COVID in Context: The Lived Experience of Richmond’s Low-Income Older Adults

Alzheimer's Disease Risk Reduction Health Coaching: Comparative Analysis

BACKGROUND AND OBJECTIVES

Recent guidelines point to lifestyle as a tool for decreasing Alzheimer's disease (AD) risk. To address the limited practice and availability of AD risk reduction interventions, this study aimed to explore the feasibility of a community-level lifestyle intervention targeting high-risk groups.

RESEARCH DESIGN AND METHODS

Diverse older adults (60+) living in the Richmond, VA, local area, with the following risk factors, incomes below $12,000/year and managing diabetes or cardiovascular disease, were offered weekly lifestyle telephone health coaching for 12 weeks in 2019-2020 (intervention group). The health coaching sessions provided Alzheimer's disease (AD) lifestyle risk reduction education and goal setting/planning. The intervention sample (n = 40, mean age 68 years (range: 60-76 years), was 90% African American/Black (n = 36) and 45% male (n = 18). Thereafter, in 2021-2022, n = 37 individuals in the same area were recruited as a comparison group and not given health coaching (control group), mean age of 65.5 years (range: 57-83 years), 92% African American/Black (n = 34), and 50% male (n = 18).

RESULTS

Repeated-measures intervention effects were seen for cognitive ability, indicating greater improvement in the intervention group (p < .01). Significant difference scores indicated greater cognitive ability (p < .01) and physical activity (p < .001) gains in the intervention group, with intervention subjects with reported memory problems showed relatively less physical activity gains (p < .05).

DISCUSSION AND IMPLICATIONS

This work creates the impetus for future large-scale AD risk reduction investigations to mitigate and improve modifiable risk among diverse older adults. Our positive trends in AD risk reduction support telephone-based health coaching as a feasible AD risk reduction intervention.

"I Have Come Because I See You Care About Me": Recruiting Older Black Americans for Genomic Research

The lack of diversity in genomic studies is a disparity that influences our understanding of human genomic variation and threatens equity in the benefits of precision medicine. Given our current genomic research with Black older adults, we conducted a qualitative study to elucidate participants' knowledge, attitudes, and beliefs about genomic research and research participation and what factors contribute to their willingness to participate and to gain insights into barriers that researchers may have in recruiting Black Americans. We conducted semistructured interviews (N=16) with previous genomic research participants, and an inductive thematic approach was used to code and interpret the data. The mean age was 70, 82% reported <$15,000 annual income, and 100% participated in genomic research. The results note that genomic research is poorly understood despite participation in prior genomic studies, and cultural beliefs about health and managing health impact an individual's research participation. Although not all participants identified with historical distrust, those who did report health system distrust also contributed distrust in research. Relationship building facilitates research participation, especially when perceived as personally relevant and meaningful. Participant incentives and convenience to engage in the study are less important if the personal benefits or relevance of the research are clear. Our results provide new context into the importance of relationship building and research literacy and highlight new considerations for engaging racially diverse populations in research.

Unmet health-related needs of community-dwelling older adults during COVID-19 lockdown in a diverse urban cohort

BACKGROUND

Shelter-in-place orders during the COVID-19 pandemic created unmet health-related and access-related needs among older adults. We sought to understand the prevalence of these needs among community-dwelling older adults.

METHODS

We performed a retrospective chart review of pandemic-related outreach calls to older adults between March and July 2020 at four urban, primary care clinics: a home-based practice, a safety net adult medicine clinic, an academic geriatrics practice, and a safety net clinic for adults living with HIV. Participants included those 60 or older at three sites, and those 65 or older with a chronic health condition at the fourth. We describe unmet health-related needs (the need for medication refills, medical supplies, or food) and access-related needs (ability to perform a telehealth visit, need for a call back from the primary care provider). We performed bivariate and multivariate analyses to examine the association between unmet needs and demographics, medical conditions, and healthcare utilization.

RESULTS

Sixty-two percent of people had at least one unmet need. Twenty-six percent had at least one unmet health-related need; 14.0% needed medication refills, 12.5% needed medical supplies, and 3.0% had food insecurity. Among access-related needs, 33% were not ready for video visits, and 36.4% asked for a return call from their provider. Prevalence of any unmet health-related need was the highest among Asian versus White (36.4% vs. 19.1%) and in the highest versus lowest poverty zip codes (30.8% vs. 18.2%). Those with diabetes and COPD had higher unmet health-related needs than those without, and there was no change in healthcare utilization.

CONCLUSIONS

During COVID, we found that disruptions in access to services created unmet needs among older adults, particularly for those who self-identified as Asian. We must foreground the needs of this older population group in the response to future public health crises.