The Age of Isolation: Factors that contribute to seniors being Isolated

Assignment #1: Mapping Wicked Problems
Carnegie Mellon, Transition Design Seminar 2023

Team Holarchy : Jasmin Palermo, Gabriela Arias, Gladys Mercier, Misari Patel, Saurin Nanavati

Simply put, the percentage of people who live alone increases with age, however the culture of individualism in the United States is creating a new era. Historically speaking, we are in an era of isolation. Various research studies are being conducted on the reasons and consequences of social isolation and the subsequent health issues that arise from loneliness. The United Nations has even deemed 2021–2030 the Decade of Healthy Ageing.

However, let’s first begin by looking at some recent statistics on seniors in the United States to understand where we stand today.

Senior isolation is a growing problem in the US which has significant impacts at multiple levels. There are more senior citizens living alone in the US than ever before, and many of them have few opportunities for engagement, which can make them feel isolated. As seen in the below image, the National Poll on Healthy Aging conducted by the University of Michigan reveals that there is a significant increase in loneliness among older adults in the US.

Image Source : https://www.healthyagingpoll.org/reports-more/report/loneliness-among-older-adults-and-during-covid-19-pandemic

Many factors contribute to this problem and some of the root causes are decline in physical mobility, limited opportunities to connect with others, health issues, divorce, no children, decline in cognitive abilities, immigrants with no family etc. However, there are three specific factors that make this the era of Isolation:

1. Risk of COVID-19 exposure and associated illness are serious concerns for older adults. Social distancing and fear have worsened social isolation, with severe impacts on connectedness with seniors. Pandemic research highlights the importance of social connections, with significant impacts on both community-living older adults and those in nursing facilities. Safety protocols have created a paradox of reduced risk along with greater harm. Consequently, adapted approaches are urgently needed to address the consequences of a long-term social recession. (Source: MacLeod S, Tkatch R, Kraemer S, Fellows A, McGinn M, Schaeffer J, Yeh CS. COVID-19 Era Social Isolation among Older Adults. Geriatrics (Basel). 2021)
2. Recent meta-analysis studies have found those who are socially isolated have a 29% increased likelihood of mortality compared to those who are not. The National Institute on Aging shared research findings that described how social isolation and loneliness came with higher risks for various physical and mental health issues. These issues include high blood pressure, heart diseases, a weaker immune system, obesity, anxiety, depression, Alzheimer’s and death.
3. The term “baby boomer” is often used to describe someone born between 1946 and 1964 — all baby boomers over 65 by 2030. At one point, the Census Bureau projected that the baby boomer population would reach 61.3 million by 2029 and that the number of elderly folks over 65 would be 20% of the population by that time.

To further investigate this issue, we have decided to investigate the population of seniors in Pittsburg. By focusing on a specific geography, we are better able to focus our efforts in order to first understand the problem.

In 2021, About 25.7% of Pennsylvania residents were above age 60. Age 65 and older individuals made up an estimated 20.5% of specifically Pittsburgh in 2019, up from 17.3% in 2010.

This tells us that the Pittsburgh community’s increasing population in this age group must also be affected by isolation issue in some manner.

Distribution of resident population of Pennsylvania in 2021

Image Source : https://www.statista.com/statistics/912116/pennsylvania-population-share-age-group/

Discovering the Wicked Problem

We are lucky to have a team that is multi generational and cross cultural. Discussing our various cultural perspectives on living with and caring for seniors was a great first step in understanding each other’s values. From these discussions we divided our research into areas that resonated the most with our personal interests. This was an important first step to collectively get familiar with the problem, then we individually conducted desktop research (review of research papers, articles), conducted some interviews, and then shared our ideas through discussions. Next, we moved towards a method where, on post-its, we took what we found from our research and composed complete phrases describing the concerns of isolation and categorized them into five categories (known as STEEP) to organize issues related to isolation of seniors :

1. Social
2. Technology/Infrastructure/Science
3. Environmental
4. Economic/Business
5. Policy/Legal

These inputs were arranged into a Miro map and in order to see connections between issues and also to learn about some potential approaches to better serve the seniors suffering from loneliness as a result of isolation in the Pittsburgh old population.

The critical part here was understanding which of the five categories the issues would be allocated, since there were many overlaps. Later as we moved towards refining our map, we understood that those overlaps were actually inter-category correlations. Some intra-category connections were also realized as we progressed further in our process.

Above image: Map as it stood when we initially started

Learning through Miro:

Miro allows us to think visually. Rather than working with text heavy lists and softwares , Miro makes it easier to see connections and build upon a visual model. One can get overwhelmed by using tons of sticky notes, but the STEEP framework helped to create boundaries which reduced proliferation of repeated information.

Some recommendations when using Miro:

• When creating a new board, brainstorm in a separate (temp) board, or make notes of ideas in text form only, so that a good point doesn’t get lost.
• After brainstorming ideas, select interesting ideas to more carefully map onto the (real) board. This helps capture a flood of ideas and removes the need to figure out how the ideas relate as you’re generating them — which could dampen the idea flow. This also removes the need to clean up the board later because the components on the board are more.
• It is also extremely useful to have a key that explains the semantics of the board components, especially the connecting lines.

P.S. It’s best to have a large screen. (Working on a physical wall-sized board seems like it would be so fun!)

Insights on the Wicked Problem:

Isolation Versus Loneliness:

Social isolation (SI) is defined as an objective condition in which an individual has limited to non-existent social contact among family members, friends, and is disengaged from social participation and religious services (Taylor, 2020). While social isolation is the objective physical separation from other people (living alone), loneliness is the subjective distressed feeling of being alone or separated (Cacioppo S, Capitanio JP, Cacioppo JT. Toward a neurology of loneliness 2014).

Social Isolation among older adults include demographic, technological, infrastructure, social, economic, environmental and legal/policy contextual factors. All of these factors are important to consider given they influence the conditions and systems in which we live. Additionally, these factors shape our relationships and interactions with family members and friends as well as how we engage with institutions and participate in social/group activities. By not accounting for how these factors connect, we are missing crucial elements that could have a significant influence on Social Isolation for senior communities and populations.

Technology / Infrastructure

Poor infrastructure designs affect elders daily. Things like the shortage of ramps, well-lit spaces, and designed accessibility for the elderly demonstrate that the isolation of older adults is “not elective but consequential of a lack of inclusive design and urban planning.” This results in significantly more extended periods of solitude for older adults. Consequently, seniors become more prone to illnesses, mainly associated with poor mental health and sedentary lifestyles. A study in Pittsburgh showed that most special sites for elders were overall in the most unsatisfactory condition. These sites tend to be single-use buildings that are difficult to renovate which leads to a better solution, the relocation of these.

This solution demands the allocation of more money towards it, which is not affordable right now because of the country’s current economic situation. “A more diverse older population, increasingly without close family connections and often hard-hit during market downturns like the 2008 recession, means the number of affordable units needed for future seniors is daunting. The United States will have 16 million middle-income seniors by 2033, according to research by N.O.R.C. at the University of Chicago.”

“We should recognize that every detail in the physical composition of the built environment has the potential to deliver comfort, convenience, and connections to others. We must create a state of mind.”

- Sim D. (2019) Soft City. Building Density for Everyday Life. Island Press

Social

Regardless of age group, the relationship between isolation and well being has a very cyclic nature. Seniors who are socially isolated may not have access to the help and companionship they need to manage the challenges of aging. Social isolation can have a negative impact on one’s physical and mental health, leading to conditions including chronic illness, depression, and cognitive decline while the same conditions could also be potential reasons for the lack of social interactions, hence leading to isolation. An elevated risk of dementia of nearly 50% was linked to social isolation. Poor social connections, which are characterized by social isolation or loneliness, were linked to a 32% and 29% higher risk of stroke and heart disease, respectively. On the other hand, disability rates increase with age, affecting roughly 2 in 5 people aged 65 and older which impacts major life activities and leads to potential decline in social interactions furthering into social isolation.

According to a recent article in the New York Times, more older Americans are living alone than ever before in history. In 2020, there were 15 million Americans over the age of 50 living alone. In 2022, that figure for this same demographic is almost at 26 million. The article also noted that what made living alone even more challenging for older baby boomers was that about one in six Americans over 55 didn’t have any children. On the surface, there’s nothing inherently wrong with older people living alone. However, research over the years has shown that people who live alone as they get older will have worse physical and mental outcomes that result in shorter lifespans. Even more interesting is that 90% of seniors interviewed about the topic stated that they would like to maintain their independence.

Studies have found numerous factors related to Social Isolation among older adults including demographic factors (e.g., low income or low education, belonging to a cultural or racial minority group, male gender) and neighborhood and environmental contextual factors including living in neighborhoods which lack meaningful activities, are unsafe, or have inaccessible built environment for older adults (Cudjoe et al., 2020; Elder & Retrum, 2012; Nicholson, 2012).

Elderly adults who lack support may be more vulnerable to financial exploitation, fraud, and other types of abuse. A total of 92,371 older people were victimized by fraud in 2021, resulting in a loss of $1.7 billion in revenue. These types of frauds create a sense of fear among the elderly and reduce their confidence when it comes to talking to strangers resulting into less social interactions.

There is lack of social interaction habits among the family members as well. According to research published in the Journal of Health and Social Behavior, frequent communication and visits with seniors can prevent cognitive and physical problems as they age. However, only an estimated 44% of Americans visit a relative or friend who is in a nursing home or assisted living facility, according to a 2019 survey by the National Center for Health Research. Such social isolation, which results in feelings of loneliness and detachment, may have a negative impact on one’s quality of life.

Environment

There is one positive impact for the natural environment connected to our issue. This impact is generated by an interest in cultivating more age-friendly outdoor spaces (Green, n.d.). When creating environments that are aesthetically pleasing and that make navigating a space safe and easy, there is also great potential to improve those areas with considerations for the non-human populations that use them. Outdoor spaces that are appropriately designed with nature in mind provide the following benefits:

• Food for others: Using a diverse mix of native plants creates a habit that can support pollinators, who play a critical role in human and non-human food chains.
• Shelter for others: Having sufficiently large and connected open spaces allow wildlife to make their homes, raise their young, find access to water, and hide from predators.

One negative impact on the environment of people living alone (elderly or not) is that they usually have an overall higher impact (Kala, 2015) than households who can share resources such as water and energy.

Economic

Older people have a significant impact on the Pittsburgh region from an economic standpoint. The aging of Pittsburgh’s population has become an important part of the local economy, due to income derived from retirement. It isn’t surprising that in this region in particular this population is so crucial, especially considering that the average cost of assisted living facilities in Pennsylvania cost $3,555 monthly. That is more than 15 times the national average!

Covid-19 caused many of these senior care facilities to be unoccupied and undesirable, however, Covid-19 also exacerbated the national shortage of home care workers. This shortage threatens the option of aging at home for elderly people up and down the economic scale. Approximately 800,000 older Americans needing subsidized care are on waiting lists because of the lack of available workers.

The main root of this cause is that Medicaid reimbursement rates are too low for the more than 1,000 agencies in Pennsylvania to recruit and retain competent caregivers. Health aides are abandoning their jobs like never before, and elderly people are left alone, in uncertainty, and lacking care and company.

Economic status is also an important factor to consider, as about 15% of elderly people in Pittsburgh are in poverty. Ageism can exacerbate poverty due to higher healthcare costs, as well as a lack of health insurance. This can be especially difficult for people who are retired, who have lost their partner or spouse, or who cannot work due to disability or illness.

In terms of care for these individuals, financially strapped adults and non-white families are more likely to support elderly parents, deepening existing socioeconomic inequalities.

In conclusion, the main association between Elderly Isolation and the economy is that most of these individuals require care, and this care can give them comfort and social connections which has tremendous benefits. However, considering that for the most part care is not available, this system is preventing elderly people from receiving the services and companionship that they need to thrive.

Policies/Legal

Policymakers look at census population data to allocate funding for specific programs. It was recently announced that the Social Security cost-of-living adjustment will be 8.7% in 2023, which is the highest adjustment in 40 years.

The Census Bureau stats are also vital for analysts and community planners to see where older Americans live and what kind of services they need to designate for those communities. The lawmakers can also determine where to open health services and senior citizen centers. The senior citizen centers and services include adult day care, home-delivered meals, and community center luncheons. Funding levels are decided by looking at the stats of seniors and seniors who live alone.

Medicare spends $6.7 billion each year on hospitalization and nursing facilities for seniors who lack close kin, according to a study by Stanford University, Harvard University, and AARP. Loneliness in senior adults is a chronically stressful condition associated with worse physical health and chronic conditions including cancer, hypertension, diabetes, and cardiovascular disease (National Academies of Sciences, 2020; Taylor, 2021; Tomaka et al., 2006). Loneliness in elders is also associated with worse mental health and greater cognitive decline and impairment (National Academies of Sciences, 2020; Nguyen et al., 2020; Taylor et al., 2018). To curb medical costs and decrease mortality, Donald Berwick, former Center for Medicare and Medicaid administrator, said the nation will “have to address loneliness.”

The issue of loneliness is something that can’t be ignored. For this reason, we are mapping issues related to the Isolation of Elderly in Pittsburg, PA. Through the course of the next 3 months, we will explore this topic in order to make connections related to social, technological, science, infrastructure, environment and political and legal issues. These connections will help us design holistic, multigenerational and multi cultural recommendations based on our research.