Background

The older-adult population in Canada is projected to continue expanding over coming decades. As of 2018, individuals age 65 and older made up 17.4% of the Canadian population. Projections estimate that by 2068, this percentage will grow to between 21.4% and 29.5%.[1] Additionally, it is expected that there will be over 5.5 million Canadians over the age of 80 in 2068, compared to 1.6 million in 2018.[1] This situation requires considerable thought and action from the Canadian health care and political systems.

A growing challenge among the older-adult community is housing, and it is exacerbated by age-related issues such as social isolation, accessibility concerns, and socioeconomic factors. Of particular relevance is social isolation, which is defined as “a quantifiable method of reduced social network” and is directly related to loneliness, which is the perceived lack of a social network.[2,3] Social isolation is a prevalent issue among older adults, who are at higher risk due to the loss of family members and geographical distancing.[4] A longitudinal cohort study by Perisonnoto and colleagues determined that approximately 18% of individuals over the age of 60 live alone, with 43% of subjects reporting that they feel lonely.[5] Similarly, the Canadian National Seniors Council estimate that approximately 50% of people over the age of 80 report feelings of loneliness.[6] While the BC government recognizes the importance of social and intergenerational connections and their ties to mental and physical health, limited initiatives exist that target social isolation.[7] Additionally, the 2019 BC Centre for Disease Control report on social isolation discussed the impact on seniors. It also stated that housing was a “key component of fighting social exclusion,” but highlighted that housing for seniors was not a priority for most municipalities in BC.[8] The literature on loneliness among older adults living in care facilities is also scarce; however, one study explored loneliness in senior housing communities and found that 42.7% of older adults living in these communities were moderately lonely and 26.6% were severely lonely, using the Hughes scale.[9] Across studies, loneliness among older adults is shown to have negative health consequences. For example, loneliness is correlated with a decline in function with activities of daily living, negatively impacting subjective health and increasing the risk of conditions such as depression, incontinence, hypertension, and vision impairment, as well as overall mortality.[5,9-12] It is clear that social isolation, and consequently, senior housing, are public health issues. Intergenerational housing models serve as a potential solution to address these concerns and help mitigate the consequences associated with social isolation.

Senior housing models

Several models of housing for older adults exist nationwide, together creating tiers for delivery of care that can be used based on an individual’s specific needs. In general, these tiers include independent living, assisted living, long-term care, and hospice care, with respite care serving as a temporary option at almost all levels to provide caregiver relief. Independent care options involve minimal professional assistance, while assisted living is suited for older adults who are able to make decisions but require support due to physical and functional health challenges.[13] Long-term care is designated for medically complex patients who require 24-hour nursing care.[1,3] Hospice care is for patients who are at end of life and require symptom management, and it is one of many palliative care options.[14]

Intergenerational housing facilities could employ a uni- or multi-tiered approach to older-adult housing, depending on community needs and available resources. The premise of intergenerational housing is that seniors’ needs are met in a similar way to the housing options mentioned above, with the added opportunity to reside with or among younger individuals who do not require these services. The BC-based company Happipad is a housing solution that frequently facilitates intergenerational housing.[15] Through its website, Happipad often connects seniors looking for social connections and additional income to younger tenants looking for affordable housing.[15] Purpose-built intergenerational-housing spaces also exist in Canada, such as the newly established Generations facility in Calgary, which integrates assisted, long-term, and palliative care in a multigenerational environment.[16] Similarly, Harbour Landing Village in Regina is a care centre for older adults that promotes personalized care and intergenerational activities.[17] Similar housing schemes are seen worldwide. For example, the Netherlands has housing plans in which students are offered free accommodation provided they spend 30 hours each month with their older-adult housemates.[18] In Fujisawa, Japan, Aoi Care houses elderly people with dementia, and is unique in that its residents decide on their daily activities, frequently choosing to interact with children by playing ball or selling tea made at the centre.[19] Generally, studies show that living and spending time with family, and specifically caring for grandchildren, serve as protective factors against older-adult loneliness, further supporting the concept of intergenerational housing.[20,21]

Intergenerational programs

Existing intergenerational programs demonstrate an improvement in seniors’ health and well-being, suggesting a similar benefit would be realized through intergenerational housing. One study conducted in Japan noted that older adults who actively participated in an intergenerational program that involved regularly reading to school-age children over an 18-month period reported improved subjective health and social networks compared to controls.[22] A follow-up study based on this program was conducted 7 years later and demonstrated that the control group had higher odds of having decreased intellectual capacity as well as lower levels of interactions with children.[23] Additionally, at follow-up, the intervention group demonstrated higher levels of physical function related to fine motor skills, as measured through functional reach and grip strength.[23] Functional limitations are also a risk factor for loneliness; therefore, intergenerational programs may help address this underlying issue.[24]

Another study in Japan consisted of exploring the impacts of participating in a weekly intergenerational day program that paired seniors with school-age children for 6 months.[25] The study noted that a subgroup of seniors who reported higher scores on a depression scale at enrolment showed a significant decrease in depressive symptoms after participating in the program.[25] A randomized trial with a similar program was conducted in the United States, which involved older adults volunteering in a local elementary school for 15 hours per week.[26] This program yielded positive outcomes for participants in the intervention group when compared to the control group.[26] Specifically, 4 to 8 months after completing the program, older adults in the intervention group showed significant improvement in physical activity, strength, and cognitive ability.[26] They also reported an increased ability to be able to turn to someone for help, perhaps indicating a decreased sense of social isolation.[26] Furthermore, 80% of the seniors returned to the program the following year, suggesting the program yielded a positive experience for the participants.[26]

While systematic reviews and meta-analyses on the topic of intergenerational housing and programming are limited, one systematic review compared seven studies on intergenerational programs, five of which showed mixed or positive outcomes for older adults.[27] Importantly, Hawkley and colleagues described that loneliness can be alleviated, with one method being through increased socialization.[24]

Benefits to society

Beyond the direct effects of improving the health of older adults, intergenerational programming can lead to beneficial outcomes for society as a whole. For example, programs that paired older adults with youth led to an increased sense of trust and social capital.[28] Additionally, such programming promotes intergenerational ties and leads to an increased sense of community. This may have a cyclical effect that ultimately decreases social isolation. The direct relationship between loneliness and depression is of note as depression costs the Canadian health care system $32.3 billion in GDP annually.[29] Although the financial ramifications of loneliness are not the primary driver for promoting intergenerational programs, the cost is substantial. Vasiliadis and colleagues state that the excess annual adjusted cost of depression in seniors in Canada in 2006 was $27.4 million.[30] As well, the cost of managing chronic depression is estimated to be twice that of hypertension and diabetes combined.[31] With these statistics, we can start to appreciate the worldwide economic impact of tackling geriatric mental health with reduced social isolation and loneliness through intergenerational housing.

The benefits of intergenerational housing also extend to the rest of the population. These include reduced housing costs for students through housing incentives and reduced caregiver burnout as a result of the added support network in intergenerational programming and housing initiatives. The latter is particularly important as the Canadian General Social Survey for Caregiving and Care Receiving found that 34% of caregivers for their grandparents felt worried or distressed about their role and responsibilities as primary caregivers.[32]

There are also beneficial effects for younger generations who participate in such programs. For example, children may benefit from improved academic performance, positive perceptions of the elderly, and enhanced skills related to communication and empathy.[33,34] Additionally, as concluded in a literature review conducted by Park in 2015, intergenerational programming has a positive effect on youth, and demonstrates a reduction in feelings of anxiety and an improved sense of self-worth.[35]

Conclusions

Intergenerational housing models should be further explored as a way of addressing older adults’ concerns about housing and social isolation in BC and Canada. Existing intergenerational programs benefit seniors through improved self-rated health scores, physical function, and cognition. Additionally, such programs have positive impacts on society at large, fostering a sense of community, improving intergenerational ties, cultivating economic gain, and increasing social capital.

Competing interests

None declared.

This article has been peer reviewed.

Ms Suleman and Mr Bhatia are fourth-year students in the Faculty of Medicine at the University of British Columbia.