Social Isolation of Seniors Part 1

Being socially active and connected is at the core of having a good retirement and ageing well. Being connected is an important social determinant of health and social connectedness is beneficial to your health. Feelings of loneliness and isolation can lead to serious consequences for senior health. 

Understanding the causes and risk factors for senior isolation can help us prevent it. Nobody relishes the prospect of ageing without a spouse or family member at their side, without friends to help them laugh at the ridiculous parts and support them through the difficult times. Yet that is just what many North American seniors face. The quality and number of connections you have with others are important to your health. These connections include

•         family

•         friends

•         neighbours

•         acquaintances

•         Also, known as social support, social capital, and social engagement

As the baby boomer generation crosses the over-65 threshold, it grows; but many of our ageing loved ones are still feeling alone in the crowd.

A key determinate of health and one that we can control the choices we make/ An example of this is where one lives. One’s neighbourhood may provide an opportunity for social interaction with others through the availability of organisations (e.g. community centres, clubs, etc.…) and community-based programs. Similarly, living in a neighbourhood where neighbours know each other builds a sense of trust and community: Having a high sense of community is associated with improved mental and immunological health

According to the U.S. Census Bureau 11 million, or 28% of people aged 65 and older, lived alone in 2010. As people get older, their likelihood of living alone only increases. Additionally, more and older adults do not have children, reports the AARP, and that means fewer family members to provide company and care as those adults become seniors

While living alone does not inevitably lead to social isolation, it is certainly a predisposing factor. Yet another important consideration is how often seniors engage in social activities.

Statistics Canada reports that 80% of Canadian seniors participate in one or more social activities on a frequent basis (at least monthly) – but that leaves fully one-fifth of seniors not participating in weekly or even monthly activities.

Social contacts tend to decrease as we age for a variety of reasons, including retirement, the death of friends and family, or lack of mobility. Regardless of the causes of senior isolation, the consequences can be alarming and even harmful. Even perceived social isolation – the feeling that you are lonely – is a struggle for many older people.

Fortunately, the past couple of decades has seen increasing research into the risks, causes, and prevention of loneliness in seniors.

Fact: Loneliness and social isolation impacts the health of seniors more than 6% of Canadians over the age of 65 reported not having any friends

It is in our best interest to combat these changes because social participation and social support are both strongly connected to good health and wellness over the life course. The interaction of poverty, a function of one’s income, with social participation displays conceptually how income may act as a social determinant of health. Although social connectedness plays a significant role in health, seniors are more likely than any other age group to feel lonely or isolated

For seniors, social exclusion is found in several forms:

• Exclusion from society due to laws or societal discrimination (e.g. mandatory retirement)
• Failure of society to provide for the needs of seniors
• (e.g. affordable housing)
• Denial of opportunities to contribute and participate actively in society (e.g. not being represented on a community planning committee)
• Economic exclusion (e.g. unequal or lack of access to resources)

Year books

Yearbooks bring back memories, a member of my FaceBook community, who I thought I only knew through a third friend, posted a picture of himself from his time at Simon Fraser University. We had been at the university at the same time. As soon as I saw his picture, I recognised it from the 1966-67 yearbook. I then realised that I knew him because of the activities we both had been involved in at the university. 

A few weeks later I had a Message from a person that I went to Elementary School with who had seen me at our high school reunion and although we did not have a chance to talk, reminded me via FaceBook of some of the good times we had when we were very much younger.

On another occasion I went to lunch with a few people I had worked with as a beginning teacher, some I had not seen in about 10 years. One of the people in attendance was the person who hired me, and who I had not seen since 1975. Neither one of us recognised the other. I had changed as he had. He looked good for 90 and as we talked, he spoke fondly of his time at the school and in the district. He was enjoying retirement and was looking forward to his next trip. He also brought his yearbooks from his time at the school, and everyone at the table was enjoying looking back. I found my picture and showed it to him and he laughed and said, I would never have recognised you.

I wonder how many use posts and groups on FaceBook or their yearbooks and from high school or university to bring back or sharpen our memories. I know that from time to time I do, and I enjoy the experience of remembering. 

Advice for talking to your Doctor

In BC the amount of time we have to see a doctor is limited to about 8 minutes per visit, so we have to make good use of our time. Many doctors, will only deal with one issue at a time, and the time they have is limited.

Make Good Use of Your Time 

Be honest

It is tempting to say what you think the doctor wants to hear, for example, that you smoke less or eat a more balanced diet than you really do. While this is natural, it’s not in your best interest. Your doctor can suggest the best treatment only if you say what is really going on. For instance, you might say: “I have been trying to quit smoking, as you recommended, but I am not making much headway.”

Decide what questions are most important

Pick three or four questions or concerns that you most want to talk about with the doctor. You can tell him or her what they are at the beginning of the appointment, and then discuss each in turn. If you have time, you can then go on to other questions.

Stick to the point

Although your doctor might like to talk with you at length, each patient is given a limited amount of time. To make the best use of your time, stick to the point. For instance, give the doctor a brief description of the symptom, when it started, how often it happens, and if it is getting worse or better. Share your point of view about the visit.

Tell the doctor if you feel rushed, worried, or uncomfortable

If necessary, you can offer to return for a second visit to discuss your concerns. Try to voice your feelings in a positive way. For example, you could say something like: “I know you have many patients to see, but I’m really worried about this. I’d feel much better if we could talk about it a little more.”

Remember, the doctor may not be able to answer all your questions

Even the best doctor may be unable to answer some questions. Most doctors will tell you when they don’t have answers. They also may help you find the information you need or refer you to a specialist. If a doctor regularly brushes off your questions or symptoms as simply a part of ageing, think about looking for another doctor.

As you talk to your doctor, make sure you remember and understand what she/he is telling you. Here are some tips to help in this area:

Helping You Remember No matter what your age, it’s easy to forget a lot of what your doctor says. Even if you are comfortable talking with your doctor, you may not always understand what he or she says. So, as your doctor gives you information, it’s a good idea to check that you are following along. Ask about anything that does not seem clear. For instance, you might say: “I want to make sure I understand. Could you explain that a little more?” or “I did not understand that word. What does it mean?” Another way to check is to repeat what you think the doctor means in your own words and ask, “Is this correct?”

Here are some other ideas to help make sure you have all the information you need.

Take notes

Take along a notepad and pen and write down the main points, or ask the doctor to write them down for you. If you can’t write while the doctor is talking to you, make notes in the waiting room after the visit. Or, bring an audio recorder along and (with the doctor’s permission) record what is said. A Recording is especially helpful if you want to share the details of the visit with others.

Get written or recorded materials

Ask if your doctor has any brochures, DVDs, or other materials about your health conditions or treatments. For example, if your doctor says that your blood pressure is high, he or she may give you brochures explaining what causes high blood pressure and what you can do about it. Ask the doctor to recommend other sources, such as websites, disease management centres, nonprofit organisations, and government agencies that may have written or recorded information you can use.

Talk to other members of the healthcare team

Sometimes, the doctor may want you to talk with other health professionals who can help you understand and carry out the decisions about how to manage your condition. Nurses, physician assistants, pharmacists, and occupational or physical therapists may be able to take more time with you than the doctor.

Call or email the doctor

If you are uncertain about the doctor’s instructions after you get home, call the office. A nurse or other staff member can check with the doctor and call you back. You could ask whether the doctor or another health professional you have talked to, has an email address or online health portal you can use to send questions

Engagement by Seniors in nursing homes is important

In BC the province where I live seniors in homes do not have the minimum care required by law and our provincial government is in no hurry to fix this problem. However, in other parts of the world, there is much being done. For example, in a survey of staff from 172 Swedish nursing homes, most residents had been outside the nursing home during the previous week, but only one-fifth had been on an outing or excursion.

Very few residents visited a restaurant, engaged in an education program, went to the cinema, or even engaged in activities such as hobbies and parlour games.

The findings can inform staff and managers to promote increased engagement in everyday activities for nursing home residents to support their wellbeing.

"The study demonstrates that activities are an important approach to increasing thriving, and that everyday activities can be conceptualised and implemented as nursing interventions to facilitate resident thriving as opposed to resident surviving in nursing home care", said Sabine Björk, lead author of the Journal of Advanced Nursing study.

The most commonly occurring everyday activities were receiving hugs and physical touch, talking to relatives/friends and receiving visitors, having conversation with staff not related to care and grooming. The least commonly occurring everyday activities were going to the cinema, participating in an educational program, visiting a restaurant and doing everyday chores. Positive associations were found between activity engagement and thriving, where engagement in an activity program, dressing nicely and spending time with someone the resident likes had the strongest positive association with resident thriving.

Engagement in everyday activities can support personhood and thriving and can be conceptualized and implemented as nursing interventions to enable residents to thrive in nursing homes.