Rural older Veterans and their caregivers are most vulnerable to social isolation and loneliness during the COVID-19 pandemic. Loneliness is a subjective, stressful and distressing feeling associated with feelings of helplessness, powerlessness, and vulnerability. The prevalence of loneliness is reported be as high as 49% and increases with age, rurality and the number of medical comorbidities. The Biopsychosocial model is useful in understanding risk factors and proposing strategies to address loneliness. COVID-19 and resulting social restrictions have adversely affected biological (chronic illnesses, functional status), psychological (depression, anxiety, PTSD) and social (contact with loved ones, lack of information, healthcare access) risk factors of loneliness in rural older Veterans. COVID-19 exacerbates all known risk factors for loneliness and warrants immediate attention. We propose to address the following biopsychosocial factors of loneliness and social isolation in rural older Veterans and caregivers during the COVID-19 pandemic: 1. Disruption in medical care, 2. Disruption in mental health care, 3. ACP preparedness, and 4. Telehealth preparedness.
The primary objective is to compare the impact of the COVID-19 crisis on loneliness among rural vs. urban older veterans and identify associated biopsychosocial factors and disruptions in medical and mental health care. Secondary objectives are to identify differences in ACP preparedness in rural vs. urban older veterans and to describe access to telehealth resources and needs of rural older Veterans during COVID-19.
We propose to conduct a two phase, mixed methods study. Phase I will be a quantitative survey of 200 older Veterans/caregivers followed by qualitative interviews of 30 selected rural Veterans/caregivers in phase II.
Phase I: A telephone survey will be conducted. Survey items will assess loneliness (primary outcome, validated measure), medical and mental health changes, COVID-19 induced isolation, ACP preparedness, delays in the care of non-COVID-19 medical conditions, and telehealth preparedness. Questions are selected to inform next steps for pandemic preparedness.
Phase II: Using semi-structured telephone interviews, we will explore older rural Veterans or caregivers' perspectives on practical strategies to overcome biopsychosocial risk factors of loneliness, ACP preparedness, and access to resources during a crisis especially related to telehealth interventions or VA-community partnerships in rural settings.
Statistical analysis: Quantitative data analysis using SAS Enterprise Guide 7.15 (SAS Institute, Cary, NC) will include descriptive analyses to assess both central tendency and variations. Appropriate tests such as two-independent-sample t-tests will be performed to compare certain groups with respect to variables of interest. Qualitative analysis will be a continuous process beginning with initial interviews. The team will develop and apply a list of codes using an emergent approach to emphasize interviewee perspectives. All coded data will be entered into ATLAS.ti v8.0 (GmbH, Berlin). Coded transcripts will be analyzed thematically to identify overall main findings, especially potential solutions to maximize social connectedness and based on perspectives as a veteran or caregiver.
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Our proposal is highly aligned with VA priorities as it serves complex veterans with multiple chronic conditions, focuses on access for rural veterans by studying barriers to use of telehealth, and gathers input from caregivers for future interventions. Our proposal makes a unique contribution to VA COVID-19 priorities by comparing rural vs urban veterans related to a meaningful outcome (loneliness), studying delays in care for non-COVID conditions, and conducting actionable research to improve Veteran health despite quarantines. The proposed mixed method research has implications for increasing older rural veterans' well-being and forming partnerships with community resources in rural areas to support older veterans during large-scale crises.
None at this time.
Aging, Older Veterans' Health and Care, Health Systems, Mental, Cognitive and Behavioral Disorders
Epidemiology, Etiology, TRL - Applied/Translational
None at this time.
None at this time.