Learn by Doing: Reducing Social Isolation

MPH student Kristen Smith is working to create tools and resources that lower the burden of loneliness for homebound older adults.

Social isolation and loneliness pose major health risks for older adults in the US, including dementia, heart disease, stroke, depression, anxiety, and suicide. The National Academies of Sciences, Engineering and Medicine considers social isolation and loneliness to be as significant a risk factor for premature death as high blood pressure, smoking, and obesity.

Kristen Smith, a Health Equity Scholar and MPH candidate in Brown University’s School of Public Health, is working to address this. She’s part of a team focused on reducing social isolation and loneliness among older adults in the Mississippi Delta Region.

Alongside Kali Thomas, associate professor of health services, policy, and practice; Jennifer Bunker, project coordinator; and Kim Gans, adjunct professor of behavioral and social sciences at Brown, Kristen created an educational video and website for Meals on Wheels drivers, community health workers, and transportation vendors who regularly interact with homebound seniors.

Smith, a native of Jackson, Mississippi, and a graduate of Tougaloo College, received her research assistantship with Professor Thomas through the Applied Public Health Experience (APHE) at Brown. They are working in collaboration with the Mississippi Department of Health and Meals on Wheels America.

We spoke with Kristen about her experiences as a Health Equity Scholar, a native of Mississippi, and a research assistant on this project.

How did you get involved with your APHE project for homebound older adults?

I am currently on the Health Services Research track in the MPH program. I met with Professor Thomas to discuss my research interests and through that discussion, I shared my interest in research aiming to address health inequities and social determinants of health. The timing was perfect! Professor Thomas had recently taken on a project with the Mississippi Department of Health. I soon began working on the project as part of my Applied Public Health Experience (APHE).

The project focuses on addressing social isolation among older adults who receive home-delivered meals in the Mississippi Delta. Research has shown that older adults increasingly deal with isolation and loneliness. Experiencing the loss of a loved one and living alone for prolonged periods, studies show that social isolation is equivalent to some of the health outcomes of smoking 15 cigarettes a day. Unfortunately, one-fourth of adults in the US ages 65 and older are socially isolated and the pandemic has made it worse.

The goal of our project is to provide resources, including an informational video and conversation prompts, for meal delivery drivers in Holmes County, Mississippi to educate them on the importance of interacting with homebound older adults on their routes, and on their unique position to reduce social isolation. Holmes County is a rural area in the Mississippi Delta region where social interaction is scarce and residents face socioeconomic challenges and limited access to healthcare.

I served as a research assistant for Professor Thomas, Jen Bunker, and Professor Kim Gans, helping to draft the video script and website content. I had the opportunity to help lead focus groups with meal-delivery drivers and conduct interviews with subject matter experts to develop the content of the video and resources. I was also able to work closely with the Mississippi Department of Health, attending and presenting at their stakeholder meetings, and with Animus Studios, the video production company. The questions and prompts that we drafted for the drivers are designed to inspire homebound adults to engage in daily conversation. It sounds like a small goal, but it has an oversized impact.

Training Video


Reducing Social Isolation among Homebound, Older Adults

What are the next steps?

The video will be shared with drivers and added to our website. The website is a landing page with resources for people who work with homebound adults, including links to AARP’s “Connect to Affect” program. These tools are now a resource that Mississippi, my home state, will be using to support delivery drivers, community health professionals, and the people they interact with.

Tell us how you came to Brown.

I grew up in Jackson, Mississippi and most of my immediate family lives in Mississippi. After high school, I attended Tougaloo College in Tougaloo, Mississippi, located in the Jackson Metropolitan area, where I studied biology. Tougaloo College has a long-standing partnership with Brown. While exploring Brown-Tougaloo post-graduation opportunities, I was encouraged to apply to the Health Equity Scholars program. I decided to apply and was accepted, and then I moved to Rhode Island.

How are you adjusting to New England?

Initially, the adjustment was somewhat difficult for me; I am extremely close with my family, and to be so far away from home was challenging. Growing up in the South and moving to the New England area, the cold weather and snow were a huge adjustment, but now I am so excited anytime I see snow in the forecast.

How did the Health Equity Scholars program help ease your transition to Brown?

It made all of the difference. It provided me with a close-knit community, and other students from Tougaloo are involved in it as well. Every two weeks, we meet as a group for leadership and professional development sessions, which are meant to strengthen our academic and professional pathways. Following these sessions, we have dinner together, where the cohort has the opportunity for fellowship and to build relationships. We also study together and go on outings. The program director has been very proactive about providing resources and making sure that we are aware of all the research opportunities at Brown. It’s nice to have a community like that, even somewhere as large-scale as Brown. The program has made me feel supported.

What made you turn from biology to public health?

I’ve always been interested in the idea of public health as a form of public service. At Tougaloo, I co-founded a community service organization called Tougaloo College Campus Civitan, which is still active today. We worked at local soup kitchens and completed on-campus clean-ups and beautification projects; we volunteered at the Veteran’s Hospital and at nursing homes, along with many other local community service opportunities. That’s what led me to public health: my strong desire to help communities facing adversities. That’s always been and continues to be my ultimate interest.

What are your plans for after graduation?

I’m interested in working for a nonprofit philanthropic organization. I am still exploring my specific areas of interest and considering options such as community development, health equity initiatives, and programs that support minority and marginalized communities. In the long term, I hope to start my own nonprofit community service organization, although I understand it will take time and experience to make that happen.

It’s More Than a Meal

Kali Thomas, associate professor of health services, policy, and practice in Brown University’s School of Public Health, noticed while growing up in a rural community that many older adults were residing in nursing homes unnecessarily. During her postdoctoral fellowship at Brown’s Center for Gerontology and Healthcare Research, Thomas conducted a ground-breaking study that found increased spending on home-delivered meals was associated with the greatest reductions in “low care” nursing home residents over a decade. The study received national attention and Thomas provided a model for states on how increased spending on home-delivered meals could result in reductions in the number of nursing home residents who may not need nursing home level of care, as well as savings for Medicaid.

Kali Smith loads up some meals for seniors
Professor Kali Thomas, herself a former Meals on Wheels volunteer, says the program provides much more than nutrition. Her work has found daily delivered meals associated with reductions in hospitalizations, nursing home placement, and emergency department visits. Credit: Mike Cohea

After her initial study, Thomas was contacted by the CEO of Meals on Wheels America, Ellie Hollander, to help increase the evidence base of their member programs. Their collaboration led to a study called More Than a Meal®, which found that home-delivered meals – whether daily or bi-weekly – reduced falls and loneliness, but clients who received daily meals showed the greatest reductions. 

A follow-up study that linked client data from thirteen Meals on Wheels programs with Medicare claims found that daily delivered meals were associated with reductions in hospitalizations, nursing home placement, and emergency department visits. Thomas attributes these positive effects to clients’ improved nutrition, but also the socialization and wellness check that the programs provide. “The meal is important,” Thomas said, “but our research consistently shows how important human interaction is.”