imagine

PART I. SOCIAL ISOLATION AND BEHAVIORAL HEALTH NEEDS

Drawing upon nearly a decade of telehealth program experiences primarily serving older adult residents of affordable housing communities, and a successful 2016 pilot study that has today expanded to multiple locations, the Front Porch Center for Innovation and Wellbeing has designed a guide to a set of best practices for other providers to establish technology-based behavioral health programs in their own communities.

The impact of social isolation and loneliness among older adults cannot be understated. A 2012 University of California, San Francisco study found not only that 43 percent of surveyed older adults felt lonely, but that only 18 percent lived alone. Similarly, IBM’s 2017 call-to-action research which cited Front Porch among its expert sources, “Loneliness and the Aging Population: How Businesses and Governments Can Address a Looming Crisis,” outlines some alarming statistics on older adults experiencing social isolation and loneliness: 29% increased risk of cardiovascular disease, 64% increased risk of dementia, and 26% increased risk of death. The consequences of loneliness and social isolation extend beyond the individual to negatively affect caregivers, the healthcare system, and the general economy.

While physical disabilities and social isolation among older adults can separately produce enormous personal, social and economic consequences, these issues are not mutually exclusive. A quarter of individuals between the ages of 65 and 74 experiencing a disability live alone, and the proportion increases to more than a third of adults 85 and older living alone and with at least one disability. With an average age of 85 among residents at Front Porch communities, the likelihood of individuals living with a disability or experiencing loneliness is high. Our affordable housing survey similarly found that 32% to 37% of residents lived with hearing loss, vision loss, mobility challenges, or low cognition; 37% lived with 2 or more of these disabilities.

LeadingAge conducted a national survey of its affordable housing members in late 2021 to assess challenges in addressing the needs of its residents throughout the COVID crisis. Their reported noted that “Resident mental health issues came ahead of every other available response, including staffing, funding, inspections, compliance, staffing, vaccine mandates, vacancy issues, fair housing issues, and disaster preparedness,” at 54.7%.

FPCIW conducted its own resident survey across two affordable housing communities during the COVID- 19 pandemic. The mental and behavioral health conditions impacting the older adult residents of these communities include depression, drug/alcohol abuse, distress/anxiety, and loneliness. Our data collected from over 350 residents representing 7 languages pointed to some grim realities exacerbated by the COVID-19 crisis: 48% of residents rated their emotional health as “fair” or “poor”. The study further showed that 43% self-reported feeling lonely “sometimes” or “often”; the Lubben social index tool further revealed, however, that over half (51%) of our residents were at “at risk” for social isolation.

This Playbook is designed to help affordable housing providers to connect with locally available, community-based resources to build sustainable mental and behavioral health programs to identify and meet the needs of residents living with depression, anxiety, and loneliness.

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  1. Summary of research on social isolation and loneliness

    (STAT 1) World Health Organization:

    • Globally, the population is ageing rapidly. Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double, from 12% to 22%.
    • Mental health and well-being are as important in older age as at any other time of life.
    • Mental and neurological disorders among older adults account for 6.6% of the total disability (DALYs) for this age group.
    • Approximately 15% of adults aged 60 and over suffer from a mental disorder.

    (STAT 2)

    Older adults face unique barriers to adoption, ranging from physical challenges to a lack of comfort and familiarity with technology.

    One challenge facing older adults with respect to technology is the fact that many are simply not confident in their own ability to learn about and properly use electronic devices. Just 26% of internet users ages 65 and over say they feel very confident when using computers, smartphones or other electronic devices to do the things they need to do online, according to a 2015 Pew Research Center survey. Roughly one-third describe themselves as only a little (23%) or not at all (11%) confident in their ability to use electronic devices to do necessary online activities

    (STAT 3) Pew Research Center Article - Social Isolation

    • 10% Americans say they feel lonely or isolated from those around them all or most of the time
    • Frequent loneliness is linked to dissatisfaction with one’s family, social and community life, the survey found.
    • (28%) of those dissatisfied with their family life feel lonely all or most of the time vs. 7% of those satisfied with their family life.
    • 26% of those dissatisfied with their social life are frequently lonely vs 5% of those who are satisfied with their social life.

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    (STAT 4) Pew Research Center Article - Loneliness

    Americans ages 60 and older are alone for more than half of their daily measured time – This amounts to about seven hours a day; and among those who live by themselves, alone time rises to over 10 hours a day, according to a new Pew Research Center analysis of Bureau of Labor Statistics data.

    (STAT 5) WHO - World Health Organization
    Mental Health and Older Adults

    • Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with heart disease can negatively affect its outcome.

    (STAT 6) CDC - The State of Mental Health
    and Aging in America

    • 20% of people age 55 years or older experience some type of mental health concern (6). The most common conditions include anxiety, severe cognitive impairment, and mood disorders (such as depression or bipolar disorder)
  2. What is Telewellness?

    Telewellness is connected wellness.

    Telewellness encompasses program activities into a comprehensive framework for addressing the behavioral and emotional wellness needs of older adults and their caregivers in low-income, affordable housing communities through the use of technology.

    This playbook discusses the Telewellness Program as a collaboration of senior-serving organizations using technology-based tools to support the mental health and wellbeing needs of residents in low- income, affordable housing communities. Telewellness produces positive community impacts, and helps residents and their caregivers understand, discuss, and address mental wellness challenges. Through video conference education workshops, personal tele counseling sessions, and outreach efforts, Telewellness can be successful in meeting the behavioral health needs of residents.

    Affordable housing providers and other community-based senior service organizations can play an important role in meeting the mental health needs of low-income older adults through locally-sourced providers and partnerships. Technology lends an important opportunity in the delivery of mental health education and services through video conferences and virtual visits by licensed counselors and therapists.

    In addressing mental health challenges of those in low-income affordable housing communities, Telewellness tries to address all six dimensions of wellness. According to the National Wellness Institute, “addressing all six dimensions of wellness in our lives builds a holistic sense of wellness and fulfillment.”

    At FPCIW

    The Telewellness Project has produced positive community impacts, and has helped residents understand, discuss, and address mental wellness challenges. Through video conference education workshops, individual tele-counseling sessions, and outreach efforts, the Telewellness Project has been successful in meeting the behavioral health needs of residents.

    We deployed the program multiple affordable housing communities throughout California. Targeted outcomes at each site included video conference presentations on mental wellbeing topics (such as depression, hoarding, bullying, etc.). Another important component of the program was to allow residents to enroll in individual telehealth therapy programs with trained counselors using iPads.

  3. The impact of COVID and social distancing on older adult wellness

    (STAT 1) The COVID-19 pandemic has only exacerbated the mental health and wellness of older adults.

    “There is a high cost associated with the essential quarantine and social distancing interventions for COVID-19, especially in older adults, who have experienced an acute, severe sense of social isolation and loneliness with potentially serious mental and physical health consequences. The impact may be disproportionately amplified in those with pre-existing mental illness, who are often suffering from loneliness and social isolation prior to the enhanced distancing from others imposed by the COVID-19 pandemic public health measures.

    Older adults are also more vulnerable to social isolation and loneliness as they are functionally very dependent on family members or supports by community services. While robust social restrictions are necessary to prevent spread of COVID-19, it is of critical importance to bear in mind that social distancing should not equate to social disconnection.” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306546/)

    One of the most vulnerable populations impacted by COVID-19 is older adults in congregate housing (i.e., affordable housing, assisted living, skilled nursing). In addition to being at greater risk of contracting COVID-19, the older adult population is particularly at risk for isolation, depression, falls, poor medication adherence, and exacerbated chronic health conditions; however, senior affordable housing communities also represent a tremendous opportunity to address these needs. The structure, programming and staffing of congregate housing compounds this problem significantly. Given shelter in-place requirements, efforts in residential settings to maintain distance for vulnerable populations, and the number of older adults and persons with disabilities living alone, there is a critical need to expand efforts to reduce social isolation and enhance personal engagement.

    At FPCIW

    COVID-19 poses a new host of challenges to meeting goals and objectives of projects. In response to concerns of social isolation among Front Porch residents and older adults everywhere, and inspired by the creativity and imagination of our community frontline care staff, the FPCIW developed Staying Home, Staying Connected, a resource guide to help engage and connect our older adults through technology. The resource guide provides suggestions on applying some technology solutions to promote growth, connectivity, and social connections during a time of uncertainty, stress, and isolation in the midst of the COVID-19 pandemic and its impact on a vulnerable population. FPCIW has developed a version of this resource for senior living providers and other senior serving organizations, and a version for direct distribution to older adult users.

    Social distancing is requiring a new approach to outreach and recruitment and other project elements, severely restricting in-person meetings, trainings, and support. To meet the need for virtualized onboarding, fully digitizing material is helpful for a seamless experience. FPCIW is continuing to design a process that leverages existing communication tools for social engagement and independence while maintaining social distancing guidelines.