Increasing Social Connectedness for Underserved Older Adults Living With Depression: A Pre-Post Evaluation of PEARLS.

OBJECTIVE: To evaluate PEARLS effectiveness for increasing social connectedness among underserved older adults with depression. DESIGN: Multisite, pre-post single-group evaluation. SETTING: Community-based social service organizations (N = 16) in five U.S. states, purposively sampled for maximum variation of participants and providers. PARTICIPANTS: A total of 320 homebound older adults (mean(SD) age 72.9(9.6), 79% female, 44% people of color, 81% low-income, 61% living alone, average four chronic conditions) with clinically significant depression (PHQ-9 mean(SD) 12.7(4.6)). INTERVENTION: Four to 6 month home-based depression care management model delivered by trained front-line providers. MEASUREMENTS: Brief validated social connectedness scales: Duke Social Support Index 10-item (DSSI-10), PROMIS-Social Isolation (6-item), UCLA-Loneliness (3-item); sociodemographic and health measures. RESULTS: At baseline, PEARLS participants overall and with ≥1 of the following characteristics were less socially connected: younger (50-64), white, LGBTQ+, not partnered, not caregiving, living alone, financial limitations, chronic conditions, and/or recently hospitalized. Six-months post-PEARLS enrollment, participants significantly increased social interactions and satisfaction with social support (DSSI-10 t[312] = 5.2, p <0.001); and reduced perceived isolation (PROMIS t[310] = 6.3, p <0.001); and loneliness (UCLA t[301] = 3.7, p =0.002), with small to moderate effect sizes (Cohen's d DSSI-10: 0.28, PROMIS-SI: 0.35, UCLA: 0.21). Increased social connectedness was associated with reduced depression. Improvements in social connectedness (except social interactions) persisted during early COVID-19. Being Latino and/or having difficulty paying for basic needs was associated with less improvement in post-PEARLS social connectedness. CONCLUSION: PEARLS has potential to improve social connectedness among underserved older adults, though additional supports may be needed for persons facing multiple social determinants of health. Further research is needed to establish causality.

Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters.

PURPOSE: An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC). METHODS: Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding important contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research. RESULTS: Key contextual factors involve complementary perspectives across multiple levels: public policy, community, health care systems, family, and person, as well as the cellular and molecular levels where most research currently is focused. Needed research involves moving from a disease focus toward a person-driven, goal-directed research agenda. Relevant research methods are participatory, flexible, multilevel, quantitative and qualitative, conducive to longitudinal dynamic measurement from diverse data sources, sufficiently detailed to consider what works for whom in which situation, and generative of ongoing communities of learning, living and practice. Important partnerships for collaborative action include cooperation among members of the research enterprise, health care providers, community-based support, persons with MCC and their family and friend caregivers, policy makers, and payers, including government, public health, philanthropic organizations, and the business community. CONCLUSION: Consistent attention to contextual factors is needed to enhance health research for persons with MCC. Rigorous, integrated, participatory, multimethod approaches to generate new knowledge and diverse partnerships can be used to increase the relevance of research to make health care more sustainable, safe, equitable and effective, to reduce suffering, and to improve quality of life.

A Brief Intervention for Malnutrition among Older Adults: Stepping Up Your Nutrition.

Despite a multitude of nutritional risk factors among older adults, there is a lack of community-based programs and activities that screen for malnutrition and address modifiable risk among this vulnerable population. Given the known association of protein and fluid consumption with fall-related risk among older adults and the high prevalence of falls among Americans age 65 years and older each year, a brief intervention was created. Stepping Up Your Nutrition (SUYN) is a 2.5 h workshop developed through a public/private partnership to motivate older adults to reduce their malnutrition risk. The purposes of this naturalistic workshop dissemination were to: (1) describe the SUYN brief intervention; (2) identify participant characteristics associated with malnutrition risk; and (3) identify participant characteristics associated with subsequent participation in Stepping On (SO), an evidence-based fall prevention program. Data were analyzed from 429 SUYN participants, of which 38% (n = 163) subsequently attended SO. As measured by the SCREEN II®, high and moderate malnutrition risk scores were reported among approximately 71% and 20% of SUYN participants, respectively. Of the SUYN participants with high malnutrition risk, a significantly larger proportion attended a subsequent SO workshop (79.1%) compared to SUYN participants who did not proceed to SO (65.8%) (χ2 = 8.73, p = 0.013). Findings suggest SUYN may help to identify malnutrition risk among community-dwelling older adults and link them to needed services like evidence-based programs. Efforts are needed to expand the delivery infrastructure of SUYN to reach more at-risk older adults.

Building a foundation for systems change: increasing access to physical activity programs for older adults.

Although 25% of U.S. adults are physically inactive, this percentage increases dramatically for older adults. Organizational change theory guided a state health department in identifying system gaps and developing strategies to expand programming for seniors. A survey of provider agencies in New Jersey assessed (a) capacity for physical activity programs for older adults, (b) accessibility of programs, and (c) barriers to providing programs. One hundred sixty agencies provided physical activity programs to almost 184,000 individuals annually. Fewer than one half of the agencies provided exercise programs for people with disabilities, and only 44% provided in-home programs. Eighty-two percent of program providers wanted to expand programming but cited lack of trained instructors and peer leaders, inadequate facility space, insufficient funding, and limited transportation resources as barriers. Sustaining older adult behavior change requires infrastructure that will ensure access to diverse physical activities. This article provides strategies to expand access to physical activity programs for older adults.

Advocacy 101: getting started in health education advocacy.

Advocacy for the public's health and for the profession are widely recognized as responsibilities of health educators. Increasing emphasis on advocacy by professional organizations has peaked the interest of health educators, yet knowing where to begin as an advocate is, to many, a mystifying process. This article provides basic advocacy terminology, dispels concerns about participating in advocacy activities, and provides a practical and stepped approach to becoming an effective advocate. A tiered approach is used in relation to the advocacy strategies of voting behavior, electioneering, direct lobbying, grassroots lobbying, Internet use, and media advocacy to help individuals in their quest to begin or enhance their engagement in advocacy. A compendium of highly accessible resources is also provided. Finally, this article provides motivation for the beginning advocate.

The health educator's role in advocacy and policy: principles, processes, programs, and partnerships.

Advocacy skills are essential for the public health practitioner. Recognizing this need, two statewide public health organizations partnered for a series of advocacy trainings. Outcomes included an increased competence for such advocacy as providing expert testimony, writing position papers, forging stronger relationships with policy makers, and committing to ongoing advocacy. An increase in statewide initiatives also included a legislative scorecard, development of a model advocacy network by voting districts, advocacy policy for associations, fact sheets for legislators on pending public health issues, a new university advocacy course, and advocacy action by two associations' members to reach common goals. The trainings and subsequent initiatives provide a template for organizations and individuals to build advocacy skills and increase the role of public health professionals in setting state public health policy.