TEAM SYNERGY: Elderly Isolation in Pittsburgh
Team Members: Corine Britto, Helen Hu, Anukriti Kedia, Sujan Das Shrestha, Shariwa Sharada, Eugenia Perez
Assignment Brief
The Transition Design Spring 2019 seminar was divided into teams to address several different wicked problems affecting the world yet more specifically the City of Pittsburgh. Our team was assigned the elderly isolation in Pittsburgh and our task was to conduct research and map out the wicked problem of elderly isolation. There were two parts to the assignment. The first part consisted on mapping out the wicked problem visually and categorizing it into social issues, environmental issues, economic issues, political issues and lastly infrastructural/ technology issues. We placed these on our project canvas and began to see the connections between each category and identified roots from consequences. The second part of the assignment was to determine all groups of people affected by the problem. We needed to speculate areas of conflict and affinities among three main stakeholder groups that could pose obstacles to problem resolution. The problem of the elderly isolation in Pittsburgh has all of the characteristics of a wicked problem because it is tied to many systems that affect a myriad of stakeholder groups. The challenge of the assignment is gathering insights found in the connections and later on designing interventions that are scalable across time horizons.
Problem Characteristics
Before diving into the process of the assignment, elderly isolation will be briefly explained to provide context and a common definition of the problem. The social isolation of an individual is the psychological and/or physical distancing from one’s own networks and needed relationships with other people. It is a loss of place within a group (Biordi & Nicholson, 2009). Isolation in adults over the age of 50 occurs at the individual, community and societal level which is very characteristic of a wicked problem. Life events, changes in health and contextual factors are some contributing aspects that can trigger isolation for the elderly individual.
Some primary risk factors of isolation that are explored in our wicked problems map include living alone, major life transitions, impaired mobility, socioeconomic status, environment, language, amongst many others (AARP Foundation, 2009).
Major demographic shifts are showing that the number of Americans ages 65 and older are projected to more than double by 2060. A steep rise in the number of people with Alzheimer’s disease could nearly triple by 2050 causing a demand for elder care. A large share of elders affects Social Security and Medicare by expenditures increasing. Policymakers have also the power to affect these issues that stem cause and perpetuate elder isolation (Mather, 2016). All of these problems affect many areas of the wicked problem in which root causes and effects are explored in our map.
Mapping the Wicked Problem
Social Issues
Through the mapping process we realized that a lot of the elderly isolation problem was deeply embedded into our social and cultural mindsets. We chose to focus on how changes in (1)cultural mindsets, (2)shifting sense of belonging (3)changing social structures and (4) overall health influences the position and perception of the elderly.
Increasing trends towards nuclear families, built on the bedrock of globalization and migration and changes in familial roles where elders are no longer seen as the heads of the households are a growing cause of generational misunderstandings and poor social networks. These problems coupled with hyper-individualism, which further increases youth isolation build an environment of intergenerational competition instead of intergenerational solidarity. Further contributing to distancing that in turn effects economic problems of how the elderly are treated in work environments and how they are viewed as tax burdens by the youth.
The shifting sense of belonging, as the elderly enter a transitioning stage in their lives, bring with them many unanticipated changes in their lives, potentially affecting their mental and physical health, reducing their self esteem and leading to depression and subjective isolation. This deteriorating self-worth and mental health problems contribute substantially to the situation of isolation of the elderly, and even look turn towards alcohol and drugs as a coping mechanism.
Research also showed that LGBTQ elders were twice more likely to face isolation and immigrants too were prone to isolation. In a world of rising immigrant population, minority challenges, location barriers, and adaptation to a new community, put more stress on the elderly’s belonging to these groups.
Health Issues
Aspects of health that were linked in our wicked problems map included mobility challenges, isolation, declining mental and physical health as well as poor social networks. There are many dangers involving health and isolation that are worth exploring. For example, in a study that sampled adults age 50 and older, it was found that chronic loneliness was associated with chronic illness and higher depression scores. Isolation is also shown to increase cognitive impairment in women (AARP Foundation, 2009).
Causes of isolation include loss of social networks, loss of role in their community and family, loss of physical and mental health as well as a loss of resources. Reasons for losing social network includes death in the family and/or close friends. When an elder loses their job their sense of identity is affected and may need to move to a new place. Additionally, dementia, limited access to transportation, unsafe community settings and relocation contribute to mental and physical decline and eventually lead to isolation.
Infrastructural/Technology Issues
The design of the built environment and inaccessibility of communication technology have been outlined as potential major causes of the wicked problem further aggravated by the lack of awareness or education in the subject matter.
With a lack of conducive environment to participate or engage in, caused the elderly to stay indoors. This aided with the lack of resting spaces, removal of park benches citing use by the homeless, and a major fear of falling is also a reason they prefer to stay indoor which later leads to isolation.
Along with the design of the built environment, the location of the elderly also plays a major role in the degree or probability of isolation. Rural areas that are served less by public transportation is often inconvenient as the elderly find themselves further away from important medical, health services as well as marketplaces. It also distances them from any neighboring communities. While the built environment and the design is at times directly related to the condition of the natural environment, the latter was deduced as a result of the insufficient tax fund allocation due to the shrinking working population. The inclement weather also poses quite the challenge to provide sufficient accessible transportation to the public regardless of rural or urban areas.
With regards to the built environment, a larger portion of the cities were heavily influenced by the highway lobby. The infrastructure built by the state in the 1950s and 1960s along with the influence of car manufacturers have caused significant damage to the built environment and the led to the lack of pedestrian friendly, pro-public transportation especially in the US.
These issues on a local neighborhood level manifest as streets that are very wide, often designed for faster traffic flows that are not well suited for the elderly. These kinds of issues do not create an engaging environment for them and leads to isolation.
As more products are seen being designed for the living, the new niche group, its uncommon to find the elderly having a difficult time get around accessing and using present day technologies. The products require a certain level of control of mental and physical faculties from the elderly which isn’t the case most of the time. On another note, with lack of social network and the increased use of social media, it exaggerated feelings of loneliness.
Lastly, the lack of research on the subject matter and the interest among young people to join the geriatrics field is something we see that has been caused due to the lack of public awareness. With the lack of awareness, the working population could potentially lack of economic literacy which later on might cause isolation as they are not prepared for life after retirement.
Economic Issues
Economic issues focused on three main areas — lack of economic literacy, lack of jobs for the elderly, and the economic crises of 2000 and 2008. The economic crises created a lot of issues that tie in all around this wicked problem but the biggest consequence of it was the inflation. Inflation resulted in money that the older population had saved up, losing its power — so the amount that the same money could buy was much lower. Since the surrounding prices did not drop — especially those of healthcare — a lot more money is now needed to get the same service. The lack of economic literacy also affects older people’s savings because as they are ageing they haven’t been taught the basics. As such they don’t realise what life decisions they are making that are harmful or even helpful to their future life. For example there is a shift from pensions to 401k(s) being offered by employers older people think as long as its a saving it will be fine but pensions offer a steady source of income where as 401k has a limited number. If you were to have emergency healthcare then you would loose a huge mount of your 401k instantly. Furthermore, the saving that you make in typical working years aren’t enough to cover the cost of living a longer life after retirement (due to longer life spans). Since, people don’t value older people in the workforce, it gets harder to earn an income after retirement or even to just stay working longer.
Political Issues
he political issues created a never ending feedback loop with the economic issues — the economic crises cause inflation, which in turn resulted in fractured healthcare policies as the government can no longer provide the same services at those reduced rates, and this is turn resulted in increased cost of healthcare, which doesn’t seem to be reducing in anyway and so once again leads to inflation and so goes the cycle. With these fractured healthcare policies come a burden on the tax system — it can no longer provide for the growing masses of the elderly and so policies are being made to cut funding from one part of the government and move the funding to supplement elderly living and care. While the inflation of everything in general has a huge part to play in this there is also the issue of the governmental policies not responding to the increased life expectancy rates and the increased elderly population. If they were to have responded better then maybe the elderly would not have been such a ta burden on everyone as seen but rather a source of tax revenue — this ties back into the economic issue of a lack of jobs being created for the elderly. There is this constant back and forth going on between issues for the elderly.
Environmental Issues
The environment exacerbates elder isolation in three main ways, (1) adverse health effects, (2) physical barriers to mobility and (3) access to resources.
Poor health is known to be correlated with elder isolation. Poor health conditions can be both prohibitive and psychologically preventative toward elderly individuals’ social activity. The adverse health effects brought by the environment include long-term factors (such as exposure to pollution, climate patterns) and short-term factors (such as natural or man-made disasters). Long-term exposure to toxic pollutants in air, water, and food lead to both acute and chronic health conditions. Airborne pollution in particular is one of the heaviest burdens on public health and affect vulnerable populations (including children and the elderly) disproportionately. Short-term factors or shocks such as natural disasters can have debilitating health consequences, as well as psychological consequences.The effects of radiation or chemicals (including on industrial workers and war veterans) introduces handicap and health conditions.
Natural landscapes pose barriers to mobility for the mobility-impaired. Mobility is one of the prerequisites to social participation, particularly in low-connectivity or rural areas. Topographic challenges toward mobility can include hilly terrain, lowlands that flood easily, mountains that erode and create landslides, and volcanic areas. Scattered communities where households are few and far between may create additional barriers to social activity.
Additionally, access to resources is limited in rural or remote locations, including access to internet and phone services, which might otherwise connect the elderly to friends and family.
Stakeholder Groups
From the map of wicked problems we derived a list of potential stakeholders. Our initial list included the following: the elderly population, families of the elder, health care system, The Media, urban designers, infrastructure/ Built environment. We came to this list by analyzing our wicked problems, tracing them back to their root cause then identifying the actors involved. For example, infrastructure limits mobility which contributes to isolation. However, because infrastructure is inanimate and slow to change we did not include it as a stakeholder. After much debate, we narrowed down to the following stakeholders and listed their hopes and desires along with their fears and concerns.
The Elderly
The most important stakeholder of course is the elder person. Elders are often at the mercy of government, healthcare and other institutions. They are often not consulted about policies that affect them the most. The hopes and desires we identified were staying healthy while maintaining social ties, autonomy and financial independence. They fear losing agency and becoming a burden their families. They also fear that a health crisis could also lead to loss of wealth.
Families
The elders families desires centered around the elder well being. They hope for adequate supervision and access to health care but fear that they may lack time and money for these needs. Since they often not able to provide constant care, they need to be able to trust the healthcare institution with the elders wellbeing. Balance is a major concern for families caring for elders. They fear while caring got the elder they will not have the resources to care for themselves. Families may also be balancing the cost of elder care with their own financial priorities.
Health Care Providers
Finally we examined the hope and desires of the health care system. The main desire of the health care providers is providing efficient services while maintaining reputation as quality health providers. They are under pressure to reduce costs while increasing profits all while maintaining the same quality of care. Meanwhile they struggle with maintaining an adequate number of staff professionals and avoiding litigation which can threaten both reputation and profit.
Mapping Stakeholder Relationships
After identifying the hopes and desires of each stakeholder then mapped hopes and desires which were in conflict. The elders desire to maintain autonomy is at odds with the families desire to maintain adequate supervision of the elders. Maintaining autonomy is also at odds with the families fear of losing their loved one. The elders' desire for financial independence is at odds with the high cost of health care. It is also difficult to maintain a high quality of life when health care is so expensive. The families desire to have budget friendly services As well as being able to trust the health care system is at odds with health care systems desire to make money. Which brings up the question of what the cost of health care should be and as you can see, conflicting financial needs are a source of conflict between elders and healthcare institutions.
We also mapped the hopes and desires that were in synergy. The elders desire to maintain social ties is in sync with the facility wish for the family to be happy and fulfilled. Health care industries desire to be seen as trustworthy aligns with the families hopes that those health care providers are in compliance with rules and regulations The elders' financial independence and Healthcare industries need to make as much money as possible. Making these connections sparked insights into how these commonalities can be leveraged. For example, if elders were able to earn money they would be better able to afford health care costs which would lead to fewer unpaid bills. These connections may be leverage points for interventions in the system.
Working Process
Our work process began with the dividing of topics (economic, social, environmental, infrastructure/technology, political) that were interesting to us. We did our own research, then came together to each other what we had learned. Even going into it as an identified wicked problem, the amount we learned surprised us.
Many issues around elder isolation, such as roads that are dangerous for pedestrians, are issues that pertain to people in general. Issues around elder isolation touch on many of the same issues of general human isolation (such as the adverse effects of social media). Some situations we found so entangled and haunting that it was difficult to know where to begin, for example, the elderly homeless, who may deal with issues of chronic health conditions and substance abuse, while also struggling with the lack of a stable home or social network. Some of our research found us running in circles, for example, the intergenerational divide that causes the young to distance themselves from the elderly or pretend they don’t exist, which in turn leads to less cultural awareness of the elderly and less budget allocation toward public health and hospice for the elderly. Are there cultural norms that make it easy to turn a blind eye to vulnerable populations?
In some ways, we discovered more questions than answers. What incentivizes economic expenditure toward the elderly? Would increased budget allocation have any impact on public perception of the elderly? Would public perception of the elderly impact intergenerational social relations?
We mapped our insights on sticky notes and began to think about how they interconnected. We drew lines of connection and quickly found that everything connected to everything else.
We thought about the various stakeholders involved and found the triad of healthcare, families, and the elderly, to be most interesting. Healthcare providers provide care by definition, but also profit from returning, frequently visiting patients. Families care for the elderly but also often isolate them (evident in the American nuclear family) by sending them to care facilities. We drew lines of connection and discussed further.
Key insights:
Changes in family structures increase both physical and social distances:
With a growing trend of nuclear families, elder family members find themselves isolated due to their loss of place and influence within that family. The impact of migration is also an influential one. In many cases, elderly are brought into a new country where they do not speak the language. If their immigration status is also questionable fear will hold them back from integrating into the new culture. In addition, distances between different generations are growing with a respect to the perceived role of the elders in the family, this may be a leading factor in the intergenerational gaps that are seen today.
Deteriorating health and elderly isolation form a cause and effect relationship:
Understanding isolation as a public health crisis is key to expanding our sense of it. While poor and diminishing health may cause barriers to interactions and cause elderly isolation; conversely increased social isolation also impacts the mental and physical health of the elderly, thus forming a positive feedback loop between the two.
Lack of research and education:
Education transcends most problems. In the case of the elderly isolation too, we found the lack of literacy around subjects that that concern long-term financial literacy, and literacy on geriatrics that cause further distancing. We also found a dearth of research on the elderly isolation problems, which speaks of growing need to not just recognize this as an impending crisis but to formulate ways to tackle the situation soon.
The built and natural environment poses structural problems:
Besides the social implications of the elderly problem, the built environment and infrastructures pose challenges that limit access to the elderly and disabled. These problems manifest themselves in tangible, heavy, expensive infrastructures, changes to which won’t be readily agreed upon or imaginable. It is important that cities provide
Designers and urban designers need to design for a more inclusive society:
A large part of the problem is the mindset of designing for the living and not for the ageing. This ethos systematically alienates the elderly from a vast majority of products and infrastructures.
Reflections on the Process
Learning a new framework of iterative research:
The process of mapping the wicked problem was an iterative and expansive project, which needed us to continuously iterate on our research and our map. To begin with the framework allowed us to scaffold our research and think of it as a larger system, with a range of implications. This process felt very distinct from the research processes we are used to, which try to frame the problem in context to a small insight. The more we researched, the bigger the problem became. In some ways, we discovered more questions than answers. While we may now better understand the elderly isolation problem a little better, we still feel that there is a long way to go to be able to do justice to mapping the whole subject and its interconnectedness. Cheryl Dahle’s words kept resonating through the process; “ don’t make the problem smaller, make it bigger”.
Distinguishing causes from effects:
A big challenge that faced us during the whole process was being able to distinguish causes from the effects. While this was most prominent on our first round of mapping, we still feel there are many points in our current map where this boundary between the two blur.
Potentially giving health its own space on the map:
Specifically, concerning the subject of the elderly, we saw health crop up at all points. It was one topic which transcended all the other five lenses. As noted above, we also saw a strong cause and effect loop between poor health and isolation, where they both affected one another. Parking it within the social lense, seemed to dilute its importance, and we felt that it may need its own space on the map.
Narrowing down on three stakeholders:
For a problem as big as any wicked problem, the list of stakeholders is massive. Choosing three stakeholders from this range of options, to distill into the stakeholder map was probably one of the hardest parts of the exercise. One key learning was to realize the importance of ‘stake’ in stakeholders, and to distinguish groups based on which groups would be directly effected and hence may have a larger stake in trying to find sustainable solutions for the problem. Yet, choosing three groups was a difficult task, and we wish we weren’t limited by quantity to narrow down on the stakeholders.
Not choosing inanimate stakeholders:
Another important learning came from our conversation with Gideon, who made us understand the importance of not choosing inanimate stakeholder groups like the built environment. Mistakenly choosing an inanimate stakeholder group presents the problem of voicing their needs in a process which requires different stakeholders to come together in a conversation. In some cases, this may require us to rethink the chosen group, push further to establish the stakeholders in a process and at times when pertinent even figure a way out to build better communication that represents the need of a non-human.
Creating newer visual frameworks for making the map:
In many ways, we felt handicapped by the tools at our dispersal to create these visual frameworks that best communicated our research. The whiteboards in the Ideate studio and the canvases provided to us were definitely not big enough. As a team, we were able to effectively collaborate well on the Real Time board, which gave us the opportunity to use post-its and form connections in a way that spanned across a wide space. However, condensing and translating the research back onto the canvas for the presentation was still a hard task, where we felt limited by the space to present our research. While we haven’t been able to crack newer ways to visually represent this information, it is definitely something that we wish to explore further in the process.
Mapping the Wicked Problem — Process Documentation
References
AARP Foundation Survey: Loneliness Numbers Rise Among Adults Age 45 and Older; Neighborhood Connections Key to Countering Social Isolation. (n.d.). Retrieved from https://press.aarp.org/2018-9-25-AARP-Foundation-Survey-Loneliness-Numbers-Rise-Among-Adults-Age-45-Older-Neighborhood-Connections-Key-Countering-Social-Isolation
AARP Foundation:Framework for Isolation in Adults Over 50.Retrieved from:
Biordi, D. L., & Nicholson, N. R. (2009). Social isolation. Chronic Illness: Impact and Interventions. 7th ed. Sudbury, MA: Jones and Bartlett Publishers, 85–116.
Mather, M. (2016) Fact Sheet: Aging in the United States. (n.d.). Retrieved from https://www.prb.org/aging-unitedstates-fact-sheet/
