Social and geographical isolation

Isolation is a risk factor for elder abuse. The Australian National Elder Abuse Prevalence Study showed that lower levels of contact with family and friends was associated with a higher likelihood of experiencing elder abuse (Qu et al., 2021). Social and geographical isolation are of concern due to their impact on the wellbeing of older people.

Social and geographical isolation can be experienced separately or together.

Social isolation is an objective lack of connection and interaction with social networks, which can include family, friends and community.

 

Geographical isolation is marked by logistical and practical barriers to an older person's connection to and active participation in the community. 


These barriers may be:

• financial
• related to limited transportation
• technological
• cultural and linguistic
• cognitive or related to other impairments.

Sources: Adorno et al., 2018; Beridze et al., 2020; Brooke et al., 2022; Byrne & Ghaiumy Anaraky, 2022; Herro et al., 2021; Holaday et al., 2022; Lamanna et al., 2020; Levasseur et al., 2020; Machielse & Duyndam, 2020; Pekmezaris et al., 2013; Winterton & Warburton, 2011.

Geographical isolation also affects older people's access to:

	Health services		Financial services
	Social and community  services		Legal and dispute  resolution services

Sources: Commissioner for Senior Victorians, 2020; Community Legal Centres Queensland Inc, 2019; Hunter & De Simone, 2009; Inder et al., 2012; Law Council of Australia, 2017; Longman et al., 2013; Parsons et al., 2021; van Spijker et al., 2019; Vine et al., 2020; Walsh et al., 2020; West & Ramcharan, 2019

How is isolation experienced by older people?

• Our findings indicated that experiences of isolation are characterised by ageism and social stigma around the ageing process.
• In previous research, older people have reported a tension between social isolation and the desire to maintain independence, which can reduce connection with others.
• The literature also showed that gender plays a role in experiences of isolation, with women more likely to engage in socially connecting activities than men.
• A lack of local opportunities, information and age-friendly infrastructure are barriers to engaging in the community.
• Interviews with service providers suggested that limited service capacity and accessibility to services in regional, rural and remote communities compounded the social isolation experienced by older people.
• Some service providers observed that geographical isolation exacerbated experiences of social isolation for older people.

What factors give rise to isolation?

Factors that give rise to isolation include:

Family conflict	Caring responsibilities
Illness, reduced mobility, cognitive or other impairments	Cultural and linguistic factors
Lack of access to technology	Low self-esteem
Challenges such as those related to COVID-19 restrictions	Stigma associated with the ageing process
Socio-economic disadvantage and housing and financial stress	Lack of access to services and community infrastructure
Disability

What are the effects of isolation on older people?

Our findings showed that the effects of isolation on older people were typically multiple and related to each other, including:

• poor personal or self-care
• decreased mobility
• decreased mood and memory
• apathy and reduced participation in previous areas of interest
• poor diet.

These multiple effects were observed by the professionals in this study, as illustrated in the following example:

So, what I have seen, people who are socially isolated, they don't eat well. And they may not be well-groomed because what is the point in getting dressed. I can be in my pyjamas all the time. 'I don't have to leave the house', and decreased mobility because they are not using their weight bearing muscles and bones to walk any distance. Decrease in mood and memory because of not having social interaction that will keep them sparked. Apathy, loss of interest in the usual hobbies and interests. (P01, public sector, rural)

Additional barriers for socially isolated people who were also geographically isolated were highlighted by some of the interviewees. The same service provider described how a client who had lost their partner was unable to access meal provision services because of their rural location but also had no incentive to prepare a meal when living alone:

If you've been living with somebody for many, many years and they passed away, it's very difficult to make that adjustment … and if you're eating on your own, we've seen the people tend to not eat a lot or they skip meals or have very, very simple meals, because what's the point in preparing a meal for just myself. (P01, public sector, rural)

How can we improve services and supports to meet the needs of isolated older people?

Individual and group interviews indicated that service providers:

used formal screening tools (e.g. Modified Monash Model scale to measure geographical isolation) and informal approaches (e.g. developing connections in the community) to identify isolated older people

suggested that adapting the My Aged Care portal to make navigation simpler would be beneficial for older people seeking support

identified that health care providers (such as general practitioners) need further support to identify isolated older people

suggested that councils and organisations could work to provide a sense of community and inclusion for older people.

Summary

• Social and geographical isolation are significant features in the lives of older people and these experiences are negative for their health and wellbeing.
• Significant life events and transitions, health and the stigma associated with ageing were identified as key factors giving rise to isolation for older people.
• The effects of isolation observed by service providers included loss of memory, poor self-care, decreased mobility and reduced engagement in previous activities of interest.
• A focus on prevention would help to improve quality of life for older people and those who care for them.
• Avenues identified to support older people and to decrease the effects of isolation included awareness-raising activities that reframe the need for social connection for older people, and offering clear options to seek social engagement.
• Interview participants suggested a review of the accessibility of the My Aged Care portal for older people and their carers was needed. They also suggested activities at the local community level have the potential to improve services and support.

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