Update on Polling and Policy Efforts on Loneliness, Telehealth, Caregiving, and Advance Care Planning

Older adults and their caregivers experienced dramatic changes in many aspects of their lives during the COVID-19 pandemic which resulted in important shifts in organizational and federal priorities and policies. To explore older adults’ changing experiences and perspectives amidst the pandemic, the University of Michigan National Poll on Healthy Aging (NPHA), a recurring, nationally representative household survey, polled over 2,000 adults age 50-80 at multiple timepoints through January 2021 about their feelings of loneliness and use of telehealth. In June 2020, the NPHA also surveyed adults age 50-80 about advance care planning before and during the COVID-19 pandemic and asked family caregivers about their care challenges in the three months since the pandemic. This session will start with a presentation of results from these polls, first exploring change over time in loneliness and telehealth use and then focusing on experiences related to advance care planning and caregiving challenges. Next, presenters from diverse national coalitions and organizations, including the Coalition to End Social Isolation and Loneliness, the National Academy for State Health Policy, the National Alliance for Caregiving, and the Coalition to Transform Advanced Care will describe their organizations’ efforts, including their work with research and advocacy partners, state and federal agencies, and the Biden administration to facilitate dialogue and advance activities and policies related to these timely topics.

Caregiving Challenges During the COVID-19 Pandemic: Findings From the National Poll on Healthy Aging

The COVID-19 pandemic posed new challenges for caregivers. This study examines the prevalence of pandemic care challenges (e.g., decreasing care to reduce virus spread, difficulty accessing medical care) and their associations with caregiver mental health and interpersonal well-being in a nationally representative sample of 311 caregivers who participated in the June 2020 National Poll on Healthy Aging. We consider seven care challenges and supports as key predictors of caregiver mental health (care-related stress, self-reported mental health, three depressive symptoms) and interpersonal well-being (lack of companionship, isolation) in bivariate tests and ordinary least squares regressions. Each care challenge/support was endorsed by between 13-23% of caregivers. Difficulty getting needed medical care was the most predictive challenge associated with increased caregiver stress, depressive symptoms, and worsened interpersonal well-being. All care challenges predicted an increase in caregiver stress. Effective caregiver tools and supports must consider changing policies and care needs, especially during a pandemic.

Findings on Loneliness, Telehealth, and Advance Care Planning From the National Poll on Healthy Aging

The University of Michigan National Poll on Healthy Aging (NPHA) taps into the perspectives of older adults to inform health care policy and practice using a nationally representative sample of more than 2,000 adults age 50-80. Questions about lack of companionship and feelings of loneliness were tracked over three time points; 34% expressed feelings of loneliness in October 2018, 41% in June 2020, and 37% in January 2021. The NPHA also found that use of telehealth increased from 4% in May 2019 to 30% in June 2020 to 43% in January 2021. Finally, the NPHA found that 37% have completed both medical durable power of attorney and advance directive with 7% completing at least one of these documents in the first three months of the COVID-19 pandemic. These poll results can be used to inform actions by coalitions and organizations to advance state and federal policy.

Poll Findings on Social Connection and Technology Use During the COVID-19 Pandemic

The National Poll on Healthy Aging conducted an online survey of a nationally representative sample of adults age 50-80 (n=2,074) in June 2020 about experiences related to loneliness, their physical environments, and telehealth and technology use. 41% felt a lack of companionship, and 46% reported infrequent social contact. Feelings of loneliness were more likely among those who lived alone or who did not have access to features in their neighborhood and community which may offer opportunities for safe interactions. The poll also found that 26% of adults age 50-80 had a telehealth visit March through June 2020 and 64% overall reported being comfortable with video conferencing technology, with notable differences by demographic subgroup. These results highlight the need for new opportunities for older adults, especially those with the greatest social and economic need, to feel connected and to be confident using technology, both during and after the pandemic.

The Everyday Ageism Scale: Development and Evaluation

Objectives Older adults regularly encounter age-based discrimination and stereotyping in their day-to-day lives. Whether this type of routine ageism negatively affects their health and well-being is unclear, in part due to the absence of validated scales that comprehensively measure this phenomenon and distinguish it from other sources of everyday discrimination. Methods This study describes the development of a novel scale, the Everyday Ageism Scale, and its psychometric evaluation using a nationally representative sample of US adults age 50–80 from the December 2019 National Poll on Healthy Aging ( N = 2012). Results Exploratory factor analysis indicated a 3-factor structure comprised of ageist messages, ageism in interpersonal interactions, and internalized ageism. The ten-item scale was psychometrically sound and demonstrated good internal reliability. Discussion Everyday ageism is a multidimensional construct. Preliminary evaluation of the Everyday Ageism Scale suggests its utility in future studies examining the prevalence of everyday ageism and its relationships with health.

Heritage Not Hate? Confederate Flag Supporters Less Likely to Perceive Criminal Injustice, More Likely to View Police as Friends

Although the post-civil rights era has motivated many people to avoid appearing racist, they may still be unwilling to relinquish privileges derived from the U.S. racial hierarchy. Because the Confederacy fought to preserve slavery, which upheld this hierarchy, support for the Confederate flag may serve as a proxy measure for individuals’ commitment to maintaining privileges stemming from structural racism. Moreover, given that the modern legal system upholds this same racial hierarchy through anti-Black discrimination, individuals who prioritize protecting their privilege may soothe the guilt they feel for benefiting from structural racism by convincing themselves the legal system treats everyone equally. Similarly, because flag supporters identify with the symbol of a failed nation that considered northern states to have insufficiently policed Black people, they may view police as protectors of the racial hierarchy. Hypotheses were tested using randomly sampled CBS News national poll data. As anticipated, flag supporters were 66% less likely to perceive anti-Black criminal justice system bias, 60% less likely to perceive anti-Black police bias, 34% less likely to consider racial profiling widespread, and 55% more likely to view police as friends.

Involvement in State and Federal Aging Policy

The fourth speaker is Dr. Erica Solway. Dr. Solway will discuss her experience working in policy at the federal level as a Health and Aging Policy Fellow and a policy advisor with the U.S. Senate Committee on Health, Education, Labor, and Pensions Subcommittee on Primary Health and Aging and in her current involvement in policy-relevant research at the state and national level at the University of Michigan Institute for Healthcare Policy & Innovation. Dr. Solway is a senior project manager forthe evaluation of the Healthy Michigan Plan, Michigan’s Medicaid expansion program, and is also an associate director of the University of Michigan National Poll on Healthy Aging.

How Loneliness, Depressed Mood, and Diet Affect Eating Habits and Grocery Shopping

This study examined the prevalence of loneliness and relationship with cooking and eating habits among older adults using data collected in December 2019 from a nationally representative sample age 50-80 through the National Poll on Healthy Aging. Older adults who live alone were more likely those who lived with others (19% vs. 8%) and those with a high PHQ-2 score were more like than those with a low PHQ-2 score (20% vs. 11%) to report that they do not cook dinner most days (0-2 times/week). Those who rated their diet as fair/poor were more likely to indicate they cook few meals a week (0-2) compared to those who reported a good or very good/excellent diet (18% vs. 11 % vs 8%). Those with a high PHQ-2 score were less likely than those with a low PHQ-2 score to say they do major food shopping less than once a week (31% vs 47%). Those with a high PHQ-2 score were more likely to say that that always ate alone in the last week compared to those with a low PHQ-2 score (17% vs 7%). These findings demonstrate that older adults who lived alone, had a higher PHQ-2 score, and had a poorer diet were more likely to cook and do grocery shopping less often. Strategies and policies to support older adults to address depressive symptoms and to increase cooking and improve diet may have many health and social benefits and will be explored through this session.

Everyday Ageism and Health: Evidence From the National Poll on Healthy Aging

This study examined the prevalence of everyday ageism, routine types of age-based discrimination, prejudice, and stereotyping that older adults encounter in their daily lives, and its relationships with health in a nationally representative sample age 50-80 (N=2,048, 52% female, 71% White). Nearly all older adults said they sometimes or often experienced everyday ageism (96% age 65-80, 92% age 50-64). The most common types were beliefs that health problems were an inevitable part of getting older (78%), hearing jokes about aging/older people (61%), and seeing material suggesting that older adults were unattractive/undesirable (38%). Those reporting more experiences with everyday ageism (>3 types) were less likely than those reporting fewer types to have excellent/very good physical health (31% vs. 50%); similar results were found for mental health (60% vs. 80%). This poll documented the ubiquity of minor, but not inconsequential, everyday ageism reported by older adults and its potential ramifications for health.