Understanding Functionality as a Component of Social Isolation Among Older Adults

The purpose of this dissertation was to: (1) ascertain the dimensions of physical functional impairments of older adults as a component of social isolation, (2) develop and conduct a confirmatory factor analysis of an ad-hoc scale to measure the multi-dimensional nature of physical functional impairments, and (3) perform a second-order confirmatory factor analysis to validate the scale, testing social isolation as a higher-order factor. A systematic literature review was completed that identified physical functional impairments as a core component of social isolation. The proof-of-concept was established with two secondary analyses of the 2021 National Survey of Older Americans Act Participants. One study used confirmatory factor analysis (CFA) to validate sub-dimensions of physical functional impairment in social isolation using the PFI-SI-34 (ad-hoc) scale. A second study applied second-order CFA, confirming social isolation as a higher-order factor unifying these sub-dimensions.

Findings from a literature review of the literature showed an emerging pattern of themes to describe physical functional impairments: (1) Perceived isolation - self-perceived isolation based on subjective experiences of loneliness; (2) Communication barriers - the inability to communicate and receive information; (3) Daily living capacities - an older person’s inability to manage functional abilities; and (4) Structural barriers - policies, infrastructure, and societal norms that disproportionately impact older adults by ignoring their unique needs.

Results of the first quantitative study provided substantial evidence of the proof-of-concept of the multi-dimensionality of the PFI-SI-34 (ad-hoc) scale. This means that physical functional impairments of older adults are multi-dimensional, reinforcing evidence to develop a future scale to measure individuals vulnerable to being socially isolated. The proof-of-concept provides a structured approach to validate the concept and identify potential issues in measuring physical functional impairments associated with social isolation.

Results of the second quantitative study revealed that social isolation in older adults is a multi-dimensional construct best measured through a hierarchical model factor influencing sub-dimensions of physical functional impairments. The findings provide a nuanced framework for assessing and addressing social isolation, emphasizing the need for comprehensive measurement tools to guide targeted interventions.