Susan Pinker, an author and psychologist, once said, “Social Isolation is the Public Health risk of our time. The secret to living longer may be your social life.” In this episode of the Public Health Insight Podcast, Ann and Justine from Age Friendly Peterborough, join us to talk about the distinction between social isolation and loneliness, its broader health implications, the burden on caregivers, and how the COVID-19 pandemic has created challenges for seniors living in community dwellings.
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Susan Pinker, an author and psychologist, once said, “Social Isolation is the Public Health risk of our time. The secret to living longer may be your social life.” In this episode of the Public Health Insight Podcast, Ann and Justine from Age Friendly Peterborough, join us to talk about the distinction between social isolation and loneliness, its broader health implications, the burden on caregivers, and how the COVID-19 pandemic has created challenges for seniors living in community dwellings.
Podcast Guests
Podcast Hosts
References for Our Discussion
Subscribe to the Newsletter
What if there was an easy way to receive timely information about public health and global health right to your inbox? Subscribe to the newsletter to stay in the loop about the latest news, live events, jobs, and professional development opportunities. Subscribe to ensure you don’t miss out: https://thepublichealthinsight.com/subscribe/.
Tell A Friend
If you enjoy our podcasts, it would mean the world if you shared it on social media and tagged us. If you are not the social media type, we would appreciate it if you shared it with a friend or colleague who you think might enjoy the podcast. It helps us to get discovered by other people.
Music Credits
Susan Pinker and author and psychologist once said social isolation is a public health risk of our time. The secret to living longer may be your social life. In this episode, we'll be speaking with two guests about a series of projects that aim to respond to the concerns about social isolation before and during the COVID-19 pandemic among community dwelling, seniors and their caregivers.
Sully:this is the public health insight podcast.
Gordon:My name is Gordon, and I'll be your host for this episode, along with my fellow co-hosts LaShaun,
Ben:Before we move on is important to note that the views expressed in this podcast are our own and do not represent any of the organizations we work for or affiliated with.
Gordon:Justine Lovech is a research and evaluation officer at the Canadian observatory on homelessness. She completed a master's in public health at McMaster university in 2020 and a bachelor of science in anthropology at Trent university in 2019, in 2020 Justine worked as a research assistant for Trenton university and age-friendly Peterborough on the social isolation to social connection research project. She continues to be involved with age-friendly Peterborough as a member of the basic needs working group and a co-chair of their housing task.
Leshawn:And McLeod practices nursing in a variety of hospital and community based settings in urban and rural areas in Canada, New Zealand and the U S which spurred her interest in health promotion and community based research. She completed her bachelor of nursing science at McGill university in Monterey. A master's of public health at the university of Michigan and a post-graduate C I H R research fellowship in collaboration with the university of Ottawa and the university of west Indies. Her research focuses on qualitative community-based research approaches to study the intersection between health professionals, the volunteer sector, and paraprofessionals in promoting health of older adults. since relocating to Peterborough in 2000, she has taught clinical and theoretical courses focusing on the care of older adults, community health, and the primary care in the Trent Fleming school of nursing. Since its inception. Please join me in welcoming Justine and Anne to the public health insight podcast.
Gordon:Welcome.
Ann:Thanks.
Justine:you.
Gordon:Awesome. So, the first question we'd like to ask you, ah, just to get the wheels turning before exciting conversation is, you know, how did you get into public health? You know, was it an accident? Was it a lifelong interest? Was it sort of a singular impactful experience that you can remember? let's start with you first, an
Ann:Well, mine was an accident and that I was working in a tertiary hospital and, uh, in Montreal and wanted a rural experience. So, transferred my was able to get my nursing license in New Zealand. And I happened to be the last train into a small town of gives for New Zealand because of a psych loan. And it very quickly threw me into flood relief and public health measures. Which serendipitously ended me up here in Peterborough.
Justine:Yeah. I said mine was kind of. On accident as well. Like I was on track to do archeology while I was doing my undergrad. And I took one course that was medical anthropology, which is very similar to public health. And I just knew this is definitely what I want to do. Very interested in the social aspects of health and social determinants of health. And so from there, I went in to do a master's.
Gordon:Awesome. I didn't expect, I was expecting some of those lifelong interests. I knew since the, since I was born, but. It's just funny to see how, you know, people from different fields, nursing anthropology, I'm from more of life sciences and Leshaun as well, and up in public health because everything pretty much has public health implications. Uh, so again, thanks for sharing how you sort of stumbled your way into public health and why you're passionate about public health issues going forward. Uh, but you know, we know you're particularly here to talk about, uh, public health issues, like, uh, healthy aging aging in place age-friendly communities. Uh, so for starters, what do we really mean when we say something like healthy?
Ann:So healthy aging is a little bit of a conundrum because for many years, it's focused on a world health organization definition around healthy aging. And that's this notion that chronologically you get older. But you're still able to engage socially, physically and mentally, um, in ways that you want to. But unfortunately it doesn't, uh, it puts on the pedestal, this notion of the 70 year old Finn jogging and doing cross country skiing into their eighties and nineties. So it doesn't really consider those the spectrum of aging and the diversity of aging, um, and even the notion of frailty that some older adults experience and others don't, but still would like a quality of life. So I think healthy aging is a bit of, um, a trope that we're trying to unpack a little bit with stories and people's experiences to see you know, what it looks like through different lens. Okay.
Gordon:Right. So you're saying healthy aging might look different depending on the person that's aging. And then we put on the PESTEL, a pedestal, like a modern role model for healthy aging, which might not be realistic for a lot of people where they're at in their kind of aging journey. And it's important to kind of like you said, unpack that. so Justine, what are your thoughts on that as well? If you can speak to that.
Justine:Yeah, I think exactly what Ann said. It's certainly based on the context that you're in, we see that with the pandemic, like what aging looks like and how you can stay connected. And as you age and stay aging in your home, particularly during the pandemic, as opposed to like more congregate living settings, like long-term care. Um, certainly based on the context in which you're in and it looks different not only in Canada, but in the west, in Europe and in other countries as well.
Leshawn:Right. So, I mean, just cause you just got into it right now. What are some of the key differences between, you know, community dwelling, seniors versus those that, you know, long-term care? Well, what are some of the key difference?
Ann:Having, having worked in long-term care and having had students in long-term care it's largely on capacity for, um, to do look after yourself independently and we place, um, in our Western society, we place a big emphasis on independence and looking after yourself independently and depending on people's supports in the community, if they're not able to look after their basic needs whether due to physical decline or cognitive decline to the point that home care. Services don't meet their needs. Then that's when they're placed on a priority to move into long-term care where your physical needs are met. And they aim through social programs and activity engagement programs to meet those cognitive and social needs as well. But it's certainly for the more frail, um, and more dependent, um, particularly seniors and particularly those who may not have an income to support aging in place.
Justine:And I think there's a little bit of like a misconception, especially when you think about sometimes the negative aspects of the negative perceptions of aging, where when you get older, that's where you're going to like, as your only option is to go into long-term care. But I think the statistics are that across Canada, like 90% of seniors live in their homes or are community dwelling as opposed to living in longterm.
Gordon:Interesting. So, you know, you kind of touched on it. A lot of those factors that influences when the points in which someone who might be in, in independently, living in the community would be considered, uh, to be moved into a long-term care facility. Um, some of the reasons from our research also include, you know, issues with falls and falls related injuries, stuff like urinary incontinence, uh, chronic diseases like dementia. I did find that social isolation also seemed to be a predictor of someone's likelihood of being transitioned from a community dwelling setting into a long-term care home. So, um, I wanted to get your take on what is social isolation? Exactly. What do we mean when we say social isolation? Another term that gets tossed around is loneliness. Are they the same? Are they different?
Justine:Phenomenon as we refer to them, but they are definitely connected. When you talk about social isolation, you do often talk about loneliness, but social isolation typically refers to a lack of high quality and quantity, social contacts. And it's often like, um, viewed as objective and you can quantify the number of social contexts in your social network. Whereas loneliness is like feelings of isolation and feeling lonely, regardless of the number of contacts you have and the number like your, your, the size of your social network.
Gordon:Right. So you might have a situation where someone is, technically not socially isolated based on the metrics that we use, but they can experience loneliness. Am I getting that, getting that right. Awesome.
Justine:yeah. I think that's a great way.
Gordon:So do we, do we know are, have a sense of. Hey, you know, the percentage of the Canadian population as, since we're talking about social isolation specifically. So those who are 65 and older, do we have a sense of what proportion of that population is? In fact, experiencing social isolation?
Justine:Yeah. So there's quite a few studies on social isolation among seniors and other countries and in Canada. And there was quite a range in terms of the prevalence estimates. So the range is typically between 6% of seniors to up to 43% of seniors, depending on how you measure it. Um, but th th the figure that we typically use and it's from statistics, Canada is about 12% of seniors. Canadian seniors are experiencing social isolation or report feelings of isolation and that's before the pandemic. So there was a recent survey that went out across Canada, and that's gone up to about 30% among Canadian seniors.
Gordon:Well, and that, that ties in to what you mentioned earlier. Uh, you in the, when we just started talking, you mentioned 90% of, uh, seniors, 65 and older, um, live in the community rather than long-term care homes. But how many of those seniors living in independent living independently in the community, if you will have, uh, are living with someone like how many of them are, um, sort of living alone? Do we know what those numbers are?
Justine:So I have it for Peterborough I'm in the last sentence that they did the percentage of people. It's like the percentage of people who are living alone. It was 43% of them were seniors in Peterborough. So almost half the seniors and Peter wrote a letter, half the people that are living alone in Hebrew are seniors and living alone is one of the risk factors for social life.
Gordon:Right. And that.
Leshawn:Oh yeah, go ahead. Okay. Yeah, no, no. Cause, um, from what I was reading, it was saying that. you know, Peter bro had one of the largest populations of senior populations among any city in Ontario. So I'm guessing that requires a bit of thinking compared to, you know, other cities that may not even have that big of a proportion of seniors as a part of their population.
Justine:Yeah, absolutely. Like, I think it's about 20% in the city of Peterborough and that's projected to increase like exponentially over the next 10 years. And so if we already know, we have a significant portion of seniors who are at risk for social isolation here, or maybe experiencing it already. And then you add in the pandemic. Um, we know that we need to like explore the factors that go into social isolation. What's helping them address that themselves. What do they need from the community, from other resources now, and also to try and mitigate that in the future. As we know that the population is going to age and there's going to be even more.
Gordon:As we approach, uh, you know, shocking numbers, north of 30% for seniors experiencing social isolation. Do we have a sense of breaking those numbers down even further? Do we know if there's any disparities by sort of race, gender, ethnicity, different cultures? Do we have a sense of how it's disproportionately affecting certain populations within those seniors 65 years?
Justine:Yup. So. For what, like, I can give you one example where when you take on caregiving responsibilities, that increases your risk of social isolation and many seniors become family caregivers. Um, like whether for their own like our family members or supposes, um, and a large proportion of caregivers are female, right? So there's that disparity in gender there. And then we also know that, um, other seniors, whether it's immigrants or refugees that come to Canada to live with their family, they also experienced greater risk of social isolation because of things like language barriers. And they're not able to attend the different types of programs that are available. And they're just not aware that those types of programs exist. And then seniors, again, that are part of the LGBTQ community. There's also, um, research and data out there that suggests they are also at risk of higher risk of social isolation.
Ann:And there's also been some studies, um, that we got from our public health unit that showed that Males also an immigrants living in urban areas where there's lower incomes experienced more pronounced, um, social isolation but also echoed that, um, it was the women who were in caregiving roles that often experienced more distress during COVID. And that those people who were socially isolated ha um, access services about 13% less.
Gordon:Interesting. So the ones that are most in need of the services are less likely to access the services, which you get kind of a cyclical problem there. Uh, so you know, we talked about social isolation, uh, some of the challenges around social isolation, but we wanted to hone in specifically. Uh, is there a connection, uh, you know, beyond social isolation, feelings, feeling socially isolated and lonely, is there a connection between mental health, physical health? Can social isolation actually impact, um, some of our health outcome?
Justine:And we will get into this a little bit with some of our findings from the research, but the social isolation affects every facet of your health, whether it's physical, mental, or of course social. And so in terms of physical impacts, you're at risk for higher blood pressure, heart disease, um, at higher risk for earlier mortality. Um, in terms of mental health, um, increase with cognitive decline has been recorded, um, increased risk of depression and anxiety and suicide. And then with the social, the social aspect, obviously you get a decrease in the quality of your relationships in the quantity of your relationships. So it impacts it's not just. It's definitely is interconnected at all times.
Ann:And also those interrelationships too. Um, for example, the, um, relationship to elder abuse there's been a large tenfold increase during the pandemic, partly because of caregiver strain. So it tends to be somewhat of a complex web of interrelationships, which if there's intersectionality with, um, living rurally or remotely, or having a digital divide and, and little access to, um, technology and supports that you might usually get though that way then those things play into it with the intersectionality as well.
Leshawn:Right. And you know, talking about all this, you know, the burden on caregivers, you know, the burden on the seniors that are experiencing social isolation, we kind of already touched on this, but the, the COVID-19 pandemic has created challenges for everyone. And, you know, seniors are not exempt from that. Those challenges that COVID. Bring how, what, what are some of these challenges that you know, COVID-19 has brought to seniors, living in these community dwelling.
Ann:Well, we were wondering what those challenges were initially. When we were meeting with age-friendly Peter. And public health. We were, co-hosting a teleconference in March of 2020 with a lot of our community care providers that reached out to seniors and we're supporting seniors before the pandemic. And when all of those organizations were told to stop going into homes and hosts. Congregate activities, everything got shut down. So we really came together to try and figure out what those impacts were. so the group actually had the question of what are the social and health implications of social isolation among our community dwelling, older adults and their caregivers as well, both family and those that are paid volunteers or paid staff, both in our city, but in our rural county surrounding us and on our first nations. So that, that research question kind of spurred our whole participatory action research and try and find out what the experiences were. And secondly, you know, what are some of the facilitators and barriers and propose. Policies, programs and services that we can adapt to, um, meet needs.
Leshawn:One of the things that was very interesting is this idea of older volunteerism. And especially in like, um, rural communities, you have these older volunteers who often help out with some of these caregiving roles, helping out the seniors, going into their communities. And that COVID-19 piece comes and interrupts that, you know, they can't be doing the same things because of all these restrictions like physical distancing and such how has that affected that kind of volunteerism?
Ann:It's interesting. Um, a colleague of ours Mark Skinner and, uh, Elizabeth Russell studied that very question during this initial call that Trent university put out around COVID-19. And I know that they're initially releasing their results, that it has really affected the volunteers and their, their actions and among our study participants volunteers had to shift towards virtual visits. And I know that some of our participants, um, noticed that that didn't really, um, Work as well as face-to-face visits. And civic engagement is one of those age friendly components of an age friendly community, but we also noticed that it was, it was issues as well as transportation. It was also issues around our outdoor building spaces and places that we could safely congregate as well as our community services and, um, support services on how those needed to change as well. That influenced a lot of how our seniors were experiencing that social isolation, um, and whether they have the resources both in their social networks, but also in our community resources. To meet their needs despite all of the restrictions imposed from the government and to promote physical safety, that mental and social health was definitely put underneath the primacy of physical health
Leshawn:In that it's even more challenging because these older volunteers are also, um, even at a, you know, more susceptible to COVID-19. So it's kind of this almost a double burden of the actual seniors that are in need and, you know, suffering from social isolation. And then you also have these volunteers who are in the community, who also are suffering from, um, you know, uh, possible effects of COVID-19. So it just it's his heart to think about. It's a very challenging situation.
Ann:and not only the volunteers, I would say the, um, who are held on a pedestal, our healthcare here. Our health care heroes in home care are working multiple jobs. They're driving in our rural area, they're driving large distances and, um, they're not necessarily paid for that driving and a really quite discouraging for them when they realize they cannot meet the needs. Um, The seniors that they're serving and, um, come home to their own social isolation, because their social experiences are limited to you know, compounded with precarity of going into homes where they may not have adequate you know, infection prevention and control measures or masks or you know, different living conditions. So it definitely puts a precarity on not only our family caregivers who were trying to juggle everything and sometimes even needed to relocate, but also you know, our paid caregivers and our volunteers. What we, what we did find was that despite the re restrictions, there were sometimes some work around. For example, in our indigenous community, um, that we worked with, they had, um, color coding schemes, a very low tech solution. A green card meant you were okay in your house. Whereas different color codes meant that you needed different things. And whether you have those, whether they were in your bubble, you could reach out to them or deliver food or water, or just a social visit to check in. So they developed work arounds despite the formal system coming to a standstill, at least for the first little.
Sully:you've just heard part one of Gordon and LeShan's conversation with en and Justine from age-friendly Peterborough about the distinction between social isolation and loneliness. It's broader health implications, the burden on caregivers and how the COVID-19 pandemic has created challenges for seniors living in community. Join us in the next episode as Anne and Justine shares some findings and lessons learned from implementing several projects and initiatives that foster the creation of an age friendly community. Thank you for listening to the public health and say podcast, you would go to space for informative conversations, inspiring community action. If you enjoy our content, I would like to stay up to date, follow us on Instagram, Facebook, Twitter, and LinkedIn, to learn more about our community initiatives and how you can support us. Visit our website@thepublicofinsight.com joined the Phi community and let's make public.