Homebound Seniors Research Articles

Using Virtual Reality Recreation Therapy to Enhance Social Interaction and Well-Being in Homebound Seniors

In view of Singapore’s rapidly ageing population, this study is an exploratory pilot designed to assess the feasibility and potential impact of virtual reality recreation therapy (VRRT) on homebound seniors. A tri-party research partnership was formed between the Singapore University of Social Sciences (SUSS), NTUC Health Home Care, and Vue Reality Labs. The aim was to explore the benefits of VR recreation therapy for homebound seniors, contributing to the goal of ‘aging in place’. Over two years, a 52-week VR curriculum was developed, featuring social, travel, and cultural topics tailored to the seniors. Five care associates from NTUC Health Home Care received facilitator training by Vue Reality Labs. A total of 71 homebound senior participants aged 50 to 102 engaged in over 1600 session hours during the 52-week trial; 62% had varying levels of dementia. A mixed-methods approach was adopted to explore the general impact and feasibility of VR recreation therapy, incorporating quantitative data on participants’ emotional, social, and cognitive conditions and qualitative data from facilitator interviews. The findings revealed that most senior participants enjoyed the VR sessions, perceiving them to positively impact their overall health and well-being. Caregivers reported improvements in cognitive, social, and emotional functioning of the participants. The positive effects extended to caregivers and facilitators, with renewed relationships and enhanced skills, respectively. The insights and observations gathered from this pilot study will serve as a foundation for designing a more robust study for deploying the VR recreation therapy programme in senior care.

Improving Hurricane Preparedness Among Galveston County Older Adults: Description of a Successful Community-Based Quality Improvement Model.

Older adults are at high risk of experiencing injury, exacerbations of their chronic conditions, and death when evacuations are ordered because of hurricanes or natural disasters. The Homebound seniors residing in Galveston County are at a particularly high risk of morbidity and mortality during evacuations for hurricanes. This paper described the impact of a quality improvement intervention designed and implemented by nurse practitioners during the 2022 and 2023 hurricane season. The education program aimed at increasing the hurricane preparedness of the home-bound patients. Of these patients, 190 returned pre and post surveys. Interventions showed a 43% increase in patients having an evacuation plan in the event of a hurricane, 633% increase in STEAR registration, 16% increase in patients having access to emergency supplies, and 34% increase in patients having an emergency contact list with up-to-date medication list. All improvements on hurricane preparedness items were significant (p < .0001) except for the need for assistance in case of an evacuation. Our findings suggest a need for continuous hurricane preparedness education in the community to ensure safe evacuation, improve hurricane preparation, and increase the number of seniors who registered with the State of Texas Emergency Assistance Registry.

The Impact of a Food Recovery-Meal Delivery Program on Homebound Seniors’ Food Security, Nutrition, and Well-Being

Food insecurity is a growing problem among seniors. A novel program was established to help mitigate the problem of food insecurity among seniors who are homebound. Volunteers recover unused prepared food donated by area hospitals, repack it into healthy meals which are delivered to program participants. To evaluate the impact of our intervention, seniors’ nutritional health and social well-being were measured at enrollment and after three to five months using the following: Mini Nutritional Assessment Short Form (MNA-SF), 24-hour recall, USDA 6-Item Food Security Survey, WHO-5 Well-Being Index, and the 3-Item Loneliness Scale. Statistical analysis indicated a significant improvement in nutritional health, well-being, and loneliness; participants also increased their consumption of protein and calories. Semi-structured interviews were conducted to investigate the self-perceived impact of the program. Thematic analysis of the interviews revealed that meal recipients perceive that food recovery-meal delivery programs may improve their nutrition health, food security, and well-being.

Serving Homebound Seniors: In-Home Senior Farmers’ Market Nutrition Program Enrollment and Fresh Fruit and Vegetable Home Delivery for Homebound Seniors in Central New Jersey

Low-income, homebound seniors may encounter affordability and accessibility-related barriers to consuming enough fresh fruits and vegetables (FV). This paper describes a two-stage pilot intervention to improve fresh FV affordability and access for home-delivered meal (HDM) program clients in Central New Jersey. The first stage of the intervention offered in-home Senior Farmers’ Market Nutrition Program (SFMNP) enrollment assistance to low-income HDM program clients, with 13 clients successfully enrolling in SFMNP. The second stage of the intervention offered fresh FV home deliveries to all 64 HDM program clients at no cost to clients. We sourced fresh FV from a farmers’ market run in partnership with a Cooperative Extension program affiliated with a large public research university. We carried out a post-intervention evaluation by conducting semi-structured interviews with 17 clients. Interviews addressed themes of farmers’ market access, SFMNP awareness, perceived changes to FV intake, and home delivery satisfaction. Evaluation results suggest that this short-term pilot intervention was well-received and effective in reducing barriers to FV access and affordability for a vulnerable senior population.

Emergency Medical Technician-Facilitated Telehealth Visits: A New Model to Expand Home-Based Primary Care for Homebound Seniors

Objective: As the number of older adults living in the United States grows, the gap between the capacity of home-based primary care (HBPC) services and the community demand will continue to widen. Older adults, living longer with mobility difficulties and multiple chronic medical conditions, often prefer to age in place, and new models of care are needed to meet this need. This article provides a framework for an innovative emergency medical technician (EMT)-facilitated telehealth program, the mobile telemedicine technician (MTT) program, which aims to increase access to medical care and efficiency within an HBPC program.&#x0D; Design: A descriptive framework outlining the deployment of an innovative telehealth model.&#x0D; Setting: An HBPC program serving homebound seniors in downstate New York.&#x0D; Participants: Homebound individuals enrolled in an HBPC program with advanced age (over half &gt;90 years), 67% with 5–6 activities of daily living (ADL) dependencies, and high rates of dementia, congestive heart failure, chronic obstructive pulmonary disease (COPD), and diabetes requiring evaluation and treatment of acute conditions.&#x0D; Interventions: HBPC program enrollees requiring evaluation and treatment of acute conditions received a home visit from a telehealth-enabled EMT who has received additional training to provide in-home care. Following an evaluation, the EMT facilitated a telehealth visit via a two-way video conference between the patient and the primary care physician.&#x0D; Main outcome measures: Description of a novel telehealth care model, preliminary results from the first 100 MTT visits including the reason for visit, patient/caregiver, physician, and telehealth-enabled EMT satisfaction survey results.&#x0D; Results: The primary care provider was able to evaluate twice as many patients in a given time period using the new model as in the regular home visit care model. The most common visit reasons were related to skin conditions (22%), neurological conditions (19%), cardiovascular conditions (16%), and respiratory conditions (15%). Satisfaction rates were high from patients/caregivers (45% response rate, 60% strongly agreed and 29% agreed that they were satisfied with the care delivery experience), physician (six surveys over time from one physician, 100% strongly agreed on the effectiveness of care delivery model), and telehealth-enabled EMTs (eight surveys from four EMTs, 100% strongly agreed that they were satisfied with the care delivery experience).&#x0D; Conclusions: In this descriptive article, we outline a new model of care using telehealth-enabled EMTs making home visits to connect with a patient’s primary care physician who is centrally located. This model shows promise for expanding primary care services within the home.

HARNESSING THE POWER OF NETWORKS TO ADDRESS SOCIAL ISOLATION, LONELINESS, DEPRESSION, AND ELDER ABUSE

Challenges to aging and risks to physical health and mortality arise when older adults have untreated mental health needs, experiences social isolation, loneliness, or is a victim of elder abuse. This symposium presents three innovative models that harness the power of networks and collaboration between aging services and an academic medical center to meet the needs of ethnically diverse community seniors. These model programs include: embedded mental health services on-site in community senior centers; Friendly Visiting to homebound seniors; and PROTECT intervention to treat elder abuse victims’ mental health needs. Research from these innovative, collaborative programs indicate that over 50% of senior center members screened positive for depression and anxiety (higher than the national average of 3-20%), social isolation, loneliness, and elder abuse. Of the 75% who engage in treatment, 37.3% and 41% showed a 3-month improvement of depression and anxiety, respectively. For seniors who have a friendly visitor, one-third also suffer from depression and/or anxiety. Three months after being visited by a friendly visitor, 42% and 53% see improvement in loneliness and social isolation, respectively. Among victims of elder mistreatment, 33% screened positive for depression or anxiety and 16% reported suicidal ideation. Clients receiving the PROTECT intervention had a greater decrease in depression, felt services were more useful, and reported greater improvement in the abuse. To find and build strength in age, it is essential that programs and policy be developed to support collaboration and provide the opportunities for building and utilizing networks across different domains of aging.

O6 Meals on Wings: A Food Recovery Meal Program to Improve the Nutritional Health and Well-Being of Seniors

Background For the older adult, maintenance of good nutritional health is essential to functioning, the prevention or management of chronic disease, and quality of life. Compounding this problem is the increasing numbers of seniors that are food insecure. Studies show approximately half of community-dwelling elders are at nutrition risk which leads to increased risk for additional health problems, functional decline, reduced quality of life and hospitalization. The Meals on Wings program offers a solution for some of those seniors in need by recovering unused food that would normally be wasted from area hospitals and repackaging it into healthful meals. The meals are delivered to home-bound seniors using student volunteers to recover food, prepare the meals and deliver to the seniors. This program not only fights hunger in the community but also helps decrease food waste. Objective Investigate the impact of a food recovery and meal delivery program on the nutritional health, social well-being, and isolation of home-bound seniors. Evaluate the impact of volunteering on student volunteers' empathy and perception of social responsibility. Study Design, Setting, Participants This study utilizes a within-group, pretest-posttest design. There are two study groups: home-bound seniors on the waitlist for Meals on Wheels and students enrolled at the University of North Florida. Measurable Outcome/Analysis Seniors’ nutritional health and social well-being are measured using a pre-post methodology. Surveys are given at enrollment, three months, and six months, and include the following measures: MNA-SF, 24-hour food recall, USDA 6-Item Food Security Survey, WHO-5 Well-Being Index, and the 3-Item Loneliness Scale. Student volunteers are surveyed at program start and at 90 days using the Toronto Empathy Questionnaire-Public Service Motivation Scale. Results After six months, the program has: delivered 2,048 meals; seen significant improvements in senior's nutritional health parameters; and seen a significant improvement in students' public service motivation. Conclusion Receiving home-delivered meals for a short duration significantly improves recipients' nutritional health and well-being, improves student public service motivation, and reduces food waste. Funding None.

TELE-BEHAVIORAL ACTIVATION FOR SOCIAL ISOLATION IN OLDER HOME-DELIVERED MEALS RECIPIENTS: PRELIMINARY RESULTS FROM AN ONGOING RANDOMIZED CONTROLLED TRIAL

Introduction Homebound older adults are often unable to participate in social interactions and activities that require leaving the home, resulting in a high prevalence of isolation among this population. Isolation is associated morbidity, disability, and mortality. Technology has been explored as a potential avenue for meaningful social interaction for homebound seniors. We present preliminary results of an ongoing randomized controlled trial evaluating the acceptability, feasibility and comparative effectiveness of delivering two interventions by video-conferencing technology to promote social connectedness among homebound older adults receiving home-delivered meals: 1. Behavioral activation (tele-BA) vs. 2. Friendly visitors (tele-FV). To our knowledge, this is the first randomized controlled trial to leverage local Meals on Wheels (MoWs) agencies to engage homebound, socially isolated older adults in a telehealth intervention for social isolation. Methods Older adults in New Hampshire and central Texas were recruited for our study by local MoWs agencies during the routine annual evaluation of their home-delivered meals clients. After a brief eligibility screening by their MoWs case workers and indicated interest, MoWs clients were referred to our study team and contacted by telephone for a full eligibility assessment. Eligible participants endorsed social isolation (6 or greater on the 3-item UCLA Loneliness Scale), but did not report symptoms of moderate to severe depression (PHQ-9 Results In the first year of our study, 50 socially isolated older adults (age M±SD73.5±9.2 years; range 51 to 90 years) participated in either the tele-BA intervention (n=28) or tele-FV comparison condition (n=22). Participants were predominantly non-Hispanic white (70%), female (65%), of lower SES (56% less than $20,000 annual income) and living alone (68%). When asked, all participants indicated they would recommend this tele-program to family and friends (Net Promotor Scale 0-10: M±SD 9.7±0.9; range 6-10). Most participants (92%) found these tele-sessions moderately to very acceptable for their social isolation and 95% indicated somewhat positive to very positive general reaction to the program. Preliminary data at 12-week follow-up showed reduction on the 8-item Social Isolation measure and the PHQ-9, with a trend towards greater improvement in participants who participated in the tele-BA group. Conclusions Overall, participants found tele-Behavioral Activation and tele-Friendly Visits to be positive experiences and acceptable for their social isolation, and would recommend the program to their friends and family. Preliminary data showed improvement in isolation and depressive symptoms for both groups, which is sustained through 12 weeks of post-intervention follow-up. Our preliminary results suggest the feasibility, acceptability and potential effectiveness of using tele-technology to deliver interventions for homebound older adults who report social isolation. We also found potential evidence of the effectiveness of modified tele-behavioral activation program, compared to friendly visitors, in reducing social isolation and subclinical depressive symptoms in this population. Finally, we demonstrated the feasibility of working in collaboration with community-based Meals on Wheels agencies to identify socially isolated clients and refer them to this program. This research was funded by AARP-Foundation

The Importance of Providing Psychotherapy Services to Homebound Seniors

The Importance of Providing Psychotherapy Services to Homebound Seniors

Nursing Student Collaborative With Meals on Wheels: Home Visits for At-Risk Senior Adults.

Nursing students at Washington State University Tri-Cities Campus are taking part in a program to provide care for homebound senior adults enrolled in home delivery meal services. Students perform home safety, functional, and cognitive assessments while learning the challenges of meeting nutritional needs of an at-risk senior adult population. This article outlines the program and its outcomes after two years of collaboration. Meals on Wheels is identified as an innovative placement for meeting nursing program outcomes and clinical practice hours. Areas for future growth include interdisciplinary collaboratives and partnering with local hospitals to study the program's impact on hospital readmission.

Food Safety Practices of Homebound Seniors Receiving Home-Delivered Meals

Little is known about the food safety knowledge, behaviors, environments, and in-home food supplies of the growing population of homebound US seniors who are dependent on home-delivered meals. This cross-sectional study of 725 home-delivered meal recipients used in-home interviews, food inventories, and kitchen audits to examine potential food safety vulnerabilities. Seniors' food safety was compromised by poor home kitchen conditions, inadequate refrigerator/freezer temperatures, vision problems, and a lack of understanding of safe food storage times. The results identify conditions that may place seniors at greater risk for foodborne disease and suggest areas for interventions to reduce this risk.

Attitudes Toward Aging in Place Using Wearable and Remote Monitoring Technology Among Underserved Homebound Seniors

Background: Wearable and remote monitoring technology have great potential to support homebound seniors aging in place. However, the seniors’ adoption of new technology has been slow, and current research has focused primarily on the rich and the motivated. Objective: The purpose of this study was to investigate underserved homebound seniors’ attitudes, including their current use, interests, preferences, and potential concerns toward aging in place using wearable and remote monitoring technology. Methods: A cross sectional survey study was conducted with 181 seniors who were participants of the Meals on Wheels program. In order to be eligible for this program, clients must be disabled adults who are homebound and over 60 years of age. Results: The sample had an average age of 77 years. The group of participants was 66% female, 36% African American, and 49% White. Nearly 51% of the residents sampled in this study reported that they lived alone; 22.7% lived with a spouse; and 22.7% lived with family. More than half the sample (54.7%) reported having ever used a health-monitoring device at home, such as a blood pressure monitor or a blood glucose meter. More than half of the resident had access to electronic devices such as a television (92.8%), regular cell phone (58.0%), DVD player (56.9%), or a landline telephone (53.6%). A smaller percentage had more popular electronic devices, such as a smartphone (21.0%), laptop computer (18.8%), desktop computer (12.7%), or tablet (12.2%). Only 1% of the residents sampled reported having no access to any type of electronic device. Nearly 50% of the residents surveyed had never heard of wearable health devices; most had never used such devices (84.0%). Sixty-one percent of the residents reported that they would be interested in using a wearable device. Well over half of the residents (68.5%) would prefer to wear the device on their wrist. This sample reported an interest in tracking the following with wearable devices: blood pressure (51.4%), heart rate (44.8%), exercise and physical activity (35.4%), blood sugar (34.3%), fall risk (32.6%), hours and quality of sleep (32.6%), weight 27.6%, diet (27.1%), body posture (19.3%), mood (17.7%), and other (9.9%). When asked about what concerns residents had about using wearable devices, 55.2% reported cost to be a concern. Other concerns were related to safety (20.4%), privacy (16.0%), fraud (14.4%), and overwhelming information (11.0%). Twenty-five percent of the residents reported having no concerns. Conclusions: While the majority of the underserved homebound seniors had never used any wearable or remote monitoring technology to support aging in place, and half had never heard of them, there is a great amount of interest in using such technology in this underserved population. Cost is the primary barrier to their adoption. Additional studies are needed to examine cost-effectiveness of using such technology to prevent expensive emergency room and other health services due to poor management of chronic conditions in this underserved population.

Home care assistants' perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity.

IntroductionElderly people with multiple chronic conditions, or multimorbidity, are at risk of developing poor mental health. These seniors often remain in their homes with support from home care assistants (HCAs). Mental health promotion by HCAs needs to be studied further because they may be among the first to observe changes in clients’ mental health status.AimTo describe HCAs’ perspectives on detecting mental health problems and promoting mental health among homebound seniors with multimorbidity.MethodsWe applied a descriptive qualitative study design using semi-structured interviews. Content analyses were performed on five focus group interviews conducted in 2014 with 26 HCAs.ResultsMost HCAs stated that they were experienced in caring for clients with mental health problems such as anxiety, depression, sleep problems, and high alcohol consumption. The HCAs mentioned as causes, or risk factors, multiple chronic conditions, feelings of loneliness, and social isolation. The findings reveal that continuity of care and seniors’ own thoughts and perceptions were essential to detecting mental health problems. Observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health.ConclusionThe HCAs had knowledge of risk factors, but they seemed insecure about which health professionals had the primary responsibility for mental health. They also seemed to have detected early signs of mental health problems, even though good personal knowledge of the client and continuity in home visits were crucial to do so. When it came to mental health promotion, the suggestions related to the aim of ending social isolation, decreasing feelings of loneliness, and increasing physical activity. The results indicate that the HCAs seemed dependent on supervision by district nurses and on care managers’ decisions to support the needed care, to schedule assignments related to the detection of mental health problems, and to promote mental health.

Partnering with Faith-Based Organizations to Enhance Positive Outcomes for Home-Bound Seniors

This innovative pilot study consisted of initiating a clinical partnership between a faith-based institution and a single clinical group of nursing students in their final semester of a bachelor nursing program of study in south Texas. Following the goals of Healthy People 2020 of improving quality of life and promotion of healthy behaviors, nursing students made home visits to home-bound seniors who were members of the partnering faith-based organization. One of the goals of this pilot study demonstrated the importance of community engagement of nursing students with home-bound seniors that holistically enriched the lives of both the students and seniors.

Hurricane Irene and the Disruption of Home Delivered Meals to Homebound Seniors

Hurricane Irene and the Disruption of Home Delivered Meals to Homebound Seniors

Food Safety Practices of Home-Bound Seniors Receiving Home-Delivered Meals

Food Safety Practices of Home-Bound Seniors Receiving Home-Delivered Meals

The Applied and Industrial Mathematics Program with Example Project: Efficient Routing for Meals on Wheels in the Shenandoah Valley

The Applied and Industrial Mathematics program partners applied mathematics students with businesses, governments, laboratories, and agencies to solve real problems. We will discuss the logistics of the program and give advice on starting and running similar programs. We also give a detailed example of a specific project, namely our work with the local Meals on Wheels program. The problem of routing the drivers who deliver meals to home-bound senior citizens was solved by writing user-friendly software that employs a genetic algorithm. Both anecdotal evidence and simulations are provided to illustrate the advantages of our method.

Will Rest for the Weary Wear Everybody Out?

Will Rest for the Weary Wear Everybody Out?

Academy Members Leading Efforts to Decrease Food Insecurity

ACADEMY OF NUTRITION and Dietetics' members have always had an awareness of hunger and its impact on families. Hunger can touch many practice areas—whether it is delivery of medical nutrition therapy to a person who has no access; delivery of healthy foods to the homebound senior; or families in the Special Supplemental Nutrition Program for Women, Infants, and Children. This article will give a snapshot of hunger today and what some of our members are doing to eliminate this issue.

Two‐year food security transition and nutrient intake among homebound seniors

Little is known about food security transition over time and the influence on nutrient intake among homebound seniors. Data are from 262 homebound older adults who received home‐delivered meals and completed in‐home assessments at two time‐points (1 year interval). Dietary intake was determined through 3 24‐hour dietary recalls at each time‐point. NDS‐R software was used to calculate nutrient intake; energy‐adjusted multiple regression models examined variables associated with nutrient intake at time 2. Food security stability was reported by 39% (n = 103), persistent risk for food insecurity by 26.3 %, and persistent food insecurity by 2.3%; 23% became less food secure; and 9% became more food secure. Nutrient intake at baseline predicted intake 1 year later. Food security transition was associated with time 2 intakes of energy, fiber, niacin, and phosphorus. Although food security transition is a predictor of energy‐adjusted dietary intake among homebound older adults, baseline dietary intake is the most significant predictor of dietary intake one year later. Thus, it is critical to monitor both food security status and dietary intake in vulnerable older populations.