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PART I. SOCIAL ISOLATION AND BEHAVIORAL HEALTH NEEDS

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  1. What is Telewellness?

    Telewellness is connected wellness. We define it as a technology-enabled program that addresses the social determinants of health with a focus on mental health and wellbeing.

    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. The program aims to produce positive community impacts, and helps residents and community staff understand, discuss, and address mental wellness challenges. Through video conference education workshops, personal tele-counseling sessions, and outreach efforts, The Telewellness Program aims to meet the behavioral health needs of residents with limited resources for managing their wellness.

    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 working together to provide mental health services as partners through technology.

    How we did it...

    FPCIW deployed our project to multiple affordable housing communities throughout California. Based on community-based partnerships our resident service coordinators established to deliver programs and services to residents, we invited community health workers, transportation outreach representatives, and public health workers to deliver live webinars from their offices and broadcasted to our communities. Each site participated in virtual presentations on mental wellbeing topics such as depression, hoarding, and bullying to promote the community education—and thus the cultural acceptance—to create a safe space for openness and discussion.

    The project also partnered with mental health providers to enable residents to receive behavioral health support from trained counselors through tablets or telephone. While telehealth was initially an innovation experiment to explore the idea of virtual counseling, the program also yielded important outcomes on cost and time savings to our partners’ therapists.

  2. Summary of research on social isolation and loneliness

    Loneliness and social isolation among older adults have been a public health problem of epidemic proportions. The AARP Foundation, a leading advocate for keeping older adults connected, notes that loneliness increases the chances of early death by 26%. According to a report from the National Academies of Sciences, Engineering, and Medicine (NASEM), nearly one-fourth of adults aged 65 and older are considered to be socially isolated—the COVID-19 pandemic only exacerbated the problem.

    Based on a digital inclusion project called Lighthouse for Older Adults to promote resident Wi-Fi and device adoption in affordable housing, FPCIW conducted a 2020 survey across two communities during COVID. The mental and behavioral health conditions impacting the older adult residents of these communities included depression, drug/alcohol abuse, distress/anxiety, and loneliness. Our data collected from over 350 residents representing 7 languages pointed to some grim realities in the midst of COVID: 48% of residents rated their emotional health as “fair” or “poor”, and further showed that 43% self-reported feeling lonely “sometimes” or “often”; our findings based on the Lubben social index tool revealed that over half (51%) of our residents were at “at risk” for social isolation.

    While physical disabilities and social isolation among older adults can separately produce enormous personal, social and economic consequences, these issues are not mutually exclusive. According to a 2014 US Census report, a quarter of individuals between the ages of 65 and 74 experiencing a disability lived alone, and the proportion increased 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 Lighthouse for Older Adults survey similarly found that 32% to 37% of residents reported to live with hearing loss, vision loss, mobility challenges, or low cognition; 37% lived with 2 or more of these disabilities.

    In tandem with the issues of social isolation and loneliness, the digital divide gulf for older adults is wide. In 2017, The Pew Research Center published its study on technology use among seniors: although there was a higher level of technology adoption for older Americans, it was evident that the “less affluent or [those] with lower levels of educational attainment continue to have a distant relationship with digital technology.” Those older adults with a household income of $30k or less had the least amount of Internet use and broadband adoption. Similarly, the same study was done in 2019 with almost identical results. As the number of general technology adoption and use goes up in older adults, the digital divide persists and is worsened by racial, linguistic, economic and access disparities.

    This Playbook aims to narrow this digital divide by providing the technological tools and adoption methods for the most underserved communities.

    Here are some research and statistical resources we’ve found along the way:

    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.

    2 Pew Research Center - 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.

    The need to support to reduce isolation and loneliness must be stressed to promote the wellness of residents of the affordable housing community because emotional or mental difficulties, such as loneliness or social isolation, have a significant impact on the physical health of seniors. Research shows that seniors benefit from supportive social connections and close personal relationships but suffer as a result of disrupted personal ties and loneliness.

    3 Pew Research Center - 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.

    4 Pew Research Center Article - Barriers to Adoption

    “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”

    5 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.
    • This is a very important part of behavioral health. Older adult households may be exposed to caregiving stress and depression because the one who is less health challenged usually assumes the caregiving role. And as the sole caregiver of the family, and them aging themselves, these caregivers are struggle with their own depression

    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. The most common conditions include anxiety, severe cognitive impairment, and mood disorders (such as depression or bipolar disorder)

    7 Aging Connected Report

    • Over 80% of COVID deaths in the U.S. have been older Americans, and research estimates that about 40% of them were unable to access need online resources because they lacked in-home internet.
    • 22 million (42%) of American seniors lack wireline broadband access at home.
    • Medicaid enrollees are 2.7 times more likely to be offline
    • Black and Latino seniors are more than 2.5 and 3.3 times more likely, respectively, to be offline.

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

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

    Older adults are particularly at risk for isolation, depression, falls, poor medication adherence, and chronic health conditions. Shelter-in-place requirements, social distancing, and living with disabilities during the COVID pandemic created a critical need to expand efforts to reduce social isolation, enhance personal engagement, and increase access to health services.

    Senior affordable housing communities as a platform represent a tremendous opportunity to address needs such as: the social structure, programming, and staffing of congregate housing allow for more efficient and coordinated delivery of services.

    Loneliness and social isolation during the COVID-19 pandemic

    “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.”

    How we did it...

    COVID-19 posed a new host of challenges in serving community needs. For residents who may have had access to devices and broadband during the pandemic, how do we promote opportunities to residents who are quarantined in their homes to engage with content and resources available online? 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, FPCIW developed Staying Home, Staying Connected, a resource guide to help 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.