Abstract

Background: Older sexual and gender minority (SGM) Veterans are vulnerable to health disparities and may experience poor health outcomes as a result. These health disparities can be traced to structural inequities, minority stress, and limited social networks. Pride in All Who Served (PAWS) is a health promotion intervention that serves SGM Veterans of all ages and has been implemented in over 71 VAMCs with over 1000 Veteran participants. The absence of key content relevant to aging dampens its impact for older SGM Veterans. Significance to VA: There are no interventions or clinical trials that address the unmet needs of older SGM Veterans. This proposal aligns with VA priorities to address health disparities and the needs of aging Veterans. Innovation and Impact: Geri Pride is a novel and vital intervention for the growing population of older SGM Veterans. By addressing the structural factors that have contributed to health disparities of SGM Veterans while addressing the pressing needs of aging, the intervention reduces marginalization, promotes resilience, and provides a means for aging SGM Veterans to engage positively in their health. Specific Aims: 1) Aim 1 focuses on adapting PAWS with pre-identified aging-focused content and resources to produce the virtual intervention, Geri Pride. Additional input will be sought from older prior PAWS participant Veterans, experienced PAWS facilitators, and key clinical leaders and operational partners (LGBTQ+ Health Program Office leadership and Geriatrics and Extended Care services). We will then pilot Geri Pride and assess pilot outcomes in Aims 2 and 3 to establish feasibility of a future clinical trial. 2) Aim 2 proposes to assess the feasibility, fidelity, and acceptability of Geri Pride for participants, interventionists, clinical leaders, and operational partners. 3) Aim 3 evaluates Veteran-centered measures by examining the preliminary effects of Geri Pride. First, mental health and psychosocial outcomes are assessed such as anxiety, depression, resilience, internalized stigma, and social connection. Next other facilitators and indicators of healthy aging are assessed such as healthcare engagement, risk of long-term care, and advance care planning. Methodology: Input via interviews and focus groups with key interested parties such as clinicians, operational partners, and PAWS facilitators and past participants will be used to create Geri Pride. The FRAME approach will be used to track and evaluate adaptations to the PAWS intervention to create the Geri Pride intervention. For the pilot of Geri Pride, between 48-64 Veterans who identify as being SGM and who are 50 years of age and older will be recruited to the pilot. The pilot is powered to detect change in anxiety as measured by 3-point pre-post differences in the Generalized Anxiety Disorder (GAD-7) score. During the pilot, fidelity will be assessed using predetermined fidelity check points and FRAME fidelity tracking. Geri Pride will be evaluated for acceptability of the intervention and feasibility for a future clinical trial via interviews with PAWS interventionists, Veteran participants, VA clinical leaders, and operational partners. For all aims, interviews and focus group content will be analyzed using rapid qualitative analysis. VA CDW and GECDAC RHF data files will be extracted to measure healthcare utilization, potential risk for admission to long- term care, financial hardship, and housing instability. Feasibility for a future clinical trial will also be assessed via data collection of structured instruments that measure anxiety, depression, social isolation, healthcare engagement, resilience, self-acceptance, and ageism. By detecting preliminary effects of these measures, we will have gained knowledge and expertise necessary for a future clinical trial. Path to Translation/Implementation: Results of this proposal will generate a first of its kind intervention designed to meet the needs of older SGM Veterans. Geri Pride will then be tested in a fully powered, randomized clinical trial. After the study is complete, we will partner with the Office of Geriatrics and Extended Care and the LGBTQ+ Health Program Office to further test and disseminate Geri Pride across VA.

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DRA: Mental, Cognitive and Behavioral Disorders, Aging, Older Veterans' Health and Care, Health Systems Science

DRE: Treatment - Efficacy/Effectiveness Clinical Trial, Engagement Science

Keywords: None at this time.

MeSH Terms: None at this time.