Emerging evidence highlights the critical role of social connectedness in seniors’ emotional well-being to help address the pitfalls of loneliness and chronic depression, which, in turn, adversely affect physical health. The linkAges Community pilot was conceptualized to support seniors by addressing social isolation, loneliness, and other barriers. Community is an online service exchange network that helps members form connections with people of all ages through activity “exchanges” based on abilities, interests, and needs. In exchanges, members offer their expertise to support others and also request services they may need. Exchange types range from shared interest groups, walking groups, home-related support (e.g., gardening), and assistance with transportation and technology. Recruitment strategies include flyer distribution, media advertisements, and partnerships with diverse community organizations. A mixed-method evaluation assessed the process, value and potential impact of Community. Data collection included member analytics, pre/post member surveys, satisfaction surveys, focus groups, key informant interviews, and case studies. 1031 members joined Community; 41% were seniors. Survey data suggest that Community may have helped meet concrete needs and resulted in new connections for some members. Also, after one year, a subset of members reported small but favorable changes in social connectedness and perceptions of aging. Qualitative data revealed the time-intensive nature of recruiting and retaining members. Members were very supportive of the overall concept, but expressed a desire for more diverse and higher levels of exchange activity. Future efforts should consider the need for a high-touch approach to facilitate engagement and meaningful social connections between members.

1. 58.2
59.2
13 17 21 25 29 33 37 41 45 49 53 57 61 65
Lessons learned from a community-based service exchange pilot promoting social connectedness in older adults
​America faces an unprecedented demographic transition
that is challenging health care systems to rethink how
to address the needs of older adults and support aging
in place. Between 2010 and 2050, the number of
Americans over 65 is expected to double to 89 million. 1
Older adults are more likely to have multiple chronic
diseases, and incur health care expenses 3 to 5X
higher than adults younger than 65. 2
​2. linkAges Community facilitated opportunities for meaningful engagement for
some users.
Jenette A. Spezeski, MPH (1); Karuna Chibber, DrPH (1) ; Subhadra Aiyer, BS (1) ; Vandana Pant (2);
(1) John Snow, Inc.; (2) Sutter Health: Palo Alto Medical Foundation’s Druker Center for Health Systems Innovation
​Launched in 2013, linkAges Community, one of the
core components of the linkAges pilot, was an online
network designed to enable members to form
meaningful connections with people of all ages
through exchanges of ability and services. Using a
timebank model, members connect with one another
to share and learn skills or to give and receive support
services. Members earn ‘time dollars’ for each hour of
service, which they can use for future exchanges.
​1. The linkAges Community concept held appeal for members.
​John Snow, Inc. (JSI) supported the linkAges project team
in evaluating the pilot program. Given the novel and
iterative nature of the pilot and the evaluation’s time
frame, data collection focused on documenting process,
outputs, shorter-term outcomes, and trends towards
improved longer-term outcomes. Data collection included
member analytics, pre/post member surveys, satisfaction
surveys, focus groups, key informant interviews, case
studies, and a monitoring system used to document
implementation activities.
CONCLUSION
​The linkAges pilot represented an ambitious and novel venture by a health system. The team applied principles of
design thinking and refined linkAges Community in response to emerging needs and learnings. Due partly to the nascent
and evolving nature of the pilot, member growth and engagement was less than expected overall, yet a core subset of
members were highly engaged and supportive of the concept. Despite implementation challenges, the pilot revealed
valuable lessons about a timebank model as means to promote social connectedness.
Building on other timebank-networks’ experiences, the
project team sought to build a ‘critical mass’ of
members to support a thriving Community network
with frequent and diverse activity. Activities included:
• Partnerships with community organizations
• Internship program to link college interns with older
adults
• In-person member engagement: monthly meet-ups
and a ‘walk and talk’ caregiver programs
• Technology ‘help desk’ events at senior centers
• Widespread advertising at health centers and
community venues
• Targeted messaging to individuals interested in
‘giving back’ to their community
17%
32%
32%
49%
50%
51%
0% 10% 20% 30% 40% 50% 60%
Get to know others in the community around
me
Share my knowledge and skills with others
Learn from others' skills and experience
Get help with my tasks
Improve the community
Other
Members joined to meet others and share skills:
Reasons for Joining. Source: Pre/Post Survey, n=76 (check all that apply)
82% of respondents rated
their Community exchange
experience
5 out of 5
40%
33%
32%
34%
0% 20% 40% 60% 80% 100%
Increased opportunities for me to use my
skills and knowledge to support others
Increased my opportunities to make friends in
the community
Improved my awareness of community
resources and services
Increased my opportunities to access
community resources and services
5 (Very much) 4
Perceived benefits resulting from participation among members
“I enjoy using my skills to help
others, and I’ve been reminded
that I have an assortment of
them that I take for granted. The
one time I requested help, it was
even better than I anticipated.”
​3. Technology-based approaches for older adults require high-touch engagement.
Liz helps Carmen
plant a garden
and earns
Community
hours.
Carmen is a retired
musician. Liz uses her
hours to take piano lessons
from her.
Janet offers transportation,
so Carmen uses some of her
hours to get a ride to the
doctor.
Jim offers
technology help, and earns
hours teaching Janet how
to use her new laptop.
The pace of membership growth
accelerated over time, with increased
uptake in the summer/fall of 2014 as
the project team implemented higher-
touch and higher-intensity strategies.
Members’ reasons for joining
Community aligned in many ways with
the vision for the pilot. From June 2013
to September 2016, 1027 new members
joined Community; 41% were seniors.
Data analyzed across multiple sources suggests that linkAges
Community facilitated opportunities for meaningful engagement for
at least a third of its members. Small but favorable changes in
outcomes of interest relating to social connectedness and quality of
life were observed in pre/post survey data. Further, a feedback
survey of all community members found increased connections
among respondents.
LESSONS LEARNEDTHE CONTEXT ​Evidence shows that social connectedness and supportive
social ties can:
 Reduce all-cause mortality risk 3
 Improve physical and mental health 4,5,6,7
 Decrease health care utilization and associated costs 8,9
​The linkAges pilot was designed to improve the wellbeing
of older adults by targeting social isolation, loneliness and
barriers to aging in the community. It was rooted in the
belief that health depends on a variety of factors, many of
which occur beyond the four walls of the doctor’s office.
THE PROGRAM: linkAges COMMUNITY
​Although originally the Community website was envisioned as a self-sustaining platform for
members to interact, the linkAges team identified a need for more ‘human touch’ to facilitate
engagement. Some individuals—particularly vulnerable seniors and families who faced barriers
like limited comfort with technology—were less likely to use a computer for exchanges. A
‘concierge’ model of intensified outreach was launched using with numerous touch points and
‘warm hand-holding’ efforts.
​
7.6 8.1
1 2 3 4 5 6 7 8 9 10
Scores for members improved from BASELINE to FOLLOW-UP
Perception of aging successfully
38.4
40
7 10 13 16 19 22 25 28 31 34 37 40 43 46 49
Perception of quality of life
Perception of social well-being
“When you’re alone and someone
talks to you, it just feels good…
I felt connected to people.”
References. ​​[1] Satariano, W., et al., Morbidity and aging: new directions for public health action. Am J Public Health, 2012. 102(8):
p. 1508-1515. [2] Glass, T. and J. Balfour, Neighborhoods, Aging, and Functional Limitations, in Neighborhoods and Health, I. Kawachi
and L. Berkman, Editors. 2003, Oxford University Press: New York, NY. p. 303-334. [3] Holt-Lunstad, J., T. Smith, and J. Bradley
Layton, Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Medicine, 2010. 7(7). [4] Reblin, M. and B. Uchino,
Social and emotional support and its implication for health. Curr Opin Psychiatry, 2008. 21: p. 201-5.​[5] Ali, S., et al., Social capital,
the miniaturisation of community, traditionalism and first time acute myocardial infarction: a prospective cohort study in southern
Sweden.Social Science and Medicine, 2006​. ​[​6]​ Cornwell, E. and L. Waite, Measuring social isolation among older adults using
multiple indicators ​​from the NSHAP study. J Gerontol B Psychol Sci Soc Sci, 2009a. 64B(Suppl 1): p. i38-46. [7]​ Cacioppo, J., et al.,
Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses. Psychology and Aging, 2006.
21(1): p. 140-51. [​8]​ Shier, G., et al., Strong social support services such as transportation and help for caregivers can lead to lower
health care use and costs. Health Affairs, 2013. 32(3): p. 544-51. [​9 ] Rodriguez-Artalejo, F., M. Herrera, and C.e.a. Otero, Social
network as a precdictor of hospital readmission and mortality among older paitents with heart failure. J Card Failure, 2006. 12(8): p.
621-27.
linkAges Community in Action
Perceived benefits of Community. Source: Member Feedback Survey (n=164).