Social Isolation and Loneliness Among Older Persons Experiencing Homelessness

By Jonas Roth (Research Assistant), Rachelle Patille (Vancouver Regional Coordinator), Gracen Bookmyer (Graduate Research Assistant), and Atiya Mahmood (Co-Investigator, SFU)

In 2017 and 2018, the former U.S. Surgeon General Vivek H. declared loneliness the epidemic of the 21st century [1]. This nationwide statement drew attention to the longstanding social issue of loneliness, which can affect everyone regardless of their socioeconomic status, educational level, or culture. Declaring loneliness as a reality that many of us face may recognize an important issue, but it does not change the unpleasant feeling of being lonely, socially isolated, and feeling disconnected from other people. Loneliness is not commonly at the forefront of mainstream concern. However, there was a shift in attention and focus on social isolation and loneliness due to the COVID-19 pandemic, especially among older adults. The social and physical well-being of older adults became headlines of the news and terms like loneliness, neglect, and social isolation were continuously covered. To put this into the Canadian context further, Wister and Ladowaki (2022) developed a report titled “Social Isolation Among Older Adults During the Pandemic” for the Federal/Provincial/Territorial Forum of Ministers Responsible for Seniors which succinctly showcased the stark impacts of the pandemic on Canadian older adults [2].

A powerful relationship exists between an individual's physical health and the experience of loneliness. One example can be found in a study conducted in 2010 by Julianne Holt-Lunstad that looked at the impacts of loneliness on an individual’s physical health. It was discovered that loneliness over time is as detrimental to one’s health as smoking 15 cigarettes per day [3]. Research has also shown that a person that experiences continued loneliness might have more anxiety, an increased risk of having a stroke, or may develop coronary artery disease [4].

Increased awareness about the impact of loneliness on health and wellbeing of individuals, especially older adults has resulted in a call to action in some countries to invest in effective interventions and social services. For example, the U.K. recently appointed a Minister of Loneliness to provide funding to build a network of important stakeholders to reinforce the effort to reduce loneliness in the community [5].

Older adults experience loneliness and social isolation for a variety of reasons. Issues and challenges pertaining to aging can contribute to feelings of social isolation and loneliness such as transitioning to a long-term care home, death of the spouse/significant other, lack of mobility or public transportation, shrinking social network, and being part of a l minority group or living in poverty [6]. These realities among many others can hinder older adults in their ability to connect with other people. To demonstrate the lack of connection among older adults, it has been identified that some older adults do not meet or interact with another person for five or six out of seven days [3]. Therefore, it is not surprising that this lack of interaction with others often results in significant negative impact on their lives such as an increased risk of detrimental physical health conditions (e.g. cardiovascular diseases, type-2 diabetes mellitus) and mental health conditions (e.g. dementia, depression, anxiety, suicidal ideation). The specific reasons for these adverse impacts are still under investigation, but one possibility is that social isolation and loneliness contribute to more stress on the mind and the body, which in turn results in the development of physical and mental conditions [7]. Data from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 study identified increased feelings of loneliness from baseline and COVID-19 (2020) which revealed a staggering 67% increase in loneliness among women aged 65 to 74 and a 37% increase among those aged 75 to 84. Among men, there was a 45% relative rise for men aged 65 to 74 and a 33% increase for men aged 75 to 84 [8]. These findings further demonstrate how critical it is for older persons have opportunities to overcome loneliness and social isolation and be more integrated into the community.

The knowledge about the consequences of loneliness has led to different interventions and preventive approaches [9]. To implement necessary interventions to prevent loneliness and social isolation, it is imperative to identify older adults who are experiencing loneliness and social isolation in the community. One intervention strategy can be outreach teams going into neighborhoods and apartment buildings with a high concentration of older adults living alone to provide information about available social support services in their community. However, it should be noted that one-size-fits-all interventions are not an effective way to battle loneliness. It is essential that programs aim to help older adults expand their social network in a way that is tailored and relevant to their specific needs and preferences. For instance, in 2016 Amie Peacock founded a group in Vancouver for older adults whose first language is not English and for those who struggle to communicate with others in English. The aim of the group is to come together once per week to practice English and foster relationships with each other in a supportive environment. This intervention makes it easier for individuals to communicate with others in the neighborhood as well as use and become aware of resources in the city [10]. Policy and programming in multiple sectors such as health services, transportation, and housing need to focus on this important issue to reduce barriers to social interactions and connectedness in neighborhoods. The “Hey Neighbour! Collective” is a project in British Columbia that is working to actively increase social connections in multi-unit and high-density rental housing by introducing as well as scaling out and scaling up community-building programs that facilitate social interactions and support among neighbours. They are also exploring how social engagement can foster intergenerational connections and aging in place for older adults living in multi-unit housing [11].

Even though community-based interventions are necessary and impactful for communities – these types of solutions might not be accessible to everyone, especially older adults who are vulnerable or facing housing insecurity. For example, an older adult who may want to join a community-based program would need to be able to get to the community center to participate in the activities. Therefore, a lack of transportation services for older adults can serve as a barrier to such interventions. The relevance of housing affordability and food security is also an important factor, as 14.5 % of older adults are experiencing poverty [6]. This indicates that accessibility to proper housing, and social interventions coupled with reliable sources of funding is necessary to sustainably reduce loneliness among older adults.

Older persons experiencing homelessness (OPEH) are frequently overlooked and neglected by society. This group of older adults face significant barriers to accessing social interventions appropriate medical care and social support services. OPEH health worsens when they are not housed which can reduce their mobility and thereby their access to community resources and social programs. This neglect is in part a reflection of policies that restrict the rights of people who experience homelessness. Furthermore, homeless communities are further marginalized through the criminalizing of panhandling and squeegeeing or camping in public spaces that further reinforce the exclusion of OPEH [12]. However, the number of OPEH are increasing in metropolitan areas of Canada and USA and attention must be paid to their health, wellbeing, and housing situation. For example, in Metro Vancouver 24% of all people experiencing homelessness in this region are older adults (55+ years) [13].

Being homeless does not only mean that one loses the roof over their head, but they may also lose their social connections and contacts due to distance from their former social network, shame concerning their homelessness, and negative encounters on the street (e.g. being blamed for their experience of homelessness, insults from strangers and violence) that can lower their self-esteem [7]. Losing housing and social connections can also be intertwined by the negative impacts of being low income, having poor mental and/or physical health or having previous experiences of exclusion and poverty on both housing and social connections. Furthermore, the death of a significant other, family ruptures, or domestic violence can lead OPEH into homelessness and further sever social contacts that were harmful [7].

Compounding this, OPEH must deal with the stigmatization of homelessness and social exclusion. This makes it even more challenging for OPEH to reach out for help because they fear being ashamed and stigmatized [7]. These feelings are comprehensible to the daily experiences of people experiencing homelessness. For example, people experiencing homelessness in Vancouver stay predominantly in the Downtown Eastside of Vancouver as this is the place in the city where people who are experiencing homelessness can exist and to locate resources they need to survive. That being said, the Downtown Eastside is disconnected from the rest of Vancouver and actively avoided by people who don’t experience homelessness. The stigmatization, as well as lack of tailored support to OPEH, present a variety of compounding challenges for OPEH community members.

The typical approaches of support for older adults to reduce feelings of loneliness are not always relevant for OPEH because they often depend on financial, mobility, and time resources. Older people experiencing homelessness require support that is appropriate and accessible to their circumstances. Due to the stigmatization of homelessness and loneliness, it is not guaranteed that OPEH will have a pleasant or fulfilling experience when they try to reach out to others. Therefore, it is important to create spaces where OPEH feel safe to talk about their social isolation and other experiences with loneliness.

Not only are homeless communities overlooked by society at large but they are often neglected by researchers who are exploring issues pertaining to loneliness and social isolation. They are overlooked when researchers conduct surveys to measure loneliness among older adults and when interventions are planned and implemented. Research with OPEH requires more resources, persistence, and patience because it is difficult to follow up with people who experience homelessness as they often do not have access to a phone or remain in certain locations regularly. The current research on OPEH is mostly qualitative and has small sample sizes, which often does not allow for data collection that represents diverse and crucial perspectives, which in turn impacts the generalization of findings [14].

Scholars have noted that improving the social and economic position of OPEH is crucial to reduce homelessness and prevent repeat experiences of homelessness. Given that no one solution fits all, OPEH researchers are still exploring how we can foster social connections among diverse groups of OPEH [14]. The lack of research that is specific to loneliness and social isolation among homeless community’s impact population-specific interventions and implementation that could serve the OPEH community. It is difficult to find information and research on OPEH and loneliness, let alone interventions for this particular group.

We must acknowledge that OPEH exist and stop ignoring the individuals who experience homelessness on our daily commutes, in our grocery stores, and in our communities. We must also conduct more research exploring the lives of OPEH and what helps them to become housed and remain housed. All community members deserve to feel included and have social connections in their daily lives. OPEH deserve to have the support that considers their specific needs and circumstances to end loneliness and social isolation. It is paramount that further research is prioritized on interventions and program development to combat loneliness and social isolation among OPEH. Recent research has provided some insight into the impact of homelessness on the well-being and health of OPEH [7]. Now it’s time to create and evaluate interventions that counteract the adverse effects of loneliness and isolation for OPEH.

References:

[1] https://www.newyorker.com/magazine/2020/04/06/the-history-of-loneliness [2] https://www.canada.ca/content/dam/canada/employment-social-development/corporate/seniors/forum/covid-19-social-isolation/covid-19-social-isolation-en.pdf  

[3] https://www.campaigntoendloneliness.org/the-facts-on-loneliness/

[4] https://www.apa.org/members/content/holt-lunstad-loneliness-social-connections

[5] https://www.gov.uk/government/news/loneliness-minister-its-more-important-than-ever-to-take-action

[6] https://bc.healthyagingcore.ca/resources/whos-risk-and-what-can-be-done-about-it-review-literature-social-isolation-different

[7] https://www.crisis.org.uk/media/20504/crisis_i_was_all_on_my_own_2016.pdf

[8] https://www.canada.ca/en/employment-social-development/corporate/seniors/forum/reports/covid19-social-isolation.html

[9] https://cnpea.ca/images/vancouver_seniors_isolation_loneliness_recommendations_may2018.pdf

[10] https://www.theglobeandmail.com/news/british-columbia/vancouver-group-looks-to-break-down-social-barriers-among-seniors/article38141077/

[11] https://www.heyneighbourcollective.ca/what-we-do/

[12] https://homelesshub.ca/about-homelessness/legal-justice-issues/criminalization-homelessness

[13] https://dailyhive.com/vancouver/vancouver-homeless-count-2020

[14] https://aginghomelessness.com/wp-content/uploads/2012/10/Literature-Review-Aging-and-Homelessness.pdf