Ensuring contact: calling rural Appalachian older adults during the COVID-19 epidemic

Introduction: Older adults, especially those age 85 and older, remain at significantly higher risk for COVID-19. This group, along with those with pre-existing heart and lung disease and diabetes, have accounted for 80% of hospitalizations and an even higher percentage of COVID-19 related deaths in the United States . West Virginia, the only state in the United States located completely within Appalachia, has a higher percentage of elderly than all but two states in the nation. Rural seniors are hesitant to use hospital emergency departments and attend routine care visits out of fear of exposure to the virus. Restricted cell phone and internet service may limit effective technological outreach to more isolated rural older adults. More information is needed to develop effective, safe, and acceptable approaches to care for rural, isolated older adults.
Methods: Telephone interviews were conducted with 124 community-dwelling residents in four counties in rural Appalachia between April 1 and April 22, 2020. Participants were age 75 years or older. Descriptive statistics were calculated and Fisher’s Exact Test was used to examine for associations among variables. 
Results: Participants consisted of 86 (69.4%) females and 38 (30.6%) males with an average age of 82.5 years. Telephone contact was the preferred method of contact among all but four participants (96.8%).  Seventeen (17) calls (13.7%) resulted in some form of intervention, including arranging for emergent home repairs, treatment of severe hypertension, scheduling urgent laboratory testing, arranging for terminal care, treating acute conditions, and providing durable medical equipment. The 17 participants requiring intervention were significantly more likely to be age 85 or older (P= 0.004), and report two or more chronic conditions (P< 0.001). Those describing themselves as “lonely,” were significantly more likely to live alone (P=0.009) and describe themselves as “anxious” or “depressed” (P< 0.001). 
Conclusions: A telephone call appears to be the most effective means of communication with patients in these rural Appalachian counties. Patients age 85 years and older and those living alone should be given highest priority for regular outreach by healthcare providers. In this population, systematically calling rural elderly patients during the COVID-19 epidemic and its aftermath represents an effective strategy for providers who care for elderly rural patients.