PHE 327 Module 7 Project Two Example

Project Two: Long Winters, Many Neighbors. Assessment Report on Isolation Among Older Adults

[Student Name]

Southern New Hampshire University

PHE 327: Research and Assessment in Public Health

Project Two

[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.

Project Two: Long Winters, Many Neighbors. Assessment Report on Isolation Among Older Adults

Summary

This assessment asked how common loneliness and long stretches indoors are among the county's residents aged 65 and over during winter, who is most affected and what the community already has to help. Roughly a third of the seniors who mailed back the survey were lonely, and close to 40% had gone a week or more without stepping outside last winter. Loneliness was nearly twice as common among people living alone. A smaller group reached by meal drivers and mail carriers looked worse still. The county also has real strengths: 43 congregations, clubs, businesses and services already support older residents, and two in three respondents have someone who checks on them daily. With an advisory group of older residents, partners chose three priorities: winter rides, a regular contact program for people living alone and help for those choosing between heat and other needs.

Methods in Brief

The assessment combined census, hospital and agency data with a two-page mailed survey sent to a random sample of 1,200 households with a resident 65 or older, using four contacts and a phone option. Loneliness was measured with a validated three-question scale (Hughes et al., 2004). Of 1,200 households, 548 responded. Results were weighted to census figures. Meal drivers and mail carriers separately surveyed 61 people living alone. An asset inventory was built with partners. Six older residents served as an advisory group throughout, in keeping with the community partnership approach described by Israel et al. (1998).

Needs

After weighting, about 32% of older residents were lonely and 39% were housebound for a week or more last winter. About 22% had chosen between heat and other necessities, and about a quarter had skipped a doctor's visit when roads or rides failed. Unweighted confidence intervals for these figures span about four percentage points on either side. Loneliness affected 44% of people living alone compared with 23% of those living with others. Remote township residents were not clearly more housebound than town residents. Among the 61 people reached by drivers and carriers, over half were lonely, suggesting the survey underestimates need among the most isolated. Holt-Lunstad et al. (2015) linked loneliness and isolation to higher mortality, so these are not minor concerns. Winter emergency visits by older adults for falls rose by about a third compared with summer months, and the volunteer driver program turned down 140 ride requests last winter for lack of drivers.

Assets

Kretzmann and McKnight (1993) urged communities to map what they have, not only what they lack. The inventory found 43 assets. They include 19 congregations, eight of which run visitation or phone ministries; a snowmobile club whose members already check on each other's parents after storms; two hardware stores and a grocery that deliver in winter; the senior center's lunch three days a week; the meal program, which reaches 140 people; the volunteer driver program with nine drivers; and the rural mail carriers, who notice uncollected mail. The survey adds a striking asset: 64% of respondents have someone who checks on them daily. Many of these assets were not coordinated or known to the agencies.

Capacity

The area agency on aging has three staff serving the county and administers the meal and driver programs. The health department has one community health worker and could reassign part of her time. The senior center has space and a phone line. Congregations and clubs have volunteers but no shared way to coordinate. Funding is the main constraint: the driver program's mileage budget is fixed, and new paid staff are unlikely. Capacity therefore lies mainly in organizing existing volunteers and services better rather than in new programs.

Priorities

The advisory group and partners rated each candidate priority by reach, severity, available assets and a willing lead partner. Three priorities emerged. First, winter rides: expand the volunteer driver program by recruiting drivers through the snowmobile club and congregations, aiming to meet requests that were turned down. Second, a regular contact program for people living alone: a phone or visit schedule run by congregations and coordinated by the community health worker, starting with people the meal drivers identify. Third, winter heating help: connect people to existing energy assistance through the meal program and senior center, since many respondents did not know it existed.

Limitations

The survey sampling list omitted some renters, and isolated people responded less, so need is probably underestimated. Results describe one winter. The driver and carrier group cannot be generalized. The asset inventory depends on what partners knew and may be incomplete.

What the Report Does Not Recommend

Some options were discussed and set aside. A new paid outreach worker was the most popular idea in the open answers but has no funding source and would duplicate the community health worker's role. A county-wide emergency alert registry for isolated seniors was raised by the sheriff's office but would require personal information many respondents said they would not share, and it would serve storms rather than the everyday isolation the survey measured. A second survey focused on remote townships was proposed because partners expected those residents to be worse off, but the data did not show a clear difference, so the report recommends watching that question in the follow-up rather than spending now. Setting these options aside keeps the three priorities achievable with the capacity the county actually has.

Sharing Results and Next Steps

Respondents will see what their answers produced in a single-page digest tucked into the agency newsletter and pinned up at the senior center. Partners will present the report to the county board and the agency's advisory council. The three priorities will enter the agency's annual plan and the health department's community health improvement plan, with a follow-up survey in two winters to see whether loneliness and confinement have changed.

Conclusion

Winter isolation affects a large share of the county's older adults, especially those living alone and those hardest to reach. The county also has many neighbors already helping. The task now is to connect those assets to the people who need them most.

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

Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202. https://doi.org/10.1146/annurev.publhealth.19.1.173

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.