The Hawai‘i Demonstration to Maintain Independence and Employment was a randomized controlled trial examining the effect of a participant-driven, multicomponent intervention on 190 employed adults with diabetes, 36% of whom were Asian and 35% of whom were Native Hawaiian or Pacific Islander. A no treatment concurrent control group was used, and the treatment group was provided an intervention that paired each participant with a life coach and a pharmacist counselor with whom they worked to achieve collaboratively chosen goals. Treatment fidelity data suggest that the intervention was largely implemented as planned. Life coaches and pharmacists performed key program functions with high to moderate adherence. The quality of their adherence to the intervention model ranged from basic to above basic and below basic to above basic for life coaches and pharmacists, respectively. Results of repeated-measures analysis of covariance analyses indicate that the intervention had a significant positive effect on participants’ diabetes self-efficacy, quality of life, and body mass index but not on hemoglobin A1c levels. Further analyses examining just the treatment group indicate a dosage effect, with body mass index and quality of life outcomes optimized among participants who engaged in a greater number of sessions with life coaches and pharmacists. Implications of the study findings for practice are discussed.

Recent federal policy supports an individual's preference for home and community-based long-term care, even among nursing home residents. Optimizing transitions from the nursing home to home is a complex undertaking that requires addressing the interrelationships between health literacy and cultural-linguistic factors in the nation's increasingly diverse older adult population. We look at four Asian American and Pacific Islander elder populations to illustrate that differing health profiles and cultural-linguistic values can affect the type of care and support needed and preferred. A research gap exists that links these factors together for optimal transitional care. The paper presents a conceptual framework and proposes a six-point research agenda that includes family assessments of health literacy abilities, exploring the relationship between culture, health, and decision-making, and the development/adaptation of transition planning tools.

This study compares the expenditure patterns and characteristics of high-cost dual eligibles to normative-cost dual eligibles within institutional and community settings. Using claims records for people dually eligible for both Medicare and Medicaid in 18 California counties (n=349,433) in 2000, high-cost users in the long-stay institutional care setting spent a much higher amount and a much greater proportion of total costs in Medi-Cal (61%) but spent less proportionally in Medicare (39%) than high-cost users in the long-term community care (66% of total costs from Medicare) or episodic care (79% of total costs from Medicare) setting. Although individuals who are long-stay nursing facility residents are high-cost in the overall sample, multinomial logistic regressions revealed that the impact of diseases/conditions on high-cost status varied within each setting. These findings suggest that policymakers and providers should consider care setting as an important component when designing disease management strategies.

This Reflection from the Field examines the need for intergenerational programming within the Native Hawaiian and Pacific Islander population. Disenfranchisement, external migration, and changing socio-economic demands have created barriers to cultural transmission to younger generations. This article examines intergenerational programs in native populations in the U.S. and internationally and discusses potential applications to Native Hawaiian and Pacific Islander communities in Hawaii.

Background: Food insecurity and social isolation among older adults are pressing public health concerns that significantly impact physical and mental health outcomes. The COVID-19 pandemic exacerbated these challenges while forcing innovative adaptations to traditional congregate meal programs. Objective: This study examined the effectiveness of Kūpuna U, an alternative flexible congregate meal program comprising three models (virtual, hybrid, and traditional), in addressing food insecurity, loneliness, and self-rated health among older adults in Hawaiʻi. Methods: A quasi-experimental study with non-equivalent groups analyzed secondary program evaluation data. Participants (N = 270, follow-up N = 116) self-selected into virtual (grab-and-go meals + online activities), hybrid (grab-and-go meals + virtual and in-person activities), or traditional (in-person congregate meals + in-person activities) models. Food insecurity (6-item scale), loneliness (UCLA 3-item scale), and self-rated health (5-point scale) were measured at the baseline and 6-month follow-up. Results: The Virtual group showed significant improvements in food insecurity (baseline: 1.73 to follow-up: 0.04, p < 0.001) and self-rated health (baseline: 2.92 to follow-up: 3.72, p = 0.005). The Hybrid group demonstrated a significant increase in loneliness (baseline: 4.25 to follow-up: 5.00, p = 0.024). The Traditional group showed no significant changes in any outcome measures. Analysis of variance (ANOVA) revealed significant between-group differences for food insecurity (F = 9.047, p < 0.001) and self-rated health (F = 5.814, p = 0.004) change scores. Conclusions: The Virtual model demonstrated a superior effectiveness in improving food security and self-rated health outcomes. However, self-selection bias limits causal inferences. These findings suggest that flexible, technology-enhanced nutrition programs may effectively serve older adults with mobility or transportation barriers while maintaining program benefits.