Report: Social Isolation Among Older Adults During the Pandemic

The new Coronavirus (COVID-19) is a highly contagious disease that was discovered near the end of 2019. COVID-19 has been conceptualized as a “gero-pandemic,” defined as a disease that has spread globally with heightened significance and negative consequences for older populations (Wister & Speechley, 2020). Older people are particularly vulnerable to the harmful health impacts of COVID-19, as well as social isolation and loneliness as a result of public health measures to reduce transmission of the disease (for example, physical and social distancing measures, closure of community spaces). This report investigates how the COVID-19 pandemic has affected older Canadians, focusing on social isolation and loneliness. Social Isolation is defined as “a lack in quantity and quality of social contacts” and “involves few social contacts and few social roles, as well as the absence of mutually rewarding relationships” (Keefe et al., 2006, p.1). Loneliness is “defined as a distressing feeling that accompanies the perception that one’s social needs are not being met by the quantity or especially the quality of one’s social relationships” (Hawkley & Cacioppo, 2010, p.1). While social isolation and loneliness can have both common and unique features, we use the term social isolation in this report to designate both terms except where distinct patterns require attention. To inform the report, a comprehensive search of academic and grey literature was conducted, including promising practices aimed at reducing social isolation. This was supplemented with new data from the Canadian Longitudinal Study on Aging (CLSA). The World Health Organization’s Age-Friendly Cities Framework was used as a guiding model for the review. In Canada, data from the CLSA reveals striking increases in feelings of loneliness from the first results of the study (2011 to 2015) to COVID-19 (April to December 2020). It is estimated that there is a 67% increase in loneliness for women aged 65 to 74, and 37% for those aged 75 to 84. Smaller increases are observed for men, where there is a 45% relative rise for men aged 65 to 74 and 33% for the oldest group.

Literature review: challenges faced by older adults during the pandemic related to social isolation

Social isolation and vulnerable sub-populations of older adults

The literature identifies sub-populations of older adults who may be particularly vulnerable to social isolation during the COVID-19 pandemic, including: rural, remote, and Northern communities; LGBTQ2 older adults; ethnic minority and immigrant older adults; Indigenous peoples; people living with dementia; caregivers; and low-income older adults. The pandemic has exacerbated pre-existing inequities in health, access to health care, employment, and other areas for older Canadians. However, sources of resilience were also identified; for example, some First Nations communities have drawn upon traditional practices and culture to protect their elders (that is encouraging return to the land, governance of community entry).

Social isolation and community-dwelling older adults

Findings on the challenges faced by community-dwelling older adults as well as examples of interventions to address social isolation are organized in the report according to the 8 domains of the Age-Friendly Cities Framework.

• Respect and social inclusion: experts have expressed concerns about the intensifying of ageist views, intergenerational tensions, and aging-related social problems (such as elder abuse) during the pandemic (Ayalon, 2020; Makaroun et al., 2021). Befriending and other intergenerational programs have sought to create connections between older and younger generations
• Housing: older adults living alone and in social housing have been identified as at-risk groups during the pandemic (Emerson, 2020; Pirrie & Agarwal, 2021). Older adults living in non-institutional congregate living settings (such as assisted living, retirement communities) share similar vulnerabilities to long-term care (LTC) residents, but live in a setting guided by social models of care and with higher levels of autonomy (Zimmerman et al., 2020)
• Community support and health services: significant disruptions have occurred to community support and health services. While remote delivery was already being used for some services prior to the pandemic (for example, caregiver support programs), others have transitioned to new models of delivery. With support from government funding, practical assistance programs have been initiated or significantly scaled up in response to high levels of demand. In some jurisdictions, governments have taken a role in coordinating large-scale responses to the pandemic and supporting community agencies
• Transportation: data suggests transit use by older adults has declined during the pandemic (Palm et al., 2020a; 2020b). On the other hand, there has been a scaling up of volunteer driver services and delivery programs in many communities to support isolated older adults. However, some communities have reported shortages of volunteer drivers resulting in gaps in service (such as CBC News, 2021; Weldon, 2020)
• Communication and information: while data suggests over two-thirds of older Canadians use the internet (Davidson & Schimmele, 2019), certain segments of the population (such as low-income older adults; people living in rural, northern, and Indigenous communities; the very old; and older adults with physical disabilities or cognitive impairments) may encounter challenges in access and use. To overcome this “digital divide,” programs that provide training and access to digital technologies are being implemented or expanded across Canada. Telephone help and information lines and telephone outreach programs have also been initiated or enhanced for older adults who prefer low-tech interventions
• Social participation: the pandemic has disrupted the operations of community and recreation organizations, and many have switched to remote delivery of programs. The Senior Centre Without Walls model that offers telephone or virtual programs has been adopted by organizations in many jurisdictions. However, securing adequate funding to support their operations has been a challenge for some non-profit and community organizations (for example, Coordinated Pandemic Response Steering Committee, 2020)
• Civic participation and employment: for some older adults, work and volunteering are important sources of social connection. Older workers in Canada have been negatively impacted by workplace closures and growing unemployment rates during the pandemic (CLSA, 2021; Statistics Canada, 2021). Declining participation of older volunteers has also been observed, with COVID-related health concerns a contributing factor (Volunteer Canada, 2020; CLSA, 2021)
• Outdoor spaces and buildings: outdoor spaces can provide lower-risk locations to safely socialize and engage in physical activities. Strategies are needed to maximize the availability of outdoor community spaces and ensure that they are “COVID-19” age-friendly in design (INSPQ, 2020). Strategies are also needed so older adults can safely return to indoor spaces (such as providing hand sanitizer, smaller groups) (OACAO, 2020)

Social isolation among older adults residing in long-term care facilities

In LTC settings, concerns about social isolation have centred around how to safely facilitate family visits and offer social activities. Methods to support in-person visits during the pandemic have included: window visits, physically distanced outdoor visits, in-person visits in special rooms or containers with barriers in place, and physically distanced in-person visits in residents’ rooms or common areas. Technology (for example, telephone and video calls) can provide safe alternatives for staying connected to family members and friends but cannot replace face-to-face contact. Facilitating resident-family connections (whether they be in-person or virtual) requires a significant amount of time and effort from already overburdened staff. Ickert et al. (2020) estimate that a LTC home with 100 residents would require a minimum of 2 full-time and 1 part-time staff to provide most residents with a once-a-week visit with family for 30 minutes.

What was learned from this review

The following are key takeaway messages based on an analysis of what was learned:

• older Canadians are a heterogeneous population, and programs should be tailored to meet linguistic and cultural needs and delivered via a range of mechanisms (such as in-person, telephone, virtual, letter, etc.)
• a digital divide exists and there are sub-populations at risk of being further excluded during the pandemic as a result. Ensuring all Canadians have access to low-cost home internet and free internet in public spaces should be a priority
• intergenerational programs not only provide social benefits for older adults and younger people, but also have been shown to be effective at reducing ageism
• the development of partnerships that leverage the expertise and resources of stakeholders has contributed to the success of interventions
• government policies on LTC (for example, design of facilities, visitor policies, staffing levels) have a significant impact on the health and social lives of LTC residents. Policies should be reviewed with a focus on how they can balance disease mitigation and social connection needs
• in LTC facilities, adequate staff support is an essential enabler for visitation with families and caregivers (in-person or virtually), social activities, and coordinating with external organizations offering programs
• moving forward, ensuring the sustainability of successful interventions is a key issue. Many of the interventions being offered by community and non-profit organizations are supported by short-term funding, and sustainable funding sources are needed

The findings from this report highlight how federal, provincial, and territorial governments can influence the development of social isolation initiatives through their funding, large-scale coordination, knowledge sharing, and policy-making. Community and non-profit organizations were identified as being at the forefront of outreach and delivering services to vulnerable older adults. Businesses and academic institutions can also add their resources and expertise to interventions to support isolated older adults. While there were limited formal evaluations of interventions to reduce the social isolation of older adults, anecdotal evidence and pre-pandemic evaluations suggest potential benefits of the following promising practices:

• Befriending programs: a small number of studies and anecdotal evidence suggest participation benefits both older adults and volunteers
• Telephone outreach programs and information lines: one pre-pandemic study has linked telephone outreach and help or information lines to reductions in social isolation. Anecdotal evidence suggests high call volumes during the pandemic
• Health promotion and wellness programs: pre-pandemic there was an emerging body of evidence supporting the provision of online caregiver support programs. Evidence of the effectiveness of other types of health promotion and wellness programs at reducing social isolation has been found, though these effects have been observed based on in-person versions of the programs
• Practical assistance programs: 2 pre-pandemic studies have linked the receipt of practical assistance (meal delivery) with reduced levels of loneliness. Anecdotal evidence suggests high rates of demand for these services
• Technology donation and training programs: anecdotal evidence suggests these programs have been successful at training older adults to use digital technology. A key enabler for their success is providing access to free internet
• Senior Centre Without Walls: to date, there have been 2 small evaluations of the Senior Centre Without Walls (SCWW) model, both of which reported reduced loneliness due to participation. Anecdotal evidence suggests consistent participation by older adults in SCWW and other virtual programs and positive feedback by participants

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