What Community Health Workers Make Possible in Supporting Older Adults
By Arkers Kwan Ching Wong
Older adults are often told to “age in place,” stay active, and manage their health independently. These are important goals, but for many older adults living in disadvantaged communities, they are not simple choices. Health is shaped not only by disease, but also by poverty, housing, transport, loneliness, digital confidence, and access to support. In these everyday realities, Community Health Workers (CHWs) often become the people who make care more reachable, more understandable, and more human.
This is something we saw clearly in Hong Kong. In one of our studies, conducted in Sham Shui Po, an underserved urban district with a high concentration of economically disadvantaged older adults, we explored the perspectives of older residents, CHWs, and NGO service providers. The findings showed that older adults were not dealing with one isolated issue. Rather, they were managing poor living conditions, chronic illnesses, mobility limitations, financial hardship, service access barriers, and social isolation at the same time. Many also struggled with digital healthcare tools, which further limited their ability to manage health independently. At the same time, CHWs were already playing an important role in bridging these gaps, even while working under strain and with limited resources.
What this reminded us is that elderly care in underserved communities is never only about Healthcare: it is also about daily life. An older person may miss appointments not because they are careless, but because transport is difficult. They may struggle with blood pressure control not simply because of “nonadherence,” but because food choices are shaped by cost, environment, and physical limitations. They may feel unsafe at home because of fall risks, poor housing conditions, or the absence of someone to help with basic repairs. They may understand what a doctor says, or they may leave the consultation confused and too embarrassed to ask further questions. CHWs often see these realities more closely than anyone else because they meet people where they actually live.
In our qualitative work, older adults frequently described CHWs as approachable, kind, and socially meaningful. This matters. Many older adults do not only need information. They need trust, explanation, encouragement, and continuity. A brief professional consultation may identify a problem, but it often cannot address the practical question underneath it: what will this person do tomorrow, at home, with the resources and support they actually have? CHWs help fill that space between formal advice and everyday action. They can notice environmental barriers, social stressors, and unspoken concerns that may otherwise remain invisible.
At the same time, our findings also showed that CHWs should not be treated as a simple low-cost solution to complex problems. Their contribution was vital but also constrained. They described physical strain, logistical difficulties, and the need for better training and support. This is an important lesson. We often celebrate CHWs for being close to the community, but if we expect them to bridge health and social care without adequate preparation, supervision, and institutional backing, we risk overburdening them while underusing their potential. Effective CHW programs do not happen by goodwill alone. They require structure.
A second study helped us understand this in a more practical way. In a feasibility randomized controlled trial, we tested a program designed to support sustained use of wearable monitoring devices among community-dwelling older adults. The intervention did not assume that older adults would automatically use a device simply because it was given to them. Instead, the program combined technology with ongoing support from CHWs, a nurse case manager, and social workers. This included a home visit, biweekly follow-up communication, and practical help in integrating the device into daily routines. CHWs were trained to support older adults in understanding the device, solving problems, setting goals, and maintaining motivation over time.
The results were encouraging. Recruitment was high, attrition was low, and older adults in the intervention group had higher self-efficacy, lower anxiety, and more frequent smartwatch use than those in the control group. The conclusion was straightforward but important: simply providing a wearable device does not guarantee that older adults will use it meaningfully in everyday life. Continuous peer and professional support matters. In other words, technology became more usable because human relationships were built around it.
This has wider implications for how we think about CHWs in elderly care. Their role is not only to pass on health messages or remind people what to do. Their role is often interpretive and connective. They translate advice into practical steps. They help older adults understand what a tool, service, or recommendation means in the context of their own routines. They can identify barriers early, reinforce confidence, and create a sense that the older person is not managing alone. This is especially important in an era when health systems are increasingly turning toward digital tools, remote monitoring, and community- based care. As our wearable study showed, older adults are much more likely to benefit from technology when someone helps them make sense of it, adapt it, and trust it.
The broader lesson from Hong Kong is that CHWs are useful. It is that they are essential to making community-based elderly care work in a realistic and equitable way. In settings where older adults face multiple and overlapping disadvantages, CHWs help connect the medical, social, and practical dimensions of care. They can identify needs that do not fit neatly into one professional category. They can improve continuity. They can reduce the distance between services and the people who most need them. And when digital innovation is introduced, they can help ensure that technology becomes a bridge rather than another barrier.
For organizations and policymakers, several messages follow. First, elderly care in underserved communities must be designed around integrated health and social support, not around disease management alone. Second, CHWs need structured training, role clarity, supervision, and referral pathways. Third, digital health initiatives for older adults should include human support as a core component rather than an optional extra. Finally, if we want aging in place to be more than a slogan, we must invest in the people who make it possible in practice.
CHWs do not replace clinicians, nor should they. What they do is equally important: they bring care closer to everyday life. They make support more continuous, more personal, and more responsive to the realities older adults face. In underserved communities, that may be the difference between a service that exists and a service that truly reaches people.