Subjective social isolation or loneliness in older adults residing in social housing in Ontario: a cross-sectional study.

BACKGROUND: Older adults face greater risk of social isolation, but the extent of social isolation among low-income older adults living in social housing is unknown. This study aims to explore the rate of, and risk factors contributing to, subjective social isolation or loneliness among older adults in social housing. METHODS: We conducted a cross-sectional study of data collected from a community program held in the common rooms of 55 social housing buildings in 14 communities across Ontario, Canada, from May 2018 to April 2019. Participants were program attendees aged 55 years and older who resided in the buildings. Program implementers assessed social isolation using the 3-Item Loneliness Scale from the University of California, Los Angeles and risk factors using common primary care screening tools. We extracted data for this study from the program database. We compared the rate of social isolation to Canadian Community Health Survey data using a 1-sample χ2 test, and evaluated associations between risk factors and social isolation using univariate and multivariate logistic regressions. RESULTS: We included 806 residents in 30 buildings for older adults and 25 mixed-tenant buildings. Based on the 3-Item UCLA Loneliness Scale, 161 (20.0%) of the 806 participants were socially isolated. For those aged 65 and older, the rate of social isolation was nearly twice that observed in the same age group of the general population (36.1% v. 19.6%; p < 0.001). Risk factors were age (65-84 yr v. 55-64 yr adjusted odds ratio [OR] 1.99, 95% confidence interval [CI] 1.01-3.93), alcohol consumption (adjusted OR 2.45, 95% CI 1.09-5.54), anxiety or depression (adjusted OR 6.05, 95% CI 3.65-10.03) and income insecurity (adjusted OR 2.10, 95% CI 1.24-3.53). Protective factors were having at least 1 chronic cardiometabolic disease (adjusted OR 0.44, 95% CI 0.24-0.80), being physically active (adjusted OR 0.47, 95% CI 0.30-0.73) and having good to excellent general health (adjusted OR 0.60, 95% CI 0.39-0.90). INTERPRETATION: The high rate of social isolation in low-income older adults living in social housing compared with the general population is concerning. Structural barriers could prevent engagement in social activities or maintenance of social support, especially for older adults with income insecurity and anxiety or depression; interventions are needed to reduce subjective social isolation in this population.

Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study.

BACKGROUND: Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data. OBJECTIVE: This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions. METHODS: Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes. RESULTS: During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use. CONCLUSIONS: Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.

Service-Enriched Housing: The Staying at Home Program.

INTRODUCTION: The purpose of this research was to determine whether service-enriched housing (i.e., the Staying at Home [SAH] program) in publicly subsidized buildings for low-income older adults influenced resident outcomes. METHOD: Eleven elderly high-rise buildings were used. Seven buildings had the SAH program and four did not. Information was collected from resident questionnaires, housing managers data, and medical information. A total of 10 desired outcomes were proposed as part of SAH (e.g., health improvements, receive more non-institutional services, receive more preventive services, and be less likely to be institutionalized). Information was collected over the course of the SAH program every 6 months from December 2008 through June 2011. RESULTS: Overall, 736 surveys were completed by SAH program participants and 399 were completed by control group participants. Seven of the ten desired outcomes were achieved, and in 3 of the ten cases, no differences between the SAH group and control group were identified. The program was also beneficial with respect to cost savings. CONCLUSION: On the basis of these findings, the SAH program should be viewed as a success. In this case, service-enriched housing for elders in high-rise buildings would appear to be beneficial.

Introducing assistive technology into the existing homes of older people: feasibility, acceptability, costs and outcomes.

We examined how far, and at what cost, the housing stock could be modified to accommodate the assistive technology (AT) necessary to enable older people to remain in their own homes. A multidisciplinary team devised seven hypothetical user profiles for 10 case study areas, with five local authorities and five housing associations in England and Wales. Each profile was considered at two times, five years apart, with the users' functional abilities deteriorating in between. In addition, in-depth interviews were carried out with a sample of 67 older people in the case study areas about their use and experience of a wide range of AT. The interviews showed the need to listen to older people and that they welcomed AT when it addressed a perceived need. The results showed that the extent of adaptation required of buildings to accommodate a user's needs varied greatly. It was also found that there was confusion about the terminology of AT, including the idea of the 'smart house'. The study shows that the adaptability of the housing depends on a range of factors and costs.

Contextualizing and assessing the social capital of seniors in congregate housing residences: study design and methods.

BACKGROUND: This article discusses the study design and methods used to contextualize and assess the social capital of seniors living in congregate housing residences in Calgary, Alberta. The project is being funded as a pilot project under the Institute of Aging, Canadian Institutes for Health Research. DESIGN/METHODS: Working with seniors living in 5 congregate housing residencies in Calgary, the project uses a mixed method approach to develop grounded measures of the social capital of seniors. The project integrates both qualitative and quantitative methods in a 3-phase research design: 1) qualitative, 2) quantitative, and 3) qualitative. Phase 1 uses gender-specific focus groups; phase 2 involves the administration of individual surveys that include a social network module; and phase 3 uses anamolous-case interviews. Not only does the study design allow us to develop grounded measures of social capital but it also permits us to test how well the three methods work separately, and how well they fit together to achieve project goals. This article describes the selection of the study population, the multiple methods used in the research and a brief discussion of our conceptualization and measurement of social capital.

Can adapting the homes of older people and providing assistive technology pay its way?

BACKGROUND: Adaptations and assistive technology (AT) have an important role in enabling older people to remain in their own homes. OBJECTIVE: To measure the feasibility and cost of adaptations and AT, and the scope for these to substitute and supplement formal care. DESIGN: Detailed design studies to benchmark the adaptability of 82 properties against the needs of seven notional users. SETTING: Social rented housing sector. MAIN OUTCOME MEASURES: Measures of the adaptability of properties, costs of care, adaptations and AT, and relationships between these costs. RESULTS: The adaptability of properties varies according to many design factors and the needs of occupiers. The most adaptable properties were ground floor flats and bungalows; the least were houses, maisonettes and flats in converted houses. Purpose-built sheltered properties were generally more adaptable than corresponding mainstream properties but the opposite was the case for bungalows. Adaptations and AT can substitute for and supplement formal care, and in most cases the initial investment in adaptations and AT is recouped through subsequently lower care costs within the average life expectancy of a user. CONCLUSION: Appropriately selected adaptations and AT can make a significant contribution to the provision of living environments which facilitate independence. They can both substitute for traditional formal care services and supplement these services in a cost-effective way.

A cognitive and physical performance assessment of retirees entering a continuing care retirement community: the Moorings Assessment Protocol.

Moorings Park Continuing Care Retirement Community (CCRC) screened 267 applicants (115 males; 152 females; mean age 80.22 years) using the Mini-Mental State Examination (MMSE), the 7-Minute Screen, the Geriatric Depression Scale (GDS), and the Physical Performance Test (PPT). They compared mean scores across admission/nonadmission groups to determine the extent to which cognitively impaired persons were effectively redirected from independent living settings inadequate for their needs. Groups differed (p < .05) on 21 test items/scores, including subscales of the 7-Minute Screen. The nonadmission group underperformed the admission group and healthy controls from earlier research, and outscored persons with Alzheimer's disease on all 7-Minute Screen subscales. Researchers concluded that geriatricians had effectively identified those with dementia and mild cognitive impairment (MCI) and placed them into supervised settings more appropriate to their clinical and social needs.

The living conditions of elderly Americans.

PURPOSE: This article profiles the housing settings of frail elderly individuals, whether their homes are facilitating or impeding their ability to live in the community, and the change in disability and housing status before and after passage of the 1990 Americans with Disabilities Act. DESIGN AND METHODS: The analysis relies primarily on statistical analysis of the 1995 national American Housing Survey (AHS), with supplementary analysis of the 1978 AHS. RESULTS: In 1995, roughly 14% of elderly individuals had a "housing-related disability," 49% had at least one dwelling modification, and 23% had an unmet need for modifications. Because half those with dwelling modification also reported unmet need, the match between disabling condition and modification, not the presence of modifications, is key. Multivariate results indicate that although unmet need is greater among the poor, lack of modifications is not. Prevalence of modifications nearly doubled between 1978 and 1995. Overall unmet need declined, but some needs were less likely to be met in 1995 than 1978. IMPLICATIONS: The analysis highlights the importance of information about housing for understanding the care and service needs of elderly individuals and provides a compelling argument for a minimum dataset on their housing and neighborhood environments.

[The study of house monitoring system in Welfare Techno-House Mizusawa].

In 1999, 8 elderly people aged over 70 stayed for 5 days in Mizusawa Welfare Techno-house and their health conditions and activities of daily life were monitored using 16 sensors attached around the house. To determine a few feasible, practical sensors and optimal sensor positions, accumulated data was analyzed. Because of bud get conditions only two sensors (infrared sensor and life line monitor sensor) were placed in one voluntary house and the data were transferred from the voluntary house to the techno-house through the ISDN and CATV lines. The data were analyzed every days. Only 2 sensors to detect were placed and attached this year, however one more sensor to detect physical conditions such as ECG records during sleeping time, will be used next year. On the other hand, an integrate system that can analyze many data transferred from various sensors simultaneously was developed. To introduce this system into privatehouse, many problems such as privacy protection, security, etc must be solved.

Policy implications on assistance for the "caged elderly" in Hong Kong.

Social policy for the "caged elderly" in Hong Kong should be formulated in the context of how they lived in the society where they were located. The paper examines (1) whether some of these elderly experienced financially constrained conditions with a weakened social support system; and (2) what policy choices, such as compassionate housing or closer monitoring of such residences, can be undertaken by a formal organization.