e.g.,

home care cuts)?

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Findings: Phase I and II• Social isolation – prevalence 17% (BC & Canada)

• Poor health status and reduced physical and mental health but not high utilization – unmet need?

• Importance of life course perspective• Portraits of multi-layered complexity that are

temporally dynamic

• SI are more vulnerable and potentially underserved

• Addressing the needs of vulnerable populations requires a corresponding diversity of approaches

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Additional Research Goals

Further exploration of key issues related to:

• health behaviours/attitudes/beliefs and social support dynamics

• psychosocial variables including religiosity, spirituality, mental health and depression

• ethnicity and immigrant status – cultural influences

• rural, remote, northern, highly urbanized communities – GVRD, single-resource towns, tourism towns

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Future Directions: An Example

• Improving health and well-being of SI persons

• Identification of target sample

• Examination/understanding of baseline data from Lifeline (research partner) – Who are the clients?

• Research design i.e., quasi-experimental RCTs Lifeline clients vs matched sample of non-users

• Linking health outcomes (e.g., well-being, mortality, chronic disease profile) with service use (e.g., Lifeline subscribers, doctor visits, hospital visits)

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Contact Information

• Karen M. Kobayashi, PhD• kmkobay@uvic.ca

• Denise Cloutier-Fisher, PhD• dcfisher@uvic.ca