PHE 327 Module 2 Indicators Short Paper Example

What to Count and Where to Find It: Indicators for an Assessment of Winter Isolation Among Older Adults

[Student Name]

Southern New Hampshire University

PHE 327: Research and Assessment in Public Health

Module Two Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

What to Count and Where to Find It: Indicators for an Assessment of Winter Isolation Among Older Adults

An assessment is only as good as the indicators it uses. Choose too many and the report becomes a list of numbers with no story; choose the wrong ones and the assessment answers a question nobody asked. This paper selects indicators for the assessment question developed in Module One: among adults 65 and older in a composite county of about 17,000 people in Michigan's western Upper Peninsula, how widespread are loneliness and long stretches indoors over the winter, and which supports already reach those affected? It explains the criteria used to choose indicators, evaluates the main existing data sources, presents the selected indicators and identifies what must be collected new.

Criteria for Choosing Indicators

Four criteria guided selection. Relevance asks whether the indicator measures something that bears directly on the question, such as isolation, its causes or its consequences. Quality asks whether the measure is valid and reliable and whether the source collects it consistently. Timeliness asks how recent the data are; a measure from a decade ago may describe a different population. Availability asks whether the measure exists for this county, since many national surveys sample too few people in small rural counties to report reliable local figures. An indicator had to meet the first criterion and at least two of the others to be included.

Existing Data Sources

Several existing sources were evaluated. Census Bureau survey data provide the number of older adults, the share living alone, income and housing characteristics for the county, though small-county estimates combine several years and carry wide margins of error. National behavioral health surveys provide self-reported health and some social measures, but too few older adults in this county are sampled for local estimates, so modeled estimates must be used with caution. Medicare data summarized by federal agencies describe chronic conditions among beneficiaries. Local administrative records offer timely and very local information: the area agency on aging's meal delivery and wellness call lists, the senior center's attendance logs, the volunteer driver program's ride records and the regional hospital's emergency visits by older adults during winter months. Each has gaps; administrative records count only people already in contact with services.

Selected Indicators

Eight indicators were selected. Four can come from existing data: the number and share of residents 65 and older; the share of older adults living alone, from census data; the share of older households below 150% of the poverty line; and the number of winter emergency department visits by older adults for falls or cold exposure, from hospital records. Two come from local administrative records: how many seniors get meals brought to the door or a wellness phone call over the winter and the number of volunteer driver rides requested and unmet. Two must be collected new through a survey: loneliness, measured with a validated short scale, and the share who went seven or more days without leaving home during the past winter. A further measure of whether each person has someone who checks on them daily will be added to the survey to capture an important asset.

Why Loneliness Must Be Measured Directly

Living alone is often used as a stand-in for isolation, but the two are not the same. Many people who live alone have frequent contact and feel connected, while some who live with others feel lonely. Holt-Lunstad et al. (2015) found that loneliness, social isolation and living alone were each separately associated with higher mortality, which means each deserves its own measure. Loneliness is a feeling and can only be measured by asking. Hughes et al. (2004) developed a three-item loneliness scale suitable for large surveys, which makes direct measurement practical within a short questionnaire.

Measuring Assets as Well as Needs

Indicators are usually about problems. Kretzmann and McKnight (1993) argued that communities should also map their assets, the associations, institutions and individuals that already support residents. The assessment will therefore count assets too: congregations that run visitation programs, clubs or groups that check on older members, businesses such as the hardware store that delivers in winter and services like the meal program. These will be gathered through a short inventory with partners rather than a database, because no database records them.

How the Indicators Fit Together

The eight indicators work as a set, not as separate figures. The census figures describe the size of the population at risk and the share living alone, which frames how many people the problem could touch. The survey measures of loneliness and days confined at home show how many actually experience isolation in winter. Emergency visits for falls and cold exposure suggest some of its consequences. The meal, wellness call and volunteer driver records show who the existing services already reach and where requests go unmet. The asset inventory shows what else the community offers. Read together, they can answer the assessment question in three parts: how large the need is, who is falling through existing services and what could be built on. A single indicator, such as the share living alone, would answer none of those parts well. The design also makes comparisons possible, for example between people who live alone and those who do not, or between residents who receive meals and those who do not, which helps show whether the services reach the people most in need.

Limitations

The selected indicators have limits. Census figures for a small county are estimates with wide margins of error. Administrative records undercount people who do not use services, who are likely to be among the most isolated. The new survey will reach only those who respond, which Module Four addresses. And winter conditions vary from year to year, so one winter's results may not represent others.

Conclusion

Eight indicators, half from existing data and half from local records or a new survey, give the assessment enough to describe the population, measure isolation directly and count what already works. The most important measures, loneliness and confinement in winter, exist in no database. Module Three will design the survey to collect them.

References

Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227-237. https://doi.org/10.1177/1745691614568352

Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys: Results from two population-based studies. Research on Aging, 26(6), 655-672. https://doi.org/10.1177/0164027504268574

Kretzmann, J. P., & McKnight, J. L. (1993). Building communities from the inside out: A path toward finding and mobilizing a community's assets. ACTA Publications.