Cultivating Relationships as a Community-Based Recruitment Strategy in Transdisciplinary Aging Research: Lessons From an Academic-Community Partnership.

Participation of Black American older adults in community-engaged research remains challenging in health sciences. The objectives of this study were to describe the specific efforts, successes, and challenges in recruiting Black American older adults in research led by the Health and Wellness in Aging Across the Lifespan core, part of the Virginia Commonwealth University Institute for Inclusion, Inquiry, and Innovation (iCubed). We conducted a cross-case analysis of 6 community-engaged research projects using the community-engaged research continuum model. Successful recruitment strategies comprised a multifaceted approach to community-based collaboration, including a wellness program with a long standing relationship with the community, engaging key stakeholders and a community advisory board, and building a community-based coalition of stakeholders. Posting flyers and modest monetary compensation remain standard recruitment strategies. The cross-case analysis offered critical lessons on the community's nature and level of engagement in research. Relationship building based on trust and respect is essential to solving complex aging issues in the community.

The Healthy Meal Program: A food insecurity screening and referral program for urban dwelling older adults.

OBJECTIVE: To describe the Healthy Meal Program (HMP), a community-academic partnership that aims to address the food insecurity and social isolation in older adults living in an urban setting. PROGRAM IMPLEMENTATION: Low-income older adults were screened for food insecurity and social isolation. A partnership with the food bank and a farm-based organization helped provide a weekly congregate or home-delivered meal, pilot a cooking class, and offer a mobile market selling fresh vegetables at discounted prices. PROGRAM EVALUATION: Overall, 339 individuals agreed to participate in the screening process. Sixty-eight percent (n = 230) screened positive for food insecurity and 41% (n = 139) screened positive for social isolation. Among individuals who were food insecure, 159 were referred to a food commodity program, 31 to meals on wheels, 23 to Supplemental Nutrition Assistance Program benefits, and 28 to emergency food pantries. The mobile market served 75 participants weekly and 15 individuals took part in cooking classes. CONCLUSIONS: Screening for food insecurity and social isolation in the HMP helped to assess the prevalence of these social determinants of health in low-income older adults. Weekly congregate meals, home visits, and group cooking classes were initiatives taken to decrease the impact of food insecurity and social isolation in this vulnerable population.

Development of the Relational Ageism Scale: Confirmatory Test on Survey Data.

The objective of the study is to test a refined measure of attitudes about aging as a multidimensional construct reflective of a relational process that includes personal identity (i.e., beliefs about oneself), social identity (i.e., self-conception based on group membership), and collective identity (i.e., self-conception based on comparison of groups) as well as capturing awareness of ageism and its impact. Researchers refined the Aging Anxiety Scale and recruited a convenience sample of 329 participants via a social media platform. A principal component factor analysis revealed the specification of three latent factors: personal, relational, and collective aging anxiety. Awareness of ageism as a problem in society was lower than awareness of other forms of discrimination, and awareness of the negative impacts of ageism was low. The findings support the incorporation of this new measure of relational aging anxiety as a by-product of social identity and construction in future ageism studies.

Social context of drinking among older adults: Relationship to alcohol and traffic risk behaviors.

OBJECTIVE: Alcohol use among older adults is a major public health concern given potentially negative effects to health and functioning in this population. Little is known about context in which alcohol use among older adults occurs, or how context of use is associated with risk behaviors. METHOD: Invitation letters were mailed to licensed drivers 65 years and older in Maryland. A total of 825 participants completed an online survey that assessed demographic characteristics, alcohol use, social context of drinking, and driving behaviors. RESULTS: The analytic sample consisted of 604 older adult current drinkers (55% male). A factor analysis revealed three separate contexts of drinking: social facilitation, emotional comfort, and relaxation. Drinking in the context of social facilitation was associated with driving after drinking. Drinking in the context of emotional comfort was associated with getting drunk, driving after drinking, and running a stop sign or red light. Drinking in the context of relaxation was associated with traffic risk behaviors, including running a stop sign or red light and getting in a near crash or collision. CONCLUSIONS: Understanding the social context of alcohol use among older adults may be useful for targeting and attempting to modify risky alcohol use and driving behaviors.

Immediate effects of a brief intervention to prevent alcohol and medication interactions among older adults.

Risk of experiencing alcohol and medication interactions (AMI) is significant among older adults due to the substantial prevalence of alcohol and medication use in this segment of the population. Given the lack of community-level AMI prevention interventions for older adults, this study aimed to examine the immediate effects of a brief, pharmacy-based intervention to prevent AMI among older adults, as well as assess differential effects by past-month drinking status. A convenience sample of 134 adults aged 59 and older was recruited from four pharmacies in rural Virginia. Participants were assessed on their AMI awareness, intentions and importance prior to and immediately after exposure to intervention materials. Findings support immediate, positive intervention effects on AMI awareness, intentions and perceived importance of AMI messaging. Changes from pre to post-test did not differ by drinking status, but participants who consumed alcohol were less likely than non-drinkers to recognize the potential consequential severity of alcohol and medication interactions at both time points. Recommendations and future research to prevent AMI are discussed.

Concurrent alcohol and medication poisoning hospital admissions among older rural and urban residents.

BACKGROUND: Alcohol and medication interactions are projected to increase due to the growth of older adults that are unsafely consuming alcohol and medications. Plus, aging adults who reside in rural areas are at the highest risk of experiencing medication interactions. OBJECTIVE: Estimate concurrent alcohol and medication (alcohol/medication) hospitalizations in adults 50+ years, comparing age groups and rural/urban regions. METHODS: Kentucky nonfederal, acute care inpatient hospital discharge electronic records for individuals aged 50+ years from 2001 to 2012 were examined. Rate differences were estimated across age and regional strata. Differences in the underlying principal diagnosis, intent, and medications were also examined. RESULTS: There were 2168 concurrent alcohol/medication hospitalizations among 50+ year olds identified. There was a 187% increase in alcohol/medication hospitalizations from 2001 (n = 104) to 2012 (n = 299). The per capita alcohol/medication hospitalization rate increased from 8.91 (per 100,000) in 2001 to 19.98 (per 100,000) in 2012, a 124% increase. The characteristics of the hospitalizations included 75% principal diagnosis as medication poisoning, self-harm as the primary intent (55%) in 50-64-year olds, and unintentional intent (41%) in 65+ adults. Benzodiazepines were most often involved in the poisonings (36.5%). CONCLUSIONS: Concurrent alcohol/medication hospitalizations in Kentucky are increasing among aging adults. Greater increases in rural areas and the 65+ aged adults were seen, although there were also higher alcohol/medication hospitalizations in urban and 50-64 aged adults. These findings indicate the need for public-health prevention and clinical intervention to better educate and manage alcohol consuming older adults on safe medication and alcohol practices.

Community pharmacy staff perceptions on preventing alcohol and medication interactions in older adults.

OBJECTIVES: To examine rural and urban pharmacy staff perceptions on messaging, barriers, and motivators for preventing alcohol and medication interactions (AMI) in older adults (≥65 years of age). METHODS: A survey was distributed through the local pharmacist association and statewide pharmacy registry in Kentucky. A total of 255 responses were received from pharmacists, pharmacy technicians, and pharmacy students. RESULTS: Across rural and urban regions alike, among the AMI prevention messages provided, participants identified the most important messages to be: AMI can be potentially dangerous and life threatening; emergency rooms should be used when experiencing an AMI; and doctors and pharmacists should be consulted about AMI. The most common AMI prevention barriers indicated were stigma, costs, and low perceived risks. The most common AMI prevention motivators indicated were physical health improvement, promoting a healthy lifestyle, convenient setting, and financial incentives. CONCLUSION: Regardless of geography, participants similarly rated the presented AMI prevention messages, barriers, and motivators. With the use of these findings, the development of an AMI prevention program is suggested to use messaging about AMI threat, behavioral management, and behavioral prevention.

Hospital outcomes in major depression among older adults: differences by alcohol comorbidity.

OBJECTIVE: The prevalence of depression in older adults has been increasing over the last 20 years and is associated with economic costs in the form of treatment utilization and caregiving, including inpatient hospitalization. Comorbid alcohol diagnoses may serve as a complicating factor in inpatient admissions and may lead to overutilization of care and greater economic cost. This study sought to isolate the comorbidity effect of alcohol among older adult hospital admissions for depression. METHODS: We analyzed a subsample (N = 8,480) of older adults (65+) from the 2010 Nationwide Inpatient Sample who were hospitalized with primary depression diagnoses, 7,741 of whom had depression only and 739 of whom also had a comorbid alcohol disorder. To address potential selection bias based on drinking and health status, propensity score matching was used to compare length of stay, total costs, and disposition between the two groups. RESULTS: Bivariate analyses showed that older persons with depression and alcohol comorbidities were more often male (59.9% versus 34.0%, p <.001) and younger (70.9 versus 75.9 years, p <.001) than those with depression only. In terms of medical comorbidities, those with depression and alcohol disorders experienced more medical issues related to substance use (e.g., drug use diagnoses, liver disease, and suicidality; all p <.001), while those with depression only experienced more general medical problems (e.g., diabetes, renal failure, hypothyroid, and dementia; all p <.001). Propensity score matched models found that alcohol comorbidity was associated with shorter lengths of stay (on average 1.08 days, p <.02) and lower likelihood of post-hospitalization placement in a nursing home or other care facility (OR = 0.64, p <.001). No significant differences were found in overall costs or likelihood of discharge to a psychiatric hospital. CONCLUSIONS: In older adults, depression with alcohol comorbidity does not lead to increased costs or higher levels of care after discharge. Comorbidity may lead to inpatient hospitalization at lower levels of severity, and depression with alcohol comorbidity may be qualitatively different than non-comorbid depression. Additionally, increased costs and negative outcomes in this population may occur at other levels of care such as outpatient services or emergency department visits.

The relationship between midlife and late life alcohol consumption, APOE e4 and the decline in learning and memory among older adults.

AIMS: The aim of the study was to determine whether the trajectory of learning and memory is modified according to an interaction between midlife or late life alcohol consumption status and the presence of one or more APOE e4 alleles. METHODS: This was a secondary analysis of cognitive, genetic and alcohol consumption data collected from members of the Framingham Heart Study Offspring Cohort. RESULTS: Light and moderate alcohol consumption during late life was associated with greater decline in learning and memory among APOE e4 carriers, whereas light and moderate alcohol consumption was associated with an increase in learning and memory among non-APOE e4 carriers. There was not a significant interaction between midlife alcohol consumption status and APOE e4 on the trajectory of learning and memory. CONCLUSION: Light to moderate alcohol consumption during late life may protect against a decline in learning and memory for non-APOE e4 allele carriers, but not for older adults who carry one or more APOE e4 alleles.

Alzheimer's Disease Risk Reduction Health Coaching: Comparative Analysis.

BACKGROUND AND OBJECTIVES: Recent guidelines point to lifestyle as a tool for decreasing Alzheimer's disease (AD) risk. To address the limited practice and availability of AD risk reduction interventions, this study aimed to explore the feasibility of a community-level lifestyle intervention targeting high-risk groups. RESEARCH DESIGN AND METHODS: Diverse older adults (60+) living in the Richmond, VA local area, with the following risk factors, incomes below $12,000/year and managing diabetes or cardiovascular disease, were offered weekly lifestyle telephone health coaching for 12 weeks in 2019-2020 (intervention group). The health coaching sessions provided AD lifestyle risk reduction education and goal setting/planning. The intervention sample (n=40, mean age 68 years (range: 60-76 years)) was 90% African American/Black (n=36) and 45% male (n=18). Thereafter in 2021-2022, n=37 individuals in the same area were recruited as a comparison group and not given health coaching (control group), mean age 65.5 years (range: 57-83 years), 92% African American/Black (n=34), and 50% male (n=18). RESULTS: Repeated measures intervention effects were seen for cognitive ability, indicating greater improvement in the intervention group (p<.01). Significant difference scores indicated greater cognitive ability (p<.01) and physical activity (p<.001) gains in the intervention group, with intervention subjects with reported memory problems showed relatively less physical activity gains (p<.05). DISCUSSION AND IMPLICATIONS: This work creates the impetus for future large-scale AD risk reduction investigations to mitigate and improve modifiable risk among diverse older adults. Our positive trends in AD risk reduction support telephone-based health coaching as a feasible AD risk reduction intervention.

Special Focus Facilities vs Special Focus Facility Candidates: What is the Difference?

OBJECTIVES: This study compares Special Focus Facilities (SFFs) and Special Focus Facility Candidate Facilities (SFFcs) on organizational traits and quality outcomes to evaluate the effectiveness of the SFF program as a quality improvement intervention and inform potential areas for program reform. DESIGN: This is a retrospective analysis. SETTINGS AND PARTICIPANTS: Using data from the Centers for Medicare and Medicaid Services archives for 2020, this retrospective study analyzed 247 nursing facilities (50 SFFs and 197 SFFcs). METHODS: Variables of interest were staffing, profit status, facility size, certification status, number of residents, and complaint citations: t tests, χ2, Fisher's Exact test, and multivariate analysis of variance were used to compare the 2 groups. RESULTS: From an organizational perspective, SFFs and SFFcs are minimally different. Both groups had similar facility size, profit status, hospital affiliation, continuing care retirement community status, and Medicare/Medicaid certification. Large and for-profit facilities were overrepresented in both groups. SFFs and SFFcs exhibited statistical differences in the number of complaint deficiencies. The groups had no significant difference in staffing levels, category, severity of complaints, or incident reports. CONCLUSIONS AND IMPLICATION: The study's findings suggest that the SFF program, while resource-intensive, is minimally impactful. The similarities between SFFs and SFFcs raise questions about the program's effectiveness in improving nursing facility care. Previous adjustments to the program may not have successfully achieved the desired quality improvements. This research highlights the need to further evaluate the SFF program's effectiveness as a quality improvement intervention. It also underscores the importance of addressing biases and subjectivity in state survey agency processes, which affect the enrollment of nursing facilities. The study underscores the flaws within the nursing home monitoring system and the 5-star quality rating system, especially when comparing small samples between states.

Alcohol effects on cognitive change in middle-aged and older adults.

OBJECTIVES: This study examines cognitive outcomes for alcohol drinking status over time, across cognitive ability and age groups. METHODS: Data (1998-2005) from n = 571 Seattle Longitudinal Study participants aged 45+years (middle-aged: 45-64, young-old: 65-75, old-old: 75+) were analyzed to examine the alcohol drinking status effect (e.g., abstinent, moderate (less than seven drinks/week), at-risk (more than eight drinks/week)) on cognitive ability (e.g., memory, reasoning, spatial, verbal number, speed abilities). RESULTS: Findings indicated that alcohol drinking status was associated with change in verbal ability, spatial ability, and perceptual speed. Decline in verbal ability was seen among alcohol abstainers and moderate alcohol consumers, but at-risk drinkers displayed relative stability. At-risk old-old adults and middle-aged adults (regardless of drinking status), displayed relative stability in spatial ability. Decline in spatial ability was however present among young-old adults across drinking status, and among abstaining and moderate drinking old-old adults. At-risk drinkers showed the most positive spatial ability trajectory. A gender effect in perceptual speed was detected, with women who abstained from drinking displaying the most decline in perceptual speed compared with women that regularly consumed alcohol, and men displaying decline in perceptual speed across drinking status. DISCUSSION: In this study, consuming alcohol is indicative of cognitive stability. This conclusion should be considered cautiously, due to study bias created from survivor effects, analyzing two time points, health/medication change status, and overrepresentation of higher socioeconomic status and white populations in this study. Future research needs to design studies that can make concrete recommendations about the relationship between drinking status and cognition.

Introduction to the JPIC issue, Aging in older adulthood: Community-level intervention programming and partnerships providing older adults with community health promotion opportunities.

Community-level health promotion programs offer opportunities to improve the lives of older adults and improve the cultural narrative about aging. However, age-discrimination, ageism, and negative attitudes about aging, across the systematic ecological community levels have undermined older adult health. While the longevity of a society is a marker for success worldwide, age-discrimination and ageism, seen through limited community-level health advancement opportunities, have thwarted progress toward societal elderhood, even in the most developed and advanced nations. As a society, we need to continue to push for community-level prevention and intervention across the older age spectrum, to continue human advancement through late life.

Understanding the preference for receiving mental health and substance use support in African Americans 50 and older.

OBJECTIVE: This study aims to determine whether current tobacco and/or alcohol use is associated with setting preferences for seeking support for substance use (SU) and mental health (MH) services to African Americans ages 50 and older. METHODS: Data from 368 African American individuals (aged 50+) who participated in a community-based needs assessment survey were used. Preferences included community-based (e.g., health centers) and traditional settings (e.g., doctor's office). SU was measured as a categorical variable detailing past-month use of conventional cigarettes and alcohol graded by risk levels. Logistic regression models tested the associations between SU and setting preference before and after adjusting for the influence of self-reported MH diagnoses. RESULTS: Prior to adjustment for the influence of MH outcomes, high-risk use of tobacco and alcohol in the past month was associated with a lower odds of preferring MH/SU support in traditional settings (OR = 0.23, 95% CI = 0.06-0.85) compared to participants engaged in no-/low- risk substance use. This association was no longer significant after accounting for the influence of mental health symptoms and covariates. DISCUSSION: These results provide preliminary evidence that mental health outcomes mediate the association between substance use and setting preference for seeking MH/SU support in traditional settings. TRANSLATIONAL SIGNIFICANCE: This exploratory study encourages additional investigation of the association between substance use, setting preferences, and the likelihood of seeking treatment in community health centers using larger sample sizes. Additional opportunities to offer mental health/substance use support to African American older adults within clinical settings should be explored.

Creating structural community cohesion: Addressing racial equity in older adult homelessness.

Older adults and racial minorities are overrepresented in homeless populations. Shelter and housing options for homeless older adults who have complex health and social needs are necessary, but not readily available. Older homeless adults that require, but do not receive, health-sensitive, age-sensitive, and racial equity housing, remain vulnerable to poor outcomes and premature mortality. Accordingly, this study examines the development of a coalition to better address older adult homelessness within a racial equity framework. A community coalition was established to better address older adult homelessness within the lens of age-sensitivity and racial equity, due to a disconnect between healthcare and senior housing placement programs, creating unaddressed multifaceted health issues/complications. The community coalition development is described, including the coalition process, activities, and outcomes. Local rehoused older adults are also interviewed and described to better understand their central life circumstances.

Evaluation of the Mental Healthiness Aging Initiative: community program to promote awareness about mental health and aging issues.

The objective of this study is to evaluate the Mental Healthiness Aging Initiative, designed to promote community awareness and knowledge about mental health and aging issues. This study occurred during 2007-2009 in 67 of 120 counties in Kentucky. A rural region (11 counties) received the intervention, consisting of focus groups, Extension Agent training, and television-based social marketing campaign. Partial-intervention counties (29 counties) received only the television-based social marketing campaign. The control counties (27 counties) received no intervention activities. Results indicated that the intervention counties agreed more with being able to assist elder adults with a potential mental illness. Also, the intervention counties understood the risk of consuming alcohol and medications better, but had a poorer recognition of drinking problems in elder adults. These findings need to be considered within study limitations, such as measurement error, degree of intervention exposure, and regional differences across intervention groups. The study demonstrates that community interventions on mental health awareness and knowledge are feasible within majority rural regions, with Extension Agents being gatekeepers, for promoting positive messages about mental health and aging issues.

Mental health and aging initiative: intervention component effects.

INTRODUCTION: The objective of this investigation is to evaluate the Mental Healthiness and Aging Initiative (MHAI) intervention. The MHAI was created to promote awareness and knowledge about mental health/substance (MH/SA) use and aging issues in rural Kentucky, USA, due to limitations in formal and informal mental health care and treatment resources as a result of multilevel barriers in rural regions and effects on health, wellbeing and quality of life. METHODS: This investigation took place between 2010 and 2011 in two rural counties in Kentucky. Participants from two counties were recruited through an email solicitation sent to Kentucky cooperative extension agents (university-affiliated community liaisons). Individuals participated in a two-hour intervention session covering facts and information, application exercises, and community tools for addressing late-life mental health and substance abuse. Effectiveness was evaluated by examining changes in attitudes and knowledge about MH/SA and aging from pre-test to post-test and again 3 months and 6 months later. The evaluation survey examined mental health and substance abuse awareness (six questions) and knowledge (13 questions) and was previously piloted and designed for the current study ensuring face validity. Seven individual linear mixed models were analyzed using each of the six awareness questions and an additional model using an aggregate score across the knowledge questions representing the total percent correct for knowledge questions. RESULTS: The participating sample (n=55) was 65.35 years of age on average, with the majority being female (85%), white (100%), married (69%), living with a spouse/partner only (68%), high school educated (57%) and having a total household income averaging US$44,199. The findings indicated sustained improvement in awareness and knowledge about MH/SA and aging. Results also indicated that there is a need to improve maintenance of knowledge regarding older adult alcohol consumption risk, clinical provider communication about mental health, identifying/recognizing mental health problems, and older adult retention of their mental abilities based on long-term retention rates. These indicators had below 90% correctness at 6 months, despite having 90%+ accuracy at post-assessment, immediately after the intervention administration. CONCLUSIONS: This study demonstrates that community interventions for MH/SA awareness and knowledge are effective within majority rural regions. As currently designed, implementing the MHAI intervention program is feasible. Evidence from the current study indicates that community residents (including rural individuals) can be recruited to participate in a program about MH/SA and aging, and as an outcome have increased awareness and knowledge about MH/SA and aging. Future research will need to explore how to utilize MHAI-type intervention programs to a point where the mental health of rural adults can be improved. Specifically, further investigation is needed to examine whether community mental health awareness interventions, such as the MHAI intervention program, can lead to earlier detection of MH/SA issues among older adults and increase treatment rates. If so, community mental health workers and facilities can expect such interventions to increase local residents' awareness of their services and likelihood of utilizing mental health services. Future research needs to enhance generalizability and ensure that improved knowledge and awareness translates into improved mental health in rural regions.

Substance use and mental health problems among graduate students: Individual and program-level correlates.

OBJECTIVE: This study evaluated variation in substance use and mental health among graduate student subgroups. PARTICIPANTS: A sample of 2,683 master's and doctoral students completed an online survey in October 2017. METHODS: Subgroup variation in behavioral health by demographic and program characteristics, particularly degree type and academic discipline, was explored. RESULTS: Compared with academic doctoral students (ie, PhD students), professional doctoral students (ie, MD, JD, etc.) were significantly more likely to report high stress levels and moderate or severe anxiety symptoms. Master's students were more likely to report moderate or severe anxiety symptoms and use marijuana than academic doctoral students. Students in the behavioral and social sciences, social work, and arts and humanities disciplines were more likely to use substances and report mental health problems than engineering and business students. CONCLUSIONS: These findings highlight graduate student subgroups who might require closer attention with respect to access to behavioral health services.

Graduate student burnout: Substance use, mental health, and the moderating role of advisor satisfaction.

Substance use and mental health problems are associated with academic difficulties among high school and undergraduate students, but little research has been conducted on these relationships among graduate students. The sample consisted of 2,683 graduate students attending two large, public universities. Standard measures were used to collect data on demographic and program characteristics, mental health, substance use, advisor satisfaction, and burnout (i.e., exhaustion, cynicism, and inefficacy). Linear regression models evaluated relationships between each mental health and substance use variable with burnout, as well as the moderating role of advisor satisfaction. Students with a greater number of substance use and mental health problems had higher levels of exhaustion, cynicism, and inefficacy. No statistically significant relationships between substance use and burnout were found. High levels of stress, moderate or severe anxiety symptoms, and moderate or severe depressive symptoms were associated with increased levels of burnout. Advisor support moderated the relationships between stress and both cynicism and inefficacy such that the effects of stress on these dimensions of burnout were lower among those who were satisfied with their advisor. Graduate students with mental health problems might be at increased risk for burnout; however, having a supportive advisor might buffer this association.

Socioeconomic Effects on Psychosocial Factors Among Low-Income Older Adults.

OBJECTIVES: Older adults have been disproportionately affected by COVID-19. The primary goal of this study is to determine the socioeconomic effects on psychosocial factors among low-income independent-living older adults, in an urban setting, during the COVID-pandemic. METHODS: Participants were recruited through Virginia Commonwealth University's Richmond Health and Wellness Program. Telephone surveys (n=100) were conducted using the Epidemic - Pandemic Impacts Inventory Geriatric with the Racial/Ethnic Discrimination addendum. Responses were analyzed for income and education effects across seven domains: home life, social activities/isolation, economic, emotional health-wellbeing, physical health, COVID-infection history, and positive change behaviors/experiences. RESULTS: The sample population was between 51 and 87 years of age, 88% were Black, 57% reported incomes of $10,000/year or less, and 60% reported a high-school education or less. There were income effects for social activities/isolation (f = 3.69, p<.05) and positive change (f = 8.40, p<.01), and education effects for COVID History (f = 4.20, p <.04). DISCUSSION: Overall results highlight the social patterns for a diverse sample of low-income urban older adults; education and income are identified as risk factors for social losses, COVID-infection experiences, racial/ethnic discrimination during the COVID-pandemic, and positive change behaviors.