Improving social connections in older adults through EMBOLDEN: A Community-Based, Co-Designed Lifestyle Intervention

Background: Social connections are fundamental to human well-being across the lifespan, and especially crucial as we get older. Nearly 1 in 5 adults over 65 in Canada report social isolation or loneliness and nearly 50% of adults over age 60 are at risk. Social isolation and loneliness are associated with an increased risk of depression, anxiety, disability and frailty. Older adults want to maintain their independence and age in place, yet many face barriers to accessing supportive healthy lifestyle programs to connect with others and optimize health.

 

Approach: We partnered with older adults living in neighbourhoods with health inequities and community-based service providers to co-design an integrated community-based program aimed at improving mobility, health, and social connections and addressing service access barriers. This process resulted in EMBOLDEN (Enhance physical and community MoBility in OLDEr adults with health inequities using commuNity co-design), a 12-week, multicomponent, community-based primary prevention intervention. EMBOLDEN incorporates physical activity, healthy eating, social participation, and system navigation, and is jointly delivered through intersectoral collaborations.

 

We conducted a mixed-methods randomized controlled trial of the EMBOLDEN program in ten neighbourhoods across Hamilton and Toronto, Canada, compared to usual care (n=324). Social network data were captured for intervention group participants through a digital tool called GENIE® at the start (T1), middle (T2), and end (T3) of the 12-week program. GENIE® captured the number of people in a participant’s network at each timepoint, classified by relationship type: family, friends, and community/hobby groups.

 

Frequency of contact was scored by multiplying interaction frequency (ranging from 1 = less than once a month to 4 = daily) by the subjective value of each member’s relationship [1 (lowest/loose ties) – 3 (highest/close ties)] and summing over all network members. Intervention participants (n= 161) received up to three 1:1 sessions with a system navigator who used GENIE® to track changes in their social network size and help them connect with community supports aligned with their interests.

 

Results: Most intervention group participants engaged in the system navigation component (n=143); GENIE® data showed statistically significant increases in both the size of their social networks and the frequency of contact with network members over time (p ≤ 0.05).

On average, network size increased by 36% (mean # of members: T1=6.4, T2=7.7, T3=8.7) representing an average growth of >2 people. Frequency of contacts increased by 34% (mean contact frequency: T1=29.6, T2=36.1, T3=39.7). The growth in network size occurred in members with looser ties to the participant (primarily friends and community groups), with statistically significant increases over time (p ≤ 0.05). Older adults reported making a new friend, meeting up with others from the group, and connecting with a variety of community programs to continue to engage with local supports beyond the program.

 

Implications: A community-based, co-designed lifestyle intervention can enhance social connections in older adults living in neighbourhoods with health inequities. These findings underscore the potential of participatory, equity-focused, community-based programs to enhance social well-being and reduce isolation among older adults — outcomes that are increasingly critical in aging populations.