A bigger-picture solution for social isolation?
By Jane Teasdale
As a social species, we have strong social and emotional dimensions to our psyches that impact mental and physical health. Our connections are developed by meaningful interactions, and each person’s meaningful interactions are different and complex. The one defining feature is community, which is the sum of the psychosocial and the centre of our interactions. But the community as a locus of engagement is not confined to one spot. While the answer to a nation’s well-being lies within communities as habitats, there is concern that investment in communities and connections across communities is underdeveloped and underfunded, and that interventions are overly institutionalized.
Our aging demographic is shining a light on our social environment’s inability to support the increasing social vulnerability. As we age, we retire from roles that have provided us with function, meaning, problem-solving, and opportunities for personal growth and connection. Our incomes drop, and over time so may our mobility and aspects of cognition. Our social networks and opportunities for meaning may wither, and we risk being viewed by our deficits—if we are viewed at all. We become dependent on our natural environment and community for engagement and connection.
The reality is that older adults remain potentially active and productive members of society, with an intense social and emotional drive. Irrespective of complex care issues, the evidence suggests that most wish to continue to engage with nature, interests, community and each other as far as reasonably possible.
The World Health Organization’s 2007 report on “age-friendly cities” noted eight domains of life critical to healthy aging: Outdoor space and places; transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication and information; and community support and health services. These all signify the importance of a richly connected habitat that is capable of meeting the basic and
higher-order needs of people.
Potential to lower health costs
This wider movement toward supportive social structures is also being met by the clinical health care model’s increasing interest in the social and emotional. Clinical care maps onto the complex whole of the individual, and the wider domain of personhood affects clinical direction and self-care. The benefits of addressing holistic needs are meant to feed into lower health care costs at a time when the
health care system is struggling to meet basic care needs. Many of the demands for greater levels of person-centredness are also resulting from general dissatisfaction of the clinical task-focused model of care and increasing evidence of the impact of ignoring social and emotional needs. But there is another reason why social and emotional needs are rising in importance. This is an acknowledgement of the impact of social isolation and social vulnerabilities, mediated by loneliness, on physical and mental health.
Dimensions of loneliness
While loneliness may once have been viewed as something lacking in redeeming qualities, the work of the late John Cacioppo has shown otherwise. Loneliness, like hunger, is a survival mechanism that is meant to stimulate us to seek social connections and the protection of groups and social habitats that are key to ensuring the survival of our progeny. Not only does loneliness have a significant impact on our physical and mental well-being, but it also forces us to feel unsafe and to be wary of social threats. It produces changes in brain structures and processes that accumulate over time, significantly increasing the risk of illness and death.
According to Cacioppo, there are three perceptual dimensions of loneliness that are relevant to our social dynamic. These are a perception of intimate isolation (the lack of intimate relationships), relational isolation (the lack of face-to-face relationships with family and friends) and collective isolation (the lack of meaningful connections with groups).
These aspects of loneliness appear to correspond to social network theory, notably that of Robin Dunbar. Here, the person has a small inner circle of supportive relationships; a secondary layer, defined as a sympathy group; and two outer layers, representing connections of lesser amount and meaning.
Social networks perform a number of functions, one of which is to provide replacements to the inner support and sympathy groups, and the networks themselves are sourced from areas of common interest and activity. Institutional interventions tend to be restricted, time-limited and focused on deficits, as opposed to the more durable natural environments required to support rich social habitats. In his research, Cacioppo differentiates between social supports and loneliness, and questions whether social supports on their own can overcome loneliness. In a 2010 paper, Cacioppo and Hawkley reported on a study into the effects of social interventions that were positive with respect to certain health outcomes and social activity but appeared to make no difference to loneliness. Yes, the activities provided more social connections and had health benefits, but the hypervigilance to social threats and other cognitive biases associated with loneliness remained.
The researchers suggested that social cognition interventions might be more successful and pointed to studies that supported this. This changes the nature of social supports and leaves the question of habitat unanswered.
All of this is relevant to recent innovations in health care. The evidence for the value of social prescribing, as it stands, is mixed and unsupportive of the ability to lower health care costs. While the data on social prescribing are supportive of health and social benefits, the advantages of social prescribing as a treatment for loneliness appear to be limited, as is its ability to address the underlying social structures and habitats necessary to support
rich social networks.
Developing a deeper supportive habitat
We need to conceptualize, and give life to, a natural working model of community that maps onto the natural social and emotional, creative, cultural, spiritual and diverse needs of people. We can map and identify existing resources to facilitate communication and interaction with these resources. But we also need to create connections between sources of social capital (public, private and not for profit) to replicate the dynamics of social and community networks at a deeper level. Last, we need to engage individuals and groups in the development of further opportunities, connections, groups and resources.
At Mosaic Homecare & Community Resource Centres, we have developed a person-centered, community-integrated model of care that addresses meaningful conversation, knowing the person, and facilitating engagement with interests and activities and with the wider community. Details of the model have recently been published in the European Journal for Person Centered Healthcare. An important part of the wider model is creating deeper connections with the community, so that older adults with complex care needs can connect with higher levels of community resources and human social capital, thereby satisfying higher-level needs associated with the social and emotional. We are currently engaged in developing a multi-level community-mapping construct that will allow individuals, families and caregivers to plan outings and connect with groups and community resources, and encourage the enhanced use of community spaces within the private sector.
To fully address the holistic needs of individuals, we need collaboration across the public, for-profit and not-for-profit sectors and a wider embracing of social enterprise objectives.
If these components of the habitat cannot work together, how can the individual social dynamic thrive?
Jane Teasdale is director of business development and a principal at Mosaic Home Care & Community Resource Centres (Mosaichomecare.com).