Episode 60: The Social Science of Living Alone with Dr. Jun Chu

12:05AM Sep 28, 2024

Speakers:

Dr. Ian Anson

Campus Connections

Jean Kim

Dr. Jun Chu

Keywords:

living

umbc

people

research

services

loneliness

expenditure

home

chu

access

great

health

anson

campus

hard

study

rural area

health services

students

hear

Hello and welcome to Retrieving the Social Sciences, a production of the Center for Social Science Scholarship. I'm your host, Ian Anson, Associate Professor of Political Science here at UMBC.

On today's show, as always, we'll be hearing from UMBC faculty, students, visiting, speakers and community partners about the social science research they've been performing in recent times. Qualitative, quantitative, applied, empirical, normative. On Retrieving the Social Sciences we bring the best of UMBC's social science community to you.

It's September here at UMBC, and the campus is alive with excitement and fun as students cross the quads with their backpacks full of notes and reading. You know, I recall that same sense of excitement when arriving at UNC's campus a decade and a half ago, totally bewildered by and eager for all the possibilities. I lived on campus, so this feeling was 24/7. And you know, one thing that more modern college students may not be able to comprehend is that my first year dorm had no air conditioning. Yeah, you can imagine how much more intense all the feelings were when accompanied by the heat and humidity of late August in North Carolina. But another feature of living in the first year dorms was that I was randomly assigned a roommate. My roommate, whose name I won't disclose, was a total stranger to me in the first year, though, we got to know each other well over the time we spent living together. He ended up going to medical school and is now a practicing physician. So I like to think that there were some good vibes emanating from that oven-like dorm room after all, in this case, UNC forced us to live together, which ended up being great for both of us. But I wonder what it would have been like if, instead of the camaraderie of my hardworking roommate, I had sweated it out in my first year dorm room, alone. Living alone is a relatively common phenomenon that bears some very important social consequences. To unpack the process of aging while living alone, I'm delighted to welcome Dr. Jun Chu to the podcast. Dr Chu is an Assistant Professor of Public Health in the Department of Sociology, Anthropology and Public Health here at UMBC. Jun conducts research in the intersection of health policy and immigrants in the United States. His other research interests include patients and caregivers of Alzheimer's disease and related dementia, access and utilization of primary care services in the US, and quantitative research methods. Let's hear what Dr. Chu has to say about the social science of living alone, right now.

So today I am delighted to welcome to the program, Dr. Jun Chu, who is here to tell us a little bit about the social science of living alone as an aging adult. And I got to say, Dr. Chu, I'm really interested in this topic. I think many of our listeners are going to be super interested in this, especially because we've done some episodes in the past on some of the difficulties and the complexities of aging. But I wanted to ask you, first of all, just what are some of these challenges associated with living alone as an aging adult? And, you know, I can imagine that there's probably some challenges associated with, like, you know, if you've got, like, a really heavy sofa that you got to move, you got to find somebody to do it, or, like, if you've got a bunch of laundry, but obviously this, there's a lot more to it. So again, thanks for being on the program and tell us about this lifestyle.

Sure you can just call me Jun. Thanks so much for having me. So that's a great question. So living alone we think of like a grandma/grandpa living in their own retirement home. That's not really living alone in the sense that somebody's truly living alone. Living alone is really like you're seeing your next door neighbor has nobody to visit, has no one to come to their house ever, he or she going in and out her house. And it's getting like you can see the sadness and this and that. You're 100% correct, the physical movement of things, or labor intensive jobs such as doing laundry, fixing a car, cutting trees, that can be a major burden. However, when we tend to think of living alone, they probably had a system figured out. Because not that's not their first day living alone. What is really becoming difficult is when they become sick. Even when they become sick, they also have a system. Oh, maybe the neighbor will come to take care of them. Maybe someone else is coming there, but for the most part, unless the person is going through trouble, or, you know, bailed out, or on the other side is the getting sick part, uh, living alone has been a life choice of a lot of individuals for years. But you're but you're correct physical and I think in addition to that, is the getting sick part.

Yeah, that's a really interesting observation that you're right, that people aren't just, you know, becoming very old and living alone kind of suddenly, right? They're developing these kind of long term patterns of of lifestyle choices that allow them to kind of get by. I think that's a really interesting thing. So, so how is it that people get into this situation though? Is this something that will just kind of coalesce and again, I also want to ask you more about this idea that they really don't have anybody. Is that really the case for most of these people, or is it like they maybe have somebody visit them occasionally? I mean, this seems like a pretty, pretty hard lifestyle.

For sure. You know, in this country, right, we tend to think that a family is with a dad and a mom. Maybe nowadays is more moderate, bit more different, but in a sense, there should be some adults then to have a family that's complete to be viewed as normal. I really forgive me for saying that viewed as normal, you need to have children, perhaps a dog, a pickup truck and a lawn mower. Like there is some stereotypical family component that you must have. Earlier days, I would say living alone as a choice, people would view the person as strange, weird, exquisite. A lot of, I would say, a lot of negative connotation goes with the term living alone. And in addition to that, when you think of living alone you think of lots of cats. Sorry, right. We think of the cat lady with like six cats. But it's not a new thing. People choose to live alone because they are satisfied from elsewhere. They are happy living alone. They have other ways to engage themselves into the situation. It's not a new concept in Europe and in Japan, but I would say there a couple categories. One is people choose to live alone since they are in their 20s and 30s, then they carry down this tradition until much later. But there are people who fall into the situation of living alone. They had to live alone. Spouse passed away, spouse walked out, divorced, single parent, their children moved away, or had a fall out with their kids, or the kids got kicked out, right? We have different kinds of living alone situations. So the idea of calling someone living alone weird and strange, that is, I think, in my opinion, slowly fading. We are accepting the idea of living alone. And truth be told, the ones who were long time living alone residents, they had a system figured out. If they ever need a couch to be removed, they call the couch removal guy. They always have a guy, right? I think Kramer always said "I have a guy" right? It's literally they have a guy. They have a guy for everything, but for the ones who fall into the situation, it's really hard, because they used to able to rely on this one person, but this person is no longer there, and it become an emotional burden, in addition to physical burden of dealing with the situation.

So this idea that some people are maybe voluntarily choosing this lifestyle, and maybe have been doing that for a very long time, that's super interesting, and especially with these kind of country context comparisons, where this is just more normal in some sort of places and cases. But then there's other people who are not choosing that lifestyle. I think that's definitely something where, you know, I think about the potential challenges there, as you've mentioned. So I'm interested in, especially this link that you've brought up here about access to medical service. What happens when people who are living alone might get sick or might experience some kind of, you know, something that happens to them that makes it more difficult for them to get along? What's the story there? Are they able to access these medical and sort of mental health services? And what happens if they maybe face challenges there?

It's like a city of two tales, like the ones who are long time residents or long time living aloners. I hate to use the term, but it's really at least for older individuals, because they have so good of a system around them. Maybe as a neighbor, maybe as someone else, living alone is no longer an issue for them to access medical care systems, including both physical and mental and, you know, interesting Ian, people who choose to live alone, right? Literature has been showing that they are more educated. They are, on average, making a bit more money. The gap is not huge, but just a bit more money. They had some type of stable, long term jobs, and for the most part, they own their residence, so a good support system, since they were in their younger years, they can rely on it. Although their friends die, they replace it with other services. In studies, we've seen that people who live alone tend to use a lot of home health services, both the ones who paid for by insurance that comes to your house to check up on you, give you medication, if you need other services, such as E-home dialysis, such as IV, such as the E-home chemotherapy, they will call on those people and say, hey, you know I need to, I need you to come home. I need to come to my house and do this for me, instead of dragging your spouse to drive there to get that thing done. But they also use non insurance paid services such as house cleaning. They call them homemaking services. They are part of health services because they can, if the person is really frail, they could get bathed, they can get dressed. The person will actually take you to a park and walk. The home health aides will actually go, take go to the grocery store and shop with you. That kind of interests me in a way that, I guess living alone is no longer issue. Then, why so hung up about this idea of living alone? Shouldn't we think of some other situations, such as feeling lonely? Is it loneliness that's driving people not be able to get out of bed, although you have a spouse, then being married for 30,40, years? Is it because of the spousal dispute or this distance between you and the children that's making you feel sad and not able to go. So we are slowly, I mean, there's a lot of literatures coming out of different camps, sociology and public health are showing that, yeah, like loneliness is the key. Living alone, it's a life choice. And that being said, the focus are slowly shifting towards living alone. With the study we recently done with Dr Christine Mair, Takashi Yamashita and another colleague in College Park, we've seen that living alone really isn't a key driver for increased expenditure or increased intensive services, such as hospitalization, emergency room. It's really other things. It's really feeling sad that's driving up the cost. It's really feeling really depressed that's making people go to the emergency room a whole lot. So I hope that answered the question.

No, absolutely. And I think this is super interesting to think about the kind of range of services that people are accessing. And I kind of wonder, I mean, I don't use these services, right? But it's kind of like this invisible economy, in a way, like, you don't realize that, you know, every day there's all these kind of, like, little trucks showing up here and there to people's houses and kind of providing some of these services, you know, partially, like, you know, I'm at work a lot, and so I don't see that kind of thing, like in my neighborhood. Is there a strong availability of that? I mean, is, I mean, are people able to access this on a regular basis? And I mean, are there places in context in which is hard to sort of get some of those services?

That's such a good question, Ian. Like, say, we are not long time residents who live alone. We probably don't know enough about those services until we have to find one. We never knew who to call if the pipe burst, until it really burst, we have to call plumber in a hurry. And no, we don't know. We can only rely on Angie's list or Yelp. There is really no Angie's list or Yelp type of review system for that. So for the people who suddenly need a service like a home health services, they rely on the word of mouth. Hey, you remember your grandma who had a nurse that come to the house? What's the company's name? In addition to that, your doctor, like for the geriatric physicians who are somehow connected with all the services, perhaps it's because of the promotion from the office coming in, buying lunches. Hey, you know, we are a home health services. You can tell your patients about it if they ever need it, or is the type of deal that the doctor may own a home health service themselves. We don't know enough about it, so we couldn't say anything about it. But the availability is so low. Unless you watches, like we watch daytime TV. The stuff on daytime TV is fascinating, by the way, Life Alert with a little device you wear around your neck. Oh, hurry, I fall. I can get up. That, I wasn't I don't know where to get one until I watched daytime TV. So there's a dedicated market towards older adults in America, such as daytime TV, maybe radio. I think you brought up a really interesting point is availability or accessibility across geographic regions. 100% correct that in the urban environment, it's easier for patients to ac ... it's easier for patients to access in the suburban type of area, simply because, well, the home nurse actually lives in the suburbs too. They don't all live in the city. And when we when we think of New York or Philly or Baltimore, you think of the downtown and there's sure they're old people, but they don't retire in the downtown area. So there is this two ends of the spectrum, where the city and the rural area are seriously lacking enough home health. I think different reasons for the urban area it's really because there are too many older people that need services, not enough workers. For the rural area, I had a classmate when we were in school together, she owns a home health services and I ask her, do you do like rural area? She's like, Oh heck no, I'm not doing that. I was like, So how come? She said, It's too far, too far for my workers to get there. Nobody's compensating on gas. People are not as nice as they're in the suburbs when we go to the rural area. So really hard to fix that issue of the accessibility. Can you tell people to move to a different area? There's a cost to that, but at the same time, I want to age in my home, right? Like I didn't go to a nursing home, because I want to age in my home.

Yeah, that's that's fascinating. And just to think about, you know, some people are getting more accessibility to these things. Other people are getting less accessibility. But I mean, what you're you're telling me, and from this research that you're talking about, it seems like, really what's happening, especially for the people that are having a hard time accessing these services, is loneliness might be setting in in those contexts. And so tell me a bit about this psychology of loneliness and how it might affect health outcomes and what some of the findings are from the study and if you wouldn't mind, also just telling me a bit about how you did the study as well. Because obviously, with a story about social sciences and a podcast where we want to focus on these things, I'd love to know some of the methods behind the research that you've done on this, this issue of loneliness.

Sure, Ian, yeah, thanks so much for this platform that I get to talk about things excites me, but kind of bores other people.

It's not, not here. My listeners are sure, very interested to know the details

I know. Like the minute I tell my wife, Oh, I did this! She's like, Oh, huh, great. Did you take out the garbage?

But for the most part, I'm a huge fan of national surveys, because somebody that's way smarter than me thought of the idea to interview hundreds of thousands of people about certain questions. So colleagues and I, we use the data from the Medical Expenditure Panel Survey that is done by the Agency of Healthcare Quality and Research, AHRQ or AHRQ. It's a national level survey. It's a sub survey of the National Health Interview Survey. Every year, they get roughly about 30,000 people from not the street, really. They sample those people, and then they ask detailed questions about their family as well, including yourself and your family that lives in your house, so per household, a bunch of health questions and basic demographics, socio demographic, income.. Then, I think what the survey is cool is they go a step further. Not only they ask who you are, they go find out who your bosses are, to go to your boss and check your employment history and your insurance status. Then they go to your doctors. They interview your doctors too. They get your diagnostic code, they make sure that you don't lie about your health, and they put them together. And you can almost study anything related health. Their data is from 2000 and like 19 something all the way to 1990 something, all the way to 2023. Albeit covid kind of messed up the 2020, but still great data set. We had to exclude covid period just because we were looking at living alone and having this psychological distress. So we basically, among older adults, you tend to feel anxious, you tend to feel sad, all of a sudden, you have this panic attack. Initially, our hypothesis was, well, overall, we know that the ones who are more likely to be depressed are going to spend more money because, well, they might have to go to the hospital all of a sudden because they feel sad, or they may have to go to the emergency room because they're having a panic attack. Maybe living alone can drive up the cost too, because they live alone and they're more likely to use services that's catered to the people who live alone, such as home health, such as more prescription services. As we documented elsewhere, that home health and prescriptions are number one and number two, ways to combat depression among older people. What we thought was quite interesting. So we use two parts model. Instead of just looking at the expenditure alone, there's a lot of people having no expenditures. We have to use a different kind of model to figure out the likelihood of having a expenditure, to figure out the overall expenditure. We did that for utilization and with healthcare utilization services, such as, how many times did you go to the emergency room? How many times you went to the hospital, how many nights you spent in the hospital, how many times you filled your prescription, how many times you did your home health and so so on and so forth. What's really interesting is, yes, it is 100% true that the ones who are having a psychological distress, feeling sad, not happy, always depressed. Their expenditure overall, it's about $2,000 more than the older adults that say I don't feel anything. I feel pretty happy. That agreement with previous literature. But what was interesting is just living alone factor, you're not driving up the cost in any categories. This is kind of bugged our mind. We understand perhaps living alone people are healthier. You don't have to go to the hospital as much, therefore their hospital expenditure is just as much as the ones who don't live alone, but home health, the ones that was catered to people living alone, for the most part, they are the higher user of it and prescription that didn't go as high as we thought, or it was not significant enough to make any notice. We had a couple theories on it. Number one, living alone does not equal to feeling lonely. Does not feeling having nobody around them. They have a good support system. And counter to that point, living with somebody doesn't mean you're not alonely. Does not mean some the people in their household cares about you. It's possible also that you can also say, well, you don't want to bother people in the house, right? Like, oh, it's my son's wife, I don't feel good about bothering her, taking me the doctor's office. So we say that living alone itself, it might not be the issue that we should solve. We hear a lot of, oh, community engagement. Get people out of the door, go to the park, do this and that. How about get them out of the door and ask, hey, how you do it? Like, how, how are things going with you? The second thing we kind of speculated is that when giving care to the ones who are psychologically depressed, it's really hard to figure out, should we treat your mental illness first, or should we take up your physical illness first? Therefore, without coordinated care. it's really hard to combat the real issue, which is, are you really sick or do you feel lonely? What we said in the paper, we recommended, is really good care coordination between physicians, between doctors, to say to each other, Hey, you, you gotta talk to each other. You gotta talk about your care plan, how to figure that out, and those people will come in. They're not crazy, they're depressed, they're lonely. Maybe don't give them antidepressants, send them home, like have your nurse talk to the person, figure it out. Maybe they don't have to come to the hospital, stay overnight, spend 1000s of dollars on it. Medicare have to be overburdened by that. So that being said, the study is really easy to get into. The data is free, publicly available. 100% you can download from internet. Software, yeah, there might be a little learning curve, but I can help you. We can help you. We're researchers. That's what we do, and then the results are fascinating.

Yeah, I think that this is such a an important thing for all of us to reflect on, because I think in terms of the takeaways that you're getting from this study, I'm really kind of floored just thinking about the idea that loneliness is not necessarily about being alone, and that we should all be thinking about people around us, either in a context where they do have other people that are living in their house sort of nominatively, or people that are living by themselves. And, yeah, I think you're right, right? I mean, this is not just healthcare providers that this is kind of a call to action here. This is a call to all of us to think about checking in on people that we care about, right, and just trying to understand this nexus. But, I mean, the fact that you're able to show these kinds of things in data, and if they tell us a story, maybe an underappreciated story, about living alone and about loneliness, is something that I think makes this research relevant for everyone. So yeah, this is such a cool study, I'm so glad that you're able to tell us about it before we let you go. I have one question that I always like to ask, and that is to tell us if you have any words of advice for student listeners who might be, you know, hearing this narrative and getting really excited the way that I got excited about the study and saying, you know, one day I want to do social science research like this, and I want to contribute to answers about this kind of subject. What are some, some words of advice you might give to students for this?

For sure. Ian, I mean, I think we are here because we are curious about something. Like things that pique your interest, pique my interest, may not pique other people's interest. I mean, I I tend not to think of that. I tend to think that this thing is interesting to me, and if at least three more person agrees with me that this is interesting, that I think is worthy of doing some research. Because a lot of times we have a lot of naysayers in today's, ah, it's not that great. Oh, I think it's hogwash. Oh, I think this is horrible. Well, I think it's cool. Like, don't get discouraged. That that's number one. Number 2, eat broccoli. I'm just kidding, that doesn't matter. I mean eat your greens! But I think find a topic that is going to make you wanting to get out your bed in the morning. There is this very cheesy line that set by Iron Man during one of the movies to Spider Man was like, what was that thing that make you want to get out of your bed in the morning? Like I asked myselall the time, like, what is that? Is this topic is going to be make me want to stay up late and look into it? If this topic going to make me want to argue with people about the importance of it? Is this topic that I'm willing to sacrifice my time and efforts to go to Congress and to talk about it in front of a bunch of senators. I think without that, it's just a job. I think without the research, without the interest, it's just another job. When I was doing grad school, I see myself no different from a blacksmith, a chef, a carpenter, right? We're learning this trade of research instead of molting hot steel into a blade or cooking this delicious Chicken Tikka Masala, i can think of, sorry. We are creating our, we're honing our craft with our advisors. We are learning how this art of research is being done, but we are adding our twist into it. So I would say in one sentence, it's. Stay curious and stay hungry. That's all I can say.

Well, I'm definitely hungry for some chicken masala now that you mentioned it, and broccoli, of course. But I think those are, those are really valuable insights for students. And you know, I'll just say, say briefly that, you know, when I was in graduate school, I read, you know, Max Weber, and I learned, you know, that politics, according to him, is the hard drilling of hard boards. And I remember thinking about it, I was like, you know, political science is kind of the hard drilling of hard boards, in a way too. So your idea about this being sort of a craft and a trade that you're learning is such an important mindset, because it is really about honing those tools and becoming more proficient over time, and kind of loving the craft, and then, yeah, I really love this and I'm going to leave us with this thought that talking to at least three people about your research idea and have them get excited about it, I think that is one of the most interesting and one of the best things that I could imagine doing when you're starting a research project. That's great advice. I'm going to do that from now on. I'm going to try to find three people to talk to, and listeners, I really hope that you also find three people to talk to about this podcast, because we'll be able to reach more, more of an audience in the near future, and we will hear more wonderful stories about fantastic research being performed by researchers at UMBC. Dr. Jun Chu, thank you so much for coming on the podcast, and thank you so much for sharing this research with us, and I wish you all the best as you continue this research enterprise.

Thank you. Ian,

Now it's time for Campus Connections, the part of the podcast that connects today's featured content to other work happening at UMBC. And with the return of the fall semester, I am delighted to welcome our production assistant Jean back to the program to tell us more about the research happening at UMBC. Welcome back, Jean. How was your summer?

Campus Connections. Campus Connections. Campus Connections.

Hey, Dr, Anson, I had a great summer. Thank you so much for asking. I'm really excited for the upcoming school year getting back on campus and, of course, being back on the podcast. So for today's Campus Connection, I wanted to highlight a recently published article from the research on social conditions and health equity lab within UMBC's Center for Health Equity and Aging. After hearing Dr. Anson and Dr. Chu discuss healthcare access equity earlier, I thought it would be a great opportunity to showcase some of the new research coming out of Roche lab. The new lab uses both epidemiologic and qualitative research methods to better understand the health and experiences of marginalized populations aiming for more equitable health services and policies. Their latest article "The Health Status of Undocumented Immigrants from Asian Countries in the United States: a Scoping Review and Recommendations for Future Directions," addresses an important but often overlooked topic. Even though immigrants from Asian countries represent the fastest growing undocumented population in the US, increasing by 47% between 2008 and 2021 there is still limited research on their health. The article reviews literature published between 2010 and 2024 highlighting the need for more comprehensive and robust studies on this population. One aspect of the article that I thought really tied into today's discussion was how many undocumented Asian immigrants become undocumented by overstaying visas, such as student or work visas, unlike other undocumented populations who may have lacked legal status from the start. So while this may offer undocumented Asian immigrants some protections due to higher socioeconomic status, you can also leave them without strong local support networks. As a result, they often face negative health outcomes due to fragmented transnational ties, loss of health insurance, and reduced access to healthcare, employment, and educational opportunities. Similarly to living alone and this concept of loneliness, support networks are essential to every individual's well being. Addressing these needs through targeted research and policy interventions can help promote better health outcomes and foster resilience within vulnerable populations. And that's it for today's Campus Connection. Back to you. Dr Anson.

Thanks as always, Jean, for your thoughtful contributions to our program. And thanks to you for listening, whether you're doing so alone in your own place, or whether you're trying to hear us over the noise of a bunch of friends or relatives who are packed like sardines in your house or apartment. As always, keep questioning.

Retrieving the Social Sciences is a production of the UMBC Center for Social Science Scholarship. Our acting director is Dr. Eric Stokan and our undergraduate production assistant is Jean Kim. Our theme music was composed and recorded by D'Juan Moreland of the UMBC class of 2024. Find out more about CS3 at socialscience.umbc.edu. And make sure to follow us on Twitter, Facebook, Instagram and YouTube, where you can find full video recordings of recent CS3 sponsored events. Until next time, keep questioning.

you.