Presentation prepared for the Intertic Colloquium, UQAM May 29, 2008 Karen M. Kobayashi, PhD Denise Cloutier-Fisher, PhD

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

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. 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. Social Integration vs Isolation Well-being Individuals/Populations Person Community Identity, beliefs, values, characteristics (age, gender, marital status, income, occupation, health), mobility Individual • Nature (e.g, rural/urban, ethnocultural) • Range of services • Access to amenities • Health care/social services Person Family/Friends Proximity, relationships, degree of closeness, loss of children/friends Ill-health

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

9. Phase I: Differences among Socially Isolated and Non-Socially Isolated Older Adults: T-test results • 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 Scale² 7.4 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

10. Phase I: Logistic Regression: Predictors of Social Isolation

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