Social connectedness in older Urban African-American adults during the COVID-19 pandemic: the roles of education and partnership

OBJECTIVE

This study examined education, partnership status, and the moderating role of the lockdown period on social connectedness during the COVID-19 pandemic in a sample of urban African-American older adults.

METHODS

Five hundred thirty-four African-American adults living in Detroit (91.0% female, Mage = 74.53) reported demographic information pre-pandemic and answered one social connectedness questionnaire between April and December 2020.

RESULTS

Participants interviewed after the lockdown (post-June 2020) reported more loneliness than those interviewed during the lockdown (April-June, 2020). Married/partnered participants reported less loneliness and social isolation. Loneliness did not differ between those with high education levels interviewed during the lockdown compared to post-lockdown. However, among individuals with low education levels, those interviewed after the lockdown reported more loneliness than those interviewed during the lockdown period.

CONCLUSION

Our findings suggest partnership status is associated with more social connectedness during the pandemic and education accentuates the effects of forced isolation related to loneliness among urban African-American older adults.

Understanding the concept of trust and other factors related to COVID-19 vaccine intentions among Black/African American older adults prior to vaccine development

Background

Black/African Americans are receiving COVID-19 vaccines at much lower rates than whites. However, research is still evolving that explains why these vaccination rates are lower. The aim of this study was to examine the effects of the pandemic among older Black/African Americans, with an emphasis on trust and vaccine intention prior to vaccine development.

Methods

Data were collected between July and September 2020 from 8 virtual focus groups in Detroit, MI and San Francisco Bay Area, CA with 33 older African Americans and 11 caregivers of older African Americans with cognitive impairment, supplemented by one virtual meeting with the project's Community Advisory Board. Inductive/deductive content analysis was used to identify themes.

Results

Five major themes influenced the intention to be vaccinated: uncertainty, systemic abandonment, decrease in trust, resistance to vaccines, and opportunities for vaccination. The last theme, opportunities for vaccination, emerged as a result of interaction with our CAB while collecting project data after the vaccines were available which provided additional insights about potential opportunities that would promote the uptake of COVID-19 vaccination among older Black/African Americans. The results also include application of the themes to a multi-layer framework for understanding precarity and the development of an Integrated Logic Model for a Public Health Crisis.

Conclusions

These findings suggest that trust and culturally relevant information need to be addressed immediately to accelerate vaccine uptake among older Black/African Americans. New initiatives are needed to foster trust and address systemic abandonment from all institutions. In addition, culturally relevant public health campaigns about vaccine uptake are needed. Thus, systemic issues need immediate attention to reduce health disparities associated with COVID-19.

Understanding the Ephemeral Moment of COVID Avoidance Hotels: Lessons Learned from Acknowledging Housing as Central to Dignified Later Life

Place and health are intricately bound. COVID has amplified system burdens and health risks within the housing care continuum, in which older adults with chronic illnesses are disproportionately represented. The paper identifies the health experiences of older adults with severe conditions living in and moving through temporary avoidance hotels during the COVID-19 pandemic. An interpretive descriptive approach was taken with qualitative chart data and provider observation to represent the experiences of 14 older avoidance hotel residents living with serious illnesses. Through provider documentation, we illustrate trends pre-pandemic, in the first nine months of the pandemic, and the second nine months. Such trends include strengths and opportunities such as the health-affirming nature of avoidance hotels, their potential in generating continuity of care and permanent housing, and synergy between harm reduction approaches and palliative care. Challenges were also identified in catering to the diverse medical, behavioral, and psychosocial-spiritual needs of older and seriously ill residents and the consequences of geographic dispersion on health care, health behaviors, and informal care networks. Through these strengths and challenges, avoidance hotels present essential lessons in considering future housing and healthcare intervention and implementation that addresses the needs of older seriously ill people facing homelessness and housing precarity.

"It Takes Some Empathy, Sympathy, and Listening": Telephone Outreach to Older Detroiters in a Pandemic as a Modality to Gain an Understanding of Challenges and Resiliency

This manuscript describes a telephone outreach project for members of a research registry program for older adults in Detroit, Michigan. From April until December 2020, the Healthier Black Elders Center designed and implemented a telephone outreach program, calling 1204 older adults utilizing 15 staff and volunteers. The calls served to check in on registry members and collect data on mental health, coping mechanisms, access to services, masks, testing, and tele-health. This paper details the methods of developing and implementing an innovative engagement program that collected time-sensitive data from older Black adults that has directly been applied to create virtual health education programs, share resource information, and create a program to reduce social isolation.

An Innovative Telephone Outreach Program to Seniors in Detroit, a City Facing Dire Consequences of COVID-19

We write this letter to share our telephone outreach project that aims to address the health implications of loneliness, social isolation, and limited access to resources among older African American adults living in Detroit during Covid-19. The extreme health disparities evidenced by case numbers and death rates of Covid-19 demands our use of basic technology, the telephone, to provide social support and document their experiences to later share in their voice. It is our hope that other groups working with older adults can replicate these strategies.

Conducting secondary analysis of qualitative data: Should we, can we, and how?

While secondary data analysis of quantitative data has become commonplace and encouraged across disciplines, the practice of secondary data analysis with qualitative data has met more criticism and concerns regarding potential methodological and ethical problems. Though commentary about qualitative secondary data analysis has increased, little is known about the current state of qualitative secondary data analysis or how researchers are conducting secondary data analysis with qualitative data. This critical interpretive synthesis examined research articles (n = 71) published between 2006 and 2016 that involved qualitative secondary data analysis and assessed the context, purpose, and methodologies that were reported. Implications of findings are discussed, with particular focus on recommended guidelines and best practices of conducting qualitative secondary data analysis.

Intersections of Home, Health, and Social Engagement in Old Age: Formal Volunteering as a Protective Factor to Health After Relocation

This study aims to further our understanding of formal volunteering as a protective mechanism for health in the context of housing relocation and to explore race, gender, and education as moderators. A quasi-experimental design evaluated the effects of volunteering on older adults' health (self-report health, number of instrumental activities of daily living [IADLs], and depressive symptoms) among individuals who relocated but did not volunteer at Time 1 ( N = 682) in the Health and Retirement Study (2008-2010). Propensity score weighting examined health differences at Time 2 between 166 volunteers (treated) and 516 nonvolunteers (controlled). Interaction terms tested moderation. Individuals who moved and engaged in volunteering reported higher levels of self-rated health and fewer IADL difficulties compared to the control group. Race moderated the relationship between volunteering and depressive symptoms, while gender moderated the relationship between volunteering and self-assessed health. Formal volunteering protects different dimensions of health after relocation. Volunteering was particularly beneficial for females and older Whites.

Aging in Place in Every Community: Social Exclusion Experiences of Parents of Adult children With Autism Spectrum Disorder

This article offers an examination of aging processes of lifelong caregivers and the possibilities for social exclusion place experienced by parents of adult children with autism spectrum disorder (ASD). This study of parental caregivers ( n = 51) sheds light on how enduring caregiving roles can lead to social exclusion in three ways: misunderstanding of ASD and stigma, the complexity of the caregiving roles, and impact on daily routines including challenges with long-term planning for both the adult children and the parental caregivers. Implications for practice to address social exclusion include education and building greater communication ties among family member for family members and advocacy for more and higher quality services including respite care. This article concludes with discussion of the impact of this aging, yet caregiving population and the need for knowledge about aging processes and anticipating aging for these caregivers.

Care networks in play: Understanding death of a parent as a contributing factor to homelessness

Offering an understanding of specialized service needs of those becoming homeless because of the death of a parent or parental figure, this project is set in Detroit's urban context, where residents face economic hardship and intergenerational poverty. In this study, we analyze the voices of practitioners (n = 5) and men (n = 5) who have experienced parental death as a contributing factor to homelessness in Detroit, Michigan. Findings include the following: (1) the impact of death and dying experiences on these men and (2) the role of care networks in these men's lives, particularly when these men have and lack "default" caregivers after death of a parent. This community-based research project was a result of a partnership between a local agency serving persons experiencing homelessness, where the practitioner initiated the project with the researcher. The paper concludes with implications for social work practice.

Somewhere to be permanent for a minute: Time and space perceptions of older adult men experiencing chronic homelessness in Detroit

Within the landscape of postwar era Detroit, space is vast, but places are hard to find. As people tumble down the side of Maslow's pyramid into abject homelessness, they attempt to anchor themselves in locations that suspend the otherwise situational free fall. This article analyzes how time and space are perceived by people experiencing chronic homelessness and how those individual perceptions are informed by the objective time and space urban environment. We conducted our community-based participatory research into the experiences of chronic homelessness both from perspectives of chronically homeless older adult men and from front-line service providers. Themes that emerged are as follows: (1) temporary permanence, (2) permanent temporariness, and (3) lostness. The article concludes with policy implications regarding the procedures for measuring the extent of homelessness and the needs of those who live it.

Addressing Heart Failure Challenges through Illness-Informed Social Work

This article describes the role of social workers in addressing the needs of people with heart failure. Although previous studies have explored the role of social workers in health care settings, few studies have addressed the challenges of specific chronic diseases such as heart failure. To address this gap in the literature, this study used qualitative interviews with health care social workers (n = 8) to obtain in-depth information about activities and challenges related to heart failure care. Findings suggest that health care social workers perceive heart failure as characterized by an uncertain illness trajectory, frequent hospitalizations, and difficulties accessing formal and informal care. These findings suggest the importance of what we term illness-informed social work, a practice that combines heart failure knowledge with social work competencies to address the complex psychosocial issues in heart failure care.

Applying Erikson's wisdom to self-management practices of older adults: findings from two field studies

According to Erik Erikson's theory on the stages of human development, achieving wisdom later in life involves revisiting previous crises and renewing psychosocial accomplishments. However, few studies have used Erikson's theory as a framework for examining how older adults self-manage physical and mental health changes that commonly occur later in life. This article presents findings from two qualitative studies that demonstrate how older adults apply wisdom in new domains. Specifically, it was found that older adults (1) reasserted autonomy by initiating creative problem solving and (2) applied skills gained from productive activities earlier in life to new health-related problems that arise later in life. These findings highlight the importance of engaging older adults to repurpose their life skills and thus reapply wisdom to new areas of their lives. Implications for practice are discussed.

Giving Back and Staying Put: Volunteering as a Stabilizing Force in Relocation

Relocation in older adulthood has been shown to have health-related and environmental triggering factors. This study explores the relationship between volunteering in a community and relocation. Using data from 2008 and 2010 Health and Retirement Study, which included 9,220 community-dwelling older individuals who were 65 years and older, our findings show that volunteering significantly reduces the likelihood of relocating out of the area, and such relationship is partially mediated by having friends nearby. This study is innovative because it identifies a stabilizing mechanism important for understanding "protective" factors, such as volunteering, as a way communities can retain older adults.

Make Mine Home: Spatial Modification With Physical and Social Implications in Older Adulthood

OBJECTIVE

The process of moving in older adulthood, intertwined with loss and anticipation, is grounded in material commodities that include one's residence and its contents. This article emphasizes the role of material culture in housing transitions.

METHODS

Based on an ethnographic study (January 2009-May 2012) of older Americans (n = 81) relocating, this study utilized interviews, participant observation, and review of documents.

RESULTS

Personalization is both a reflection of a previous self as a homeowner and a projection of a future self as extensions of temporality intertwine with commodification processes. Through creative appropriations of their housing, residences are personalized to promote physical or social functionality or because of preference.

DISCUSSION

Given the findings, the transitions involved in relocation must be supported by greater understanding and facilitation of key issues of personalization and its importance to older adults' decisions to relocate.

Seasonal variation and homes: understanding the social experiences of older adults

There has been limited research on the importance of seasons in the lives of older adults. Previous research has highlighted seasonal fluctuations in physical functioning--including limb strength, range of motion, and cardiac death--the spread of influenza in seasonal migration patterns. In addition, older adults experience isolation for various reasons, such as decline of physical and cognitive ability, lack of transportation, and lack of opportunities for social interaction. There has been much attention paid to the social isolation of older adults, yet little analysis about how the isolation changes throughout the year. Based on findings from an ethnographic study of older adults (n = 81), their family members (n = 49), and supportive professionals (n = 46) as they embark on relocation from their homes, this study analyzes the processes of moving for older adults. It examines the seasonal fluctuations of social isolation because of the effect of the environment on the social experiences of older adults. Isolation occurs because of the difficulty inclement weather causes on social interactions and mobility. The article concludes with discussion of the ways that research and practice can be designed and implemented to account for seasonal variation.

Assessing the educational and support needs of nursing staff serving older adults: a case study of a community coalition/university partnership

Given the expected changes in demography and dependent care ratios, communities are preparing for the needs of older populations. Sometimes, communities form coalitions to address health-care needs. This case study evaluates a coalition/university partnership formed to assess the educational and support needs of nursing staff who are taking care of older adults across all service settings in one geographically defined community. A 17-member community-based coalition contracted with researchers from an external university to determine the perceptions of three key stakeholder groups: older adults and their families, all levels of nursing staff, and agency administrators. By applying principles of Participatory Action Research (PAR), this case study presents the challenges faced in the community-based coalition/university research team partnership. This coalition/research partnership is unique, differing from most academic examples of PAR because nursing professionals initiated the partnership.

The Rite of Relocation: Social and Material Transformations in the Midwest US

Concerns of appropriate housing may arise in older adulthood. Some older adults may make life work in the place we call home; others take steps to voluntarily relocate in anticipation of health and other needs. While moving at any age can be challenging, moving from one's home in later life also represents multiple reflections: past, present and future selves, control of one's space and relinquishing the care of one's space to another person or corporation, family support and family fissures, and the body's capacities and limitations. Moving is examined as a moment where regimes of value are negotiated through competing semiotic ideologies and at times social roles are transformed. Ethnographic fieldwork occurred from January 2009-May 2012 in the Midwest United States. This paper presents experiences of relocation of material and social role transformation as older adults make this housing, and writ large, life transition.

In The Best Interest Of The (Adult) Child: Ideas About Kinship Care Of Older Adults

This article uses a qualitative, ethnographic approach to examine the experiences older adults and their kin, as the older adult engages in relocation. Studies looking at caregiving by kin for older adults highlight burdens for the adult child. This study offers a life course perspective on kinship care, analyzing older adults' decisions' to move. It was found that many older adults are strongly influenced by the desire to not be cared for by their kin as well as to select housing near their existing social network, which might exclude kin. In conclusion, policy implications are discussed.

Relocation remembered: perspectives on senior transitions in the living environment

The experience of aging may necessitate transitions in living environments, either through adaptations to current residences or through relocations to more supportive environments. For over a half century, the study of these transitions has informed the work of researchers, health and mental health providers, policymakers, and municipal planners. In the 1970s and 80s, knowledge about these transitions advanced through Lawton and Nahemow's ecological theory of competence and environmental press, Wiseman's behavioral model of relocation decision making, and Litwak and Longino's developmental perspective on senior migrations. This article revisits influential theoretical frameworks that contribute to our understanding of senior transitions in living environments. These seminal works are shown to inform recent studies of relocation and gerontology. This article concludes with a call for a view on housing transitions that reflects the contemporary context.

"That model is sooooo last millennium!" Residential long term care as a system, not a place

The current quandary with the design of existing long term care (LTC) settings results from focus on structures ("institutions") instead of on a system of supports and services that transcends physical and traditional boundaries across settings, including nursing homes, assisted living residences and the home. Supported by analysis of the commonalities, socio-historical and political contexts, core values and fallacies of social and medical models in existing and emerging LTC options, a holistic model is proposed based on new core values which facilitate community and family integration, and which asserts dignity and personhood as universal attributes in an array of settings.

The amniotic fluid as a source of cells for fetal tissue engineering

PURPOSE

This study was aimed at determining whether fetal tissue constructs can be engineered from cells normally found in the amniotic fluid.

METHODS

A subpopulation of morphologically distinct cells was isolated mechanically from the amniotic fluid of pregnant ewes (n = 5) and expanded selectively. Its lineage was determined by immunofluorescent staining against multiple intermediate filaments and surface antigens. Proliferation rates were determined by both oxidation and total DNA assays and compared with immunocytochemically identical adult and fetal sheep cells. Statistical analysis was by analysis of variance for repeated measures (ANOVA). After expansion, the amniocytes were seeded onto a polyglycolic acid polymer/poly-4-hydroxybutyrate scaffold. The resulting construct was analyzed by both optical and scanning electron microscopy.

RESULTS

The immunocytochemical profile of expanded amniocytes was consistent with a mesenchymal, fibroblast/myofibroblast cell lineage. These cells proliferated significantly faster than comparable fetal and adult cells in culture. Amniocyte construct analysis showed dense, confluent layers of cells firmly attached to the scaffold, with no evidence of cell death.

CONCLUSIONS

(1) Subpopulations of fetal mesenchymal cells can be isolated consistently from the amniotic fluid. (2) Mesenchymal amniocytes proliferate more rapidly in vitro than comparable fetal and adult cells. (3) Mesenchymal amniocytes attach firmly to polyglycolic acid polymer. The amniotic fluid can be a reliable and practical source of cells for the engineering of select fetal tissue constructs.