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Henning-Smith C, Tuttle M, Tanem J, Jantzi K, Kelly E, Florence LC. Social Isolation and Safety Issues among Rural Older Adults Living Alone: Perspectives of Meals on Wheels Programs. J Aging Soc Policy 2024; 36:282-301. [PMID: 35635290 DOI: 10.1080/08959420.2022.2081025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/13/2021] [Indexed: 10/18/2022]
Abstract
Ensuring the safety and social well-being of rural populations, especially rural older adults living alone with complex medical conditions, is challenging, given large, sparsely populated communities and limited resources. Using qualitative data from surveys with 42 rural Meals on Wheels programs from across the U.S., we highlight particular challenges to meeting the social and safety needs of rural older adults living alone. Respondents described challenges, opportunities, and successes in meeting the needs of their clients. We describe these under four domains: main challenges, what can be done to address social isolation and loneliness, safety issues, improving safety, and current successes. We also identify cross-cutting themes related to programs' rural environment (long distances, inclement weather), infrastructure (housing quality, access to broadband Internet and technological connectivity, road conditions), funding and resource availability, and service provision (availability of health care and partner organizations.) We describe each of these in more detail and also share policy recommendations for improving health and safety of older adults living alone in rural areas, including funding nutrition programs as a health benefit and addressing aging, poor-quality housing stock.
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Affiliation(s)
- Carrie Henning-Smith
- Associate Professor, Division of Health Policy and Management, University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, US
| | - Mariana Tuttle
- Research and Communications Fellow, Division of Health Policy and Management, University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, US
| | - Jill Tanem
- Graduate Research Assistant, Division of Health Policy and Management, University of Minnesota Rural Health Research Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, US
| | - Katie Jantzi
- Vice President of Government Affairs, Meals on Wheels America, Arlington, Virginia, US
| | - Erika Kelly
- Chief Membership and Advocacy Officer, Meals on Wheels America, Arlington, Virginia, US
| | - L Carter Florence
- Senior Director, Strategy & Impact, Meals on Wheels America, Arlington, Virginia, US
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Yu K, Wild K, Potempa K, Hampstead BM, Lichtenberg PA, Struble LM, Pruitt P, Alfaro EL, Lindsley J, MacDonald M, Kaye JA, Silbert LC, Dodge HH. The Internet-Based Conversational Engagement Clinical Trial (I-CONECT) in Socially Isolated Adults 75+ Years Old: Randomized Controlled Trial Protocol and COVID-19 Related Study Modifications. Front Digit Health 2021; 3:714813. [PMID: 34713183 PMCID: PMC8521795 DOI: 10.3389/fdgth.2021.714813] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Increasing social interactions through communication technologies could offer a cost-effective prevention approach that slows cognitive decline and delays the onset of Alzheimer's disease. This paper describes the protocol of an active project named "Internet-based conversational engagement clinical trial (I-CONECT)" (ClinicalTrials.gov: NCT02871921). The COVID-19 pandemic related protocol modifications are also addressed in the current paper. Methods: I-CONECT is a multi-site, assessor-blind, randomized controlled behavioral intervention trial (RCT). We aim to randomize 320 socially isolated adults 75+ years old [160 Caucasian and 160 African American participants, 50:50 split between those with normal cognition and mild cognitive impairment (MCI)] recruited from the community to either the video chat intervention group or the control group (1:1 allocation). Those in the video chat group receive a computer and Internet service for the duration of the study, which they use to video chat with study staff for 30 min/day 4×/week for 6 months (high dose), and then 2×/week for an additional 6 months (maintenance dose). Both video chat and control groups have a brief (about 10 min) telephone check-in with study staff once per week. The primary outcome is the change in global cognitive function measured by Montreal Cognitive Assessment (MoCA) from baseline to 6 months. Secondary outcomes include changes in cognition in memory and executive function domains, emotional well-being measured by NIH Toolbox emotional battery, and daily functional abilities assessed with the Revised Observed Tasks of Daily Living (OTDL-R). Eligible participants have MRIs at baseline and 6 months. Participants contribute saliva for genetic testing (optional consent), and all video chats, weekly check-in calls and neuropsychological assessment sessions are recorded for speech and language analysis. The pandemic halted research activities and resulted in protocol modifications, including replacing in-person assessment with remote assessment, remote deployment of study equipment, and revised targeted sample size. Discussion: This trial provides user-friendly hardware for the conversational-based intervention that can be easily provided at participants' homes. The trial aspires to use age and culture-specific conversational materials and a related platform developed in this trial for enhancing cognitive reserve and improving cognitive function.
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Affiliation(s)
- Kexin Yu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States
| | - Katherine Wild
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Kathleen Potempa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Benjamin M. Hampstead
- Mental Health Service, Veterans Affairs Medical Center Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Research Program on Cognition and Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Peter A. Lichtenberg
- The Institute of Gerontology, Wayne State University, Detroit, MI, United States
| | - Laura M. Struble
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Patrick Pruitt
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- The Institute of Gerontology, Wayne State University, Detroit, MI, United States
| | - Elena L. Alfaro
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Jacob Lindsley
- The School of Psychological Science, Oregon State University, Corvallis, OR, United States
| | | | - Jeffrey A. Kaye
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Lisa C. Silbert
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Hiroko H. Dodge
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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Scott J, Fidler G, Monk D, Flynn D, Heavey E. Exploring the potential for social prescribing in pre-hospital emergency and urgent care: A qualitative study. Health Soc Care Community 2021; 29:654-663. [PMID: 33704851 DOI: 10.1111/hsc.13337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/22/2021] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
There is a sustained increase in demand for emergency and urgent care services in England. The NHS Long Term Plan aims to reduce the burden on emergency hospital services through changing how pre-hospital care operates, including increased delivery of urgent care. Given the recognised potential of social prescribing to address wider determinants of health and reduce costs in other settings, this study aimed to understand the role that social prescribing can play in pre-hospital emergency and urgent care from the perspectives of staff. Semi-structured interviews (n = 15) and a focus group (n = 3) were conducted with clinical staff (n = 14) and non-clinical health advisors (n = 4) from an English Ambulance Service covering emergency (999) and non-emergency (111) calls. Data were analysed using a pre-defined framework: awareness of social prescribing; potential cohorts suitable for social prescribing; and determinants of social prescribing. Awareness and knowledge of social prescribing was limited, though when social prescribing was explained to participants they almost universally recognised its benefits for their role. Social prescribing was considered to be most beneficial to those calling for reasons relating to mental health, loneliness or social isolation, in particular older people and frequent users of 999 and 111 services. Determinants of social prescribing were identified across the micro (patient and staff acceptability of social prescribing), meso (triage and referral pathways) and macro (commissioning and funding) levels of analysis. This is the first empirical study to explore social prescribing in pre-hospital emergency and urgent care services, which suggests that it has potential to improve quality of care at the point of people accessing these services. There is a pressing need to address the micro, macro and meso level determinants identified within this study, in order to support staff within pre-hospital emergency and urgent care services to socially prescribe.
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Affiliation(s)
- Jason Scott
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Gayle Fidler
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daniel Monk
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Darren Flynn
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Emily Heavey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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Mountain G, Gossage-Worrall R, Cattan M, Bowling A. Only available to a selected few? Is it feasible to rely on a volunteer workforce for complex intervention delivery? Health Soc Care Community 2017; 25:177-184. [PMID: 26445894 DOI: 10.1111/hsc.12285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 06/05/2023]
Abstract
This paper recounts the process of undertaking a randomised controlled trial which was designed to examine the effectiveness of an intervention for socially isolated older people aged 75 years and over. It describes the reasons for early cessation of the study and raises the implications of this outcome for policy, practice and research. The intervention under investigation was designed to alleviate loneliness and foster companionship. It involves participants being linked with a small group of others through a teleconferencing system with each group being facilitated by trained volunteers. There was a requirement to recruit and train a minimum of 30 and a maximum of 60 volunteers over 1 year to facilitate 20 friendship groups to meet the number of older people required to be recruited to the study. Problems with recruiting and retaining the volunteer workforce by the voluntary sector organisation, who were commissioned to do so, led to the study closing even though older people were recruited in sufficient numbers. The paper draws upon analysis of various data sources from the study to identify the potential reasons. The discussion raises considerations regarding the extent of infrastructure required to deliver community services to vulnerable user groups at scale, identifies some of the issues that need to be addressed if such volunteer-initiated services are to be successful and informs future research programmes in this area.
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Affiliation(s)
- Gail Mountain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Mima Cattan
- Health and Lifestyle/Nursing and Public Health Group, University of Northumbria, Newcastle, UK
| | - Ann Bowling
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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