What is Influencing the Isolation of The Elderly?
Mapping a Wicked Problem
Isolation of the elderly remains a recurring issue across the US. Whether they can age in place (in their homes) or in a separate facility, the elderly often experience a lack of companionship, camaraderie and a sense of belonging as their community continues to narrow. According to the State of Aging report, age group of 65+ typically face the highest rates of isolation due to the compounding effect of an array of issues, such as yet not limited to declining cognitive and physical health and residing in a society that values productivity and individualism. This predicament does not escape the aging community in Pittsburgh. In the city of Pittsburgh, 15% are over the age of 65, and 11.2% are between the ages of 55–64 (Age-Friendly Greater Pittsburgh, 2017). According to the US Census and Pittsburgh Economic Quarterly, Allegheny County, where Pittsburgh is situated, has had the highest population of individuals over the age of 65 for the past two decades; the communities across city and county lines are deeply intertwined as families seek ways to support their elderly, if equipped with the means, through facilities, larger homes, and/or avenues with more appropriate care across the area. The majority of the elderly in both city and county are experiencing isolation in some fashion, emphasized by the built environment and politics that mostly benefit the able-body experience. This results in a myriad of symptoms such as depression, atrophy, and loss of appetite.
Moreover, the US Census, The State of Aging report, and the Age-Friendly Greater Pittsburgh report underscore that the peak of the baby boomer population will occur by approximately 2030 in Pittsburgh proper. This brings to light several key questions on how prepared Pittsburgh will be for this possible future. Some concerns include the level of preparedness to serve the elderly in 2030 and depth of understanding of the issue of isolation in the elderly community in Pittsburgh. Some argue that this group is an untapped resource that may boost the economy, while others center a need to reorient our collective mindset to foster cultures that are intergenerational rather than exclusively profit-driven.
Our research emphasizes the complexity of existing feedback loops that illustrate multiple dimensions of persistent to emergent qualities of isolation in Pittsburgh’s elderly community. The cyclical nature underscores the deep entanglement regardless of how mildly or acutely one may be experiencing this issue; rather, it emphasizes the need to view it holistically — in part and in whole — than separate from weighted contextual variables.
It is noteworthy that COVID-19 exacerbated the issue of isolation across many age groups, particularly of the elderly; however, our group underscores the historical background of this issue.
Mapping a Wicked Problem
In order to reflect a rich and nuanced illustration of the issue, we applied four key steps to our process.
- Scope the issue: focused on those residing in the city of Pittsburgh and the age groups of 65+
- Secondary research: conducted secondary research encompassing academic literature, city and county generated reports, and local news reports. To further contextualize this issue, we cross-referenced national and peer-city reports across the US.
- Aggregate & analyze data: applied affinity mapping techniques, determined scale, and highlighted variants of cause and effect relationships across the categories
- Determine intersections & feedback loops: drew lines of intersections while underscoring the feedback loops that each category contained.
Our Wicked Problem Map
To illustrate the complexity of our issue in a digestible format, our map deconstructs the issue through five lenses:
- Political/Legal: the intersection of public policies, social services, and the public realm
- Infrastructure/Technology: key components that encompass the built environment
- Economic/Business: historical and burgeoning markets
- Social: mindset and cultures
- Environmental: the relationship between humans and the natural world
The mapped feedback loops articulate the cyclical nature that intensifies and entangles multiple symptoms of this issue. To illustrate this in part and in whole, we identified root causes and cause-and-effect relationships within and beyond each lens or category.
Each section of the map is constructed around several main themes as the root causes of that section. Each section focuses on several feedback loops (represented by solid blue lines) which connect detailed contextual factors of the issue to demonstrate the perpetuating nature of the wicked problem studied. Feedback loops are intra-connected (through dotted blue lines) within a section through specific contextual factors, and interconnections between different causal issues were created through grey lines.
The “wicked” nature of the issue of isolation experienced by the elderly in Pittsburgh is seen through these entanglements while providing digestible sets of information to understand critical facets of the issue.
Interconnections and Loops
Politics
The politics and law section of our wicked problem map includes issues involving local legislation, civic policy, legal practice, and the functioning of the municipal government. Problems such as failures of government to create appropriate social services, a gap in the understanding of those services, and issues accessing legal advice all fall under this category. This category heavily interacts and connects with other issues in the Economic/Business and Infrastructure/Technology categories, since government and civic action is often concentrated in these areas.
The politics and law section splits into three main problem areas:
1. Fragmented or siloed public services perform poorly and cannot battle isolation: public services offered to the elderly in the Pittsburgh area are sometimes isolated from other services, reducing the use of the full suite of services needed for members of the elderly community to interact robustly with their broader community. This problem area involves three important feedback loops:
Feedback Loop A: General need for more services: according to The State of Aging in Allegheny County by Musa et al., while the elderly use the social services available to them in Allegheny County, they are still in need of further services (such as information/advice, transportation, and home-care services). The other side of the coin of this need for services is that not all elderly members of the community use these services, which negatively impacts community estimation of the impact of said services and reduces administrative interest in increasing service budgets. A lack of increased funding leads to few, if any changes in the number of elders served by govt sponsored services, maintaining the need for more services. This inability to get the necessary services to the necessary elder individuals can lead to their inability to “get out there” and increase isolation.
Feedback Loop B: Transportation utilization: options for public transportation that can be used by the elderly are not always well communicated by the municipal government. This leads to low levels of utilization of the available public transportation options by those who are most impacted by the poor communication. This lack of interaction with the system ensures that feedback about the poor communication does not reach those designing the communication, leading to further ineffective communication. This feedback loop keeps utilization of the public transport system lower than it needs to be, increasing isolation of the elderly.
Feedback Loop C: Need for legal advice: according to The State of Aging in Allegheny County by Musa et al., a need for advice/information was the highest-rated service needed by persons 65 years of age or older. This need for information is exemplified in the need for legal advice, and seniors without proper legal representation can find themselves overwhelmed and taken advantage of by the legal system or fraudsters. Problems around immigration status can further complicate legal problems and increase the need for professional representation. Legal representation, however, can be prohibitively expensive, as can the consequences of a lack of legal representation. Economic costs can lead to further isolation as elders can no longer act in the economy with gusto, leading to further isolation and perhaps further need for legal advice as that isolation leads to a greater risk of fraud and abuse.
2. Systemic barriers exist to financial investment in building robust services for the elderly: Lack of funding creates ill-fated social services that cannot effectively serve the elderly they are intended to support. These systemic barriers are many in number; however, one that is often overlooked is the use of poorly conceived quantitative methods used to analyze populations and allocate funds. While algorithmic approaches are often lauded for avoiding bias, biases are often baked-in to the sort of information algorithms use and how they process information. This use of algorithms can easily lead to government investment serving different parts of the population in a disproportionate manner.
3. Seniors underutilize/are unaware of existing services that may help battle isolation: knowledge gaps between generations can lead to underutilization or unawareness of services intended to include elders in their surrounding community. This effect may be due to issues like communication that misses the mark or the use of service platforms that elders have less experience operating (for instance, internet-based or mobile device-based services). This underutilization has a number of knock-on effects that increase isolation, including an inability to take part in physically and mentally stimulating activities and the gradual atrophy of community bonds.
Infrastructure/Technology
The infrastructure/technology section of our wicked problem map includes issues involving the inaccessibility of the built urban environment, inaccessible transportation services, related inadequate housing options, and problematic community emergency planning. In general, infrastructural programs greatly contribute to elderly people’s immobility, mainly in form of lacking walking facilities and inadequate access to transportation methods which, when further fueled by ineffective communication with the community, feeds back into limitations in infrastructure.
Feedback Loop A: The most significant feedback loop centers around inaccessible built environments in the city, referring to unsafe and unwelcoming public spaces that were originally intended to lead citizens, including elders, out of isolation and to form stronger bonds with the bigger community. To start with pedestrian safety is a huge concern as Pittsburgh is a car-centric city and with growing car density, it’s becoming increasingly unsafe to walk sidewalks or to crossroads. This safety concern is further intensified by poor urban planning and building strategies, resulting in obvious physical barriers in the built environment such as uneven sidewalks, inadequate road lighting, or simply barriers on paths. This unsafe environment then makes other environmental resources unwelcoming for the elderly population. This counters the elderly population’s need for healthier lifestyles in general. High rates of obesity in Pittsburgh alone add to immobility, and thus isolation, by keeping elders inside. Obesity also contributes to the elderly’s need for open, public, recreational, and social spaces as they may help stimulate healthier eating habits, outdoor exercises, and peer communications. The current built environment in Pittsburgh doesn’t satisfy the elderly population’s need for natural and green living environments such as gardens for horticultural activities. On the other hand, inaccessible transportation also adds to this immobility. Though institutions like the Port Authority provide free rides as well as special transportation services for people aged 65 or above, methods of transportation are still largely limited or too expensive. Existing public transportation, which is heavily relied upon by the elderly, is also inconsiderate of accessibility needs. This has also made existing open and natural public spaces inaccessible.
Feedback Loop B: The second feedback loop relates the need for a natural environment to the institutional living of the elderly population. Houses in Pittsburgh are old and poorly designed for elderly people and affordable options are limited. Yet, in spite of the seeming advantages of institutional living and standardized support, most elders remain in their own households and are unwilling to be institutionalized. Similar to the first feedback loop, this has resulted in a simultaneous need for and difficulty accessing the natural environment, as it’s harder to provide green spaces for a scattered population.
Feedback Loop C: The third feedback loop is based upon negligence toward accessibility requirements in urban planning and relates to failures in emergency planning for the elderly. The isolation of the elderly is more profound during emergencies such as natural disasters or infrastructural breakdowns and can lead to further safety concerns. The elderly are more vulnerable to emergencies due to their immobility, yet are also marginalized in emergency planning as their accessibility requirements are sometimes neglected. It’s hard to reach those elders who are less connected to others through communication technology and who are living alone. Comprehensive tutorials and informational support are also lacking, which may make available resources inaccessible for the elderly.
Feedback Loop D: The fourth feedback loop points back to poor urban planning and the elderly’s need for natural, green spaces. Even when initiatives are taken to build more green environments poor planning leads to the addition of unsafe or unwelcoming built environments instead of accessible green spaces.
The infrastructure/technology section is also interrelated with other sections. Limited access to green spaces relates to elders’ different socio-economic backgrounds as well as the city’s lack of financial investments in building such spaces. Green spaces are also vital in helping with the elderly’s cognition and mental health. The ineffectiveness of emergency planning and inaccessible transportation both relate to their limited financial resources.
Economics
The business/economics section of our wicked problem map includes issues involving business dynamics, economic opportunities, and economic involvement (especially involvement in the local economy). Problems such as expensive care for elders, economic vulnerability, and economic stagnation all fall under this category. The business/economics category heavily interacts with the politics and law section due to the effects of regulation on the economy.
The economics section includes two primary feedback loops, one nested inside the other:
Feedback Loop A: Economic stagnation and isolation: traditional retirement can feed into further physical isolation. This physical isolation makes it harder to take part in economic opportunities in the local community, leading to further economic stagnation and deepening the isolation.
Feedback Loop B: Interplay of economic stagnation, exploitation, and expensive care: economic stagnation and the physical isolation that comes along with it can make elders more likely to be exploited or defrauded, adding to economic peril. This then is compounded by the need for expensive home care, which feeds into economic stagnation/decline and increases associated isolation.
In addition to these economic feedback loops, elders need to contend with stigma and discrimination in the business and economic world and, at times, loss of economic agency due to potentially unwarranted beliefs about their mental soundness or ability. Such stresses incentivize elders to isolate themselves and not take part in economic activity.
Additionally, elders may find themselves unable to take part in physical activities that require economic resources (such as going to the gym or taking part in other activities), further increasing barriers to interaction with the community.
Social
The shape of wicked problems is contingent a society’s culture and mindset; thus, the social. As Pittsburgh is set in the US, where modernity and progress reside, we concluded the primary mindset in Pittsburgh is one that values individualism; ergo, fostering a culture that prioritizes productivity and convenience above all. This influenced how the elderly experienced the sense of isolation and feeling of loneliness in Pittsburgh.
The ramifications of a skewed perspective and approach results in variants of experiences such as elderly with neither means nor a network having little to no options of affordable, high-quality housing, or male elderly experiencing a deeper sense of loneliness due to the tendency to withdraw sooner and more frequently than females. Through our research and process, we identified two feedback loops that impact one another’s ongoing effects.
Feedback Loop A focuses on the impact of a collective mindset of individualism and progress onto the elderly as they experience signs of aging:
- According to a report by Rial, when an aging individual begins to experience their cognition diminishing, the stress-inducing circumstance intensifies the life situations in which I find themselves, particularly if negative. Symptoms of such cognitive diminishment may include having difficulty retaining information and orienting themselves in place.
- This typically deepens undercurrents of depression that typically come with aging; those that are living in isolation are more prone to this than those with a network of some kind.
- The combination of lack of lucidity and undercurrents of depression makes the elderly prone to predatory practices that specifically target them. AARP reports that both the elderly (65+) and the sandwich generation (45–60) are prime targets to be defrauded. The diminished capability to think clearly and respond immediately makes them vulnerable.
- These are further intensified by the culture of individualism; oftentimes elders feel overlooked and undervalued.
- Each of these points are amplified by an ongoing threat of perceived progress where the elderly feel pressure to understand the utility of emerging technologies. This pressure, both from external and internal sources, induces more stress as one ages.
Feedback Loop B emphasizes such values, of individualism and productivity, reflected in an elderly person’s day-to-day that hinders them from reorienting themselves to a new sense of self as they age:
- As stated in the last point of Loop A, the elderly feel added pressure to understand the rapidly changing world around them though their physiology begins to experience atrophy.
- In addition to this added pressure, they begin to feel unable to navigate the world due to their growing immobility and a built environment solely created for able-bodied individuals, as stated by researchers Qiu, Chen, and Gao.
Both loops underscore how the world around the elderly in Pittsburgh reflects the mindsets and cultures developed and fostered in such a setting. Ultimately, it hinders their ability to reorient themselves into a new life stage, making them feel even more alone and, in some instances, abandoned.
Environmental
The environmental category underscores the friction between the natural world and the human/man-made environment. We found that the core issue of the natural world’s degradation is human disruption resulting from the symptoms and core problems illustrated through our focal point: the isolation of the elderly in Pittsburgh.
Pollution and toxins created by human society have impacted the environmental degradation that ultimately influences both humans and more-than-humans. Through the introduction of pesticides, toxins, and pollution into the natural environment, all living forms begin to absorb and consume these same toxins that have the potential to alter biology slowly. Increased susceptibility to illness and disease rises in all life forms. Among the elderly, the increase in illness and disease begin to impact multiple social issues that perpetuate the isolation of the elderly. With higher levels of illness, the elderly are facing faster rates of diminishing health and cognition which is compounded with illnesses caused by natural aging.
While many studies demonstrate the positive effects of the natural environment in aging cognition, infrastructure issues, like the built environment, create a physical barrier between nature and the elderly. A reaction to these barriers is the formation of elderly communities in areas with access to nature; however, these communities tend to be in suburban areas that are naturally isolating and costly. As the natural world degrades, access to the natural environment decreases, and the connection between the elderly population and the environment begins to disappear.
The human-caused depletion of resources and the environment form a cyclical reactionary loop. As the physical environment degrades, the reduction of land and space affects both the atmosphere and species. What is unique about this feedback loop is how the decline of life-forms is affected by changes in the physical environment and climate; as natural habitats are destroyed and climate change begins to alter habitual patterns native to specific life-forms, fauna and flora are not able to sustain themselves. With the reduction of necessary species, existing replenishment cycles among the natural environment begin to weaken and break. For example, bees are the primary pollinators to sustain food crops and trees and flowers necessary for wildlife habitats. However, globally bees are declining as they face habitat loss and behavioral changes due to pesticides and climate change. With the replenishment of natural resources being a slower process than the speed at which these resources are used, environmental degradation continues. While this feedback loop focuses on the natural environment, these issues are also influencing the isolation of the elderly with greater death tolls due to the effects of climate change and susceptibility to illness. The feedback loop emphasizes the man-made nature in which the erosion of our natural environment is upheld.
Insights
Through the exploration of different issues surrounding the isolation of the elderly in Pittsburgh, our team found the issues among Politics, Infrastructure and Technology, and Economics results in the creation and looping of Environment and Social issues. Through the process of mapping this wicked problem, it became evident that:
- The issues within each category had feedback loops that perpetuate the larger thematic issues.
- Larger political problem areas have a deep connection to establishing society’s mindset and largely impacts economic and infrastructure issues that re-emphasize society’s culture and social issues.
- Social issues are perpetuated by the remaining four areas.
- There is clear coupling with other wicked problems, such as gentrification and lack of access to public transportation to name a few.
While we believe this map captures the complexity of different issues, we are cognizant of how additional iterations would be needed to fully understand the wicked problem. Still, we feel that the map itself provides us with a stepping stone to identify areas where solutions may have the most impact. The process of mapping provided our team an understanding of the interconnected nature of our issues across multiple scales. Through each iteration of our map, our team discovered the compounding effects that deepened and loosened the impacts of isolation of the elderly in Pittsburgh across scales and categories. These insights ultimately led us to develop a map that underscored the cause-and-effect and cyclical nature of feedback loops living within wicked problems.
This post was collaboratively written by Team Holarchy: Esther Kang, Isabel Ngan, Will Rutter, & Yu Jiang
Wicked Problem: The Isolation of the Elderly
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