Deliverable 3 Complete Report

OUR SOCIAL NETWORK 1
Our Social Network: A Community-Based Program to Address Older Adult Mental
Health Amidst COVID-19
Kathleen Melei, OTDS1,2, Dr. Rita Gray, PsyD3 Jill Linder, DHSc, OTR4
Huntington University1
Will County Health Department2,3
Parkview Health4
Author Note
Kathleen Melei https://orcid.org/0000-0002-1503-1032
Jill Linder
We have no known conflicts of interests to disclose.
Correspondence concerning this article should be addressed to Kathleen Melei, OTDS at
meleik@huntington.edu. A special acknowledgement to Dr. Katie Bergman, Ph.D. and
Dr. Laura Gerig who assisted with data analysis and interpretation.
The Table of Contents
The Table of Contents ..................................................................................................................... 2

Abstract ........................................................................................................................................... 3
Our Social Network: A Community-Based Program to Address Older Adult Mental Health
Amidst COVID-19 .......................................................................................................................... 4
Literature Review............................................................................................................................ 6
Part I: Social Participation and QOL ....................................................................................... 6
Part II: The Role of Occupational Therapy in Social Participation ..........................................10
Part III: Program Development ..............................................................................................15
The Current Project ...............................................................................................................17
Method .......................................................................................................................................... 18
Study Design .........................................................................................................................18
Part I: Quantitative .................................................................................................................19
Part II: Qualitative ..................................................................................................................24
Part III: Program Development ..............................................................................................30
Discussion ..................................................................................................................................... 34
Conclusion .................................................................................................................................... 37
References ..................................................................................................................................... 38
Tables and Figures: Part I ............................................................................................................. 46
Tables and Figures: Part II ............................................................................................................ 55
Tables and Figures: Part III........................................................................................................... 65
Appendix A ................................................................................................................................... 67
Appendix B ................................................................................................................................... 68
Appendix C ................................................................................................................................... 69
Appendix D ................................................................................................................................... 72
Appendix E ................................................................................................................................... 73
Appendix F.................................................................................................................................... 74
Appendix G ................................................................................................................................... 75
Abstract
The purpose of this study was to explore the unique experiences of older adults amidst the
COVID-19 pandemic to further understand the relationship between social participation and
quality of life (QOL). Utilizing survey and interview responses from community-dwelling older
adults, current evidence, and an occupational therapy perspective, a community-based program
was developed for a county health department in Illinois. Termed, “Our Social Network” the
program provided community stakeholders with a program manual with recommendations and
guidelines for program design, a continuing education video series for training on using the
manual, and an online network group. This study and its components were part of an OTD
(Doctor of Occupational Therapy) capstone project that is working to facilitate improved
prevention and intervention for social isolation and loneliness to support the older adult
population within the context of COVID-19.
Keywords: older adults, mental health, social isolation, loneliness, COVID-19,
occupational therapy
Our Social Network: A Community-Based Program to Address Older Adult Mental Health
Amidst COVID-19
COVID-19 is an infection caused by severe acute respiratory syndrome coronavirus-2
(SARS-CoV-2). First reported in December 2019 and declared a global pandemic in March of
2020 (CDC, 2020; Sheehy, 2020), the pandemic has disproportionately impacted the older adult
population. According to a report cited by Shahid et al. (2020), 355 patients who died from
COVID-19 had a mean age of 79.5 years and similarly, Wu (2020) reported 78% of COVID-19
deaths occurred among individuals 65 and older. However, the pandemic has consequences
which reach beyond the serious physical risks, altering the psychological, emotional, and social
health of older adults as well. The shelter-in-place and self-isolation measures taken to prevent
the spread of COVID-19 have in turn increased social isolation and loneliness in older adults,
both of which are significant risk factors linked with increased hospitalizations, symptoms of
depression and anxiety, increased blood pressure, heart disease, obesity, immuno-deficiency,
cognitive decline, vitamin D deficiency, and falls (Dickens et al., 2011; Office et al.,
2020; Pelicioni & Lord, 2020; Wu, 2020).
Despite the increased risks many older adults face during the COVID-19 pandemic, the
pandemic provides an opportunity to expand resources to support overall mental health in older
adults. Schutte (2020) challenges current research to reframe the narrative which describes older
adults are “at risk, vulnerable, and even expendable” and instead work to preserve and support
the “vital, abundant, and essential” roles older adults play in society (p. 118). Optimizing social
participation in provides opportunities to, not only preserve, but also enhancse older adults’
ability to be vital members of the global community.

This paper describes an occupational therapy (OT) doctoral capstone project that utilized
previous evidence, survey data, and qualitative interview data to develop a community-
based program manual that addresses social isolation and loneliness within the older adult
population during the COVID-19 pandemic. Utilizing current evidence and an occupational
therapy perspective, this project further explores the relationship between mental, physical, and
social well-being, to support the older adult population within the context of COVID-19. The
current report will overview the following objectives:
1. To explore the unique experiences of older adults amidst the COVID-19 pandemic using
survey responses from 230 community-dwelling older adults in order to further
understand the relationship between social participation and QOL.
2. To explore the needs of older adults within an Illinois county in response to the social
distancing and isolation guidelines during COVID-19, based on conversations within
one-on-one, semi-structured interviews.
3. To synthesize survey and interview data into general and organization-specific needs
assessments. The needs assessments provide the basis for a community-based program
manual that addresses the social-emotional needs of older adults during the COVID-19
pandemic.
4. To propose and discuss plans for program implementation, evaluation, and sustainability
in order to ensure that older adults are supported during the current
pandemic and beyond.

Literature Review
Part I: Social Participation and QOL
Social isolation involves an "objective state of having few social relationships or
infrequent social contact with others" (Wu, 2020, p. 2). While most definitions consider social
isolation a unidimensional concept, alternate definitions recognize "structural" and "functional"
social support. Structural social support involves the size and frequency of social interaction,
while functional support focuses on the quality of interactions (Dickens et al., 2020). Closely
intertwined with social isolation is loneliness, "a subjective feeling of being isolated", which also
involves both social and emotional dimensions (Dickens et al., 2020; Wu, 2020). Risk factors for
isolation and loneliness include living alone, living in a rural area, poor functional status,
widowhood, female gender, lower socioeconomic status, depression, and feeling misunderstood
(Berg-Weger & Morely, 2020).
Prior to the pandemic, older adults were already at risk for social isolation and loneliness,
which was considered a “loneliness epidemic” of its own (Berg-Weger & Morely, 2020, p.1).
However, the current measures of sheltering in place, limited ability to participate in the
community, decreased physical activity, and decreased connection with others all exacerbate the
likelihood of social isolation and loneliness to occur. Quarantine/medical isolation is defined as
“the separation and restriction of movement of people who have been potentially exposed to a
contagious disease to ascertain if they become unwell, so reducing the risk of them infecting
others" (Brooks et al., 2020 cited by Baker & Clark, 2020). While older adults rely on medical
isolation to prevent infection from COVID-19, the resulting social isolation can also be
detrimental to physical health, mental health, and overall QOL.

Physical Health
Humans, from birth, crave connection, touch, or simply eye contact, all of which result in
biological responses in the brain that support development and functioning. When individuals are
prohibited from this connection, there are significant consequences to both QOL and medical
outcomes (Nicol et al., 2020). Though medical isolation is intended to decrease the risk of
COVID-19 infection, the resulting social isolation may result in increased debility. Social
isolation is associated with increased hospitalizations, increased blood pressure, heart disease,
obesity, immuno-deficiency, vitamin D deficiency, and falls (Dickens et al., 2011; Office et al.,
2020; Pelicioni & Lord, 2020; Wu, 2020). When older adults are isolated and restricted to
activities in the home, they may be less likely to be physically active thus increasing their risk for
physical decline. Such a decline has already been noted as some reports have revealed, since the
pandemic, adults’ average number of daily steps have decreased between 7-38% (Aubertin-
Leheudre & Rolland, 2020). The decreased level of physical activity can have significant
repercussions, resulting in decreased participation in Activities of Daily Living (ADLS),
pulmonary reserves, life expectancy and increased disability progression and severity (Aubertin-
Leheudre & Rolland, 2020; Baker & Clark, 2020; Pelicioni & Lord, 2020).
The risks associated with social isolation, particularly decreased physical activity, can
contribute to negative health outcomes that are of increased concern within the context of
COVID-19. Decreased pulmonary reserves, increased blood pressure, and compromised
immunity all contribute to likelihood of infection. Similarly, the increased risk of
falls and potential hospitalizations, cultivate more opportunities for potential exposure which can
further exacerbate functional decline (Office et al., 2020; Pelicioni & Lord, 2020). Thus, the
resulting consequences of social isolation may cause increased risk for infection, exposure,
additional complications, and functional decline that places individuals at greater risk during the
pandemic.
However, even when older adults maintain physical activity and physical health, social
isolation can still affect QOL. Social isolation can limit access to caregivers and routine
healthcare services which reinforces the overall risk to older adults. Similarly, physical
distancing restrictions might force many older adults to self-manage medications,
symptoms, and overall health (Baker & Clark, 2020). Without adequate access to services,
support networks, and even caregivers, older adults might have difficulty taking all the necessary
measures to preserve physical health. Overall, the comprehensive physical effects of social
isolation highlight the need for social connection amidst the pandemic.
Mental Health
The close relationship between social participation and physical health assert the value of
considering mental health while caring for older adults. Baker and Clark (2020) stated that health
professionals tend to explore only primary diagnoses, resulting in a systemic oversight of mental
health needs. Attention to both physical and mental health is especially relevant within the
context of COVID-19, as altered mental state has been shown as an initial symptom of COVID-
19 for many older adults. Health professionals might identify changes in mental health as
significant indicators for changes in physical health, or vice versa. For example, increased
depression and anxiety, disrupted habits and routines, changes in continence/self-
care, and additional comorbidities can all be indicators for mental and/or physical decline.
Jeffrey Reynolds, cited in Koons et al. (2020) stated, “There’s a paradox. . .social isolation
protects us from a contagious, life threatening virus, but at the same time it puts people at risk for
things that are the biggest killers in the United States: suicide, overdoses, and diseases related to
alcohol abuse.” According to Neimeyer et al. (2020), mental health problems could become a
much longer lasting pandemic due to resulting increases in unemployment, financial insecurity,
increased gun sales, suicide rates, post-traumatic stress disorder, depression, phobias, attachment
disorders, and exacerbation of disposition. Symptoms associated with coronavirus anxiety
include hopelessness, alcohol and drug use, suicidal thoughts, helplessness, insecure attachment
in caregiving, crisis of meaning, confusion over God's role, loss of community rituals,
overwhelmed medical systems, and limited family support (Neimeyer, 2020).
Mental Health and QOL
Through addressing mental health specifically, care providers promote, not only physical
health, but relationships, experiences of meaningful activities, and sense of purpose, all of which
are crucial for QOL. Dickens et al. (2011) reported that social isolation interventions facilitated a
broad range of QOL factors such as: structural/functional social support, less loneliness, mental
and physical health (Dickens et al. 2011). Hill et al. (2020) and Office et al. (2020) noted the
advantages of social participation interventions which included, not only physical benefits, but
also sense of purpose companionship, communication skills, and improved understanding
(Office et al., 2020). Through a focus on social participation, health providers can promote
physical and mental health needed to improve QOL.

Part II: The Role of Occupational Therapy in Social Participation
Occupational therapy practitioners play distinct roles as healthcare providers during the
COVID-19 pandemic by ensuring that individuals can continue to access their occupations
(Dirette, 2020). Occupation is defined as “. . . things people do in their day-to-day lives that
occupy time, modify the environment, ensure survival, maintain well-being, nurture others,
contribute to society, and pass on cultural meaning through which people develop skills,
knowledge, and capacity for doing and fulfilling their potential” (Crepeau et al., 2009, p.1162
cited in Stephenson, 2011). Occupational therapy addresses a wide variety of occupations,
from bathing, dressing, and feeding, to social participation, leisure, work, and education. The
comprehensive role of occupational therapy in supporting the older adult population extends to
training in productive routines, health promotion, life balance, and “living life meaningfully”,
regardless of context or ability (Stephenson, 2011).
Occupational therapy practitioners address social participation through optimizing older
adults’ access to transportation, technology, navigation of community resources, modifying the
environment or daily routines, and even providing caregiver support (Stephenson, 2011).
Occupational therapy practitioners implement preventative approaches and chronic illness
management, both of which also assist with social isolation and mental health (Stephenson,
2011). Occupational therapists use problem solving skills to develop strategies such as
environmental adaptation, individual coping strategies, activity modification, and even assistive
technology to address mental and physical health (Dirette, 2020). With such targeted approaches,
occupational therapy can play an instrumental role in the effects of the pandemic on older
adults’ QOL.
Model of Human Occupation
The model of human occupation (MOHO) is an occupation-based model with 4 main
constructs that explain a person's view of self and their priorities. The constructs include volition,
habituation, performance capacity, and environment, all of which are related to skills, identity,
performance, and occupational adaptation (Lin & Fisher, 2020; Parkinson et al.,2006). The
current COVID-19 social distancing and isolation guidelines affect each of the four components
of the MOHO. Individuals have more difficulty participating in valued
interests and challenging/enjoyable work which impacts volition. Habits, routines, and roles are
also disrupted such as work routines, sleep habits, and expectations for societal roles. The
new/changed physical and occupational environments also have the potential to be supportive or
disruptive for individuals (Lin & Fisher, 2020). Limited access to fresh air, adequate
temperature, sanitation, and good ventilation might increase the likelihood of infection,
depression, and anxiety (Baker & Clark, 2020). These disruptions of choice, in turn, affect
physical, psychological, and even cognitive performance and ultimately limit occupational
choice and QOL.
While the MOHO outlines the disruptions caused by COVID-19, the model also has
space to recognize the strengths of older adults. Performance capacity consists of
physical and mental components that allow an individual to participate in activities (Lin
& Fisher, 2020). Occupational therapists are trained to recognize how these components can
serve as both facilitators and barriers to engagement in occupation. In the context of COVID-19,
older adults may have some advantages.

Carstensen et al. (2020) conducted a study that involved a survey of 945 older adults
regarding their emotional experiences during the pandemic. Results showed that older
participants reported less negative emotion and more positive emotion despite perceiving greater
risk and reporting more financial stress than younger participants (Carstensen et al., 2020). These
results support other evidence that on average, older adults tend to display more positive and
stable emotions, increased life satisfaction, improved regulation, and even higher feelings of
connectedness compared to their younger counterparts (Carstensen, 1993; Carstensen, 2006;
Carstensen, et al., 1999; Toepoel, 2012). Similarly, when circumstances are out of their control,
older adults display less reactivity compared to younger individuals (Charles, et
al., 2009; Birditt, 2014).
Relevant theories of aging that further explain the performance capacity of older adults
include socioemotional selectivity theory (Carstensen et al., 2020), future time
perspective, and uncertainty regulation (Grote & Pfrombeck, 2020). Socioemotional selectivity
theory posits that individuals shift their perspective to value emotional meaning and positive
experience as time is viewed as more constrained (Carstensen et al., 2020). As individuals age,
future time appears more limited, which causes older adults to focus on experiences that are
more meaningful to them. This tendency to seek out emotionally meaningful experiences paired
with the increased likelihood of positive emotions, emotional regulation, and even attention to
more emotionally meaningful experiences, may serve as protective factors for older adults during
the pandemic (Grote & Phrombeck, 2020). Older adults may cope with the challenges of the
pandemic more easily and sustain a positive, healthy outlook longer, preserving their sense of
purpose, social connectedness, and overall wellness. As more interventions are developed to
address older adults’ needs during the pandemic, it is crucial that these strengths and abilities are
considered.
Through utilizing the MOHO, occupational therapy
practitioners and other healthcare professionals can collaborate to optimize both the
physical and mental health of the older adult population during COVID-19.
Assessments of Mental Health and Social Participation Amidst COVID-19
Developing assessments and methods to identify social isolation and loneliness is one of
the first steps to ensuring effective interventions are implemented (Baker & Clark, 2020; Berg-
Weger & Morely, 2020; Hill, 2020; Wu, 2020). Access to effective and evidence-based
assessments, however, is limited for several reasons. Firstly, social isolation and connectedness
are difficult to define, measure, and operationalize (Toepoel, 2012). Secondly, it is increasingly
difficult to identify individuals who are extremely lonely, as "loneliness can generate a vicious
cycle in which lonely people withdraw further because they perceive social interactions as
negative or unfriendly" (National Academies of Science, Engineering, and Medicine (NASEM,
2020, p. 184). Each of these challenges, however, reinforce the need to develop assessments that
help researchers and clinicians understand social isolation and loneliness and identify individuals
in need.
A relevant tool to measure the specific impact of COVID-19 and screen for mental health
concerns was developed by Repišti et al. (2020). The COVID-19 QOL Scale (COV19-QoL)
assesses mental health changes for older adults with a short, 6 question screen. Additional
assessments that may be useful include the Coronavirus Anxiety Scale (CAS) and the Unfinished
Bereavement Scale which address depression, anxiety, and coping with anxiety and
grief during and following the pandemic (Neimeyer, 2020). These assessments not only assist
with identifying at risk older adults, but also assist with the development of relevant and
effective interventions. With the ability to identify older adults at risk for social isolation and
loneliness, healthcare providers can maximize quality of care and prevent further decline amidst
the COVID-19 pandemic.
Occupational Therapy Interventions for Social Participation
The United Kingdom's Campaign to End Loneliness identified four types of
interventions: foundation, direct, gateway, and structural enablers. Foundation services consist of
the first steps that focus on recruiting individuals, understanding personalized
responses, and supporting access. Direct interventions primarily focus on increasing the
quantity and/or quality of relationships. Gateway services support services such
as transportation and technology and structural enablers address environmental factors (NASEM,
2020). Similarly, Dickens et al. (2011) categorized interventions that address social isolation into
those that offer activities, support, internet training, and home visit/service provision.
Currently, several challenges exist when comparing studies regarding intervention
effectiveness: (a) limited number of studies that demonstrate effectiveness; (b) poorly outlined
recruitment procedures and; (c) identifying individuals who were extremely isolated or
lonely (NASEM, 2020). However, previous literature does provide significant guidance for
characteristics that promote successful intervention design. Previous evidence supports
interventions that produced beneficial effects include those offered at a group level, theoretically
based, participatory, and included social activity and support (Dickens et al., 2011). In a meta-
analysis of systematic reviews, interventions were most successful when they: involved high
quality training of facilitators, active participation, include input from target populations, target
specific groups/contexts, have a theoretical basis, use technology, focus on education, address
maladaptive thinking, and focus on the individual (NASEM, 2020). A study conducted
by Toepoel, 2012 also highlighted the utility of leisure activities in promoting social
participation. Cultural activities, reading books, and hobbies had the strongest effect for adults
aged 55 and older. Friends and family also were the strongest motivators for older adults
compared to neighbors (Toepoel, 2012).
In response to COVID-19, however, a modified approach is needed to truly meet the
needs of older adults during this time. Balser et al. (2020) discusses how COVID-19 has
worsened the difficulties vulnerable populations face by exacerbating health disparities,
shortages of resources, and limiting access to adequate care. While meta-analyses reveal mixed
evidence supporting the use of group intervention for social isolation and loneliness (NASEM,
2020), Balser et al. (2020) suggest that interventions during this time should be provided to
groups and populations collectively to improve conditions for all individuals.
Smallfield and Molitor (2018) also support the use of community-based, group
interventions. Finally, group intervention is supported by the occupational therapy practice
framework (OTPF) which states, “occupational therapy interventions achieve the greatest
outcomes and provide the most benefit to the clients we serve when holistic, client-
centered, and population-based practices are used in place of the individual, medical models of
disability interventions” (OTPF, 2020, p.4, cited in Balser et al., 2020).
Part III: Program Development

While quality interventions and assessments specific to COVID-19 make occupational
therapy services more effective, implementing community programs is crucial to ensuring that
interventions and assessments can reach the older adult population. Scaffa and Brownson (2014)
compare the program planning process to the occupational therapy process in which preplanning
is compared to the chart review, the needs assessment to evaluation, program planning to
intervention planning, implementation to intervention, etc. (Scaffa & Brownson, 2014, p. 65,
see Table 1).
However, many occupational therapy practitioners do not have direct training in program
development. Townsend (1987) outlines 12 strategies for program development specifically
within the scope of occupational therapy practice. The author suggests that, to be successful,
programs must fit into the organizational system that is already established and maintain
compatibility with the organizational structure, geological/cultural contexts, and with available
resources (transportation, labor force, etc.) Townsend (1987) also asserts that involved
administrators should understand occupational therapy services and there should be ample
support within the occupational therapy profession. By following a process and cultivating a
network of experts, occupational therapy practitioners are equipped to develop programs to serve
older adults amidst COVID-19.
When developing community-based programs for social isolation and loneliness, certain
challenges exist. Currently, little evidence addresses the specific recruitment methods used for
community-based research studies on loneliness and social isolation (Ige et al., 2019). When
recruitment is successful, participation is often low due to difficulty with identifying individuals
who are at risk and overcoming the stigma of mental health (Ige et al., 2019). Further
exacerbating the problem, individuals who are socially isolated or lonely are even more unlikely
to participate in programs as they are often caught in "a vicious cycle in which lonely people
withdraw further" due to negative perceptions of social interaction (NASEM, 2020, p. 184).
Ige et al. (2019) conducted a systematic review of methods utilized to recruit older adults
at risk of social isolation and loneliness. Common methods of recruitment included print media,
referral, and mixed methods (flyers, online advertisement, infomercials). However, the findings
indicate a need for more specific documentation of (a) methodology for recruitment strategies;
(b) details of recruitment and retention procedures, and; (c) all subsequent costs. Overall,
identifying older adults at risk for social isolation and loneliness is an overlooked problem that
must be addressed during the program development process.
Overall, a need for further research exists to understand the pandemic’s impact on mental
health and ensure an effective response to support older adults. Schutte (2020) states, “Our
collective imperative as a society is to work together as long as needed to mitigate the spread of
the virus, to support our health care system, and to preserve the integrity of our families, local
communities, and global neighbors” (p.188). Further research into mental
health, QOL, and social connectedness achieves each goal through maintaining both physical
health and mental health, providing health care providers with tools for quality and holistic
care, and cultivating a better future for older adults beyond the COVID-19 pandemic.
The Current Project
To further understand the relationship between social participation and QOL and promote
program development to address that relationship, the current study explored the unique
experiences of older adults amidst the COVID-19 pandemic. Utilizing current evidence, survey
responses and qualitative interviews from community-dwelling older adults, and an occupational
therapy perspective, the current doctoral capstone project promotes improved
prevention and intervention for social isolation and loneliness. Ultimately, the project proposes a
program manual to support the older adult population’s mental health within the context of
COVID-19.
Method
Study Design
In order to develop a program manual that was both evidence-based and applicable to a
specific organization, the project involved a mixed methods design which consisted of: (a) a
quantitative survey for a general needs assessment, (b) one-on-one qualitative interviews for an
organization-specific needs assessment and, (c) triangulation of data for program development.
The samples consisted of a group of older adults 65 years of age and older that completed the
survey (n = 230) or participated in an interview (n = 5). The survey portion of data collection
occurred from November 2020 until January 2021 following approval from the Institutional
Review Board at a regional hospital in September of 2020. Results from the survey were further
explored through a series of interviews. Approval for the interviews was obtained from a
university Institutional Review Board in January of 2021 and the interviews were conducted
between January 2021 and February 2021.
The interview data was coded utilizing the constructs of the MOHO, categorized into
program objectives, strategies, and procedures, and then analyzed for converging and diverging
themes. The identified themes were triangulated with previous evidence and results from
stakeholder interviews with health department staff.

Ultimately, the results helped to develop a program manual and continuing education
series (see Appendix A.) that was specific to meet the needs of the older adult population within
the suburbs of Chicago, Illinois. The following methods and procedures are organized into Part I
(quantitative), Part II (qualitative), and Part III (program development).
Part I: Quantitative
For more details on the complete method, results, discussion, tables, and figures see the
link in Appendix A.
Design
This analytical, cross-sectional study utilized a group of older adults 65 years of age and
older to collect survey data on QOL factors, experiences during COVID-19, and relevant
demographics. The following objectives were addressed:
1. To determine if there is a difference in lifestyle routine (number of weekly interactions,
number of exercise activities, number of community activities, perceptions of social
support, reliance for Instrumental Activities of Daily Living (IADLS), preferred methods
of interaction, and satisfaction with access to healthcare in relation to the COVID 19
pandemic.
2. To determine if there is a statistically significant difference in scores on the COV19-QoL
scale by demographics (age, gender, marital status, employment status, and living
arrangement), access to healthcare, and lifestyle routine (preferred modes of socialization
during pandemic and frequency of social isolation).

Sample
A convenience sample of 230 older adults ages 65 years or older participated in the
survey. The median age of participants was 72 years of age and there were 159 females, 71
males, and 0 non-binary or transgender who participated.
Recruitment
Participants were recruited through an email to members of a Community Senior Club
that contained a letter describing the study and a link to the online survey. The email letter and
online link were also sent to personal and professional contacts. Once utilizing the link,
participants were provided informed consent. Consent was indicated through continuation of
with the survey.
Instruments
Participant demographics reported before and following the pandemic and the CoV19-
QoL scale were entered into a REDCap survey for email dissemination and electronic data
recording. Study data were collected and managed using REDCap electronic data capture tools
(Harris et al., 2009; Harris et al., 2019). Demographics collected included: age, gender, marital
status, employment status, living arrangement, and comorbid conditions/diagnoses that have
been reported to increase risks associated with COVID-19. To further assess current status
amidst COVID-19, participants were also asked to report whether they had tested positive for
COVID-19, and whether they were socially isolating. Preferred methods of communication,
number of interactions per day, and number of activities currently able to participate in were also
recorded.
CoV19-QoL. Repišti et al. (2020) developed a measure to assess the perceptions of QOL
and mental health amidst the COVID-19 pandemic. Results from Repišti et al. (2020) supported
the internal reliability and construct validity of the COV19-QOL Scale. The scale consists of six
items rated on a 5-point Likert scale, based on self-report of experiences within the past 7 days.
Total scores are calculated by averaging the scores on all the items. A higher score indicates an
increased impact of the pandemic on QOL. For the purpose of the present study, items were
reverse coded and total scores used in the analysis so that a higher score indicates improved
QOL.
Data Analysis
Data analysis was completed using the IBM SPSS Statistics for Windows, Version 27.0.
All comparisons conducted were two-tailed and a significance level of 0.5 was considered
statistically significant. Data was reported using medians and interquartile ranges. Since most of
the data were not normally distributed (Shapiro-Wilk p < 0.001) a series of non-parametric tests
were conducted. Following analysis and interpretation, the results were then integrated into a
“community profile” within the general needs assessment of the program manual.
Results and Discussion
Analyses revealed significant differences in reported lifestyle routines before and
following the onset of the COVID-19 pandemic and significant differences in CoV19-QoL
scores across various demographic groups. Descriptive characteristics of the sample and reported
characteristics in relation to the onset of COVID-19 can be found in Table 2 and Table 3.
Reported differences in lifestyle routines in relation to the onset of COVID-19 can be found in
Table 4 and Table 5. Comparisons of COV19-QoL scores between demographic groups can be
found in Table 6. The results overall identified 4 primary needs among older adults: (a)
opportunities for social connection, (b) identification of at-risk adults, (c) education regarding
mental health, and (d) recognition of advantages.
Need 1: Opportunities for Social Connection. Overall, results from the survey data
regarding experiences before and following the outbreak of COVID-19 indicate a significant
shift in social participation. Significant decreases in number of interactions, number of physical
activities, and number of community activities reflect a change in social participation through
limiting opportunities for connection with others. The results affirm previous findings that
showed or suggested decreases in physical activity and social participation during COVID-19
(Aubertin-Leheudre & Rolland, 2020; Baker & Clark, 2020; Lin & Fisher, 2020). Due to these
decreases, older adults need more opportunities for social connection within the context of the
pandemic.
However, the need for social connection involves attention to both subjective and
objective experiences of social interaction. While there was a 7.4% increase in the number of
individuals who reported reliance on family and friends for assistance with IADLS, there were
also significant decreases in perceived social support. From a physical perspective, an increase in
reliance on others often reflects a decrease in independence. However, when examining through
the lens of social participation, reliance on others provides opportunities for social participation.
Yet reliance on others might not directly relate to the subjective feeling of being
supported. Research suggests that experiences during the COVID-19 pandemic might exacerbate
attachment difficulties with caregivers or cause shifts in societal roles which can result in
decreased feelings of social support (Neimeyer, 2020; Lin and Fisher, 2020). Thus, the results
reveal both the shift in social participation and its complexity amidst COVID-19.
Need 2: Effective Outreach. Developing assessments and methods to identify social
isolation and loneliness is one of the first steps to ensuring effective interventions are
implemented (Baker & Clark, 2020; Berg-Weger, Morely, 2020; Hill, 2020; Wu, 2020). Due to
the significant differences in QOL scores based on group characteristics, it is important to ensure
those groups are prioritized when developing a program. Therefore, the results provide evidence
for a target population of older adults who are younger (age 65-75), live alone, have low
perceived social support, and self-isolated to prevent the spread of COVID-19.
Need 3: Education Regarding Mental Health. A large majority of participants agreed
or strongly agreed that they had a lower overall QOL and roughly half of participants agreed or
strongly agreed to feeling more depressed and tense. Consistent with the non-clinical sample in
Repišti et al. (2020), the majority of participants indicated the greatest impact for QOL in general
whereas mental health was impacted the least. Additionally, more participants recognized a
negative impact of the pandemic regarding components of mental health (depression, tension,
and lack of personal safety) but not mental health overall. This could be because of the broad
meaning of QOL that includes both mental and physical health and an overall increased focus on
physical health rather than mental health (Repišti et al., 2020). Overall, the scores on the CoV19-
QoL scale support the need for more education on mental health and more resources to deal with
mental health problems during and following the pandemic.
Need 4: Recognition of Performance Skills. Whether individuals had family within a
15-mile radius, or which was their primary method of interaction (face to face, video chat, e-
mail, text, phone call) did not show any significant differences in CoV19-QoL scores. While this
might appear contradictory to the other evidence, it does pose as a potential asset to supporting
older adults: regardless of the method of intervention, reflecting that social connection is
valuable.
Similarly, older adults’ likelihood to have better CoV19-QoL scores could be used as an
intervention in which older adults can assist others with coping with the pandemic, indirectly
supporting social participation. Though contrary to current stereotypes of age, age might pose as
an advantage when working for mental health related QOL.
In conclusion, this study revealed that while the COVID-19 pandemic is cause for a wide
range of risks and deficits, while the pandemic also provides an opportunity for occupational
therapy to optimize meaningful engagement for older adults. If social isolation and loneliness
can be detrimental to physical health, mental health, and QOL, then social participation and
social connection can be just as potent mediators of health and wellness.
Part II: Qualitative
For more details on the complete method, results, and discussion, tables, and figures see
the link in Appendix A.
Design
A semi-structured interview template was developed based on survey results and five
individuals were recruited to participate. The interviews were conducted primarily over the
phone, transcribed using a recording software, and summarized. Qualitative analysis was utilized
to identify potential guidelines for intervention, target populations, and overall needs of the
general population. The following objectives were addressed:

1. To further explore the relationship between social participation and QOL.
2. To gain an in-depth understanding of older adults’ pandemic experiences related to QOL,
mental health, and social participation.
3. To gain concrete information regarding the specific needs of older adults that might be
fulfilled through a community-based program.
Sample
A convenience sample of stakeholders of the proposed program in a county health
department was recruited for the interviews. The inclusion criteria consisted of community-
dwelling older adults age 65 years or older who were current residents of the county and the
surrounding area. Exclusion criteria consisted of individuals who were residents in assisted or
community living.
Recruitment
Recruitment was completed by the primary researcher (K.M) and supervising professors
(J.L and L.G) who made initial contact with interested participants to explain the study. An email
letter (Appendix B) was sent through the Behavioral Health Department, Human Resources
Departmet, Program Development Department, MAPP (Mobilizing for Action through Planning
and Partnerships) Collaborative, and participating partners with the Health Department such as
senior services and the area agency on aging.
Instruments
The instrument was developed by the primary researcher based on stakeholder interviews
and results from Part I of the project. Several stakeholders reviewed this instrument to improve
validity. The semi-structured interviews were conducted using a template (see Appendix C) that
contained a general screening, descriptive data, and pandemic experiences. Pandemic
experiences were divided into four subgroups: QOL, mental health, social participation, and
program design. The interview template guided the structure of the interview and was used by
the primary researcher to take notes.
Interviews were recorded using a voice recorder app on a tablet while the researcher took
notes. The recordings were deleted following transcription and any potentially identifying
information was deleted. Transcription was completed using the website Temi © (Rev.com, 2021)
and summary data was transferred into the interview template for analysis.
Data Analysis
The primary researcher utilized a coding and categorization system (see Figure 1) based
on the MOHO Model constructs of volition, habituation, performance capacity, environment,
occupational adaptation, and occupational identity/competence. Following coding, the data was
analyzed for common themes and convergence and divergence. Data was then triangulated and
applied to program objectives, intervention strategies, and intervention procedures.
Results and Discussion
Descriptive characteristics of the interview participants can be found in Table 7. Coding
of the data revealed that all four constructs of the MOHO and the relationships between them
were present within individuals’ interview responses (see Table 8). Upon observation, there was
a relatively equal frequency of each of the four constructs across participants and responses (see
Table 9). Identifying MOHO constructs provided directionality and structure to the data so that
data could be categorized into program objectives, program strategies, and program procedures
(see Table 10). Ultimately, the results indicated needs for (a) social connection, (b) activity, (c)
service learning, and (d) strategy training for meaningful activity.
Need 1: Opportunities for Social Connection
Participant’s values and interests were often inherently social, involving spending time
with friends, family, and even spontaneous interaction with strangers. Activities that were
completed alone such as baking, home management, or physical activity were related to life
roles. When social participation was disrupted--such as cancelled vacations and family events or
even participating in more indoor activities—participants felt the effects across QOL areas. They
expressed feelings of boredom, frustration, tension, and depression while also commenting on
decreased physical activity and leisure participation. Furthermore, participants discussed
difficulty with motivation and interest in typical activities which decreased participation even
more, reflecting a cycle of less participation and decreased QOL.
While only one participant reported feeling lonely or isolated, all participants mentioned
having to narrow their social circles and limit interactions with close family and friends. While
social connections were available, participants expressed the value of physical closeness in their
relationships. Participants One, Two, Three, and Four discussed how much they missed the
grocery store as a social activity that provided spontaneous interaction and a physical experience.
Similarly, while all the participants still interacted with family, they missed the physical
experiences of being with a large group in their home or restaurant. Participant Five expressed
that, while it was beneficial to Zoom, it did not allow for spontaneous or separate conversations
with family members. Participant Five also missed hugging.
Need 2: Opportunities for Activity

There was an overall decrease in daily activities which most participants found frustrating
or disheartening. The activities that were disrupted often involved activities that required travel,
leaving home, being in a large group, or an activity that needed to be engaged in a particular
way. Participants demonstrated modifying activities such as using technology to communicate
with family, adding a swing in their yard or using a heated garage to socially distance outdoors,
and doing kickboxing classes online. However, the pandemic also resulted in a complete loss of
experiences as individuals reported several cancelled vacations, retirement plans, leisure
activities, and family rituals. Each participant mentioned difficulties with winter during COVID-
19 and how that limited their ability to socially distance outside.
Participants expressed changes in mental health related to the shift in activity.
Participants reported a lost sense of freedom or opportunity, mental exhaustion, and anxiety over
contracting COVID-19. Participants also demonstrated use of coping activities and coping
thoughts, despite (or due to) these increased difficulties.
One major concern regarding mental health involves the collective disinterest and
unwillingness to engage in novel activities. However, whether this disinterest was due to the
nature of the pandemic, inflexible thinking, cognition, or self-efficacy was unclear. Though they
were less willing to participate in completely novel activities, they were willing to modify the
activity or context to continue a previous activity. For example, participants One and Three
participated in exercise classes online that, before the onset of the pandemic, they had engaged in
regularly. Participant Five explained that they preferred a video tour show related to their
interests and that could be watched in their own time. Four participants were unwilling to mentor
someone they did not know, while one participant was only willing to do so over the phone.
Participants did not report engagement in novel activities during the pandemic, but rather
participated in familiar activities in modified ways. Most participants were willing and interested
in learning new skills, especially if they did so with a family member or friend. Overall, these
findings suggested individual concerns for mental health, unwillingness to participate in novel
experiences, and avoidance of social participation and engagement in activity.
Need 3: Opportunities for Service Learning
One unexpected result was the impact of the socio-political climate during the pandemic
on mental health. Three participants indicated feelings of uncertainty, frustration,
disillusionment, and disengagement because of online conflict, disappointment in leadership, and
uncertainty regarding the rules. For most of the participants who expressed concern, these
feelings resulted in some avoidance of social participation, being more likely to watch television,
avoid online communication, and sometimes avoiding certain friendships with individuals who
had opposing political views to their own.
Similarly, when discussing loneliness, mental health, or other changes during the
pandemic, participants mentioned more concern for family, friends, and society rather than
concern for self. Participant Two, Three, and Four expressed concerns with access to healthcare
when they could not accompany their spouse during an emergency or routine visit. Similarly,
Participant One reported difficulty with changes in their work or family roles where they could
not support others. Participant Five expressed interest in working to deliver groceries for
homebound people but was unable to due to anxiety about exposure risks. Participants One,
Three, Four, and Five expressed feelings of uncertainty, frustration, and sadness with society, the
older adult population, and even concern for the younger generation.
The finding that older adults have great concern for their communities and society at
large indicates a need for opportunities for community service and legacy investment. This is
consistent with theories of aging, such as Erikson’s stages of development: “generativity vs
stagnation” and “integrity vs despair” which posit that older adults have great concern for family,
future generations, and society while ultimately having satisfaction looking back on life
(Orenstein & Lewis, 2020).
Need 4: Strategy Training for Meaningful Activity
Participants primarily demonstrated the need for education and training regarding
perceptions of aging, coping and compensatory strategies, self-efficacy, and self-regulation.
Participants had difficulty coping with disrupted routines, aging, and changing relationships.
Self-regulation was also identified as a challenge regarding feelings of frustration and
disappointment with other people and society during the pandemic. Lastly, participants displayed
limited self-efficacy in their ability to seek out and participate in novel activities.
Based on the wide range of needs identified by both the survey and interviews, the
program manual focused primarily on recommendations and guidelines for program design
rather than focusing on a specific program.
Part III: Program Development
The program manual provided the basis for a continuing education series and online
group, all of which were components of “Our Social Network”. Our Social Network is a
community-based program that provides health professionals, community partners, or
individuals with resources and training for addressing older adult mental health during the
COVID-19 pandemic. For the completed program manual and continuing education series, see
the link in Appendix A..
Design
The development of the manual followed the process (see Table 1) adapted from a
chapter in Occupational Therapy in Community-Based Settings (2 nd edition) on page 64 (Scaffa
& Reitz, 2014). The process provided the structure of the manual which was divided into
involved pre-planning, needs assessments, program recommendations, and useful tools/materials.
The program recommendations within the manual provided guidelines and recommendations for
planning, implementation, evaluation, sustainability, and dissemination (Scaffa & Brownson,
2014).
Following the completion of the manual, a series of educational videos was created to
train stakeholders on interpretation and use of the manual. The videos were created using a web-
based tool, VoiceThread (2021). The video series consisted of five parts that explored the
manual: “Introduction and Background Information”, “General Needs Assessment
(quantitative)”, “Specific Needs Assessment (qualitative)”, “Program Planning
Recommendations”, and “Community Resources”.
To further facilitate community collaboration and future program development,
participants also gained access to an online LinkedIn group. The LinkedIn group allowed
participants to provide feedback on the videos, engage in conversation about their use of the
manual, and network with other community members to expand services for older adults.
Program Goals and Action Plan
The goals and action plan of Our Social Network can be found in Figure 2 and Figure 3.
Program Implementation Plan
An implementation plan involves objectives, activities, measurement of outcomes, short-
term and long-term outcomes. Implementation planning requires consideration of location and
space issues, participant recruitment, staffing, supplies, budget, and regulation compliance (Doll,
2014). Due to the COVID-19 pandemic, the goal of implementation planning was to utilize
minimal resources and provide ease of access to the program. Therefore, Our Social Network is a
completely online program through use of VoiceThread (2021) and LinkedIn. Participants will
be recruited through the health department staff, community organizations, local universities, and
health professionals in the area. Participants will sign-up for the program using the form found in
Appendix E. Following sign-up participants will receive an email welcome letter with links to
the VoiceThread, LinkedIn Group, Program Manual, and Google Drive (see Appendix F). The
program requires minimal staffing for recruiting participants, managing the dissemination of
program materials, and monitoring the success of the program. Potential staff might include the
program creator or a student intern.
Because the materials are pre-created, the program does not require a budget at this time.
However, future funding might be considered for scaling the program up with upgraded
software, more materials, follow-up research, or event coordinating. Potential funding may be
attainable through the Coronavirus Aid, Relief, and Economic Security Act (CARES, 2020),
Health Resources and Services Administration (2021), corporate sponsorship, and private grants.
Additionally, the program could charge for access following accreditation through professional
associations as a continuing education course.

Program Evaluation Plan
Program evaluations can be formative and summative while addressing five foci: needs
assessment, program theory, program implementation, program impact, and efficiency.
Evaluations involve stakeholders, specific questions, data, and instruments. An evaluation plan
can include outcomes, indicators, source of data, and method of collection (Ensminger et al.,
2014).
The evaluation plan includes periodic review of a feedback survey Linkedin group, a 6-
month check in with participants or organizations regarding experience, and a potential follow-
up study to the surveys and interviews to update the needs assessment.
A potential follow-up study might also consider conducting participatory action research
(PAR) which is “the process of systematically examining an issue from the perspectives and
lived experiences of the community members most affected by that issue." (Cockburn, 2002, p.
21). PAR would allow older adults and community organizations to collaborate to ensure that the
needs of the population are truly being met by the program. PAR also provides opportunities to
further expand resources and services for older adults through expanding the research base.
Program evaluation will also include a feedback survey following the training and on the
LinkedIn group. According to McGuire (2016, p.33), gaining feedback using the following
questions will be beneficial for program evaluation:
1. To what extent is the program meeting the needs of the participants?
2. To what extent is the program consistent with best practices?
3. What is needed to make the program consistent with best practices?

4. What is the optimum size of the program to achieve goals while remaining client
centered?
Program Sustainability
Several formative sustainability meetings and two final sustainability meetings with
stakeholders were conducted to discuss the potential for follow through following the
development of the program (See Appendix G). The sustainability meetings occurred with
health department staff and a Local Area Network team. The final meetings consisted of a
presentation and a discussion to gain concrete feedback on improving program sustainability.
The presentation involved an overview of evaluation procedures, potential community
partnerships, funding sources, and discussion of different uses of the program. Following the
discussion, stakeholders were asked to complete a feedback survey regarding sustainability (see
Table 11).
Program Dissemination
The program will be disseminated following the completion of capstone in April 2021.
The program will be made available in the LinkedIn group, health department behavioral health
department, and participating community partners. Additionally, several reports and
presentations have been developed to disseminate the program via peer-reviewed journals,
academic conferences, and community organizations.
Discussion
This project and its components were the result of an occupational therapy doctoral capstone
project that addressed the following objectives.

1. To explore the needs of older adults within an Illinois county in response to the social
distancing and isolation guidelines during COVID-19 based on conversations within one-
on-one, semi-structured interviews.
2. To synthesize survey and interview data into general and organization-specific needs
assessments. The needs assessments provide the basis for a community-based program
manual that addresses the social-emotional needs of older adults during the COVID-19
pandemic.
3. To propose and discuss plans for program implementation, evaluation, and sustainability
in order to ensure that older adults are supported during the current pandemic and
beyond.
Implications for Occupational Therapy
The study accentuates the value of occupation and the relevance of the MOHO for
addressing social isolation and loneliness. Despite its limitations, the current study both affirms
the role of OT during the COVID-19 pandemic while also providing recommendations and
guidelines for OT-based, community programs.
As a component of an OT doctoral capstone project, the current study also directly
supported the development of an OT-based community program. The program was developed
for a county health department, supporting the role of OT in public health.
Limitations
The sample sizes were small and not fully representative of the population. Consistent
with challenges mentioned in previous studies (Ige, 2019; NASEM, 2020) the researchers had
limited access to individuals who were severely isolated. Additionally, due to time constraints
the researcher was unable to recruit a larger and more diverse sample. The recruitment and study
procedures were more likely to attract and include individuals who had access to a computer.
Additionally, there were several limitations with the instruments used throughout the
project. First, the entire survey required recall and self-report of experiences before COVID-19
which makes the results susceptible to hindsight bias. Further exacerbating this effect, all items
were administered in the same order and were not counterbalanced. Lastly, due to the novelty of
the COV19 pandemic, evidence on the topic is limited.
Qualitative analysis had no inter-rater reliability and depended on the interpretation of
one researcher. Additionally, the primary researcher conducted data collection and analysis
which also biases the results.
Future Research
In addition to furthering the OT profession, the current project poses several
opportunities for future research.
The COV19-QoL scale is freely available to use and data can be shared with the
IMPULSE project team (Repišti et al., 2020). Additionally, future research might examine the
relationship between reliance on others, social support, and number of interactions to further
explore the subjective and objective experiences of social participation.
Future research might utilize different theory beyond the MOHO to analyze qualitative
data, such as Attachment Theory or Canadian Model of Occupational Performance and
Engagement (CMOP-E). Future research might also explore different domains of behavioral
health such as spirituality or specific sub-populations of gender, race, class, or marital status.
Lastly, future research may explore various experiences linked with social participation such as
peer support, technology, or retirement.
Overall, future studies are crucial as the pandemic is still progressing which might result
in changes to the current data in the future. As more information is gathered, research regarding
OT-based interventions will be crucial for addressing social participation within the older adult
population following COVID-19.
Conclusion
Despite the increased risks many older adults face during the COVID-19, the pandemic
provides opportunities to expand resources to support older adults. Optimizing social
participation in particular provides opportunities to preserve and enhance older adult’s ability to
be vital members of the community. Ultimately, if social isolation and loneliness can be so
detrimental to physical health, mental health, and QoL, then social participation and social
connection are just as potent mediators of health and wellness--even amidst a global pandemic.
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Tables and Figures: Part I
Table 1.
Program Manual Foundation

Program Planning Process Occupational Therapy
Process
Preplanning (Exploration)
• Identify/state the problem and the target population (also called
“issue identification”).
Chart Review
• Identify existing information regarding issue of concern.
• Assess the internal and external resources and barriers.
• Determine the goals of, and an approach for, the needs assessment.
Needs Assessment (Data Gathering and Analysis)
• Collect relevant data.
• Analyze and synthesize data.
Client Evaluation
• Determine priorities.
• Identify and evaluate alternative solutions.
• Formulate an action plan.
Program Planning
• Establish goals and objectives.
• Develop the details of the intervention strategies, procedures,
Intervention Planning
and timelines.
• Develop a plan for evaluation.
• Pretest materials and procedures.
Program Implementation
Intervention
• Implement/offer the program or service.
Program Evaluation
• Monitor and evaluate the program process, its impact, and
Evaluation and Re-
ultimately the outcome.
evaluation
• Revise program as indicated and plan next steps (e.g., continue,
terminate, and expand).
Sustainability Plan
• Identify future sources of funding. Discharge and Home
• Build community capacity. Carryover
• Cultivate supportive relationships.
Dissemination Plan
Documentation
• Share the results with stakeholders, peers, and clients
Scaffa, M., Brownson, C. (2014). Program Planning and Needs Assessment. In M. Scaffa & M. Reitz (Eds),
Occupational Therapy in Community-Based Practice Settings (2nd ed, pp. 61-79). F.A. Davis Company.
Table 2. Descriptive Characteristics of Survey Sample (N = 230)
% (n)
Gender
Man 30.9 (71)
Woman 69.1 (159)
Non-Binary/Gender Nonconforming 0
Transgender 0
Prefer not to Answer 0
Marital Status
Married 71.7 (165)
Divorced 9.1 (21)
Widowed 14.8 (34)
Separated 0.4 (1)
Never Married 3.5 (8)
Living with Partner 0.4 (1)
Other 0.4 (1)
Family living within a 15-mile radius
Yes 66.1 (152)
No 33.9 (78)
Reliance on Family and Friends for IADLS

Yes
14.3 (33)
No
85.7 (197)
Confidence in technology skills
Yes 94.3 (217)
No 5.7 (13)
Self-Isolation Frequency
Always 10.9 (25)
Most of the Time 65.2 (150)
Sometimes 14.3 (33)
Rarely 5.2 (12)
Never 4.3 (10)
COVID-19 Positive
Yes 4.3 (10)
No 95.7 (220)
Medical Conditions
Cancer 18.3 (42)
COPD 7.4 (17)
Heart Conditions (coronary artery disease, congestive heart 16.5 (38
failure, etc.) 1.7 (4)
Weakened Immune System due to organ transplant

3.5 (8)
Chronic Kidney Disease
13.9 (32)
Type II Diabetes
0
Sickle Cell Disease
58.7 (135)
High Blood Pressure
25.7 (59)
None of the Above
CHANGE in Employment
No change 63.9 (147)
Hours increased 0.9 (2)
Hours decreased, maintained employment 2.6 (6)
Laid off 0.9 (2)
Not applicable 31.7 (73)

CHANGE in Social Activities
Not Much Change 22.2 (51)
Changed for the Better 3.0 (7)
Changed for the Worse 74.8 (172)
Table 3. Differences in Survey Descriptive Characteristics in Relation to COVID-19 (N = 230)
Before COVID-19 Following Onset of COVID-

% (n) 19 % (n)
Employment Status
Full-time (40+ hours) 5.7 (13) 4.8 (11)
Part-time (up to 32 hours) 6.5 (15) 4.8 (11)
Unemployed, looking for work 0.4 (1) 0.4 (1)
Unemployed, not looking for work 0.4 (1) 1.3 (3)
Retired 85.2 (196) 86.1 (198)
Homemaker 0.9 (2) 1.3 (3)
Self-employed 0.9 (2) 0.9 (2)
Unable to work 0.4 (1) 0.4 (1)
Volunteer Status
Yes 63.5 (146) 30.4 (70)
No 36.5 (84) 69.6 (160)

Main method of interaction
Face to face conversation 87.4 (201) 10.9 (25)
Phone call 3.5 (8) 25.7 (59)
Text 6.1 (14) 36.1 (83)
Email 2.2 (5) 7.4 (17)
Video call 0 19.6 (45)
Other 0.9 (2) 0.4 (1)
Reliance on Family and Friends
Yes 3.0 (7) 10.4 (24)
No 97.0 (223) 89.6 (206)
Perceived Social Support 97.8 (225) 78.7 (181)

Adequate
2.2 (5) 21.3 (49)
Not Adequate
Living Arrangement
Alone in a private residence 21.3 (49) 22.2 (51)
Not alone in a private residence 73.5 (169) 71.7 (165)
Private residence with children 3.5 (8) 3.9 (9)
Alone in senior living 0.9 (2) 1.3 (3)
Not alone in senior living 0.9 (2) 0.9 (2)

Frequency of Family Visits
Frequently (daily/weekly) 63.5 (146) 26.5 (61)
Often (monthly) 26.5 (61) 40.9 (94)
Yearly (rarely) 10 (23) 32.6 (75)
Satisfaction with Healthcare

Not satisfied at all
0.4 (1) 3.0 (7)
A little satisfied
1.3 (3) 9.1 (21)
Neutral
3.0 (7) 16.5 (38)
Satisfied
56.1 (129) 50.4 (116)
Extremely satisfied
39.1 (90) 20.9 (48)
Table 4.
Descriptive Characteristics for Survey Differences in Lifestyle Routines in Relation to COVID-
19 (N = 230)
Before COVID-19 COVID-19

Mdn (IQR) Mdn (IQR)
Number of Interactions* 20 (30) 5 (25)
Number of community activities 3 (2) 0 (1)
Number of physical activities 3 (14) 1 (4)
*Outliers removed from analysis

Table 5.
Descriptive Characteristics of Survey Sample
M(SD) Minimum Maximum
COV19QoL Score 18 (4.8) 7 30
Age (years) 72.86 (5.66) 65 97
Table 6.
Comparison of COVID19-QoL Scores by Survey Participant Characteristics (N = 230)
COV19-QoL
Score
Mdn (IQR) p
Age Category (years)
65-75 17(7) p = 0.008
76-86 19 (8)
87+ 15(-)
Gender
Man 18(8) p = 0.574
Woman 17(22)
Marital Status Category
Married 17(8) p = 0.381
Not Married 17(8)
Living Arrangement Category
Lives alone 16(23) p = 0.031
Does not live alone 17(21)
Employment Status (during COVID-19)
Full-time (40+ hours)

17(15)
Part-time (up to 32 hours)
2(7) p = 0.283
Unemployed, looking for work
15(4)
Unemployed, not looking for work
17(8)
Retired
17(-)
Homemaker
21
Self-employed
Healthcare Satisfaction (during COVID) 17 (8.7)

Satisfied/Extremely Satisfied
15.5 (5) p = 0.007
Not Satisfied /A little satisfied
Primary method of interaction (during COVID-19) 22 (10.8)

Face to face conversation
18 (7.3) p = 0.218
Phone call
16 (7)
Text
18.5 (10)
Email
17.5 (9)
Video call
Social Isolation Frequency
Never 24 (9.25) p < 0.001
Rarely 20.5 (7)
Sometimes 17(9.50)
Most of the time 17(6.25)
Always 15(7)
Social Support
Adequate 18(7) p < 0.001
Not Adequate 14(2.50)
Tables and Figures: Part II
Table 7. Descriptive Characteristics of the Interview Sample

Gender Age County Lived Followed
Alone Isolation Guidelines
1 female 70 Cook no yes
2 female 83 Will no yes
3 female 68 Cook no yes
4 male 72 Cook no yes
Table 8. Examples of the MOHO within Interview Responses

Volition Habituation
“I Try to prioritize and have things to do, but I “We’re eating more, shopping more, home
mean it—just it’s bad.” more, some boredom.”
“It would have been nice but be able to converse “A lot of life is routine.”
with other people.”
“I used to be the “mom” at work.”
“And I see, like, we like to go shopping, we eat
out a couple of times. Those are the biggest “Individual is now ‘zooming or
things you get [when you’re] our age. We don’t snapchatting’ and reports ‘missing out on
have big aspirations.”
grandnephew’.”
“We do look forward to go to the grocery store.”

“We go to McDonald’s in the morning,
they have a group that we meet with and
“But to me, the best thing to do is keep moving.
we have been unable to do it. March 16,
Even if it’s just walking around the house.”
it’ll be one year that we have no contact
with—I mean, other than on the phone—
“But it is mentally trying, and I think more for
my husband because he’s 76 and he was really with the people that we are friends with...
active.” And we lost some, some have died during
the process.”
“I quit watching the news a lot because that’s, I
think [it] affects your mental being. And I’m like, “Oh, the routine, you know, you can get
I don’t care. I don’t want to listen to it . . . So up sometimes and—you got to know I’ve
yeah. I’d like to watch a movie instead. So, I worked for 55 years—so I’ve been on a
think the whole world’s brought upside down routine, everything. And now it’s like,
right now. what day is it? I don’t even know what
day it is.”
“No, more frustrated than anything else. I think [I
am] more frustrated or feeling sad for him
“I went, we had it, we had the six months,
because he is different than I am. I have a good,
every six months we did okay. We were
good attitude where he is like, oh my gosh, what
able to go to there together. My husband, I
was happening today on the news?”
could make the appointment 15 minutes
apart and I had to go once a month by INR
“That keeps me going when I move and... that’s
check...And that was a pain a lot of the
my theory. . .I have to be moving.”
time. I mean, you had to step out in the
hall, they had to take your temperature and

“It would have been nice but be able to converse ask you a million questions. That’s been a
with other people [is what I needed most during little bit easier now. My husband still can’t
the pandemic] ... just interacting with other go in with me. So, he has to sit out in the
people and our friends.” car because I have to get my blood
checked every month.”
“[I miss] leisure time with our friends.”
My husband had an appointment with a
“I think the older you get, I think you’ get set in pulmonologist...and I have to be there,
your ways and your opinions...even with the kind of listen to what the doctor has to say
pandemic or without it, that’s not a healthy thing. for him, because I have been, I know the
You’ve got to keep an open mind.” medical field pretty good since I was in it
for a long time, and I couldn’t go with
“Can’t go on vacation, fish, or take dog for walks him. So, we canceled, canceled the
[because of the snow], can’t go downtown, appointment until I can go in with him.”
shopping, or out to eat like we used to.”
“I think [I am] more frustrated or feeling
“I’m so sick of watching TV.” sad for him because he is different than I
am. I have a good, good attitude where he
“...But I, I don’t think I felt lonely. I think my is like, oh my gosh, what was happening
husband might have because he, you know, visits today on the news?”
with the neighbors or whatever. We all kept our
distance to this year. So, but me, no, I don’t think “That was a little different, friends that
I’ve ever felt lonely.” you were friends with for such a long
time. You’re seeing their point of view on
something that you totally don’t believe
in. That was a rude awakening but that
was shoved down our throat, I think,
through the news and stuff like that.”
“People do not wear mask or follow

rules... then someone complains or calls
the manager because they do not want to
wear a mask and then I can’t get what I
need [from the store].”
“[I miss] sense of being free...

quarantine feels like a jail. [I even miss]

Strangers in the grocery store at a
distance, it’s strange.”
“Can’t go on vacation, fish, or take dog

for walks [because of the snow], can’t go
downtown, shopping, or out to eat like we
used to.”
“I don’t think I’ve ever felt lonely because

like I said, I have my sisters, my brother,
we keep in contact with that. And, and
that’s a good thing, you know what I
mean?”
Researcher Observations:
“Individual worked in March and retired
in August, working from home between
March and August.”
“Individual retired in March and a few weeks

after retirement COVID-19 hit which changed
plans for travel/ They had to cancel trips to
Boston, Maine, and Florida.”
“Individual’s spouse contracted COVID-

19, and both had to quarantine from each
other in home. They had to take on new
role of caregiver.”
Performance Capacity Environment

“I Try to prioritize and have things to do, but I “The thing that helped us is we got a
mean it—just it’s bad.” beautiful, big swing in our yard, our yard,
we got a big yard and during the summer,
all our neighbors, we would be six feet
“[I am] Always kind of a “worry wart.” apart, but we’d be able to visit in the
evening. And that was really wonderful.”
“I usually put in about 8,000 to 10,000 steps and
I mean, I’m down to 3000 steps a day and that’s “We were pretty good up until about
like, Whoa, like how much walking can you do in November. And after that, that’s when it
the house? And you don’t want to take a chance really got tough for me.”
to the grocery store.”
“I mean, I hate that, or you have to be—
“When you have a good, positive attitude
the mask and being spread out like that. I
towards things. I’m not a Debbie downer, but don’t think there’s not a lot you can do
could you believe people that are mentally ill that with that time.”
the stress and what they’ve gone through that
that’s a little scary or the opioid addiction?”
“[I miss] absolutely leisure time even to
go to the grocery store, you know, you’d
“Well, where there’s a beginning there’s an end.
walk down the aisles and, and, uh, you
That’s what I always keep telling him.”
know, look at things or, you know, not
even the grocery store, but department
“I quit watching the news a lot because that’s, I
stores just to get away or Meijer’s or
think [it] affects your mental being. And I’m like,
Menards or whatever. And we don’t do
I don’t care. I don’t want to listen to it . . . So
that anymore because of the fact we don’t
yeah. I’d watch a movie instead. So, I think the
want to be around a lot of crowds for a
whole world’s brought upside down right now.
long time.”
“That was a little different, friends that

“I haven’t thought about my mental health.”
you were friends with for such a long
time. You’re seeing their point of view on
“Can’t go on vacation, fish, or take dog for walks something that you totally don’t believe
[because of the snow], can’t go downtown, in. That was a rude awakening but that
shopping, or out to eat like we used to.” was shoved down our throat, I think,
through the news and stuff like that.”
“But it’s such a small little group. It’s not

like 25 people getting together. It was six
of us, you know what I mean? And, and so

that, that’s a nice thing I guess, to get to
them.
“And things like that, that was and my

coping mechanism...going for those walks
that really, really did help this summer to
get out and get into the fresh air. And it’s
funny that you stay out longer, start
something and it’s like, no, I, I, I’m not
going to go home yet. I’m gonna walk a
little longer and stuff. So that was nice.”
“United health care is actually been pretty

good with, you know, uh, reaching out
with what they have too, you know,
programs that go online. And you can say
this today or are there was also on the
AARP (American Association of Retired
Persons), there were games that you could
play.”
“And, and Facebook, I, I hardly even go

on Facebook anymore because of what’s
politically. Oh yeah. I think it’s a mental
thing for a lot of people.”
“Trying to do what Dr. Fauci wants and

the neighbor or stranger in the grocery
store not doing it.”
A lot of Americans think they don’t have
to do it [wear a mask] and say “this is my
right! ...that’s not right.”
Researcher Observations:
“Individual created a “woman cave” as a
coping mechanism when self-isolating.”
Table 9. Frequency of MOHO Constructs in Interview Data

Volition Habituation Performance Environment
Capacity
Record 1 15 13 11 7
Record 2 15 13 11 5
Record 3 25 21 13 13
Record 4 17 15 7 19
Table 10. Categorization into Program Objectives, Strategies, and Procedures
Program Objectives Intervention Strategies

Occupational Identity
Perception of age: Stereotypes, future time Skills training
perspective, Dissatisfaction with society Activity modification
Perceptions of activities Skills training
Environmental adaptation
Activity modification
Continuity with previous relationships amidst Environmental adaptation
social distancing Activity modification
Continuity with previous activities amidst Environmental adaptation
Values: Education Skills training
Values: activities Environmental adaptation
-grocery store, shopping Activity modification
-exercise, walking
-leisure
-eating out
-time with family/friends
-cleaning, baking
Values: physical closeness Environmental adaptation
Values relationships with family, friends, Environmental adaptation
sometimes neighbors Activity modification
Skills training
Healthcare accessibility Activity modification
Values: Going with family members Environmental adaptation
Advocacy
Caregiver training
Willingness to participate in motivation, self- Activity modification

efficacy, values, interests. Skills training
Effect of political context on relationships, Skills training: conflict management, self-

perception of aging, and sense of regulation, uncertainty regulation
purpose/community Environment/activity adaptation
Feelings of uncertainty, frustration, sadness in Skills training

response to what family members experience
Feelings of frustration, sadness in response to Environmental adaptation

not being able to participate in activities. Activity modification
Skills training
Retirement: changes in activity, perceptions Environmental adaptation
of age, roles/routines, adjusting expectations. Activity modification
Skills training
Occupational Competence
Coping thoughts Skills training
Coping activities: physical Activity modification
Coping activities: social Activity modification

Skills training
Continuity with previous activities amidst Environmental adaptation

winter weather and pandemic
Continuity with previous relationships amidst Environmental adaptation

Uncertainty with new activities: such as Skills training (self-efficacy)

mentoring a new person.
Uncertainty with finding assistance Skills training

Effect of political context on activities Skills training: conflict management self-
(continuity of using Facebook, less regulation, uncertainty regulation
willingness to participate in online activities) Environment/activity adaptation?
Minimizing social circles, narrowing groups Activity modification

to most important people to maintain social
connections.
Program Procedures
Recruitment
Difficulty finding information and seeking out activities.
Facebook
newspaper
Magazine
newsletter
Difficulty with clarity of “where to go.”
Online vs. In-Person
Some prefer online due to the need for social distancing.
Some prefer online due to the need to continue previous activities.
Some prefer online due to the need to continue relationships.
Zoom, snapchat, mobile apps.
Outdoor social distancing
In person conversation
Continuity
Switching to online of same activity done previously rather than trying novel activity online.
Switching context to make novel activities more comfortable (participating with friends,
narrowing groups, going outside)
Trying new activities: cleaning, baking, exercising
Values
Physical safety
Staying active
Engaging in valued relationships
Sense of purpose
Helping others
Figure 1.
Qualitative Analysis Process

Tables and Figures: Part III
Table 11. Sustainability Feedback Survey

What could this program improve on in order
to better serve the needs of the behavioral
health department and its clients?
What do you anticipate are the major barriers

with using this program long-term?
What resources are available to support the

use of the program?
Are there areas within the community or

current research that need to be further
explored in this project?
Figure 2.
Program Goals
To educate health
professionals and community
Health Department Goals partners on the needs of the
older adult population in
Health Department Mission general and within the
Persons with behavioral
community.
health issues will receive
culturally competent and age-
To prevent disease and
appropriate services. To train health professionals
promote a healthier
and community partners on
environment for all residents,
evidence-based interventions
business operators, and
for social participation and
visitors. Our agency of
older adult behavioral health.
professionally trained staff
works cohesively to assure
public health and safety To provide recommendations
measures are maintained and guidelines for program
through services and design, implementation,
programs the department evaluation, and sustainability
provides based on the needs to address social isolation and
The stigma related to
of the community.” loneliness in older adults.
behavioral health and
substance use disorders will
Program Goals be reduced. To advocate for the role of
occupational therapy in public
health, particularly when
serving the older adult
population.
Figure 3.
Inputs Activities Outputs Outcomes Impacts

(resources needed) (use of resources) (amount of service) (benefit of service) (change in community)
Completed Program Series of 5 Videos Training on use of
Training for use of
Manual the manual within
the Manual via Increased awareness
(Simplebooklet) practice, research,
VoiceThreads of the older adult
LinkedIn Group and program population
Completed development.
Plans for using the
Sustainability Plan training and manual
and Meeting Use of the program Cultivated network
within WCHD. manual within the opportunities to Additional training
Plans for community support community for professionals
VoiceThreads (series dissemination to
of 5) and interprofessional within the field of
community partners. . collaboration. behavioral health
Completed Papers Google Drive/Voice
Thread with Access Enhanced
and PowerPoint understanding of the Expansion of services
Presentations to all Supplemental and opportunities to
Materials community while
exploring the empower older adults
implications of the within the
recommendations for community.
future research.
Program Action Plan
Appendix A
Links to External Documents

Capstone Website
https://our-social-network.weebly.com/
Reports and Presentations

https://drive.google.com/drive/folders/191GreH-
7QkTyZckluDaVWNBHPL3xhRZw?usp=sharing
Simplebooklet Collection
https://simplebooklet.com/otdcapstone
LinkedIn Group
https://www.linkedin.com/groups/12518210/
Sustainability Webinar
https://youtu.be/h0KGYRgHzJE
VoiceThread
 Part I: https://voicethread.com/share/17203865/
 Part II: https://voicethread.com/share/17204084/
 Part III: https://voicethread.com/share/17204541/
 Part IV: https://voicethread.com/share/17204657/
 Part V: https://voicethread.com/share/17204717/
Appendix B
Email Letter
Dear Invitee,
My name is Kathleen Melei and I am an occupational therapy doctoral student working under the
supervision of Dr. Jill Linder, in partnership with -- Health, -- Health Department, and
Huntington University. We are kindly requesting your participation in a research study we are
conducting titled: Development of a Community-Based Program to Address Older Adult Mental
Health Amidst the COVID-19 Pandemic with an Occupational Therapy Approach. To be eligible
for the study you must be 65 years of age or older AND be a current resident of --.
The study involves a 20–30-minute interview regarding your experiences during COVID-19 and
your thoughts about a community program that would address mental health during and
following the pandemic. The interview can be over the phone, in person, or via online video
conferencing at any time that might work for you. Participation in the study is voluntary. The
study is anonymous; therefore, you will not need to provide your name or any identifying
information.
During this time of COVID-19, many individuals feel socially isolated and lonely. The goal of
our study is to identify the factors that influence loneliness and develop a program manual that
can be used to support mental health. If you are willing to participate in the study, please see the
contact information listed below.
Thank you for taking the time to consider participating in our study. Your input
is very valuable.
Sincerely,
Kathleen Melei, OTDS, CLIPP

Appendix C
Interview Template
Screening
Age
Resident of - -?
Y N
Where in -- do you live?
Did you participate in an online survey through

Y N
-- about COVID-19
Descriptive
Did you contract COVID-19?
Y N
Did you socially isolate?
Y N
Do you live alone?

Y N
Did you participate in an online survey through -
- about COVID-19 Y N
Pandemic Experiences
Quality of Life
1. Tell me about your experience during the
COVID-19 pandemic:
a. How was your life different, if at
all?
b. What changes occurred in your
routine?
2. What kinds of things did you need, but
were you unable to get during the pandemic?
Explain.
3. What role did your health providers play?
Were you able to access care in the way you
wanted?
4. How did your experience make you feel
about your age?
Mental Health
5. What changes did you notice in how you

think felt and acted?
a. Were there any positive changes?
6. Did you ever feel lonely or isolated?
7. What is the most difficult part of the

pandemic for you?
8. What kinds of activities or thoughts helped

you? What were some coping mechanisms you
used?
Social Participation
9. What changes, if any, happened in your
relationships and life roles?
10. What are some activities you value and
how were those impacted during the
pandemic?
a. Did you find new activities to do
that you did not realize you would
enjoy?
11. Did your community (church, workplace,
gym, city, etc) do anything to help you with
your experience during the pandemic?
a. If so, what was it and how did it
help or not help you?
b. If not, what might your community
do that could help you right now?
12. What did you miss most about your social
life during the pandemic?
Program Design
1. Are you aware of any programs, resources,
activities, etc in your community that were
offered to you during the pandemic?
a. If yes, what were they and what
made you decide to participate or
decide not to participate?
b. If no, what would be a valuable
way to inform you of available
resources in your area?
2. How likely would it be for you to

participate in a community program that
addressed social isolation and loneliness
during the pandemic?
a. If it is not likely at all, why not?
And what might make you likely to
participate?
3. Would you prefer a program that was
more passive (reading, education, etc.) or
active (interacting with others, reaching a
specific goal, etc.)
4. How would you feel about mentoring a
peer or someone else who might be feeling
more isolated than you?
5. Would you prefer something online, over

the phone, or in person
6. This program will take the form of

something educational, but also will provide
opportunities to help with creating
connections and relationships with others.
Would both aspects be helpful for you?
Appendix D
Informed Consent
DISCLOSER STATEMENT: The following study involves topics surrounding social

isolation and loneliness and may be emotionally distressing to some participants. All
participation is voluntary, and participants can withdraw from the study at any time.
I have been asked to participate as a subject in a research project entitled: Development of a

Community-Based Program to Address Older Adult Mental Health Amidst the COVID-19
Pandemic with an Occupational Therapy Approach. This project is being conducted under the
direction of Dr. Jill Linder, DHSc, OTR at -- Hospital, Dr. Laura Gerig at Huntington University,
and Dr. Rita Gray at the -- Health Department. Kathleen Melei can be contacted at 815-416-
8226 for any questions pertaining to the research.
 I understand that I will be asked to participate in an interview with Kathleen Melei which
will be audio recorded.
 I understand that the recording will be transcribed and then deleted, and no information
will be identifiable.
 I understand that there are minimal risks associated with participating in this
project. These risks may include emotional distress due to the nature of the topic.
 I understand that at any point in time I may withdraw myself from the study, and that any
data I have provided will be excluded from the data analysis.
 I understand that information gathered from me during this project will be anonymous
and not shared with anyone outside the project team in any manner which might allow
someone to identify me.
 I understand that a report on combined and generalized results involving multiple
participants will be prepared and may be presented for educational purposes only. I
understand that the results of this study may be submitted for professional publication and/or
presentation and utilized for program development.
Your signature and date below indicate your consent to the interview and the above conditions.
You must sign two copies (one for your records and for the researchers’ record).
Signature: Date:
Appendix E
Sign-up Form
Appendix F
Welcome Letter
Appendix G
Sustainability Meeting Outlines

Formative Sustainability Meetings
Date Stakeholder Position Meeting Description Contact
1/6/21 Health Department Discussed contact tracing
Program Manager-Resource procedures and older
Coordination, COVID -19 adult needs.
1/8/21 Health Department Discussed behavioral health
Director of Behavioral Health procedures and changes with
COVID-19.
1/15/21 Health Department Discussed MAPP,
Adult Mental Health Program recruitment, and
Coordinator program design.
1/18/21 Behavioral - Introduction
Health Staff
Meeting
1/19/21 MAPP - Introduction
Collaborative
Meeting
1/19/21 Health Department Discussed CIS, program design
A/R - Billing Manager

Behavioral Heath
1/20/21 AgeGuide Northeastern Illinois Program Development and
Design
Aging & Disability Resource Needs Assessment
Network Specialist
1/21/21 Adult - Introduction

Services Presentation
Meeting Recruitment brainstorm
1/26/21 Health Department Program Development and
Program Manager Community Design
Planning and MAPP Needs Assessment
2/1/21 Senior Services Program Development and
CCU Coordinator Design
Needs Assessment
2/8/21 Narwhal and the Manatee: Program Manual Design
owner
2/17/21 Senior Companion Program Program Development and

Catholic Charities Design
Recruitment, funding,
sustainability
2/18/21 Bicentennial Park Program design
Intervention setting, procedures
2/25/21 a Health Department Intervention design
Program design
Program Manager
Substance Treatment Options
Program (STOP)
2/26/21 Health Department Intervention design
Licensed Clinical Psychologist Program design
Director of Training
3/3/21 i Health Department Sustainability
Information Technology and
Telecommunications
3/5/21 Behavioral - Program sustainability
Health Staff
Meeting
3/11/21 Adult Local - Program sustainability
Area
Network
Summative Sustainability Meetings

Health Department Staff Meeting
1. Presentation (35 minutes)
a. Project Description
b. Program Manual Overview
c. Program Description
i. Intervention
ii. Implementation
iii. Sustainability
iv. Evaluation
d. Future Research/Programming Recommendations
2. Discussion (10 minutes)
a. Further explore
i. Townships and transportation services they offer
ii. Barriers in technology
b. Future Research
i. Resilience
c. Planning
i. Roll out manual through local network, neighborhood emails,
United Way
ii. Present at LAN adult planning meeting (Thursday 10)
iii. Bullet point summary to be included on WJOL Interview with Dr. Troiani
(BH Consequences of COVID-19)
Local Area Network Meeting

 Presentation (45 minutes)
o Project Description
o Program Manual Overview
o Program Description
 Intervention
 Implementation
 Sustainability
 Evaluation
o Future Research/Programming Recommendations
 Discussion (15 minutes)
o Further explore:
 Transportation
 Use of program to deal with decline (cognitive/physical) that has
happened.
o Future Research
 Erikson’s theory
 technology
o Planning
 Send additional information so people have more time to process and sift
through.

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OUR SOCIAL NETWORK 1

Our Social Network: A Community-Based Program to Address Older Adult Mental

Health Amidst COVID-19

Will County Health Department2,3

Kathleen Melei https://orcid.org/0000-0002-1503-1032

We have no known conflicts of interests to disclose.

Correspondence concerning this article should be addressed to Kathleen Melei, OTDS at

meleik@huntington.edu. A special acknowledgement to Dr. Katie Bergman, Ph.D. and

The Table of Contents

The Table of Contents ..................................................................................................................... 2

adults, current evidence, and an occupational therapy perspective, a community-based program

(Doctor of Occupational Therapy) capstone project that is working to facilitate improved

population within the context of COVID-19.

Keywords: older adults, mental health, social isolation, loneliness, COVID-19,

COVID-19 is an infection caused by severe acute respiratory syndrome coronavirus-2

2020; Pelicioni & Lord, 2020; Wu, 2020).

ability to be vital members of the global community.

current report will overview the following objectives:

survey responses from 230 community-dwelling older adults in order to further

understand the relationship between social participation and QOL.

distancing and isolation guidelines during COVID-19, based on conversations within

one-on-one, semi-structured interviews.

pandemic and beyond.

Part I: Social Participation and QOL

Social isolation involves an "objective state of having few social relationships or

isolation a unidimensional concept, alternate definitions recognize "structural" and "functional"

(Berg-Weger & Morely, 2020).

likelihood of social isolation and loneliness to occur. Quarantine/medical isolation is defined as

detrimental to physical health, mental health, and overall QOL.

repercussions, resulting in decreased participation in Activities of Daily Living (ADLS),

COVID-19. Decreased pulmonary reserves, increased blood pressure, and compromised

immunity all contribute to likelihood of infection. Similarly, the increased risk of

distancing restrictions might force many older adults to self-manage medications,

depression and anxiety, disrupted habits and routines, changes in continence/self-

disorders, and exacerbation of disposition. Symptoms associated with coronavirus anxiety

overwhelmed medical systems, and limited family support (Neimeyer, 2020).

Mental Health and QOL

also sense of purpose companionship, communication skills, and improved understanding

physical and mental health needed to improve QOL.

Part II: The Role of Occupational Therapy in Social Participation

cited in Stephenson, 2011). Occupational therapy addresses a wide variety of occupations,

regardless of context or ability (Stephenson, 2011).

Occupational therapy practitioners address social participation through optimizing older

adults’ access to transportation, technology, navigation of community resources, modifying the

Occupational therapy practitioners implement preventative approaches and chronic illness

Model of Human Occupation

The model of human occupation (MOHO) is an occupation-based model with 4 main

of the MOHO. Individuals have more difficulty participating in valued

choice and QOL.

space to recognize the strengths of older adults. Performance capacity consists of

older adults may have some advantages.

connectedness compared to their younger counterparts (Carstensen, 1993; Carstensen, 2006;

older adults display less reactivity compared to younger individuals (Charles, et

al., 2009; Birditt, 2014).

include socioemotional selectivity theory (Carstensen et al., 2020), future time

Through utilizing the MOHO, occupational therapy

Assessments of Mental Health and Social Participation Amidst COVID-19

negative or unfriendly" (National Academies of Science, Engineering, and Medicine (NASEM,

the COVID-19 pandemic.

Occupational Therapy Interventions for Social Participation

The United Kingdom's Campaign to End Loneliness identified four types of

the first steps that focus on recruiting individuals, understanding personalized

quantity and/or quality of relationships. Gateway services support services such