Since 2020 our multicultural health service has been engaging more deeply with older adults and the level of loneliness and social isolation experienced by some is considerable. As we take a social view of health and wellbeing, we wanted to link and support older people to engage in groups and activities to combat their feelings of loneliness and social isolation, but our warm referrals did not work. The activities and programs were not culturally familiar or could not accommodate seniors with very low English proficiency and did not feel culturally safe. We were delighted when the Eastern Star Foundation supported a new initiative we proposed – a social link program dedicated to multicultural seniors. The program has been running for just over 12 months and we have many learnings to share from delivering this impactful and very well attended program.
Why is it important to reduce social isolation and loneliness among older people? According to the World Health Organization there is a large body of research that shows that social isolation and loneliness have a serious impact on older people’s longevity, their physical and mental health, and their quality of life. In fact, the impact on mortality is comparable to other risk factors such as smoking, obesity and physical activity. By inadvertently excluding cultural communities from social isolation programs, we are perpetuating and deepening inequities in health and life outcomes.
Unfortunately, there are few studies on loneliness among older migrants, just as there are few investments in programs tailored to aging migrants in Australia. One study that specifically focused on loneliness among migrants showed that the structural factors of the social environment in which they find themselves in as they age, rather than their culture of origin, is more important for older migrants’ feelings of loneliness in later life. The key factors to alleviate this are: a favourable social environment with high social capital, and low level of discrimination and ageism. This is important information as it shifts our attention away from an individual-based deficiency model to a society-based deficiency model. The key factors are all about the characteristics of the ‘receiving’ society, not the individual migrant’s characteristics. So, building social capital, inclusion, combatting aging and discrimination, building cultural safety and social opportunity should be the focus of any programs that seek to reduce loneliness and social isolation among elderly migrants.
Here are our success factors:
In-reach into community grass-roots beyond service providers: our staff spent considerable time talking to people from multicultural backgrounds at shopping centres, ethnic grocery stores, libraries, places of worship and community gathering places. We engaged the networks of our Care Finder advisory group members who are grassroots leaders with large networks. This resulted in 65% of program participants coming to us from our own outreach activities, rather than relying on service providers to refer to us. We did this based on the assumption that people experiencing loneliness are not well linked to service providers. The other sources of referrals have been internally through our other World Wellness Group programs and other community and health organisations.
Flexible assessments: our model involves an individual wellbeing assessment prior to the older person joining the monthly group program. This has been integral to understanding people’s support needs – both from an aging perspective and also social and other supports. Assessments were done via home visits, to break down any transport or financial barriers and were done in a flexible manner. Some adult children refused for their parent to receive a home visit while they were not there and we were flexible with such conditions. Other findings from the assessment were that lots of participants felt they were lacking social connections and had a considerable knowledge gap around available services and eligibilities such as concession cards. Family members also had this knowledge gap.
Cultural support: the absolute clincher to the success of the program has been the provision of cultural support. Just as an interpreter provides language support, a Multicultural Peer Support Worker provides cultural support by bringing their cultural knowledge and lived experience to the interaction. They have supported older adults to remain engaged, to explain how the group program ‘works’, build the bridge between participants and to provide ‘cultural translation’. The integration of cultural support in the program has made the program genuinely culturally tailored.
Removing common barriers: Older people from multicultural backgrounds face numerous barriers to engage in social activities such as cost, transport, language, cultural safety and literacy. We designed the program with these barriers in mind and had a solution for each barrier. The program was free of charge and we provided a free light lunch, we provided transport support, we provided interpreters and Multicultural Peer Support Workers and we reduced written and digital content in the group program. WWG’s social impact framework is identifies the barriers multicultural communities experience in healthcare and identifies the input, outputs and outcomes we seek to achieve to overcome these barriers. It’s how our organisation does business.
Another barrier can be the environment in which programs take place. We moved the group program from one community centre to another – one was a largely mono-cultural centre where we were hoping to make a positive impact. However, both staff and participants did not always feel welcome and felt rushed. The new community centre has a large multicultural clientele where participants not only feel welcome, but they feel encouraged to get involves in other activities. Cultural safety truly matters.
Transport is a big barrier, particularly for older people as they come to terms with losing their driver’s license. We ran a workshop, CarFreeMe which is specifically designed for people going through the process of giving up their driver’s license and encourages them to stay active after they stop driving. This helped build participants’ confidence in using various forms of transport and applying for government subsidies and concessions.
Relevant content: We have covered a lot of topics at the monthly group sessions and many of these have been requested by the participants themselves. A few months into the group we ran a participant survey to get feedback and to identify topics and activities participants were interested in. Some of the topics have been: falls prevention, disaster preparedness, scam awareness, wills and powers of attorney and dementia awareness.
Nurturing natural relationships: the absolute success stories of the program have been the formation of natural relationships and the participants ‘spinning off’ to form other groups and join other activities. Participants have met for lunch in between the monthly groups, have invited each other to activities and events in their own communities and have plans to start other groups such as an art group and gardening group at the community centre we congregate. This social linking has occurred across cultures, with participants forging new friendships and enjoying new experiences together.
So has our program made any difference in the lives of the participants? Our pre- and post- assessments indicated yes. People report feeling more connected, more skilled with knowledge about healthy aging, increased social wellbeing via sharing cultural experiences, increased service access via 75 warm referrals to services, and the best feedback of all – participants consistently request to meet more frequently. The impact of our program is going to be formally evaluated in 2024 and we will be able to report on additional outcomes for participants.
So if you’re embarking on a program that addresses social isolation among seniors, consider what it takes to engage aging migrants who comprise 37 % of Australia’s seniors over 65 years. Leaving them out of your program is well, discriminatory actually. Consider building in your program specific strategies that overcome the structural barriers to engagement and actively combat discrimination and agism. Embedding cultural and language supports and transport support will ensure your program is well tailored to the needs to your participants. Breaking down social isolation could well have the same impact as helping people cease smoking on their wellbeing and longevity. It is life enhancing work.
