1. 1 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, UQAM May 29, 2008 Karen M. Kobayashi, PhD Denise Cloutier-Fisher, PhD

2. 2 Presentation Outline Focus on Social Isolation among Older Adults Social Isolation Research Program Future Research Directions/Areas for Exploration

3. 3 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

4. 4 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?

5. 5 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 Community Identity, beliefs, values, characteristics (age, gender, marital status, income, occupation, health), mobility Proximity, relationships, degree of closeness, loss of children/friends

6. 6 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

7. 7 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

8. 8 Research Program 2005-08 Phase 1 Quantitative Research n=1064 Non-socially isolated n=883 Socially Isolated n=181 Phase 2 In-depth Qualitative n=27 Research Objective: develop profile of social isolation among older adults in BC Research Objective: develop profile of social isolation among older adults in BC Research Objective: develop insights into the experience/meaning of social isolation among a selected group of older adults in BC Research Objective: develop insights into the experience/meaning of social isolation among a selected group of older adults in BC Multi- layered

9. 9 Phase I: Differences among Socially Isolated and Non-Socially Isolated Older Adults: T-test results SociallyNon-Socially IsolatedIsolated N = 181N = 883 CharacteristicMeanMeanSig. Age76.974.30.000 # Chronic Conditions3.43.00.011 # ADLs that require help1.20.80.000 Annual consultations with: family physicians5.55.70.719 eye specialists1.11.20.825 other medical doctors0.91.30.379 nurses 0.71.00.576 dentists1.11.50.005 alternative health providers1.91.90.653 Days physical health not good18.713.20.000 Days mental health not good15.010.00.008 Days health from usual activities19.012.80.001 Nights in hospital in last year9.810.50.884 Bradburn Positive Affect Scale¹10.812.00.000 Bradburn Negative Affect Scale²7.46.60.000 Length of Res. in BC (years)43.544.20.721 Time in current home (years)11.514.00.016

10. 10 Phase I: Logistic Regression: Predictors of Social Isolation VariableOdds Ratio Age1.04 Gender (males)1.6 Marital Status – Single -Wid or Div/Sep 6.0 2.0 Lower (or refused) Income2.0 Poor Health Status2.2 Rent rather than own home1.9 Being from another country (than the US or UK) 2.5 Lower religiosity2.3

11. 11 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)

12. 12 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

13. 13 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)?

14. 14 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

15. 15 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

16. 16 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)

17. 17 Contact Information Karen M. Kobayashi, PhD kmkobay@uvic.ca Denise Cloutier-Fisher, PhD dcfisher@uvic.ca