Examining social isolation by gender and geography: conceptual and operational challenges using population health data in Canada

In 2003, the Canadian Federal/Provincial/Territorial Task Force on Seniors identified social isolation as an important issue for further study and policy development given that socially isolated persons are considered to be more vulnerable to both inappropriate use of the health care system and poorer health outcomes. In order to provide adequate support to this vulnerable population, it is critical to untangle the complex web of relationships that influence the need for care, and the health status and service utilization patterns of socially isolated older adults. Using data from the 2000-01 Canadian Community Health Survey (CCHS), this article explores social isolation as a multidimensional social construct examining in particular the axes of gender and geography to try to tease out some of this complexity and its relationship to health status and service utilization. When individual characteristics like gender are considered together with broader contextual variables like place of residence, a more comprehensive and layered portrait of vulnerability among socially isolated persons begins to emerge with insights into their unique patterns of health and service use. For example, home care may be an extremely critical resource for keeping older women in their homes and out of hospital. On the other hand, among socially isolated older men, those living in rural communities may be particularly 'invisible', neither benefiting from home care nor having strong social supports. It seems plausible then that both men and women may be in need of special interventions or targeted programmes to help them to remain, or to become, more socially integrated in their communities as they age in place. In addition, this article addresses some of the limitations of using both a quantitative analytic approach and the CCHS dataset itself in grappling with such complexity.