"I'm Part of Something That Matters": Exploring What Older Adults Value Through Their Engagement in Age-Friendly Community Initiatives.

Older adults' engagement in age-friendly community (AFC) initiatives is considered an essential element of community transformation. However, research on older adults' experiences of engaging in AFC initiatives remains nascent. Based on qualitative interviews with 23 older adult participants from 15 AFC initiatives across four states in the United States (U.S.), our reflexive thematic analysisidentified three themes regarding what participants value from their engagement: (a) social contribution; (b) social connectedness and integration; and (c) staying active and personal growth. Exploring older adults' interest in contributing to, connecting with, and growing in their community can inform recruitment and retention in AFC initiatives.

Trust in physicians, health insurance, and health care utilization among Chinese older immigrants.

OBJECTIVE: Trust in physicians (TIP) plays a critical role in the health care utilization (HCU) of minority older adults and older immigrants. Although previous studies suggested that TIP was positively associated with primary care visits, negatively associated with Emergency Room (ER) visits and hospitalization among African Americans in the United States (U.S.), it is unclear whether and how TIP influences various types of HCU among Chinese older immigrants, a fast-growing group of minority older immigrants in the U.S. Furthermore, despite the important role insurance plays in HCU and health disparities, few studies have tested whether TIP influences the HCU of the insured and uninsured Chinese older immigrants differently. Therefore, this study aims to examine the role of TIP in three types of HCU (physician visits, ER visits, and hospitalization) among Chinese older immigrants and whether the associations differ by insurance status. DESIGN: The data were derived from the Population Study of ChINese Elderly in Chicago (PINE), N = 3,157. The sample is representative of Chinese older immigrants (60+ years) in Chicago. Guided by Andersen's behavioral model, hierarchical regression analyses examined the role of TIP in physician visits, ER visits, and hospitalization among Chinese older immigrants. An interaction term was added to examine whether the aforementioned associations differed by insurance status. RESULTS: TIP was positively associated with the likelihood of physician visits (Odds Ratio [OR] = 1.07, p < 0.001) but not with ER (OR = 1.02, p = 0.054) or hospitalization (OR = 1.01, p = 0.13). The results of the moderation analyses further showed that TIP was more positively associated with ER visits (OR=0.94, p=0.006) and hospitalization (OR = 0.93, p = 0.004) among the uninsured population, compared to those insured. CONCLUSIONS: TIP played an important role in facilitating primary care visits among Chinese older immigrants regardless of insurance status. Additionally, TIP facilitated the ER visit and hospitalization among uninsured Chinese older immigrants.

I Wanna help, but my Hands can be a Little Tied: The Challenges and Benefits of Formal Volunteering among Low-Income Diverse Older Adults.

Volunteering is often considered an important component of productive and active aging. Although there is a rich body of literature on the predictors and outcomes of volunteering among the general older adults in the United States (U.S.), few studies have explored the unique volunteering experiences of culturally and linguistically diverse older adults. Given the growing number of diverse older adults and the importance of optimizing their contributions to society, this study investigates the challenges and benefits of volunteering among low-income diverse older adults. We conducted eight 90-minute focus groups in six languages (English, Nepali, Khmer, Somali, Russian, and Chinese) with 70 older volunteers attending a Senior Companions monthly training in a U.S. Midwestern metropolitan area. Data analysis followed the Rapid and Rigorous Qualitative Data Analysis (RADaR) technique and thematic analysis through an interactive team approach. Three overarching themes highlighted the challenges of volunteering: (1) transportation, (2) community emergencies and workload, and (3) family caregiving; and three themes reflected the benefits of volunteering: (1) stress-relief, (2) training and information, and (3) peer support and socialization. Study findings shed light on diverse older adults' unique volunteering experiences with implications for recruitment and retention.

Recovery Support and Capacity Assessment Using the Calculating an Adequate System Tool: Two Case Studies.

BACKGROUND: There are multiple, reliable, and authoritative federally managed data sources for understanding the incidence and prevalence of substance use disorder (SUD) and its sequela. However, there remains a gap in metrics representing the need and capacity for treatment and related supports within local communities. To address this challenge, Calculating an Adequate System Tool (CAST) was developed in 2016 by an interdisciplinary group of researchers at the Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality to assess the capacity of the SUD care system within a defined geographic area. It allows for risk assessment of local social and community determinants of substance abuse, as well as an assessment of local service needs across the continuum of SUD care. METHODS: This article describes the application of the CAST to 2 counties in Ohio and 1 county in Montana. The purpose of using CAST for each area, results of the application, and experiences in utilizing the tool are described. RESULTS: Application of the CAST demonstrated unique findings within each of the geographic areas. In Ohio, recovery support services were lacking in both counties assessed, while differences in crime rate and alcohol outlet density were attributed to varying rates of drug-related hospitalization. Notable findings in Montana included an oversaturation of coalitions focused on substance use prevention and gaps in the areas of detoxification services, partial day treatment, recovery residences, and peer support specialists. CONCLUSIONS: CAST is a useful tool for guiding decision-making relative to substance use care needs and capacities for local geographic areas. Findings should be interpreted thoughtfully and in the context of data availability. CAST continues to be enhanced and further expanded for assessing capacity of local and statewide substance use care systems.

A Mixed-Method Social Network Analysis of Low-Income Diverse Older Volunteers.

Although volunteering has been associated with numerous social benefits for diverse older adults, there is little information on how they establish relationships within a multicultural volunteering program outside of their co-ethnic communities. This convergent mixed-method social network study adopts the bonding and bridging social capital theory to explore the structures and dynamics of social interactions within a multicultural volunteer program. Low-income Russian, Khmer, Somali, Nepali, and English-speaking older volunteers in the Senior Companions Program (SCP) in a Midwest metropolitan (N = 83) participated in the surveys and focus groups. Homophily coefficients (r) show that the SCP volunteers mostly interacted with people who identified with the same nationality (r = .86), race (r = .87), and gender (r = .50). Qualitative results suggested that volunteers strengthened their social networks through within-cultural social bonding while appreciating opportunities for cross-cultural social bridging. Compared with within-cultural social bonding, cross-cultural social bridging in multicultural volunteer programs require intentional facilitation, resources, and organizational commitment.

The Loneliness of Low-Income Older Adults in a Federal Volunteering Program: A Network Perspective.

Volunteering has been associated with increased social interactions and reduced feelings of loneliness among older adults. However, a growing number of social network analyses (SNA) conducted in the general population outside of volunteering contexts suggest that lonely individuals tended to interact with other lonely individuals in the network, reinforcing loneliness through peer associations. To better understand the psychosocial impact of peer interactions among older adults within volunteer programs, this study examines how older adults' loneliness is correlated with their peers' loneliness within the Senior Companions Program (SCP). This study collected information on the social networks within an SCP in a Midwest Metropolitan and feelings of loneliness among low-income Russian, Khmer, Somali, Nepali, and English-speaking older volunteers (N = 41). A linear network autocorrelation model (LNAM) was constructed to quantify how volunteers' loneliness is correlated with their peers' loneliness within SCP. The LNAM results indicated that less lonely volunteers tended to make friends with lonelier volunteers (ρ = -.06, p < .05) in SCP even when accounting for statistical controls. The finding that more and less lonely individuals connect indicates an altruistic tendency for less lonely individuals to interact with those who are lonelier. This may be an important pathway by which volunteering addresses loneliness.

Developing a typology of network alteration strategies for implementation: a scoping review and iterative synthesis.

BACKGROUND: Social networks transmit knowledge, influence, and resources. These relationships among patients, professionals, and organizations can shape how innovations are disseminated, adopted, implemented, and sustained. Network alteration interventions-interventions that change or rewire social networks-have the potential to be used as implementation strategies. Yet, the types, mechanisms, and effectiveness of these interventions for implementation are unclear. This scoping review and iterative synthesis identified and described network alteration strategies that could be tested for implementation. METHODS: We used forward and backward citation tracking of influential articles on network interventions, bibliometric searches, and hand searches of peer-reviewed social network journals. At least two team members screened article titles/abstracts to identify studies that met inclusion criteria: empirical studies of an intervention, the intervention was designed to alter some element of a social network, and changes in social network metrics were measured at two or more time points. During full-text reviews, information about the network interventions, actors, ties, and main findings was extracted. Reporting was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). To develop our typology, we synthesized these results using an iterative team-based and consensus-building process. RESULTS: Fifty-three articles met the inclusion criteria. The interventions described were conducted in healthcare systems or behavioral health systems (34%), communities (26.4%), and schools (22.6%). The majority included records describing interventions designed to alter social support, information-sharing, or friendship networks (65%) among individual actors (84.9%), or to increase ties. Eight strategies emerged. Three strategies targeted the general context: (1) change the environment, (2) create groups, and (3) change the composition. Four strategies targeted individual actors: change (4) motivations, (5) skills for networking, (6) knowledge of one's social network, and (7) prominence/roles. One strategy (8) targeted specific ties within the network (targeting a particular pair-wise relationship or changing the nature of an existing tie). CONCLUSION: The network alteration strategies in this typology provide further operational specificity for how implementation strategies target relationships. Advancing these strategies will require greater theoretical specification, the development of strategies that target professionals and organizations, and studies that examine the impact on implementation outcomes.

Social Cognitive Theory, Driving Cessation, and Alternative Transportation in Later Life.

Having viable alternative transportation options could help individuals stop driving when appropriate. This study employs the Social Cognitive Theory (SCT) to understand the barriers and facilitators of alternative transportation among a sample of adults aged 55 and older (N = 32). Using a daily transportation data collection app, MyAmble, the research team asked participants questions structured around environmental, individual, and behavioral factors as outlined in the SCT framework. Responses were analyzed using directed content analysis. Findings suggest a substantial reliance on motor vehicles and it was evident that many participants had never seriously considered what they would do if they could no longer drive. We posit that SCT principles may be applied to help older adults build self-efficacy to transition to driving cessation when needed.

Individual- and group-level network-building interventions to address social isolation and loneliness: A scoping review with implications for COVID19.

PURPOSE: Worldwide mandates for social distancing and home-quarantine have contributed to loneliness and social isolation. We conducted a systematic scoping review to identify network-building interventions that address loneliness and isolation, describe their components and impact on network structure, and consider their application in the wake of COVID19. METHODS: We performed forward and backward citation tracking of three seminal publications on network interventions and Bibliographic search of Web of Science and SCOPUS. We developed data charting tables and extracted and synthesized the characteristics of included studies, using an iteratively updating form. FINDINGS: From 3390 retrieved titles and abstracts, we included 8 studies. These interventions focused on building networks at either individual- or group-levels. Key elements that were incorporated in the interventions at varying degrees included (a) creating opportunities to build networks; (b) improving social skills; (c) assessing network diagnostics (i.e. using network data or information to inform network strategies); (d) promoting engagement with influential actors; and (e) a process for goal-setting and feedback. The effect of interventions on network structures, or the moderating effect of structure on the intervention effectiveness was rarely assessed. CONCLUSIONS: As many natural face-to-face opportunities for social connection are limited due to COVID19, groups already at risk for social isolation and loneliness are disproportionately impacted. Network-building interventions include multiple components that address both the structure of individuals' networks, and their skills and motivation for activating them. These intervention elements could be adapted for delivery via online platforms, and implemented by trained facilitators or novice volunteers, although more rigorous testing is needed.

Age-friendly communities and perceived disconnectedness: the role of built environment and social engagement.

Objective: To examine the effect of access to outdoor space and buildings and social or community events on elders' perceived disconnectedness. Method: Data were from a representative survey conducted as part of an age-friendly community initiative in a large midwestern city in the United States. Hierarchical logistic regression was employed to examine the relationships between environment, engagement, and connection. Results: Having access to ramps to enter buildings reduced the odds of perceived disconnectedness by 79%, participation in social or community events reduced the odds of perceived disconnectedness by 83%. The odds of perceived disconnectedness for elders "not sure" of their access to public buildings were around 6 times that of those without access, holding all else constant. Discussion: Ensuring access to ramps to enter buildings, disseminating information about the accessibility of parks and buildings, and social or community events may reduce elders' perceived disconnectedness.