Lené Levy-Storms ^1* Soohyoung Rain Lee ² Camille Castelyn ³ Mary Beth Morrissey ² Marcia G Ory ⁴

• ¹ Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, United States
• ² Yeshiva University, New York City, New York, United States
• ³ University of Pretoria, Pretoria, South Africa
• ⁴ Texas A and M University, College Station, Texas, United States

In the first research article, Wilbur et al. address the exacerbated vulnerability of having a disability, ageing, or caregiving during COVID-19 in low-and middle-income countries (LMIC) through an observational study of the Hygiene Behavior Change Coalition (HBCC). Based on using a water, sanitation, and hygiene (WASH) checklist applied to 137 documents from HBCC grantees' interventions, the results indicated that having a disability, ageing, and caregiving targets occurred but interventions did not ensure their participation in WASH infrastructure. The authors recommend more explicit targets with monitored actions to ensure benefits from intervention efforts and honor such vulnerable populations' inclusivity rights.Williams et al. explored effectiveness of targeted messaging around "self-isolation" and "social distancing" in Australia using an online survey of 3,300 adults aged 18+ through 80+. Analyses focused on comparisons across age in groups of 10 years. Results indicated that age differences existed in correct understanding of messaging on these to preventive behaviors as well as in the source of the messaging with older adults being more likely to get information from TV compared to younger adults. Regardless of age groups, messages were confusing and often perceived incorrectly with no clear pattern of enhanced understanding by either older or younger adults. Most concerning, though, were the findings that older adults may not have received needed medical attention, because they misunderstood to stay isolated and/or social distancing protocols.Guzman et al. employed qualitative methods to explore 57 older adults' perceptions of how individual, social, and environmental factors intersected with their health and well-being during COVID-19 in 2021 from the Well-being, Interventions, and Support during Epidemics (WISE) study. Community-dwelling participants living in Ireland varied in their concerns, capabilities, and roles in society. Findings underscored how a one-size-fits-all approach based on chronological age did not suit them well. Implications include the need for adaptive strategies for the development of age-friendly interventions during such crises.Using a mixed method study design, Yang et al. focused on 109 home-based and community care services' staff members in Hong Kong to implement and evaluate a risk management process and service enhancement for home and community-based services in latter 2021 and 2022 during COVID-19. Both quantitative and qualitative results suggest that staff members' regular trainings, updated guidelines, and proactive phone calls to older adults all helped the quality of the services. Implications include the value of combining standard protocols with outreach efforts for community social services in general and especially in disasters. Shaked et al. investigated how social and medical factors affected medical services use among 102,303 older adults during two periods in 2019 during the COVID-19 lockdown in Israel. Findings revealed how social factors strongly predicted less medical services use during both periods but medical need reduced for those older adults with social supports. Implications suggest that older adults living in the community fare relatively much better-even well-when they have access to social supports. Thus, governmental organizations need to allocate ample financial resources to ensure social support and services for vulnerable populations. Cases et al. also examined the risk for mortality among 175,497 older adults but in long-term care institutions living in Catalonia during the period 2015 to 2022 using healthcare registries. A key aspect of the retrospective, observational study design included comparative analyses of pre-pandemic mortality with those deaths after COVID began. Findings indicate excess relative mortality for older adults during all waves, especially the first with additional nuanced findings for crude compared to standardized mortality rates within this population-based study of 50 years and older adults. Implications point towards the importance of using relative mortality measures in such vulnerable settings.Nicklett et al. delved into the particular health issue of food insecurity over time into COVID-19 among a sample of 2,413 older adults in 2018 through 2020 from the Health and Retirement Survey (HRS). Food insecurity in this study entailed measuring having enough money to buy food. Findings included a doubling of food insecurity in this time period. In addition, a lower risk for food insecurity occurred among higher income and better educated individuals but a greater risk occurred for Black and rural individuals. Additional factors that increased the risk for food insecurity in 2020 included being younger, living with a disability, and renting. Implications point to the need for policies addressing the disparities in vulnerability to food insecurity especially during disaster periods.. Kibe et al. also studied food insecurity but using multiple measures of food quantity relative to need in households. The authors also measured food environment and related it and food insecurity to overall diet quality among 102 older African American adults in Los Angeles, CA. Food insecurity but not food environment related to dietary quality as well as recommended fruit and vegetable intake. Implications point to the dire need for intervention in this vulnerable population of underserved older African American adults. Soo Oh et al. examined post-acute care (PAC) utilization among 4,310 Nevadans living with Alzheimer's disease and related disorders (ADRD) with extremity fractures after hospitalization preand post-COVID (i.e., 2018-19 & 2020-2021, respectively). They studied two rehabilitation locations as outcomes: institution-and home-based and analyzed predictors including age, gender, race, fracture location, comorbidity, rural location, and pay source. Findings indicated that Hispanic populations had lower utilization rates of rehabilitation facilities and care at home. Overall, utilization rates shifted from institution-to home-based care, which, in turn, increased the risk for disability and caregiver burden. Implications suggested the need for more geriatric healthcare workforce education to target underserved communities.Lai et al. conducted a qualitative inquiry into the perception of heatwaves, vulnerabilities, and preparedness among older adults and service providers in Hong Kong. Semi-structures interviews included 46 older adults, 18 staff, and 2 district councilors. Findings indicated that older perceived increasingly hot weather but did not feel vulnerable. Staff and councilors described a lack of services in the community and education about heat threats to health. Implications point to the urgent need to take a systems approach to co-create a heat preparedness plan, improve community awareness, and buttress resources for protection especially for vulnerable older adultsIn conclusion, the co-editors and I wish to thank all the authors, the reviewers, and the editorial board members for contributing to this Research Topic. Social determinants of health challenge healthcare systems based on their inherent complexity and require a coordinated efforts across multiple global sectors. In editing this Research Topic, the authors call for further research, innovation, and critical thinking to learn from our past and prepare for our future.