Social Isolation Among the Elderly Population

Posted: July 17, 2014 by tinamaschi in Uncategorized

Social Isolation Among the Elderly Population

By Carmelita Brooks

The older adult population will soon represent the larger portion of our population. Technological advancements and medicine with the availability of proper healthcare have made major contributions towards the life expectancy of aging adults. (Gutheil, Heyman & Chernesy, 2009). As this population is growing there remain many misconceptions and negative stereotypes toward the aged. There is ongoing research that attempts to explore and understand the attitudes of the youth towards the elderly. This understanding is important for an overall better quality of life for what will soon be the majority of the population. The field of social work needs to be prepared for this, as it is the mission of the profession to cater to the well-being of all and to help meet the basic needs of those who need it.
As the trend of lower birth rates and longer life expectancy continues within the United States, there will soon be more people over the age of 65 than under age 15. So while American society is getting older, the issue of social isolation is becoming an increasingly larger problem. “In general, the ageing field believes isolation is one of the biggest issues facing all older people” (SAGE). Therefore, the needs of the elderly population must be addressed in order to remain successful. Social relationships and connectedness are central to human well being and are proven to be critical in health maintenance. Research shows that people who experience social isolation, especially amongst the older population, are facing significantly higher health risks. The mortality risks for the socially isolated are three times higher than those who maintain various sources of social contacts. The need to alleviate social isolation in the elderly population has been mostly recognized by caregivers of the elderly as well as various others serving this population. I’ve come to recognize this need from working with the elderly and taking notice of the fact that they need social outlets among other things – though social involvements remains a link to healthier habits.

It is noted that in comparison with various other industrialized countries, the United States has few family-friendly workplace policies. It is suggested that adjustments with more flexibility within the workforce, particularly where part-time work and retirement are concerned, that social connectedness would increase.

The relationship between social supports, loneliness and the impacts of it on overall health and well being, along with social service usages can be complex and varied. While it may be difficult to define and pinpoint the exact link between social supports and health care usage, there are clear links between these variables. Socially isolated seniors tend to use less fewer health care and social services. This may be due to the fact that seniors with support networks in place, such as family members, are able to better recognize the needs of their loved one and assist and advocate for them in various ways that can help the senior enter into formal health care. Coinciding with this, support from family members can also alleviate the need for formal services at times and in various ways such as the need for home care and entry into a nursing home.

There are several related concepts of social network in literature. The World Health Organization (2003) defines it as “belonging to a social network of communication and mutual obligation makes people feel cared for, loved, esteemed and valued- this has a powerful protective effect on health” (p. 22). While both social isolation and loneliness can impair an individual’s quality of life, efforts to reduce isolation are more relevant to mortality rates.

Isolation therefore obviously affects an individuals’ well being on all levels, with ultimately their health being at risk. Family members of an isolated individual are also affected. They may feel the added pressure of being able to provide adequate support for their loved one. Having the time and means to do so can also be an issue. But, as noted, for healthy ageing to occur, the risk factors for isolation in the elderly needs to be addressed.

Case Example
A brief example of an individual affected by this issue is the case of a woman whom we shall refer to, as J. J is a 59-year-old divorced woman who lives alone in Westchester, NY. She has one child, a son who moved out of their two-bedroom sparsely furnished apartment to live with his girlfriend in San Diego, CA almost two years ago. He was diagnosed with ADHD as a child and she often describes the challenges in raising him. J is also an immigrant whose primary language is Italian. She does speak English well but with a heavy accent. Her mother and brother, her only two remaining relatives, live in Italy. She communicates with them regularly by phone. J is living on a very limited income and is also receiving Section 8 benefits. While J is in relatively good health, she suffers from arthritis and also has a diagnosis of celiac disease, which requires a very expensive diet is therefore adds to her financial strain. She is also diagnosed with severe anxiety (reason for losing her last job). She’s lived in the same neighborhood for about 30 years and has seen some changes there that are undesirable for her and her situation. The nearby churches no longer hold mass in Italian or Latin, it’s spoken in Spanish in order to accommodate the neighborhood demographic. She does not have a car and public transportation can be a challenge for various reasons. She also has very few friends nearby with whom she can visit with or talk to. J has had a very hard life and looks older than her 59 years. She is in her older years now and it would be nice to not face some of the challenges she currently has. Being socially isolated and lonely remains her biggest issue right now, she longs for healthy forms of social connectedness.

Theory
Ageing is a universal phenomenon and in recent decades there have been many theories that have emerged on various aspects of ageing. How society defines the ageing population and treats them is socially constructed, and therefore the attitudes towards the elderly, being rooted in society, vary from one social group to another. In some/most foreign countries, the elderly are almost revered and hold a place of honor in their family. Nursing homes may not be common and looked down upon and ageing parents are expected to and almost naturally, move in with their adult children.

Erikson’s theory of disengagement states that older adults withdraw from personal relationships and society as they age. This theory claims that this behavior of withdrawal is natural and acceptable and that there are mutual benefits to both the individual and society. Another theory for this age group is the activity theory, which does however conflict with the disengagement theory; it notes the positive correlation between maintaining a healthy lifestyle and healthy ageing. Neither one of these theories have proven to be superior, (although the disengagement theory may be viewed as outdated) as ageing may mean different thing to different people. Some may view the disengagement theory as devaluing to an individual because it may be interpreted as denying an individual their choice as well as negate the fact that they may still possess the same skill set as when they were working. As the activity theory states, I do believe that the older population is well able to maintain an active lifestyle. While needs of society may not necessarily affect the older adult’s lifestyle I do find that our particular culture does in fact place a higher value on youth and beauty. Socialization is now a focus in many long-term care environments, as the benefits of social connectedness have become well known. From the contemporary perspective, ageing is now meant to be viewed at as a process that can flow smoothly with the proper supports in place as opposed a sharp decline. Even the nature of the workforce has changed in recent years, especially with the economy, many seniors are now forced to work for longer years and even part-time after retirement.

Human Rights

As the growing elderly population around the world brings to attention the issue of healthy ageing in some industrialized countries, the fact that there are so few policies in place to protect the human rights of this population becomes highlighted. Along with the personal challenges that come with getting older, this population will generally face age-discrimination, and quite possibly along with other compounded discriminations such as race, ethnicity, sex and socio-economic and health status. While most countries do have some kind of universal health care system in place, these systems are beginning to feel the impact of an increasingly older population to provide for. This brings into play the fact that an older person’s right to security, as stated in the Universal Declaration of Human Rights, becomes threatened. The right to healthcare is another component of the right to security that would also be in danger of violation.
As the current trend of lower birth and death rates continue, the United Nations Department of Economic and Social Affairs reports that by the year 2050, one out of every five people will be aged 60 years or older and by 2150, one out of every three persons will be ages 60 years or older. While many governments systems in place currently do provide services (such as Social Security) for the elderly, it was on the premise that there will continually be significantly fewer older people than the middle-aged and younger individuals living at any one time. This presents an issue where societies and governments become less able to provide and care for their elderly population. The varying issues that pertain to the elderly and their rights are very complex for many reasons. Documents from the United Nations such as the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Convention on the Elimination of All Forms of Racial Discrimination (CERD) do contain provisions which are applicable to older people and the International Convention on the Protection of the Rights of Migrant Workers and the members of their families (ICMW), article 7, does includes “age” in the list of prohibited grounds for discrimination. Article 25, paragraph one of the Universal Declaration of Rights also establishes the rights of the elderly, however these provisions are very general and are not specific in protecting the needs of the elderly population. This specific population may also be very vulnerable and is often viewed as easily taken advantage of.
There was a public Consultation on the Human Rights of Older Persons in April of 2013 at the UN in Geneva. Various experts from UN agencies, governments and national human rights institutions as well as academic institutions and other organizations from around the world gathered to discuss the challenges to the fulfillment of human rights by older adults and what the best practices are. Among the various discussions that were scheduled to be discussed are ageism and discrimination against the elderly, the rights of older people that include work, healthcare, and social security along with abuse, violence and neglect against the elder population. I was unable to find a report of this meeting and so am unaware of any significant changes in policies or discussions that may have taken place.
The Department of Health and Human Services states that as they continue to grow in knowledge about the consequences and seriousness of the neglect, abuse and exploitation of the older adult population, bills are being introduced to Congress to strengthen the programs and services that help to detect, prevent and intervene in the abuse of elders and persons living with disabilities. The Elder Justice Act (EJA) was just enacted as part of the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010. It is noted to be the first part of a legislation passed that authorizes specific sources of federal funds to address elder neglect, abuse and exploitation. It provides for the improvements in established services that provide long-term care in state agencies that use Medicaid and Medicare as well as Adult Protective Services (APS) and long-term care Ombudsman programs. While this is all great news for adults needing long-term care, there is still nothing that specifically addresses the issue of social isolation among the elderly. So this issue continues to have to need of being addressed on the federal and state level in terms of policy. In order for the need for policies to be put into place, there first needs to be a great deal of attention that is demanded to this issue. That starts by a great deal of advocacy on the parts of the general public. Care-givers and family members who are affected by loved ones facing isolation can and should advocate for programs that work to alleviate social isolation in the elderly by making a demand for it to the facilities involved in the care of the elder individual as well as getting the message out to their city or town representative as well as their Congressman. Rallying up the neighboring public and those around who are at risk for being in similar situations, whether as a client/victim or care-giver and loved one would be a great start in advocating for this cause.

Prevention or Intervention Response
DOROT is a multi-service agency that was founded in 1976 by a group of Colombia University students who became aware of the isolated elderly population with various unmet needs. They visited the homebound elderly living in the Upper West Side of Manhattan. Their mission was to enhance the lives of the homebound and homeless elderly by helping them to maintain their independence with dignity for as long as possible. Their mission to alleviate social isolation among the elderly population has not changed within the last 38 years. DOROT continues to serve the Jewish community as well as the wider community.
Grants and a lot of fundraising fund DOROT, along with bequeaths from those who were served by DOROT. Also, a small percentage comes from the Jewish Federation of Philanthropies. In 1999-2000, about 56% of financial support received came from individuals and about 28% came from various foundations and corporations. Just 7% came from the government and about 3% of support came from the UJA-Federation, clients and others sources. The county of Westchester also funds the Westchester programs. The partnership of professionals and work of many volunteers is really the forefront of this agency. The interns are students like myself were not and are not paid.
While service to the geographical area has not changed, the served demographic has expanded. There isn’t much that has changed historically regarding services but certain programs in New York City are not offered in Westchester country, such as Cemetery visits. DOROT of Westchester does not have a field office to work out of, the hired professionals work from home. There is no affiliation with other organizations or agencies, and clients are referred through various sources. Other social service agencies, families, and other community agencies can refer clients. Individuals can even refer clients.
The intergenerational programs of DOROT that provides food, housing, spiritual and intellectual support are very organized. One new goal is to extend services as the aging population continues to grow. DOROT remains committed to setting the standard for quality care for aged population.
The evidence of effectiveness within this program can be measured by the amount of clients that the agency services and the programs that the clients have themselves enrolled for. The agency itself has been created with this specific population in mind and so their clients are all within their target population. The only requirement is that a client needs to be at least the age of 62, while they have service younger clients who are socially isolated. There are various programs within the agency of DOROT and while they are all available to all of their clients, there is no required participation for all of them, the clients make a decision, sometimes with their loved ones, about what’s available to them and they simply choose what is appropriate for them.
I’m not aware of any specific policy reforms that play a part of this agency’s role. They are however are compliant with all the standard rules and regulations that pertain to confidentiality such as HIPPA. However, advocacy on the part of families for an agency that specifically targets this social issue does naturally create a demand for the services offered. Evidence of the effectiveness of advocacy is shown when there becomes an increased demand for services such as those that the agency offers. Clientele for the agency comes mainly through referrals. Referrals can come from anyone, even the individual themselves. Many times, as a client enters some sort of formal care, they are referred by a social worker with knowledge of the agency or even family members who begin looking for outlets for their loved ones.
Recommendations for DOROT would be for them to offer the same exact services that are offered to the clients in New York City to the clients in Westchester. The services offered in Westchester are much more limited. These services include cemetery visits where clients are accompanied by a volunteer on a visit to the grave site of a loved one who has passed away. Another service offered only to clients in the city is the Shop and Escort program that provides trained assistants to escort seniors for shopping, medical appointments, or a walk in the park. For homebound elders, escorts shop & perform various errands. Another recommendation for DOROT would be for them to create an office space for their workers in the county of Westchester. While they are based in New York City, there remains no office space in Westchester. The employed social workers and student interns all work from home and various meeting places. An office space would be especially beneficial for students, as they will be able to learn from other employees, students and just gain a more enriching experience overall. Though there are pros to working from home – such as never having to get out of your sweats and pajamas during a snowstorm, of which there were many this past winter.
Some resources that address this population include these listed:
SAGE
DOROT

Critical Self Reflection
This assignment has helped to develop skills in researching, especially where policy and structures in place are concerned. I’ve often felt very intimated and overwhelmed when considering all of the various services and agencies in place that target various populations. It’s very easy to feel this way when you lack knowledge about polices concerning the population you’re serving and about those concerning the agency itself in which you may be working for. I’ve always felt that there are so many rules and regulations that apply to different agencies, which is true but I’m less intimated by recognizing that over all of the rules and regulations of any agency that there are policies regarding that specific population which more adequately prepares me in knowing how to better serve any specific population.

References

Anderson , Jeff. (2013, August, 14). 14 Ways to help Seniors Avoid Social Isolation.
Retrieved from http://www.aplaceformom.com/blog/help-seniors-avoid-social-
isolation-8-14-2014/

Bajko, Matthew. (2014, April 10). Isolation hampers seniors’ well-being. Retrieved
from http://www.sageusa.org/newsevents/news.cfm?ID=125

http://www.aarp.org/aarp-foundation/our-work/isolation/info-2012/health-effects-of- social-isolation.html

Berzoff, J., Silverman, P. (2004) Living with Dying: A Handbook for End-of-Life
Healthcare Practitioners. New York: Columbia University Press

http://www.DOROTUSA.org

Chernesky, R.H., Gutheil, I.A., Heyman, J.C., (2009). Graduate Social Work Students’
Interest in Working with Older Adults. Social Work Education 28(2), 54-64.

http://www.gov.uk/government/policies/improving-opportunities-for-older-
people/supporting-pages/helping-older-people-most-at-risk-of-longer-term-
loneliness-and-social-isolation-to-remain-active

http://ncea.aoa.gov/Library/Policy/Law/Federal/index.aspx

Maschi, Tina. , Bradley, C., & Ward, K. (Eds.) (2009). Forensic Social Work:
Psychosocial and Legal Issues Across Diverse Practice Settings. New York:
Springer Publishing Company.

Northern, H. (1992). Intervention. Clinical Social Work Knowledge and Skills. (138-162).
Columbia University Press.

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