Senior Center Services Research Articles

Rural Older Adults’ Experiences With Pain From Chronic Illnesses and Its Treatment

Although pain control is an essential factor in promoting quality of life, pain is undertreated among certain sub-populations, such as older adults and rural residents. The purpose of this study was to explore pain experiences and its treatment among rural older adults. A qualitative research design was adopted to capture the common essence of participants’ experiences through a phenomenological method. Purposeful sampling was used, and the participant criteria was: age 55+, have good thinking skills, resident of Alabama, have chronic/serious health conditions, and experienced pain or discomfort in the last 3 months. Twenty-three participants were recruited from rural counties of West and South Alabama through the local Area Agency on Aging and health and senior service centers. Individual semi-structured interviews were conducted via phone and were recorded and transcribed verbatim. Thematic analysis was conducted to identify emerging themes and repeated patterns from the data. Our results revealed themes in four categories: 1) impact of pain: physical limitations and coping strategies, 2) Impact of Covid-19: physical health, social, and mental health impact, 3) challenges in pain treatment: transportation (driver/time/cost/Covid-19 exposure) and non-transportation related problems (lacking resources/mistrust/limited health insurance coverage), and 4) suggestions: transportation-related (more transportation options/financial assistance) and non-transportation-related support (improved insurance coverage/non-pharmacological care) . Findings of this study highlight rural older adults’ unique needs in access to pain treatment, further amplified during the Covid-19 pandemic. Increase in sustainable, funded transportation programs and the supply of local pain specialists is critical to meet such needs and improve their quality of life.

Examining Physical and Social Environments of Korean American Family Caregivers of Persons Living with Dementia

IntroductionGrowing research supports the use of older volunteers to provide respite and community-based assistance to persons with ADRD and their caregivers. This study explores the impact of COVID-19 on a face-to-face, peer-led psychoeducational intervention for African American ADRD family caregivers, the Senior Companion Program Plus (SCP-Plus), and its subsequent need to ‘pivot’ during the pandemic. Method: The SCP-Plus was a randomized control trial across three states that assessed program impact on ADRD family caregiver stress/burden, coping, and social support. In spring 2020, the SCP-Plus intervention was halted because of the potential risk to participants due to COVID-19 (n = 20 enrolled dyads). In an effort to maintain rapport and trust, critical to retention in research studies, team members began weekly (March-April) and then bi-weekly calls (May-December) for the purpose of providing a social check-in and to provide updates on the status of the intervention.ResultsA total of 396 calls lasting approximately 10 minutes each were completed. Participants shared concerns around safety, access to food/supplies/masks/testing, feelings of stress and loss, concern for others, and the importance of technology as a means of social connection. Although the intervention aspect of the SCP-Plus ultimately ended due to COVID-19, information gleaned from these check-ins were used to pivot the study. The study moved forward by using a descriptive phenomenological approach to capture dyads’ lived experiences during COVID-19.DiscussionOverall, purposeful participant engagement through weekly/bi-weekly phone calls suggests that this is a promising strategy for participant retention as well as for pivoting research.

Senior Center Service Utilization: Do Social Ties Affect Participation Patterns?

A better understanding of service utilization patterns at senior service centers can improve program development and constituent usage. This research examines whether participation in senior center activities is a function of senior socialization that reinforces and supports existing social ties by selecting specific activities in senior centers. A total of 924 participants of senior centers in a municipality in the Southwest were surveyed. We find that having closer friends influences participation in certain senior center services. We also find that gender, race, ethnicity, and income also explain different usage rates beyond age. Opportunities to foster social interaction to grow and reduce barriers to participation and market to a broader range of current and potential participants are discussed.

Mobility and Vitality Lifestyle Program (MOVE UP): A Community Health Worker Intervention for Older Adults With Obesity to Improve Weight, Health, and Physical Function.

Background and ObjectivesObesity rates in adults ≥65 years have increased more than other age groups in the last decade, elevating risk for chronic disease and poor physical function, particularly in underserved racial and ethnic minorities. Effective, sustainable lifestyle interventions are needed to help community-based older adults prevent or delay mobility disability. Design, baseline recruitment, and implementation features of the Mobility and Vitality Lifestyle Program (MOVE UP) study are reported.Research Design and MethodsMOVE UP aimed to recruit 26 intervention sites in underserved areas around Allegheny County, Pennsylvania and train a similar number of community health workers to deliver a manualized intervention to groups of approximately 12 participants in each location. We adapted a 13-month healthy aging/weight management intervention aligned with several evidence-based lifestyle modification programs. A nonrandomized, pre–post design was used to measure intervention impact on physical function performance, the primary study endpoint. Secondary outcomes included weight, self-reported physical activity and dietary changes, exercise self-efficacy, health status, health-related quality of life, and accelerometry in a subsample.ResultsOf 58 community-based organizations approached, nearly half engaged with MOVE UP. Facilities included neighborhood community centers (25%), YMCAs (25%), senior service centers (20%), libraries (18%), senior living residences (6%), and churches (6%). Of 24 site-based cohorts with baseline data completed through November 2017, 21 community health workers were recruited and trained to implement the standardized intervention, and 287 participants were enrolled (mean age 68 years, 89% female, 33% African American, other, or more than one race).Discussion and ImplicationsThe MOVE UP translational recruitment, training, and intervention approach is feasible and could be generalizable to diverse aging individuals with obesity and a variety of baseline medical conditions. Additional data regarding strategies for program sustainability considering program cost, organizational capacity, and other adaptations will inform public health dissemination efforts.

Effect of interactive cognitive motor training on gait and balance among older adults: A randomized controlled trial

BackgroundAging is a normal degenerative process that results in a decline in the gait and balance performance of older adults. Interactive cognitive motor training is an intervention that integrates cognitive and motor tasks to promote individuals’ physical and cognitive fall risk factors. However, the additive effects of the interactive cognitive motor training on objective quantitative data and comprehensive descriptions of gait and balance warrants further investigation. ObjectivesTo investigate the effect of interactive cognitive motor training on older adults’ gait and balance from immediate to long-term time points. DesignA double-blind randomized control trial. SettingsFour senior service centers and community service centers in Taiwan. Participants62 older adults who met the inclusion criteria. MethodsThe study participants were older adults without cognitive impairment, and they were randomly allocated to the experimental group or active control group. In both groups, older adults participated in three sessions of 30-min training per week for a total of 8 weeks, with the total number of training sessions being 24. The primary outcome was gait performance, which was measured using objective and subjective indicators. iWALK was used as an objective indicator to measure pace and dynamic stability; the Functional Gait Assessment was employed as a subjective indicator. The secondary outcome was balance performance, which was measured using iSWAY. A generalized estimating equation was used to identify whether the results of the two groups differ after receiving different intervention measures; the results were obtained from immediate to long-term posttests. ResultsStride length in the pace category of the experimental group improved significantly in immediate posttest (p = 0.01), 3-month follow-up (p = 0.01), and 6-month follow-up (p = 0.04). The range of motion of the leg exhibited significant improvement in immediate posttest (p = 0.04) and 3-month follow-up (p = 0.04). The Functional Gait Assessment result indicated that statistically significant improvement was observed in immediate posttest (p = 0.02) and 12-month follow-up (p = 0.01). The results of balance performance showed that the experimental group attained statistically significant improvement in centroid frequency in the immediate posttest (p = 0.02). ConclusionsThe research results validated that the 24 sessions of the interactive cognitive motor training intervention significantly improved gait and balance performance. Future studies should extend the sample to communities to promote the gait and balance performance of community-dwelling older adults without cognitive impairment and reduce their risk of falling and developing gait-related diseases.

Using the Centers for Disease Control and Prevention's Stay Independent Checklist to Engage a Community of American Indians and Raise Awareness About Risk of Falls, 2016.

BackgroundThe unintentional death rate from falls is higher among American Indians from the US Southwest than from other regions in the country. The Zuni Pueblo is a geographically isolated, rural American Indian community located in western New Mexico. Education and screening for falls risk is lacking in this community and may be needed to reduce falls and falls-related illness and death.Community ContextBuilding on a 17-year relationship with the Zuni Health Initiative, meetings were held with Zuni tribal leadership, staff from the Zuni Senior Center and Zuni Home Health Services, members of the Zuni Comprehensive Community Health Center, Indian Health Service, and Zuni community health representatives (CHRs) to discuss elder falls in the community. Existing infrastructure, including CHRs who were already trained and certified in diabetes education and prevention, provided support for the study. MethodsTribal leadership agreed that CHRs would be trained to administer the Centers for Disease Control and Prevention’s (CDC’s) Stay Independent checklist to assess falls risk. They administered the checklist during one-on-one interviews in Shiwi (Zuni native language), English, or both to a convenience sample of 50 Zuni elders.OutcomesMean age of participants was 72 (standard deviation, 7.4) years, and 78% were women. Fifty-two percent reported at least 1 fall during the past year; 66% scored 4 or more on the CDC Stay Independent checklist, indicating elevated risk for falls. CHRs reported that the checklist was easy to administer and culturally accepted by the elder participants.InterpretationThis study broadened the Zuni Health Initiative to include falls risk screening. Self-reported falls were common in this small sample, and the incidence was significantly higher than the national rate. These results highlight the need for community engagement, using culturally acceptable falls screening, to promote falls education and implement falls prevention programs.

Mealtime Interactions and Life Satisfaction Among Older Adults in Shanghai.

We examined the association between older adults' mealtime interactions at senior centers in Shanghai and their life satisfaction. Competing hypotheses, derived from socioemotional selectivity theory and activity theory, were tested. Data were obtained from the 2011 Shanghai senior center service utilization survey ( N = 320). Relationships between respondents' mealtime interactions and life satisfaction were tested using multilevel regression modeling. After adjusting for demographics, interactions with tablemates (companionship, self-disclosure, and instrumental support) were positively associated with respondents' life satisfaction. These associations varied by senior centers. However, the number of tablemates was not significantly associated with respondents' life satisfaction. Findings support the activity-theory-based hypothesis that mealtime interactions are related to older adults' life satisfaction independent of the number of tablemates. This study illuminates the value of social interactions in the context of community dining programs for the rapidly increasing older population in urban China.

Neighborhood and healthy aging in a German city: distances to green space and senior service centers and their associations with physical constitution, disability, and health-related quality of life.

The composition of the residential environment may have an independent influence on health, especially in older adults. In this cross-sectional study, we examined the associations between proximity to two features of the residential environment (green space and senior service centers) and three aspects of healthy aging (self-rated physical constitution, disability, and health-related quality of life). We included 1711 inhabitants from the city of Augsburg, Germany, aged 65years or older, who participated in the KORA-Age study conducted in 2008/2009. We calculated the Euclidian distances between each participant's residential address and the nearest green space or senior service center, using a geographic information system. Multilevel logistic regression models were fitted to analyze the associations, controlling for demographic and socioeconomic factors. Contrary to expectations, we did not find clear associations between the distances to the nearest green space or senior service center and any of the examined aspects of healthy aging. The importance of living close to green space may largely depend on the study location. The city of Augsburg is relatively small (about 267,000 inhabitants) and has a high proportion of greenness. Thus, proximity to green space may not be as important as in a densely populated metropolitan area. Moreover, an objectively defined measure of access such as Euclidian distance may not reflect the actual use. Future studies should try to assess the importance of resources of the residential environment not only objectively, but also from the resident's perspective.

The restorative potential of senior centers

Purpose – The purpose of this paper is to help senior center managers and service researchers understand why some patrons experience health benefits, primarily fatigue relief, through senior center day services participation. Design/methodology/approach – The authors conduct two separate studies at a senior center. The first study represents a grounded theory that offers an original, basic social process regarding mental restoration in senior centers. The second study draws on Attention Restoration Theory (ART) and employs survey methodology. Findings – Senior center patrons who perceive a center's restorative stimuli experience health benefits such as relief from four types of fatigue, enhanced quality of life, and improved physical and mental well-being. Research limitations/implications – The paper shows that senior centers may be relatively inexpensive, non-medical services that can help patrons relieve fatigue symptoms, which are often treated with pharmaceutical medication and medical visits. A limitation is the small sample size, which restricts generalizability. Practical implications – The results show that senior center managers may promote patron health by fostering service designs and programs that allow members to temporarily escape from everyday life and interact in an ever-changing environment that fosters a sense of belonging. Social implications – Senior center day services help patrons relieve fatigue, and its symptoms, in an affordable, non-medical, and non-pharmaceutical manner. Originality/value – The paper clarifies the role of senior centers in patrons’ lives by drawing on ART. Senior centers that can offer patrons restorative environments are likely to play a significant role in patrons’ physical, social, and mental well-being.

Meeting Hurricane Sandy Head-On: New York City’s Aging Services Network Delivers in a Crisis

When Hurricane Sandy pummeled New York City on October 29, 2012, it crippled mass transit, devastated whole neighborhoods, and triggered gas shortages and power outages that left thousands of residents without heat, hot water, or electricity. These conditions created formidable challenges for the city's providers of senior center, home-delivered meals, and other vital services to older New Yorkers.At many program sites along shoreline areas, flooding, wind, sand accumulation, and debris damaged windows, doors, walls, ceilings, kitchen equipment, furniture, files, and computers. Widespread electrical failure shut down elevators; heating, ventilation, and air-conditioning (HVAC) systems; hot water heaters; fire alarm; and telephone systems.Staff faced huge hurdles doing their jobs. Like the elders they served, many were themselves victims of the storm, coping without heat and electricity at home, and worrying about their cars that had been washed away, their flooded basements, and disrupted lives. It took hours, sometimes, to get to work by car pool or mass transit, even when mass transit was running. Where gas for their vehicles was not available, staff and volunteers walked to deliver meals to the homebound. Those who could obtain gas waited in long lines at stations and drove through debris-strewn streets without working traffic lights. They climbed flights of stairs flashlight in hand, and groped their way down hallways to knock on doors in darkened apartment buildings that lacked buzzers and elevators. Case managers making home visits underwent the same ordeal of climbing stairs in the dark to get to clients' apartments. When senior centers reopened as warming centers for their communities,1 hundreds of individuals of all ages turned to directors and staff for hot meals and respite, not just their regular members.New York's aging services providers-a network of communitybased organizations in every borough-overcame these obstacles to achieve a remarkable level of service delivery. They not only managed to continue to provide services to their clients during a time of havoc and devastation but also to bring relief to thousands they had not previously served. This article describes the mandated New York City emergency preparation and response procedures that guided these agencies through the crisis. It also describes how the New York City Department for the Aging (DFTA)-the city agency that administers aging services-facilitated the network's response and coordination efforts within the context of the city's overall response, despite a compromised communications system and the absence of a central office. Although recognizing that more programs than can be mentioned here have similar stories, the article's third section tells of exemplary programs that worked tirelessly and selflessly to ensure that elders in stricken communities were safe, fed, cared for, and assisted.NEW YORK'S SERVICE SYSTEM FOR THE ELDERLYAging services in New York City are administered by the city's DFTA, a mayoral agency as well as a Federal Area Agency on Aging under the New York State Office on Aging. Actual service delivery is the province of hundreds of community-based organizations throughout the five boroughs that contract with the department. Eighty-five percent of the federal, state, and city tax levy funds that DFTA receives to serve the elderly under the Older Americans Act and other statutes is channeled by the Department to these contracted community-based organizations for direct service provision. DFTA monitors these community agencies and manages contract compliance.DFTA-funded services provided in the community include senior center services such as congregate meals, information and assistance, exercise programs, and social, creative, recreational, and learning activities. They also include home-delivered meals for older adults who cannot prepare or shop for food on their own and home care services for elders with functional impairments who are not eligible for Medicaid. …

Older adults’ home- and community-based care service use and residential transitions: a longitudinal study

BackgroundAs Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and community-based services and their residential transitions.MethodsThe study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults’ residential status at the three follow-up interviews, four residential transitions were tracked: (1) Community-Community-Community (CCC: Resided in community during the entire study period); (2) Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3); (3) Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3); (4) Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.).ResultsOlder adults’ use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults’ use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS) and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other services, such as senior center services or meal services, were associated with different directions in residential transition, such as CIC and CII respectively.ConclusionsOlder adults’ differing HCBS use patterns may be the key to explaining older adults’ transitions. Attention to older adults’ HCBS use patterns is recommended for future practice. However, this was an exploratory study and the analyses cannot establish causal relationships.

Senior Centers and Policy Advocacy: Changing Public Perceptions

As critical components of the aging continuum of care, senior centers promote older adult health and well-being by providing opportunities for recreation, socialization, nutrition, health education, and access to vital social services. Nationally, a vast network of 11,000 senior centers serves over four million older adults annually. As the United States population ages rapidly, public funding, which is the primary source of support for a majority of senior center services, has remained stagnant. If senior centers are to continue to effectively serve older adults and meet their comprehensive needs, they need to demonstrate their relevance to the community and advocate for increased funding support. This paper explores the policy concerns of senior center administrators, investigates their efforts to influence public policy, illustrates advocacy techniques currently utilized by them, and highlights the learning needs of administrators in this regard. Practice implications for senior centers, their constituents, and gerontological education are provided.

Components of Cultural Competence in Three Mental Health Programs

The aim of this study was to identify components of cultural competence in mental health programs developed for cultural groups by community and mental health professionals from these groups. Three programs were studied: a prevention program primarily serving African-American and Afro-Caribbean youth, a Latino adult acute inpatient unit, and a Chinese day treatment program in a community-based agency. Nine study-trained field researchers used a semistructured instrument that captures program genealogy, structure, processes, and cultural infusion. Program cultural elements were identified from field notes and from individual and group interviews of consumers and staff (N=104). A research-group consensus process with feedback from program staff was used to group elements by shared characteristics into the program components of cultural competence. Components included communication competencies (with use of colloquialisms and accepted forms of address); staff in culturally acceptable roles; culturally framed trust building (such as pairing youths with mentors), stigma reduction, friendly milieus (such as serving culturally familiar foods and playing music popular with the culture), and services; and peer, family, and community involvement (including use of peer counselors and mentors, hosting parent weekends, and linking clients with senior center and community services). Incorporating these components into any program in which underserved cultural populations are seen is recommended for improving cultural competence.

Step by Step: Integrating Evidence-Based Fall-Risk Management Into Senior Centers

Our purpose in this project was to conceptualize and implement evidence-based fall-prevention programming into senior centers. We present challenges to this process and strategies to overcome them. We carried out a dissemination project in nine diverse senior centers in Connecticut. Participants included investigators from the Connecticut Collaboration for Fall Prevention (CCFP), senior center administrators, and trained staff interventionists implementing a program of fall prevention based on the Yale Frailty and Injury Cooperative Studies of Intervention Trials (known as the Yale FICSIT). Using CCFP materials that were based on the stages of change, senior center staff developed methods to integrate fall-prevention programming into their centers. We extracted implementation challenges, and the strategies that senior center staff developed to overcome them, from the minutes of monthly work-group meetings. Monthly counts of individual assessments were also a source of data. Challenges included staffing and the delineation of authority, structural issues, engaging senior center membership, cultural issues, and the modification of existing practices. Each senior center devised site-specific methods to overcome these challenges when CCFP investigators convened work-group meetings. We developed creative strategies to inform senior center membership about fall prevention, and in the first 18 months, 4% of members scheduled individual assessments. The challenges of integrating evidence-based fall-prevention programming into existing senior center services can be negotiated by collaboration among senior center administrators, health providers, the center membership, and researchers. This experience suggests that senior centers may be important venues to reach older adults with fall-prevention programming.

Rural Senior Service Centers

Two hundred seventy-five non-institutionalized senior citizen volunteers participated in this study that evaluated the impact of rural senior service centers on emotional and practical issues affecting elder consumers. Responses of participating seniors were compared to a similar group of seniors who did not participate. The findings indicated that there were significant differences between the two groups on issues of loneliness, nutrition, and overall quality of life. Findings have strong implications for activity specialists in the field of gerontology.

Use of Senior Center Services of the Elderly Chinese Immigrants

Using the Andersen-Newman service utilization framework, this study examined the factors explaining different types of senior center service use among a random sample of elderly Chinese. Although most of the elderly Chinese visit a senior center regularly, there is a substantial underutilization of support services. The findings also show that the predictors of use vary for different types of senior center services. While the use of acculturation services is predicted by age of the users, the use of recreation services is better explained by place of origin and negative affect. The use of task assistance services is best explained by gender, satisfaction toward services and negative affect. The use of support services is predicted by living arrangement, satisfaction toward services and fewer mental health symptoms. Finally, the frequency of drop-in is predicted by gender, place of origin and satisfaction toward services. The implications of these findings to social work practice with elderly Chinese are discussed in the paper.

Senior Service Centers: A Comparison of Affiliated and Nonaffiliated Participants

The authors divided 275 elderly volunteers into 2 groups (affiliated and non-affiliated participants) and examined demographic, emotional, and practical issues that affect elderly people. There were significant differences between the groups on issues of loneliness, nutrition, and overall quality of life.

Health Care Utilization Among Clients With Alzheimer's Disease: Public Policy Implications From the California Alzheimer's Disease Diagnostic and Treatment Center Program

This study examines health and social service utilization among Alzheimer's disease clients of the California Alzheimer's Disease Diagnostic and Treatment Center (ADDTC) Program. This longitudinal study includes a nonrandom sample of program participants from 1988 to 1992 with a diagnosis of Alzheimer's disease (N = 737). Sample characteristics, service utilization rates, and recommendations for service use by ADDTC staff are described. Comparisons of service utilization at baseline assessment and first-annual assessment are made for 10 health and social services—physician services, senior center services, congregate or home-delivered meals, home health care, homemaker-chore services, adult day care, case management, transportation services, residential care, and nursing home care. The influence of ADDTC staff recommendations on subsequent service utilization is assessed and policy implications regarding the efficacy of these recommendations are discussed.

Exploring intra-ethnic diversity among four groups of Hispanic elderly: patterns and levels of service utilization.

This study investigates service use by a sample of 2,135 Hispanic elderly in order to address the issue of the homogeneity or heterogeneity within the older Hispanic population as revealed by the use of formal services. Factor analysis revealed a high degree of homogeneity in the patterns of formal service use among the four Hispanic groups in this study that follows three latent, but distinct, patterns of behavior: the use of federal entitlement programs, in-home services, and senior center services. Although the patterns of service use reflect substantial homogeneity among the Hispanics in this sample, there is a high degree of heterogeneity in the level of service use. Overall, service use was systematically lower among "Other" Hispanic elders and systematically higher among Puerto Rican elders, with somewhat more erratic use among Cuban American and Mexican American elders. Controlling for between-group differences in socio-demographic characteristics did little to reduce relatively systematic between-group differences in levels of service use.

Setting Priorities in Aging Populations: Formal Service Use Among Mexican American Female Elders

This study establishes empirical patterns of formal service use by a sample of 483 elderly Mexican American women, and identifies the predictors of formal service utilization. Results indicated two patterns of service use–in the home and at senior centers. Regression analysis demonstrated that the best predictors of who used formal in-home services were those with functional impairment in Instrumental Activities of Daily Living (IADLs) and those with the least amount of assistance with IADLs provided by family members. Living alone and attending group social events were the best predictors of the use of senior center services. Anticipated changes in the Mexican American population portend a growing need for both in-home and senior center services. These findings can be used to establish policy and programming priorities for this neglected population. If resources are to be effectively targeted to frail elders, in-home services should receive priority, and the provision of in-home services should be modified to include additional programs that facilitate care of the elderly by the family.