Senior Centers Research Articles

Information and Assistance Needs and Expectations of Senior Residents in a Nursing Home in Singapore: Semi-structured Interviews With Senior Residents and Staff

Singapore, a young multi-racial and multi-religious city-state in Southeast Asia, is facing a demographic challenge—that of a rapidly falling birth rate and an increasingly aging population. By 2030, Singapore is expected to be a “super-aged” society, where more than 21% of its population will be 65 years of age or older, as defined by the Organization for Economic Cooperation and Development (OECD). Hence, the urban landscape in Singapore is also set to evolve. We expect to see more acute care hospitals, community hospitals, nursing homes, senior care centers, and senior activity spaces. As infrastructure and spaces for older persons, or seniors, become an increasingly more significant part of the built environment in Singapore, there is a need to explore how the design of the physical environment can improve the well-being of seniors and that staff, caregivers, family members as well as the larger community. In this paper, a brief look into nursing homes in Singapore is done, followed by the data and findings of a small-scale study involving semi-structured interviews that were carried out to explore the needs and expectations of senior residents in a nursing home in Singapore. In essence, this study found significant outcomes concerning the needs and expectations of nursing home residents, such as the desire for sustained social interaction, the preference for human-based assistance (rather than technology-based aid), and the penchant for independence (such as for food choices or having a variety of preferred daily activities) by seniors in their everyday lives. These inputs can be insightful and instrumental for the effective and user-centered design of new nursing homes in this rapidly aging city-state or other locales with similar demographics and settings.

Aging in the downtown corridor: Mapping the neighborhood experiences of Seattle's unhoused adults over age 50

Research has established the importance of understanding the dynamic relationship between older adults and the environments in which they are embedded. However, the meaning of place for unhoused older adults amidst an increasingly contested urban landscape is largely unknown. This exploratory study aims to further include unhoused older adults' experiences in the scholarship on aging and place by asking how unhoused adults over age 50 (1) describe their spatial patterns and experiences and (2) negotiate their relationship with common urban places. Through iterative mapping conducted in focus groups and interviews at Seattle senior centers, respondents identified how they interacted with their communities and environment. Using inductive and deductive coding of both textual and geospatial data, thematic analysis indicated that respondents: (1) experienced confinement to the downtown corridor and expulsion from surrounding areas– a phenomenon compounded by physical and subjective aging; (2) created routines amidst geographic and temporal restrictions to maximize comfort and security; (3) attempted to create residential normalcy in public places through adaptive and accommodative practices; and (4) experienced identities shaped by movement through and access to place. Current social, spatial, and political contexts of city living present many challenges for older unhoused adults. Supports that ignore people's identification with the places that are important to them are unlikely to be successful. Findings from this paper call for service, policy, and design strategies that facilitate personal agency and connection to place among unhoused people midlife and beyond.

Unsung Heroes: How Senior Centers Have Adapted to Provide Essential Services in the Face of COVID-19

This presentation will describe the ways in which senior centers in Massachusetts have adapted during the COVID-19 pandemic. Three surveys (distributed in April, August, and November, 2020) were conducted with 342 senior centers in the state to learn about current operations through the pandemic, challenges faced, and steps taken to solve those challenges. Results suggest that almost all senior centers (91%) continued to provide limited programming or essential services during the pandemic. Senior centers are prioritizing socialization and nutritional needs as critical services, but are changing the way they operate to continue to meet those needs. Despite facing uncertainty about the future, senior centers continue to adapt to changing conditions as they seek to meet their core mission. This presentation will discuss effects of COVID-19 on how senior centers will continue to operate through and post-pandemic times as well as local and state policy implications.

Saving Senior Smiles: A Community Outreach Educational Program and Pilot Research Project

Globally, poor oral health has been evidenced more frequently among older adults. Thus, it is imperative to develop strategies for improving the oral health knowledge and access to dental care amongst the older adult population. The Saving Senior Smiles (S3) pilot outreach program was launched as an oral health education and awareness program for community-dwelling older adults across senior centers in the greater Boston area (Massachusetts, USA). The outreach consisted of oral health educational seminars presented by pre- doctoral dental students from three dental schools in the Boston area. The presentations highlighted the significance of oral health, and the importance of seeking routine dental care. Pre and post-test surveys were administered to assess the participants’ utilization of oral health services and oral health knowledge. The surveys were completed by 85 older adults (Female= 58.8%) across five senior centers. Questions pertaining to utilization of dental services revealed that 78.8% of the participants had a dentist. Expectedly, the center that reported the greatest number of missing teeth (Fenway center= 70.6%) had the least number of individuals who had a dentist (58.3%). With regard to oral health knowledge, before the seminars, less than half of the participants (42.2% ) across all the senior centers were aware of the common oral conditions that affected older adults ( dry mouth, gum recession and changes in oral bacteria) and after the presentation over 60% of the participants responded correctly to these knowledge questions. Overall, these findings emphasize the value of simple community-based interventions for older adults.

Aging services workers in the pandemic: Voiced experience of senior center staff & case workers

The pandemic necessitated immediate shutdown of senior centers, requiring a rapid pivot in the delivery of services to older adults by direct care workers. We provided psychosocial support to older adult service personnel-including Aging and Adult Services case workers and Senior Center Staff, and conducted focus groups with staff at intervals to capture the mid-point of the pandemic (peak of older adult deaths), onset of vaccine availability and the re-entry phase as programs re-opened. We evaluated coping and self-efficacy of workers and discerned sustained high levels of coping and perceived job performance. Using a phenomenological lens, we analyzed transcribed recordings, generated codes, and created categories of experiences. Several themes emerged: personal and professional resilience, passion for serving older adults, motivation to perform their job well, stress of not having face-to-face contact with clients, insufficient resources-especially in rural areas, lack of essential training, feeling disjointed as a team, and work-life balance. Over the course of the pandemic, workers expressed increasing resiliency and skills to navigate the pandemic, oscillations in their fears for their clients’ well-being, and gratitude that they kept their jobs and gained additional State resources. As the vaccine was available and utilized, and as senior centers were reopening, senior center staff were enthusiastic, yet case workers remained apprehensive about long-term consequences of the pandemic. This study affirms the role of direct care workers as essential and valuable. Yet, their expressed need for more education, psychosocial support, and community awareness of their service remains to be addressed.

Senior Centers and LGBT Participants: Engaging Older Adults Virtually in a Pandemic

Upon the outbreak of COVID-19, recommendations to cease all non-essential in-person social services were mandated across the United States to prevent transmission to non-infected individuals. As a result, approximately 96% of all senior centers in the United States were closed to in-person programming (National Council on Aging, 2020). LGBT older adults in particular were at higher risk of isolation and declines in overall health as they were more likely to live alone, experience loneliness or have less immediate family support systems when compared to non-LGBT older adults (Yang, Chu & Salmon, 2017). The purpose of this presentation is to explore how LGBT older adult participants in senior centers transitioned to virtual programming during the pandemic. Using a risk-resiliency theory framework, the purpose of this presentation is to share the impact of virtual programming on the health and well-being of LGBT community-dwelling older adults. An exploratory, cross-sectional study was conducted utilizing an online survey to understand their needs, concerns and experiences. Participants reported a relatively easy adaptation to technology, steady participation in programs and services, satisfaction with virtual senior center programming and a consistent sense of engagement with their peers. Higher levels of engagement with senior center programs were associated with greater perceptions of social support. Additionally, stronger perceptions of social support and participation in exercise and fitness programming were associated with higher life satisfaction and lesser symptoms of depression and anxiety. Strategies for outreach, engagement and service provision will be presented.

Social Disengagement and Cognitive Function: Does the Association Vary by Gender?

Although social disengagement is considered to be a predictor of cognitive decline, and increase risk of Alzheimer’s and related dementias, little is known regarding the gender-specific association between social disengagement and cognition among Korean middle-aged and older adults. Korea’s Confucianism-based gender roles provide unique contexts to examine gender differences in the influence of social disengagement on cognition. This study investigated the association between social disengagement and cognitive function in a nationally representative sample of Koreans aged 45 years or older (N = 5,196 women and 2,707 men), using data from the Korean Longitudinal Study of Aging (2008-2018). Results from the generalized estimating equation model showed that compared to consistent social engagement, consistent non-engagement was significantly associated with lower cognitive function among both genders. Transitioning from social engagement to non-engagement was significant for males only. Of various types of social activities (religious, senior center, sport, reunion, voluntary, political), consistent non-engagement in a senior center was most associated with lower cognitive function among both genders, while consistent non-engagement in religious activities was significant for females only. While household arrangements were not associated with cognition in men, widowed women had increased risk of cognitive decline than married women, as did women living in households of three or more people. Depression was a predictor of cognitive decline among males only. In this gender-specific study, we found that consistent participation in social activities, especially via membership in a senior community center, is beneficial in preventing cognitive decline among both genders.

Self-Reported Utilization of Nutrition-Related Resources in Veterans Compared to Non-Veterans

Clinical trials show that palliative care improves patient experiences and reduces costs, and use of palliative care and hospice care have been increasing over the past three decades. In the Veterans Administration health care system (VA), Veterans may receive palliative care concurrently with other treatments. However, many barriers exist to the use of palliative care, such as patients’ misperceptions. Social workers in primary care teams may increase use of this valuable service by establishing trust between patient and care team, educating patients and caregivers, and coordinating services. Leveraging a national social-work-staffing program as a natural experiment, we evaluated the effect of hiring one or more social workers to the primary-care team on use of palliative or hospice care among Veterans with a recent hospital stay. Our data included 91,675 episodes of care between 2016 and 2018. 1.45 percent of episodes were followed by use of palliative care or hospice within 30 days. The addition of one or more social workers through the staffing program was associated with an increase of 0.53 percentage points (p<0.001) in the probability of any palliative or hospice care, i.e., a more than 30% increase relative to the mean. Policy makers and health system leaders who seek to improve patient experience and reduce costs through increased access to palliative and hospice care could consider social work staffing as a policy tool to achieve those aims.

Stuck in Stage 3: The Case of an Effective Depression Intervention for African American Older Adults

Beat the Blues (BTB) is a culturally tailored depression program for older African Americans. Tested in an NIA Stage 3 efficacy trial, findings showed statistically and clinically significant benefits, including decreased depressive symptoms, improved depression knowledge and symptom recognition, and behavioral activation. The multi-component intervention was co-constructed in partnership with a large senior center. Drawn from previously tested depression programs and tailored to preferences/needs of the targeted population, its five components included care management, depression education and symptom recognition, resources/referrals, and stress reduction and behavioral activation techniques. Despite significant findings, strong effect sizes and high acceptability, moving BTB to NIA Stage 4 (effectiveness) or 5 (dissemination) has been challenging. Challenges that will be discussed include lack of senior center funding to support training and delivery and infrastructure to embed BTB in community-based programs, and reluctance of health systems to adopt BTB because of its focus on one racial group.

Generation to Generation Project: Pairing Students With Older Adult Mentors During the COVID-19 Pandemic

To meet the needs of older adults isolated in the midst of the COVID-19 pandemic, we began pairing Human Services and Gerontology students with community dwelling adults 55 years of age and older, recruited through senior centers and other organizations serving older adults.Students paired with isolated older adults were tasked with building supportive relationships, assuring that basic needs were being met and that all available community resources were in place, and then documenting their mentor’s life stories with an emphasis on the resilience, strength and wisdom of their older adult mentors (to focus and build on their strengths, the older adults we engage with are referred to as our “mentors”). Oral histories and supporting artifacts are archived in the university’s library permanent repository.The oral histories portray unique perspectives into life, strength, and resilience during the COVID-19 pandemic and quarantine. The older adult mentors participating in the Generation to Generation project reported feeling strengthened and connected through their participation in the Generation to Generation project. To determine if social Isolation and loneliness can be ameliorated through participation in the Generation to Generation oral history project, researchers utilized the UCLA Loneliness Scale in pre- and post- participation interviews; findings will be shared.

Research Participation among Community Dwelling Dementia Caregivers: Reflections and Suggestions

Clinical trials for dementia caregivers have suffered from small sample sizes that lack adequate power to detect treatment benefits. Addressing these methodological shortcomings is contingent upon successful recruitment and enrollment of caregiver participants, but major barriers impede their participation in research. This presentation describes the lessons learned from recruiting and enrolling dementia caregivers into a pilot randomized controlled trial designed to help caregivers recognize and communicate about pain in dementia care recipients. Using Bronfenbrenner’s ecological model, we organize our discussion of challenges and opportunities into three levels: community (ecosystem), institution (microsystem), and individual. A key challenge at the community level was gatekeeping by organization leaders, including those from support groups, senior centers, and congregate living facilities. At the institutional-level, challenges included an absence of administrative mechanisms for identifying caregivers and a lack of caregiver research expertise on the Institutional Review Board. At the individual-level, challenges included time constraints and varying motivations for participating in research. Strategies for overcoming these challenges spanned the three levels and included establishing trust and rapport with various constituencies; adapting our recruitment approaches to meet the specific motivations of prospective participants; and refining recruitment scripts to allow for greater personalization. Employing these strategies, which can be generalized to recruit other hard-to-reach populations, helped to overcome recruitment challenges and expedite enrollment of caregivers from a diverse range of sociodemographic backgrounds. Further improvement will require coordinated changes at the institutional and community levels, including the development of central research registries and administrative mechanisms for identifying caregivers.

Adult Day Services as an Essential Service and Support

Throughout the COVID-19 pandemic, the significant challenges and gaps related to the care of older people in the U.S. were made distressingly apparent. This summary presentation will consider the effects of COVID-19 and associated shutdowns on older persons who use ADS programs, their family caregivers, and programs/staff themselves. Among recommendations to consider are the classification of adult day services and similar community-based long-term care providers as essential (and clarifying their difference from senior centers). In addition, considering new financing approaches and utilizing ADS or similar community-based programs as incubators of evidence-based innovation are options to consider to better align ADS with optimal dementia care.

Community Collaborations &amp; Technology Successfully Connect Isolated Older Adults to Education &amp; Activities

Providing programs, activities and education to older adults (OA) is a challenge under normal circumstances. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with a mission to “provide high quality programs that support healthy aging in Arkansas.” Prior to the pandemic, AGEC educators provided face-to-face programs to OA’s through senior centers, places of worship and other public venues. The pandemic changed all that. In-person programs were replaced with zoom presentations, social media events and pre-recorded programs placed on websites and patient-learn platforms for 24/7 viewing. Gaining viewership proved difficult and after collaborative research, it was determined the major barrier was a digital divide between access, usage and knowledge of digital platforms. To overcome this barrier, AGEC utilized TV, radio, libraries, digital infographics, newsletters and video tips addressing Wi-Fi and technology training. Videos, distributed via multiple routes, addressed basic topics such as “Creating and Utilizing Zoom and Facebook accounts” and “how to improve telehealth visits”. After establishment of a regular audience, AGEC engaged new and established partners and hosted a plethora of educational programs and activities further expanding the viewing audiences. In addition, with personalized emails and targeted marketing, AGEC engaged OA audiences in caregiving workshops, on-line caregiver support groups, telephone check-ins and exercise programs. Many OAs have found ways to bridge the digital divide and are engaged and active with educational and program activities and have used their new skills to connect with other OAs, grandkids, friends and even their spiritual communities.

Effects of a 6-week integrated dementia prevention intervention in community-dwelling older adults

This study examined the week of a 6-session integrated dementia p program on dementia knowledge, attitude toward dementia, fear of dementia, and dementia prevention behaviors among community dwelling elders. Using a nonequivalent control group, pre-posttest design, study participants were recruited from a senior center in Seoul, Korea. A total of 40 participants completed the study while half of them were in the experimental group and another half were in the control group. They completed survey questionnaires before and after the program. The findings showed that the program was effective only to decrease the fear of dementia of the older adults. Knowledge, attitude toward dementia, and healthy behaviors may be difficult to change in a short period of time. However, the integrated dementia prevention program may be effective to decrease negative emotions, particularly, fear toward dementia among older adults. The fear of dementia needs to be further assessed individually in order to identify particular causes and triggers and provide tailored interventions.

Effects of a Web-based Intervention on Cardiovascular and Physical Health of Korean Older Adults During the Pandemic

During the lockdown, 97.5% of Korean senior centers in South Korea were closed to prevent the spread of the coronavirus disease 2019 (COVID-19). The threat of the COVID-19 presented the need for alternative interventions for Korean older adults to maintain cardiovascular and physical health. Korean senior centers implemented web-based interventions to provide physical health services, but their effectiveness was not yet assessed. Thus, our study aimed to identify the effects of a web-based intervention using a smartwatch and mobile app in older adults when compared to center-based intervention during the pandemic. This study collected 117 Korean older adults (≥ 60) who participated in the 12-week web-based and center-based physical interventions using a smartwatch and mobile app. This quasi-experimental study was conducted between August and December in 2020. We analyzed the pre-posttest of cardiovascular and physical health across two intervention types. Our regression results indicated that participants in the 12-week web-based intervention reported better cardiovascular (systolic blood pressure: b = -13.77, p < .001; cholesterol: b = -11.71, p < .05) and physical health (muscular function: b = 2.99, p < .001; body balance: b = -1.31, p < .001; cardiopulmonary endurance: b = 33.33, p < .001) than those in center-based intervention at posttest. The findings imply a web-based intervention is likely to become an innovative therapeutic strategy for older adults' health to respond to the rapidly changing social service systems amid the pandemic.

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.

Successes and Lessons Learned From Age-Friendly Community Collaborations: Baystate Health GWEP

Baystate is the largest health system in Western Massachusetts with 4 hospitals, 3 Community Health Centers (CHCs) and a large primary care network. Baystate Medical Center (BMC) is in Springfield, Massachusetts. BMC and the CHCs were the first health care sites nationally to be recognized by the Institute for Healthcare Improvement as “Committed to Care Excellence” in the age friendly movement. Collaboration with a city-wide coalition of community-based organizations led to simultaneous recognition of Baystate as “age friendly” and recognition of the city as both dementia and age friendly. The 3 awards were presented at a Springfield senior center with media coverage and the participation of the mayor and other political leaders. This collaboration persists and the GWEP and coalition partners continue to participate in multiple joint educational and community outreach projects. As a result, the city coalition has added health care to its initial focus on housing and transportation.

The Effectiveness of an Intergenerational Technology Program for Older Adults: A Pilot Study

Medical residents need training to assess social determinants of health (SDOH) related to chronic conditions. We created a checklist to identify SDOH affecting residency clinic patients’ ability to manage chronic conditions. The tool: 1) involves resident training; 2) provides decision support checklist; 3) influences patient activation; and 4) increases provider and patient communication through shared decision making. Action Planning Guide checklist (APG) includes questions pertaining to SDOH preventing patients from managing their chronic conditions and actions patients will take. Areas identified are discussed between patient and resident, increasing patient activation. The clinic’s nurse care facilitator guides referrals to community-based resources. Fifty-two patients were enrolled, with 75% of patients responding they would like to be better managers of their chronic conditions. This information is used to develop patient’s goals of care. Over 90% of patients said their conditions affect their lives and discussed ways better to care for themselves. Over 80% discussed medication management, health goals to improve their quality of life, and made a plan that maps out ways to reach their goals. All of these are essential for achieving positive health outcomes for older patients with chronic conditions. These attributes promote effective patient/provider partnerships. Seventy referrals were made; food through 2-1-1 (47%); monthly commodity food program (30%); utility payments (11%), and transportation (9%). Twenty-seven referrals were made to agencies serving older adults; 25 to the local AAA information and assistance services, and 2 to Senior Project Fresh Voucher Program.

Effective Recruitment Strategies for Community-Dwelling Persons Living With Dementia and Their Caregivers

Recruitment of diverse community-dwelling persons living with dementia (PLWD) and their caregivers (dyads) into randomized controlled trials (RCT) is challenging, time consuming and expensive. This presentation will describe community outreach efforts used over a one-year period to recruit dyads of PLWD and their caregivers in Healthy Patterns RCT. Community outreach yielded 296 inquiries, such that people expressed interest in joining the study. Of the 296 inquiries, almost all (95.6%) identified as African American, and 91(30.7%) consented to join the study. Presentations at senior centers yielded the highest number of inquiries (n=148), followed by staff presence at various community events such as health fairs and senior galas (n=145) and referrals (n=3). We found that community outreach was an effective recruitment strategy to generate inquiries among diverse PLWD and their caregivers to enroll in Healthy Patterns. We will discuss these strategies and provide suggestions for recruiting diverse dyads into clinical trials.

A Peer Intervention Facilitates Trust and Improves Psychosocial Well-Being in Diverse, Low-Income Older Adults

We evaluate a peer outreach intervention to improve the psychosocial well-being of diverse, low-income older adults. Participants (N=74, Age 58-96 years) were recruited from an urban senior center and matched with peers who were >55 years old, received mental health training, and connected participants with health or social activities. We conducted surveys at baseline and 6-month follow-up for 2 years with validated measures of loneliness, social interaction, barriers to socializing, and depression, and thematically analyzed qualitative, semi-structured interviews conducted among a subset of participants (n=15) and peers (n=6). Participants were 58% male, 18% African-American, 19% Latinx, and 8% Asian. Over 2 years, participants experienced sustained reductions in loneliness (p=0.015), depression (p<0.001), and barriers to socializing (p<0.001). Qualitative interviews detailed the role of longitudinal relationships, program flexibility, and the matching process in facilitating trust, motivation, and improved mood. Results can inform larger efficacy studies and implementation of peer-driven community programs.