Toolkit: Building Resilience in Older Adults: Bibliography & Appendix

Bibliography

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  • NACCHO—See National Association of County and City Health Officials.
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Appendix

Brief Description of Methods Used to Develop the Toolkit

We created this toolkit because no other similar toolkits existed. To create the toolkit, we conducted interviews with public health department staff, village executive directors, and AFC coordinators across the United States. We also conducted a survey of older adults' resilience that compared older adults living in villages and those not living in villages.

Interviews of Staff at Public Health Departments and Aging-in-Place Efforts

We interviewed three stakeholder groups. The first group consisted of 16 leaders (primarily executive directors) of senior villages. We recruited these executive directors with the help of the Village to Village Network. The Village to Village Network is a member-based organization of villages across the United States with a national staff that provides expert guidance, resources, and support to help communities establish and maintain their villages. Our recruitment strategy was to locate villages representing diversity in size and geographic region. The villages in our sample were formed between 2008 and 2015 (the average was 5.5 years in existence).

The second group consisted of leaders of AFCs, recruited with an initial email and up to four follow-up emails with the help of the AARP Public Policy Institute. We interviewed ten leaders of AFCs representing an even distribution across all U.S. geographic regions, rural or urban status, and varying tenure in the AARP Network of Age-Friendly Communities. These leaders were generally not AARP staff but, rather, were representatives of the coordinating bodies of the AFCs; most respondents were employed by local governments, but a few respondents had primary roles at academic institutions, community foundations, or other types of community-engaged organizations.

In order to understand the role that public health departments have in supporting older adults' resilience, we conducted a third set of interviews with health department representatives. These representatives were recruited with an initial email and up to four follow-up emails with the help of NACCHO. We interviewed 11 health department representatives primarily responsible for implementing emergency preparedness activities (mostly preparedness coordinators) representing an even distribution across all U.S. geographic regions and rural or urban status, all located within areas that had an AFC in the same jurisdiction (in the same city or county).

For all respondent groups, the interview protocols included questions about the greatest needs around helping older adults prepare for disasters; the types of resilience activities engaged in by their organizations, both generally and for older adults; other types of older adult–focused programming conducted by their organizations; who leads resilience activities for older adults in their service areas; awareness of and collaboration with other older adult–serving and resilience-focused organizations and agencies in their regions; and ideas for how to assess progress around emergency preparedness and resilience for older adults. All informants gave verbal consent to participate, and the methods were approved by the RAND Corporation's Human Subjects Protection Committee and the Federal Office of Management and Budget.

Interviews were led by a member of the research team, with another team member taking detailed notes. Interviews were also audio-recorded. Recordings were referred to for clarification of the written notes and to confirm verbatim quotes, as needed.

Two researchers independently reviewed and summarized interview themes for each group, using the interview protocol as a guide for major topics. Lead researchers on the project, both of whom participated in conducting interviews, then reviewed the summary of themes, verifying major themes and suggesting clarification or expansion of key points when needed. Themes were then refined and expanded iteratively among the research team.

Survey of Older Adults

As part of toolkit development, we surveyed 357 older adults living in 17 villages and 884 older adults living in communities without the support of a village. Villages were located in 12 states and all four regions of the United States. For each village, we identified a matched non-village community (defined for the purposes of the match as a single county): We took the county in which the village was located and, from among surrounding counties, identified the county that most closely matched based on four characteristics—the percentage of the population older than 65, the percentage of the population with a disability, the percentage of the population below the federal poverty line, and population density per square mile. We calculated standardized scores representing each of these characteristics to determine the match.

Survey participants were interviewed over the phone and asked questions about their health resilience, social resilience, disaster resilience, and emotional resilience. The phone interviewer also collected information about participants' demographics (age, gender, income, living situation, race/ethnicity, length of time living in their current location, and presence of chronic conditions) and their exposure to AFCs in their county. Surveys took approximately 15 minutes to complete. Survey data were analyzed using linear regression to determine whether older adults living in villages were more resilient than older adults not living in villages. All survey participants gave verbal consent to participate, and the methods were approved by the RAND Corporation's Human Subjects Protection Committee and the Federal Office of Management and Budget.