Before the COVID-19 pandemic, the National Seniors Council recognized social isolation as a major public health crisis; one that particularly affects seniors.
Researchers have connected social isolation to higher risk of early mortality, lower quality of life and many other adverse health impacts among seniors. With the implementation of pandemic restrictions, social isolation, which is defined as a lack of high quality social contacts in a person’s life, also became a major threat to the health of both seniors and caregivers in our community.
In response to this threat, a team of community members and researchers at Trent University created the Social Isolation to Social Connection study. This study was co-led by Ann MacLeod, Professor for the Trent-Fleming School of Nursing and Dr. Catherine Ward-Griffin Research Fellow at the Trent Centre for Aging and Society (TCAS). Support was also provided by Dawn Berry Merriam (TCAS), Jayne Culbert (Age-friendly Peterborough), and Justine Levesque (McMaster University) and several undergraduate and graduate nursing students from Trent University.
Our research aimed to discover the social and health implications of social isolation among older adults and their caregivers in Peterborough. We listened to the lived experiences of seniors and caregivers in our local context, reinforcing the known impacts of chronic social isolation including depression, anxiety, mental strain, and exacerbation of chronic physical conditions.
Virtually, Age-friendly Peterborough members and participants drafted 10 recommendations targeted toward local decision makers.
We found that adequate physical, financial, and human resources must be made accessible to seniors and caregivers. Without resources like technology, transportation, supportive housing, and fair wages, seniors and caregivers will continue to fall through the cracks in times of crisis.
We met many seniors, family caregivers, and health workers through the course of our research. They shared their stories to help us better understand social isolation in the pandemic. They agreed to share their stories with Peterborough Currents below.
Jean Koning and Valerie Koning Keelan
Last summer, we met Jean Koning and her daughter Val Koning Keelan. Jean Koning is one of the 27,000 seniors living in Peterborough during the pandemic. They told their stories of social isolation to our research team last August.
Jean is a 97-year-old senior, who before the pandemic was quite socially active. She lives alone in her apartment at a local seniors’ residence and pre-pandemic kept busy with weekly attendance at her church.
Each day Jean would make her own breakfast and lunch but walk down to the kitchen door to get her supper to bring back to her apartment, where she ate it, as and when she wished. Jean also regularly visited with her children, grandchildren, and great grandchildren at the seniors’ residence or at their homes.
Much of Jean’s day-to-day life changed in the first wave of the pandemic. When asked how all these changes had affected her, she said, “I feel lonely… But I don’t believe in sitting around and feeling like I’m a victim to anything. I’m inclined to sort of work through those kinds of things.”
Across town, Jean’s 68-year-old daughter Val Koning Keelan shared her story as both a senior and family caregiver during the pandemic. Before the pandemic, Val was alternating between trips to the hospital to see her husband, calls with her children and friends, and visiting with her mother.
In April 2020, Val’s husband passed away. She has had to process her grief with virtual support from her family all while continuing to care for her mother. Val described how this had impacted her: “I’d feel lonely sometimes and also, I would feel overwhelmed like I thought I just can’t do this.”
Val was grateful for the support that the seniors’ residence provided to her mom. Both Jean and Val appreciated that the seniors’ residence prevented COVID-19 outbreaks. However, they each described a loss of freedom because of the restrictions from the residence.
Jean said, “I have to recognize that nobody here apparently has had the virus so they must be doing something right. On the other hand, I think in some ways [the] approach puts the fear of the Lord into a lot of the people in this building, so they [seniors] just don’t go anywhere.”
Val echoed Jean’s comments from her perspective, “Well before the pandemic, it was just complete freedom like I could just visit mom anytime and I could go over there, I could go there and pick her up and bring her here. There were no restrictions at all.”
When asked how she is doing now, Val said “I’ve managed throughout the pandemic by having weekly Skype calls with the family. I’ve been able to keep up to date on what the adults [her kids] are doing and I’ve had conversations with my grandchildren. My mother and I keep in touch over the computer, and we’ve also had a few socially distanced visits.”
Cameron and David MacLeod
Two other participants, Cameron and David MacLeod, shared similar stories with us. Dave MacLeod is a 59-year-old family caregiver to his father Cam MacLeod, an 85-year-old senior.
Cam is living with dementia. He continues to live on his own in his home in Peterborough, with his daughter Ann living nearby. Before the pandemic, Dave was living with his family in Toronto but regularly came to Peterborough to check in on Cam.
Cam was participating daily in dementia-friendly programs from organizations in Peterborough including Community Care Peterborough, Activity Haven and the Alzheimer’s Society’s Minds in Motion program, a program offering physical and social activities for both seniors and caregivers, before the pandemic in person, and during the pandemic virtually.
Cam also received support from his other children, and a PSW provided by the government. When the pandemic began, all of Cam’s external activities were temporarily halted.
Cam reflected on his life before and during the pandemic. He explained, “I am not able to remember things as much now…I was a little more independent before the pandemic. I would go to the YMCA and Activity Haven for exercises but now, for example, each day I’m told I’m not allowed to meet with people. And the news really bothered me about the pandemic, that the world was going in this direction. This bothered me that the world was, and it is still like this. It was challenging in that I could not do the things that I was normally doing.”
The PSW was also withdrawn when the risk of contracting COVID-19 became too high. Cam’s children felt that government-funded PSWs who visited many patients a day without proper infection control training/equipment at the beginning of the pandemic increased Cam’s risk of COVID-19.
Dave explained, “I think we were the first people in the Peterborough region to say, unfortunately, the various PSWs coming to help Cam are a potential vector of disease and, we don’t want them coming in here anymore. [So] I said I’ll just do it myself.”
However, trying to balance a full-time job, his own family life in Toronto and living full time in Peterborough as a caregiver became unsustainable. Dave and his siblings hired one dedicated caregiver that would see Cam as her only client three afternoons a week. Together they do meaningful activities such as painting, Wii bowling, gardening and outings to fish and feed ducks.
Through these altered arrangements, to some extent, Cam can connect most days virtually with other seniors. Now, with support from his daughter Ann, Cam is able to get on Zoom to participate in free physical and social programs. Recently, Cam and Ann have started going to outdoor yoga classes offered in the park beside Activity Haven.
The pandemic also brought on major changes for paid caregivers’ work environments. And through our research we saw caregivers also faced challenges with social isolation. In this study we met Karen Hicks, a 55-year-old nurse, who supports seniors and their families in the emergency department at the Peterborough Regional Health Centre (PRHC).
Hicks’s story reflects the critical need for more community-based resources for seniors and their family caregivers. She described how the challenges her older adult patients are facing before and during the pandemic are influenced by social determinants of health.
The social determinants of health are non-medical factors that influence health outcomes. This includes income, housing, food insecurity, education, and access to health services. Hicks emphasized how as a formal caregiver during the pandemic it was difficult to connect seniors with resources to meet their needs.
Limited access to community-based resources and resources from formal care institutions exacerbated seniors’ health concerns. While messaging towards seniors discouraged them from making unnecessary trips outside their homes.
Hicks explained the repercussions of this situation, “[Seniors] were much sicker than they were when they would just come in on a regular basis. They are staying home, they weren’t seeing their doctor, they might have run out of a prescription or were self-medicating. They weren’t eating as well, just lots of contributing factors. But I was definitely seeing seniors that were a lot more ill than they would have been prior to the pandemic.”
We asked Hicks how she is doing now. She explained that for the most part, she is still seeing older adults in the emergency department who are very unwell but more of them have gained access to at least some type of services that have assisted them over the past few months.
Hicks also concluded that, “As the pandemic continues and more individuals choose to receive their vaccinations, the rhythm of the pandemic has become more established and where a sense of doom once existed, resilience has taken its place.”
We also heard from Lindsay Barr, a 39-year-old Registered Practical Nurse providing care in people’s homes across the county. She started her job just three days before the first lockdown and continued to work throughout the entire pandemic.
Barr especially emphasized that the home care sector was already under-resourced before the pandemic. She described the immense expectations and responsibilities placed on home care workers both before and during the pandemic.
These ‘healthcare heroes’ were caring for some of the sickest members of our communities and yet were not given the financial, physical or social resources they needed. She said this, “They [the government] are not paying us an acceptable wage for what is reflective of what nurses are doing in the community, in comparison to the wages made by nurses who are employed at hospitals or nursing homes. We are also keeping people in their own homes and out of institutions as per the patient’s individual preference which actually saves [money].”
Barr, like other formal caregivers, was also missing her support system. Her parents and close friends live out of Ontario, and she described similar feelings of isolation and loneliness that were felt by seniors.
When we interviewed her in September 2020, she said, “[The pandemic is] a real eye-opener to see how small my social life really is – truly is, you know? My mom comes every four months, and my dad didn’t come last time, so it’s been a year and a half since I’ve seen my dad, and six months now since I’ve seen my mom and I don’t know when I’m going to see them again, that’s a huge difference.”
Barr has since left her RPN position in homecare, now vaccinating for Peterborough Public Health. She explained that she was becoming increasingly burned out due to continuous requests for overtime.
She also reiterated that her decision to leave was influenced by the pay inequity that exists between community based RPNs and RPNs hired by public health, hospitals or long-term care facilities. To buoy her spirits, she continues to sing, see her small bubble of friends, and cannot wait until she can see her parents from Newfoundland again.
The stories heard from our participants and from consultations with members of Age-friendly Peterborough resulted in 10 recommendations for decision-makers. We want to highlight five key recommendations that reflect the stories of Jean, Val, Dave, Cam, Lindsay, and Karen.
First, it is critical that opportunities and channels for collaborative communication between seniors, caregivers, and institutions be established. Second, resources must be made available and accessible to seniors and caregivers.
These resources should include accessibility supports to age at home, technology supports and educational resources to stay connected in the community, affordable and communal housing options, and funding to enhance caregiver wages and encourage people to work in home care.
Third, governments, organizations and individuals need to promote and follow public health guidelines. Fourth, the pandemic has shown us that the virtual care system must be expanded, yet acknowledge the digital divide.
Lastly, everyone from our neighbours to local businesses, seniors’ organizations, and care facilities need to increase outreach to the marginalized members of our community with a focus on seniors and their caregivers.
Progress has already been made with many organizations including Community Care, the Alzheimer’s Society and Activity Haven who are all continuing to offer virtual physical activity and social programs for both seniors and their caregivers.
Activity Haven is also sponsoring daily events through the Seniors’ Centre Without Walls – a free interactive telephone-based group activity program.
These recommendations are not new, but the pandemic has resulted in an urgency that they be addressed. It is up to our leaders to act on the recommendations and reduce the mental and social strain that has grown during this pandemic. Only when systemic and structural barriers experienced by marginalized populations are addressed will their health inequities be lessened.
Justine Levesque completed a Master’s in Public Health from McMaster in 2020 through which she served as a Research Assistant on this project. She now works full-time for the Canadian Observatory on Homelessness, but continues her involvement with Age-friendly Peterborough.
This story is based on research from Social Isolation to Social Connection study, which was co-led by Ann MacLeod, Professor of Nursing at Trent-Fleming School of Nursing and Dr. Catherine Ward-Griffin Research Fellow at the Trent Centre for Aging and Society (TCAS) and Professor Emeritus at Western University. Support was also provided by Dawn Berry Merriam (TCAS), Jayne Culbert (Age-friendly Peterborough), and Justine Levesque (McMaster University).