Local Companions and Healthcare Touchpoints in Older Adults' Communication Ecologies: Harnessing Information...

As the US population ages, community-based services (CBS) are critical for supporting older adults' health, independence, and quality of life, yet many remain disconnected from the support for which they are eligible. Following a county-wide older adult needs assessment, this qualitative study used an ecological communication framework and community-based participatory research approach to explore how multilevel communication processes shape awareness, access, and uptake of CBS among adults ages 75 and older. At the individual level, informational gaps, interpretations of fit, and rushed, transactional encounters influenced how CBS messages were noticed, filtered, or dismissed. Microsystem dynamics including shrinking networks, loss of locally situated relationships, and ties built with unfamiliar people in shared spaces shaped the trustworthiness of and access to information. At the exosystem level, organizational communication routines, digital and automated systems, and environmental constraints created opaque and often alienating pathways to services, while community events and outreach at familiar locations provided more relationally grounded opportunities for engagement. Health-care interactions emerged as underutilized opportunities to share CBS information and connect institutional resources and individual needs. Macrosystem narratives emphasizing self-reliance, pride, and earned entitlements contributed to the stigma around help-seeking. Across the levels, peer-to-peer storytelling and informal "information ambassador" roles enacted by trusted local companions emerged as meso-level mechanisms that translated institutional messages into trusted, actionable guidance and bridged gaps between older adults and CBS. Our findings highlight older adults as communicators within complex ecologies of care, foreground location-based storytelling, peer-facilitated access, and community-engaged health care key levers for improving CBS awareness and uptake.