Unmet Needs and Social Challenges for Older Adults During and After the COVID-19 Pandemic: An Opportunity to Improve Care

Elman, Alyssa; Baek, Daniel; Gottesman, Elaine; Stern, Michael E.; Mulcare, Mary R.; Shaw, Amy L; Pearman, Morgan; Sullivan, Michelle; Clark, Sunday; Platts‐Mills, Timothy F.; Sharma, Rahul; Rosen, Tony

doi:10.17294/2694-4715.1004

Cited by 5 publications

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“…This intervention may be coordinated by team members from multiple disciplines and may involve ensuring safety, connecting older adults to community-based programs and resources, strengthening existing social supports, offering respite care for an overwhelmed caregiver, identifying other unmet needs, and reporting to the department of adult protective services as appropriate. 40 , 41 , 42 Initiating intervention may be deeply impactful even for older adults experiencing nonphysical mistreatment, including financial exploitation and verbal, emotional, or psychological abuse, given the impact that this mistreatment can have on an older adult’s quality of life. Additionally, the ED or hospital may ensure that older adults have access to outpatient care and that outpatient clinicians are more proactive in treating these patients to minimize acute unscheduled ED or hospital care.…”

Section: Discussionmentioning

confidence: 99%

“…This offers an opportunity for potential intervention in the ED and/or hospital for older adults known or suspected to be experiencing mistreatment. This intervention may be coordinated by team members from multiple disciplines and may involve ensuring safety, connecting older adults to community-based programs and resources, strengthening existing social supports, offering respite care for an overwhelmed caregiver, identifying other unmet needs, and reporting to the department of adult protective services as appropriate . Initiating intervention may be deeply impactful even for older adults experiencing nonphysical mistreatment, including financial exploitation and verbal, emotional, or psychological abuse, given the impact that this mistreatment can have on an older adult’s quality of life.…”

Section: Discussionmentioning

confidence: 99%

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Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

et al. 2023

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ImportanceElder mistreatment is common and has serious health consequences. Little is known, however, about patterns of health care utilization among older adults experiencing elder mistreatment.ObjectiveTo examine emergency department (ED) and hospital utilization of older adults experiencing elder mistreatment in the period surrounding initial mistreatment identification compared with other older adults.Design, Setting, and ParticipantsThis retrospective case-control study used Medicare insurance claims to examine older adults experiencing elder mistreatment initially identified between January 1, 2003, and December 31, 2012, and control participants matched on age, sex, race and ethnicity, and zip code. Statistical analysis was performed in April 2022.Main Outcomes and MeasuresWe used multiple measures of ED and hospital utilization patterns (eg, new and return visits, frequency, urgency, and hospitalizations) in the 12 months before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. Chi-squared tests and conditional logistic regression models were used for data analyses.ResultsThis study included 114 case patients and 410 control participants. Their median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. Race and ethnicity were reported as racial or ethnic minority (114 [21.8%]), White (408 [77.9%]), or unknown (2 [0.4%]). During the 24 months surrounding identification of elder mistreatment, older adults experiencing mistreatment were more likely to have had an ED visit (77 [67.5%] vs 179 [43.7%]; adjusted odds ratio [AOR], 2.95 [95% CI, 1.78-4.91]; P &lt; .001) and a hospitalization (44 [38.6%] vs 108 [26.3%]; AOR, 1.90 [95% CI, 1.13-3.21]; P = .02) compared with other older adults. In addition, multiple ED visits, at least 1 ED visit for injury, visits to multiple EDs, high-frequency ED use, return ED visits within 7 days, ED visits for low-urgency issues, multiple hospitalizations, at least 1 hospitalization for injury, hospitalization at multiple hospitals, and hospitalization for ambulatory care sensitive conditions were substantially more likely for individuals experiencing elder mistreatment. The rate of ED and hospital utilization for older adults experiencing elder mistreatment was much higher in the 12 months after identification than before, leading to more pronounced differences between case patients and control participants in postidentification utilization. During the 12 months after identification of elder mistreatment, older adults experiencing mistreatment were particularly more likely to have had high-frequency ED use (12 [10.5%] vs 8 [2.0%]; AOR, 8.23 [95% CI, 2.56-26.49]; P &lt; .001) and to have visited the ED for low-urgency issues (12 [10.5%] vs 8 [2.0%]; AOR, 7.33 [95% CI, 2.54-21.18]; P &lt; .001).Conclusions and RelevanceIn this case-control study of health care utilization, older adults experiencing mistreatment used EDs and hospitals more frequently and with different patterns during the period surrounding mistreatment identification than other older adults. Additional research is needed to better characterize these patterns, which may be helpful in informing early identification, intervention, and prevention of elder mistreatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

et al. 2023

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“…A recent synthesis of the literature noted older adults reported an increased presence of psychological symptoms and loneliness due to COVID-19 pandemic–related social isolation, and difficulty with finding help to address functional needs (e.g., ADLs) and social needs (e.g., meal delivery and transportation) ( Lebrasseur et al, 2021 ). The CAPABLE program intervention is designed to take place in the home environment, which has become a critical component of programmatic implementation during the COVID-19 pandemic ( Elman et al, 2021 ; Hoffman et al, 2020 ). The evidence produced from the CAPABLE program has shown significant improvement in the areas of daily functional activity, home hazards, and reported depressive symptoms ( Breysse et al, 2022 ; Szanton et al, 2011 , 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Implementation of the CAPABLE Program With Older Adults During the COVID-19 Pandemic

Washington

Edwards

Stiles

et al. 2023

OTJR: Occupational Therapy Journal of Research

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This study explores the implementation and impact of an evidence-based client-driven program, CAPABLE (Community Aging in Place Advancing Better Living for Elders), during the COVID-19 pandemic. The study reviews outcomes related to client engagement and retainment, client-directed goals, therapeutic intervention, home modifications, and functional outcomes of older adult participants. The CAPABLE program addresses basic and instrumental activities of daily living, medication use, pain, mobility, fall prevention, and environmental modifications within the home. The services were provided by an interprofessional team which included an occupational therapist, a registered nurse, and home contractor professional. The study team utilized descriptive, paired t test, and correlational analyses to evaluate the CAPABLE programs’ influence on the functional outcomes of older adults living within the city of St. Louis, during the COVID-19 pandemic. This study identified significant improvement in instrumental activities of daily living (IADLs) independence, readiness to change, self-reported health status, and depressive symptoms, and 11 significant correlations were found between age, implementation expenses, and functional outcomes.

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“…However, they are often likely to experience a range of unmet needs at different levels 6 . Social isolation, inadequate care, inability to perform daily activities, food insecurity, housing insecurity, poverty, abuse/neglect/exploitation, inadequate medical care, inadequate dental care, vision/hearing impairments, and poor medication are some of the examples of unmet needs in daily life 7 . They can lead to failures to manage acute or chronic health problems and health‐related events 6 .…”

Section: Introductionmentioning

confidence: 99%

“…6 Social isolation, inadequate care, inability to perform daily activities, food insecurity, housing insecurity, poverty, abuse/neglect/exploitation, inadequate medical care, inadequate dental care, vision/hearing impairments, and poor medication are some of the examples of unmet needs in daily life. 7 They can lead to failures to manage acute or chronic health problems and healthrelated events. 6 At this point, recognizing older adults' unmet needs seems essential to be able to provide relevant social support, health-care services, housing, transportation, social insurance, and formal or informal care plans and policies.…”

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confidence: 99%

The Turkish version of the Camberwell Assessment of Need for the Elderly: A validity and reliability study

Güzel

2022

Australas J Ageing

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Objectives The present study attempted to adapt and validate the Turkish version of the Camberwell Assessment of Need for the Elderly (CANE‐T). Methods The data of this methodological study were collected from 610 older people who volunteered between September 10 and December 15, 2019. The SPSS 20 and LISREL software were used to perform reliability (internal reliability, parallel forms reliability/equivalent forms, and test–retest reliability) and validity (exploratory factor analysis and confirmatory factor analysis) analyses for the CANE‐T. Results The Kaiser–Meyer–Olkin test revealed the sampling adequacy to be 0.72. After deleting four items (psychological distress, behavior, alcohol, and money) with a factor loading below 0.30 from the dataset, it was found that the scores on the scale explained 55% of the total variance. Besides, the confirmatory factor analysis revealed the following fit indices: p < 0.05, root mean square error of approximation (RMSEA) = 0.08, root mean square residuals (RMR) = 0.07, standardized root mean square residual (SRMR) = 0.07, goodness‐of‐fit index (GFI) = 0.88, and adjusted goodness‐of‐fit index (AGFI) = 0.84. Concerning reliability, Cronbach's α values were calculated to be 0.78 for ‘Physical Needs’, 0.74 for ‘Psychophysiological Needs’, 0.75 for ‘Security Needs’, 0.75 for ‘Social Needs’, and 0.75 for ‘Health Needs’. Conclusions Overall, it was concluded that the 20‐item five‐factor CANE‐T is a valid and reliable tool to measure the needs of older adults in the Turkish context.

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Unmet Needs and Social Challenges for Older Adults During and After the COVID-19 Pandemic: An Opportunity to Improve Care

Cited by 5 publications

References 0 publications

Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

Implementation of the CAPABLE Program With Older Adults During the COVID-19 Pandemic

The Turkish version of the Camberwell Assessment of Need for the Elderly: A validity and reliability study

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