Connecting the Digital Dots: Engaging Diverse Older Adults Through Virtual Outreach

Abstract

According to the Administration on Aging in 2018, 34% of older adults are racial and ethnic minorities. The median income of older adults was ∼$25K, with 18.9% of older Non-Hispanic (NH) Blacks, 11.7% of older Asians, and 19.5% of older Hispanics living below the poverty level (compared to 7.3% NH Whites). With a growing cohort of older adults ≥75 years old, 50% report difficulty in physical functioning. At the intersection of race/ethnicity, income inequality, age and frailty; many older adults face challenges to receiving high quality mental health care and access to clinical trials. 40% of homebound older adults have a psychiatric or cognitive disorder but have limited access to mental health services. Despite increased illness burden, both racial/ethnically diverse and homebound older adults are underrepresented in clinical trials.The Montefiore Home Care Geriatric Psychiatry Program (MHC-GPP) and the Montefiore Hudson Valley Center of Excellence for Alzheimer's Disease (CEAD) have extensive experience serving a culturally and economically diverse patient population since 2004 and 2014, respectively. Both programs have collaborated to provide older adults with comprehensive assessments of psychological symptoms, cognitive and psychosocial needs across varied cultural and socioeconomic backgrounds. These assessments have connected patient/caregiver dyads with community supports and clinical trials. In 2016, the MHC-GPP and the CEAD secured two funding opportunities to provide problem based psychosocial interventions in the home. Over ¾ of the patients served by these programs are NH Black or Hispanic older adults, most of which have less than 12 years of education.However, in March 2020, the COVID-19 pandemic presented new barriers to reaching frail and cognitively impaired patients in this diverse community. In order to address these complex needs, the MHC-GPP social work team began proactively calling patients admitted to a Certified Home Health Agency (CHHA) during the first quarter of the pandemic. This provided a unique opportunity to address the concrete and mental health needs of those most vulnerable to COVID-19. In addition, the MHC-GPP psychiatric team pivoted to telehealth evaluations that would still provide comprehensive assessment and management of psychological and cognitive symptoms. The MHC-GPP team also conducted virtual support groups for the CHHA staff. At the same time, the CEAD team converted the community engagement studio framework to a virtual format to engage a cohort of older predominately NH Black woman to discuss recruitment and retention of participants to a future clinical trial.During this session, the presenters will describe how telehealth interventions were implemented throughout the pandemic to engage diverse older adults in community. Presenters will describe how the MHC-GPP social work team developed a telephone assessment to proactively identify both concrete and mental health needs during the first quarter of the pandemic. Presenters will describe how the MHC-GPP in home psychiatric assessment was adapted to telehealth, while still continuing to provide behavioral and cognitive assessment in English and Spanish, to initiate treatment, to refer to clinical studies, and to provide a training site for fellows and residents. Finally, presenters will share results from a virtual community engagement studio, which was conducted to improve the recruitment and retention of under-resourced populations in a future clinical trial. The chair will also facilitate discussion of case examples and lessons learned.