Meeting Needs of Diverse Older Adults and Caregivers During Public Health Emergencies: What Can We Learn From COVID-19?

Abstract With support from the CDC Foundation and technical assistance from the Centers for Disease Control and Prevention, NORC at the University of Chicago conducted studies to examine the needs and concerns of older adults and unpaid caregivers during COVID-19, including their trusted sources of COVID-19 information and available public health interventions. Methods included a nationally representative survey of 1,030 adults aged 50+ years using computer-assisted telephone and web interviewing; online focus groups with older adults and caregivers in Spanish and English; a survey and interviews with stakeholder organizations; secondary analysis of U.S. caregiver surveys; analysis of public social media posts; and searches of peer-reviewed and grey literature in Spanish and English to identify interventions. Results suggest that needs and concerns differed among older adult subpopulations, including racial and ethnic minority populations, people with lower incomes, rural and tribal populations, people with limited English proficiency, and people with disabilities as well as caregivers. Older adults perceived news media, the internet, and healthcare providers as important resources for COVID-19 information, although trusted sources varied by race and ethnicity, urbanicity, and income. Findings suggested the need to increase awareness of existing public health interventions and resources to support older adults and caregivers during public health emergencies like COVID-19. Strategies for tailoring communication for diverse older adults and caregivers include partnering with national organizations, leveraging community-level infrastructure, and disseminating information through trusted sources. Studying the needs of older adults and caregivers during COVID-19 can inform future public health emergency response priorities.


The CDC Foundation, Atlanta, Georgia, United States
With support from the CDC Foundation and technical assistance from the Centers for Disease Control and Prevention, NORC at the University of Chicago conducted studies to examine the needs and concerns of older adults and unpaid caregivers during COVID-19, including their trusted sources of COVID-19 information and available public health interventions. Methods included a nationally representative survey of 1,030 adults aged 50+ years using computer-assisted telephone and web interviewing; online focus groups with older adults and caregivers in Spanish and English; a survey and interviews with stakeholder organizations; secondary analysis of U.S. caregiver surveys; analysis of public social media posts; and searches of peer-reviewed and grey literature in Spanish and English to identify interventions. Results suggest that needs and concerns differed among older adult subpopulations, including racial and ethnic minority populations, people with lower incomes, rural and tribal populations, people with limited English proficiency, and people with disabilities as well as caregivers. Older adults perceived news media, the internet, and healthcare providers as important resources for COVID-19 information, although trusted sources varied by race and ethnicity, urbanicity, and income. Findings suggested the need to increase awareness of existing public health interventions and resources to support older adults and caregivers during public health emergencies like COVID-19. Strategies for tailoring communication for diverse older adults and caregivers include partnering with national organizations, leveraging community-level infrastructure, and disseminating information through trusted sources. Studying the needs of older adults and caregivers during COVID-19 can inform future public health emergency response priorities.

COMMUNITY-ENGAGED RESEARCH WITH INDIGENOUS COMMUNITIES TO IMPROVE ELDER HEALTH AND WELL-BEING Chair: Jordan Lewis
Much of the past research conducted with tribal communities was coined "helicopter research," because researchers would enter the community, gather data, and leave the community, never to inform communities how the data was used or published, creating mistrust. Community Based Participatory Research (CBPR) is a research approach conducted as an equal partnership between community members, organizational representatives, and researchers that serve as guidelines for researchers working collaboratively with communities. This symposium will offer a panel of presentations highlighting research studies with tribal communities that honor and respect tribal sovereignty in addressing health and wellbeing among their older adults. The panel presentations will consist of presentations on dementia caregiving, generativity and successful aging, social support and diabetes management, elder-centered research methods. We examined social support among older American Indians in relation to their diabetes management. In-depth interviews were conducted with 28 participants aged ≥ 60 years who were members of a federally-recognized tribe. We examined professionally transcribed audio recordings with a systematic text analysis approach. Main sources of social support were family/friends, clinicians/formal services, community/culture, and spiritual/God. Most of the support was instrumental in nature, including food shopping, meal preparation, and medication management. Social support had both positive and negative influences diabetes management while there were some participants who lacked support. The four main social support types were present, including instrumental, emotional, informational, appraisal support. Value orientations among American Indian families command lateral-group relational behavior rather than autonomy and independence with extended social systems fostering interdependence. A deeper understanding is needed of how social relationships can be better leveraged to aid in the effective diabetes management among older American Indians. Alaska Native (AN) Elders have historically been underrepresented in research. Innovative AN research posits that practice-based evidence is fundamental to culturally grounded, multifaceted methods. AN Elders is a cultural convention distinguishing Elders who continue to serve as an integral part of their family and community and recognized by their community as role models. Several studies will be discussed which employed Elders at every level of the research, ensuring cultural relevancy, outcomes, and dissemination activities. The findings lay the foundation for an Elder-centered research methodology that can be adapted and applied in other studies to encourage engagement of older adults. This methodology has potential to impact research for underrepresented groups and to rethink and reshape Western-centric practices. Findings from this research provides best practices for capacity building and sustainability, strategies for empowerment and prevention, and a framework for supporting the AN community in all phases of research.

CULTURAL CONTINUITY IN A RESERVATION NURSING HOME Pamela Monaghan-Geernaert, Northern State University, Aberdeen, South Dakota, United States
Throughout our lifespan we experience the culture of our families and communities. Our cultural selves guide our understanding of health and illness. However the health care system often ignores our culture in the delivery of care. This can have devastating effects on individuals and particularly the elderly. This presentation reviews a case study of a tribally owned and operated nursing home. The emphasis on maintaining cultural activities, feasting on traditional foods, offering sacred practices led to high satisfaction of the health care experience by residents and staff. Creating this environment was difficult and barriers in culturally responsive care delivery will also be discussed.

COMMUNITY-BASED PARTICIPATORY RESEARCH ON DIET AND ACTIVITY WITH AN INDIGENOUS PUEBLO COMMUNITY Karen Kopera-Frye, University of New Mexico, Las Cruces, New Mexico, United States
Tribal Critical Race Theory (Brayboy, 2005) supports the use of decolonizing methodologies such as Community-Based Participatory Research when collaborating with Indigenous communities. This paper highlights the underlying processes in working with a Pueblo community on an intergenerational health project. Indigenous participants included 16 Piro Pueblo individuals who collaborated on a project examining healthy diets and activity in their community. The project involved providing information on the importance of activity and healthy eating of traditional foods to promote healthy living.
Thematic analysis of open-ended questions exploring the role of culture in food and activity yielded important themes of gathering, resilience, history, honoring ancestors at mealtime, cultural ways, and activities such as dancing and drumming. The results suggest that projects addressing diet and activity collaborate to ensure cultural values, e.g., connectedness, cultural ways, e.g., gathering, dancing, and Indigenous knowledge are represented in the project and viewed through an Indigenous lens.

CPBR PROCESS IN URBAN SETTINGS AND THE UNIQUE CHALLENGES AND SUCCESSES Steffi Kim, University of Alaska Anchorage, Anchorage, Alaska, United States
CBPR is a framework that allows for the collaboration of researchers and communities as co-partners and is a supported approach for Indigenous communities. The community engagement and co-partnership in this study allowed for the researcher's flexibility to be responsive to culturally appropriate practices and priorities of the communities and participants. CBPR principles, including the Elder Advisory Committee (EAC), were utilized in this urban-based project. Challenges presented in many ways, including the processes of a) entering communities, b) relationship building, c) time involvement, and d) recruitment. Successes represented the unique opportunity to enter communities at an interpersonal level, b) close community engagement, c) gathering information beneficial for the research team and the community, and d) extended community engagement. While challenges exist, this approach's benefits are far-reaching promoting trust, support, and interest in future research endeavors. The presenter will discuss strategies and processes helpful in engagement, recruitment, and data collection.

CREATIVE ARTS-BASED APPROACHES TO IMPROVE THE WELL-BEING OF OLDER ADULTS
Chair: Darina Petrovsky Discussant: Justine Sefcik As older adults age they may face cognitive impairment, disruption in their sleep, and a decrease in mood and overall well-being. Given the negative consequences of the COVID-19 pandemic, they may experience a disruption in their access to health care services. Creative arts-based approaches have shown promise in improving the well-being