Local Companions and Healthcare Touchpoints in Older Adults’ Communication Ecologies: Harnessing Information Ambassadors to Strengthen Pathways to Community-Based Services

Abstract

As the US population ages, community-based services (CBS) are critical for supporting older adults’ health, independence, and quality of life, yet many remain disconnected from the support for which they are eligible. Following a county-wide older adult needs assessment, this qualitative study used an ecological communication framework and community-based participatory research approach to explore how multilevel communication processes shape awareness, access, and uptake of CBS among adults ages 75 and older. At the individual level, informational gaps, interpretations of fit, and rushed, transactional encounters influenced how CBS messages were noticed, filtered, or dismissed. Microsystem dynamics including shrinking networks, loss of locally situated relationships, and ties built with unfamiliar people in shared spaces shaped the trustworthiness of and access to information. At the exosystem level, organizational communication routines, digital and automated systems, and environmental constraints created opaque and often alienating pathways to services, while community events and outreach at familiar locations provided more relationally grounded opportunities for engagement. Health-care interactions emerged as underutilized opportunities to share CBS information and connect institutional resources and individual needs. Macrosystem narratives emphasizing self-reliance, pride, and earned entitlements contributed to the stigma around help-seeking. Across the levels, peer-to-peer storytelling and informal “information ambassador” roles enacted by trusted local companions emerged as meso-level mechanisms that translated institutional messages into trusted, actionable guidance and bridged gaps between older adults and CBS. Our findings highlight older adults as communicators within complex ecologies of care, foreground location-based storytelling, peer-facilitated access, and community-engaged health care key levers for improving CBS awareness and uptake.

The United States is experiencing a dramatic demographic shift as the population of older adults rapidly grows now out-numbering children in many regions (U.S. Census Bureau, 2025). This unprecedented trend challenges families, caregivers, and aging service providers to ensure adequate resources for a growing cohort of older adults (Knickman & Snell, 2002). Despite preferences for aging in place, awareness, understanding, and utilization of community-based services (CBS) remains low, especially among the oldest adults (Siconolfi et al., 2023). Consequently, many seniors aged 75+ do not have access to CBS that could support their health and well-being.

This study responds to these demographic and service delivery challenges by using a community-based participatory research (CBPR) approach to examine barriers to CBS utilization among older adults, centering communication as a critical but under-theorized influence on service access and use. CBPR foregrounds the lived experiences and communication preferences of older adults, moving beyond reductive service models to identify multilevel barriers that constrain access to essential services (Chandanabhumma et al., 2019).

Gerontologists have put forth ecological models of aging and highlighted the importance of multilevel contexts for understanding care systems (Greenfield, 2012), yet there has been limited attention to communicative processes that link older adults to available services. The present study addresses this gap by theorizing how communication across ecological levels shapes whether adults 75+ can perceive, interpret, and act on community-based services. Additionally, this manuscript builds on prior work that examined communication resources and contextual dynamics influencing communication among older adults in the same county using a population survey and qualitative interviews (Leach et al., 2023). Whereas this study applied communication infrastructure theory to describe communication disparities and contextual dynamics related to aging in place, this study uses an ecological communication framework and CBPR to co-theorize multi-level communication processes, meso-level intermediary activities, and roles that shape CBS utilization among older adult ages 75 +.

We extend ecological approaches by conceptualizing communication as a multi-level process that influences whether adults 75+ can perceive, interpret, and act on CBS, and by specifying the communicative mechanisms and meso-level roles involved in that process. Service use is not only a function of structure or individual behavior but of communicative processes, such as storytelling, information gatekeeping, trust-building, and identity negotiation across ecological levels. Through a CBPR approach, we position community partners and older adults as co-theorists of these communication ecologies and as collaborators in generating strategies for closing the disjuncture between older adults and CBS.

Communication and service utilization among older adults

Communication is fundamental to how older adults become aware of, interpret, and act on CBS. Relationships are central to older adults’ lives, yet there is little understanding of how those relationships shape access to and use of CBS (Blieszner et al., 2002; Craig, 1994). Examining service use through a communication lens foregrounds the vital role of messages, interactions, and dynamics between older adults, their social networks, and service providers (Burleson et al., 1994). Because support is accomplished through interaction, the way it is communicated can either impede or enable access, with implications for how services are designed and delivered (Burleson et al., 1994). Taken together, this work suggests that CBS utilization cannot be reduced to individual need, rather it should be understood as emerging from communication processes within older adults’ relational environments.

Scholars have long argued that communication is central to how health and care are organized, experienced, and evaluated. Kaplan (1997) argued for approaches that foreground communication processes and quality of life, while Lee et al. (2023) emphasized that neglecting broader social and cultural dimensions in health communication risks missing key aspects of care. Communication plays a foundational role in enabling care, independence, and identity for older adults, anchoring their experiences of inclusion and belonging (Williams, 1994). Early scholars of later-life communication showed how interaction patterns in old age are shaped by older adults’ social environments and developmental context (Baltes & Wahl, 1996). Together, this scholarship underscores that communication is not an optional add-on to service delivery but a central determinant of how aging, support, and autonomy are experienced across older adults’ social environments.

Despite evidence that CBS can improve health and delay institutionalization (Chapman et al., 2003; Gardner, 2011), and despite innovations like Independence at Home that demonstrated added value (DeJonge et al., 2009; Thomas et al., 2016), many older adults remain disconnected from services that could meaningfully enhance their lives. Research that explicitly centers communication as an influence on CBS utilization remains limited, particularly among people ages 75+ and in work that examines, rather than only investigating structural or environmental features, as a determinant of CBS use. This gap motivates the present study’s focus on communication ecologies to understand and explain the disconnect between older adults and CBS. The present study was guided by the overarching question: How do communicative processes and communicative environments influence CBS utilization among people 75 and older?

Building on Moran et al. (2016) ecological health communication framework, our specific research questions were:

• RQ1: How do individual-level communicative constructs influence utilization of CBS?

• RQ2: How do microsystems, relationships and everyday interactions, influence CBS utilization?

• RQ3: How do exosystem-level communicative practices influence CBS utilization?

• RQ4: How do macrosystem-level narratives and discourse influence CBS utilization?

• RQ5: How do connections among these levels, including meso-level roles and activities, influence CBS utilization?

Individual-level barriers to service utilization

At the individual level, communication-related capacities, awareness, and attitudes shape whether older adults recognize a need, understand available CBS, and feel motivated to engage with them. Older adults face personal, psychological, and informational obstacles that affect their decisions to use services, yet age-related physiological changes have received more attention than communication forces, such as health-literacy, self-efficacy, technology access, and attitudes. Low health literacy and self-efficacy can impede the ability to recognize, evaluate, and act on available CBS; for example, self-efficacy mediates the relationship between health literacy and health behaviors (Geboers et al., 2014), highlighting the need for engagement strategies that are accessible and confidence-building. Age-related cognitive changes, such as greater reliance on automated processing, can further hinder decision-making (Forquer et al., 2014). Together, these findings suggest that individual-level communication resources are foundational prerequisites for CBS engagement, not peripheral concerns.

Lack of awareness and access are persistent individual-level problems. Many older adults have limited knowledge of resources and community support (Black et al., 2015; Denton et al., 2008; Tindale et al., 2011), and fewer than half have ever been exposed to such services (Siconolfi et al., 2023). These awareness gaps extend to caregivers, who often share similar limitations in knowledge (Waymouth et al., 2023). Digital access and technological literacy present additional challenges: although internet access among older adults is rising, relatively few consistently use digital health tools, meaning that the digital divide can compound disparities when outreach relies heavily on online platforms (Schroeck & Leach, 2023; Wu et al., 2023; Yang et al., 2024). When considered together, these studies indicate that information about CBS is unevenly distributed and that older adults’ capacity to locate and act on that information is shaped by both traditional and digital communication channels.

Attitudes also shape service uptake at the individual level. Values such as independence, privacy, and pride can deter help-seeking (Schoenberg et al., 2001; Timonen & Lolich, 2020), while cultural norms of stoicism and frugality may reinforce reluctance, particularly among marginalized groups (Lau et al., 2012; Townsend, 2021). These dynamics risk excluding underserved populations and can skew program design toward existing users, who may differ systematically from non-users (Wilby & Chambless, 2012). Thus, understanding how older adults communicate their needs and interpret offers of help is essential for improving service uptake and addressing inequities (Nussbaum, 2014). These studies suggest that individual-level communication barriers are not separate from the interpersonal and structural contexts in which they are formed and expressed.

Microsystem: the role of social networks and informal support

At the microsystem level, everyday relationships and informal support function as critical communication pathways for CBS awareness and use. Relationships with family, friends, neighbors, and caregivers play a pivotal role in shaping older adults’ access to information and assistance, especially as formal systems become harder to navigate. As informal support declines with age, reliance on social ties in one’s immediate environment increases (Carstensen, 1992; Denton et al., 2008), yet older adults who live alone often experience social isolation that diminishes these communication channels and limits awareness of available services (Czaja et al., 2021). These patterns suggest that the structure and quality of immediate social networks can either buffer against or exacerbate informational disadvantage.

Trusted companions in the microsystem do more than provide referrals, they help interpret service interactions, and provide logistical and emotional support, with decision-making shaped by this “inner circle” (Marzorati et al., 2018). The benefits of support depend partly on the network members’ health literacy and communication skills (Suárez Vázquez et al., 2020). Everyday talk in these relationships often takes the form of narratives about health, aging, and prior CBS experiences, which personalizes information and influences how CBS is evaluated and remembered. Stronger, denser social networks buffer against isolation and depression and are linked to enhanced psychological wellbeing (Dorrance Hall et al., 2020), while participation in civic or social activities, such as volunteering or community events, can reinforce these ties and promote a sense of purpose (Lee et al., 2021). Taken together, these studies position close relationships as active communication resources that can translate, tailor, or impede information about CBS.

Social relationships are active mechanisms for health promotion and access, not merely background variables. Levy-Storms (2005) advocated from shifting interventions to mobilizing social ties, consistent with socioemotional selectivity theory, which holds that as people age, they prioritize emotionally meaningful relationships within a smaller network (Charles & Carstensen, 2010). Family and friend resources, organizational design, and cultural norms intersect to influence how effectively social networks facilitate pathways to care.

Exosystem: institutional and environmental constraints

At the exosystem level, organizational, environmental, and policy-level forces shape the communication circumstances through which older adults encounter CBS. Institutions such as senior centers, health clinics, transportation systems, and local governments mediate access to information and resources, yet persistent communication gaps between service providers and older adults hinder meaningful engagement (Menec et al., 2011; Williams, 1994). Although programs have evolved over time, relatively few studies have examined the day-to-day communication barriers within these settings. This suggests that organizational and policy structures often remain misaligned with older adults’ communication needs and preferences.

The built environment further influences how and where communication about services can occur. Sites like churches, grocery stores, and recreational facilities are sites that provide opportunities for older adults to participate in meaningful activities and secure care, particularly for those with mobility or sensory impairments (Martin et al., 2011; Michael & Yen, 2014). Senior centers, though designed to foster independence and social participation, may struggle to adapt to changing demographics and needs, risking misalignment with intended users (Liao & DeLiema, 2021). These findings indicate that physical environments and organizations are places for “touchpoints” where CBS information can circulate or leave older adults in informational “cold spots.”

Many environmental and institutional barriers are not readily visible in daily interactions, yet they significantly influence service access and perceptions. Transportation remains a major challenge, especially in rural and low-density areas where older adults report issues with transit, awareness, and eligibility concerns as reasons for nonuse (Duppen et al., 2017; Gaber et al., 2022; Gallo et al., 2022; Yu & Liu, 2024). Urban areas face distinct constraints, underscoring the need for contextually sensitive solutions that account for environmental dynamics. Institutional responsiveness is also shaped by provider capacity and training; insufficient gerontological training and time constraints can undermine the quality of communicative experiences, foster confusion, and weaken trust (Black, 2008; Jiang, 2017; Liu et al., 2023; Mendez et al., 2022). Overall, exosystem literature reveals how structural issues, like transportation, facility design, and staffing, are deeply entwined with communication processes that signal welcome, exclusion, or complexity for older adults. Addressing these age-sensitive communication challenges is essential for engagement.

Macrosystem: norms, stigma, and age-related beliefs

At the macrosystem level, societal values and cultural narratives shape how older adults interpret CBS and help seeking. Values such as self-reliance, privacy, pride, and stoicism can discourage service use, particularly when help seeking is perceived as exposing vulnerabilities to outsiders. Cultural norms may suppress help-seeking, for example, Japanese American elders’ reluctance rooted in reservation and restraint (Lau et al., 2012), and gendered patterns in which women hesitate to seek help for household tasks and men for home repairs reflect persistent role expectations (Bacsu et al., 2012). These studies collectively show that macro-level norms about independence and gender roles influence when and how older adults view services as legitimate options.

Social stigma related to aging and dependency further shapes CBS engagement. Many older adults perceive formal assistance as signaling frailty or burden, generating fears of exclusion or being a problem for others (Bell & Menec, 2015). Some avoid programs like senior centers because eligibility or label signal “being old,” which conflicts with their identities (Liao & DeLima, 2021). These attitudes are reinforced by ageism in health care where oversimplified or infantilizing communication, such as overly slow speech or reduced complexity, can erode dignity and internalize negative stereotypes (Carpiac-Claver & Levy-Storms, 2007; Keaton et al., 2016; Ryan & Butler, 1996; Shaw & Gordon, 2021).

At the same time, work on communication and aging suggests that older adults often exhibit high levels of narrative competence and tend to embed concerns within longer autobiographical stories, using reminiscence as a key relational and coping resource (Harwood, 2007; Moody & Sasser, 2015; Sparks & Nussbaum, 2008). These narrative preferences can function as privacy strategies: older adults may prefer to situate requests for help within broader life stories, or may avoid storytelling altogether if they fear that disclosure will signal weakness or loss of autonomy (Sparks & Nussbaum, 2008).

This research illustrates how stigmatizing narratives and ageist communication at the macrosystem-level shape the environment where service decisions are made. Internalized ageism presents an additional barrier to CBS use. Some older adults distance themselves from peers to maintain a positive identity, particularly in contexts where aging is portrayed negatively (Ishikawa, 2023; Tully-Wilson et al., 2021). When older adults reject labels associated with aging, even when they meet eligibility criteria, they may avoid services that could support well-being. Overall, macrosystem norms and narratives are not separate from individual decisions. They are embedded in interactions and media that frame offers of assistance, shape how older adults see themselves, and influence whether CBS is interpreted as appropriate, deserved, or stigmatizing.

Mesosystem: communication networks and gaps

The mesosystem captures how links between older adults, local companions, community organizations, and service providers interact to influence whether CBS pathways are visible, trusted, and navigable. Barriers arise when interaction breakdown, institutional capacity is limited, or agencies lack coordination, resulting in fragmented outreach and inconsistent messaging. While formal service agencies operate in silos with limited coordination among outreach teams, health-care providers, and informal caregivers, older adults are left without clear entry points or coherent information about CBS.

Prior research has shown that the configuration of interpersonal, organizational, and media communication networks can either constrain or enable older adults’ access to information and services (Leach et al., 2023). Older adults who are not connected to information-sharing relationships and community settings where information circulates are less likely to learn about available programs, particularly when information is mediated by gatekeepers who may filter or unintentionally block access. In settings, such as senior centers, housing community rooms, and faith-based organizations, places where older adults have time and social permission to talk, longer, story-rich conversations allow people to embed questions about need, eligibility, and “fit” within broader life narratives, and to hear peers’ detailed experiences with CBS (Gardner, 2011; Harwood, 2007). These story-rich interactions can make services feel more relevant and trustworthy, or, when stories emphasize negative experiences, can reinforce disengagement. The perceived visibility and resonance of messages, as well as trusted endorsements from intermediaries, directly affect whether information is acted on.

Structural delays such as long waitlists also illustrate mesosystem failures, although often classified as operational issues, these delays compound communicative breakdowns by signaling scarcity, uncertainty, and low responsiveness, and can contribute to health risks (Gum et al., 2020; Thomas et al., 2016). The literature shows that the quality of networked communication, not just the existence of services, shapes utilization.

Ultimately, understanding how older adults and organizations connect, or fail to connect, is essential for designing interventions that bridge service gaps. Building on the reviewed work, the present study advances ecological communication scholarship by: (1) specifying communication mechanisms that link individual, interpersonal, organizational, and societal levels that shape service utilization; (2) integrating CBPR with ecological communication perspectives to center the lived and living experiences of the oldest old; and (3) identifying meso-level communication activities and roles that can be leveraged to improve CBS provision and use.

Methods

Study design and rationale

This study used a CBPR approach to examine multilevel communication barriers to older adults’ use of CBS. CBPR involves researchers and community members as equal partners who collaboratively define concerns and generate insights (Hacker, 2013; Tracy, 2013). This qualitative study was a spin-off research project that emerged from a county-wide needs assessment. The resulting report documents how community collaborators worked with researchers to co-design a county-wide needs assessment from conception through dissemination, and how partnering with older residents and CBS network members led to the improvement of local aging policy and practices (Jankowski & Leach, 2015; Leach & Jankowski, 2024). Building on these established partnerships and processes, the present study extends the CBPR collaboration, which lasted more than 7 years, with our three study partners who were older adults themselves, residents, and leaders or retirees of local CBS.

In a previous study, the present study focuses in depth on resident ages 75+, who were identified as “hardly reached” by service providers to understand the multilevel communication barriers they experience. CBPR was selected for its ability to produce locally relevant findings and ensure older adults’ perspectives guide both the research and resulting practice changes. Particularly among understudied and marginalized populations, CBPR prioritizes lived experience, interactive reflection, and co-learning and strengthens local engagement while shaping policy and practice (Peterson et al., 2012). Grounded in an ecological communication framework (Moran et al., 2016), the study emphasized multilevel influences on service utilization, with community partners actively involved at every stage.

Community partners and academic researchers engaged in in-depth discussions about the study conception and research questions, which were refined over time, and jointly made decisions about the budget and data collection procedures, including recruitment strategies. During multiple in-person co-analysis meetings that continued over 3 months, community partners reviewed coded excerpts initially organized broadly at ecological level and then fragmented into finer themes. Partners continued to work with the research team through the translation of findings so that the aging network and CBS community would have concrete, actionable recommendations.

These relationships were sustained over 7 years, extending beyond dissemination to the county-wide decision-making body, consistent with prior work from the larger county-wide needs assessment and with research suggesting that successful CBPR collaborations often generate successful future spin-off projects and outcomes (Jagosh et al., 2012; Leach & Jankowski, 2024). Together, these activities reflect CBPR principles of co-learning, shared decision-making, mutual benefit, and long-term commitment to the communities engaged (Hacker, 2013; Israel et al., 2013).

Participants, recruitment, and data collection procedures

Twenty adults aged 75 and older participated, all living independently and willing to complete a ~ 90 min in-person, audio-recorded interview (IRB #046315B3E). Institutional residents were excluded to focus on those engaging with CBS while living independently. Participants were recruited through partners, as well as CBS staff, and directors who we worked with during the previous study. Community partners for the present study expressed concern about being too directly involved with recruitment and encouraged us to concentrate our recruitment efforts across the county and to include perspectives from each of the nine commission-on-aging (COA) districts. They noted that an uptake of the results would be more likely if the study reflected the constituencies of the nine COA district leaders. Demographic information was collected via a questionnaire; ages ranged from 75 to 96 (M = 83). We employed maximum variation sampling to recruit participants from across the county to ensure diversity in income, gender, education, and marital status and living arrangements. Every effort was made to interview residents from each of the nine COA districts, and participants ultimately represented eight of the nine districts. Half of the participants were female and half male; half were married or partnered and the other half were single, divorced, or widowed. Eleven participants lived alone and nine lived with at least one other person. Reported monthly income ranged from $800–$2,100 for 10 participants, with the remainder reporting income above $2,100. Four participants had a high-school education or less, 10 had some college but no degree, and six held associate degrees or higher.

In-depth, semi-structured interviews were conducted at participant-chosen locations, including homes, senior centers, libraries, and community sites. Interviews averaged 82 min each, totaling 25.8 hr of recorded data. Each participant received a $25 grocery gift certificate. Interview topics covered perceptions of aging, experiences with CBS, and related communication practices, with an emphasis on encouraging storytelling and sufficient time to reflect on needs, barriers, and support systems. Following each interview, time was devoted to capturing fieldnotes so that the interview process could be improved using an iterative process based on discovery. For example, fieldnotes included insights such as the need to lower timbre when speaking, slowdown the pace of speaking, and other notes that led to changes in the process, including asking each person if they were a veteran-based learning about non-use, low awareness of Veterans Affairs benefits from early interviews, providing a booklet to each interviewee that lists all services, especially, while each participant is captive. In doing so, the academic-community partner team served as meso-level CBS connectors.

Analytic strategy

Interviews were transcribed using Otter.ai and ExpressScribe, then managed and coded in ATLAS.ti qualitative analysis software. Analysis began with an immersion phase in which the first author carefully reviewed and cleaned each transcript in ExpressScribe while taking detailed analytic notes and memos (Tracy, 2013). Clean transcripts were then printed, and an initial round of open coding was conducted on paper using a color-coded approach to organize excerpts at ecological level (individual, microsystem, exosystem, macrosystem, and mesosystem), allowing preliminary patterns to be identified across interviews. This “old-fashioned” print-and-marker process supported close engagement with participant language and early insights about how experiences clustered across levels. Next, the cleaned word documents were uploaded into ATLAS.ti, and the ecologically organized segments were coded in the software so that all excerpts associated with each level could be compiled and printed (Moran et al., 2016). These level-specific excerpts (over 400, not mutually exclusive) were then shared with community partners in advance of co-analysis meetings via e-mail, giving them time for careful reading and reflection. During a series of in person co-analysis meetings (approx. 2 hours each) over 4 months the community partners and the first author reviewed the coded excerpts together, discussed how responses were mapped onto and then across ecological levels and identified recurrent keywords, concepts, and patterns grounded in older adults’ perspectives. Through this collaborative process, the team decided to add a cross-cutting “technology” category to capture recurring references to digital frustrations including with automated phone systems, and other technology-related communication challenges that occurred across levels.

Throughout the analysis, we treated saturation as reaching a “critical threshold of interpretive competence” (Lindlof & Taylor, 2002), the point at which conducting additional interviews no longer produced novel insights or extended existing themes per ecological level, and the data substantiated meaningful claims about the multilevel communication experiences. ATLAS.ti color coding and analytic memos were used to track themes and connections across levels and to document interpretive decisions. This collaborative analytic process enabled us to identify communication barriers and facilitators as they emerged in context and ensured that interpretations remained aligned with community priorities. We interviewed participants until interviews reiterated existing patterns (e.g., technology-related constraints, housing “hotspots,” local companion as information ambassadors and their roles and activities, etc.) rather than revealing new insights.

Results

All participant names have been replaced with pseudonyms and potentially identifying details that have been altered or omitted to protect confidentiality. The findings below are organized at the social ecological level and are summarized in Figure 1, which depicts the ecological communication processes enabling and constraining CBS utilization across individual, microsystem, mesosystem, exosystem, and macrosystem levels among adults 75 +.

Figure 1.

Ecological communication processes enabling and constraining CBS utilization among adults 75 +.

Individual level

From an ecological perspective, individual-level forces include perceptions, attitudes, beliefs, and physiological conditions that influence how older adults understand and use CBS. Participants often described a pervasive lack of awareness; many simply did not know such services existed or doubted their relevance. “Probably they’re not aware, a lot of them are not aware of what is available,” one person noted. Another added, “They don’t know it’s there. Not truly aware.” Those who resided on sites with other older adults reported improved access to CBS information. As Ella, who recently moved to senior housing, indicated, “Until I moved here, I did not know anything about any of the services.” The benefits of living in a site with a strong information environment, however, were unevenly distributed: participants who lived in buildings or neighborhoods with on-site programs, community rooms, or regular outreach described learning about CBS incidentally, while those living in more dispersed settings remained largely unaware that comparable resources existed.

A recurring theme at this level was the interpretation of “personal fit.” Some participants dismissed services perceived as incompatible with their identities or preferences. For example, Albert avoided the local senior center, assuming, “People just sit around [and] play cards all day.” Eddie resisted the “senior” label: “I haven’t got to where I want to go down and hang around with a bunch of old people, even though I’m 85.” These comments highlight how social identity and internalized age norms shape engagement. Caregiving responsibilities complicated decisions further. Albert, a spouse caregiver, learned about CBS only through informal conversation, highlighting the consequences of communication gaps. In many cases, these perceptions were informed less by direct experience than by stories they heard about CBS, which shaped whether the services seemed like a plausible option. Together, these accounts illustrate how individual-level perceptions of fit and identity are shaped by, and fed back into, communication processes, when services are framed, or imagined as best suited “for other people,” older adults filter out CBS messages before they can even be considered as plausible options.

Physiological changes, such as mobility loss and hearing or memory difficulties, posed significant yet often unspoken barriers. Losing the ability to drive meant loss of autonomy. Some aides struggled to meet the needs of a population they had no experience working with, as Leonard illustrates: “You can’t step out of high school and come in to take care of people if you’ve never been around [seniors].” Navigating complex systems created additional cognitive load. Fast, transactional interactions left little room for clarification. Lucy noted, “They’re too busy. They are so overloaded.” These comments highlight how mobility loss, sensory changes, and cognitive load interact with rushed, transactional encounters to create communication environments in which older adults feel unable to ask questions or clarify information. In practice, this means that even when CBS information is offered, many participants experience it as inaccessible or overwhelming, reinforcing withdrawal rather than engagement.

Efficiency-driven interactions, especially when mediated by technology, left many participants feeling frustrated and deterred by CBS engagement. George noted the challenge of keeping up, remarking, “It’s so fast today.” Automated phone menus and online systems were experienced as confusing and impersonal, offering no clear path to a “real person” who could help make sense of CBS. As one participant explained, “I was trying to get through to them, you know, what I needed … it didn’t give me an option to talk to a real person … I think there’s a lot of people my age and older that just give up,” capturing how convoluted menus and rapid exchanges led some to disengage from CBS. Together, these findings illustrate that even when information is technically available, attitudes toward technology intersect with cognitive strain, time pressure, and lack of human contact to make CBS interactions feel impersonal and inaccessible, reinforcing withdrawal rather than engagement.

Taken together, these results show that individual-level barriers, including informational gaps, cognitive and physical changes, social identity and perceptions of fit, and attitudes toward technology shape how CBS messages are noticed, interpreted, and acted on. Participants were active evaluators of interactions, not just passive recipients, but interpreters of their social world whose communicative choices constrained and enabled CBS utilization.

Microsystem level

Microsystem communication within immediate social environment, including neighbors, peers, and shared spaces, significantly shaped older adults’ service awareness and engagement. Shrinking and geographically dispersed networks often brought a sense of loss and eroded practical channels for acquiring information, particularly from friends and family. Virginia reflected on her existing pool of friends, “There’s not many of them left,” and Albert echoed, “All our friends and kids we grew up with and knew and all this, they’re all passed away. And I’m the last surviving member of my family.” Lucy, who had lived in the county for more than eight decades, observed, “[It’s] different now, it’s hard to find a family that doesn’t have a child or two living across the country or across the sea.” For these participants, the loss or dispersal of close and locally situated relationships meant fewer people who might pass along information, assist with logistics, or report about or normalize CBS use, leaving them with fewer potential pathways to engagement.

Conversely, participants who cultivated ties within shared settings, such as senior centers, housing complex gathering spaces, or volunteer sites, reported better access to both formal and informal support. Community rooms, newsletters, discussion groups, and informal gatherings acted as hubs for sharing advice, service referrals, and emotional support from local companions. Establishing trust in these spaces was vital for deeper engagement as Ella described about moving into a new housing site, “It gets scary when you first move in … You don’t know who to trust.” Over time, however, building relationships in these settings created relational anchors through which CBS information circulated in ways that felt safe, reliable, and relevant.

Volunteering and civic roles facilitated communication flows, with some participants adopting “information ambassador” roles, sharing resources and guidance with peers of the same age. Learning about CBS and passing knowledge along often occurred casually through conversations with staff, volunteers, and local materials at sites older adults frequented. These examples show that when older adults occupy visible, trusted roles in shared spaces, they help transform microsystem settings into an active communication place-based resource that facilitates connections with CBS.

Participants consistently emphasized that information shared by similar others (e.g., people of similar age, local residents), even if they were strangers, felt more trustworthy and comprehensible than messages from institutions. Time constraints with health-care providers and other professionals limited opportunities for disclosure or clarification. In contrast, unhurried conversations with intragenerational peers provided the space needed to embed questions or stories within lived experience. As Nussbaum (2014) suggests, storytelling allows older adults to situate their concerns in longer narratives, making communication more resonate and actionable. As a result, microsystem interactions with similar others often did more to move people toward or away from CBS than formal outreach, suggesting that peer narratives and everyday conversations with such local companions may be the most consequential communication settings for shaping service trajectories.

Microsystem dynamics shaped not only what older adults knew about services but also their reasons for engaging, avoiding, or opting out of CBS. Informal network members or “local companions,” acted as personal advocates helping with navigating formal systems, emphasizing that service use is mediated by relationships, routines, and shared meaning within one’s immediate environment, rather than by information alone.

Exosystem level

At the exosystem level, organizational practices, media channels, and service design-shaped participants’ experiences with communication and service access. Many found institutional systems opaque and inaccessible, especially homebound individuals who relied heavily on newspapers and printed materials. As Opal noted, “There’s got to be communication through the paper … Actually, the technology is taking over, and technology does not give communication.” Her comment reflects broader mistrust of digital platforms and a preference for familiar formats. Several participants recounted multi-step menus that delayed access to human contact and deterred them from moving forward. These automated phone menus were often cited as frustrating barriers, as Ella explained, “A real person to talk to is … very critical.” These efficiency-oriented tools functioned as gatekeepers, reinforcing perceptions of institutional distance and impersonality. For those already facing mobility or cognitive limitations, technological barriers proved especially alienating.

Staffing, organizational culture, and environmental features further impacted communication. Participants described rushed or dismissive staff members who were unfamiliar with age-related needs. For example, Virginia recounted a doctor who lacked time for questions, and Dorothy critiqued staff members for not having sufficient training on aging resources. Such practices, driven by organizational priorities like productivity metrics, instead of tailored communication tactics, unintentionally deter older adults from engagement. These reflections suggest that institutional priorities, such as productivity metrics for digital service platforms, can unintentionally exclude older adults by overlooking the communication accommodations they require. Environmental constraints have compounded these challenges. Participants described a lack of accessible transportation, poor sidewalk maintenance, and distant locations as obstacles. These environmental challenges not only hinder physical access to services but also isolate individuals from the informal spaces where word-of-mouth information exchanges take place.

Despite these barriers, participants identified community health events as vital communication opportunities. These events served dual functions: they reduced informational asymmetry and provided social interaction. Participants reported learning about flu clinics, caregiver support groups, and nutrition services at local expos or senior fairs. These spaces also allowed for direct contact with service providers, which many found reassuring. Trust emerged as essential, as Agnes explained, “It’s got to be somebody they trust … there’s so many scams and so many rip-offs.” Participants relied on these local companions, who were largely unfamiliar intermediaries, including volunteers, retired aging service staff members, and church goers to learn about and validate CBS information and overcome exosystem complexity.

Exosystem-level barriers are not neutral, they reflect assumptions about user capacities and preferences. For older adults, these assumptions often fail to align with lived experience, underscoring the need for community-informed strategies that prioritize human interaction over efficiency, restore trust, prioritize accessibility, and reflect the communicative realities of end users.

Macrosystem level

At the macrosystem level, older adults’ service experiences were shaped by broad cultural norms, social ideologies, and broad policy discourses influencing how aging, independence, and help seeking were understood. Many participants voiced discomfort by seeking help, rooted in generational values of self-reliance, stoicism, and pride. For example, Dorothy noted, “They feel embarrassed to have to call,” and Stanley reflected on familial norms: “You just kept working until you died.” These attitudes were not simply individual beliefs but echoed larger cultural scripts about aging with dignity and the moral value of autonomy. While participants recognized the practical benefits of CBS, many simultaneously framed their use as a concession to frailty or dependence, complicating their willingness to engage.

Social and spatial age segregation limited understanding between generations and contributed to stigma. Eleanor recalled a moment with her grandson, “He’s had no experience with anybody sick …, And he doesn’t understand sometimes,” highlighting society’s tendency to hide aging and decline, reducing empathy and shared vocabulary. Stigma was often greater for services branded for “seniors” or “the elderly”; in contrast, social security and Medicare were widely regarded as earned entitlements, not charity. Participants preferred messaging that affirmed their contributions and agency, accepting programs perceived as entitlements but hesitating to use those they thought of as welfare or framed as help.

Macro-level ideologies shaped attitudes toward policy and institutional messages; some participants were skeptical of government programs or worried about the loss of personal choice within structured systems. Participants noted public discourse that often focused on financial costs, rather than wellbeing or community participation. These dominant narratives contributed to a sense that older adults were viewed as burdens rather than assets. Altogether, these findings show that cultural expectations, societal narratives, and institutional framing shape older adults’ engagement with CBS. Addressing macro-level dynamics by reframing service use such as civic participation and collective care may help mitigate stigma and encourage broader, more inclusive engagement.

Mesosystem level

The mesosystem encompasses the interactions and linkages between settings, particularly where microsystem experiences (such as relationships with family or health-care providers) intersect with exosystem structures (like institutions and community organizations). In this study, meso-level dynamics emerged as critical points of missed connection, facilitation, and informal bridging as critical components that influence CBS engagement and use. For example, participants identified key moments, particularly during health-care interactions, where CBS connections could have been initiated but weren’t part of their conversations. Agnes described hospital discharges as missed opportunities: “The hospital dischargers, they don’t provide the people with information,” she added that this left seniors “sitting there and they don’t know what to do,” leaving them uninformed and feeling unsupported. Such failures illustrate how gaps between institutions and individuals serve as barriers to CBS, particularly when communication is fragmented or transactional.

CBS retirees and civically engaged older adults played an important bridging role, such as disseminating resource booklets or acting as de facto case managers or technology navigators for peers, despite lacking formal titles or compensation. Trusted, embedded communicators with both institutional knowledge and community credibility proved especially valuable. Word-of-mouth communication proved vital. Larry, who initially encountered CBS by chance through a flyer, went on to share information with others whenever the opportunity presented itself. Larry called learning from other seniors the “greatest information source that I’ve come across,” exemplifying the relational dynamics that support awareness and engagement. Unlike institutional outreach efforts, which may fail to reach or resonate with older adults, peer-driven communication, through local (often unfamiliar) companions who shared similarities (e.g., older age and local resident) was experienced as reliable and trustworthy.

These meso-level exchanges functioned as connective tissue within the communication ecology, translating institutional messages and linking older adults to insight about CBS. Their effectiveness hinged on the initiative and social capital of volunteers, highlighting both the strengths and vulnerabilities of relying on informal intermediaries to address systemic gaps.

Discussion

Barriers to service utilization among older adults are embedded within dynamic communication ecologies spanning individual, interpersonal, institutional, and cultural systems. Through ongoing collaboration with older adult partners and community collaborators, this study foregrounds how communication processes across levels shape awareness, access, and uptake of CBS. Meso-level intermediaries were key connectors and trusted conduits of information, helping older adults make sense of CBS during informal interactions (Matsaganis et al., 2014; McFarlane et al., 2025). These individuals were often county residents and older adults themselves, including affiliates, volunteers, or retirees of CBS, senior centers, and housing sites, who acted as “information ambassadors” by engaging peers in unhurried conversations and sharing guidance and materials. Their efforts created a fluid “comingling” of identity, community, and information, and highlighted how fragmented local communication networks can weaken links between place, relationships, and resources (Ford et al., 2009; Wilkin et al., 2010, 2011). Their hybrid roles bridged microsystem and mesosystem boundaries, circulating flyers, newsletters, stories, and recommendations, and underscored the importance of peer-driven access to CBS.

From a CBPR perspective, the mesosystem is where participatory efforts and institutional structures can be most effectively aligned to bridge the disjuncture between older adults and services. In this project, older adult partners helped develop and refine recruitment strategies, interview guides and procedures, and participated in co-analysis meetings where they interpreted patterns and verified themes. Engaging older adults as communicative agents, not only as service recipients, who circulate, translate, and adapt information within their communities, reflects the equity-centered ethos of CBPR. It also points to the need to develop, support, and sustain these local companion roles, rather than relying on individual goodwill or minor programmatic reforms. Strengthening this layer of the communication ecology may be one of the most actionable paths for improving service utilization outcomes.

Senior housing sites functioned as communication hotspots, providing physical and social environments that promoted storytelling about CBS experiences (Wilkin et al., 2010). In contrast, those in dispersed or disconnected settings described “cold zones” lacking frequent and meaningful exchanges. These contrasts underscore how place-based storytelling functions as a meso-level communicative mechanism, making services either visible and relatable or more distant and irrelevant. Companions in less familiar roles filled gaps left by shrinking networks and formal providers, supporting Gardner’s (2011) view of complementary networks that extend beyond immediate kin. At the exosystem level, organizational practices and technology often hindered access, with participants expressing frustration over automated systems, complex phone trees, and impersonal staff encounters that deterred further engagement. Health fairs, outreach events, and on-site presentations and materials at familiar locations, on the other hand, offered alternative venues for trusted communication and relationally grounded and trustworthy connections to information.

Health-care interactions (e.g., physicians, pharmacists, and clinic staff) were identified as untapped resources for connecting seniors to relevant CBS. Participants voiced a need for print materials and meaningful conversations during care visits, suggesting that integrating resource dissemination into clinical encounters could help bridge gaps between institutional resources and individual needs. At the macrosystem level, cultural narratives prioritizing independence, self-reliance, and “earned” benefits shaped attitudes toward service engagement. Programs viewed as entitlements (e.g., those linked to prior work or social insurance) garnered wider acceptance compared to those framed as assistance, highlighting the impact of framing, perceived deservingness, and broader cultural narratives about whether CBS is seen as appropriate or stigmatizing.

Importantly, older adults were not passive recipients but active facilitators who bridged communication gaps for their peers, distributing materials, offering rides, and quietly observing unspoken needs. Recognizing these “information ambassadors” as central agents align with equity-centered, participatory models that position community members as co-producers of care rather than outreach targets (Canham et al., 2019). Our partnership built on roles older adults were already occupying in their community by highlighting and naming the kinds of peer storytelling and support that participants described as most meaningful and feasible in their everyday lives.

These findings advance ecological communication scholarship by foregrounding the role of place-based storytelling, peer-facilitated access, and community-engaged health care shaping CBS awareness and uptake, and by specifying communication mechanisms such as narrative framing, informal gatekeeping, and accommodation practices that link individual identities to broader institutional and cultural systems.

Limitations

This study has several limitations. Our sample was small and limited to one county, which constrains transferability to other geographic or policy contexts. Recruitment through service-related organizations likely excluded older adults who are completely disconnected from formal systems, meaning our findings may underestimate some barriers and challenges. Because we focused on independently living adults ages 75+, experiences may differ for younger cohorts or institutionalized adults who interact with CBS under different constraints. Finally, as a qualitative CBPR project, our analysis privilege depth and contextual understanding over statistical generalizability, although participatory co-analysis strengthens the credibility, local relevance, and community ownership of the findings (Tracy, 2013).

Implications and future directions

Even with these limitations, our findings point to opportunities for communication intervention. These implications emerged through iterative dialogue with our partners, who helped identify which communication adjustments were realistic and locally feasible. At the meso-level, CBS organizations could recognize and support older adults as “information ambassadors” by providing training, co-designed talking points and materials, and encouragement to share information with their peers (Canham et al., 2019). These strategies build on activities that are already being performed informally in this community. Organizations could embed CBS communications into routine touchpoints, such as hospital discharge planning, primary care visits, housing intake, and volunteer onboarding, so that trusted contacts consistently introduce local services and make warm referrals rather than relying on impersonal websites and phone trees. Cross-agency communication efforts could coordinate engagement, reduce conflicting messaging, and tailor CBS information to the values and preferences of adults 75+, especially those with limited digital access.

Future research should examine how these strategies operate in different geographical and organizational contexts and integrate insights from CBS providers and caregivers to further refine multilevel, older adult-centered communication approaches to aging in place. Sustaining and expanding CBPR partnerships, with older adults, caregivers, and frontline staff as co-investigators, will be critical for adapting communication strategies and evaluating their impact.

Ecological health communication studies could incorporate service provider perspectives to explore how institutional routines and assumptions may inadvertently limit older adults’ engagement (Kieffer et al., 2013). Targeted work with adults ages 75+, who remain underrepresented in research, will be increasingly critical as this cohort continues to grow. Finally, studies that explicitly evaluate the formalization of community connector roles (e.g., retired professionals and volunteers serving as trained information ambassadors) and cross-agency collaborative models would help assess how such approaches affect CBS awareness and engagement.

Ultimately, meeting the needs of an aging population will require interventions that integrate ecological and community-grounded perspectives and are co-developed with older adults as end users, ensuring that those most affected have a decisive voice in how services are designed, delivered, and talked about in the peer conversations that most powerfully shape utilization.

Conclusion

Service utilization among older adults depends on layered and dynamic communication ecologies. Awareness, trust, and engagement are mediated by relationships, institutional practices, environments, and societal norms. Older adults are vital and active interpreters and ambassadors, underscoring the need for participatory, context-aware communication strategies. Ultimately, meeting the needs of an aging population will require interventions that integrate ecological and community-grounded perspectives and are co-developed with older adults as end users, ensuring that those most affected have a decisive voice in how services are designed, delivered, and talked about in the peer conversations that most powerfully shape utilization.