Updated: Aug 27, 2019
What's Uber got to do with healthcare, hearing and your ears? Good question!
Too long has healthcare in Western societies focused on incumbent and siloed systems to help those who need it. Like the taxi industry, healthcare was/is tunnelled visioned!
Uber didn't disrupt the taxi industry, taxi's still exist, they still charge the same amount and you still can't easily order one. What Uber did was create a niche within catching a ride, utilising technologies.
Conversations, Communities & Ageing.
How does Uber create conversations? As an audiologist one of my key areas of interest (and concerns) for individuals with hearing loss is community connections. This is extremely relevant and important for quality of life and care.
At the superficial level your Uber rating depends on it. Would you feel comfortable getting into an Uber with a driver who has a 2.5/5 or 3/5 star rating? I would certainly question it. At the least, saying hello and asking how you are is a good start. It doesn't necessarily lead to riveting conversations, sure you might sit in silence for the rest of the trip, but it's a polite way to start the journey.
If you are like me and you feel there is room for a conversation, you strike one up. I realise this comes more naturally to some, however there is an opportunity for you to move out of your comfort zone and start a conversation should you feel the need. Conversations with perfect strangers (with 4.5/5 Uber ratings) can lead you down an interesting thought path. Here are 2 conversations I had recently with my Uber drivers that have got me thinking about social isolation, depression and if we are doing enough to combat these.
Part I: Communities & conversations.
I was in an Uber on my way to the airport for an outreach work trip. I asked my Uber driver, what do you think makes a good community and how do we create one in Western societies? We came to this question as we both discussed the usual questions, where are you travelling to, why, what do you do etc.
This Uber driver was born and raised in a remote village in Kenya. He had moved out to pursue his studies in psychology and during the day (9-5 job) he works as a family psychologist. His context of community was different to mine and it made me feel upset to hear how isolated we (Western society) really are.
He told me the village he was from, most people didn't have much. They lived in huts, had limited material possessions, limited to no wifi coverage and it was rare for many people to stick in a 9-5 job. He said whist this may sound dire, he felt and observed that they were happier than the people he had met in Western Australia and through his travels with his family across Australia.
He felt his village had less mental health concerns and loneliness was not a real issue there. He felt there was a true sense of community and that's what WA lacked.
How and why I asked? He said people were happy to live off the land, share what they had and talk to each other. If someone didn't have something, for example a rice pot, others would be willing to share. He said that people were willing to talk and be heard. He said that people really listened and checked in on you when they thought you needed it and would make the effort to catch up with you. He said there isn't much loneliness in this village and he reported most of his family and friends who still lived there, were happy. He described a village that valued human connections, conversations and spending time with each other. He contrasted this with an example of his time in Esperance, Western Australia.
When we first moved to WA we felt a rural setting would provide a sense of community and help with the transition from Kenya to Australia. He was really upset to find that this wasn't the case. His family had attempted a few local BBQs where they invited their neighbours, pinned posters up at the school library and invited their neighbours over for lunches, dinners and weekend play time who had similar aged kids. Every invite was met with a 'no', even with months of planning in advance. "We finally got the message. No one wanted to see us or hang out with our family. We started to feel... lonely."
It was an interesting realisation and sad to hear out loud. "We started to feel... lonely." He understood there are cultural differences that come into effect here; generally speaking Australian culture is individualistic, compared with Aboriginal or Kenyan culture who portray a community or collectivist culture.
Being a psychologist he was well versed with individuals switching between cultural frames depending on the context, however he didn't realise it was going to be so obvious, without any room for a mixture between each culture. His family moved up to Perth, WA as they wanted to feel part of and contribute to the community.
The community question really resonated with me. How have we drifted from our core foundations as humans (connect, nurture, learn and progress)? How have Western societies created such a contrast between cultures? How have we gotten to a stage where we think the normal for community involvement requires maximum effort with minimal return? Have we become a lazier society when it comes to creating true community connections?
This area is concerning to me, not only as a healthcare professional, but also to my immediate family and friends with ageing parents. There is mounting evidence to show that the greatest modifiable risk to cognitive decline is social activity and inclusion (read about it here and here). "By the way," I asked him, "Why have you chosen to drive for Uber?", he responded so he could have conversations with people outside his family and work space should the need arise. And to earn some extra cash.
Part II: Ageing.
On my return from this trip similar questions were raised by my next Uber driver. Where did you fly in from, what do you do etc. When I told him I was away for audiological work he immediately thought I worked with the elderly. I asked if he could give me an age range and he said "yeah you know, 80 year olds or the miners up north", on other occasions he may have been correct.
We got onto the subject of family care and aged care homes in Perth. He was surprised to learn from some of his peers that ".. we put old people into facilities and no one visits them... Not until they are really sick or about to pass away." I was a bit affronted by this comment, but could empathise with it.
My mum was a clinical nurse specialising in aged care and my father a doctor, so as a child who frequented these residents after school and later working in them, the smell and noises of these places didn't bother me. What did bother me was the loneliness and isolation.
My mother always said please never place me in a nursing home (aside note: my mother is a fit 60 something year old who is actively involved in communities such as travelling, exercising, a walking group and taking care of her grandchildren). When we as a family discuss the ageing process and the realities that come with it, the reality that a nursing home or aged care facility is on the horizon for my mother is very low.
When we both worked in aged care, we witnessed loneliness and depression on a mass scale. I can distinctly remember certain residents and their change in behaviours over a 3 to 6 month period. Despite the gallant efforts of the staff members, the limited resources and time meant that socialisation was not a priority.
I digress from my Uber conversation. The point he raised was this, in his home town it was the responsibility of the immediate family and community to care for and support the ageing family members. It made me think about "healthy ageing across your lifespan", which is a motto that really resonates with me.
Are we, Western cultures, equipped to empower our ageing populations to stay socially engaged and active, even if circumstances dictate that some care may need to be provided? Whose responsibility is it to ensure Healthy Ageing happens? Are there better ways we can reduce loneliness and social isolation without compromising on the quality of care that may need to be delivered concurrently, for healthy ageing to occur?
What really struck a cord in me was they way he found it strange how we treated our elderly. I think we have some valuable lessons to learn from other cultures that need to be blended into ours.
I don't think there is a concrete, text book answer out there for healthy ageing across the life span, for tackling social isolation, loneliness and depression in aged care. Everyones definition and expectations of Healthy Ageing will also differ, especially as Healthy Ageing comes in different forms to different people across a variety of ages and cultures. However, I Feel we can put ourselves in better ageing positions.
What I can comment on from what I have observed in a clinical and community environment is this; individuals aged over 60 years who are working and/or socially engaged are less likely to show symptoms of loneliness and report better engagement across all aspects of their life (personal, family, relationships, mateships, colleagues and confidence). They have a 'spring in their step' compared to those who are not striving or feel the need to contribute.
I have a diverse age group of friends, which I am proud to say, I have made throughout social activities and social involvement. Not only have i learned a thing or two from my friendship groups, I feel we each support and can call one another up when needed.
Let me wrap this piece up by saying why I think Uber-isation is important to the healthcare industry and systems. If we can't reimagine how Healthy Ageing and healthcare will evolve, if we can't find a cross between Eastern and Western philosophies and cultures, will we change they way we care for and treat our aged/ageing population? I think we need to give people options, like Uber did within the taxi industry, for how to access healthcare and how to support their lifestyle needs and demands. Remember, we are all 'ageing' and the quality of ageing will be different for everyone.
I'd love to hear your thoughts, perspectives and comments on Healthy Ageing and social inclusion as we age?
Hears 2 ears, Kat Penno
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