The Effectiveness of Peer-to-Peer Community Support to Promote Aging in Place

The investigators' overall objective is to evaluate the effectiveness of peer-to-peer support programs in preventing the necessity of acute health care and nursing home services for older adult populations and in promoting their health and wellness. The investigators' Specific Aims are:

1. To compare the effectiveness of peer-to-peer community support in preventing hospitalization, emergency department (ED) use, and nursing home placement in an at-risk older adult population relative to standard community services.
2. To compare the effect of peer-to-peer community support on intermediary measures of health and wellness such as self-rated health, depression, and anxiety relative to standard community services.

The investigators will accomplish the aims by conducting a longitudinal comparative-effectiveness study in which at-risk older adult study participants in three communities across the US are followed for 12-months. Using a quasi-experimental design, investigators will compare outcomes in those receiving peer-to-peer community support to those receiving standard community services.

At all three sites investigators will include 120 older adults in the peer-to-peer support group and 120 in the standard community services group for a total intervention group size of 360 (120 from each site) and 360 in the control group (120 from each site).

Study Outcomes \& Measures To meet the first two aims investigators will (1) compare annualized rates of hospitalization, ED use, and nursing home placement and (2) examine the changes in self-reported health, depression, anxiety, and other measures of well-being in the group receiving peer-to-peer support compared to the group receiving standard community services from baseline to the end of study enrolment. The investigators describe each of our outcomes and additional study measures in detail below. Measures have been translated and used in Spanish and have been shown to be valid or have high reliability in Spanish

Eligibility Criteria:
Inclusion Criteria:

* Overall

  * ≥65 years of age
  * Speaks English or Spanish
  * Lives independently in their community year-round
  * Meet the community defined criterion for receiving peer-to-peer support (at least one of the following)

    * Low income (at or below poverty level)
    * On a fixed income that barely meets their living expenses
    * Social and/or familial isolation
    * Chronic Illness
    * In need of frequent community services or resources. Peer-to-peer support group (must meet the overall inclusion criteria as well as the following)
  * Enrolled in the peer-to-peer support program and have an assigned peer volunteer

Exclusion Criteria:

* \< 65
* Score ≤ 30 on the Telephone Interview of Cognitive Status (TICS) because they will not have the ability to complete the survey
* State that it is unlikely that they will receive peer-to-peer support services for at least a year. Individuals who are unlikely to receive at least a year of services include those who need short-term help after a surgery and are likely to return to full functioning and those planning to transition to nursing home care or move away.

  * Currently receiving hospice services