By Paul Brockwell
Social isolation can be dangerous. In 2020, isolation became the experience of people across the country as states issued stay-at-home orders to mitigate the spread of COVID-19.
The loss of social activity can be detrimental to health and reduce access to care when people may not have the means to participate in face-to-face or telehealth visits with providers. For low-income older adults, the effects of social isolation have been especially disproportionate.
The spread of COVID-19 only underscored the value and importance of the Richmond Health and Wellness Program (RHWP).
Since 2012, the Richmond Health and Wellness Program has brought together care partners across disciplines to address health disparities in vulnerable older adults and disabled older adults living in low-income housing through collaborative care models that enhance the lives of individuals, decrease healthcare costs and educate future practitioners.
Once community members identify a need, the program has partnered with an array of experts from multiple disciplines ranging from social work and occupational therapy to law and pharmacy.
One such expert is Elvin Price, Pharm.D., Ph.D., Victor A. Yanchick Associate Professor and director of the Geriatric Pharmacotherapy Program at the VCU School of Pharmacy. Dr. Price is also co-director of the Institute for Inclusion, Inquiry and Innovation (iCubed) Health and Wellness in Aging Core. His expertise in pharmacogenetics has helped the older adults who are part of the RHWP.
“Our work centers around making the best decisions possible with medications for people based on their needs and genetic profile,” Dr. Price said. “You may also see this called personalized medicine or precision medicine, but it’s a way of being able to optimize medication based on an individual’s specific needs and how their body reacts and processes available medicines.”
Dr. Price and his students are genotyping participants to evaluate them for the most commonly characterized drug-gene pairs. The goal is to avoid adverse drug reactions and educate participants on how to best manage their prescriptions based on their genotype. His investment in this work is more than just scientific. Part of what inspired him to pursue his dual doctorates, he said, was growing up and seeing friends and family who suffered from chronic diseases and often lacked adequate, regular access to professionals who could help with understanding prescriptions and ensuring they are optimized to treat the individual’s condition.
“We know that a large percentage of our patients in this program have reported having an adverse drug event,” Dr. Price said. “We gauge their knowledge level and then go through the genetic sequencing hoping to potentially characterize the frequencies of how often we might find bad drug-gene pairs out in our older adults living in the community.”
COVID-19 temporarily halted work on this aspect of the program, but Dr. Price and his team resumed processing and isolating the DNA this fall and continue to receive positive feedback from residents who are interested in participating.
Based at the VCU School of Nursing, the Richmond Health and Wellness Program was the idea of Pam Parsons, Ph.D., associate professor and associate dean of practice and community engagement at the school, who was recently named a fellow of the American Academy of Nursing. RHWP also received an important distinction as an Age Friendly Health System Practice.
The designation is given by the Institute for Healthcare Improvement, a national organization encouraging improvement in healthcare delivery and outcomes.
Prior to the pandemic, the program operated weekly with either full or half-day sessions at five housing locations. It also recently expanded to the new VCU Health Hub@25th, a freestanding wellness center developed to serve one of the most health disparate populations in the Richmond region. Participants in the program work with students and faculty to develop collaborative wellness plans customized to the health conditions, social needs and resources of each individual. Social connectedness serves as a pathway to improved health and wellness, and the relationships built over time through the program have led to improved health outcomes.
“Loneliness is such a huge factor, and it’s at the forefront of NIH to ask what factors related to social isolation are presently influencing health outcomes,” Dr. Parsons said. “We’re teaching the students what that means using evidence-based tools to assess loneliness and making strategies to connect people to services and help set goals to be more socially connected.”
The social connection provided by the program is one of the key elements of its success and what attracted the attention of the AARP Foundation. In January, the foundation awarded a grant to the program to support more formally measuring the influence of social connection on health outcomes. That work became especially relevant in the era of COVID-19; and the project also received a COVID-19 Rapid Research Grant from VCU.
“A really big component of what we’re doing is fulfilling this social need,” said Jodi Winship, Ph.D., an assistant professor of occupational therapy at the VCU College of Health Professions. “For my dissertation, I’d interview program participants about their experiences working with a team of students. I thought I’d hear about how they appreciated student help with managing their medicines and things like that, but one of the biggest things I found in my dissertation research was how much they loved simply talking to the students, both hearing students’ stories and sharing their own.”
Dr. Winship connected with the program when she was studying social behavior and sciences as a doctoral student in the VCU School of Medicine. Her academic interest evolved into long-term attachment to RHWP through bringing occupational therapy clinical skills to the program. The team has always known the social component is important, but now there is a specific intention on measuring the effects of loneliness and social isolation on health outcomes and educating students on how to recognize and understand the importance of these factors.
The partnerships RHWP has built are a key part of the success, and they start with the community participants.
“We’re not researching the individuals,” Dr. Winship said. “In every way, this is a process in which they are as equally engaged in and directing as the faculty and students. We’ve established a community advisory board, and we’re really trying to guide our research based on what the community wants and how we can help them and work together.”
Overnight, all the work that clinicians had been doing with the program had to evolve. Most of the RHWP sites quickly restricted visitors and on-site programs to protect older adults, an especially vulnerable population, from the spread of COVID-19. The program had been acquiring devices that would allow greater communication between residents and program participants, but the suspension of in-person programs accelerated the need to deploy and work with technology in a community that often experiences barriers to access. Thankfully, some of the locations have recently invested in wireless internet connections that enable the program team to pilot the use of tablets and other personal technology devices.
Dr. Parsons and the team have been refining and understanding technology needs and how people could and would want to use technology if they are in a different living environment, income bracket or older. They hope this research and the adaptation will yield insights that will help improve delivery of care and social engagement to residents, but also equip students for their careers beyond the MCV Campus. Their biggest questions are whether technology can help address some of the gaps they have seen in the healthcare system for older adults and whether technologically mediated social connection proves as important and valuable to improving health behaviors and conditions. “The work we do over the next three years will add evidence to a growing understanding around models of care for older adults when national policymakers are looking at how to frame care for this health disparate population,” Dr. Parsons said.
More than anything, though, the research team has missed being with their community participants. This fall, they worked on reactivation plans to safely get teams back in the communities to resume work while continuing to adopt a hybrid model to programs they are unable to hold in person.
A version of this article originally appeared in NEXT, a publication of the MCV Foundation.