IMPACT OF INTERGENERATIONAL SERVICE LEARNING ON PSYCHOLOGICAL DISTRESS FOR HOMEBOUND OLDER ADULTS DURING COVID

More than 2 million of older adults are homebound and 5 million need help leaving their homes. They often experience social isolation, food insecurity, and lack of connection to community resources, which for many has intensified since the pandemic. To date, home-based services for those aging in place are lacking. Using newly available data, this study examined the benefits of an intergenerational home-based service learning program in reducing psychological distress for a community-based sample of 190 homebound older adults during the COVID-19 pandemic. Multivariate regression analyses were conducted to examine the association of living in one’s own home, disability status, presence of child and spousal caregivers, and length of services from the program with psychological distress. Findings indicated that length of service with the intergenerational in-home support program was associated with lower psychological distress (β = -0.16, p < 0.05). Having a child as a caregiver was associated with lower psychological distress (β = -0.15, p < 0.05). Poor health status was associated with higher levels of psychological distress (β = 0.16, p < 0.05). Living in one’s own home, having a spouse as a caregiver, disability status, and having a long-term medical condition were not associated with psychological distress in the analysis. Results from this study suggest that intergenerational in-home support services can help reduce psychological distress for homebound older adults. Policies and practice can support a pipeline of geriatric health professionals through innovative service learning models to benefit older adults, caregivers, and students.

Teaching Note-Supporting Homebound Older Adults and Caregivers Through Integrative Service Learning

The Supporting Older Adults & Caregivers: Integrative Service Learning (SOCIAL) partnership trains undergraduate social work students to provide practical home-based support for older adults with chronic illness and their family caregivers, serving as a pipeline for future leaders in older adult care. More than 2 million older adults are homebound, and 5 million need help leaving their homes due to physical limitations from chronic conditions or cognitive impairments. Family members often assume daily caregiving tasks to assist their loved ones, navigate health care systems, and provide much needed emotional support. The challenges of caregiving are further compounded by the problems associated with insufficient health care professionals who are trained to work with older adults. Integrative service learning models can provide home-based support to older adults while offering valuable, hands-on learning experiences for students. In this teaching note, we acknowledge a need for developing an educational pipeline that can provide training opportunities for students to work with older adults and their caregivers at home. We provide an example of an integrative service-learning model which offers valuable pedagogical experiences to baccalaureate students along with strategies for curriculum building, community engagement, research and evaluation, and program sustainability.

Validation of a Measure of Loneliness for Homebound Older Adults

The pandemic has disproportionately impacted older adults, highlighting the need to address social isolation for this population. Homebound older adults are at risk for loneliness, which is a correlate of poor mental and physical health. COVID-19 has exacerbated effects of social isolation by limiting contact with family and other visitors. In-depth empirical validation of loneliness scales is needed to examine the measurement of this construct for homebound older adults who are aging in place. This study examined the reliability and validity of the UCLA Loneliness Scale (v3) for a community-dwelling population of older adults who received home-based support services due to their homebound status or have chronic illness resulting in ADL limitations. Using in-home interviews, data were collected for 175 older adults using the UCLA Loneliness Scale. Reliability and confirmatory factor analyses were conducted to examine its psychometric properties. Findings demonstrated the scale had good internal consistency reliability (ɑ = 0.91). Confirmatory factor analyses indicated a two-factor solution, 1) disconnectedness and 2) connectedness, accounting for 92% of the variability in the 20 items. The lack of meaningful relationships (ƛ = 0.73, p &lt; 0.05) or having someone to turn to (ƛ = 0.68, p &lt; 0.05) substantively contributed to disconnectedness. Feeling that there were people to talk to (ƛ = 0.67, p &lt; 0.05) and turn to (ƛ = 0.76, p &lt; 0.05) contributed to connectedness. Future research can further examine how quality of relationships and benefits of being connected to others can address loneliness and isolation for this population.

Cost-effectiveness of a Digital Health Intervention for Acute Myocardial Infarction Recovery

BACKGROUND

Acute myocardial infarction (AMI) is a common cause of hospital admissions, readmissions, and mortality worldwide. Digital health interventions (DHIs) that promote self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction may improve health outcomes in this population. The "Corrie" DHI consists of a smartphone application, smartwatch, and wireless blood pressure monitor to support medication tracking, education, vital signs monitoring, and care coordination. We aimed to assess the cost-effectiveness of this DHI plus standard of care in reducing 30-day readmissions among AMI patients in comparison to standard of care alone.

METHODS

A Markov model was used to explore cost-effectiveness from the hospital perspective. The time horizon of the analysis was 1 year, with 30-day cycles, using inflation-adjusted cost data with no discount rate. Currencies were quantified in US dollars, and effectiveness was measured in quality-adjusted life-years (QALYs). The results were interpreted as an incremental cost-effectiveness ratio at a threshold of $100,000 per QALY. Univariate sensitivity and multivariate probabilistic sensitivity analyses tested model uncertainty.

RESULTS

The DHI reduced costs and increased QALYs on average, dominating standard of care in 99.7% of simulations in the probabilistic analysis. Based on the assumption that the DHI costs $2750 per patient, use of the DHI leads to a cost-savings of $7274 per patient compared with standard of care alone.

CONCLUSIONS

Our results demonstrate that this DHI is cost-saving through the reduction of risk for all-cause readmission following AMI. DHIs that promote improved adherence with guideline-based health care can reduce hospital readmissions and associated costs.

The impact of discrimination on allostatic load in adults: An integrative review of literature

OBJECTIVE

The objective of the paper is to critically review the current state of the literature on the association between discrimination and allostatic load (AL) in adults and determine whether this association differs by sociodemographic characteristics.

METHODS

An extensive literature search was conducted in PubMed, CINAHL, PsycINFO, and Embase to identify studies that investigated the association between discrimination and AL. The search was limited to the English language, articles that were peer-reviewed and articles that were published within the last 10 years.

RESULTS

A total of 11 studies met the eligibility criteria for this review, 8 of which were cross-sectional and 3 of which were longitudinal. There was heterogeneity in the type of discrimination measured, the composition of AL summary score, and the analytic approach utilized to examine the relationship of interest. Nine studies found a significant, positive association between discrimination and AL. The types of discrimination found to be positively associated with AL included lifetime discrimination, childhood racial discrimination, everyday discrimination, and everyday weight discrimination. One study found that this association differed by educational attainment.

CONCLUSION

There is evidence that discrimination is associated with AL. Longitudinal studies with diverse samples are needed to further explore this association and how it differs based on sociodemographic characteristics.

The Home, Block, and Community Environments and Biomarkers of Aging in the National Health and Aging Trends Study

Prior studies have linked household and community conditions to the health and functioning of older adults. However, few studies have investigated associations between household, block, and community environmental conditions with biomarkers of aging. This study used NHATS Round 7 (2017) data on 3,283 community-dwelling older adults to test cross-sectional associations between interior and exterior household disorder, block disorder, community social cohesion, and four biomarkers: C-reactive protein, hemoglobin A1c, cytomegalovirus, and interleukin-6. Survey-weighted models adjusted for age, sex, race/ethnicity, income, education, homeownership, housing type, and metropolitan area; HbA1c was stratified by diabetes diagnosis. Greater interior household disorder was associated with higher IL-6 (β=0.06, SE=0.025, p=0.014) and, among diabetics, greater block disorder was associated with higher HbA1c (β=0.11, SE=0.05, p=0.046). These results link home and block environmental characteristics with biomarkers of aging, suggesting that modifiable aspects of older adults’ living environments may be related to disease and disability risk via physiologic dysregulation.

Financial Resources and Biomarkers of Aging in the National Health and Aging Trends Study

Lower income and financial strain (i.e. difficulty making ends meet) are associated with worse aging biomarkers, but evidence among nationally representative samples is limited. This cross-sectional study tested whether income to poverty ratio (analyzed separately for those <500% vs. ≥500% poverty threshold) and financial strain are associated with biomarkers of aging among NHATS participants aged ≥65 years (n=4,648), adjusting for age, race/ethnicity, gender, smoking, BMI, and diabetes diagnosis for hemoglobin A1c. Sampling weights were applied. Among those with incomes <500% poverty, higher income was associated with lower hemoglobin A1c (b= -0.0196, p=0.007), CMV (b= -0.0689, p<0.001) and CRP (b= -0.0428, p=0.012). Among those with incomes ≥500%, higher income was associated with lower IL-6 (b= -0.0001, p=0.023) and lower CMV (b= -0.0001, p<0.001). Financial strain was not associated with biomarkers. Income is more strongly associated with biomarkers among the lower income group, calling for special attention to this vulnerable population.

Supporting Older Adults and Caregivers Through Integrative Service Learning During COVID

There is a growing population of older adults who are living longer and acquiring chronic illness and disabilities, making it difficult for them to complete everyday activities and age in place. More than 2 million of these older adults are homebound and 5 million need help leaving their homes. They experience social isolation, food insecurity, and lack of connection to community resources which has intensified since the pandemic. Integrative service learning models can provide home-based support to older adults while offering valuable, hands-on learning experiences for students. This study examined findings for a community-based program which trained university students to provide practical home-based support for older adults and their caregivers. Data was collected for 109 older adults who were connected with student trainees. Students provided services with groceries, companionship, and help accessing needed services. Findings from t-test results using the UCLA Loneliness Scale indicated that older adults reported less loneliness after engagement with students (mean difference = 6.15, t = 3.14, df = 82, p < 0.01). Qualitative process data suggested that older adults benefited from services and a connection to their assigned students prior to and during the pandemic. Student trainees reported that the experience enriched their learning and reaffirmed their commitment to working with older adults. Community-based service learning can address home-based needs of older adults and their caregivers and enhance learning opportunities for students. Policies and practice can support a pipeline of geriatric health professionals through innovative service learning models to benefit older adults, caregivers and students.

Older African Americans’ Perspectives on Exposure to Structural Discrimination Across Contexts and the Life Course

This presentation reports on findings from the first phase of a mixed methods study aimed at developing an instrument to assess older African Americans’ exposure to structural racial discrimination. We conducted semi-structured interviews with older African Americans about their perspectives on and exposure to structural discrimination. Participants (n=20) were community-dwelling African Americans aged fifty and older in Baltimore, MD. Participants described exposure to structural discrimination that had accumulated across the life course and across the contexts of education, employment, healthcare services, criminal justice system, neighborhood factors, media and marketing of unhealthy products, environmental toxin exposures, and income, credit and wealth. In the next phase of the study, we will incorporate these findings into the development of instrument items. Developing and testing a tool to assess exposure to discrimination beyond the interpersonal level is an important step in identifying solutions to mitigate the contribute of discrimination to racial health disparities.

The Value of Home-Based Primary Care: Qualitative Exploration of Homebound Participant Perspectives

Older adults' preference to age in place and health systems' commitment to cost-effective quality care has set the stage for a growing interest in home-based primary care (HBPC). The objective of this study was to explore what patients and caregivers value about HBPC and what modifications could improve its value. Semi-structured individual interviews (n = 20) were audio-recorded, transcribed, and coded for themes. Four themes emerged: (a) HBPC offers peace of mind because patients can access care without leaving the home and can reach the primary care team at all hours, (b) HBPC supports aging in place by providing in-home care, (c) HBPC supports provider rapport building because of the intimate setting and continuity of care, (d) HBPC patients and caregivers have significant nonmedical needs. Findings suggest that teams developing or expanding on HBPC programs should prioritize access to providers, rapport building with patients and families, and supporting patients' and caregivers' nonmedical needs.

Service learning in public health nursing education: How COVID-19 accelerated community-academic partnership

Days after COVID-19 physical distancing precautions were implemented, a coalition of community leaders in Baltimore City founded the Baltimore Neighbors Network (BNN), a volunteer network established to provide proactive phone-based support to older adults in Baltimore City. BNN was a community-driven approach aimed at reducing social isolation and improving health equity both during the pandemic and long-term. This paper describes how the Johns Hopkins School of Nursing's (JHUSON) public health nursing clinical faculty and students partnered with BNN to support a community-driven crisis response effort while creatively meeting student learning objectives. While engaging in the work of BNN remotely, nursing students were able to meet competencies across all eight domains of the Quad Council Coalition of Public Health Nursing Organizations. Schools of Nursing throughout the country can use this partnership as a model of a service-learning strategy for public health nursing education during a crisis.

Exergames and Depressive Symptoms in Older Adults: A Systematic Review

To synthesize and critique studies that examined the impact of exergames on depressive symptoms in older adults. Articles were retrieved from the databases CINAHL, Embase, PsychINFO, and Medline. Studies were included in the review if they involved a physical activity/videogame intervention and measured outcomes of depressive symptoms in older adults. The search generated 957 articles for consideration, which were narrowed to 17 articles after applying exclusion criteria. In studies that required depressive symptoms as an inclusion criterion, there was an improvement in depressive symptoms in older adults following the exergame intervention. In studies that did not require depressive symptoms as an inclusion criterion, researchers found mixed results. Future older adult exergame research should measure depression as a primary outcome, utilize control groups with random sampling, consist of larger sample sizes, and include people with disabilities.

PREVENTING FALLS AMONG OLDER FALLERS: LIVE-LIFE

OBJECTIVES: To evaluate whether a fall prevention intervention, adapted from the LiFE program, reduces fall risk in older adults who have previously fallen. DESIGN: Randomized controlled pilot trial SETTING: Participants’ homes INTERVENTION: LIVE-LIFE is an occupational therapy delivered fall prevention intervention that integrates strength and balance training into daily habits in 8 visits over 12 weeks. The intervention also provides 1) up to $500 in home safety changes prioritized by the participants 2) vision contrast screening and referral, and 3) personalized fall risk medication recommendations to Primary Care Providers (PCP) from a Pharmacist. This multi-component intervention was compared to a control condition consisting of CDC fall prevention materials and an individualized fall risk summary. MEASUREMENT: Primary outcome: Fall risk measured by Timed Up and Go (TUG) and Tandem stand. Secondary outcomes: Falls efficacy, feasibility and acceptability of the intervention. RESULTS: The sample of 37 people was 65% female, 65% white and an average 77 years old. Two were lost to follow up (95% retention). Compared to the control group, the mean of each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect size (1.1) for amount of time study participants could hold a tandem stand, a moderate effect (0.5) in falls efficacy, and a small effect (0.1) in the TUG. CONCLUSION: LIVE-LIFE was acceptable to participants, feasible to provide, and averaged large to small effect sizes. Simultaneously addressing preventable fall risk factors is feasible and should be investigated due to the growing population at risk for falls.