Improving Physical and Psychosocial Functioning in Older Adults: A Community Health Worker-Led Intervention

: Many older adults, especially following difficult or disruptive periods or events, face a downward spiral of psychological distress, reduced physical and social activity, and physical deconditioning. Timely intervention is critical to prevent or slow this decline. Re-Engaging in Self-care and Enjoying Today (RESET) is a self-management and resilience-building intervention led by community health workers (CHWs) at the Detroit Health Department (DHD). CHWs have a unique ability to form a therapeutic alliance with their patients/clients, provide individualized care, and form a bridge to formal services, yet have been vastly underutilized in the geriatric healthcare workforce. This intervention targets individual (self-management, resilience), interpersonal (social support) and community (enhanced DHD capacity) levels. The long-term goal of this research is to build an evidence base for engaging the CHW workforce to promote improved psychosocial and physical functioning among older adults. The project’s objective is to assess the impact of RESET on functional outcomes. The central hypothesis is that RESET, delivered via a synchronous group telephone platform, an asynchronous podcast series, and activity trackers, will improve psychosocial and physical functioning at 2 and 8 months. In an ongoing randomized pilot trial, a version of RESET called Positive STEPS has been well-received and delivered by CHWs with high fidelity. In analysis to date of post-program outcomes, the intervention group (n=16) has shown clinically significant improvements of 2 to 5 points across PROMIS domains of physical functioning, anxiety, depression, fatigue and pain interference, while controls (n=18) are unchanged or worse. The DHD will work with other City of Detroit units to recruit participants with elevated physical or psychological symptoms. Specific aims are: 1) With input from a Community Advisory Board made up of local community members and staff of local agencies, modify Positive STEPS for group delivery (RESET) and conduct a mini-pilot (n=10). 2) Conduct an RCT to assess its impact (vs. telephone wellness check) on PROMIS-29 Psychosocial Score (a weighted combination of distress, fatigue, pain, social participation and sleep) among 456 older adults. 3) Using qualitative data from participants and other stakeholders, conduct mixed-methods analyses to provide context for quantitative findings, assess community impact, and inform a dissemination toolkit. This project is significant in that it will rigorously test a scalable model for improving psychosocial and physical functioning among older adults in an urban setting. It is innovative in that it tests a unique blend of CHW support with broadly-accessible mobile health tools. Last, it has potential for broad impact, given the approach’s transferability to other settings.