How do existing HRSN assessment tools assess social needs for older adults? A systematic review

Health related social needs (HRSNs) limit access to healthcare and contribute to significant health disparities among older adults. The Louisiana-Mississippi Geriatrics Workforce Enhancement Program (LAMS-GWEP) is a federally funded program that educates and trains healthcare professionals to address the needs of older adults living with Alzheimer's disease and related dementias (ADRD) and their care partners. Given that HRSNs compound caregiving stress and may limit access to dementia-related healthcare, understanding how to accurately assess these needs in geriatric context is essential to the aims of LAMS-GWEP. Accordingly, we (the LAMS-GWEP team) conducted a systematic review with a threefold purpose: (a) to identify studies that applied an HRSN-focused empirical measure with older adult samples; (b) to assess the methodological rigor of these studies; and (c) to examine psychometric properties and utility from the HRSN assessment tools among these studies.

Using the PRISMA methodology, inclusion criteria included publication within 10 years; use of an HRSN focused assessment tool; and geriatric samples in the healthcare setting. Exclusion criteria included gray literature, or publications not controlled by traditional commercial publishing; and psychiatric care settings. Each study was assessed for methodological rigor using the Newcastle-Ottawa Scale (NOS) adaptation for cross-sectional analysis. The studies were reviewed for findings of their respective HRSN psychometric properties: reliability, validity, cultural adaptability, acceptability, feasibility, and responsiveness.

Seven studies (N = 7) met inclusion and exclusion criteria. Methodological rigor of the studies' designs was high, and the sample of studies mentioned six HRSN assessment tools. Regarding psychometric properties and utility, none of the seven studies reported any statistics related to reliability. Two studies reported at least one type of validity with the geriatric population.

Literature that assesses geriatric-related social needs using HRSN assessment tools is scarce. Further, the tools used in this limited body of knowledge overwhelmingly lack adequate psychometric testing and understanding. Implications from this review address the need for formal testing of these tools with older adult samples to ensure empirically accurate representation of HRSNs within geriatric communities. This enhanced understanding should increase age-friendly initiatives endorsed by Centers for Medicare and Medicaid services and other geriatrics organizations.