Continuing Care Retirement Community Residents Research Articles

MUSICAL THEATER AND MEANING MAKING IN A RETIREMENT COMMUNITY

Abstract “I think I’ve had it up to here with pickleball…” Thus begins the first song in “Movin”, an original musical written, produced, and performed by members of a continuing care retirement community (CCRC), which addresses themes ranging from dementia, death and widowhood to finding community, purpose, and late-life love. The idea began in informal conversation between two former university colleagues, Philip Sloane (a geriatrician, GSA member, and former CCRC board member) and Hugh Tilson (a CCRC resident, aged 82) about describing the aging experience through song. Hugh gathered a group of fellow CCRC residents, none of whom had professional songwriting or theater experience but several of whom had musical backgrounds or an interest in theater. Meeting regularly over nearly two years, they envisioned, created, and then produced an original musical around the theme of “freshman year in a retirement community.” The final production included 9 cast members, 12 original songs developed by five lyricists and two composers, many production-related volunteers, and a narration to link the songs together. This symposium will describe the process, present and illustrate aging-related themes from the production, place the musical in the context of existing research about meaning-making and the arts in later life, and conclude with a discussion by a senior leader in a major senior housing organization. Presentation about development and production of the musical will include videos of rehearsals, songs from the production, and interviews with performers. Sponsored by the Humanities, Arts, and Cultural Gerontology Advisory Panel

Objective Physical Activity Levels, Sedentary Time, and Muscle Mass, Strength, and Function: Impact on Physical and Mental Health-Related Quality of Life in Older Adults.

Limited physical activity, sedentary behavior, and reduction in muscle mass, strength, and function are accompanied by negative outcomes. The relationship between these factors and physical and mental health-related quality of life (HRQoL) has yet to be elucidated in continuing care retirement community (CCRC) residents. The current study investigated the relationships among physical activity, sedentary behavior, and muscle mass, strength, and function to physical and mental HRQoL. A sample of 105 CCRC residents participated in this cross-sectional correlational study. Findings demonstrated that low physical activity and muscle function were significantly associated with low physical HRQoL and explained 38% of the variance in physical HRQoL. Handgrip strength was significantly associated with low mental HRQoL and explained 8% of the variance in mental HRQoL. Older adults living in CCRCs may benefit from interventions targeting physical activity and the distinct muscle components of sarcopenia that have the potential to improve physical and mental HRQoL. [Research in Gerontological Nursing, 15(3), 131-139.].

Self-management processes, sedentary behavior, physical activity and dietary self-management behaviors: impact on muscle outcomes in continuing care retirement community residents

BackgroundDespite the known benefits of non-sedentary behavior, physical activity, and protein and caloric intake to health and muscle mass, strength, and function, many older adults do not meet physical activity and dietary recommendations. A better understanding of the factors associated with sedentary behavior, physical activity and dietary self-management behaviors, and muscle outcomes (muscle mass, strength, and function) is needed, particularly among continuing care retirement community residents. The objective of this study was to examine the factors associated with sedentary behavior, physical activity and dietary self-management behaviors, and muscle outcomes among continuing care retirement community residents. It also aimed to determine whether sedentary behavior and physical activity and dietary self-management behaviors mediate the relationships between self-efficacy, goal congruence, aging expectations, social support, and muscle outcomes.MethodsA sample of 105 continuing care retirement community residents (age > 70 years) participated in this correlational, cross-sectional study. Questionnaires on pain, self-efficacy, goal congruence, aging expectation, social support, and daily protein and caloric intake were administered. Physical activity and sedentary behavior (ActiGraph wGT3X-BT), muscle mass (ImpediMed SFB7), muscle strength (Jamar Smart Digital Hand Dynamometer), and muscle function (Short Physical Performance Battery) were measured. Multiple regression, logistic regression, and mediation analyses were performed.ResultsLow goal congruence predicted engagement in sedentary behavior and light physical activity. Higher levels of self-efficacy and social support were associated with increased likelihoods of achieving greater moderate physical activity and meeting daily recommendations for caloric intake, respectively. Self-efficacy and goal congruence predicted muscle function and strength. Moreover, sedentary behavior and achieving greater moderate physical activity were found to partially but significantly mediate the relationship between self-efficacy and muscle function.ConclusionFuture research should evaluate whether attempts to reduce sedentary behavior and promote physical activity and dietary self-management behaviors and muscle outcomes are more successful when modifications to the self-management process factors are also targeted.

Malnutrition-Sarcopenia Syndrome and Self-Management Behaviors in Continuing-Care Retirement Community Residents.

Malnutrition–sarcopenia syndrome (MSS) might put older adults at higher risk for disability, frailty, and mortality. This study examined the prevalence and association of the self-management-process factors (i.e., self-efficacy and aging expectations) and behaviors (protein and caloric intake and sedentary and physical-activity behaviors) to MSS among older adults living in continuing care retirement communities (CCRCs). Using a cross-sectional correlational design, data of 96 CCRC residents (82.4 ± 7.4 years) were analyzed. Muscle mass, strength, function, nutritional status, sedentary time, physical activity levels, protein and caloric intake, self-efficacy for physical activity, aging expectations, and physical and mental health-related quality of life were measured. Results show that 36 (37.5%) had sarcopenia, 21 (21.9%) had malnutrition risk, 13 (13.4%) had malnutrition, and 12 (12.5%) had MSS. We also found that high time spent in sedentary behaviors (OR = 1.041; 95% CI: 1.011–1.071) was associated with higher odds of having MSS and high expectations regarding aging (OR = 0.896; 95% CI: 0.806–0.997) were associated with less likelihood of having MSS. Findings suggest that CCRC residents should be screened for MSS. Self-management interventions that consider the self-management-process factors are needed to prevent MSS and mitigate its negative outcomes among CRCC residents.

Location, location, location: Close ties among older continuing care retirement community residents.

This study examines two theoretical explanations for the existence of close ties among continuing care retirement community residents: the attractiveness theory, which suggests that residents who possess certain attributes are more likely to be perceived as appealing to others; and the homophily theory, which argues that individuals are more likely to have close ties with people who share similar attributes. As a variant of the homophily theory, we also examined whether sharing a physical location makes the existence of certain connections more likely. Data from four continuing care retirement communities were used. To test the attractiveness theory, correlations between the number of individuals who named a person as a significant contact (ego’s in-degree) and ego attributes were examined. To test the homophily theory, the median value of existing ties was compared against all possible social ties as though they were randomly formed. Finally, to further test the role of the institutional culture against various motivations that drive social ties—attractiveness and homophily—we used link prediction models with random forests. In support of the homophily theory, beyond the institutional culture, the only consistent predictor of the existence of close ties among residents was sharing a wing in the retirement community (geographic proximity). Therefore, we discuss the role of the physical location in the lives of older adults.

A Typology of Source of Information About the Continuing Care Retirement Community and Older Adults’ Living Arrangement

A continuing care retirement community (CCRC) represents a residential alternative for older adults. It offers a variety of social and health care services to meet older adults’ needs and preferences. Using the theory of innovation as a theoretical basis, the overall goal of the study was to use the source of information about the CCRC as a potential predictor of the decision to move. In total, 76 older adults responded to a question about the source of information on the CCRC. Of these, 40 were CCRC residents and 36 were community dwellers, who expressed an interest in the CCRC but decided to remain in their community. Based on their responses, respondents were classified into one of five clusters (e.g., spouse, friends, children, nonhuman sources, mixed human and nonhuman sources). Those classified into the spouse or adult children as sources of information were more likely to live in a CCRC. Results show that information about the CCRC should be conveyed to additional members in the family, such as adult children, as they often take a major role in the decision to relocated. The findings have implications for administrators as they clearly point to potential sources of greater influence on older adults’ decision to relocate.

Should I've stayed or should I've gone? What residents of continuing care retirement communities and former candidates think and feel one year after their decision: a quantitative longitudinal comparison

AbstractThe aim of this study was to compare satisfaction with residence, wellbeing and physical health of continuing care retirement community (CCRC) residents with people who considered enrolling in the same CCRCs but elected not to move. A total of 101 participants were recruited from 13 CCRCs located in multiple cities in the United States of America. A phone interview was conducted with participants three months or less from enrolment and one year later. Compared with those who chose not to move, CCRC residents reported lower satisfaction at baseline, but higher satisfaction at one year. Wellbeing declined from baseline to follow-up for both groups, but was higher in CCRC residents both at baseline and at one year. CCRCs might consider giving new residents a longer cancellation period in order to allow sufficient time for the adjustment process. This, in turn, might both prevent an early departure and affect the decision of potential CCRC residents to move into the community.

Diagnostic Assessments of Service Quality in a Continuing Care Retirement Community (CCRC): an Exploratory Study

ABSTRACTThis study assesses service quality and suggests customized strategies for improvement of the service quality in a continuing care retirement community (CCRC). Questionnaires based on the SERVQUAL framework and adapted for CCRCs were distributed to 293 CCRC residents first to measure their perceived importance and subsequently asses the performance of the CCRC on 25 service quality attributes. Descriptive analysis, confirmatory factor analysis, paired-samples t-test, and regression were used to analyze the data from 118 respondents who participated in both surveys. The results indicated that four service-quality attributes (one item in the reliability dimension and three items in the responsiveness dimension) were the priorities for service quality improvement. Theoretical and practical implications are discussed and recommendations are made for future research in the CCRC context.

COMMUNITY-BASED SERVICES AND RESOURCES IN A RESIDENTIAL SETTING: LOCATION MATTERS

One key component to facilitate an older adult’s ability to remain in the community is provision of formal services in their residence. However, service-accessible housing options are often limited to those with financial means, and many older adults remain in housing that is considered “service-poor.” The study examines the disparity of services availability by types of residence. Using cross-sectional data from Wave 2 of the Pathways to Life Quality dataset, we examined the sociodemographic characteristics, health status, and social support by residence for adults aged 50 and older. Data were categorized by elders living in their own home in the community (N=347), independent elders living in service-rich housing (Continuing Care Retirement Community residents; N=188) and elders living in service-poor housing (government subsidized housing; N=137). Data were analyzed across groups using ANOVA. The sample was a majority female, with an average age of 76 (range 50–101). Older adults living in the service poor residences had lower socioeconomic resources (lower education levels, less income; p-values<.000), worse health (higher functional limitations, more chronic conditions; p-values<.000), and less social resources (less social integration, less social support, lower marriage rates; p-values<.000) compared to those in service-rich residences or living in the community. These data suggest that elders living in service-poor areas are not only vulnerable due to lower service availability, but also have high social, economic, and health vulnerability. It is particularly important to identify groups that are most vulnerable in order to target interventions efficiently. Recommendations for policy and practice will be discussed.

The Role of Hospitality Service Quality in Third Places for the Elderly: An Exploratory Study

This study examines the role of hospitality service quality in a third place for the elderly using a Continuing Care Retirement Community (CCRC) setting. The study builds from the relational theory of third places testing the causal relationships among resident needs, place meaning, and loyalty outcomes. The study extends the theory by applying it to the CCRC context through using data that were collected from 157 CCRC residents in the southeastern portion of the United States. The proposed relational third-place model using the construct of place meaning was tested using confirmatory factor analysis (CFA) and structural equation modeling (SEM). Results indicated that resident needs (tangibles, instrumental support, and emotional support) positively influenced place meaning, and in turn place meaning positively impacted resident loyalty outcomes. Through the relational theory of third places, the CCRC is a meaningful place to residents, and CCRC residents are loyal to the community. Most importantly, the results of the study identified that service quality strongly impacted place meaning in the CCRC. Theoretically, the study provided valid and reliable support suggesting that the construct of place meaning is applicable to the CCRC setting. Practically, this study provides empirical support for the importance of providing a rich hospitality service culture through strengthening instrumental support, emotional support, and tangibles. In this way, management should establish a culture that is rich in hospitality and service through the enhancement of tangibles, empathetic and interactive staff care. Finally, this rich culture will lead to enhanced place attachment as supported by this exploratory study.

Do not hear, see, or speak: views of older residents and their adult children about the nursing unit in the continuing care retirement community.

The present study evaluated views of continuing care retirement community (CCRC) residents and their adult children concerning the nursing unit (NU) within the CCRC. Qualitative interviews with older adults and their adult children were conducted. Analysis consisted of 187 interviews with older adults and their adult children over a period of up to six years. Analysis relied on constant comparisons within the same interview, over interviews of the same person over time, and between CCRC residents and their adult children. Major themes were identified to construct a coherent storyline. The NU was viewed as a different universe that should be avoided at all costs. This was attributed to: (1) the association of the NU with one's impending decline and dependence and (2) beliefs about substandard care in the NU. The findings point to the ambivalence expressed by CCRC residents and their adult children concerning the NU, even though to some degree, the NU represents the main reason for the transition to a CCRC.

Designing for social needs to support aging in place within continuing care retirement communities

With advancing age and disability, continuing care retirement community (CCRC) residents relocate to the next care level as needed. Occasionally, independent living does not offer services a resident needs, yet the resident may not be ready for assisted living. Additionally, since research indicates relocation negatively impacts frail adults’ health/well-being (Bernard et al. 1996), it is reasonable to ask if this approach is optimal. Might aging in place within independent living be more beneficial? Research also shows satisfying social needs is increasingly important to supporting health (Glass et al. 2006) and life satisfaction (Jang et al. 2004) as we age. How then, do we design to support resident social interaction without necessitating relocation? As aging residents experience physical declines such as limited mobility, nearby space designs become increasingly important. This study involving south eastern US, CCRC residents sought to determine how aging in place might be supported by social space designs. Using the Successful Social Space Attribute Model (Campbell 2014) as its organizing framework, this study examined independent and assisted living resident perspectives to identify factors impacting how well social spaces were liked and used, the markers of social space success. For both groups, this study identified two factors: active engagement opportunities (i.e. ways to engage with the environment and other people), and home range (i.e. resident’s daily path of travel). These findings suggest guidelines for designing CCRC social spaces to support aging in place.

Perceptions of old age and aging in the continuing care retirement community.

The continuing care retirement community (CCRC) is a long term care alternative available to older adults who are independent upon entrance. The present study evaluated perceptions of old age and aging among new CCRC residents and their adult children. A qualitative study with 34 dyads of older adults and their adult children (34 adult children and 36 older adults) was conducted. Interviews were analyzed using constant comparisons within and across interviews. Dyadic analysis of older adults-adult children interviews was followed. Three major themes concerning the perception of old age and aging emerged: (a) expectations for multiple losses that occur in old age; (b) different views and definitions of old age as being composed of various dimensions including chronological age, mental age, physical age and appearance and (c) diverse perceptions of the CCRC as a luxurious hotel vs. the "last stop." A more balanced portrayal of old age and the CCRC might result in an easier acceptance of these concepts among older adults and their adult children.

Drinking behavior among older adults at a continuing care retirement community: affective and motivational influences

Objectives: The purpose of this pilot study was to describe patterns of alcohol consumption among continuing care retirement community(CCRC) residents and to explore the role of drinking motives and affective states on drinking context and consumption.Method: We utilized a phone-based daily diary approach to survey older adults about their daily alcohol consumption, context of drinking (e.g. drinking alone), positive and negative affect, and their motives for drinking. Data were analyzed descriptively, and regression models were developed to examine associations between sociodemographic factors, affect, drinking context and motives, and alcohol consumption.Results: CCRC residents drank most frequently at home and were alone almost half of drinking days on average, although the context of drinking varied considerably by participant. Problem alcohol use was rare, but hazardous use due to specific comorbidities, symptoms and medications, and the amount of alcohol consumption was common. Respondents endorsed higher social motives for drinking and lower coping motives. Social motives were associated with decreased likelihood of drinking alone, but negative affect was associated with decreased likelihood of drinking outside one's home. Coping and social motives were associated with greater consumption, and higher positive affect was associated with lower consumption.Conclusion: Among CCRC residents, alcohol use may be socially motivated rather than motivated by coping with negative affect. Future research should examine other motives for drinking in older adulthood. Evaluation of older adults living in CCRCs should include attention to health factors beyond problem use as other forms of hazardous use may be common in CCRCs.

Social Ties in the Context of the Continuing Care Retirement Community

In this article, we evaluate social ties in the context of the continuing care retirement community (CCRC). We interviewed 29 CCRC residents and 19 adult children about the transition to the CCRC. We analyzed the interviews thematically, while searching for consistencies and differences regarding social ties within and across interviews. Three major themes were identified: a time dimension, representing the perceived qualities of relationships based on the time during which the relationships were first formed; and two spatial dimensions, representing the CCRC vs. the community at large and private vs. public space and identity. The findings demonstrate that social ties can be classified according to dimensions of time, space, and quality--classifications that are not currently incorporated in the gerontological literature. Although CCRCs help to alleviate the social loneliness (i.e., lack of social ties) experienced by older adults, they are less successful in alleviating emotional loneliness (i.e., lack of intimate relations).

Factors Associated With Permanent Transition From Independent Living to Nursing Home in a Continuing Care Retirement Community

Identify risk factors for and time to permanent transition from independent living units to nursing home among residents in a continuing care retirement community (CCRC). Prospective cohort study (n=298) among residents at least 75 years of age living independently at baseline. Proportional hazard regression identified risk factors associated with permanent transition from sociodemographic and health status data. During the 3-year follow-up, 11% of the subjects were permanently transferred. Predictive factors were depression (relative risk [RR] 3.9; 95% CI 1.5-9.8), incontinence (RR 3.8; 95% CI 1.3-11.4), impaired cognition (RR 3.6; 95% CI 1.1-11.3), and dependence on activities of daily living disability (RR 1.5; 95% CI 1.3-1.8). Compared with those with no risk factors, presence of all 4 increased the relative risk to 74-fold and shortened the time to permanent transition by 32 months. Prevention and treatment for depression, incontinence, and programs to improve or maintain cognitive function and ability to perform activities of daily living among CCRC residents may prolong their independent living life.

"But I Am Not Moving": Residents' Perspectives on Transitions Within a Continuing Care Retirement Community

This article investigates how continuing care retirement community (CCRC) residents define transitions between levels of care. Although older adults move to CCRCs to "age in place," moving between levels of care is often stressful. More than half a million older adults live in CCRCs, with numbers continually increasing; yet, no studies address transitions between levels of care in these communities. I completed 23 months of live-in observation and conducted 35 face-to-face in-depth interviews with CCRC residents across 3 levels of care. I performed a thematic analysis of observation notes and interview transcripts. Residents perceived transitions as both disempowering and final. They discussed decreases in social networks that occurred after such moves. Resident-maintained social boundaries exacerbated these challenges. Although the transition to institutional living is one of the most important events in older persons' lives, transitions within CCRCs also are consequential especially because they are coupled with declining functional ability. These findings may inform policy for retirement facilities on topics such as increasing privacy, challenging social boundaries, and educating residents to prepare them for transitions.

(220) Evaluation of the Effects of Pain and Depression on the Physical Functioning of Continuing Care Retirement Community Residents: Implications for the Treatment of Pain in Older Individuals

Chronic pain is a major obstacle to a satisfying old age. With 35 million persons over age 65 in the U.S., and the number projected to double by 2030, chronic pain in the elderly is becoming a significant public health problem. A longitudinal study of 228 independently living retirement community (CCRC) residents was conducted to explore the relationships between pain, depression, and functional disability. The sample was predominantly age 75–84, the majority were female, and most had completed college. Self-report measures of pain (adaptation of McGill Pain Questionnaire), depression (Geriatric Depression Scale (GDS), and physical functioning (Self-reported physical performance, ADL, IADL, and 3 meter walking speed) were assessed. 79% of the sample reported pain within the past 2 weeks. 50% of these indicated pain limited their activities. Sub-threshold or major depression was diagnosed in 39%, and almost 23% reported both activity limiting pain and sub-threshold or more severe depression while 13% reported freedom from pain and depressive symptoms. For analyses, individuals in the worst quartiles of functional performance and walking speed at baseline were contrasted to all others; for ADL and IADL, those needing help were compared to those independent in activities. In univariate analyses, pain and depression were strongly related to physical performance; depression was related to ADL and walking speed. Multivariate analyses revealed an interaction effect in which the effects of pain depended on depression level. Individuals reporting activity limiting pain and elevated depressive symptoms, sub-threshold, or major depression were over 7 times more likely than non-depressed persons to be in the worst physical performance quarterly. This finding is statistically significant (P < 0.001). While pain and depression affect physical performance, depressive symptoms rather than pain appear more critical. When seeing older patients with pain complaints, thorough evaluation for and treatment of depressive symptoms and disorders are essential.

Intergenerational Engagement in Retirement Communities: A Case Study of a Community Capacity-Building Model

An intergenerational intervention strategy called Generation Station was established and field tested at a continuing care retirement community (CCRC) in central Pennsylvania over a 13-month period beginning in 2001. With the goal of exposing residents to a broad range of possibilities for intergenerational contact, the emphasis of this intervention was on building the institution’s capacity to conduct intergenerational programs rather than on creating a finite, activity-specific program. The process involved identifying local children and youth programs, engaging administrators in interagency dialogue, and formulating intergenerational program-matic links based on complementary objectives and curricula of local organizations. Results were drawn from interviews conducted with CCRC residents and staff and from observations of intergenerational activities. CCRC residents and staff deemed multiple activities with multiple organizational partners as a convenient way to establish a flexible program and address the diverse interests, abilities, and preferences of retirement community residents and local youth.

Do Residents Want Automated External Defibrillators in Their Retirement Home?

The administration of a continuing care retirement community (CCRC), while weighing practical and ethical questions surrounding installation of automated external defibrillators (AEDs), wanted to consider resident opinions. No databased studies on this subject were found. After an information session about AEDs, CCRC residents were surveyed concerning their opinions on AED installation, their beliefs and concerns regarding AEDs, their advance directive status, and their demographic characteristics. Correlations were sought between choices about AED installation and beliefs, advance directives, and demographics. Seventy-eight percent of 107 eligible residents participated. Twenty-seven percent wanted AEDs installed, 37% were not sure, 23% were opposed, and 11% did not answer this question. Univariate analysis showed that women, the widowed or single, and those with a college degree were more likely to oppose AEDs. In the best logistic regression (LR) model the hope that "AED use could be life saving" and the fears that "AED use might lead to a very poor quality of life" and that "AEDs might be misused" were more important than any demographic variables and only education remained in the model. Those opposing AEDs supplied powerful written comments to support their choice. There is no consensus and great indecision about AED installation among the residents of this CCRC. The subjects were somewhat older and more affluent than the typical retirement home population, pointing to the need for replicating the investigation with a larger and more diverse study population. However, these findings suggest that AED installation in a retirement home would be premature without engaging the entire community in discussions and education in a process considerate of the wishes of all residents, which are likely to be quite diverse.