Senior Housing Residents Research Articles

Falls as a mental health risk among Korean-American residents in subsidized senior housing: mediating effect of fall-related self-efficacy

Objectives The study examined the mediating role of fall-related self-efficacy in the association between falls and mental health among older Korean Americans living in subsidized senior housing in the greater Los Angeles area. We focused on serious fall incidents (i.e. multiple falls or any fall with a fracture) and used symptoms of depression and anxiety as indicators of mental health. Method Survey data from 315 participants (M age = 79.4 years) were used to examine the direct effects of serious fall incidents on mental health symptoms, as well as indirect effects through fall-related self-efficacy. Results The mediating effect of fall-related self-efficacy was found to be significant in both models for depressive symptoms (B [SE] = 0.15 [0.07], bias-corrected 95% CI = [0.03, 0.31]) and anxiety symptoms (B [SE] = 0.11 [0.05], bias-corrected 95% CI = [0.02, 0.23]). Conclusion The mental health impact of serious fall incidents was shaped by older individuals’ perceived concerns about falls and confidence in performance. The findings highlight the importance of addressing fall-related psychological responses in preventing falls and promoting mental health among senior housing residents.

Life events and the experience of quality of life among residents of senior housing in Finland

A more holistic view is needed regarding the impact of life events on the quality of life of older adults. We explored how senior housing residents perceive the influence of life events on their current quality of life, from a life course perspective. Semi-structured interviews were conducted with 33 residents aged 68 to 97 years from three senior houses. The thematic analysis suggested that events related to social relationships and human agency may influence quality of life in old age. Experiences that contribute to personal development, feeling safe, social connectedness, and a strong sense of human agency were perceived to add quality to life. Events that cause anxiety, reduces one’s sense of autonomy, and involve loss of social closeness were perceived to detract from quality of life. Life events can also sometimes evoke conflicting feelings. The study implies that the influence of life events depends on whether human needs are met.

PREVALENCE OF DEMENTIA AND COGNITIVE IMPAIRMENT IN PUBLIC SENIOR HOUSINGS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Older residents in public housing represent a particularly vulnerable population at risk for cognitive decline due to their disadvantaged socioeconomic and health-related characteristics which are well-known risk factors of dementia. This study aims to synthesize available evidence regarding the prevalence of dementia and cognitive impairment among public senior housing residents. We conducted a literature search for studies published in English in the following databases: PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. We focused on observational studies about residents of public senior housings that reported prevalence and/or incidence of dementia and/or cognitive impairment screened by assessment tools for detecting dementia equivalent cognitive impairment. A total of ten studies were included for a meta-analysis to estimate the overall prevalence of cognitive impairment and dementia. Seven of ten studies utilized screening tools to detect dementia equivalent cognitive impairment. Overall pooled prevalence of cognitive impairment or dementia was 20.4% (95%CI: 14.1-27.5). The subgroup analyses revealed the pooled prevalence of cognitive impairment among residents of public senior housing was 25.5% (95%CI: 22.0-29.1) and pooled prevalence of dementia was 13.5% (95%CI: 8.3-19.7). The subgroup findings suggest the prevalence of dementia may be higher among residents of public senior housing compared to their peers in non-public housing. Also, this population may be particularly susceptible to an unrecognized or delayed diagnosis of dementia due to the lack of formal detection strategies in public senior housing. More resources should be allocated for detection to ensure better support the residents.

Quality of Life among Low-Income Older Residents in Subsidized Senior Housing: Rural vs. Suburban Comparisons

Older adults living in subsidized senior housing tend to be at risk for poor psychological well-being related to their advanced age and low income. This study aims to explore multilevel factors affecting perceived quality of life (QoL) among non-urban subsidized senior housing residents and to compare these factors between rural and suburban communities. Community/residential-level data were collected from the interviews with residential service coordinators (RSC) of five subsidized senior housing communities in the New England region: two rural and three suburban communities. Individual- and interpersonal-level data came from the survey with 82 residents. A mixed-methods approach was utilized. We used thematic content analyses for the interview data and multivariate ordered logit regression for the survey data. Our results showed that rural residence was positively associated with QoL (OR = 4.913, p<.01) even after controlling for all the individual-, interpersonal-, and community/residential-level factors. From RSCs’ perspectives, four main themes emerged, which could potentially contribute to better QoL among senior housing residents: access to services, social spaces for residents, inequitable connections to community resources, and social engagements among senior housing residents and with RSCs. Our findings contribute to the development of strategies to improve QoL among older adults living in rural/non-metropolitan subsidized senior housing.

A Pilot Study of a Game-Based Cognitive Training Intervention for Public Senior Housing Residents in South Korea

The current study investigated the effects of a game-based intervention on cognitive function and mood for older adults in South Korea. In a nonrandomized controlled, pretest-posttest study, sixteen older adults were allocated to an intervention or control group. The intervention group received the 10-week cognitive training using Happy Table. The game-based cognitive training intervention significantly improved cognitive function and memory loss, whereas the control group maintained a similar level of impairment. However, there were no significant changes in anxiety and depression for both groups. The implementation of game-based intervention may be promising for improving cognitive abilities for older adults.

Active Aging in Senior Housing Residents and Community-Dwelling Older Adults: A Comparative Study in Finland.

Leading an active life in old age underpins positive life experience. This study aimed to compare the levels of active aging in senior housing residents and community-dwelling older people. We combined data from the BoAktiv senior house survey (N = 336, 69% women, mean age 83 years) and AGNES cohort study among community-dwelling older adults (N = 1021, 57% women, mean age 79 years). Active aging was assessed with the University of Jyvaskyla Active Aging scale. Data were analyzed with general linear models, and the analyses were stratified by sex. Men in senior houses demonstrated lower active aging scores in general than community-dwelling men. Women in senior houses showed greater will to be active, but poorer ability and possibilities for activity than community-dwelling women. Despite the social and supporting environment, senior housing residents' possibilities for leading an active life seem to be compromised, potentially leading to an unmet activity need.

Enhancing social connections through an acting and improvisation course for older Americans in low-income housing

ABSTRACT Background Older adults living in subsidized housing may be at increased risk of social isolation. Applied theater, a participatory art program, can facilitate social connections among older adults. Methods A professionally-facilitated 12-week acting and improvisation course was held in two federally subsidized buildings in an urban setting. The mixed-method design included thematic analysis of interviews, participant observation, field notes, and statistical analysis of change over time in social isolation, community belonging, and social exclusion. Results Participants were motivated to meet other building residents, and the course included aspects that encouraged social bonding. Conclusions Although recruitment of socially-isolated older adults presented challenges, this study presents lessons on what motivates residents of low-income senior housing to enroll in an acting program and how to design a theater course in this setting that promotes group bonding.

Social Participation Considered as Meaningful in old age − the Perceptions of Senior Housing Residents in Finland

As populations across the world age, there is a recognised need for promoting social participation in older adults. Previous studies related to social participation have addressed that interactions perceived as meaningful may improve quality of life in old age. However, what is less clear is the nature of such participation from the perspective of older adults, as the vast majority of studies have been quantitative. The present study aimed to explore what characterises social participation that contributes to a meaningful everyday life, from the viewpoint of independently living Finnish older adults. Thematic analysis was used as an interpretative method drawing on semi-structured in-depth interviews with six residents aged 82 to 97 years from one senior housing facility. The analysis showed that social participation perceived as meaningful involved caring reciprocal interactions with people they connected with; having the freedom to make autonomous decisions and influence matters that affected their own or others’ everyday life; and, on a more abstract level, feeling significant as a person. It furthermore fostered independence and companionship as well as reduced loneliness. To describe social participation that is perceived as meaningful from a theoretical perspective, we used Levasseur and colleagues’ (2010) taxonomy and found that such involvement creates a sense of connectedness, a sense of belonging and relates to the concepts of social integration, social networking and social engagement. This type of involvement is associated with enhanced quality of life and a more meaningful life, highlighting the importance of creating environments where older adults can socially connect.

SOCIAL ISOLATION AND LONELINESS AMONG OLDER ADULTS IN SUBSIDIZED SENIOR HOUSING: DOES IMMIGRATION STATUS MATTER?

Abstract Older immigrants are at increased risk for social isolation and loneliness due to cultural and linguistic barrier to forming social networks. The vulnerability to social isolation could be exacerbated by the gaps between older immigrants’ cultural expectations on social relations and actual social connectivity. Guided by the cognitive discrepancy model of loneliness, this study examined how social isolation influences loneliness among low-income older residents living in subsidized senior housing and if the relation varies by immigration status. Survey data were collected in 2019 and 2020 from 231 residents in subsidized senior housing communities located in St. Louis and Chicago. Social isolation was measured by frequency of social contacts, accounting for the types of relationships (family vs. friends) and the modes of contacts (in-person vs. remote). Loneliness was measured by the Revised University of California Los Angeles loneliness scale. Perceived quality of friendship was also included in the analytic models. The results of multiple linear regression showed that having positive friendship (b=-1.00, p&amp;lt;.001) and more frequent in-person contacts with friends (b=-1.29, p&amp;lt;.001) were negatively associated with loneliness, respectively. A significant moderating effect was found that older immigrants felt less lonely than non-immigrant counterparts when they had more in-person family contacts (b=-1.09, p&amp;lt;.05). The results suggest that the impacts of social isolation on loneliness among senior housing residents could differ depending on immigration status. The findings of this study could contribute to developing culturally sensitive interventions to enhance social connectedness and reduce loneliness among older immigrants in subsidized senior housing.

INTEGRATING HOUSING, HEALTH, AND SUPPORTIVE CARE IN AFFORDABLE SENIOR HOUSING: EVALUATION OF THE R3 PROGRAM

Abstract This symposium reports evaluation findings from the Right Care, Right Place, Right Time (R3) program. The initiative is designed to integrate housing, health, and supportive care to residents of affordable senior housing using a wellness team (nurse and social worker). The embedded team works directly with residents to address health-related, educational, and informational needs and access to services - focusing on proactive outreach and prevention, coordination with providers, constant contact with residents, and targeting high-risk residents. The initiative aims to create a replicable, scalable, and sustainable model of housing with supportive services that enables independent living while reducing health care costs. Two wellness teams served approximately 400 participants at seven Boston-area buildings. The R3 program was implemented in two phases. The 18-month pre-intervention period was January 2016-March 2017, while the 18-month Phase 1 intervention period was July 2017-December 2018. The 21-month Phase 2 implementation period (known R32), which introduced a targeting strategy to identify high risk residents, was January 2019-September 2020. Evaluation activities included quantitative and qualitative components. Program participants and non-participants at intervention and comparison sites were surveyed on program-related experiences. Program, housing, and community partners were interviewed. Key performance indicators were tracked. Medicare claims data were analyzed using comparison groups. Focus groups were completed with payers, housing providers, and community stakeholders. The purpose of this symposium is to identify the experiences of program participants and key stakeholders with the R3 program, and to assess program impact. Edward Miller and Marc Cohen will serve as chair and co-chair, respectively.

ENGAGING LOW-INCOME SENIORS IN PARTICIPATORY DESIGN OF SMART SPEAKER APPLICATIONS FOR WELLNESS

Abstract Low-income senior housing (LISH) residents are at a high risk of unmanaged health conditions, loneliness, and limited healthcare access. Smart speakers have the potential to improve wellness in LISH settings. We conducted a user-centered process with primarily African American, LISH residents (N=25) to develop prototypes of smart speaker applications for wellness and social connections. Five focus groups were conducted to elicit feedback about challenges with maintaining wellness and attitudes towards smart speakers. Participants expressed their desires for using the technology for safety and health. Through design workshops, they identified several smart speaker functionalities perceived as necessary for improving wellness and social connectedness. Then, seven low-fidelity prototypes and scenarios were developed in the following categories: wellness check-ins, befriending the virtual agent, community involvement, and mood detection. We demonstrate how smart speakers can provide a tool for their wellness and increase access to applications that provide a virtual space for social engagement.

TECHNOLOGY DESIGN AND IMPLEMENTATION TO PROMOTE EQUITY, INCLUSION, AND DIVERSITY

Abstract The design of technology and technology-based solutions for the challenges many older adults face must consider principles of equity, inclusion, and diversity, or there is a risk of exacerbating digital divides in our society. This session focuses on the design, evaluation, and implementation of technologies to support older adults considering the diversity of the older adult population with respect to factors such as race and ethnicity, income level, health conditions, and cognitive status. M. Harris will discuss the facilitators and barriers identified by Black older adults related to the use of wearable devices for health monitoring. J. Chung will present on the development of a smart speaker application to support wellness among low-income senior housing residents. C. Berridge and E. Sanders will discuss designing technology solutions related to diversity with respect to cognitive status, with Berridge discussing preferences of older adults with mild Alzheimer’s disease for a technology-delivered planning tool, and Sanders presenting technology-based solutions to support the prospective memory of older adults with diverse cognitive impairments. Finally, Schiaffino will present a study examining the acceptability of community-based telehealth programs among vulnerable older adults as a function off health, language, and ethnicity. General themes of inclusive design to ensure that all older adults can benefit from existing and emerging technology-based solutions will be highlighted.

Preference to Age in Place in Low-Income Senior Housing

ABSTRACT Low-income senior housing provided through the Section 202 Supportive Housing for the Elderly program is a critical site for aging in place, and many of these properties have hired service coordinators to monitor residents’ quality of life, provide access to services, and promote their ability to age in place. To address gaps in the limited literature on Section 202 buildings, this study examined the association between service coordination and low-income senior housing residents’ preference to age in place with particular attention to the most economically vulnerable. We analyzed data from 255 older adults living in eight Section 202 buildings in Southeastern Michigan using logistic regression. Self-perceived economic vulnerability moderated the relationship between service coordination and preference to age in place. Among those who had not received service coordination, the high economic vulnerability group was more likely to prefer to age in place compared to more economically secure residents. Among those who received assistance from a service coordinator, economically vulnerable residents were less likely to express a preference to age in place compared to other residents. Findings indicate a complex relationship between service coordination, economic resources, and preference to age in place in senior housing, and suggest areas for future research.

Using Smart Speakers in Low-Income Senior Housing to Enhance the Aging in Place Experience: Stakeholder Views

Smart speakers provide a platform that can integrate smart home technology and/or safety devices within the home to enhance quality of life and independent living for older adults. However, few attempts to utilize this technology specifically within low-income senior housing (LISH) residents have been documented. Our purpose was to explore different stakeholder perceptions about the use of smart speakers to support aging in place in older adults living alone in LISH. Smart speakers were deployed in individual LISH apartments, equipped with a voice technology-based aging in place solution for the facility. A qualitative analysis of semi-structured interviews using a constant comparative approach for emerging themes was conducted (n=10: older adult users, n=2: housing staff, n=2: voice technology developers). The three participant groups showed diverging perceptions in terms of benefits, uses, and stakeholder interests. Older adults found smart speakers useful in four main areas: assistance with daily tasks, feeling connected, safety measures, and emotional wellbeing. The two other groups showed a broader interest in the use of the smart speaker device, such as residential management tools and communication channels in addition to its potential use as safety and wellness tools. Older adults experienced significant difficulty setting up desired functions or finding instructions, which restricted utilization of the technology to a limited set of tasks. All stakeholder groups addressed a need for formal training or personalized tech support for older adult users. Findings indicate the importance of developing deployment strategies tailored to the needs and characteristics of the target user group.

Generating synthetic occupants for use in building performance simulation

Occupant behaviour simulation frameworks can employ synthetic populations to characterize occupancy and behavioural patterns in buildings based on observed demographic data at a certain geographical location. For buildings, very few synthetic occupant populations have been generated. This paper uses a Bayesian Networks (BN) structural learning approach to synthesize populations of occupants in a multi-family housing case study. Two additional cases of office occupants and senior housing residents are considered as a cross-case comparison. We draw upon the extended version of drivers-needs-actions-systems (DNAS) framework to guide the selection of variables and data imputation. Our results show that the BN approach is powerful in learning the structure of data sets. The synthetic data sets successfully match the joint distributions of the underlying combined data sets. Experiments on the multi-family housing particularly show better performance than the office and senior housing cases.

Limited Technology Access Among Residents of Affordable Senior Housing During the COVID-19 Pandemic.

While U.S. adults living in affordable senior housing represent a vulnerable population during the COVID-19 pandemic, affordable housing may provide a foundation for interventions designed to improve technology access to support health. To better understand technology access among residents of affordable senior housing, we surveyed members of a national association of resident service coordinators to assess their experiences working with residents during the pandemic (n = 1,440). While nearly all service coordinators report that most or all residents have reliable phone access, under a quarter report that most or all have reliable internet access; they also report limited access to technology for video calls. Lack of internet access and technology literacy are perceived as barriers to medical visits and food procurement for low-income older adult residents of affordable housing. Policies to expand internet access as well as training and support to enable use of online services are required to overcome these barriers.

Attitudes and Perceptions Toward Voice-Operated Smart Speakers Among Low-Income Senior Housing Residents: Comparison of Pre- and Post-Installation Surveys.

Smart speakers have the potential to support independent living and wellness among low-income senior housing (LISH) residents. The aim of this study was to examine and compare LISH residents’ attitudes and perceptions toward smart speakers at two time points: before and after technology use (N = 47). A descriptive survey was administered to ask questions about hedonic motivation, perceived ease of use, self-efficacy, perceived usefulness of some potential or existing smart speaker features, cost, and privacy. Participants were initially favorable toward using a smart speaker and its digital agent (e.g., Alexa) as a daily assistant and wellness tool. They especially liked the smart speaker’s potential functionality of detecting harmful events and notifying someone to receive immediate help. The comparison of pre- and post-use responses revealed non-significant declines in most items, with the exception of willingness to use Alexa as a reminder system (p < .01), asking Alexa for help (p < .01), and asking for help in using Alexa (p < .01). This finding may reflect confusion or frustration with the device among participants. We conclude with recommendations for the design of smart speakers specifically tailored to the needs of LISH residents.

The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing.

Background/ObjectivesThis study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services.DesignCluster randomized controlled trial with randomization at the housing site level.SettingGreater Boston, Massachusetts.ParticipantsThe study includes 6 sites with 75 individuals in the TC treatment condition and 6 sites with 67 individuals in the health education control condition.InterventionMembers of the treatment group received up to a year-long intervention with twice weekly, in-person TC exercise sessions along with video-directed exercises that could be done independently at home. The comparison group received monthly, in-person healthy aging education classes (HE). Study recruitment took place between August, 2015 and October, 2017. Key outcomes included acute care utilization (inpatient stays, observation stays and emergency department visits). In addition, the cost of utilization was estimated using the age, sex and race adjusted allowed amount from Medicare claims for a geographically similar population aged ≥ 65.ResultsThe results suggested a possible reduction in the rate of ED visits in the TC group vs. controls (rate ratio = 0.476, p-value = 0.06), but no findings achieved statistical significance. Adjusted estimates of imputed costs of ED and hospital care were similar between TC and HE, averaging approximately $3,000 in each group.ConclusionED utilization tended to be lower over 6 to 12 months of TC exercises compared to HE in older adults living in low-income housing, although estimated costs of care were similar.

MULTIPLE FACTORS INFLUENCING SUCCESSFUL AGING

Empirically-based theories on successful aging have emphasized the multidimensional nature of aging well, including physical health and functioning, cognitive and emotional well-being, and social connectedness and engagement (e.g., Rowe & Kahn, 1987, Depp & Jeste, 2006). Yet, the field is still continuing to discover, deeply characterize, and better understand the biopsychosocial mechanisms through which varying social, physical, or cognitive activities may influence unique domains of successful aging. The current symposium builds on this growing body of research by addressing factors supporting successful aging across multiple dimensions of well-being and among a diversity of samples ranging from urban to rural, West Coast to Midwest, and community populations to professional athletes. Webster and Antonucci examine the links between social engagement and successful aging among affordable senior housing residents. They found that more frequent participation in social activities was associated with increases in life satisfaction over time. Toyama and Fuller examine how social engagement and health affect aging well, finding that older adults’ subjective health plays a more important role than objective health in maintaining social integration over time. Similarly, Turner describes the role of social networks and religiosity for health outcomes among aging NFL athletes. Finally, Casaletto and colleagues examined mechanisms underlying cognitive wellness as an aspect of successful aging. They found that engagement in both physical and cognitive activities independently support brain health and cognitive reserve in late-life. Taken together, these presentations provide a diverse and broad perspective on how varying factors influence the multiple dimensions of successful aging.

Low rates of eye care utilization among visually impaired subsidized senior housing residents

Objective To examine the rate of self-reported vision impairment, eye disease, and eye care utilization among residents of subsidized senior housing (SSH) communities. Methods In this cross-sectional, observational study, residents of 14 SSH communities in Jefferson County, AL, USA self-reported their vision status and eye care utilization as part of vision screening events held in their community. Results Two hundred and thirty-seven residents self-reported their vision status, presence of eye disease, and eye care utilization. A third of participants (33.3%) reported difficulty with distance vision while 38% reported difficulty with near vision. Rates of eye disease among this sample were as follows: 40.3% reported having cataracts, 13.6% reported having glaucoma, 4.2% reported having age-related macular degeneration, and 5.5% reported having diabetic retinopathy. The majority of participants (52.8%) had not been to see an eye care provider within the last year. Persons with vision impairment were less likely to report having seen an eye care provider within the last year than those without impairment (p = .03). Conclusion This study illuminates the low utilization of eye care among socioeconomically disadvantaged older adults residing in SSH, especially among those with vision impairment and eye disease. Vision-related health care is important in maintaining both physical and mental health in older adults.