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Building Support Networks for Isolated Seniors

I Introduction

Isolated seniors are a vulnerable, hard to reach group. With a growing aging population and the current climate of overwhelmed health and community services, the challenge is to assist these older adults to continue independent living in the community. Community Action for Isolated Seniors (CAIS), a City of Ottawa Public Health Program, developed from an action research project (Moyer et al 1998) and has been offered since 1995. It is staffed by two Public Health Nurses (PHNs) who conduct individual and community level interventions to reach out to isolated seniors and build community capacity to support isolated seniors.

II The Target Group

Isolated seniors are generally very old, and are frequently suffering from chronic medical conditions and dealing with the stress of significant life events (e.g., bereavement, hospitalization or recent change in living arrangement). Other challenges associated with isolated seniors include lifestyle choices (e.g., substance abuse), environmental issues (e.g., living in harsh climates or high crime areas), socioeconomic issues (e.g., financial concerns) and personal beliefs and attitudes. Only minimal support is required to help this vulnerable group remain independent, yet isolated seniors have difficulty accessing health and community services. Reasons for this vary. Sometimes they do not meet participation criteria, other times they lack the financial resources required to participate, yet other times they do not perceive a need for assistance or are unwilling to accept it. Many seniors wish to remain self-sufficient despite their needs because they do not want to be a burden. This "independence at all costs" often results in the refusal of service, to the point where the senior places themselves at risk as their health and living conditions deteriorate. Isolation is a gradual but complex process resulting from the interplay of many factors associated with advanced age. Communities are generally aware this population exists but the very nature of the issue makes it difficult to identify these seniors. Programs such as CAIS ensure that these seniors are identified before a crisis is reached.

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III Individual Interventions

Isolated seniors are difficult to identify and reach, therefore it is important to cast a broad net to "catch" this population. Community partners, both formal and informal, are the key sources of referral.

CAIS nursing assessment and interventions focus on functional ability and social support. A modified ECOMAP tool (Moyer et al, 1998) is used for the assessment. It is a visual diagram that documents who is involved with the client, the quality of the relationship and the needs being met as a result of the relationship. It answers questions such as "Does the senior need to connect with a family physician?"; "Is practical assistance required for activities such as grocery shopping and housekeeping?"; and "Does the isolated senior feel lonely and want social contact?". Health, emotional, social, spiritual and practical needs of the senior are then addressed as needed.

CIAS PHN's also attempt to improve isolated seniors' self care behaviors. This may include managing a chronic illness, using health care services appropriately, coping with loss and change, and/or being aware of community services and how to access them.

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IV Community Interventions

The ultimate goal of CAIS community interventions is to build community capacity to reach out and support isolated seniors. A number of different strategies are used:

* Public awareness -- Messages focus on the prevention of social isolation in seniors and the significance of social support/relationships to health. They are delivered through displays, community newspapers, posters, information sessions, etc. They are targeted to the general public and to seniors themselves.

* Education and skill building -- Sessions are offered to volunteers from agencies and community groups who want to reach out to isolated seniors (e.g., Meals on Wheels, faith communities, seniors' clubs). They provide general information on the isolated senior population, tools to identify problem situations and information on how to refer seniors to appropriate community services.

* Partnerships -- These are established in order to increase support for isolated seniors, address barriers to services, modify existing programs and create new programs that better meet the needs of isolated seniors. An example of this work is the development of an Interfaith Network that focuses on increasing outreach to isolated seniors in faith communities. Representatives from Hindu, Muslim and Christian groups work with the PHN to share information, develop and distribute resources for seniors and volunteers in faith communities and to advocate for improved services for seniors by lobbying key decision makers.

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V Lessons Learned

1. There is often a presumption that isolation is a choice. Usually this is not the case.

2. Capturing the quality and quantity of an individual's social support network is difficult. Support can fluctuate or may not be identified by the senior. The modified Ecomap (Moyer et al 1998) has been a valuable tool to capture the subtleties of social support.

3. Perception of need for support will vary. Some isolated seniors choose to live at risk and are resistant to efforts to build their support network. There may be long-established behavior patterns that are difficult to break.

4. Faith groups are excellent partners for public health as both mandates include servicing vulnerable populations.

5. Interventions at the individual level continually reveal needs of the isolated senior population and gaps in community services and programs. This knowledge gives credibility to the PHN's efforts to engage the community to address barriers and improve access to services and programs for isolated seniors.

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VI Conclusion

The Community Action for Isolated Seniors program is an innovative approach that builds community support for isolated seniors, improves their quality of life and prevents unnecessary use of acute care services. Given the significance of social support to health and independence, programs like this are necessary to respond to the needs of an aging population.

For more information about City of Ottawa's Community Action for Isolated Seniors Program please call Myriam Jamault, 724-4122 x26183, or Ann Nowak, (613) 724-4122 x23579,

VII References

Moyer, A. et al. (1998). Designing and Testing Individual and Community-Based Interventions for Older Adults with Social Needs Using Action Research. (CHRU Publication No. M98-05). Ottawa: Community Health Research Unit.