Engagement Of Older Adults Research Articles

“It Is More Than Just about Music”: Lifelong Learning, Social Interaction and Connection

For older people, participating in leisure activities enhances their sense of social, emotional, mental, spiritual and psychological wellbeing. This article reports on a case study that situated itself across two southern hemisphere countries – Australia and South Africa – and with two ensembles, namely: an instrumental ensemble in Melbourne (all musical readers); and a vocal ensemble in Clarens (all non-readers of music). The authors drew on Seligman's elements of positive emotion, engagement, relationships and meaning, and accomplishment (PERMA) to explore the ensemble members’ engagement as “serious leisure and the wider community”. Using qualitative case study methodology, they employed interpretative phenomenological analysis (IPA) as an organising tool to analyse and code their questionnaires and interview data. The findings are presented under three overarching themes, namely: meeting for serious leisure; music learning; and connecting with the wider community. While music engagement for older adults is an achievement in itself, sharing it with the wider community is considered most significant for the participants. Discussing two ensembles is a limitation in itself, therefore generalisations to other ensembles cannot be made. The article was written in 2020 during the COVID-19 lockdown period in both countries. Further research is planned across both countries to explore any implications the lockdown has had on the two groups once they are permitted to recommence rehearsals.

Advance Care Planning: Social Isolation Matters.

Social isolation is a risk factor for poor health that influences the well-being older adults. We compare advance care planning (ACP) engagement of older adults who were severely socially isolated, socially isolated, and not socially isolated. Cross-sectional analysis of the 2012 National Health and Aging Trends Study (NHATS). United States of America. A total of 2015 older adults (aged ≥65 years) randomly selected from a representative sample of community-dwelling Medicare beneficiaries to participate in an ACP module as part of an annual in-person interview. We classified participants in three groups: severely socially isolated, socially isolated, or not socially isolated. ACP refers to three (yes/no) questions regarding whether a participant had a: (1) prior discussion about care preferences in the case of serious illness (EOL Discussion); (2) durable power of attorney (DPOA); and (3) advance directive (AD). We performed logistic regression analyses to examine the association between social isolation and ACP. Approximately 23% of older adults were either severely socially isolated or socially isolated. Older adults who experienced social isolation were less likely to engage in ACP than those who were not socially isolated. In adjusted analysis, older adults who were socially isolated had lower odds of having an EOL discussion (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI] = 0.49-0.87) or having a DPOA (AOR = 0.71; 95% CI = 0.53-0.96) compared to those who were not socially isolated. Social isolation is associated with lower engagement in ACP. Clinicians should identify older adults who are at risk for or experience social isolation as they may benefit from targeted ACP efforts. J Am Geriatr Soc 68:841-846, 2020.

USING SOMATOSENSORY GAMES TO IMPROVE HEALTH AND SOCIAL ENGAGEMENT OF TAIWANESE OLDER ADULTS IN A COMMUNITY

Objective. Playing games has become a new way to enhance the physical activity, quality of life, social engagement of older adults. This study aims to conduct a 6-month somatosensory game program, inviting older adults to play Microsoft Xbox Kinect games and study whether games can bring benefits to them. Methods. A total of 70 community-dwelling older adults (35 as experimental group, 35 as controls) were recruited. The experiment group played somatosensory games twice per week in a local health center. These games contained three types of categories: 1) Tournament games (for upper limb and lower limb); 2) Single games (for aerobic exercise and muscle training);3) Puzzle games (for collaboration and group dynamics): Results. After 6 months, in the experiment group, the body mass index decreased from 23.45 to 23.29 (p<0.03). In muscular endurance category, 30 second chair rise jumped from 18 to 23.07 (p<0.0001). And 2 min leg lifting increased from 119.48 to 137.75 (p<0.001). In the flexibility category, back scratch test from right hand on top and left hand on top both improved (p<0.026; p<0.46, respectively). Trend analysis indicates that the improvements in 30 second chair rise (p<0.0001) and 2 min leg lifting (p<0.001) is linear. The intensity of social interactions increased noticeably in the experiment group. The SF8 health survey also revealed that experimental group perceived lower level of bodily pain. No significant improvement in the control group in all categories. Conclusion. Playing somatosensory games regularly may help older adults physically and socially.

SENIOR COMMUNITY CENTER AS A SOCIAL ENGAGEMENT PLATFORM FOR OLDER ADULTS IN NEPAL: AN ADAPTATION OF WESTERN CONCEPT

Older adults around the world are living longer. Similarly, in Asian countries longevity of older adults have significantly altered the demographics shift as well as the cultural landscape and needs of the society. These changes have compounded with challenges and needs as a community grapples with how to best take care of aging population. Nepal, a developing country, is also faced with a similar demographic shift among the geriatric population. This shift has brought challenges and needs to communities such as health care, daily living needs, social support systems, economic needs, etc. The geriatric population will require social support systems as they age. Historically, older adults have relied on traditional family support systems for their care and needs maintaining cultural values and norms which may burden immediate or extended family members. Recently, traditional family structures along with social support systems are breaking away from their family trees due to community advancement and modernization, and many are leaving for better economic opportunities. This trend has left many older adults alone in social isolation. Despite challenges in the community, Nepal government doesn’t offer infrastructure for social engagement for older adults. One solution to prevent isolation and loneliness is to establish “senior community centers” (western based concept) for social engaging older adults. Based on ecological framework, this presentation proposes a need of “Senior Community Centers” for older adults where they can become involved in social engagements and receive social supports outside traditional family support systems; thus, optimizing their health and well-being.

WECHAT, WERUN: A GROUP-BASED WALKING STUDY TO ENHANCE PHYSICAL ACTIVITY AMONG COMMUNITY-DWELLING OLDER ADULTS

The benefits of physical activity (PA) and social engagement for older adults are well established, yet the majority of adults over age 50 in the U.S. do not engage in regular exercise. We conducted a 4-week pre-post study with a one-month follow-up using a smart phone application called WeChat WeRun to explore the mechanisms of social engagement and competition to increase PA among older adults. Participants (N=40, mean age=65.7) were randomly assigned to one of two conditions. Participants in the activity competition condition used the WeRun to track their daily walking steps and interact via text with their group members for 4 weeks. The daily walking steps were displayed to the group and the participant with the highest daily steps in the group was indicated as the champion each day. Participants in the control group only used WeRun to track their own walking steps. Outcome variables included average weekly steps, exercise self-efficacy, and social engagement. The two-way repeated measures ANOVA results revealed that participants in the competition condition had higher average weekly steps and level of social engagement at the posttest, compared to those in the control group. Post hoc tests using the Bonferroni corrections revealed that the intervention increased their average weekly steps and social engagement from pretest to post-test, while these outcomes did not change in the control group. The effects were maintained at the one-month follow up. Discussion will consider the motivational role of competition and social interactions in increasing PA among older adults.

EFFECTS OF PRODUCTIVE ENGAGEMENT ON SUBJECTIVE HEALTH AMONG OLDER ADULTS WITH SENSORY IMPAIRMENTS

Background: Productive engagement becomes significant protective factors in healthy aging. Yet, subgroups of older adults with age-related vision and hearing impairments lack access to various activities , suggesting that unequal ability to participate in productive aging is a major public health and health-disparities concern. Methods: Older adults experiencing age-related vision and hearing impairments were drawn from the 2015-2017 National Survey on Drug Use and Health (n=2,164). Perceived health status (good vs. poor) was outcome measures used in multivariate logistic regression. Two aspects of productive engagement was considered: 1) employment status (unemployed vs employed) and 2) regular religious service attendance as tools to build social capital in their faith-based communities. Gender, race, marital status, educational attainment, poverty, urbanization, obesity, chronic disease, hospitalization, binge drinking, cigarette smoking, and difficulty with mobility were considered as covariates. Results: Working older adults with sensory loss were more likely to perceived good health status, compared to their unemployed counterparts (OR=2.46, p<.05). Religious service attendance also became protective factors for health (OR=1.60, p<.01). Of the covariates, higher educational attainment, White race, having one chronic disease, hospitalization, smoking, drinking, and mobility challenges appeared to affect the health status. Conclusions/Implications: Study findings implied the needs to identify late-life engagement through work and participation in faith-based community as a major public health issue. Given the barriers and disincentives to the productive engagement of older adults in this culture, healthcare providers should provide programs promoting employment and religious attendance.

Stakeholder Requirements for an Ethical Framework to Sustain Multiple Research Projects in an Emerging Living Lab Involving Older Adults.

Living Lab (LL) research should follow clear ethical guidelines and principles. While these exist in specific disciplinary contexts, there is a lack of tailored and specific ethical guidelines for the design, development, and implementation of LL projects. As well as the complexity of these dynamic and multi-faceted contexts, the engagement of older adults, and adults with reducing cognitive and physical capacity in LL research, poses additional ethical challenges. Semi-structured interviews were undertaken with 26 participants to understand multistakeholder experiences related to user engagement and related ethical issues in emerging LL research. The participants' experiences and concerns are reported and translated into an ethical framework to guide future LL research initiatives.

Experience of Older Adults with Mild Cognitive Impairment in an Arts Program

This study aimed to explore the experiences of art engagement with older adults experiencing mild cognitive impairment. Data was collected from participants (n = 8) involved in a group art engagement program. A thematic approach was used for data analysis. Researcher field notes were used to further support and enrich the data. Three themes emerged: socialization, session enjoyment, and mental stimulation. Participants identified that the program held meaning and benefitted them. This study supports the use of group art engagement for older adults experiencing mild cognitive impairment for socialization, enjoyment and mental stimulation and may improve overall quality of life.

Aging, exercise and motivating engagement

ABSTRACTSome older people describe learning to stay fit and healthy and exercise as a regular part of their lives. There is evidence that exercise is beneficial in terms of physical, psychological and social functioning in older adults. This paper is unique in that it is an analysis of the spontaneous discussion of exercise by older people as a priority in their lives. It also provides information about the kinds of exercise they choose. An online written data forum in Australia with responses from 103 people aged 50 to 92 years (F52, M 51) was analysed for all mention of exercise. The respondents were prompted to comment on sustainable lifestyles as they aged. Thirty per cent mentioned exercise as a priority in their lives. Activities included irregular exercise (11%) routine organised exercise such as golf or tennis (8%) and purposeful exercise such as regular gym attendance (11%), where the respondents explained why they needed to exercise. A few (7%) talked about the need to stay healthy without explaining how. Some (2%) described barriers and conditions that made exercise difficult. These figures for engaging in exercise are similar to those identified in 2018 by the Australian Institute for Health and Welfare. As evidenced by the literature in the area, lack of awareness of the specific benefits of exercise and barriers to exercise for older adults are not new problems. However, given the increase in the percentage of older people in the population and the demonstrated beneficial effects of exercise, it is worthwhile to document the motivation for exercise and engagement in older adults and to suggest strategies to increase their activity.

Social Engagement and Amyloid-β-Related Cognitive Decline in Cognitively Normal Older Adults

ObjectivePublic health recommendations promote social engagement to reduce risk of cognitive decline and dementia. The objective of this study was to evaluate the longitudinal associations of social engagement and cognition in cognitively normal older adults with varying levels of neocortical amyloid-β, the Alzheimer's disease (AD) pathologic marker. MethodsTwo hundred seventeen men and women, age 63–89 underwent assessments for social engagement and cognitive performance at baseline and 3 years later using the Community Healthy Activities Model Program for Seniors questionnaire and the Preclinical Alzheimer Cognitive Composite (PACC). Amyloid-β was measured using Pittsburgh compound B-PET. Multivariable regression models estimated main and interactive effects of baseline social engagement and amyloid-β on cognitive change. Reciprocal models estimated main and interactive effects of baseline cognitive performance and amyloid-β on change in social engagement. ResultsBaseline social engagement was associated with PACC change as a modifier but not as a main effect. Lower baseline social engagement was associated with greater amyloid-β-related PACC decline, while higher baseline social engagement was associated with relative preservation of PACC scores (β = 0.05, p = 0.03). Reciprocally, lower baseline PACC score was associated with decline in social engagement score (β = 1.1, p = 0.02). This association was not modified by amyloid-β, and there was no direct association of amyloid-β with change in social engagement. ConclusionsLow social engagement may be a marker of neurocognitive vulnerability in older adults who are cognitively normal but have evidence of AD pathophysiologic change. Understanding changes in social engagement in older adults may lead to earlier diagnosis of AD and advances in evidence-based prevention and treatment.

Loneliness and social engagement in older adults: A bivariate dual change score analysis.

Few longitudinal studies have explored the impact of loneliness on social engagement. We investigated whether loneliness would result in decreased social engagement over time among older adults and also whether the converse, that low levels of social engagement would predict increases in loneliness, held. Additionally, we explored potential mechanisms (specifically, memory and depressive symptomatology as mediators) in the bidirectional relationship(s) between loneliness and social engagement. Data from 4,714 adults over 50 years of age, participating in Waves 3, 4, and 5 of the English Longitudinal Study of Ageing (between 2006 and 2011), were analyzed using bivariate dual change scores within structural equation models. Higher levels of loneliness were inversely associated with social engagement over time, and high levels of social engagement were inversely associated with loneliness over time. To address the 2nd aim, we used structural equation modeling to evaluate potential mediators of the bidirectional relationships between loneliness and changes in social engagement. Depressive symptomatology, semantic memory, and episodic memory were found to partially mediate the relationship between loneliness measured at baseline and social engagement 4 years later. In addition, these variables also partially mediated the relationship between social engagement at baseline and loneliness 4 years later. A comparison of the 2 models revealed that the model proposing a pathway from loneliness to social engagement (as mediated by depressive symptoms and memory) provided a better fit to the data. Implications for theories of loneliness are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Fall Worry Restricts Social Engagement in Older Adults.

Objective: To examine cross-sectional and longitudinal associations between (a) activity-limiting fall worry (ALW) and (b) self-reported health-related restrictions and social engagement among older adults. Method: The National Health and Aging Trends Study Waves 5 (T1) and 6 (T2) provided data (n = 6,279). Binary and multinomial logistic regression models were used to examine association of T2 social engagement restrictions with T2 fall worry and association of T1-T2 changes in social engagement restrictions with T1-T2 changes in fall worry. Results: ALW was significantly associated with both informal and formal social engagement restriction at T2. Onset of ALW and continued ALW between T1 and T2 were also significantly associated with newly reported restrictions in both informal and formal social engagement at T2 even controlling for falls incidents and changes in health status and other covariates. Discussion: The findings underscore the importance of reducing fall worry and preventing social disengagement in late life.

Video-Delivered Relaxation Intervention Reduces Late-Life Anxiety: A Pilot Randomized Controlled Trial

The study's aim was to demonstrate the feasibility and preliminary efficacy of a 4-week video-delivered relaxation program called Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE) for reducing anxiety and increasing activity engagement in older adults with anxiety disorders. This was an 8-week pilot randomized controlled trial performed as outpatient and self-directed learning at home among 40 community-dwelling adults aged 60years or older who met criteria for an anxiety disorder (generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, or anxiety disorder unspecified). The study looked at the BREATHE intervention compared with a wait list control condition. The primary outcome measure was anxiety symptoms (Geriatric Anxiety Scale). Secondary outcomes included activity engagement (modified Activity Card Sort), depressive symptoms (Patient Health Questionnaire), and somatic symptoms (Somatic Symptom Scale). In linear mixed-effects models, findings indicated a significant reduction in anxiety symptoms. There was no significant effect of group on activity engagement. Results also showed significant reductions in depressive and somatic symptoms associated with the BREATHE intervention compared with wait list. Our findings demonstrate feasibility and preliminary efficacy for this brief video-delivered relaxation intervention and suggest that older adults can benefit from technology-delivered interventions with minimal provider contact. Although activity engagement did not improve, lessons learned suggest that targeted coaching around activity goals may help target this outcome.

Cultural engagement and incident depression in older adults: evidence from the English Longitudinal Study of Ageing.

There is a recognised need for the identification of factors that might be protective against the development of depression in older adults. Over the past decade, there has been growing research demonstrating the effects of cultural engagement (which combines a number of protective factors including social interaction, cognitive stimulation and gentle physical activity) on the treatment of depression, but as yet not on its prevention.AimsTo explore whether cultural engagement in older adults is associated with a reduced risk of developing depression over the following decade. Working with data from 2148 adults in the English Longitudinal Study of Ageing who were free from depression at baseline, we used logistic regression models to explore associations between frequency of cultural engagement (including going to museums, theatre and cinema) and the risk of developing depression over the following 10 years using a combined index of the Centre for Epidemiological Studies Depression Scale (CES-D) and physician-diagnosed depression. There was a dose-response relationship between frequency of cultural engagement and the risk of developing depression independent of sociodemographic, health-related and social confounders. This equated to a 32% lower risk of developing depression for people who attended every few months (odds ratio (OR) = 0.68, 95% CI 0.47-0.99, P = 0.046) and a 48% lower risk for people who attended once a month or more (OR = 0.52, 95% CI 0.34-0.80, P = 0.003). Results were robust to sensitivity analyses exploring reverse causality, subclinical depressive symptoms and alternative CES-D thresholds. Cultural engagement appears to be an independent risk-reducing factor for the development of depression in older age.Declaration of interestNone.

More Than Preaching to the Choir: Religious Literate Activity and Civic Engagement in Older Adults

Civic engagement has long been a topic that has drawn the attention of scholars in literacy and composition studies more broadly, and it is also a particular interest of both religious literacies and Age Studies. This article has an eye toward bringing these two conversations together—civic engagement in religious settings and civic engagement as practiced by older people—-through the lens of literate activity as practiced by progressive Christian churchgoers. Drawn from ethnographic fieldwork with a church book group, I argue that the members of the Pub Theology book group push back against the isolation and individualism of decline ideology and cookie-cutter notions of volunteerism promoted by productive aging, instead creating a robust model of civic engagement for older adults that is rooted in literate activity. Instead of being obsolete and useless, their familiar literate practices are crucial to connecting what they learned from their chosen texts, The New Jim Crow and Just Mercy , to their more expansive experiences of civic engagement as older members of their community.

Improving Patient-Provider Partnerships across the Healthcare System

Background: Patient engagement has been identified as a central element of patient-centred care, and engaged patients are more likely to understand their health conditions, participate in treatment plans, and report greater satisfaction with their healthcare 1. Despite the widely recognized benefits of a more patient-centred healthcare system, there is a lack of consensus on how this can be achieved. Patients and their caregivers wish to be engaged in decision-making, but this is often not well accommodated in existing practice models. In prior work, we synthesized available evidence around engagement of older adults in healthcare decision-making into the “CHOICE” Patient Engagement Framework 2. The CHOICE framework emphasizes the development of meaningful relationships that allow mutual understanding of values and preferences. In partnership with patients, caregivers and health care providers, this current project aimed to answer the following questions: 1 How do the CHOICE principles correspond with actual experiences of engagement? 2 What factors currently facilitate or hinder engagement? and 3 What resources and materials are needed to support patient engagement? Methods: We conducted observations and interviews in two healthcare settings with providers n=10 and older adults n=15 to understand current perspectives, practices, and facilitating/hindering factors related to patient engagement. Health care providers n=120 were also consulted in a facilitated one-day workshop, with notes taken of small group discussion and individual feedback. Observation and interview data were analyzed using emergent coding as well as directed coding guided by the CHOICE Framework. Results: Experiences of engagement were consistent with the CHOICE Framework, and confirmed the importance of: understanding the whole patient; recognizing the importance of family caregivers; and training health care providers to engage patients and families in a meaningful way. System constraints, lack of education, and family dynamics present challenges to engagement of patients and families in decision-making. Flexibility in care approaches, knowledgeable care providers, and the building of trusting relationships facilitate more meaningful engagement. Healthcare providers indicated a need for more education on strategies for meaningful engagement of patients and families in decision-making; preferred education modalities include hands-on workshops and e-learning modules. Discussion & Conclusions: Our study found that elements of the CHOICE framework are relevant to the development of meaningful patient-provider engagement. Resources and education may facilitate these partnerships, but current practice and system constraints will challenge these efforts. Lessons Learned: In the current health care system, regardless of strategies and resources provided; it is difficult to take the time to have meaningful conversations with patients during clinic appointments. Building trusting relationships is key to successful patient-provider partnerships. Limitations: Work to date has been limited to primary and community care settings. Suggestions for Future Research: The resources and materials co-designed in this project will be implemented as part of a larger study to improve patient and family caregiver engagement in primary care settings. In future work, we aim to link engagement strategies, which enable mutual understanding of values and preferences, with tools for shared decision-making that support consideration of available research evidence.

Supplemental Material for Loneliness and Social Engagement in Older Adults: A Bivariate Dual Change Score Analysis

Supplemental Material for Loneliness and Social Engagement in Older Adults: A Bivariate Dual Change Score Analysis

Association between visual status and mental health status in Thai rural elderly: a community-based study.

To evaluate the association between visual impairment (VI) and mental health or social engagement in older adults living in rural Thailand. Data for this cross-sectional study were drawn from a community survey conducted in 2015 in Saraburi Province, Thailand. Participants were 327 adults aged ≥50y. VI was assessed using presenting distance visual acuity. Mental health and social engagement were evaluated in face-to-face interviews using validated questionnaires. After determining the prevalence of VI and relevant sociodemographic characteristics, multivariate regression analysis was used to evaluate the impact of VI on mental health and social engagement. The prevalence of VI was 18.3%. Major causes were refractive error (58.3%) and cataract (35%). Factors associated with VI in the crude analysis were: older age [odds ratio (OR) 8.08], unemployment (OR 2.72), widowhood (OR 2.47), being divorced/separated (OR 3.27), smoking (OR 2.09) and disability in activities of daily living (OR 2.35). Protective factors were undergoing eye screening at least once a year (P=0.029) and obesity (P=0.005). VI was significantly associated with low social engagement (adjusted OR 4.13) but not with poor mental health (P>0.05). Although VI older adults reported less participation in social activities, there is no significant association between VI and poor mental health. Annual eye examinations may prevent VI in older adults. Information about employment and anti-smoking should be targeted to older adults with VI.

Effect of Antidepressant Medication Use and Social Engagement on the Level of Depressive Symptoms in Community-Dwelling, Older African Americans and Whites With Dementia.

Objective: This study examines the effect of antidepressant medication use and social engagement on the level of depressive symptoms at the time of initially meeting criteria for dementia. Method: Measures of social engagement, medication use, and depressive symptoms from 402 participants with incident dementia were utilized for the study. Proportional odds models adjusted for demographics were constructed with depressive symptoms as the outcome and social network size, perceived social isolation, and antidepressant medication use as independent variables. Results: Each additional person in the social network was associated with a lower depressive symptom score, odds ratio (OR) = 0.93, 95% confidence interval (CI) = [0.90, 0.97], p ≤ .01, and each unit increase in perceived social isolation was associated with a higher depressive symptom score (OR = 4.14, 95% CI = [2.94, 5.85], p ≤ .01). No association was found between antidepressant medication use and depressive symptom score. Discussion: Depression management at the time of dementia diagnosis should probably be directed toward increasing social engagement in older adults.

PP39 Health Technology Assessment And Aging: Moving Evidence To Action

Introduction:With the rapid increase in technologies and innovations to support a growing aging population in many countries, health technology assessment (HTA) of technologies for the aging populace warrants special consideration. Building on our efforts at Health Technology Assessment international (HTAi) conferences in 2016 and 2017, this presentation will highlight themes generated from two previous HTAi collaborations, with an aim of continuing to build interest and capacity in HTA for aging-related technologies in an international ecosystem that is responsive to local needs and global opportunities.Methods:Researchers from Canada's technology and aging network (AGE-WELL) collaborated with international panelists at HTAi conferences in 2016 and 2017 to explore interest in HTA focused on aging. International panelists shared the current state of aging and HTA in their respective countries. At both sessions, opportunities were provided for participants to rate the importance of themes identified by the panelists.Results:At the 2016 session, the two most highly ranked themes were: (i) how HTA can help identify the unmet needs of older adults in society that could be met by technology; and (ii) engagement of older adults and caregivers. These two themes became the starting point for the panel discussion in 2017. At this session, the highest ranked themes were: (i) identification of challenges in HTA and aging; (ii) approaches to advancing the effectiveness of HTA in addressing technology and aging; and (iii) development of an aging-related interest group in HTAi.Conclusions:International collaborations have identified a number of recommendations to consider for HTA and aging-related work including: developing a good mutual awareness and understanding of barriers and opportunities; the importance of co-creating solutions with patients, healthcare providers, researchers, innovators, and funders; and the identification of a suite of methods and tools that can help accelerate technological innovation in care delivery.