The Isolation of the Elderly: People, Influence, Hopes, and Fears
Mapping Stakeholders
The elderly population in Pittsburgh is one of the highest in the nation and assumed to reach its peak around 2030 (Southwestern Pennsylvania Partnership for Aging, 2021, University of PIttsburgh, 2014). In such a context, our wicked problem, the isolation of the elderly in Pittsburgh, consists of actants from across sectors and scales. Our multi-faceted approach aims to provide an overview of the stakeholders that have some type of impact on this issue and build out the identified feedback loops in the previous mapping of this wicked problem.
In doing so, we outlined four core parts:
- Hopes and Fears: the key elements that underpin their understanding of and approaches to the elderly community in Pittsburgh
- Conflicts and Affinities: the ways in which relationships are built or fractured due to interests, history, motivators, and/or access to resources
- Financial and Social Influence: the core systemic forces that shape the webs of complexity which, ultimately, influence how an elderly individual experiences being in isolation
- Relationship to feedback loop(s): the varying ways in which the three aforementioned elements correlate and intersect
Each illustrates a vital dimension of stakeholder relations for the wicked problem, isolation of the elderly.
Process
Our process entailed deep asynchronous and virtual (in-real-time) collaboration spanning three key phases:
Phase one: Landscape Assessment
- Create a comprehensive list of stakeholders directly and adjacently related to the issue of isolation of the elderly in Pittsburgh
- Highlight relationality across multiple stakeholders with an added emphasis on connections, fractures, and anticipation
- Distinguish variances in levels across clusters of stakeholders to illustrate high-level, mid-level, and low-level with regard to scale, accessibility, and proximity to the issue
- Highlight each group’s broader hopes, fears, and goals
Phase two: Focused Relational Mapping
- Identify key groups that shape the experiences of the elderly in isolation
- Identify specific hopes, fears, and goals per stakeholder
- Draw lines of connections that underscore potential conflict of interests and/or collaboration
Phase three: Outline of Power Dynamics
- Identify key stakeholder groups and actors that impact the feedback loops illustrated in the wicked problem map
- Place them in accordance to the degree and depth of their impact in relation to the narrative per feedback loop
E.g., Stakeholder groups and actors are likely to have a deeper impact the closer they are to the outer ring of the circular diagram
This three-step process allowed us to understand the issue from multiple perspectives while gaining insight into particular dynamics between key actors. This provides both hindsight and foresight in how we may potentially address the issue of isolation of the elderly in Pittsburgh.
Our Map and Key Stakeholders
Through our research, we identified sets of stakeholders that profoundly shape the experiences of Pittsburghese elders. We narrowed our scope to solely focus on the dynamics of these three stakeholders: first responders, University of Pittsburgh Medical Center’s (UPMC) senior services, and Pittsburgh’s city council. Though these stakeholders represent micro, meso, and macro points of influence on the issue, this set illustrates the interconnected qualities that shape a niche group’s experiences and livelihoods, while underscoring the wicked nature of the issue of isolation of the elderly in Pittsburgh.
Each stakeholder and elements of their dynamics are highlighted below.
First Responders: This group encompasses Emergency Medical Technicians and members of the local fire department. They are the primary point of contact between elders and potential means of assistance that extends beyond their immediate network. First responders’ technical training, level of awareness, and set of knowledge(s), arguably, determine the acuity of the initial health disparity that brings them to the fore.
UPMC’s senior services: UPMC is a large-scale medical institution with facilities that comprehensively address commonly faced issues in the Pittsburgh area. It is argued that this organization has no competitor within its local region; thus, creating a duality to its role — a point of contention for grassroots on-the-ground efforts and an influential entity that proactively addresses issues that many Pittsburghese elders face.
Pittsburgh’s city council: The city council drafts the city budget prior to moving through a series of actants in an arduous line of decision making. Though influential actors shape the city budget, the initial drafting of items, such as parameters, priorities, and proposals, lay the foundation of the dialogue and debate that follow it. The allocation of public funds profoundly informs how elders in Pittsburgh are perceived, prioritized, and ultimately, sustain agency as they age.
We found that each insight held a duality in that it could potentially be a point of collaboration (affinity) or tension (conflict). We further examine this by illustrating two examples marked by the dynamic between the above stakeholders.
Communication: First responders and UPMC staff require communication lines to be streamlined and clear. First responders have a thorough understanding of the context in which an elder may have experienced a fall or other health disparity; this insight is a key ingredient for UPMC to properly treat and diagnose them. This is where collaboration may occur if they are able to sustain healthy relationships and clear lines of communication. It may also be a point of tension due to ego-driven dialogue and/or miscommunication from either party.
Organizational Priorities: In their respective capacities, first responders and Pittsburgh’s city council are expected to be in service and keep the needs of the most vulnerable as a high priority. This general notion in public service may forge a natural collaboration between the two when needs on either end arise and/or policies regarding first responders’ needs are in question. However, this may also be a point of tension due to possible fluctuation of performance of the first responders impacting the use of (additional or excess) public funds. Additionally, political agendas of individuals or weighted council people may impact how funds are generally allocated.
The Power of Feedback Loops
Politics
Earlier work analyzing the political and legal aspects of Pittsburgh’s problem of elderly isolation revealed three key interconnected feedback loops; all of which had significant touchpoints with social services provided or subsidized by the government. Each feedback loop involved some degree of disconnect between the elders using the services and the creators and designers of the services.
The aforementioned disconnects may have a degree of dependence upon the design processes and systems that exist within the government services themselves. These processes and systems are almost certainly, however, highly impacted by the interactions of the actors’ motivations and power dynamics within those systems.
Financial motivations and power dynamics play a large role in each of the identified feedback loops. Most social services need to be funded in order to compensate those who design, organize, run, and perform those services. Funding for these services can come from those who benefit from the services, from taxpayers via government, from private funding, or some combination of those three sources. In the case of the political issue of taxpayer funding, however, funding senior services is a low-yield investment because politicians, such as the Mayor, are largely concerned with actions that will lead to re-election. Seniors, especially those in precarious financial situations who may need these services most, are unlikely and perhaps unable to donate funding to future election campaigns. Therefore, government funding may be withheld from these services, ultimately making it difficult for the folks within the services to procure the resources needed to improve the services in the manner elders require.
Social motivations and clout also influence these political feedback loops. Social memes around what services are expected, desired, or even acceptable are highly influential in politics. Memes of top-down, monolithic approaches to government intervention that are prevalent amongst the powerful actors in government interact especially unfavorably with memes of individualism and autonomy on the part of elders. This conflict of interests and expectations creates a communication disconnect, creating fertile ground for the several feedback loops that leave elders without the services they wish to utilize to live their own conception of a fruitful life.
Infrastructure/Technology
The major feedback loops in the infrastructure section of our issue map concern the perpetuation of inaccessible and unsafe living environments, ineffective communication regarding infrastructural needs, and the growing needs among residents for more accessible and greener living environments. Other important feedback loops concern the support of elders in different aspects of life including housing, transportation, and emergency planning. Feedback loops in the infrastructure section overlap significantly, usually connected by factors such as transportation, through which elderly residents can access other infrastructural resources.
The transportation methods available for elders are mainly provided by private businesses in Pittsburgh and vary in vehicles available, services provided, and prices charged. This transportation network, loosely constituted by individual business entities with moderate financial and social power, contributes to infrastructure ineffectiveness in Pittsburgh.
To make up for the isolation of elders partially caused by ineffective transportation, Pittsburgh has a close-knit and active community of support services aiming at socially connecting elders through different activities. Organizations like Area Agency for Aging (AAA), UPMC Senior Services, and Caregiver Connection thus have little financial power but are influential socially as they actively reach out to elders and connect them to combat the isolation issue.
Further, Pittsburgh’s housing design does not consider the specific needs of elders. Due to this fact and the above-mentioned inaccessible, unsafe living environment and transportation, senior community centers provide institutional living to take better care of the elders, potentially providing collective green open spaces. Yet with their financial and social influence limited, community centers are unable to reach and attract a wider population while many of the elders in Pittsburgh prefer individual living.
Economic
Earlier work concerning the issue of elder isolation in Pittsburgh revealed two connected feedback loops involving the far-reaching impacts of economic stagnation. The dynamics of stagnation and isolation are closely tied to financial and social motivations and power dynamics.
Financial power dynamics have extensive effects in the area of economics. These financial power dynamics are many and varied; however, a few provide a particularly firm footing for the feedback loops described in our earlier work. Service providers, such as landlords, transportation providers, and retail providers, wield significant economic power over their customers through their control of prices, and increasing prices can exact high economic tolls on individuals. This is especially true for price-inelastic goods like medication, housing, or necessary transportation because price increases will not decrease demand for these necessary goods. The drive to make high profits, when combined with the aforementioned economic power, can create blatantly exploitative economic dynamics. Elders are especially at risk to these dynamics due to their higher propensity to require price-inelastic goods as well as their economic situation (perhaps being retired or reducing working hours). All of this yields an economic drain, siphoning the economic resources from elders especially quickly. This in turn means that elders have less resources to spend at their discretion, often on goods and services that would entail interacting with the community. When they are able to occur, expenditures at such institutions as local retailers, restaurants, or perhaps activity organizers increase elders’ interaction with the community. In their absence, elder interaction diminishes and isolation increases.
Economic factors around elder isolation are also heavily impacted by social motivations and power. One particular social meme that is prevalent throughout our society is that of retirement: this meme causes elders to believe that they should not be engaged in productive economic activity, and also cause non-elders to believe that elders should not be engaged in such activity. This works hand-in-hand with subtle forms of ageism that discriminate against elders in the hiring process. These social factors can lock otherwise qualified (perhaps overqualified) elders out of the workforce, reducing the number of reasons that they have to leave home, and increasing their economic precarity.
Social
As seen in our map initial mapping of this wicked problem, the two primary feedback loops spoke to the compounding effect of multiple health disparities on the elderly and the change to one’s perception of temporal and spatial dynamics as one ages. Both underscore that such cycles deepen and propel the sense of isolation particularly if without a partner, community, and resources.
Such circumstances are deeply shaped by financial and social influences where decision-making, power dynamics, and interdependencies are further articulated.
For both feedback loops, decisions and directives are typically driven by motivations for (further) financial gain. In this light, the primary influential entities are foundations, healthcare, and government funding. For instance, government funding underscores the interdependency of funding networks, from foundations like The Pittsburgh Foundation to healthcare models such as private donors to a hospital, and decision-making processes across multiple scales, from the types of direct services available to the design of a built environment. Government funding largely impacts how entities prioritize their immediate resources and staff capacity; all of which shapes the experiences and attitudes towards the elderly in isolation.
Similarly, social influencers shape culture and mindset deeply informing what may become a trend, readily accessible, or abruptly unavailable. In this regard, technology, politicians, and one’s neighborhood will play large roles in how a place may materialize, feel, and affect the elderly. For example, technological advancements place added pressure on the elderly to understand the utility of emerging trends while their intuition loses its intimacy with the world they live in. This typically is a facet of ageism that is normalized than addressed and refuted.
Environment
While the environmental issues feedback loop identified in our initial mapping of a wicked problem focuses on the degradation of the environment and its effects on climate change and the decline of living species, the cycle underscores the way the natural environment and its changes push humans to give the natural world social and economic power as a way to slow, and ultimately stop, the feedback loop.
As the natural environment cannot speak out on its conflicts and issues, we humans are put in a position to provide that natural environment with economic and social power.
In addition to its non-human stakeholders, the natural environment also has advocates within government, private businesses, education, and nonprofits. The feedback loop’s apparent simplicity belies the complexity of the subtleties within it. Financially, the natural environment holds power across all levels of society; however, its financial power stems from the high social power that the natural environment has.
The natural environment’s social power lies within activists, educators, and advocates. With a number of nonprofits on all societal levels that push for policy change, preserve the natural environment, and increase access to nature, this influence can affect societal change as the power relies on human action. What’s unique about the natural world’s social power is that the non-human living forms hold the highest amount of social power. Flora, fauna, and viruses are indicative of demonstrating the real issues within the natural environment. With the loss of species, both plant and animal, we find humans react via education, law, and activism. Additionally, as the feedback loop progresses, viruses adapt and change, forcing us humans to change our social behavior. For example, with COVID-19, the virus dictated new societal rules that changed the way humans interact with each other and isolated each other, which increased the isolation of the elderly.
Insights and Reflection
Through investigations into individual stakeholders, our team uncovered vital players that influence the manifestation of the feedback loops that drive the isolation of the elderly in Pittsburgh. Numerous people have a stake in the issue of the isolation of the elderly, which reflects and contributes to the complexity of the problem. The varying economic and social powers that guide social, political, infrastructure, environmental, and economic issues demonstrate how these power structures influence the feedback loops through the impact of each stakeholder’s goals and fears. We found:
- The same stakeholders have the potential to be partners and also conflict with each other’s missions depending on the issue.
- Understanding stakeholder motives and how they are reflected in stakeholder goals, fears, and desires provided us with an idea of how they influence or relieve issues surrounding the isolation of the elderly.
This process provided us a way to illuminate the nuances of how power dictates the cyclical nature of issues. The mapping of stakeholders allowed our team to reflect on the types of impacts that national power and local institutions have on the elderly and the ways they are isolated in Pittsburgh.
This post was collaboratively written by Esther Kang, Isabel Ngan, Will Rutter, & Yu Jiang
Wicked Problem: The Isolation of the Elderly
Bibliography
Southwestern Pennsylvania Partnership for Aging. 2021. “Age-Friendly Greater Pittsburgh.” Accessed February 15, 2021. https://www.swppa.org/agefriendly/.
The University of Pittsburgh. 2014. “State of Aging in Allegheny County.” Accessed February 09, 2021. http://pittsburghtoday.org/stateofaging2014
