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From left: Jodi Winship, Elvin Price, and Pam Parsons. [View Image] From left: Jodi Winship, an assistant professor of occupational therapy in the College of Health Professions; Elvin Price, a professor at the School of Pharmacy; and Pam Parsons, an associate professor at the School of Nursing. (Chris Ijams, MCV Foundation)

Healthier together: Confronting loneliness and health care challenges among older adults

COVID-19 accelerated how one community-driven partnership is reimagining the way care is provided to vulnerable older adults through inclusion, inquiry and innovation.

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Social isolation can be dangerous. And since the arrival of COVID-19, it’s been a shared experience of people across the country.

A group of Richmond researchers has long been examining how a lack of social connection can present challenges for older adults that go beyond the inconveniences of being stuck at home. The loss of social activity can be detrimental to their health, not to mention reduce their access to care if they do not have the means to participate in face-to-face or telehealth visits with providers. For low-income older adults, the effect of social isolation has been especially disproportionate.

The Richmond Health and Wellness Program has been partnering with low-income older adults with the goal of understanding how to build a better health care delivery model to meet their needs where they live. The spread of COVID-19 only underscored the value and importance of the efforts. 

Since 2012, the Richmond Health and Wellness Program has brought together care partners across disciplines to address health disparities in vulnerable and disabled older adults living in low-income housing through care models that enhance the lives of individuals, decrease health care costs and educate future practitioners. The program, based at the Virginia Commonwealth University School of Nursing, was created by Pamela Parsons, Ph.D., an associate professor and associate dean for practice and community engagement.

Prior to the pandemic, the program operated at five housing locations. They also recently expanded to the new VCU Health Hub at 25th, a freestanding wellness center developed to serve one of the most health disparate populations in the Richmond region. Program participants work with VCU students and faculty to develop 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 better outcomes.

“Loneliness is such a huge factor, and it’s at the forefront of [the National Institutes of Health] to ask what factors related to social isolation are presently influencing health outcomes,” 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.”

Fulfilling a social need

The social connection provided by the program — a key element of its success — attracted the attention of the AARP Foundation. In 2019, the foundation awarded a grant to the program to support more formally measuring the influence of social connection on health outcomes. That work has become especially relevant during the pandemic; and the project received a COVID-19 Rapid Research Fund grant from VCU.Winship, Price and Parsons. [View Image] Winship, Price and Parsons. The Richmond Health and Wellness Program combines the expertise of various healthcare fields to build a coordinated care model for participants. (Chris Ijams, MCV Foundation)

“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 who connected with the program when she was studying social behavior and sciences as a doctoral student in the VCU School of Medicine.

“For my dissertation, I’d interview program participants about their experiences working with a team of students,” Winship said. “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.”

Winship’s 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.

“We’re not researching the individuals,” 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.”

Experts from multiple disciplines

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., the Victor A. Yanchick Associate Professor and director of the Geriatric Pharmacotherapy Program at the VCU School of Pharmacy. Price is also co-director of the Institute for Inclusion, Inquiry and Innovation’s Health and Wellness in Aging Core with Parsons.

“Our work centers around making the best decisions possible with medications for people based on their needs and genetic profile,” 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.”

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 were 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,” 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.”Pam Parsons. [View Image] Pam Parsons created the Richmond Health and Wellness Program to bring together care partners to address health disparities in vulnerable and disabled older adults living in low-income housing. "Loneliness is such a huge factor, and it’s at the forefront of [the National Institutes of Health] to ask what factors related to social isolation are presently influencing health outcomes,” she said. (Chris Ijams, MCV Foundation)

Disruption and adaptation

Overnight, all the work that clinicians were doing with the program had to evolve. The program had been acquiring devices that would allow greater communication between residents and program participants, but the suspension of in-person programs because of COVID-19 accelerated the need to deploy and work with technology in a community that often experiences barriers to access.

Parsons and the team have been refining and understanding technology needs and how people would use technology if they are older, are in a different living environment or are in a different income bracket. They hope the 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.

Through the Voice2Connect project, for example, VCU School of Nursing assistant professor Jane Chung, Ph.D., is leading a team that includes VCU College of Health Professions’ Gerontology Chair and Professor Tracey Gendron, Parsons and Winship in studying how smart speaker technologies can support the needs for social connectedness among older adults living alone in senior housing communities. A two-year award of $155,000 from the NIH’s National Institute on Aging in 2020 will fund Chung and the team’s research to facilitate the planning of future low-cost, technology-based interventions for reducing social isolation.

The biggest questions are whether technology could help address some of the gaps they have seen in the health care 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,” Parsons said.

More than anything, though, the research team has missed being with their community participants. In the 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.

This story was originally published in NEXT Magazine under the headline “Healthier Together.” For more stories like this, visit MCVFoundation.org/next.

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