As the only foundational program of its kind to span 52 hospitals, Faith Community Health at Baylor Scott & White Health is a movement that integrates faith communities with healthcare to provide effective patient navigation, education, and support.

Faith Community Health functions on a two-pronged approach focused on congregational health ministries and community member outreach. A health ministry is an organized effort within a faith community, beyond the scope of normal worship and fellowship gatherings, which actively promotes the holistic health needs of the congregation and surrounding area. Secondly, congregational volunteers known as “Faith Community Caregivers” provide weekly one-hour home visits in which volunteers provide a ministry of presence to lonely and isolated patients, assist with local resource navigation, and encourage adherence to their medical plan of care.

Through five years of operation, program benefits have shown a 40% reduction in hospital admissions and a 29% reduction in emergency department utilization. Additionally, inpatient service costs and emergency department utilization costs have decreased by 59% and 41% respectively. The program provides an opportunity for cross collaboration among several provider entities such as social workers, nurses, chaplains, community organizations, and more. In this session, participants will explore how Faith Community Health, in partnership with local faith communities, utilizes four principles (Right Door, Right Time, Ready to be Treated, and Reassured Not Alone) to bring optimal health to those in need. Participants will have the opportunity to assess how integration between healthcare and local communities can foster optimal health within communities.

Gay and lesbian individuals face multiple health challenges in older age, including decreased access to aging resources and poorer health outcomes than their heterosexual counterparts. These challenges are exacerbated in rural communities. Utilizing a multi-method network science approach, this research sought to explore the social networks and the relationships between networks, identity, health, and quality of life among aging lesbian and gay individuals living in rural communities. Participants (n=25; gay=13; lesbian =12) were recruited from Kentucky, West Virginia, and Tennessee. Data were collected from a self-reported health questionnaire, in-person interviews, and ego-centric social network data collection. Findings indicate that rural gay and lesbian individuals develop networks based on need with limited consideration for network members’ acceptance of their identity. The findings also indicate limited connections to other gay and lesbian individuals. Social isolation and loneliness remain a pervasive issue in the rural gay and lesbian aging community. Finally, network size does not affect the overall health and quality of life for rural aging lesbian and gay individuals, but identity congruence does. Conclusions point to the greater need for research to understand the factors affecting aging lesbian and gay individuals in rural environments and the difficulty in parsing out the influence of a rural location, the aging process, and being a lesbian or gay, on social network development, identity, health, and quality of life. Opportunities abound for developing further research addressing social isolation among this population and exploring the positive relationship between identity congruence and quality of life.

Elder abuse, both physical and mental, is a growing area of concern among advocates, social service providers, and health care officials. As the US population continues to age, the frail elderly represent an increasing component of the nation’s overall care and support needs. With reduced family support networks resulting from smaller family size and greater mobility, elders with care requirements increasingly depend upon social services and institutionalized care to help them maintain quality of life. Higher costs for care, combined with stressed support networks and stagnant wages among employed providers, create circumstances where the risks of abuse and unsupervised, sub-standard care become more likely. Even within a home care situation, caregivers such as spouses and family members face high levels of stress and time demands which can result in abusive behavior. On the opposite side of the care equation, poor or limited training, lack of understanding about behaviors resulting from pain, medication side-effects or depression increase the risk of elders acting out aggressively and hurting either the caregiver or themselves. Measuring and analyzing the risks of elder abuse is difficult as reporting is often episodic and the systematic study of abuse is still evolving. To help better identify data that collects information on abuse among elders, NACDA has partnered with the National Archive of Criminal Justice Data (NACJD) to organize and make available data more discoverable for secondary research. The round-table discussion will present on available data resources, analysis approaches, and methodologies to better address the problem of elder abuse.

background: Social determinants of health (SDH) play an important role in the lives of older adults with depression, yet little research has been conducted to examine how SDH are identified and addressed within collaborative care and other evidence-based depression treatments.

purpose: The Care Partners Project was funded by the Archstone Foundation beginning in 2015 to build on the traditional collaborative care model through primary care partnerships with community-based organizations. SDH emerged as common challenges to engaging patients in treatment and to improving depression outcomes. This session will describe the ways clinic-CBO partnerships identified and addressed these social needs in practice across nine Care Partners sites.

methods: As part of a qualitative evaluation of the Care Partners Project, 84 key informant interviews and 20 focus groups were conducted over five years with selected primary care physicians, care managers, administrators and psychiatric consultants. These data were coded and organized using an inductive thematic analysis approach.

findings: Older patients engaged in the Care Partners Project often struggled with transportation needs, housing quality, and economic insecurity. Addressing these and other needs within the SDH framework was foundational to providing effective depression treatment. The clinic-CBO partnerships approached SDH in several ways, such as through home visits, case management, and social support, with variation in approaches across sites.

conclusion: The Care Partners Project illustrates critical opportunities to address unmet needs among older adults. We will share a variety of approaches to identify and manage social needs in the context of collaborative late-life depression care.

SGM older adults have experienced lifetime discrimination and social exclusion, possibly preventing development of social networks and leading to social isolation. Despite discrimination and exclusion, some SGM older adults have created and sustained supportive social networks throughout life. These social networks provide varying levels of social support resources and play an important role in healthy aging of SGM older adults. Few studies have examined the social support networks of SGM older adults and in particular, those of SGM older women and gender non-binary adults. To better understand their social networks, 37 semi-structured interviews were conducted with SGM older ( >50 years) women and gender non-binary adults.

Five social network types were examined: diverse, diverse/no children, friend-centered network, immediate family-focused, and restricted network. Recorded interviews were transcribed and, guided by the network types, analyzed thematically. Participants were grouped based on their current network size and ties. Within each network type, common themes were identified. Lifetime experiences such as when a participant came out influenced current social networks. Larger and more diverse networks had higher healthcare utilization and access compared to the restrictive network. As the SGM older adult population continues to grow, more research to better understand population characteristics associated with network size and diversity to help develop interventions to reduce isolation of SGM older adults. Attention is greatly needed to develop interventions that consider the needs of those living in isolation while also considering the possible burden placed on caregivers and the aging SGM community.

Background: Social isolation has emerged as a key social determinant of health. While older adults are at risk for being or feeling isolated (loneliness), few interventions exist. One goal of implementation science is to appropriately expand EBPs for public health impact. The Program to Encourage Active, Rewarding Lives (PEARLS) is a community-based depression EBP that reaches isolated older persons. We are evaluating whether and how PEARLS can improve social connectedness.

Methods: We partnered with 15 social service organizations in five U.S. states who were purposively sampled for various settings, providers, and populations. We used concurrent mixed methods: validated surveys of structural and functional social support (DSSI, PROMIS, UCLA), and semi-structured interviews with PEARLS participants and providers. Analysis includes descriptive statistics, paired t-tests and regression (surveys); thematic analysis (interviews), and joint displays to compare and contrast quantitative and qualitative findings.

Findings: Our sample (N=400) has mean (SD) age 71(6), 78% female, 44% people of color, 80% low-income, 4:5 live alone and/or are unpartnered. Preliminary findings from 246 pre/post surveys indicate improved social connectedness (p < 0.001, small effect sizes 0.26). Interviews (N = 20 ) suggest several possible mechanisms, including better social skills, support, opportunities for interactions, and less maladaptive social cognition. Interventions are needed to address structural determinants of isolation (e.g., housing, ageism). We will present final results at APHA (data collection concludes in summer).

Implications: Our community-engaged, pragmatic research suggests PEARLS can improve social connectedness among diverse older persons with depression. Multi-level strategies are needed to address this SDOH.

Background. Older informal caregivers are believed to be less socially connected than non-caregivers; however, little is known about their connectivity and the context surrounding their social isolation. This study examined factors associated with self-reported social isolation risk among informal caregivers age 60 years and older.

Methods. The Upstream Social Isolation Risk Screener (U-SIRS) was developed to assess social isolation risk among older adults within clinical and community settings. Comprised of 13 items (Cronbach’s alpha=0.80), the U-SIRS assesses physical, emotional, and social support aspects of social isolation. Using an internet-delivered survey, data were analyzed from a national sample of 701 informal caregivers age 60 years and older. Theta scores for the U-SIRS serve as the dependent variable, which were generated using Item Response Theory. An ordinary least squares regression model was fitted to identify indicators associated with social isolation risk.

Results. Caregivers’ average age was 69.1(±5.0) years, and the majority of participants was female (63.6%). Higher U-SIRS theta scores were reported among caregivers who were younger (B=-0.10, P=0.005), who did not live with a spouse/partner (B=-0.10, P=0.009), and those self-reporting worse general health status (B=-0.19, P<0.001). Caregivers who reported more chronic conditions (B=0.91, P=0.026) and not having people they can call for help (B=0.19, P<0.001) also reported higher U-SIRS theta scores.

Conclusion. Social isolation risk among older informal caregivers is contextualized by their living situation and health/disease profiles. Caregivers could benefit from resources and services to expand their social and support networks, facilitate meaningful interactions with others, and provide respite opportunities.

Despite periodic publications on the topic of family caregiving in the American Journal of Public Health, caregiving of older adults and people with disabilities remains under examined and in need of increased theoretical and practical attention. Underestimates of the prevalence of caregiving remain, as the different subgroups related to age of caregivers or care receivers are excluded from discussions of caregiving. For example, there are an estimated 43.5 million family caregivers in the US, contributing as much as $522 billion annually. While widely cited, this estimate excludes the 1.4 million young caregivers, children between the ages of 8 and 18, and the 3.6- 5.5 million young adult caregivers, age 18-25 providing significant care to family members. These overlooked populations require attention as indicated by the designation of the US as emerging in terms of awareness, interventions and policy responses to young caregivers.

The aim of this roundtable is twofold, to bring together stakeholders across public health theory and practice to reignite the conversation and generate new ideas to address the under examined and ongoing challenges of family caregiving, and to broaden the scope of the discussion around caregiving incorporating the social ecological model to inform and deepen the conversation around caregiving in the US.

Background: Whether disability prevention, a major clinical and public health priority, could be enhanced by systematically targeting social isolation in clinical settings remains to be determined. In this context, investigation seeking to advance limited knowledge on the relationship between social isolation and disability is warranted.

Objective: To assess if social isolation was an independent risk factor for incident disability performing basic activities of daily living (ADL) in community-dwelling Medicare beneficiaries.

Methods: Prospective study using National Health and Aging Trends Study data from Medicare beneficiaries. Analytic sample (n=573) included at-risk adults 65+ with dynapenia. Disability defined as ADL dependence. Social isolation categories – no isolation, lower and higher isolation levels – derived from: (a) participation in organized activities; (b) religious services; (c) current marital/partner status; (d) in-person-visits with friends/family; and (e) family/friends availability to talk. Binary logistic modeling regressed incident ADL disability three years later on baseline social isolation status, with adjustment for demographics, living arrangement, comorbidities, depression, pain, short-physical-performance-battery, and self-rated health.

Results: Odds of incident ADL disability were significantly higher among those in lower (OR: 2.4; 95%CI: 1.3-4.6) and higher (OR: 2.6; 95%CI: 1.3-5.5) social isolation levels, compared to participants not isolated, even after comprehensive adjustment.

Conclusions: Social isolation, a common and potentially modifiable social determinant of health, was a strong risk factor – hypothetically causal – for incident ADL disability in Medicare beneficiaries with dynapenia. Research to determine whether integration of social isolation assessment into primary care delivery algorithms may enhance disability prevention in older adults is warranted.

Engagement in productive roles has been associated with better health. According to identity accumulation theory, more social roles help individuals be more socially integrated, leading to enhanced psychological well-being by diminishing the risk of committing all their energy into single role. However, few studies have assessed the influence of productive roles on mental health for caregivers, and less is known about the mechanism behind such relationships.

The aims of this study are to examine: (1) the association between productive social roles and psychological well-being for caregivers and non-caregivers, and (2) the mediating effect of social isolation on this relationship. The study analyzed 3,951 community-dwelling Medicare beneficiaries aged 65 or above from Round 1 to 3 of National Health and Aging Trends Study (210 caregivers, 3,741 non-caregivers). Multiple-group analysis for structural equation modeling was conducted to compare caregivers to non-caregivers.

For both caregivers and non-caregivers, having a volunteer role increased well-being. However, working as a paid employee wasn’t significantly associated with well-being for both groups. Social isolation mediated neither employee nor volunteer role with well-being for both caregivers and non-caregivers.

Assuming that volunteering for others without monetary compensation brings meaning in life, this finding supports policies (e.g., respite care) that could supplement caregiving time, allowing caregivers to have more freedom to use the time in such community-engaging roles. Even though physical health was controlled, there is a chance that healthier individuals engage in productive roles. Thus, reciprocal relationship between productive roles and health should be considered in future investigations.