building older adults' resilience by bridging public health and aging-in-place … ·...

C O R P O R A T I O N

Toolkit

Building Older Adults' Resilience by Bridging Public Health and Aging-in-Place Efforts

Joie D. Acosta, Regina A. Shih, Emily K. Chen, Lea Xenakis,

Eric G. Carbone, Lane F. Burgette, Anita Chandra

https://www.rand.org/pubs/tools/TL282.html

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iii

Preface

Theincreasingfrequencyandintensityofweather-relatedandotherdisasterevents

combinedwiththegrowingrepresentationofolderadultsintheoverallpopulationhave

createdanewenvironmentinwhichpublichealthprogramsandpolicieswillneedtoactively

promotetheresilienceoftheolderpopulation.

Thistoolkitcontainsinformationandactivitiesthatcanbringtogetherthoseinvolvedin

aging-in-placesupportandthoseinvolvedindisasterresilienceeffortstoimprovetheresilience

ofolderadultstonaturalandhuman-causeddisasters.

Thistoolkitisaccompaniedbytwocompaniondocuments(areportavailableat

www.rand.org/t/RR2313andajournalarticlemanuscriptavailableuponrequestfromthe

authors)thatprovideadditionalbackgroundforthoseinterestedinhowthetoolkitwas

created.Toinformdevelopmentofthistoolkit,RANDresearchersconductedinterviewswith

publichealthdepartmentstaff,villageexecutivedirectors,andage-friendlycommunity

coordinatorsacrossthecountry(Shihetal.,2018).

Thecontentsofthistoolkitwillbeofparticularinteresttopoliticalleaders(e.g.,mayors’

offices);emergencypreparedness,response,andmanagementstaff;healthdepartmentsatthe

local,state,andnationallevels;andleadersofage-friendlycommunitiesandvillages.

ThisresearchwassponsoredbytheCentersforDiseaseControlandPreventionthrough

contract200-2014-59627andconductedwithinRANDHealth.

AprofileofRANDHealth,abstractsofitspublications,andorderinginformationcanbe

foundatwww.rand.org/health.

http://www.rand.org/t/RR2313

http://www.rand.org/health

iv

Contents

Preface..........................................................................................................................................iii

Figures............................................................................................................................................v

Tables............................................................................................................................................vi

Tools...............................................................................................................................................v

Summary......................................................................................................................................vii

Acknowledgments.......................................................................................................................viii

Abbreviations.................................................................................................................................x

ChapterOne.IntroductionandOverview......................................................................................1

GoalsandSpecificAimsoftheToolkit......................................................................................1

PurposeofToolkit.....................................................................................................................4

IntendedAudiences...................................................................................................................5

HowtheToolkitWasDeveloped...............................................................................................5

User’sGuide..............................................................................................................................6

Summary...................................................................................................................................9

ChapterTwo.FindingCommonGround:AStartingPoint...........................................................10

WhatAretheGroupsThatHelpSupportOlderAdultstoAgeinPlace?.................................10

WhatDoPublicHealthDepartmentsDo?...............................................................................11

WhatDoTheseAging-in-PlaceGroupsandPublicHealthDepartmentsHavein

Common?...............................................................................................................................12

HowCanIFindaGroupNearMe?..........................................................................................14

Summary.................................................................................................................................15

ChapterThree.ImprovingOlderAdults’Resilience.....................................................................16

WhatDoVillagesDoThatCanPromoteOlderAdults’Resilience?.........................................16

WhatDoAge-FriendlyCommunitiesDoThatCanPromoteOlderAdults’Resilience?...........17

WhatDoPublicHealthDepartmentsDoThatPromotesOlderAdults’Resilience?...............19

WhatArePublicHealthDepartmentsandGroupsThatSupportAginginPlaceDoing

CollaborativelytoPromoteOlderAdults’Resilience?...........................................................20

HowCanMyGroupImproveOlderAdults’Resilience?..........................................................22

Summary.................................................................................................................................28

ChapterFour.EvaluatingandImprovingYourEffortstoPromoteOlderAdults’Resilience.......29

ConductinganEvaluation........................................................................................................29

OutcomeandProcessMeasures.............................................................................................33

PartnershipMeasures.............................................................................................................37

UsingEvaluationDatatoInformYourWork...........................................................................40

Summary.................................................................................................................................46

v

Appendix:BriefDescriptionofMethodsUsedtoDeveloptheToolkit........................................47

References....................................................................................................................................49

Figures

Figure1.1.BuildingBlocksofaResilientCommunity....................................................................2

Figure1.2.IntendedAudiencesforThisToolkit.............................................................................5

Figure2.1.DefinitionsofAging-in-PlaceGroups..........................................................................11

Figure2.2.PublicHealthDepartmentResponsibilities................................................................12

Figure2.3.OverlapinKeyFunctionsofAging-in-PlaceGroupsandPublicHealth

Departments..........................................................................................................................13

Figure2.4.AARPNetworkofAge-FriendlyCommunities(asofNovember2017).......................14

Figure2.5.ExampleSearchResultsfromVillagetoVillageNetworkWebsite.............................15

Figure3.1.AnExcerptfromAge-FriendlyPortland’sStrategicPlanHighlightingItsResilience

Work.......................................................................................................................................19

Figure3.2.ExamplesofPublicHealthDepartmentActivitiesThatPromoteOlderAdults’

Resilience...............................................................................................................................20

Figure3.3.ExamplesofCollaborativeActivitiestoPromoteOlderAdults’Resilience................21

Tables

Table3.1.ExampleResilienceActivitiesCurrentlyBeingConductedbyVillages.........................17

Table3.2.Age-FriendlyDCStrategicPlanExcerpt,EmergencyPreparednessandResilience

Domain...................................................................................................................................18

Table4.1.SurveyQuestionstoMeasureOlderAdults’Resilience...............................................34

Table4.2.SurveyQuestionstoMeasurePartnership..................................................................39

Table4.3.SampleMeasuresforCollaborativeActivities.............................................................40

Tools

Checklist1.1.IsThisToolkitRightforMe?.....................................................................................8

Worksheet3.1.ResilienceActivitySelf-AssessmentandPlanningforAge-Friendly

Communities..........................................................................................................................24

Worksheet3.2.ResilienceActivitySelf-AssessmentandPlanningforVillages............................25

Worksheet3.3.PublicHealthDepartmentActivitySelf-AssessmentandPlanning.....................26

Worksheet3.4.PlanforShort-TermandLong-TermResilienceActivities..................................27

Worksheet4.1.IssuestoConsiderforMyEvaluation.................................................................31

Worksheet4.2.UpdatedPlanforShort-TermandLong-TermResilienceActivities....................33

vi

Worksheet4.3.ReviewProgramOutcomes................................................................................42

Checklist4.1.WhatContinuousQualityImprovementActionsAreNeededtoImprovethe

Activity?..................................................................................................................................44

vii

Summary

Theincreasingfrequencyandintensityofweather-relatedandotherdisasterevents

combinedwiththegrowingrepresentationofolderadultsintheoverallpopulationhave

createdanewenvironmentinwhichpublichealthandpreventionplanningandprogramswill

needtoactivelypromotetheresilienceofolderadults.Resilience-buildingeffortsofpublic

healthdepartmentstosupportarangeofemergencyresponseissueshavenotalwaysbeen

tailoredtotheneedsofolderadults(Shihetal.,2018).Relatedly,aging-in-placeefforts

(specifically,age-friendlycommunitiesandvillages),whichhavearisentosupportolderadults’

social,economic,andresidentialneeds,oftendonotfocusonaspectsofresilience-building.

Thegoalofthistoolkitistobringtogetherthoseinvolvedinaging-in-placesupportand

thoseinvolvedindisasterresilienceeffortstoimprovetheabilityofolderadultstowithstand

andreboundfromtheeffectsofnaturalandhuman-causeddisasters.Thetoolkitendeavorsto

bringtogetherthesetwofieldsthatarecurrentlyengaginginseparate,yetcomplementary,

work;toidentifytheirsharedinterestsandfunctions;andtohelpthemplan,implement,

evaluate,andimprovetheirindependentandcollaborativeactivitiesdesignedtopromoteolder

adults’resilience.

viii

Acknowledgments

Thankyoutothevillages,age-friendlycommunities,andpublichealthdepartmentsthat

participatedinthisstudy.WewouldalsoliketothankBoyerBazelias,ClaraAranibar,NinaRyan,

andChanelSkinnerfortheirhelpinmanagingthesurveyandschedulingtheinterviews,aswell

asourcolleaguesRodneyHarrellatAARP,NatalieGaluciaatVillagetoVillageNetwork,Gail

KohnandNickKushneratAge-FriendlyDC,andLauraBiesiadeckiandGeoffreyMwaunguluat

theNationalAssociationforCountyandCityHealthOfficialsfortheirinputandtheirhelpwith

recruitinginterviewees.ThankstoJaimeMadriganofromRANDandJonathanAdrianofromthe

EastCentralHealthDistrictinAugusta,Georgia,whoreviewedthistoolkitandprovidedideas

andguidancethathavehelpedustoimproveitsclarityandpracticality.Inaddition,wewould

liketothankAmyWolkin,theVulnerablePopulationsOfficerintheOfficeofPublicHealth

PreparednessandResponseattheCentersforDiseaseControlandPrevention,forher

thoughtfulreviewofthetoolkitandGreggStickeler,JohnRoses,andJeanneHaskellatthe

InterviewingServicesofAmericafortheirsurveysupport.Finally,wewouldliketothankthe

CentersforDiseaseControlandPreventionforfundingthestudythatmadethisworkpossible.

ix

Abbreviations

AFC age-friendlycommunity

CDC CentersforDiseaseControlandPrevention

LT longterm

N never

NACCHO NationalAssociationofCountyandCityHealthOfficials

ST shortterm

1

ChapterOne.IntroductionandOverview

Inthischapter,wereviewthistoolkit’sintendedaudience,itsgoalsandspecificaims,and

whyitisneeded.Weconcludewithabriefuser’sguidethatpreviewsthetoolkit’scontentand

providestipsforitsuseandnavigation.Wealsoofferaquickchecklisttoenableyouto

determinewhetherthistoolkitisrightforyourwork.

GoalsandSpecificAimsoftheToolkit

Thegoalofthistoolkitistoimprovetheresilienceofolderadultsbyhelpingtobring

togethertwogroupsthatarecurrentlyimplementingseparate,yetcomplementary,work:(1)

publichealthdepartmentsand(2)aging-in-placegroups—specifically,age-friendlycommunities

(AFCs)andvillages.Publichealthdepartmentsaregovernmentagenciesthatareresponsible

forcreatingandmaintainingconditionstokeeppeoplehealthy.AFCsareagencycollaborations

atthemunicipalorregionallevelthatseektofacilitatetheinclusionofolderadultsinall

aspectsofcommunitylifeandaresupportedintheirplanningandimplementationbyAARPand

theWorldHealthOrganization.Villagesaremembership-drivengrassrootsnonprofit

organizationsthatseektohelpolderadultsageinplacesuccessfully.Villagesgenerallycovera

neighborhoodoracitybut,insomecases,cancovermultipleadjacentcountiesinruralareas.

MoredetaileddefinitionsofeachandhowtolocatethemareavailableinChapterTwo.To

accomplishthisgoal,thetoolkitaimsto

• orienteachgrouptotheirsharedinterestsandfunctions

• describeandsupportworkthateachgroupisalreadydoingorcouldbedoingto

promoteolderadults’resilience

• provideguidanceabouthowtoevaluateandimproveeachgroup’sindependentand

collaborativeeffortstopromoteolderadults’resilience.

NeedtoBuildtheResilienceofOlderAdults

Therearetwoimportanttrendsthatmakebuildingtheresilienceofolderadultsimportant:

changesinenvironmentalstressesandchangesinthenumbersandneedsofthoseagingin

place.

Asweatherisbecomingmoreunpredictableandnaturaldisasterslikehurricanes,flooding,

tornadoes,andearthquakesgrowinintensityandfrequency,itisincreasinglyurgenttobuild

resilientcommunitiesthatcannotonlybouncebackfromadversitybutalsobecomebetter

preparedtorespondtofutureevents(NationalOceanicandAtmosphericAdministration,

2

NationalCentersforEnvironmentalInformation,2017;NationalAssociationofInsurance

Commissioners,CenterforInsurancePolicyandResearch,2017).Resilientcommunitiesare

thosethatcananticipateandsuccessfullyadapttoarangeofdifficulties(e.g.,community

violence,naturaldisasters,economiccrises;Acosta,Chandra,andMadrigano,2017).Building

resilientcommunitiesrequiresbothneighbor-to-neighborrelianceandstrongorganizational

connections(Figure1.1).

Figure1.1.BuildingBlocksofaResilientCommunity

Thebackboneofaresilientcommunityisresilientindividualswiththeknowledgeandability

topreparefor,respondto,andrecoverfromadversity,trauma,tragedy,threats,orsignificant

sourcesofstress.Linksbetweentheseindividualsandvolunteersandorganizationsformthe

connectivetissueofaresilientcommunity.Strongorganizationalrelationshipshelptoweave

theseconnectionstogether(Chandra,Acosta,etal.,2011).Whencommunitiesareunableto

attendtothoseresidentswhomayhavemultipleorspecialneeds,itismoredifficultforthose

communitiestoberesilient.Whencommunitiesdonotactivelyleveragetheassetsofallof

theirresidentstohelprespondandrecover,thosecommunitiesarelessresilient.

Inadditiontothechangingdisasterlandscape,communitiesarenowfacedwithgrowing

numbersofolderadults,aspeoplelivelongeringeneralandasthebabyboomercohortswells

theranksofolderadults.Whiletheabilitytolivelongerisapromisingadvancement,some

Individualsandfamilieshavetheknowledgetoprepareforandrespondtodisaster

Thereareenoughvolunteerstohelpinadisaster

Organizationsarereadyandpreparedtorespondandrecover

Therearestrongrelationshipsbetweenorganizations

Peoplecanrelyoneachother(neighbortoneighbor)

RESILIENTCOMMUNITIESRESILIENTCOMMUNITIES

3

olderadultsarenowlivingwithmultiplechronicconditions,limitationsinactivitiesofdaily

livingandinstrumentalactivitiesofdailyliving,physicalandcognitivedisabilities,andsensory

impairments.Thiscanmakeolderadultsparticularlyvulnerabletophysiologicaland

psychologicalstressesduringnaturaldisasters(Beietal.,2013;Weisler,Barbee,andTownsend,

2006).Socialisolationalsopreventsmanyolderpeoplefromreceivingwarningsignalsorasking

forhelp,renderingtheminvisibletorescueteams(Eisenmanetal.,2007).Three-quartersof

thosewhoperishedinHurricaneKatrinain2005wereolderthan60(Jonkmanetal.,2009).

RecentwildfiresinCaliforniaandhurricanesinFloridahaveputaspotlightonthevulnerability

ofolderadultsafteraseriesofpreventabledeaths(Nedelman,2017).Mostfatalities,injuries,

anddamagecausedbynaturaldisasters,suchasfloods,tornadoes,hurricanes,and

earthquakes,arepreventable(FuseandYokota,2012).Preparingolderadultsfordisaster

responseandrecoverycanalleviatesomeproportionofthephysical,social,andemotional

damagethatoccursinthesesituations.

Olderadultscanalsocontributeimportantassetstodisasterresponse.A2017qualitative

study,usingliteraturereviewand17focusgroupswithat-riskindividuals,foundthatolder

adultscontributetheirexperience,resources,andrelationship-buildingcapacitytoprepare

themselvesandtosupportothersduringanemergency(Howard,Blakemore,andBevis,2017).

Specifically,olderadultsbothgenerateandmobilizesocialcapitalatalocallevelduringa

disaster.

Despiteexistingandusefuldisasterpreparednessguidelinesandresourcesforolderadults,

criticalgapsremaininaddressingtheneedsandleveragingthestrengthsofolderadults(age65

andolder),apopulationthatisexpectedtoriseto20percentoftheU.S.populationby2050

(Fernandezetal.,2002).A2014nationalsurveyofolderadultsfoundthattwo-thirdsofthe

samplehadnoemergencyplan,hadneverparticipatedinanydisasterpreparedness

educationalprogram,andwerenotawareoftheavailabilityofrelevantresources.Morethan

one-thirdoftherespondentsdidnothaveabasicsupplyoffood,water,ormedicalsuppliesin

caseanemergencysituationweretoarise(Al-Rousan,Rubenstein,andWallace,2014).Such

deficitscouldresultinfurtherdeclineinhealthstatus,especiallyinthepresenceofmobilityand

functionallimitations(O’Sullivan,2009).About15percentofthesampleusedmedicaldevices

requiringexternallysuppliedelectricity.Powerinterruptionscouldposeimportantadverse

healtheffectsfortheseindividuals.

Growingproportionsofolderadults,coupledwithtoday’sincreasingclimaticandother

disasterrisks,pointtothefactthatpublichealthandotherprogramsneedtoengageincross-

sectorcollaborationtobetteridentifyandaddresstheneedsofolderadults(Al-Rousan,

Rubenstein,andWallace,2014).Whilepublichealthdepartmentsarethegovernmententity

primarilyresponsibleforthepublic’shealthandforresponsestodisastersandotherstresses,

theiractivitiesarenotalwaystailoredforolderadultsandthusmaynotmakeaccommodations

4

fortheirneeds.Aging-in-placeefforts,includingAFCsandvillages(alsoknownassenior

villages),representapromisingstrategyforU.S.communitiesandcitiestosupportolderadults’

abilitiestoliveintheirownhomessafely,independently,andcomfortably(CentersforDisease

ControlandPrevention[CDC],2009)andcouldcontributetotheeffortsofpublichealth

departmentstobuildcommunityresilience.

PurposeofToolkit

Thistoolkitisintendedtobringtogetherpublichealthdepartmentsandaging-in-place

groupstoimprovetheresilienceofolderadultsinthefaceofemergenciesordisasters.It

specificallyfocusesontheroleofAFCsandvillagesbecausethesetwogroupsrepresentlong-

standingeffortsthathavesupportedsuccessfulaginginplaceandarebeingusedacrossthe

UnitedStatesandglobally.Toinformthedevelopmentofthistoolkit,weinterviewed37

representativesfromvillages,AFCs,andpublichealthdepartmentstoidentifyneedsand

barriers,aswellasorganizationalandcollaborativeactivitiestopromoteolderadults’

resilience.Wefoundthatwhilesomevillageshaveincorporatedresilience-buildingactivities

aimedatimprovingindividuals’knowledgeandabilitytopreparefor,respondto,orrecover

fromadisaster,thevariabilityisgreat,anditisunknownwhetherthisactuallyimprovesthe

resilienceofolderadultsinthefaceofanaturalorman-madedisaster.Whileasmallnumberof

theAFCsincludedinourinterviewshavewhollyincorporatedthecriticalelementofresilience,

themajorityhavenot.Publichealthdepartmentshaveafocusonbuildingresilienceof

individualswithfunctionallimitations—whichincludesmany,butnotall,olderadults—but

havelimitedcollaborationwithvillagesandAFCs.Improvingthiscollaborationiscriticalto

addressingthreekeybarrierstopromotingolderadults’resilience,identifiedthroughour

interviews.First,leveragingexistingeffortsacrossgroups(e.g.,havingvillagesdisseminate

preparednesspamphletsfromthepublichealthdepartment)canhelpaddressresource

constraintsofanyonegroup.Second,somevillagesandAFCsfeltthattheyweretoobusy

focusingonwaystoimprovedailyqualityoflifeanddidnothavetimeforresilienceactivities.

Bringingpreparednessexpertsfromthepublichealthdepartmenttotalkabouthowaspectsof

resilience-buildingcanhelpimprovequalityoflifeonadailybasis(e.g.,socialconnections)can

helpthesegroupsunderstandthatresilienceactivitiesarecomplementary,notincompetition

withactivitiestoimprovedailyqualityoflife.Finally,publichealthdepartmentsand

preparedness,response,andrecoverystaffcanengagemorewitholderadults(throughAFCs

andvillagesthathavedeepconnections)toraisestaff’sawarenessandimprovetheirattention

totheneedsandstrengthsofolderadults,especiallythosewithoutfunctionallimitations.

5

IntendedAudiences

Theintendedaudiencesforthistoolkitarepolicymakers;emergencypreparedness,

response,andmanagementstaffandtheirsupervisors;healthdirectors,commissionersof

health,andotherhealthandhumanservicesdepartmentleadersatthelocal,state,andfederal

levels;andleadersandpartnersinvolvedwithaging-in-placeefforts(specificallyAFCsand

villages).Thesegroups,whicharenotmutuallyexclusive,aredepictedinFigure1.2.UsersinterestedindevelopingnewAFCsorvillagesshouldrefertotheresourcesontheAARP

website(https://www.aarp.org/livable-communities/network-age-friendly-communities/;

AARP,undated)andVillagetoVillageNetworkwebsite(http://www.vtvnetwork.org;Villageto

VillageNetwork,2017a).

Figure1.2.IntendedAudiencesforThisToolkit

HowtheToolkitWasDeveloped

Becausetherewerenosimilarexistingtoolkits,theRANDteamconductedinterviewswith

publichealthdepartmentstaff,villageexecutivedirectors,andAFCcoordinatorsacrossthe

countrytocreatethistoolkit.Wealsoconductedasurveyofolderadults’resiliencecomparing

olderadultslivinginvillagesandthosenotlivinginvillages.Findingsaredetailedinajournal

articlemanuscriptavailableuponrequestfromtheauthors.Theinterviewsprovided

TargetAudiences

Age-friendlyinitiatives

Individualsresponsibleforemergency

preparednessandresponse

Villages

OlderadultsPolicymakers

Researchers

Publichealthdepartments

https://www.aarp.org/livable-communities/network-age-friendly-communities/

http://www.vtvnetwork.org

6

informationaboutthetypesofresilience-buildingworkthatpublichealthdepartments,

villages,andAFCsarecurrentlyleadingwitholderadults—aswellasthebarrierstoand

facilitatorsoftheseefforts—andofferedinsightsaboutwhetherandhowthesegroupscould

partnertobuildresilience.Thesurveycontainedmeasurestocharacterizeolderadults’

resilience.Adetaileddescriptionofthemethodsandfindingsfromtheinterviewsandsurvey

canbefoundinacompanionreport(Shihetal.,2018)andthejournalarticlemanuscript

(availableuponrequestfromtheauthors),respectively.

Wealsobasedaportionofthetoolkit(evaluationplannerandcontinuousquality

improvementinformationinChapterFour)ontheGettingToOutcomesapproachbecauseitis

theonlyevidence-basedmodelandinterventionproventoincreaseapreventionpractitioner’s

abilitytoconductself-evaluations.GettingToOutcomesisasetoftools,trainings,and

technicalassistancethatbuildspractitionercapacitytoconducttenimplementationbest

practices.Processevaluation,outcomeevaluation,andcontinuousqualityimprovementare

threeofthosepracticesthatwehighlightinthistoolkitbecausetheycanhelppublichealth

departmentsandaging-in-placegroupstoevaluateandimprovetheireffortstopromoteolder

adults’resilience.

Moredetailsonthemethodsusedtodevelopthetoolkitcanbefoundintheappendix.

User’sGuide

OverviewofContent

Theremainderofthistoolkitwalksusersthroughaseriesoffiguresandtools.Thesefigures

andtoolshelpyou(thetoolkit’sintendedaudiences)identifyareaswhereyourorganizationor

groupmayhavesharedinterestsandfunctionswithothersimilarordifferentgroups,including

publichealthdepartments,villages,orAFCs(ChapterTwo);whattypesofactivitieseachofthesegroupsmayalreadybedoingtopromoteolderadults’resilience(ChapterThree);andwhatadditionalactivitiescouldbedoneindependentlyortogetherwithotherorganizationsor

groupstopromoteolderadults’resilience(ChapterThree).Thetoolkitconcludeswithguidanceonhowtodesignanevaluationtocaptureprocess,outcome,andpartnershipmeasures.These

measureswillhelpyoudeterminewhetheryourresilienceworkisachievingthedesiredeffects.

Wealsoofferguidanceonhowtouseevaluationfindingstoimproveyourcurrentandfuture

work(ChapterFour).

PotentialBenefits

Thistoolkitwillhelpyouachievethefollowingbenefits:

7

• Supportcollaborationbetweenpublichealthdepartmentsandtheworkofaging-in-

placegroupsbyclarifyingtheircommonground.

• Promoteactivitiestoenhanceolderadults’resiliencebybuildingonthiscommon

ground.

• Collectandapplydatatoevaluatewhethertheseeffortsareeffective.

Thetoolkitisdesignedtoguideusersthroughaseriesofsequentialstepstohelpyou

identifywaystocollaborate(acrosspublichealthdepartmentsandaging-in-placegroups)to

achievesharedinterestsandimproveolderadults’resilience.Repeatingtheprocessona

regularbasiswillhelpyouimprovethiscollaborativework.

TipsforNavigatingtheToolkit

Thisdocumentcontainsseveraltypesoftools,whicharemarkedwithcorresponding

signposts:

StartUsingtheToolkit

Checklist1.1willhelpyoudecidewhetherthistoolkitisappropriateforyourgroup.Ifthetoolkitisrightforyou,itistimetostartusingit!Besuretousethetoolkitsequentially.

Worksheets,tables,andfiguresbuildonpreviouscontent,informingtoolsinlatersectionsof

thetoolkit.Startinginthemiddleofthetoolkit(e.g.,inChapterThree)mayrequirereferring

backtoearlierchapters.Therefore,westronglyencourageuserstogothroughthetoolkit

sequentially.

Worksheets askyoutoanswerquestions.

Checklists helpdirectyouthroughthetoolkitandprovideguidelinestoreviewyourownwork.

Tables summarizerelevantresearch.

Figures provideasnapshotofkeyinformationinavisuallyappealingformat.

8

Checklist1.1.IsThisToolkitRightforMe?

1. Doyourepresentapublichealthdepartmentoranaging-in-placegroup,suchasa

villageorAFC?

� Yes—Thistoolkitisrightforyou!Skiptheremainingquestionsandproceedto

theSummarysectionforthischapter.

� No—Thistoolkitisprimarilyintendedforindividualswhoareworkingwitha

publichealthdepartment,avillage,oranAFC.However,itdoescontain

measuresandguidancerelevanttopoliticalleaders,statepublichealthstaff,and

federalagenciesinvolvedwithhealthandhumanservices.Ifyouarestillunsure,

proceedtoQuestion2.

2. Areyoulookingforwaystoprovideorimproveaccessorcoordinationofcommunity

andhealthservicesorsystemsforolderadults?

� Yes—Thistoolkitisrightforyou!Suggestionsforwaystocollaboratetokeep

olderadultssafeandhealthythroughprovidingorimprovingaccessor

coordinationofcommunityandhealthservicesorsystemsarecoveredin

ChapterTwo.SkiptheremainingquestionsandproceedtotheSummarysection

forthischapter.

� No—ProceedtoQuestion3.

3. Areyoulookingforwaystoworkwithothersinyourcommunitytopromoteolder

adults’resilience?

� Yes—Thistoolkitisrightforyou!Collaborationsandpartneredactivitiesto

promoteolderadults’resiliencearecoveredinChapterThree.Skipthe

remainingquestionandproceedtotheSummarysectionforthischapter.

� No—ProceedtoQuestion4.

4. Areyoulookingtomeasureolderadults’resilience?

� Yes—Thistoolkitisrightforyou!Measuresofolderadults’resilienceare

containedinChapterFour.

� No—Thetypesofinformationprovidedinthistoolkitareprobablynotapplicable

toyouoryourgroup.

9

Summary

Thischapterdescribedthepurposeandcontentofthistoolkitinordertohelpyoudecide

whetherthistoolkitisappropriateforyourgroup.Thischapteralsoprovidedabriefsummary

ofhowthetoolkitwasdeveloped.Nowthatyouhavereadthischapterandcompleted

Checklist1.1,youshouldknowwhetherthistoolkitisrightforyouandyourgroup.Ifitis,proceedtoChapterTwo,whichwillhelpyoufindcommongroundbetweenyourgroupand

othersandidentifywaystocollaboratetoachieveyoursharedinterestsofkeepingolderadults

safeandhealthy.

10

ChapterTwo.FindingCommonGround:AStartingPoint

Despitehavingdisparatemissions,responsibilities,andactivities,publichealthdepartments,

AFCs,andvillagesallhavesomethingincommon—theyareuniquelypositionedtopromote

olderadults’resilience.Thischapteroutlineswaysinwhichtheworkofthesethreegroupscan

bealignedtooptimizetheirabilitytopromoteresilienceamongolderadults.Animportant

startingpointisexploringcurrentgoalsandmission,aswellascommonactivitiestofindareas

foralignment.

WhatAretheGroupsThatHelpSupportOlderAdultstoAgeinPlace?

Thistoolkitfocusesontwospecificgroupsthatsupportaginginplace:villagesandAFCs

(Figure2.1).Inadditiontobeingmember-driven,grassroots,andinclusiveofavolunteer

network,villagesaredefinedbykeyservice-deliveryandsupportfunctions:coordinatingaccesstoservices;providingvolunteerservices(suchastransportation,healthandwellnessactivities,

andsocialactivities);offeringaccesstovettedanddiscountedserviceproviders;andpositively

impactingisolation,interdependence,purpose,andsafetyofindividualmembers.TheVillage

toVillageNetworkwebsiteprovidesmoredetailonthevillagemodel

(http://www.vtvnetwork.org/content.aspx?page_id=22&club_id=691012&module_id=248578;

VillagetoVillageNetwork,2017c).

AFCsfocusonimprovingeightdomainsrelatedtolivability:outdoorspacesandbuildings,

transportation,housing,socialparticipation,respectandsocialinclusion,civicparticipationand

employment,communicationandinformation,andcommunityandhealthservices.However,

insteadofusingaservice-deliverymodellikevillages,AFCsengageinafive-yearstrategic

planning,implementation,andevaluationprocessthatisintendedtohighlightandchangethe

environmental,economic,andsocialfactorsthatinfluencethehealthandwell-beingofolder

adults.TheWorldHealthOrganizationoverseestheGlobalNetworkforAge-FriendlyCitiesand

Communitiesandtracksanddisseminatesinformationaboutage-friendlypracticestofacilitate

theworkofthesecollaborations.IntheUnitedStates,theworkoftheWorldHealth

OrganizationisextendedbyAARP,whichofferstoolkitsandotherresourcestotheirmembers

intheAARPNetworkofAge-FriendlyCommunities.MoredetailsonAFCs’five-yearstrategic

planningprocesscanbefoundonAARP’swebsite(https://www.aarp.org/livable-

communities/network-age-friendly-communities/;AARP,undated).

http://www.vtvnetwork.org/content.aspx?page_id=22&club_id=691012&module_id=248578



11

Figure2.1.DefinitionsofAging-in-PlaceGroups

WhatDoPublicHealthDepartmentsDo?

Publichealthdepartmentsaregovernmentagenciesthatareresponsibleforcreatingand

maintainingconditionstokeeppeoplehealthy.Theymustbeawareofthespecifichealthissues

confrontingthecommunityandhowenvironmental,social,andeconomicconditionsaffect

them.Inthisway,publichealthdepartmentscanbeahelpfulsourceofinformationtoAFCs

aboutcommunityconditions.Publichealthdepartmentsalsoimplementhealthpromotion

programsandcommunityengagementactivitiestoaddresspublichealthissuesthatmaybe

usefultovillagemembers.Publichealthdepartmentsmustformpartnershipswithpublicand

privatehealthcareproviders,community-basedorganizations,andothergovernmentagencies

tocollectivelyidentify,alleviate,andactonthesourcesofpublichealthproblems—andpublic

healthdepartmentsprovideexpertisetootherswhotreatoraddressissuesofpublichealth

significance.TheCDC,thelargestpublichealthagencyintheUnitedStates,recentlypublisheda

seriesofreportsonthestateofhealth,mentalhealth,andaginginAmericathatcallfora

greateremphasisonolderadults’mentalhealth,useofpreventiveservices(suchasthefluand

Age-friendlycommunityAnage-friendlycommunity(AFC)isanagencycollaborationatthemunicipalorregionallevelthatseekstofacilitatetheinclusionofolderadultsinallaspectsofcommunitylife.Age-friendlycommunitiesstrivetobeinclusiveofallmembersregardlessofageandtofacilitatesocialconnectednessandengagementofolderadultsinparticular.

VillageAvillageisamembership-drivengrassrootsnonprofitorganizationthatseekstohelpolderadultsageinplacesuccessfully.Villagesgenerallycoveraneighborhoodoracitybutinsomecasescancovermultipleadjacentcountiesinmoreruralareas.Villagesdifferbasedontheirsize,governancestructure,membershipcharacteristics,andregionalcoverage.

Topdown(AFC)

Bottomup(village)

Supportingolderadultstoageinplace

12

pneumoniavaccines),andprotectionduringemergencies

(https://www.cdc.gov/aging/agingdata/data-portal/mental-health.html;CDC,2016).

Figure2.2showsthewaysthatpublichealthdepartmentscanimpactdailylife.Afull

operationaldefinitionofafunctionalpublichealthdepartmentcanbefoundontheNational

AssociationofCountyandCityHealthOfficials(NACCHO)website

(http://archived.naccho.org/topics/infrastructure/accreditation/OpDef.cfm;NACCHO,2017c).

Figure2.2.PublicHealthDepartmentResponsibilities

SOURCE:NACCHO,2017a,usedwithpermission.

WhatDoTheseAging-in-PlaceGroupsandPublicHealthDepartmentsHaveinCommon?

Bothaging-in-placegroupsandhealthdepartmentsworktowardcreatingcommunities

whereolderadultscanbehealthy,happy,andsafeintheirhomes.TheworkofAFCsand

villagescontributestoolderadults’accesstoanduseofpreventiveservices,aswellastheir

mentalhealth(forexample,throughimprovedsocialparticipation)—bothofwhichare

importanttopromotingoverallpublichealth.Infact,AFCstargeteightdimensionsoflivability

(transportation,housing,socialparticipation,respectandinclusion,civicparticipationand

employment,communicationandinformation,communitysupportandhealthservices,and

Infectious disease prevention and control

Chronic disease prevention and control

Public health departments impact our lives every day

https://www.cdc.gov/aging/agingdata/data-portal/mental-health.html

http://archived.naccho.org/topics/infrastructure/accreditation/OpDef.cfm

13

outdoorspacesandbuilding)thatallinfluencehealth,haveimplicationsforpublichealth,and,

thus,arerelevanttotheworkofpublichealthdepartments.Publichealthdepartmentsoffer

healthpromotionprogrammingandcoordinatecommunityandhealthservicesthatcouldbe

usefultomemberslivinginvillagesandshouldbeconsideredwhendevelopinganAFCstrategic

plan.Inaddition,publichealthdepartmentshavearangeofexpertise(forexample,in

infectiousdisease,fallprevention,andemergencypreparedness)andaretaskedwithsharing

thatexpertisewithcommunityandhealthserviceprovidersthroughtrainingorother

educationaleventsandmaterials.Villageshaveestablishednetworksandcommunication

channelstoreacholderadultvolunteersandmemberslivingathome—agroupthatiscritical

forpublichealthdepartmentsandAFCstoidentifyandcommunicatewithbutoftendifficultto

reachbecausetheyarediffusedacrosstheircommunities.TheseolderadultscaninformAFCs’

planningbyprovidinginsightaboutwheretherearelimitationsandneedsrelatedtoolder

adults’communityandhealthservicesandtransportation.Figure2.3summarizestheoverlapin

keyfunctionsofeachofthesegroups.

Figure2.3.OverlapinKeyFunctionsofAging-in-PlaceGroupsandPublicHealthDepartments

TheseareasofalignmentacrossthemissionsandfunctionsofAFCs,villages,andpublic

healthdepartmentsprovideacommonlanguageandpurposearoundwhichthesegroupscan

collaborateonsharedissuesthatnotonlyadvancetheirownworkbutalsocreate

opportunitiestopromoteolderadults’resilience.

Publichealthdepartment

Age-friendlycommunity

Village• Coordinateandvetaccessto

communityandhealthservices

• Plan,implement,andevaluateactivitiesthatinfluenceolderadults’accesstocommunityandhealthservices

• Implementhealthpromotionprograms

Improvingcommunityandhealthservices

systems

Communitywhereolderadultscanbehappy,healthy,andsafeintheirhomes

• Coordinatecommunityandhealthservices

• Provideexpertiseandtrainingtocommunityandhealthserviceproviders

• Providevolunteerservices(transportation,socialandeducationalevents)

Expandingcommunitysupports

• Plan,implement,andevaluateactivitiesthatinfluenceolderadults’accesstotransportationandsocialparticipation

Functions

Effortstoimproveservicesandsystems Effortstoexpandcommunitysupports

Goal Age-friendlycommunity


Village

Overlappingareas

14

ChapterThreegoesintodetailonactivitiesthateachgroupisdoingandcandotopromote

olderadults’resilience.

HowCanIFindaGroupNearMe?

ThereareAFCsincitiesandstatesacrosstheUnitedStates(Figure2.4).YoucanfindanalphabeticallistandaninteractivemapofthesecommunitiesonAARP’swebsite

(https://www.aarp.org/livable-communities/network-age-friendly-communities/info-

2014/member-list.html;AARP,2017).Foreachstate,thereisalsoaphonenumberandemail

addressofanAARPrepresentativewhocanprovidemoreinformationontheAFCsinthatstate.

Figure2.4.AARPNetworkofAge-FriendlyCommunities(asofNovember2017)

SOURCE:AARP,2017.

Thereisalsoalargenationwidenetworkofvillages.TheVillagetoVillageNetworkwebsite

(http://www.vtvnetwork.org/content.aspx?page_id=1905&club_id=691012;VillagetoVillage

Network,2017b)providesaninteractivemapthatallowsuserstofilterbystate,city,zipcode

distance,andwhetheravillageiscurrentlyopenorstillindevelopment.Themapwillshowyou

thelocationofvillagesandprovideasummaryboxincludingthevillagename,phonenumber,

andalinktoitswebsite(Figure2.5).

https://www.aarp.org/livable-communities/network-age-friendly-communities/info-2014/member-list.html


http://www.vtvnetwork.org/content.aspx?page_id=1905&club_id=691012

15

Figure2.5.ExampleSearchResultsfromVillagetoVillageNetworkWebsite

SOURCE:VillagetoVillageNetwork,2017b.

SimilartovillagesandAFCs,publichealthdepartmentsalsohaveanonlinedirectorythat

allowsyoutofindapublichealthdepartmentandcontactinformation(phonenumberand

emailaddress)usinganinteractivemaporazipcodesearch

(http://archived.naccho.org/about/LHD/index.cfm;NACCHO,2017b).Thedirectory,hostedby

NACCHO,canbeinsertedasawidgetonyourdesktop,whichwillautomaticallyupdatethe

directoryeverytimenewcontactinformationbecomesavailable.

Summary

Congratulations,youhavecompletedthefirstinteractivechapterofthetoolkit!Thischapter

providedinformationaboutwhataging-in-placegroupsdo(Figure2.1),whatpublichealthdepartmentsdo(Figure2.2),andwherethesetwogroupshavecommongroundorshared

interests(Figure2.3).Thechapterendedwithinformationabouthowtofindgroupsinyour

areaforcollaboration(Figure2.4andFigure2.5).ChapterThreewillprovideyouwithguidanceonhowtoworkwiththesesamegroupstopromotenotonlyolderadults’healthandsafetybut

alsotheirresilience.

ResultsofVillagetoVillageNetworkwebsitesearchforvillagesinArlington,Va.

Villagewebsitelocated

http://archived.naccho.org/about/LHD/index.cfm

16

ChapterThree.ImprovingOlderAdults’Resilience

Inthischapter,weprovideasummaryofactivitiesthataging-in-placegroupsandpublic

healthdepartmentsarealreadydoingtopromoteolderadults’resilience.Ourinterviews

suggestedthat,inmostlocations,thereisnoagencyworkingspecificallyondisaster

preparednessorresilienceeducationandoutreachforolderadults.However,villages,AFCs,

andpublichealthdepartmentsallreportedengaginginsomeactivitiesthatcanpromoteolder

adults’resilience(Table3.1,Table3.2,Figure3.1,Figure3.2).Thischapteralsosummarizesactivitiesthatthesegroupscanundertakecollaborativelyto

promoteolderadults’resilience(Figure3.3).

WhatDoVillagesDoThatCanPromoteOlderAdults’Resilience?

Interviewswithvillagessuggestedthatthemajorityofvillagesprovidedatleastoneactivity

aimedatimprovingtheresilienceoftheirmembers,rangingfromeducationalsessionstoone-

on-onevisitstoprepareanemergencypreparednesskit.Theactivitiesvariedbasedonthe

needsofthevillagemembersandabilitiesofthevillagestaffbutcouldbegroupedintothree

generalapproaches:(1)outreachandinformation-sharingbyvillagestaffandvolunteersto

improvemembers’knowledgeandsupports,(2)improvingcommunicationbetweenmembers

andfirstresponders,and(3)workingwithmemberstoassesspreparednessandplansfor

emergencies.Foreachoftheseapproaches,Table3.1listsexampleactivitiesbeingdoneby

villagesweinterviewed.

17

Table3.1.ExampleResilienceActivitiesCurrentlyBeingConductedbyVillages

WhatDoAge-FriendlyCommunitiesDoThatCanPromoteOlderAdults’Resilience?

AFCsproactivelyengagetheirmembersaroundemergencypreparednessandresilience

issuesspecificallyandcoordinatewithpartnersthataredirectlyresponsibleforemergency

preparedness(forexample,emergencymanagers,fire,police)—usuallyothermunicipal

agencies.

AnexampleofacityAFCisAge-FriendlyDC,basedinWashington,D.C.Thisinitiativeisbuilt

onanoverarchingpolicyandcommunityengagementframeworkfocusedonabroadarrayof

issues,includingtransportation,housing,health,andfinances.Thegoalofthiscollective-action

effortistoensurethat“allDCresidentsareactive,connected,healthy,engagedandhappyin

theirenvironment”(Age-FriendlyDC,undated).

Table3.2containsinformationfromtheAge-FriendlyDCstrategicplanthatoutlineskey

goalsandobjectivesrelatedtopreparednessandresilience.Thisexampleshowshowonecityis

integratingresilienceintousualcaresystems—byaskingindividualstoregisterforemergency

communicationandidentificationsystemsduringtheirintakefornonemergencydirectservices.

Thisexamplealsoshowsthewiderangeofpartnersthatcancontributetobuildingolderadults’

resilience.

GeneralApproach ExampleActivityInformationsharingandoutreach

• Providebrochureswithinformationaboutdisasterpreparednessandemergencyservices

• Callmembersbefore,during,andafterdisasters• Provide remindersandsupporttochangesmokedetectorbatteries

Improvingcommunicationwithfirstresponders

• AssistmemberstoenrollinSmart911orotherregistriestomakeemergencyrespondersawareofmembers’needs(e.g.,VialofLifeprogram)

• Hosteducationsessionsfromlocalemergencyresponse/preparednessentities

• Supportmedicalalertsystems(monitors,buttons)

Assessmentandplanning • Provide homesafetyinspections(trippinghazards,firesafety)byvillages,firedepartment,oranotheragency

• Supportemergencyplanning,includinghavingsuppliesonhandandphonenumbersofwhotocall

• Supportadvancecareplanningconversations(wishesin case ofahealthevent)

18

Table3.2.Age-FriendlyDCStrategicPlanExcerpt,EmergencyPreparednessandResilienceDomain

InterviewswithAFCcoordinatorsalsosuggestedthatsomeAFCsareengagedinresilienceas

anextensionoftheirworkaroundneighborhoodcohesionandsocialengagement.Theleader

ofoneoftheseAFCs,forexample,describedhowtheeverydayengagementofolderadults

withfriends,neighbors,andtrustedinstitutionssupportedotheragencies’resilienceeffortsby

strengtheninginformaltiesandbuildinginformationnetworks.Intheeventofadisaster,they

believedthatolderadultswouldbelessisolatedandmoreableandwillingtoreachoutforhelp

orfollowinstructionsbecauseoftheAFC’ssocialengagementefforts.

Figure3.1.showsanexampleofhowoneAFCincorporatedresilienceintoitssocial

participationandinclusionwork.Inthisexample,resilienceisframedasbeingakeyoutcome

forthecommunityandislinkedwithimprovedhealthandrecreationprograms.

Domain9.EmergencyPreparednessandResilience,aDCfocus:Information,education,andtrainingtoensurethesafety,wellness,andreadinessofseniorsinemergencysituations

LeadAgency Partners

Goal9.1:Identify,locate,andreachspecial,vulnerable,andat-riskolderresidentpopulationsinanemergency.

9.1.1:IncreaseAlertDC,Smart911,andSmartPrepare enrollmentbyrequiringdirectservicecontractorsandgranteestoofferenrollmentduringtheclientintakeprocess.

DCOA,DDS,DHS,DBH,DHCD,DDOE,DCHA,CFSA

OUC,HSEMA

9.1.2:Providetrainingonpreparednesspracticestoshelter in placeorrelocatetoaccessibleshelterswhennecessary.

DOH,ServeDC DHS,DGS,ODR

Goal9.2:Buildindividualandcommunityresiliency.

9.2.1:Developaplantoensureuninterruptedprescriptionrefillstoresidentswithchronicmedicalconditionsintheeventofanemergency.

DHCF DOH (BoardofPharmacy)

9.2.2:Promoteandsupportpersonalresponsibilityandfirst-responderopportunitiesforresidentsandneighborhoods.

EOM

9.2.3:Createandassistcommunity-supportedneighbor-to-neighbornetworksacrossthecitythatareaccessibletoallincomelevels(e.g.,villages,fraternalorganizations,faith-basedcommunities,neighborhoodassociations).

HSEMA,DCOA,EOM DMHHS

9.2.4:Provideguidanceandrequiredirectservicecontractorsandgranteesconsideredessentialtodevelopacontinuityofoperationsplan.

HSEMA,OCP Allagencies withdirectservicecontracts andgrants

PROGRAMDEFINITIONS:AlertDC:communicationssystemthatsendsemergencyalerts,notifications,andupdatestodevices; Smart911:canaddkeyinformationaboutmembersofyourhouseholdthatwouldhelpfirstresponderscareforyouintheeventofanemergency,whetherfromhomeormobile;SmartPrepare:citizenssharekeyinformationwithemergencyrespondersandpublichealthofficials,allowingofficialstomoreeffectivelyhandlecomplexanddynamicincidents.AGENCYACRONYMS:DCOA:DCOfficeonAging;DDS:DepartmentonDisabilityServices;DHS:DepartmentofHumanServices;DBH:DepartmentofBehavioralHealth;DHCD:DepartmentofHousingandCommunityDevelopment;DDOE:DepartmentofEnergy&Environment;DCHA:DCHousingAuthority;CFSA:ChildrenandFamilyServicesAgency;DOH:DepartmentofHealth;ServeDC:Mayor’sOfficeonVolunteerism; DHCF:DepartmentofHealthCareFinance;EOM:ExecutiveOfficeoftheMayor;HSEMA:HomelandSecurityandEmergencyManagementAgency;OCP:OfficeofContractingandProcurement;OUC:OfficeofUnifiedCommunications;DGS:DepartmentofGeneralServices;ODR:OfficeofDisabilityRights; DMHHS:OfficeoftheDeputyMayorforHealthandHumanServices.

19

Figure3.1.AnExcerptfromAge-FriendlyPortland’sStrategicPlanHighlightingItsResilienceWork

SOURCE:Age-FriendlyPortlandandMultnomahCounty,2017.

WhatDoPublicHealthDepartmentsDoThatPromotesOlderAdults’Resilience?

Findingsfromourinterviewsprovidedasnapshotofhowpublichealthdepartments

promoteolderadults’resilience.Inmostcases,publichealthdepartmentsdonotexplicitly

conductpreparednessorresilienceactivitiesjustforolderadults,nordotheymakethisgroupa

specialfocusofprogrammingandplanning.Publichealthdepartmentrepresentativesdescribe

theirpreparednessandresilienceactivitiesashavingbroadrelevancethatcutsacross

populationgroupsandclaimthatthesemessagesandactivitiesdonotrequiretailoringfor

olderadultsorotherspecificgroups.Forexample,educational“lunchandlearn”sessionson

preparednesstopicsandmedication-dispensingsimulationexercisesarenotedasgeneral-focus

activitiesfromwhicholderadultsmightbenefitbutarenottargetedspecificallyatolderadults.

Mostintervieweeschallengetheideathatolderadultsareuniversallyvulnerableandexplain

thatmanyoftheiragenciesfocusonvulnerabilityfactors(e.g.,functionallimitations,

intellectualdisabilities,medicalneeds,notspeakingEnglish)ratherthanpopulationsdefinedby

olderage.Respondentsacknowledgethatwhilesomevulnerabilityfactors,especiallyaround

disabilityandmedicalneeds,mightbemorecommoninolderadults,thereseemstobea

Recommendation:RecreationRx:Healthprogramsthatpromoterecreationshouldbeincorporatedintoneighborhoods.Physical

activityandrecreationareimportantforthehealthofallpeople;olderadultsoftenlackaccessible

recreationalopportunitiesandinformationaboutactivitiesthatareavailable.Theexpansionofsocialand

recreationalopportunitiestoengagepeople’sbodiesandmindswillkeepolderadultsmoreresilient.

Charge:Portlandwillseeasubstantialincreaseinthepopulationofolderadults,bothinsizeandasapercentageof

thepopulation.Properlysupported,thisgenerationalshiftcanresultinamoreresilient Portlandwithstrongerneighborhoodswherepeoplecangrowupandgrowold.

Implementationstrategies:ImprovecoordinationbetweenPortlandParksandRecreation(PP&R)andlocalhealthproviders.

Workwithhealthcareprovidersandlocaladvocacypartnerstoexploreandexpandascholarship

programforlow-incomeseniors.

AddadditionalPP&Rstaffmemberstomeetthedemandforseniorrecreationalservices.

ExpandPP&Rscholarshipandfee-waiverbudgetinordertoprovideadditionalolderadultswith

recreationopportunities.

Expandage-friendlyfitnesscentersincommunitycentersandoutdoorfitnessstationsinpartareas.

AdoptAccessRecreationpracticesandpoliciesthatincreaseawarenessofoutdoorrecreation

facilitiesandtheirlevelofaccessibilitysothatpeoplecanmakemoreinformedchoices.

PromotePP&Rprogramminginhospitalsandclinics.

20

resistancetousingageasaproxyforvulnerabilityinandofitself.Figure3.2liststhemost

commontypesofactivitiesthatpublichealthdepartmentsdescribedascontributingtoolder

adults’resilience.Theseactivitiesaregroupedbythosedoneinpartnershipwitholderadults,

thosedoneinpartnershipwithotherorganizations,andthosedonewithinthepublichealth

department.

Figure3.2.ExamplesofPublicHealthDepartmentActivitiesThatPromoteOlderAdults’Resilience

WhatArePublicHealthDepartmentsandGroupsThatSupportAginginPlaceDoingCollaborativelytoPromoteOlderAdults’Resilience?

Ourinterviewssuggestedthatthereislimitedcollaborationbetweenthesegroups.

However,Figure3.3summarizessomeexamplesofactivitiesthatthesegroupsaredoingor

thatintervieweessuggestedaswaystoimprovetheirpartnership.Theseareintendedas

examplesanddonotrepresentacomprehensivelistofallpossibilities.

Witholderadultsinthecommunity:- Conductoutreachtoolderadultstorecruitvolunteersfordisasterexercises,suchasamedication-dispensingexercise.

Withotherorganizations:- Workwithlong-termcarefacilitiesorotherresidentialfacilitiesforolderadults(e.g.,seniorhousing)tohelpfacilitiesplanforemergenciesortoofferpreparednesseducationactivitieswithresidentsinconjunctionwiththefacilities.- Partnerorcoordinatewithotherhealthdepartments,AreaAgenciesonAgingandsimilarorganizations,RedCross,andothernonprofit-typeorganizations(suchastheAlzheimer’sAssociation)inordertodistributetheirpreparednessmessagesandprogrammingbroadly,includingtoorganizationsservingolderadults.

Withinthepublichealthdepartment:- Developmessagesandactivitiesforvulnerablegroups,suchasindividualswithfunctionallimitations,intellectualdisabilities,ormedicalneedsorwhodonotspeak English(whichmayincludeolderadultswithspecificvulnerabilities).

21

Figure3.3.ExamplesofCollaborativeActivitiestoPromoteOlderAdults’Resilience

Giventheirroleasapublic-privateagencycoordinatingbody,AFCsarewellpositionedto

cultivaterelationshipsbetweenpublichealthdepartments,villages,andemergency

managementagenciesandamplifyandsupportongoingefforts—ratherthanduplicated

effort—byleveragingexistingprogrammingandexpandingdisseminationofotheragencies’

work.Thesetypesofcollaborativerelationshipsareimportantforvillages—especiallyforsmall

tomid-sizevillagesthatlackthestaffingcapacityorresourcestodesigntheirownpreparedness

educationalmaterialsorcurriculum.Whilehavinglocalpreparednesspartnershipsandstrong

programmingaroundpreparednessdoesnotguaranteeuptakebyvillagemembers,our

interviewsshowedahighinterestamongnearlyallvillagesrelatedtoplanningfororpreventing

healthemergencyevents.Encouragingolderadultstojoinorsignupforemergencyinformationsystemscouldensurethatfirstrespondersareawareofspecificneedsofolderadultsandareabletolocateandsupportolderadultswhenrespondingtoahealthemergencyortoadisaster.

Villagemembersmaybemoremotivatedandwillingtoputtimeintoactivitiestheyperceive

ashavingbroadapplicabilityormultiplebenefits,beyondthedisasterscenariothatmightbe

easiertoignoreasunlikely.Villagescanbeatrustedbrokertoconnectmemberstoother

servicesandinformationand,withpartners,candevelopmessagingthatdrawsconnections

betweenresiliencedealingwitheverydaystressandhealth-relatedemergencypreparedness

anddisasterresilience.Thiscouldincludepartneringtobringkeyhealth-promotingservicesto

CollaborativeActivities- Encourageolderadultstosignupforemergencyinformationsystems(e.g.,Smart911,CodeRed).- Partnertobringkeyhealth-promotingservicestoolderadults(e.g.,flushots,inspectionsforissuesthatexacerbaterespiratoryillnesses).- Participateinpreparednessplanningtoensurethattheneedsofolderadultsarerepresented.- Develop/providefeedbackonconcisetargetededucationalmaterialsforolderadults.- Trainoreducateeachotheronspecificareasofexpertise(e.g.,olderadults,emergencypreparedness).


Age-friendlycommunity

Village

22

olderadults.Publichealthdepartmentscanusefluclinics(atwhichflushotsaredispensed)asa

waytotesttheprocessestheyusetoreacholderadultswithneededmedicationintheeventof

aninfectiousdiseaseoutbreak,inpartnershipwithvillagemembers.Publichealthdepartments

andAFCleadershipcouldalsocoordinatetoprovidehouseholdinspectionsforissuesthatcan

exacerbaterespiratoryillnesses,suchasasthma.

Becauseoftheirbroadmembership,AFCsarealsowellpositionedasaforumforgathering

agencyinputondisasterplansandeducationalmaterialsdevelopedbypublichealthandemergencymanagementagencies.Villagescanalsoserveasahelpfulplacetogatherinput

fromolderadultsontheutilityofmaterialsandthefeasibilityofplansforcommunicationand

trackingsystemsforusewitholderadults.

Tohelpdisseminatethesetrackingsystems,educationaleffortsmaybeneededtohelpolder

adultsrecognizetheirassetsandvulnerabilitiesandidentifyareasinwhichtheyneed

assistance.Publichealthdepartmentscouldprovidetrainingoreducationtovillagemembers

onhowtoassesstheirassetsandvulnerabilitiesandonavailableprogramstoimprove

communicationwithfirstrespondersabouttheirneeds.Similarly,AFCs’regularassessmentof

communityandhealthservicesforolderadultscouldprovideusefulinformationtoinform

publichealthdepartments’plansandvillages’services.AFCscanprovideabriefpresentation

tailoredtotheinterestsofpublichealthdepartmentsandvillagestofurthertheirpartnership.

Ideally,publichealthdepartments,villages,andAFCsareworkingtogetherseamlesslyto

advancetheirsharedgoalofbuildingacommunityinwhicholderadultscanbehappy,healthy,

andsafeintheirhomes.Astrongpartnershipbetweenthesethreegroupsmeansthatthey

recognizeeachother’svalue,areregularlysharinginformationandresources,andare

continuallyimprovingtheirowneffortsandtheirsharedeffortsthroughinputandengagement

witheachotherandtheolderadultsintheircommunity.

HowCanMyGroupImproveOlderAdults’Resilience?

UseWorksheets3.1,3.2,and3.3toidentifytheactivitiesthatyourgroupisalreadydoingindependentlyandincollaborationwithothergroupsinyourcommunity,aswellasactivities

thatmightbeofinterestintheshortorlongterm.Foreachactivity,selectwhetheryouare

doingitnow(Now)orwhetheritissomethingyourgroupwouldliketoplantodointheshort

term(ST),longterm(LT),ornever(N).Takingsomeofthesesimplestepscanhelpimprovethe

resilienceofolderadultsinyourcommunity.Beforeimplementinganyactivities,besureto

explorewhethertheseactivitiesmightalreadybeoccurringinyourcommunity.Thiswillhelp

yourgroupfindtherightpartnersandavoidanyduplicationofefforts.

Taketheactivitiesthatyouindicatedyourgroupwouldliketodointheshortorlongterm

anduseWorksheet3.4toplanmoredetailsabouthowyourgroupmightaccomplishthese

23

activities.Therearespacestoincludeactivitiesthatyourgroupcandoonitsown,aswellas

activitiesthatcanbedoneincollaborationwithothers.Inthe“Activity”column,listthe

activitiesthatyourgroupwouldliketoaccomplishintheshortandlongterm.Thenindicatethe

timeframeinwhichyouareplanningoncompletingtheseactivitiesinthe“Dates(TimeFrame)

forCompletion”column.Identifytheperson(s)andorganization(s)responsiblefortheactivity

andthesourceofanyresourcesthatwillbeneeded(forexample,“Wewillgetvolunteersfrom

thelocalvillage”)inthe“WhoIsResponsible”and“WhereWillWeGetAnyResourcesWe

Need?”columns,respectively.Whentheactivityiscomplete,fillinthe“DateCompleted”

column.

24

Worksheet3.1.ResilienceActivitySelf-AssessmentandPlanningforAge-FriendlyCommunities

Whatactivitiesismygroupinterestedinoralreadydoing...

1. onour own? Now ST LT N

• Includingresilienceorpreparednessintheobjectives,recommendations,orimplementationofourage-friendlycommunityactionplanning

� � � �

• Addingadomainspecifically focusedonresilienceorpreparedness � � � �

• Including localvillagesincommunityactionplanning � � � �

• Seekinginputfromlocalvillages andlocalhealthdepartmentsonneedsofolderadults

� � � �

• Includinginformationonlocalrisksandhazardsrelatedtodisastersandemergenciesinthecontextofourcommunityactionplan

� � � �

2.withothers? Now ST LT N

• Encouragingolderadultstosignupforregistriesandemergencyinformationsystems

� � � �

• Participatinginpreparednessplanningtoensurethattheneedsofolderadultsarerepresented

� � � �

• Developing/providingfeedbackonconcisetargetededucationalmaterialsforolderadults

� � � �

• Trainingoreducatingeachotheronspecificareasofexpertise(e.g.,olderadults,emergencypreparedness)

� � � �

25

Worksheet3.2.ResilienceActivitySelf-AssessmentandPlanningforVillages

Whatactivitiesismygroupinterestedinoralreadydoing...1. onour own? Now ST LT N

• Providingbrochureswithinformationaboutdisasterpreparednessandemergencyservices

� � � �

• Callingmembersbefore,during,andafterdisasters � � � �

• Givingremindersandsupporttochangesmokedetectorbatteries � � � �

• AssistingmemberstoenrollinSmart911orotherregistriestomakeemergencyrespondersawareofmembers’needs(e.g.,VialofLifeprogram)

� � � �

• Hostingeducationsessionsfromlocalemergencyresponse/preparednessentities

� � � �

• Supportinguseofmedicalalertsystems(monitors,buttons) � � � �

• Conductinghomesafetyinspections(trippinghazards,firesafety) � � � �

• Supportingemergencyplanning,includinghavingsuppliesonhandandphonenumbersofwhotocall

� � � �

• Supportingadvancecareplanningconversations(wishesintheeventofahealthevent)

� � � �



� � � �


� � � �


� � � �


� � � �

26

Worksheet3.3.PublicHealthDepartmentActivitySelf-AssessmentandPlanning

Whatactivitiesismygroupinterestedinoralreadydoing...

1. onour own? Now ST LT N

• Reaching outtoolderadultstoserveasvolunteersfordisasterexercises,suchasamedication-dispensingexercise

� � � �

• Partneringwithlong-termcarefacilitiesorotherresidentialfacilitiesforolderadults(e.g.,seniorhousing)tohelpfacilitiesplanforemergenciesortoofferpreparednesseducationactivitieswithresidentsinconjunctionwiththefacilities

� � � �

• Partneringwithotherhealthdepartments,AreaAgenciesonAgingandsimilarorganizations,RedCross,andothernonprofit-typeorganizations(suchastheAlzheimer’sAssociation)inordertodistributetheirpreparednessmessagesandprogrammingbroadly,includingtoorganizationsservingolderadults

� � � �

• Developingmessagesandactivitiesforvulnerablegroups,suchasindividualswithfunctionallimitations,intellectualdisabilities,ormedicalneedsorwhodonotspeakEnglish(whichmayincludeolderadultswithspecificvulnerabilities)

� � � �



� � � �


� � � �


� � � �


� � � �

27

Worksheet3.4.PlanforShort-TermandLong-TermResilienceActivities

Activity Dates(TimeFrame)for Completion

WhoIsResponsible?

WhereWillWeGetAnyResourcesWeNeed?

DateCompleted Evaluation Plan

Onourown

1. Sample:DataCollection:Measures:



Withothers




28

Summary

Thischapterprovidedguidanceaboutthetypesofactivitiesthatvillages,AFCs,andpublic

healthdepartmentsarealreadydoingorcoulddotopromoteresilienceontheirownandin

collaborationwitheachother(Table3.1,Table3.2,Figure3.1,Figure3.2,Figure3.3).Nowthatyouhavecompletedthischapter,youshouldhaveidentifiedpresentandfutureactivitiesfor

yourgroup(Worksheet3.1,Worksheet3.2,Worksheet3.3)anddevelopedaplanforhowtotackletheseactivitiesintheshorttermandlongterm(Worksheet3.4).ChapterFourwillhelpyoutoassesswhetheryoureffortstopromoteolderadults’resiliencehavehadthedesired

effects.

29

ChapterFour.EvaluatingandImprovingYourEffortstoPromoteOlderAdults’Resilience

Thischapterprovidessomelimitedguidanceonhowtoconductanevaluationofyour

effortstopromoteolderadults’resilience(Worksheet4.1andWorksheet4.2).Thechapterthenwalksthroughwaystomeasurepotentialoutcomesfromyourgroup’sindependentand

collaborativeworkpromotingolderadults’resilience(Table4.1andTable4.2).Thechapterconcludeswithguidanceonhowtouseevaluationfindingstoinformandimproveyourongoing

work(Checklist4.1andWorksheet4.3).Thisisabriefevaluationprimer.Moreinformation

withdetailedevaluationandcontinuousqualityimprovementguidanceisavailableonlinein

RAND’sGettingToOutcomesmanuals

(https://www.rand.org/pubs/technical_reports/TR101.html;Chinman,Imm,andWandersman,

2004;andhttps://www.rand.org/pubs/tools/TL179.html;Hunteretal.,2015).

ConductinganEvaluation

Adesignistheoutcomeevaluationtermforthetypeofevaluationyouwillconduct.The

typeofdesignguideswhenyoucollectdataandfromwhichgroups.Forexample,asimpleand

inexpensivedesignusesaquestionnairetocollectdatafromolderadultsparticipatingina

resilienceactivityjustbeforeyoubeginandafteryoucompletetheactivity(oftencalleda

pre/post).Anothertypeofdesigncalledthepre/postwithcomparisongroupcompares

participatingolderadultswithasimilargroupofolderadultsnotparticipatingintheactivity

duringthesametimeperiod.Thisway,youcanbesurethatanychangesobservedintheolder

adultsparticipatingintheactivityfrompretopostwererealandwerenothappeningtoall

olderadults(i.e.,ifbothgroupsimprovethesameamount,thentheactivitydidnothavean

effect).Thisevaluationdesignisamorerigorouswaytoevaluatewhethertheactivityachieved

thedesiredeffects.However,thisdesignismorecomplicated,soyoumaywanttoconsulta

programevaluator.

Worksheet4.1providessomereflectionquestionstoconsiderwhendesigningan

evaluation.Answeringquestionsabouttheintendedtimingandaudienceoftheevaluation,and

yourgroup’sevaluationexpertiseandavailableevaluationresources,isimportanttoinforming

yourevaluationplan.Timingoftheevaluationisimportant—itisbesttobeginanevaluation

priortoconductinganyactivitysothatyoucancollectsomedatafromparticipantspriorto

theirinvolvementwiththeactivity.Requirementsofgrantfunding,suchasthePublicHealth

EmergencyPreparednessCooperativeAgreement,ordeadlinesforreportingtofunders,

boards,orotheroversightbodiesmayalsodriveevaluationtiming.Answeringthequestionsin

https://www.rand.org/pubs/technical_reports/TR101.html


30

the“TimingofEvaluationandIntendedAudience”sectionwillhelpinformyourdecisionsabout

evaluationtiming.Finally,allevaluationsrequireresources(e.g.,staffexpertisetoconductthe

evaluation,moneyforasurvey).Answeringthequestionsinthe“EvaluationExpertiseand

AvailableEvaluationResources”sectionwillhelpyouunderstandtheresourcesyourgrouphas

andmightneedinordertoconductanevaluation.Ifyourgroupdoesnothaveevaluation

expertiseorestablishedrelationshipswithorganizationsthatcanprovideevaluationexpertise,

youmightconsiderengaginganexternalevaluatortohelpsupportyourevaluationefforts.The

AmericanEvaluationAssociationprovidesasearchabledatabaseofmembersavailablefor

evaluationconsulting(http://www.eval.org/p/cm/ld/fid=108A;AmericanEvaluation

Association,undated).Itisimportanttoseekevaluationexpertisewhileplanninganevaluation.

Worksheet4.2providesanupdatedplanningtemplate(updatedfromWorksheet3.4)inwhichyoucanincludeabriefsummaryofyourevaluationplanforeachactivity.Nextto

“Sample,”specifythetargetpopulationandestimatednumberofprogramparticipantsforthe

evaluation.Nextto“DataCollection,”specifythetimingofyourevaluation(thedatesthe

evaluationwilloccur,whichshouldbetiedtothebeginningandendoftheactivity).Nextto

“Measures,”specifyanymeasuresyouplantouse.Thesecouldincludetheprocessoroutcome

measuresdescribedinTable4.1andTable4.2.Besuretoupdatethe“WhereWillWeGetAny

ResourcesWeNeed?”columntoincludeanyexpertise,supplies,orequipment(forexample,

accesstocomputers);stafftime;financialresources(forexample,moneytosupportanonline

surveysubscription);andorganizationresources(forexample,buy-infromleadership)that

mightbeneededfortheevaluation.

http://www.eval.org/p/cm/ld/fid=108A

31

Worksheet4.1.IssuestoConsiderforMyEvaluation

Reflectonthequestionsbelow;theylayoutsomekeyissuesthatyouwillneedtoconsider

whendesigningyourevaluation.

TimingofEvaluationandIntendedAudience

Whendoesyourevaluationneedtobecompleted?

_____________________________________________________________________________

_____________________________________________________________________________

Doestheactivityhaveaspecificenddate?

_____________________________________________________________________________

_____________________________________________________________________________

Istheactivitycyclical(forexample,runsforeightweekstwiceayear)?

_____________________________________________________________________________

_____________________________________________________________________________

Ifyes,whenisthenexttimetheactivitywillbeoccurring?

_____________________________________________________________________________

_____________________________________________________________________________

Ifno,forhowlonghastheactivitybeenrunning?

_____________________________________________________________________________

_____________________________________________________________________________

Howwillevaluationdatabeused?

_____________________________________________________________________________

_____________________________________________________________________________

EvaluationExpertiseandAvailableEvaluationResourcesDoesanyoneinvolvedwiththeactivityhaveevaluationexpertise?

_____________________________________________________________________________

_____________________________________________________________________________

32

Doestheactivityinvolveanyorganizationswithevaluationexpertise?

_____________________________________________________________________________

_____________________________________________________________________________

Whatkindsofresourcesdoesyourgrouphavetosupportanevaluation?

_____________________________________________________________________________

_____________________________________________________________________________

Whatotherresourcesareavailableinyourcommunitytosupporttheevaluation?

_____________________________________________________________________________

_____________________________________________________________________________

33

Worksheet4.2.UpdatedPlanforShort-TermandLong-TermResilienceActivities

OutcomeandProcessMeasures

Thereareavarietyofmeasuresthatcanbeusedtocaptureolderadults’resilience.We

highlightaselectsetofmeasuresthatweusedinarecentstudyofvillages’impactonolder

adults’resilience(seejournalarticlemanuscript,availablefromtheauthors).Thesemeasures

capturefactorsrelatedtoolderadults’resilienceinfourareas:disasterpreparedness,physical

health,emotionalhealth,andsocialhealth(Table4.1).Whenselectingspecificmeasures,you

mustconsiderhowthesemeasuresalignwithactivities(e.g.,doyouexpectachangeinthese

measuresbasedonthespecificactivitiesyourgroupisperforming?).Forexample,ifyourgroup

isprovidingtargetededucationalmaterialstoimproveolderadults’disasterpreparedness,then

youcouldusethedisasterpreparednessmeasures.SeeTable4.1forexamplesofthetypesof

activitiesthatyoucoulduseeachmeasuretoevaluate.

Inadditiontoaligningmeasureswiththespecificactivities,youwillalsoneedtoconsider

howthemeasureswillbecollected(timing,frequency,andpersonresponsible),howthedata

fromthesemeasureswillbeanalyzed,andwhatresourcesandexpertisewillbeneededto

understandandapplyanyfindings.Collectingtheseoutcomemeasureswillallowyoutoanswer

importantquestionsaboutwhetheryourworkishavingthedesiredeffect.

Activity Dates(TimeFrame)for Completion

WhoIsResponsible?

WhereWillWeGetAnyResourcesWeNeed?

DateCompleted Evaluation Plan

Onourown




Withothers




34

Table4.1.SurveyQuestionstoMeasureOlderAdults’ResilienceArea SampleActivity Measurement

DomainQuestions ResponseOptions References

Disasterpreparedness Disseminatetargeted

preparednesseducational

materialstoolderadults

Preparedness

knowledge

•Iamknowledgeableaboutlocalemergencyplansformycommunity

•Iknowtheevacuationroutetotakeintheeventofanemergency

•Iknowhowtogetinformationinanemergency

•IknowwhatsuppliesIneedtosecurelyseekshelterforupto72hours

•Icouldhelpmyneighbor,ifheorsheneededit,duringadisaster

Stronglyagreetostrongly

disagree

Chandra,Williams,et

al.,2013

Trainolderadultsin

emergencypreparedness

planningorprocesses

Preparedness

behaviors

Inthepast12monthsIhave…

•Participatedinaneighborhoodorcommunitymeetingaboutemergency

preparedness

•Beentrainedinhowtohelpmyneighborhoodormyneighborin

respondingtoanemergency

•Puttogetherahouseholdpreparednesskit

•Workedwithpeopleinmyneighborhoodtodevelopacommunity

emergencyplan(e.g.,call-downlists,storingresources)

•Attendedtraininginpsychologicalfirstaidorothertypeoftraining

relatedtodealingwithemotionalstressofdisasters

•Identifiedwhereindividualswhoneedextrahelpinadisastermaylive

•Puttogethera3-daysupplyofprescriptionmedicationstouseduringan

emergency

•SigneduptobepartofaSmart911program

•Signeduptoreceivegovernmentalertsduringanemergency

Yes,No,Don’tknow Chandra,Williams,et

al.,2013

Hostaneventwhereolder

adultscanmeet

supportingorganizations’

representativesintheir

community

Localsupports •Doyoubelongtoacommunityorganization(e.g.,school,churchor

otherfaithcommunity,orvolunteerorganization)thatyoucandepend

oninadisaster?

•Couldyoucallupononeofyourneighborstoassistyouinanemergency,

suchasprovidingfood,transportation,orhelpwithyourchildren?

Yes,No,Don’tknow Chandra,Williams,et

al.,2013

Physicalhealth Conductatrainingonthe

importanceofandprocess

foraccessingprimarycare

providerstomaintain

health

Accesstocare IsthereaplaceyouUSUALLYgowhenyouaresickorneedadviceabout

yourhealth?

Yes,

ThereisNOplace,

ThereisMORETHANONE

place,Refused,Don’t

know

Blewettetal.,2008

WhatkindofplacedoyouUSUALLYgowhenyouaresickorneedadvice

aboutyourhealth?

Don’tgetcareanywhere,

Clinicorhealthcenter,

Doctor’sofficeorHMO,

Blewettetal.,2008

35

Area SampleActivity MeasurementDomain

Questions ResponseOptions References

Hospitalemergency

department,Someother

place,Don’tgotoone

placemostoften,

Refused

Isthat[fillinresponsefromquestionabove]thesameplaceyouUSUALLY

gowhenyouneedroutineorpreventivecare,suchasaphysical

examinationorcheckup?

Yes,No,Refused,Don’t

know

Blewettetal.,2008

Recentcarevisit Abouthowlonghasitbeensinceyoulastsawortalkedtoadoctoror

otherhealthcareprofessionalaboutyourownhealth?Includedoctors

seenwhileapatientinahospital.

Never,6monthsorless,

Morethan6monthsbut

notmorethan1year

ago,Morethan1year

butnotmorethan2

yearsago,Morethan2

yearsbutnotmorethan

5yearsago,Morethan5

yearsago,Refused,Don't

know

Blewettetal.,2008

Emotionalhealth Deliveraneducational

programonemotionand

coping

Activecoping ThesequestionsaskaboutwhatYOUusuallydowhenYOU

experienceastressfulevent.

• Iconcentratemyeffortsondoingsomethingaboutit

• Itakeadditionalactiontotrytogetridoftheproblem

• Itakedirectactiontogetaroundtheproblem

• Idowhathastobedone,onestepatatime

Stronglyagree,

Moderatelyagree,

Neitheragreenor

disagree,Moderately

disagree,Strongly

disagree

Dieneretal.,2010

Emotionalwell-being • Ileadapurposefulandmeaningfullife

• Mysocialrelationshipsaresupportiveandrewarding

• Iamengagedandinterestedinmydailyactivities

• Iactivelycontributetothehappinessandwell-beingofothers

• Iamcompetentandcapableintheactivitiesthatare

importanttome

• Iamagoodpersonandliveagoodlife

• Mymateriallife(income,housing,etc.)issufficientformy

needs

• Igenerallytrustothersandfeelpartofmycommunity

• Iamsatisfiedwithmyreligiousorspirituallife

Stronglyagree,

Moderatelyagree,

Neitheragreenor

disagree,Moderately

disagree,Strongly

disagree

Dieneretal.,2010

36

Area SampleActivity MeasurementDomain

Questions ResponseOptions References

• Iamoptimisticaboutthefuture

• Ihavenoaddictions,suchastoalcohol,illicitdrugs,or

gambling

• Peoplerespectme

Socialhealth Conductsocial

engagementeffortswhere

olderadultsgettoknow

theirneighborsandeach

other

Social

disconnectedness

Approximatelyhowmanypeopledoyouknowwithwhomyoucan

discussimportantmatters?

Inthepasttwomonths…

• abouthowoftendidyoutalkwithoneormoreofthese

individuals(byphone,email,orinperson)?

None,Oneortwo,Three

tofive,Sixtoten,More

thanten,Don’tknow

Severaltimesaweek,

Aboutonceaweek,

Aboutonceamonth,

Lessthanonceamonth,

Never

Suzman,2009

Approximatelyhowmanyfriendswouldyousayyouhave?

Inthepasttwomonths…

• abouthowoftendidyougettogethersociallywithfriendsor

neighbors?

• howoftendidyouattendmeetingsofanyorganizedgroup?

(suchasachoir,acommitteeorboard,asupportgroup,asportsor

exercisegroup,ahobbygroup,oraprofessionalsociety)

• howoftendidyoudovolunteerworkforreligious,charitable,

political,health-related,orotherorganizations?

None,Oneortwo,Three

tofive,Sixtoten,More

thanten,Don’tknow

Severaltimesaweek,

Aboutonceaweek,

Aboutonceamonth,

Lessthanonceamonth,

Never

Suzman,2009

Socialisolation Inthepasttwomonths…

• howoftendidyoufeelthatyoulackedcompanionship?

• howoftendidyoufeelleftout?• howoftendidyoufeelisolatedfromothers?

• Howoftendoyoufeelthatyoucanopenuptootherpeopleaboutpersonalconcerns?

• Howoftendoyoufeelthatyoucanrelyonotherpeopletoprovidehelpwhenyouneedit?

Hardlyever(ornever),

Someofthetime,Often

Suzman,2009

37

Inadditiontotheseoutcomesthattellyousomethingaboutolderadults’resilience,yourgroupmightalsowanttocollectprocessevaluationdata.Processevaluationsaredesignedtodocumentandanalyzethedevelopmentandactualimplementationofprogramsandotheractivitiesassessingwhetherandhowwellservicesaredeliveredasintendedorplanned.Processdatacanincludetrackingattendanceorparticipation,participantdemographics,participantsatisfaction,andmeasuresofimplementationactivities(forexample,programfidelitymeasures,suchasadherencetotheprogramcurriculum).Collectingprocessdatacanhelpyourgroupanswerimportantquestionsabouttheimplementationofyouractivity:

• Howmuchoftheactivitydidparticipantstakepartin?• Whatarethecharacteristicsofparticipants?• Howsatisfiedareparticipants?Howsatisfiedarethestaffwhoimplementedthe

activity?• Wastheactivityimplementedasplanned?

Thesequestionsmayprovideexplanatorysupportindicatingwhyyouractivitiesmayormaynothaveachievedtheirdesiredeffects.Ifyouneedmoredetail,GettingToOutcomesprovidesaprimeronprocessevaluation(https://www.rand.org/pubs/technical_reports/TR101.html;Chinman,Imm,andWandersman,2004).

PartnershipMeasures

Giventheimportanceofcollaborationbetweenvillages,AFCs,andpublichealthdepartmentstoachieveolderadults’resilience,wealsoincludeseveralmeasuresofpartnershipthatmayhelpprovideinsightaboutthepresenceandqualityofthesepartnerships.ThesemeasuresreflectabriefversionofalongertoolcalledPARTNERthathasbeenusedtocapturetheworkofpublichealthcollaborativesacrosstheUnitedStates(http://partnertool.net;PARTNERTool,2017a).

Tounderstandhowwellapartnershipisworking,dataareneededtodescribe

• whoispartofthepartnershipandhowfrequentlytheyworktogether• thestrengthandqualityofinteractions• theleveloftrustandvaluewithinthepartnership• changesincollaborativeactivityovertime(capturedthroughrepeatingmeasuresover

time)• theorganizationalandcommunitybenefitsofcollaborativeactivities.


http://partnertool.net

38

Table4.2providessamplequestionsthatcanbeusedtoevaluatethedifferentaspectsofpartnership.Specialanalysisskillsarerequiredtounderstandhowpartnershipsresultinorganizationalnetworksandtocalculatenetworklevelmeasures.TechnicalassistanceusingPARTNERmeasuresisavailablethroughtheCenteronNetworkScienceattheUniversityofColoradoDenver(http://partnertool.net/translating-data-to-practice/;PARTNERTool,2017b).TheCDCalsohasaguidethatdescribesthefundamentalsofevaluatingpartnerships(https://www.cdc.gov/dhdsp/docs/partnership_guide.pdf;CDC,2008).Itincludestoolstohelpplanapartnershipevaluationandcontainsasimpleinventorythatcanbeusedtoself-assessapartnership.

Inadditiontocapturingpartnershipdynamics,youmaywanttocapturetheimpactofcollaborativeactivities.Table4.3containssamplemeasuresthatcouldbeusedtodescribethesuccessofthecollaborativeactivitiesoutlinedinChapterThree.

http://partnertool.net/translating-data-to-practice/

https://www.cdc.gov/dhdsp/docs/partnership_guide.pdf

39

Table4.2.SurveyQuestionstoMeasurePartnership

MeasurementDomain Questions ResponseOptions

Presence ofpartnership Overthepastmonth,whatorganizations oragencieshaveyouworkedmostcloselywithtopromoteolderadults’resilience? Freetextlistoforganizations

Questions askedforeachorganizationlisted intheresponsetothepresenceofpartnershipquestion

Frequencyofinteraction Abouthowfrequentlyhaveyoucommunicatedwith[insertorganizationname]inthepastmonth? Lessthan monthly,Monthly,Weekly,Daily,Don’tknow

Levelofinfluence Howmuchpowerorinfluence(e.g.,decisionmaking authority,leadershipresponsibility)doyouthink[insertorganizationname]hasoveractivitiestopromoteolderadults’resilience?(Selectoneandpleasetakeyourbestguess)

Notatall,A smallamount,Afairamount,Agreatdeal

Levelofinvolvement Howinvolved is[insertorganizationname]inpromotingolderadults’resilience? Notatall,A smallamount,Afairamount,Agreatdeal

Resource contributions To whatdegreehas[insertorganizationname]contributedresourcestopromotingolderadults’resilience? Notatall,A smallamount,Afairamount,Agreatdeal

Reliability Towhatdegreehas[insertorganizationname]beenreliableinpromoting olderadults’resilience? Notatall,A smallamount,Afairamount,Agreatdeal

Opencommunication Towhatdegreeis[insertorganizationname]’scommunicationopen andtransparent(forexample,theirpurposeandwhattheyintendtodoareclear)aboutolderadults’resilience?

Notatall,A smallamount,Afairamount,Agreatdeal

Summaryquestionsasked ofasingleorganization

Organizational benefits Whatbenefitshasyourorganizationreceivedasaresultofworkingwitheach organization? Freetext

Community benefits Inyouropinion,whathas beentheimpactofyourandyourpartnersworkpromotingolderadults’resilience? Freetext

40

Table4.3.SampleMeasuresforCollaborativeActivities

UsingEvaluationDatatoInformYourWork

Onceyourevaluationdataarecollectedandanalyzed,yourgroupwillbeabletodeterminewhetheritsworkishavingthedesiredeffects.Itisimportanttoacknowledgethatthemorerigorousyourevaluationdesignis,themoreconfidenceyoucanhavethatyouractivityproducedordidnotproducetheintendedeffects.Worksheet4.3providesatemplatetodocumentwhichoutcomesyouractivitywassuccessfulinachievingandwhichmayrequirefurtheraction.Inthefirstcolumn,listeachoutcomeyourgroupwastracking(forexample,disasterpreparednessknowledgeorstrengthofpartnershipinteraction).Thendescribeinasinglesentenceanydifferenceorchangeintheoutcome(secondcolumn),andusethethirdcolumntoindicatehowthischangedfrombeforetheactivitywasconducted(whetheritgotbetter,gotworse,orstayedthesame).Inthefourthcolumn,specifywhetherthismetyourexpectationsfortheactivity.Forexample,iftheactivitywassupposedtoimprovedisasterpreparednessknowledgeandyourevaluationshowedthatknowledgedidnotimproveaftertheactivity,youwouldmark“Same”inthethirdcolumnand“No”inthefourthcolumn.Inthefifthcolumn,specifyanyactionneeded.Forexample,iftheactivitywasintendedtostrengthen

CollaborativeActivity SampleMeasure

• Encourageolderadultstojoinemergencyinformationsystems

Proportionofolderadultsinthecommunitywhoaresignedupforautomatedemergencyalertandinformationsystems

• Participateinpreparednessplanningtoensurethattheneedsofolderadultsarerepresented

Presence ofspecificguidanceincommunityAFCandpreparednessplansthataccountfortheneedsandstrengthsofolderadults

• Develop/providefeedbackonconcisetargetededucationalmaterialsforolderadults

Penetrationofdisseminationeffortsanduptakeofinformation

• Trainoreducateeachotheronspecificareasofexpertise(e.g.,olderadults,emergencypreparedness)

Proportionofsupportiveserviceagenciesthathaveresponseplans,communicationsplans,andcontinuity-of-operationsplansinplacetoassistolderadultsduringanemergency

• Encourage olderadultstojoincommunityemergencyresponseteamsorMedicalReserveCorps

Presenceofolderadultsincommunity emergencyresponseteamsorMedicalReserveCorps

41

partnershipinteractionsbutyoumissedyourexpectations,youwouldmark“Yes”toindicatethatactionisneeded.Finally,thelastcolumnasksyoutoreflectonanypotentialbarriersthatmighthaveinfluencedwhethertheactivityhadthedesiredeffect(forexample,participationintheactivitywaslow).

42

Worksheet4.3.ReviewProgramOutcomes

Outcome Difference/ChangeinAnyoftheOutcomes?

MetExpectations? ActionNeeded? PotentialBarriers?

1. Was thisrelatedtoanyissuescapturedbyprocessdata?

Whatisthetrend?� Better� Same� Worse

Didthismeetyourexpectationsfortheactivity?� Yes� No

� Yes� No




� Yes� No




� Yes� No

43

Checklist4.1walksyouthroughabriefcontinuousqualityimprovementexercisetohelpidentifypotentialchallengesthatmighthaveaffectedyouractivityandspecificactionsthatyoucouldtaketoaddressthesechallengesmovingforward.Thenrecordwhowillparticipateintheaction,theresourcesneeded,locationdetails,andthetargetdateforimprovementasnewactivitiesinyourexistingplan(Worksheet4.2).EnhancingyourplanwithimprovementactivitiesusingWorksheet4.2willhelpyouidentifywhatisnecessarytoachieveyourgoalsandhelpyouspecifyatargetdateforimprovementstobemade.Ifpossible,completetheimprovementspriortodoingtheactivityagain.

44

Checklist4.1.WhatContinuousQualityImprovementActionsAreNeededtoImprovetheActivity?

A. Didparticipantsrepresentthetargetpopulation?� Yes� No—Reviewpartnershipsandreferralsourcestodeterminewhetheryourgrouphasthe

rightrelationshipsinplacetogetappropriatereferrals.Revieweligibilitycriteriausedtoidentifythetargetpopulationtoensurethattheyarespecificenoughtorecruitappropriateparticipants.

B. Wastheactivityimplementedasintended?� Yes� No—Improvestafftrainingonhowtoimplementtheactivityandassesswhether

implementationimproves.C. Wasparticipationadequate?

� Yes� No—Revisithowyourecruitandretainparticipantsintheactivitytoidentifywhere

improvementscanbemade.Assesswhetherthereareanylogisticalbarriersthatmightmakeitdifficultforparticipantstoattend(forexample,transportation).Considerwhetherchangingthetimeandplaceoftheactivitywouldimproveparticipation.Considerwhethertheactivityisappropriateforthetargetpopulation.

D. Didyouhavetheresourcesneededtoimplementtheactivitycompletelyasintended?� Yes� No—Reviewyourresourcesforimplementationandevaluationtodeterminewhether

youhavetherightstaff,resources,andpartnershipstoconducttheactivity.Trytoleverageadditionalresourcesfromuntappedsourcesinyourcommunity.Acommunityresourcesassessmentmayhelpinformthiseffort.RAND’sGettingToOutcomesmanualscontaininformationonhowtoconductacommunityresourcesassessment(https://www.rand.org/pubs/technical_reports/TR101.html;Chinman,Imm,andWandersman,2004).

E. Weretheoutcomesyouexpectedreasonableandappropriatefortheactivity?� Yes� No—Revisitthegoalsofyouractivityandrevisethemtobemorereasonableand

appropriate.F. Wasyourprocessandoutcomeevaluationappropriate?

� Yes


45

� No—Updatetheprocessand/oroutcomeevaluationplantobemoreappropriateforyouractivity.

46

Summary

Nicejobcompletingthetoolkit!Thischapterprovidedinformationonprocess,outcome,andpartnershipmeasures(Table4.1andTable4.2)andguidanceonhowtousethosemeasuresaspartofanevaluationofyouractivitiestopromoteolderadults’resilience(Worksheet4.1andWorksheet4.2).Thischapteralsoprovidedguidanceonhowtousethefindingsfromyourevaluationtoimproveandinformyourworkgoingforward(Checklist4.1andWorksheet4.3).Afterusingthischapter,youshouldhaveselectedyourevaluationstrategy,plannedhowtouseyourevaluationdata,andreflectedonwhatyourevaluationfindingsmeanforyourcurrentandfutureworkpromotingolderadults’resilience.Thecontentandworksheetsofthistoolkitareintendedtobereused,evenafteryouhavecompletedyourevaluation.Considerreviewingthetoolkitannuallytocontinueimprovingyourworkandrefiningyourevaluation.

47

Appendix:BriefDescriptionofMethodsUsedtoDeveloptheToolkit

Wecreatedthistoolkitbecausenoothersimilartoolkitsexisted.Tocreatethetoolkit,weconductedinterviewswithpublichealthdepartmentstaff,villageexecutivedirectors,andAFCcoordinatorsacrosstheUnitedStates.Wealsoconductedasurveyofolderadults’resiliencethatcomparedolderadultslivinginvillagesandthosenotlivinginvillages.

InterviewsofStaffatPublicHealthDepartmentsandAging-in-PlaceEfforts

Weinterviewedthreestakeholdergroups.Thefirstgroupconsistedof16leaders(primarilyexecutivedirectors)ofseniorvillages.WerecruitedtheseexecutivedirectorswiththehelpoftheVillagetoVillageNetwork.TheVillagetoVillageNetworkisamember-basedorganizationofvillagesacrosstheUnitedStateswithanationalstaffthatprovidesexpertguidance,resources,andsupporttohelpcommunitiesestablishandmaintaintheirvillages.Ourrecruitmentstrategywastolocatevillagesrepresentingdiversityinsizeandgeographicregion.Thevillagesinoursamplewereformedbetween2008and2015(theaveragewas5.5yearsinexistence).

ThesecondgroupconsistedofleadersofAFCs,recruitedwithaninitialemailanduptofourfollow-upemailswiththehelpoftheAARPPublicPolicyInstitute.WeinterviewedtenleadersofAFCsrepresentinganevendistributionacrossallU.S.geographicregions,ruralorurbanstatus,andvaryingtenureintheAARPNetworkofAge-FriendlyCommunities.TheseleadersweregenerallynotAARPstaffbut,rather,wererepresentativesofthecoordinatingbodiesoftheAFCs;mostrespondentswereemployedbylocalgovernments,butafewrespondentshadprimaryrolesatacademicinstitutions,communityfoundations,orothertypesofcommunity-engagedorganizations.

Inordertounderstandtherolethatpublichealthdepartmentshaveinsupportingolderadults’resilience,weconductedathirdsetofinterviewswithhealthdepartmentrepresentatives.Theserepresentativeswererecruitedwithaninitialemailanduptofourfollow-upemailswiththehelpofNACCHO.Weinterviewed11healthdepartmentrepresentativesprimarilyresponsibleforimplementingemergencypreparednessactivities(mostlypreparednesscoordinators)representinganevendistributionacrossallU.S.geographicregionsandruralorurbanstatus,alllocatedwithinareasthathadanAFCinthesamejurisdiction(inthesamecityorcounty).

Forallrespondentgroups,theinterviewprotocolsincludedquestionsaboutthegreatestneedsaroundhelpingolderadultspreparefordisasters;thetypesofresilienceactivitiesengagedinbytheirorganizations,bothgenerallyandforolderadults;othertypesofolderadult–focusedprogrammingconductedbytheirorganizations;wholeadsresilienceactivities

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forolderadultsintheirserviceareas;awarenessofandcollaborationwithotherolderadult–servingandresilience-focusedorganizationsandagenciesintheirregions;andideasforhowtoassessprogressaroundemergencypreparednessandresilienceforolderadults.Allinformantsgaveverbalconsenttoparticipate,andthemethodswereapprovedbytheRANDCorporation’sHumanSubjectsProtectionCommitteeandtheFederalOfficeofManagementandBudget.

Interviewswereledbyamemberoftheresearchteam,withanotherteammembertakingdetailednotes.Interviewswerealsoaudio-recorded.Recordingswerereferredtoforclarificationofthewrittennotesandtoconfirmverbatimquotes,asneeded.

Tworesearchersindependentlyreviewedandsummarizedinterviewthemesforeachgroup,usingtheinterviewprotocolasaguideformajortopics.Leadresearchersontheproject,bothofwhomparticipatedinconductinginterviews,thenreviewedthesummaryofthemes,verifyingmajorthemesandsuggestingclarificationorexpansionofkeypointswhenneeded.Themeswerethenrefinedandexpandediterativelyamongtheresearchteam.

SurveyofOlderAdults

Aspartoftoolkitdevelopment,wesurveyed357olderadultslivingin17villagesand884olderadultslivingincommunitieswithoutthesupportofavillage.Villageswerelocatedin12statesandallfourregionsoftheUnitedStates.Foreachvillage,weidentifiedamatchednon-villagecommunity(definedforthepurposesofthematchasasinglecounty):Wetookthecountyinwhichthevillagewaslocatedand,fromamongsurroundingcounties,identifiedthecountythatmostcloselymatchedbasedonfourcharacteristics—thepercentageofthepopulationolderthan65,thepercentageofthepopulationwithadisability,thepercentageofthepopulationbelowthefederalpovertyline,andpopulationdensitypersquaremile.Wecalculatedstandardizedscoresrepresentingeachofthesecharacteristicstodeterminethematch.

Surveyparticipantswereinterviewedoverthephoneandaskedquestionsabouttheirhealthresilience,socialresilience,disasterresilience,andemotionalresilience.Thephoneintervieweralsocollectedinformationaboutparticipants’demographics(age,gender,income,livingsituation,race/ethnicity,lengthoftimelivingintheircurrentlocation,andpresenceofchronicconditions)andtheirexposuretoAFCsintheircounty.Surveystookapproximately15minutestocomplete.Surveydatawereanalyzedusinglinearregressiontodeterminewhetherolderadultslivinginvillagesweremoreresilientthanolderadultsnotlivinginvillages.Allsurveyparticipantsgaveverbalconsenttoparticipate,andthemethodswereapprovedbytheRANDCorporation’sHumanSubjectsProtectionCommitteeandtheFederalOfficeofManagementandBudget.

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