scholarly journals A Mixed-Methods Evaluation of a Nurse-Led Community-Based Health Home for Ethnically Diverse Older Adults With Multimorbidity in the Adult Day Health Setting

2019 ◽  
Vol 20 (3) ◽  
pp. 131-144
Author(s):  
Tina Sadarangani ◽  
Lydia Missaelides ◽  
Emily Eilertsen ◽  
Harini Jaganathan ◽  
Bei Wu
Keyword(s):  
Older Adults ◽  
Mixed Methods ◽  
Social Services ◽  
Registered Nurse ◽  
The United States ◽  
Nutritional Risk ◽  
Emergency Department Utilization ◽  
Care Utilization ◽  
Community Based ◽  
Health Home

Multimorbidity affects 75% of older adults (aged 65 years and older) in the United States and increases risk of poor medical outcomes, especially among the poor and underserved. The creation of a Medicaid option allowing states to establish health homes under the Affordable Care Act was intended to enhance coordinated care for Medicaid beneficiaries with multimorbidity. The Community-Based Health Home (CBHH) model uses the infrastructure of the Adult Day Health Center (ADHC) to serve as a health home to improve outcomes for medically complex vulnerable adults. Between 2017 and 2018, we used a sequential explanatory mixed-methods approach to (a) quantitatively examine changes in depression, fall risk, loneliness, cognitive function, nutritional risk, pain classification, and health care utilization over the course of 12 months in the program and (b) qualitatively explore the perspectives of key stakeholders (registered nurse navigators, participants, ADHC administrators, and caregivers) to identify the most effective components of CBHH. Using data integration techniques, we identified components of CBHH that were most likely driving outcomes. After 12 months in CBHH, our racially diverse sample ( N = 126), experienced statistically significant ( p < .05) reductions in loneliness, depression, nutritional risk, poorly controlled pain, and emergency department utilization. Stakeholders who were interviewed ( n = 40) attributed positive changes to early clinical intervention by the registered nurse navigators, communication with providers across settings, and a focus on social determinants of health, in conjunction with social stimulation and engagement provided by the ADHC. CBHH positions the ADHC as the locus of an effective health home site and is associated with favorable results. CBHH also demonstrates the unique capacity and skill of registered nurses in integrating health and social services across community settings. Continued exploration of CBHH among diverse populations with multimorbidity is warranted.

scholarly journals Evidence for the Effectiveness of Health and Social Services Partnerships

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 225-226
Author(s):  
Traci Wilson ◽  
Suzanne Kunkel ◽  
Amanda Brewster ◽  
Jane Straker ◽  
Elizabeth Blair ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Outcomes ◽  
Social Services ◽  
Independent Living ◽  
Social Needs ◽  
Care Utilization ◽  
Community Based ◽  
Health And Social Services ◽  
Community Based Organizations

Abstract Integration of health and social services is touted as a key method to address social needs and improve population health. We will share the latest evidence on how Area Agency on Aging (AAA) partnerships with health care entities and other organizations improve health outcomes for older adults, while reducing health care costs. AAAs are community leaders in cross-sectoral partnerships that effectively address social determinants of health for older adults, who account for a substantial share of overall health care spending. Results of a longitudinal study (2008 – 2016) which links data from four waves of the National Surveys of AAAs to data on county-level health outcomes show that AAA–health care partnerships and programs reduced health care utilization and costs. AAA partnerships with hospitals reduced Medicare spending by $136 per beneficiary. AAA involvement in evidence-based health promotion programs decreased potentially avoidable nursing home use by nearly one percentage point (representing a change of 6.5%). Finally, we will describe the prevalence and nature of contracting relationships between community-based organizations and health care entities, based on data from the 2020 CBOs and Health Care Contracting Request for Information, the third national RFI of AAAs, Centers for Independent Living, and other aging and disability community-based organizations.

scholarly journals BUILDING DISASTER RESILIENCE FOR OLDER ADULTS AGING IN PLACE: THE ROLE OF COMMUNITY-BASED ORGANIZATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S340-S341
Author(s):  
Claire Pendergrast ◽  
Basia Belza ◽  
Ann Bostrom ◽  
Nicole Errett
Keyword(s):  
Older Adults ◽  
Social Services ◽  
Aging In Place ◽  
Well Being ◽  
Local Context ◽  
Disaster Resilience ◽  
Community Based ◽  
Senior Centers ◽  
Community Based Organizations

Abstract Older adults are more susceptible to adverse health outcomes during and after a disaster compared with their younger counterparts. Developing community resilience, or strengthening communities to reduce the negative impacts of disasters, has the potential support older adults’ health and well-being. Community-based organizations (CBOs), such as senior centers and Villages, provide social services and programming that support aging in place and may support older adults’ resilience to disasters. This study examines CBO leadership perspectives on the role of CBOs in building disaster resilience for older adults aging in place, as well as perceived barriers and facilitators to incorporating disaster resilience activities into organizational programming. In-depth interviews were conducted with a purposive sample of staff-members of CBOs serving older adults aging in place in King County, Washington. Participants included representatives from 14 organizations that varied in size, geographic setting, organizational structure, and ethnic, linguistic, and socio-economic backgrounds of organizational members. The sample included five government-run senior centers, seven non-profit senior centers, and two Villages. Interviews were audio-recorded and transcribed verbatim. We used a combined inductive and deductive approach to code and thematically analyze the data. Results indicate that local context, leadership risk perception, collaborations, and existing services and programming influence CBOs’ willingness to engage in activities supporting disaster resilience for older adults aging in place. Findings suggest that CBOs supporting aging in place may support disaster resilience for older adults by serving as a trusted source of disaster preparedness information and tailoring disaster-related messages for an older adult audience.

Determining the Long-Term Effectiveness of a Group-Based Physical Activity Program

2018 ◽  
Vol 20 (3) ◽  
pp. 401-408
Author(s):  
Anamica Batra ◽  
Richard C. Palmer ◽  
Elena Bastida ◽  
H. Virginia McCoy ◽  
Hafiz M. R. Khan
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Healthy Aging ◽  
Population Level ◽  
The United States ◽  
South Florida ◽  
Community Based ◽  
Evidence Based Programs ◽  
The Impact

Objective. In 2015, only half (48%) of older adults in the United States (≥60 years) reported engaging in any kind of physical activity. Few studies examine the impact of evidence-based programs when adopted in community-based settings. The purpose of this study is to assess the effectiveness of EnhanceFitness (EF) upto 12-months. Method. EF was offered to older adults in South Florida. A total of 222 EF classes were offered between October 2008 and December 2014. Program consisted of a 1-hour session held three times a week. Even though participation was required for 4 months, 1,295 participants continued the program for at least 1 year. Results. All participants showed significant improvement in outcome measures. A mean change of 1.5, 1.7, and 1.9 was seen in number of chair stands at 4, 8, and 12 months (p < .001), respectively. The number of arm curls performed improved from 16.8 at baseline to 18.8, 18.8, and 19.2 at 4-, 8-, and 12-months, respectively. Participants improved their up-and-go time by decreasing from 9.1 (baseline) to 8.7 (4 months) to 8.6 (12 months; p = .001). Discussion. Randomized controlled trials are commonly used to determine the efficacy of an intervention. These interventions when disseminated at the population level have the potential to benefit large masses. EF is currently offered at more than 700 locations. This tremendous success of EF brings attention to an important question of continuous monitoring of these programs to ensure program consistency and intended outcomes. The model used by the Healthy Aging Regional Collaborative could be replicated by other communities.

scholarly journals THE INTERSECTION OF ETHICS AND VULNERABLE ELDERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S238-S238
Author(s):  
Pamela B Teaster ◽  
Georgia Anetzberger
Keyword(s):  
Older Adults ◽  
Social Services ◽  
Ethical Issues ◽  
Elder Abuse ◽  
Cognitive Status ◽  
Ethical Challenges ◽  
Community Based ◽  
Conducting Research ◽  
Definition Of ◽  
Community Based Services

Abstract Researchers, practitioners and policymakers are daily confronted with multiple and competing situations regarding vulnerable older adults and the complex issues that they face in all aspects of their lives. Challenges can arise in the provision of social services, dispensing justice, conducting research, or addressing legal issues. The purpose of this symposium is to discuss dilemmas that vulnerable older adults and concerned others face by elucidating current and future challenges facing this population, particularly in the realms of compromised health (cognitive impairment); effective status (gender); care arrangements (home and community-based services); and abuse, neglect, and exploitation. Teaster and Anetzberger discuss relevant ethical theories and principles as well as a definition of vulnerability. Santos and Nichols-Hadeed report on ethical issues embedded in vulnerable elders’ cognitive status. Bowland and Halaas highlight the intersection of ethics, gender and vulnerable elders. Niles-Yokum and Beaumaster discuss the nexus of ethics and the provision of home and community based services for vulnerable older adults. Heisler considers vulnerabilities of older adults and ethical challenges when addressing elder abuse. Throughout the papers, we weave the ethical principles of autonomy, beneficence, nonmaleficence, and justice.

A participatory mixed-methods evaluation of a falls awareness programme

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Megan Elliott ◽  
Hannah Watson ◽  
Amy Lewis ◽  
Carolyn Wallace
Keyword(s):  
Older Adults ◽  
Mixed Methods ◽  
General Health ◽  
Sheltered Housing ◽  
Methodological Issues ◽  
Community Based Interventions ◽  
Community Based ◽  
Content Type ◽  
Behaviour Changes ◽  
Awareness Programme

Purpose Falls are common in older adults and are associated with injuries and serious ongoing problems. This paper aims to present a participatory evaluation of a Falls Awareness Programme implemented in South Wales for older adults living in sheltered housing schemes or in the community. It identifies methodological issues and provides recommendations for evaluation design and methods for community-based interventions in the future. Design/methodology/approach A mixed-methods study combining a non-experimental pretest–posttest design with face-to-face focus groups. Findings Concerns about falling and self-reported general health at baseline were worse for participants living in sheltered housing schemes, compared to participants in the community. There was no statistically significant change between baseline and follow-up in general health or concerns about falling; however, the data suggesting the programme may be more effective for people in sheltered housing schemes. Participants reported making small, but sustainable behaviour changes following the programme and described unexpected outcomes from the programme, e.g. socialising and meeting new people. Originality/value This paper demonstrates the benefit of engaging older adults in research using a participatory approach, highlights key components of community-based interventions for older people and identifies some methodological issues when conducting evaluations in the community. Specifically, it highlights the importance of selecting appropriate measurement tools for data collection and the utility of continuous monitoring where programme participation is flexible and fluid.

scholarly journals Homelessness during COVID-19: Challenges, Responses, and Lessons Learned from Homeless Service Providers in Tippecanoe County, Indiana

2021 ◽  
Author(s):  
Natalia M. Rodriguez ◽  
Alexa M. Lahey ◽  
Justin J. MacNeill ◽  
Rebecca G. Martinez ◽  
Nina E. Teo ◽  
...  
Keyword(s):  
Service Delivery ◽  
Social Services ◽  
Service Providers ◽  
Qualitative Content Analysis ◽  
The United States ◽  
Adverse Outcomes ◽  
Lessons Learned ◽  
Community Based ◽  
Health Crisis ◽  
Community Based Organizations

Abstract Background: The COVID-19 pandemic laid bare some of the United States’ most devastating health and social inequities faced by people experiencing homelessness. Homeless populations experience disproportionate rates of underlying health conditions, stigma and marginalization that often disenfranchise them from health and social services, and living conditions that potentiate the risk of COVID-19 transmission and adverse outcomes. Methods: Guided by the socio-ecological model, this community-based participatory research study examined the impacts of the COVID-19 public health crisis on people experiencing homelessness in Tippecanoe County, Indiana, and the ways in which homeless service providers prepared for, experienced, and responded to the pandemic. Eighteen (18) semi-structured interviews were conducted with representatives of 15 community-based organizations, including shelters and other homeless service providers.Results: Qualitative content analysis revealed multilevel challenges and responses to COVID-19 impact mitigation in this community, including the implementation of diverse safety measures, policies and novel service delivery innovations.Conclusions: Community-based organizations, including homeless shelters, are uniquely qualified to inform pandemic response and disaster risk mitigation in order to respond appropriately to the specific needs of people experiencing homelessness. Many of the emergency measures put in place by homeless service providers in Tippecanoe County, Indiana created opportunities for innovative solutions to longstanding challenges faced by homeless populations that can inform better service delivery moving forward, long after the COVID-19 pandemic. The lessons learned and shared by homeless service providers on the frontline during the COVID-19 pandemic have important implications to improve future disaster response for homeless and other vulnerable populations.

Examining the role of ageing-in-place organisations in building older adults’ disaster resilience

2020 ◽  
pp. 1-26
Author(s):  
Claire Pendergrast ◽  
Basia Belza ◽  
Ann Bostrom ◽  
Nicole Errett
Keyword(s):  
Older Adults ◽  
Social Services ◽  
Health And Safety ◽  
The United States ◽  
Local Context ◽  
Disaster Resilience ◽  
Structured Interviews ◽  
Ageing In Place ◽  
Building Activities

Abstract Older adults are more susceptible to adverse health outcomes during and after a disaster compared with their younger counterparts. Ageing-in-place organisations such as senior centres and Villages provide social services and programming for older adults and may support older adults’ resilience to disasters. This study examines the role of ageing-in-place organisations in building disaster resilience for older adults. Semi-structured interviews were conducted with a purposive sample of 14 ageing-in-place organisation leaders in King County, Washington in the United States of America. The sample included representatives of five government-run senior centres, seven non-profit senior centres and two Villages. Interviews were audio-recorded and professionally transcribed. We used a combined inductive and deductive approach to code and thematically analyse the data. Ageing-in-place organisation leadership recognise disasters as a threat to older adults’ health and safety, and they see opportunities to provide disaster-related support for older adults, though the type and extent of participation in resilience-building activities reflected each organisation's unique local context. Organisations participate in a variety of disaster-related activities, though respondents emphasised the importance of collaborative and communication-focused efforts. Findings suggest that ageing-in-place organisations may be best equipped to support older adults’ disaster resilience by serving as a trusted source of disaster-related information and providing input on the appropriateness of disaster plans and messages for the unique needs of older adults ageing-in-place.

scholarly journals The Community-Based Information Infrastructure of Older Adult Digital Learning

2017 ◽  
Vol 38 (s1) ◽  
pp. 65-77 ◽  
Author(s):  
Noah Lenstra
Keyword(s):  
Older Adults ◽  
Public Libraries ◽  
Social Institutions ◽  
Information Infrastructure ◽  
The United States ◽  
Public Institutions ◽  
Digital Learning ◽  
Community Based ◽  
Technology Learning ◽  
Institutional Contexts

Abstract In the United States of America, senior centers and public libraries are ubiquitous social institutions found in virtually every municipality. This article analyses these institutions as community-based information infrastructure in the digital learning practices of older adults. Older adults turn to these institutions to learn technology in retirement. How learning takes place in these spaces is shaped both by the institutions, and by the older adults. Negotiations between institutions and older adults shape digital learning. These negotiations are shaped by societal ageism. This article shows that older adults are not passive participants in technology learning, using services provided for them by others, but instead actively shape both how learning services are proffered and the institutional contexts in which these services exist. By learning to embrace the agency of older adults, these under-funded public institutions could powerfully reconfigure themselves for an information society that is also ageing.

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