It was clear by March 2020 that older adults were at greatest risk for severe complications and death from COVID-19. Yet many had little access to accurate, easy-to-use information or support to protect themselves from the virus.
As lockdowns kept most of society housebound to limit the spread of the illness, many geriatricians and healthcare professionals feared that older adults would face special challenges to getting needed healthcare.
That concern prompted Marian Ryan, PhD, MPH, chief policy and research officer for the Institute for Healthcare Advancement (IHA), to contact UCI Health geriatricians Dr. Lisa Gibbs, director of the UCI Health SeniorHealth Center, and Dr. Sonia Sehgal for help in devising a method to give at-risk older adults timely information about the pandemic and ways to prevent infection.
Ryan proposed a research study to test an innovative approach to keep seniors safe during the pandemic: a resource kit explaining how to protect themselves from COVID-19 and teaching them to use technology to schedule telehealth visits, speak with their doctors and connect with loved ones while in lockdown.
Designing the study
Gibbs, chief of the UCI School of Medicine’s division of Geriatric Medicine and Gerontology, and Sehgal, a UCI professor and Archstone Endowed Chair in Geriatrics, helped Ryan obtain a $20,000 campus-community research incubator grant for the study from the university’s Institute for Clinical Translational Science (ICTS). The geriatricians also used their considerable research prowess to design the study, gather preliminary data and provide research staff.
Ryan developed the Senior Health Resource Kit, which included a book geared toward seniors’ healthcare concerns, a magnifying bookmark for easier reading, an LED light to prevent nighttime falls along with other useful items. They’d hoped to include hand sanitizer, gloves and masks but those were unavailable early in the pandemic.
Ryan’s colleague Rachel Roberts, MPH, manager of community health engagement and strategy at IHA, partnered with existing senior food programs and senior centers in La Habra, Calif., to distribute the kits because they already had pivoted to home delivery of meals.
The research study’s prime directive: Could these kits positively affect awareness and knowledge of COVID-19, encourage telehealth doctor visits, improve exercise habits and alleviate loneliness for seniors?
“We hoped the results from this study would inform a new model of healthcare and community collaboration to reach underserved populations with variable health literacy competencies,” says Gibbs.
Creating the resource kit
All potential study enrollees received the resource kit, which included a cover letter describing the study and inviting them to join it. They also received:
- The “What to Do for Senior Health” booklet
- A COVID-19 flyer with a list of resource and crisis telephone numbers and helpful websites
- A fall prevention booklet and exercise DVD
- An advanced directive with instructions on how to make their healthcare wishes known in the event of severe illness or incapacity
- An LED light to help prevent nighttime falls
- A magnifying bookmark, eyeglass cleaner and cloth to make reading easier.
All written materials were available in both English and Spanish.
From October 2020 through February 2021, kits were distributed to 203 people, ages 60 and older, 98 of whom were enrolled in the study. Participants were divided in half, a control group that received only the kit and the others who received follow-up coaching calls.
In addition, three participant groups were interviewed by video and telephone from February to June 2021 to collect data.
Stress levels off the charts
During the pandemic, most people reportedly experienced elevated stress levels. Seniors were no exception. Anxiety, constant worry, loneliness and grief because of the loss of loved ones were the greatest contributors, study participants told interviewers.
Almost everyone said they knew someone who had died during the pandemic and expressed how difficult it was to cope without having the support of family and friends because of lockdowns.
They also described being mentally “down” and feeling very much alone.
“One participant described her neighborhood as very friendly prior to the pandemic but then everyone stopped interacting or even waving because there was so much fear,” says Ryan.
But these older adults said participating in the study helped them feel safe and supported, “like someone cares and is listening to us,” she says, adding that those in the treatment group looked forward to the coaching calls, not just for learning but also because someone was listening to them and hearing their concerns.
“Many wanted more information on mental health especially how to handle loneliness and depression which still has some stigma attached. Those in a couple where one spouse was ill also wanted tips and resources about caregiving.”
Appreciation and pride of place
All participants were appreciative of the resource kit and valued the information. Most reported learning something they had not known about aging and staying healthy.
“Having this information helped my quality of life — it’s better now that I know who to call — everything is tenfold better!” said one recipient.
Many placed the kit in a central spot in their homes for easy access and some even added their personal medical information. Some of the oldest participants said they wished they’d had the senior health book 10 or 15 years earlier.
“Seniors were excited to help themselves and learn new things,” says Ryan. “They even taught their neighbors and friends. One lady read the booklet to her senior neighbor who was blind.”
Positive results across the board
Nearly 60% of participants reported using the home assessment book to identify potential fall risks in their home, and nearly two-thirds of this group took action to fix potential fall risks. Another 12% of the study group reported using the assessment tool and finding no fall risks at all.
Participants also reported a significant increase in their exercise because they learned it could reduce the risk of falling, improve their immune response, promote a sense of well-being and help maintain their independence.
Behaviors to prevent the spread of COVID-19 increased among both the treatment and control (those that didn’t get coaching) groups including safe distancing when in public, wearing a mask, handwashing and using hand sanitizer.
After a vaccine became available in December 2020, researchers discovered that 85% of the treatment group got the COVID-19 shot vs. 63.8% in the control group who were vaccinated.
The researchers were excited to see such positive results across the board from a simple health resource kit.
“This study shows that low-touch interventions developed using health literacy principles and delivered by a trusted partner are feasible to reach community-dwelling older adults during lockdown,” says UCI Health geriatrician Dr. Sonia Sehgal. “And this can be tested on a larger scale to keep older adults safe and engaged in life.”
The campus-community incubator grant from ICTS was instrumental in their successful outreach efforts, Ryan says.
“It was wonderful to work with the UCI team — to couple our efforts and resources with their research brilliance was a privilege and extends what can be done in the community.”