As people age, they may experience physical symptoms associated with illness, frailty or the aging process. For others, disabilities may be a life-long or long-term experience. Although physical health issues and disabilities are distinct factors, both may be associated with physical vulnerability to social isolation. In Canada, most persons aged 65 and over have at least one chronic illness, and a majority have more than one chronic illness (Public Health Agency of Canada, 2010). Additionally, approximately 45% of seniors report a mild, moderate or severe disability, with this rising to 75% among those aged 85 and over (Statistics Canada, 2007).
While a majority of older adults rate their perceived health, well-being and daily functional ability as high even in the face of chronic illness or aging-related disability, many seniors nonetheless face challenges to daily functioning and maintaining connections with their family, friends and community. These impairments include pain, limited mobility due to sight, strength, and balance problems, loss of breath, general weakness, or fatigue, and other indicators of frailty and mobility impairment (Wister and McPherson, 2014). In the Canadian Community Health Survey – Healthy Aging (CCHS), health reasons were the most common reason given by seniors 75 years and over who were unable to participate in activities as much as they would have liked (Turcotte, 2012).
In a study on social isolation among seniors in British Columbia, Kobayashi et al. (2009) found that individuals who report being in fair or poor health have considerably higher odds of being socially isolated than those who report being in excellent, very good, or good health. Data from the CCHS revealed that the odds of being lonely were significantly higher for seniors who reported urinary incontinence than for those who did not, even when age, sex, education and living arrangements were taken into account (Ramage-Morin and Gilmour, 2013). Keefe et al. (2006) also found that higher number of chronic illness was associated with higher levels of vulnerability to isolation even when controlling for other factors. Earlier research from the 1990s showed that chronic illness was one of the main factors linked to social isolation (see Hall et al., 2003).
Although physical health has been associated with social isolation and loneliness, the directionality of the relationship remains ambiguous. Most research have examined the effects of social isolation on a variety of health outcomes, including perceived health, functional health (disability), chronic illness, and accessing health care (Cornwell and Waite, 2009; de Jong Gierveld et al., 2015a; Kobayashi et al., 2009; Newall et al., 2015).
By definition, social isolation can restrict connectedness with social networks, which can result in fewer resources, lower social support, poorer health behaviours and lower access to health and community care system, all of which result in poorer health outcomes and lower levels of healthy aging (Keefe et al., 2006; National Seniors Council, 2014a and 2014b). Social isolation can also act as an aggravating factor in the diagnosis of disabilities among seniors – with fewer family members and friends, socially isolated individuals who develop sensorial problems as they age are likely to go untreated (Covelet, 2007).
Physical vulnerabilities can also limit mobility, which can compound transportation difficulties, particularly in areas where there is inadequate transportation provision. In the CCHS, when controlling for all other factors, seniors who travelled mostly by driving their car were more likely to participate than those who used any other form of transportation. Seniors who were mainly passengers and did not have a licence and those who used accessible transit or taxis had the lowest participation rates (Turcotte, 2012). In qualitative research undertaken by Hall et al. (2003), seniors indicated that the cessation of driving due to health problems was a problem of particular significance, especially in rural areas (see also North Sky Consulting Group Ltd, 2013). Some also mentioned the stigma of being dependent upon others as a barrier to asking for assistance. According to the World Health Organization, transportation is in turn a determinant of health because of the role it plays in seniors’ independence and ability to access resources (Keefe et al., 2006).