Older adults and their communities can be resilient, yet deficit-based portrayals of older adults living in rural communities remain common in research and public discourses. Drawing from contemporary research on aging, rural communities, and social connection, we explored rural older adults' resources and resilience processes during the COVID-19 pandemic. This longitudinal, case study research included 66 qualitative interviews with 22 older adults at three different points in time between May 2020 and June 2021 in rural Manitoba, Canada. Findings highlighted that even during this adverse time, many older adults experienced well-being in this study, demonstrating resilience. Explaining their experiences, participants described adopting new technologies and using long-established strategies to maintain important social relationships during periods of isolation. Participants social connections varied, with some experiencing lessening of loneliness over time. Some older adults resisted public health restrictions and developed their own mitigation strategies for safe gatherings while a loss of community spaces contributed to some participants' experiences of chronic loneliness and low levels of well-being. Purposeful community activities (especially volunteering), access to the outdoors, and access to essential community spaces (e.g., grocers and post-offices) were described as important strategies and resources at the local level. By describing rural older adults’ valued resources and resource gaps with attention to both place and time this study contributes to the growing body of research in relation to social connection and resilience and advances resilience theoretical approaches to the study of rural aging.

Background Preventing and addressing social isolation and loneliness among older adults is important because of the known associations with negative health outcomes. The Canadian Coalition for Seniors’ Mental Health (CCSMH) took on the task of creating clinical guidelines. Method A multidisciplinary working group was established. The process was guided by an initial rapid scoping review of the literature focused on older adults. An adapted GRADE approach was utilized. Results CCSMH has produced first-ever clinical guidelines on social isolation and loneliness in older adults. Prevention, including recognition of risk factors and educational approaches focused on clinicians and students, is recommended. Targeted screening with validated tools is recommended. A comprehensive assessment is optimal to treat any underlying conditions and to identify contributing factors that may be responsive to psychosocial interventions. An individualized approach to interventions with shared decision-making is recommended. A variety of possible interventions include social prescribing, social activity, physical activity, psychological therapies, animal-assisted therapies and ownership, leisure skill development and activities, and the use of technology. Conclusion The problem of social isolation and loneliness is a “geriatric” giant that needs to be recognized and addressed. Because of its complexity, it will require the collective attention of many individuals and organizations working together at multiple levels of society, to raise awareness and find solutions. We recommend that healthcare and social service providers use these guidelines as a comprehensive tool to identify, assess, and implement strategies to reduce the negative impact of social isolation and loneliness.

Drawing on resilience research in rural studies, this study examined the mental health experiences of frontline healthcare workers during two stages of the COVID-19 pandemic in rural Manitoba, Canada. Data were collected using online surveys from May to June 2020 (n = 137) and from May to June 2021 (n = 219). The surveys assessed symptoms of anxiety and identified strategies and barriers to addressing mental health concerns. Most respondents exhibited clinical symptoms of anxiety as measured by the GAD-7 scale. Respondents mostly accessed informal supports, such as family and friends, in the first survey in 2020, and a broader mix of informal and formal supports in the 2021 survey. In both surveys, numerous barriers to accessing formal mental health support were identified. Our findings suggest that although some degree of resilience in the face of the pandemic was prevalent in rural areas, there is a need for accessible professional and peer mental health support for frontline healthcare workers. The research also highlights the importance of context and resources in sustaining the healthcare workforce in rural areas as part of the pandemic response.

We investigated the association between pre-COVID-19 memory function and (a) receipt of a COVID-19 test and (b) incidence of COVID-19 using the COVID-19 Questionnaire Study (CQS) of the Canadian Longitudinal Study on Aging (CLSA). The CQS included 28,565 middle-aged and older adults. We regressed receipt of a COVID-19 test on participants' immediate and delayed recall memory scores and re-ran the regression models with COVID-19 incidence as the outcome. All regression models were adjusted for sociodemographic, lifestyle, and health covariates. In the analytical sample (n = 21,930), higher delayed recall memory (better memory) was significantly associated with lower COVID-19 incidence. However, this association was not significant for immediate recall memory. Immediate and delayed recall memory were not associated with receipt of a COVID-19 test. Health policymakers and practitioners may viewmemory status as a potential risk for COVID-19. Memory status may not be a barrier to COVID-19 testing.

Public health and media discourses have often portrayed older adults as a vulnerable group during the COVID-19 pandemic. Yet, some emerging research is showing that older adults are faring better in terms of their mental health when compared to their younger counterparts. Understanding older adults' mental well-being during the pandemic requires in-depth exploration of the different place-based resources and systems around them. In particular, rural older adults face distinct challenges and opportunities related to accessing valued resources to promote their well-being. Drawing together research on aging and multi-systemic resilience, we explored what strategies, resources, and processes rural older adults valued in the initial stages of the COVID-19 pandemic. A series of 51 semi-structured telephone interviews were conducted from May to August 2020 with 26 rural older adults in Manitoba, Canada. Despite adversities, participants drew on and developed resources at the individual, local, community, institutional, and societal level to support their well-being. Specifically, they identified individual strategies (e.g., positivity, acceptance, and gratitude), resources in their immediate environments (e.g., opportunities to keep busy, connect with friends, family and neighbours, and outdoor visits), and community organizations that contributed to their well-being. They also identified broader systems that shaped their resilience processes, such as access to health services, opportunities to volunteer and support others, media stories, reliable information, and public health policies and practices that value older adult lives. Importantly, some resources were less accessible to some participants, highlighting the need to develop strategies that address inequitable resources at different levels. By describing rural older adults' resilience we seek to advance the growing body of research in relation to social ecological resilience that moves beyond a focus on individual characteristics to include understanding of the role of material, social, and cultural contexts.

Introduction: Obesity is an important public health concern, and large studies of rural–urban differences in prevalence of obesity are lacking. Our purpose is to compare body mass index (BMI) and obesity in Canada using an expanded definition of rurality. Methods: A cross-sectional analysis of self-reported BMI across diverse communities of Canadians aged 45–85 years was conducted using data from the Canadian Longitudinal Study on Aging (CLSA), a national sample representative of community-dwelling residents. Rurality was identified in the CLSA based on residential postal codes, which were divided into 4 categories: urban, peri-urban, mixed and rural. Logistic regression models were constructed to calculate adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) between obesity (BMI ≥30 kg/m2 from self-reported weight and height) and rurality, adjusting for age, sex, province, marital status, number of residents in household and household income. Results: Twenty-one thousand one hundred and twenty-six Canadian residents aged 45–85 years, surveyed during 2010–2015, were included. 26.8% were obese. Obesity was less prevalent amongst urban (25.2%) than rural (30.3%, P < 0.0001), mixed (28.7%, P < 0.0001) or peri-urban communities (28.1%, P < 0.0001). When compared to urban areas, the aOR (95% CI) for obesity was 1.09 (1.00–1.20) in rural regions and 1.20 (1.08–1.35) in peri-urban settings. In areas of mixed urban and rural residence, the aOR was 1.12 (0.99–1.27). Conclusion: One in four Canadian adults were obese. Living in a non-urban setting is an independent risk factor for obesity. Rural–urban health disparities could underlie rural–urban differences, but further research is needed.

AbstractPurposeTo document the prevalence of functional impairment in middle‐aged and older adults from rural regions and to determine urban‐rural differences.MethodsWe have conducted a secondary analysis using data from an ongoing population‐based cohort study, the Canadian Longitudinal Study on Aging (CLSA). We used a cross‐sectional sample from the baseline wave of the “tracking cohort.” The definition of rurality was the same as the one used in the CLSA sampling frame and based on the 2006 census. This definition includes rural areas, defined as all territory lying outside of population centers, and population centers, which collectively cover all of Canada. We grouped these into “Urban,” “Peri‐urban,” “Mixed” (areas with both rural and urban areas), and “Rural,” and compared functional status across these groups. Functional status was measured using the Older Americans Resource Survey (OARS) and categorized as not impaired versus having any functional impairment. Logistic regression models were constructed for the outcome of functional status and adjusted for covariates.FindingsNo differences were found in functional status between those living in rural, mixed, peri‐urban, and urban areas in unadjusted analyses and in analyses adjusting for sociodemographic and health‐related factors. There were no rural‐urban differences in any of the individual items on the OARS scales.ConclusionsWe found no rural‐urban differences in functional status.

Background and Objectives: Based on the World Health Organization Age-Friendly Cities and Communities (AFCC) framework, the government of Manitoba, Canada, launched a province-wide age-friendly initiative in 2008. The objective of this study was to explore the sustainability of the AFCC initiative more than a decade later. The study was guided by conceptualizations of sustainability as multidimensional and dynamic, composed of 4 aspects (continued capacity, institutionalization, continued benefits, and development/adaptation), and an ecologic perspective that highlights the importance of contextual influences, and their change over time, on AFCC activities. Research Design and Methods: The study involved a qualitative, multiple case study design. Semistructured interviews were conducted in 2020 with a key informant from each of 52 AFCC. Interview data were analyzed deductively, guided by the sustainability framework and an ecologic perspective. Census data were used to describe the demographic characteristics of AFCC. Results: We identified 6 groups of AFCC initiatives that varied in degree from the most to the least sustainable: active, in hiatus, reorganized, stalled, discontinued, and never got off the ground. Both local community factors (e.g., lack of capacity) and broader contextual factors, such as demographic changes and provincial legislations, influenced initiatives' sustainability. Discussion and Implications: AFCC initiatives can range in their degree of sustainability and can wax or wane over time. Ongoing external support for AFCC (e.g., from provincial or state government) to promote the vision of age-friendliness and to address lack of capacity (e.g., to assist with community assessments) could help with the long-term sustainability of initiatives.

Objectives Previous studies on depression in rural areas have yielded conflicting results. Features of rural areas may be conducive or detrimental to mental health. Our objective for this study was to determine if there are rural-urban disparities in depressive symptoms between those living in rural and urban areas of Canada. Design We conducted a cross-sectional analysis of a prospective cohort study, which is as representative as possible of the Canadian population-the Tracking Cohort of the Canadian Longitudinal Study on Aging. For this cohort, data were collected from 2010 to 2014. Data were analysed and results were obtained in 2020. Participants 21 241 adults aged 45-85. Measures Rurality was grouped as urban (n=11 772); peri-urban (n=2637); mixed (n=2125; postal codes with both rural and urban areas); and rural (n=4707). Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression. We considered age, sex, education, marital status and disease states as potential confounding factors. Results The adjusted beta coefficient was -0.24 (95% CI -0.42 to -0.07; p=0.01) for rural participants, -0.17 (95% CI -0.40 to 0.05; p=0.14) for peri-urban participants and -0.30 (95% CI -0.54 to -0.05; p=0.02) for participants in mixed regions, relative to urban regions. Risk factors associated with depressive symptoms were similar in rural and urban regions. Conclusions The small differences in depressive symptoms among those living in rural and urban regions are unlikely to be relevant at a clinical or population level. The findings do suggest some possible approaches to reducing depressive symptoms in both rural and urban populations. Future research is needed in other settings and on change in depressive symptoms over time.

Objective: The objective is to determine the use of health-care services (physician visits, emergency department use and hospitalisations) in rural areas and examine differences in four geographic areas on a rural to urban spectrum. Methods: We conducted a secondary analysis of cross-sectional data from a population-based prospective cohort study, the Canadian Longitudinal Study on Aging (CLSA). Participants included community-dwelling adults aged 45-85 years old from the tracking cohort of the CLSA (n = 21,241). Rurality was classified based on definitions from the CLSA sampling frame and similar to the 2006 census. Main outcome measures included self-reported family physician and specialist visits, emergency department visits and hospitalisations within the previous 12 months. Results were compared for four geographic areas on a rural-urban continuum. Univariate and bivariate analyses were performed on data from the 'tracking cohort' of the CLSA, Chi-square tests were used for categorical variables. Logistic regression models were created for the main outcome measures. Results: Participants in rural and mixed rural and urban areas were less likely to have seen a family physician or a specialist physician compared to urban areas. Those living in rural and peri-urban areas were more likely to visit an emergency department compared to urban areas. These differences persisted after adjusting for sociodemographic and health-related variables. There were no significant rural-urban differences in hospitalisations. Conclusion: Rural-urban differences were found in visits to family physicians, specialists and emergency departments.

Older adults have been described as a vulnerable group in the current context of the COVID-19 pandemic. In Canada, where this study took place, older adults have been encouraged to self-isolate while the rest of the population has been cautioned against in-person contact with them. Prior to COVID-19, social isolation and loneliness among older adults was considered a serious public health concern. Using a series of semi-structured interviews with 26 community-dwelling older adults (65+) living in rural Manitoba, we explore older adults’ experiences of isolation and loneliness in the initial stages of the pandemic between the months of May and July 2020. Participants identified a loss of autonomy, loss of activities and social spaces (e.g., having coffee or eating out, volunteering, and going to church), and lack of meaningful connection at home as factors influencing their sense of isolation and loneliness. Although these loses initially influenced participants’ self-reported isolation and loneliness, the majority developed strategies to mitigate isolation and loneliness, such as drawing on past experiences of isolation, engaging in physically distanced visits, connecting remotely, and “keeping busy.” Our findings call attention to the role of different environments and resources in supporting older adults social and emotional wellbeing, particularly as they adapt to changes in social contact over time.

Introduction: Understanding rural-urban differences, and understanding levels of life satisfaction in rural populations, is important in planning social and healthcare services for rural populations. The objectives of this study were to determine patterns of life satisfaction in Canadian rural populations aged 45-85 years, to determine rural-urban differences in life satisfaction across a rural-urban continuum after accounting for potential confounding factors and to determine if related social and health factors of life satisfaction differ in rural and urban populations. Methods: A secondary analysis was conducted using data from an ongoing population-based cohort study, the Canadian Longitudinal Study on Aging. A cross-sectional sample from the baseline wave of the tracking cohort was used, which was intended to be as generalizable as possible to the Canadian population. Four geographic areas were compared on a rural-urban continuum: rural, mixed (indicating some rural, but could also include some peri-urban areas), peri-urban, and urban. Life satisfaction was measured using the Satisfaction with Life Scale and dichotomized as satisfied versus dissatisfied. Other factors considered were province of residence, age, sex, education, marital status, living arrangement, household income, and chronic conditions. These factors were self-reported. Bivariate analyses using χ2 tests were conducted for categorical variables. Logistic regression models were constructed with the outcome of life satisfaction, after which a series of models were constructed, adjusting for province of residence, age, and sex, for sociodemographic factors, and for health-related factors. To report on differences in the factors associated with life satisfaction in the different areas, logistic regression models were constructed, including main effects for the variable of interest, for the variable rurality, and for the interaction term between these two variables. Results: Individuals living in rural areas were more satisfied with life than their urban counterparts (odds ratio (OR)=1.23; 95% confidence interval (CI): 1.13-1.35), even after accounting for the effect of confounding sociodemographic and health-related factors (OR=1.32, 95%CI: 1.19-1.45). Those living in mixed (OR=1.30, 95%CI: 1.14-1.49) and peri-urban (OR=1.21, 95%CI: 1.07-1.36) areas also reported being more satisfied than those living in urban areas. In addition, a positive association was found between life satisfaction and age, as well as between life satisfaction and being female. A strong graded association was noted between income and life satisfaction. Most chronic conditions were associated with lower life satisfaction. Finally, no major interaction was noted between rurality and each of the previously mentioned different factors associated with life satisfaction. Conclusion: Rural-urban differences in life satisfaction were found, with higher levels of life satisfaction in rural populations compared to urban populations. Preventing and treating common chronic illness, and also reducing inequalities in income, may prove useful to improving life satisfaction in both rural and urban areas. Studies of life satisfaction should consider rurality as a potential confounding factor in analyses of life satisfaction within and across societies.

Rural healthcare workers are experiencing barriers to accessing supports for their own mental health and well-being. Findings from an online survey during the initial stages of the COVID-19 health pandemic reveal that healthcare workers (N=137) in rural and non-metropolitan Manitoba, Canada, are increasingly stressed by fluctuating COVID-19 protocols and policies and face challenges such as lack of anonymity and stigma about their mental health concerns. The health pandemic has amplified existing challenges to healthcare in rural places and has created extended periods of stress and isolation for healthcare workers. Implications to policies and practices relevant to providing essential mental health supports to reduce the likelihood of long-term negative health outcomes are discussed. Rural healthcare workers' experiences emphasize the importance for place-specific research and practice.

Background Although a large body of research has focused on social isolation and loneliness, few studies have examined social isolation and loneliness together. The objectives of this study were to examine: 1) the relationship between four groups derived from combining social isolation and loneliness (socially isolated and lonely; only socially isolated; only lonely; neither socially isolated nor lonely) and the desire for more social participation, and social support; and 2) the relationship between the four groups and psychological distress. Methods The study was based on the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Using CLSA baseline data (unweighted N = 30,079), ordinary and logistic regression analysis was used to examine the cross-sectional relationship between the four social isolation/loneliness groups and desire for more social participation and four types of social support (tangible, positive interaction, affection, and emotional support). Prospective logistic regression analysis was possible for psychological distress, which was derived from the Maintaining Contact Questionnaire administered about 18 months after the baseline questionnaire (unweighted N = 28,789). Results Findings indicate that being socially isolated and lonely was associated with the most social support gaps; this group also had an increased likelihood of psychological distress, relative to those who were neither socially isolated nor lonely. Participants who were only socially isolated, and those only lonely also perceived some social support gaps. In addition, the only lonely group was more likely to be psychologically distressed than the only socially isolated group and the neither isolated nor lonely group. Conclusion Examining the four social isolation/loneliness was useful, as it provided more nuanced risk profiles than would have been possible had we examined social isolation and loneliness separately. Findings may suggest avenues for interventions tailored to the unique needs of at-risk individuals.

Abstract Social isolation is deleterious for both mental and physical health (Coyle & Dugan, 2012; Hawkley et al., 2006). Conversely, social participation has mental and physical health benefits (Novek et al., 2013). In light of the current Covid-19 pandemic requiring social distancing, the present study examined whether living situation and ability to access information about social activities are associated with older adults’ loneliness during the pandemic. Specifically, we surveyed ninety-one adults aged 60 years or older in May and June of 2020, at a time when social distancing measures were still in place. We tested whether their living situation and having access to information about social activities was associated with loneliness. OLS regression analyses revealed living alone was associated with higher loneliness (b = .43, p = .050); and having access to information about social activities was associated with lower loneliness (b = -.18, p = .027) amidst the pandemic. The analyses controlled for participants’ age, gender, and education. Our findings highlight that during Covid-19, older adults’ living situation and access to information about social activities matter and may impact their social behavior. Thus, at this difficult time, it is recommended organizations that offer social activities find creative ways to reach those living alone who will benefit most from having access to such activities.

Research shows that social isolation and loneliness are important health issues for older adults. This message is increasingly being recognized by policy makers and service providers. Although the concepts of loneliness and social isolation are often discussed and compared with one another, they are largely examined separately, even if they are both included in the same study. In the present article, we argue for bringing together these two related concepts. For example, focusing only on social isolation overlooks differences between those older adults who are socially isolated and lonely versus socially isolated but not lonely. Consequently, we discuss four groups of older adults: isolated, but not lonely; lonely in a crowd; isolated and lonely; and not isolated or lonely. We argue that considering loneliness and social isolation together will aid in the understanding of the social situation of older adults and can provide new directions for research and intervention programs for older adults.

BACKGROUND:A large body of research shows that social isolation and loneliness have detrimental health consequences. Identifying individuals at risk of social isolation or loneliness is, therefore, important. The objective of this study was to examine personal (e.g., sex, income) and geographic (rural/urban and sociodemographic) factors and their association with social isolation and loneliness in a national sample of Canadians aged 45 to 85 years.METHODS:The study involved cross-sectional analyses of baseline data from the Canadian Longitudinal Study on Aging that were linked to 2016 census data at the Forward Sortation Area (FSA) level. Multilevel logistic regression analyses were conducted to examine the association between personal factors and geographic factors and social isolation and loneliness for the total sample, and women and men, respectively.RESULTS:The prevalence of social isolation and loneliness was 5.1% and 10.2%, respectively, but varied substantially across personal characteristics. Personal characteristics (age, sex, education, income, functional impairment, chronic diseases) were significantly related to both social isolation and loneliness, although some differences emerged in the direction of the relationships for the two measures. Associations also differed somewhat for women versus men. Associations between some geographic factors emerged for social isolation, but not loneliness. Living in an urban core was related to increased odds of social isolation, an effect that was no longer significant when FSA-level factors were controlled for. FSAs with a higher percentage of 65+ year old residents with low income were consistently associated with higher odds of social isolation.CONCLUSION:The findings indicate that socially isolated individuals are, to some extent, clustered into areas with a high proportion of low-income older adults, suggesting that support and resources could be targeted at these areas. For loneliness, the focus may be less on where people live, but rather on personal characteristics that place individuals at risk.

Abstract There are many definitions of social isolation which draw on structural indicators (e.g. living alone), functional indicators (e.g. social support) or both. This makes comparing prevalence rates across studies difficult and provides little guidance for practitioners and service providers to identify and target socially isolated clients. The purpose of the present study was to compare, within one large population-based data-set of Canadians aged 45–85, single-item and composite indicators of social isolation, by total sample and by socio-demographics (age, sex) and health. Data were from the Canadian Longitudinal Study on Aging (CLSA) which assessed features of social network, social support and social participation. Two composite scales were created to compare prevalence rates based on structural only or both structural and functional indicators. Results indicated overall low prevalence rates of social isolation, regardless of the measure used. A composite scale using only structural features identified 5.8 per cent socially isolated adults aged 45–85. This compared with a structural and functional scale that identified 9.8 per cent socially isolated adults. The composite measures showed less variation across socio-demographics than single-item measures. Results shed light on different ways in which social isolation can be defined and how single-item and composite definitions impact our understanding of identifying socially isolated adults in a given population. Results add to discussion of measures that can be used by researchers, services providers and practitioners.

Objectives: The objectives of this study were to examine: 1) whether the relationship between social network types, depressive symptoms and life satisfaction is mediated by different types of perceived social support; and, 2) whether social support plays a mediational role for married versus unmarried older adults. Methods: The study was based on national, baseline data (Tracking Cohort) from the Canadian Longitudinal Study on Aging for participants aged 65 to 85 (N = 8782). Five social network types derived from cluster analysis were used as predictors in the mediation analyses, with the four social support subscales of the Medical Outcomes Survey (MOS) Social Support Survey (tangible, emotional, positive social interactions, and affectionate) included as mediators, and depressive symptoms and life satisfaction as outcome variables. Socio-demographic and physical health variables were included as covariates. Results: Significant indirect effects emerged, with less diverse social network structures generally associated with less social support which, in turn, was related to more depressive symptoms and lower life satisfaction. However, different findings emerged for different types of social support, for participants who were married and unmarried, and for depressive symptoms versus life satisfaction. Conclusion: Our findings suggest that restricted social networks that are reflective of social isolation, as well as those that are intermediate in terms of their diversity can create gaps in perceived social support and, consequently, can negatively impact mental health and life satisfaction.

It is well-documented that social isolation is detrimental to health and well-being. What is less clear is what types of social networks allow older adults to get the social support they need to promote health and well-being. In this study, we identified social network types in a national sample of older Canadians and explored whether they are associated with perceived availability of different types of social support (affectionate, emotional, or tangible, and positive social interactions). Data were drawn from the baseline questionnaire of the Canadian Longitudinal Study on Aging for participants aged 65–85 (unweighted n = 8,782). Cluster analyses revealed six social network groups. Social support generally declined as social networks became more restricted; however, different patterns of social support availability emerged for different social network groups. These findings suggest that certain types of social networks place older adults at risk of not having met specific social support needs.