Subsidized Senior Housing Research Articles

Health risks associated with urinary incontinence among older Korean Americans living in subsidized senior housing.

We examined the association of urinary incontinence (UI) with physical, mental, and social health among older Korean Americans living in subsidized senior housing. Data were obtained from surveys conducted in 2023 with older Korean Americans residing in subsidized senior housing in the Los Angeles area (n = 313). UI was measured using a question about the frequency of involuntary urine loss. Physical, mental, and social health risks were assessed with a single item for self-rated health (fair/poor rating), the Patient Health Questionnaire-9 (probable depression), and the Lubben Social Network Scale-6 (isolation from family and friends). Over half of the sample reported UI, with 46.3% experiencing it infrequently (i.e. seldom) and 10.3% frequently (i.e. sometimes or often). UI was significantly associated with physical and mental health indicators; the odds of reporting fair or poor health and having probable depression were 1.94-7.32 times higher among those with either infrequent or frequent UI compared to those without UI. While family isolation was not associated with UI, the odds of being isolated from friends were 2.85 times greater among those with frequent UI compared to those without UI. Our findings confirm the adverse impact of UI on physical and mental health and highlight its unique role in social health. UI-associated social isolation was significant only in relationships with friends, providing new insights into the distinction between isolation from family and friends. These findings enhance our understanding of the health risks associated with UI and inform strategies for health management and promotion within the senior housing context.

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.

Publicly subsidized senior housing: the national profile of independent living models in South Korea

ABSTRACT Understanding alternative senior housing arrangements is important because of the expanding global aging population, increasing cost concerns for long-term care, and the desire of older people to age in place (AIP). Using a convergent mixed-method design, we examined the South Korean case using national data on independent living models for older adults. We examined the socioeconomic and health characteristics of residents and the service and operational environment of their housing. Based on quantitative and qualitative information collected by the executive director and key staff in senior housing, we discussed areas of mismatch between aging individuals’ needs and housing resources. Our findings suggest that the current service delivery model of housing needs to be reformed to address (1) the heterogeneous support and care needs of residents, (2) limited operational capacity, and that the spatial design needs to be restructured to ensure privacy. We discuss several programmatic and policy-level reforms to build and expand sustainable publicly subsidized senior housing.

The Role of Sensory Impairment in Cognitive Health Appraisal: A Study of Older Korean Americans Living in Subsidized Senior Housing.

We examined how the association between cognitive performance and cognitive health appraisal would be moderated by vision and/or hearing impairment. Data were collected from 315 older Korean-American residents in subsidized senior housing in Los Angeles (M age = 79.4years). Linear regression models examined the direct and interactive effects of cognitive performance, vision impairment, and hearing impairment on cognitive health appraisal. Negative appraisal of cognitive health was associated with lower cognitive performance and poorer ratings for vision and hearing. Moreover, we found a significant interaction between cognitive performance and hearing impairment (β = .13, p < .05), as well as a three-way interaction among cognitive performance, vision impairment, and hearing impairment (β = .12, p < .05). The association between objective and subjective measures of cognition was weakened when hearing was impaired. Such a pattern was further evident when both vision and hearing were impaired.

Mental Health Impact of Bullying by Ethnic Peers in Senior Housing: A Study with Older Korean American Residents in the Greater Los Angeles Area

ABSTRACT Using data from Korean-American residents (N = 343) in subsidized senior housing in the Los Angeles area, we examined the effect of peer bullying on mental health. About 18% of the sample had been a target of bullying, and over 31% had witnessed someone being bullied. Being a target of bullying was a significant predictor for both depressive symptoms and anxiety, whereas witnessing other residents being bullied was a significant predictor for anxiety only. Findings shed light on the adverse mental health impacts of peer bullying among ethnic minority older residents in senior housing.

Effect of a Bladder Control Self-Management Program Delivered Through a Health Kiosk.

The purpose of this study was to examine the feasibility of delivering a bladder control self-management program through a multiuser health kiosk and to evaluate the program's effect on urinary incontinence (UI) and incontinence-specific quality of life (QoL). Secondary analysis of data collected during participants' interactions with the Bladder Control Module (BCM) from the parent study. One hundred eleven participants from the parent study were eligible to be included in this secondary analysis. Their mean age was 72.8years, and most were female (n=95, 85.6%); 81 (75.7%) identified themselves as Caucasian. Each participant could access the BCM at a health kiosk situated at one of several sites: senior centers, subsidized senior housing, retirement communities, and a public library. The BCM comprised 6 sessions self-administered at least 1 week apart. The content focused on lifestyle modification, pelvic floor muscle training, and bladder (habit) retraining, with encouragement of behavioral self-monitoring between sessions. The feasibility of delivering the intervention was measured by the proportion of participants completing each session. The effect of the BCM on incontinence episodes and incontinence-specific QoL was measured, respectively, by a 7-day bladder diary and the Incontinence Impact Questionnaire Short Form. Sixty-one of the 111 eligible participants accessed the BCM. Participants recording incontinence episodes in their baseline bladder diary and completing at least 3 BCM sessions experienced significant decreases in median total UI (P =.01), urge UI (P <.001), and stress UI (P =.02) episodes per day. Incontinence-related QoL significantly improved (P =.03). Our findings support the potential effectiveness of providing community-based, kiosk-enabled access to a conservative behavioral intervention designed to improve incontinence-related outcomes among older adults with UI. Additional research with a larger sample is warranted.

SUBSIDIZED SENIOR HOUSING IN THE U.S.: A SCOPING REVIEW

Abstract Although Subsidized Senior Housing (SSH) has been considered an important model to promote healthy aging among vulnerable subgroups of older adults, progress in developing, expanding, and improving SSH has been limited compared to other housing models. A comprehensive review of the recent knowledge base is a critical step toward developing and expanding policies and programs for senior housing for low-income older adults. This scoping review used a five-stage scoping review methodology to answer two research questions: 1) What are the trends in SSH empirical studies? 2) What are the main topics in the existing literature on SSH in the US? This review explores the social, physical, and service environments related to SSH in older adults in the US. Personal and environmental factors were key in examining study outcomes or main focus. We reviewed a total of 61 articles and found several notable trends, including a focus on racial and ethnic minorities, cognitive impairment among SSH residents, and Collaborative partnerships between housing operators and healthcare providers. More than half of the studies (54%) were quantitative, while the rest were qualitative (38%) or mixed-methods (8%). The lack of longitudinal or causal design research reflects the limited empirical knowledge of SSH. Four themes emerged: health and well-being (52.5%), healthcare use and health behaviors (31.1%), social relations (8.2%), and housing relocation (8.2%). We discussed implications for future research and program development efforts in SSH. Future research should explore the fit between individual characteristics and the multiple-factor environmental context.

Subsidized Senior Housing in the US: A Scoping Review.

Subsidized senior housing (SSH) is important to support healthy aging among vulnerable subgroups of older adults, yet progress in developing and expanding SSH has been limited. This scoping review had two research questions: (1) What are the trends in SSH empirical studies? (2) What are the main topics in the existing literature on SSH in the US? We reviewed a total of 61 articles and found several notable trends, including a focus on racial and ethnic minorities, cognitive impairment among SSH residents, and collaborative partnerships between housing operators and healthcare providers. More than half of the studies were quantitative, while the rest were qualitative or mixed-methods. The lack of longitudinal or causal design research reflects the limited empirical knowledge of SSH. Four themes emerged: health and well-being, healthcare use and health behaviors, social relations, and housing relocation. We discussed implications for future research and program development efforts in SSH.

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.

Loneliness Among Low-Income Older Immigrants Living in Subsidized Senior Housing: Does Perceived Social Cohesion Matter?

ABSTRACT This study compared the level of loneliness among older immigrants residing in subsidized senior housing with that of non-immigrant residents. The study also sought to examine the differential influence of perceived social cohesion on loneliness among these groups. 231 study participants were recruited from subsidized senior housing in St. Louis and the Chicago area. Multiple regression analyses showed that there was a significant difference in loneliness between immigrants and non-immigrants (b = .3, SE = 0.150, p < .05). Also, perceived social cohesion was negatively associated with loneliness (b=−.102, SE = .022, p < .001). Furthermore, immigration status moderated the relationship (b=−.147, SE = .043, p < .01), showing immigrants may benefit more from higher perceived social cohesion in terms of loneliness. The results suggest that perceived social cohesion may act as an important community-level protective factor against loneliness, particularly for older immigrants residing in subsidized senior housing. Creating socially cohesive environments, particularly for this subgroup, could be a crucial strategy for mitigating loneliness.

Safety Concerns for Persons with Dementia in Senior Housing: A Qualitative Study with Korean American Caregivers in Los Angeles

ABSTRACT Subsidized senior housing helps many socioeconomically disadvantaged older adults pursue independent living and aging in place. However, cognitive impairment or dementia poses a critical challenge to many residents’ ability to live independently and safely. Focusing on Korean American dementia caregivers, a group known to be vulnerable to caregiving burden but understudied, we explored the safety of persons with dementia in senior housing from the perspectives of caregivers. Qualitative data from nine caregivers whose care recipients were current or former residents of subsidized senior housing in Los Angeles were analyzed by the constant comparative method. Major concerns emerged were: (1) fire risks, (2) wandering, (3) physical injury (e.g., self-harm, falls), and (4) potential neglect. Caregivers also mentioned errors in the self-administration of medications, potential financial exploitation, and interpersonal conflicts. These concerns provide implications for services and programs for the safety of persons with dementia who live in senior housing.

LONELINESS AMONG OLDER IMMIGRANTS LIVING IN SUBSIDIZED SENIOR HOUSING: DOES PERCEIVED SOCIAL COHESION MATTER?

Abstract The study compared the level of loneliness among older immigrants living in subsidized senior housing to non-immigrant residents. Also, the role of perceived social cohesion on loneliness was investigated, focusing on the differential influence among older immigrants and non-immigrants. Residents of subsidized senior housing in St. Louis and the Chicago area were recruited, and 182 responses were used in the analysis (126 immigrants and 56 non-immigrants). Descriptive analysis examined the difference in loneliness between immigrants and non-immigrants. Also, multiple regression models estimated the association between 1) immigrant status and loneliness, 2) perceived social cohesion and loneliness, and 3) the moderating role of immigrant status. Linear regression model showed that there was no significant difference between loneliness levels between immigrants and non-immigrants. However, perceived social cohesion was negatively associated with loneliness (β=-.338, SE= .025, p &amp;lt; .001). Additionally, immigration status moderated the relationship between perceived social cohesion and loneliness (β=-1.143, SE= .052, p &amp;lt; .01), which implies that immigrants may benefit more from higher perceived social cohesion in terms of loneliness compared to their non-immigrant counterparts. High perceived social cohesion might be an important community-level protective factor against loneliness in old age, especially for low-income older adults living in subsidized senior housing. Creating socially cohesive environments, particularly for this subgroup, would be crucial for mitigating loneliness and facilitating aging-in-place.

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.

DIFFERENCES IN HEALTH AMONG LOW-INCOME OLDER IMMIGRANTS: DOES ETHNICALLY HOMOGENEOUS ENVIRONMENT MATTER?

Abstract Older immigrants comprised 14% of the US older population, which is predicted to continue to rise. Despite the importance of ethnic attachment in older immigrants’ well-being, little is known how ethnically homogeneous housing environment affect older adults’ health. This study aims to fill the gaps in knowledge on low-income older immigrants living in subsidized senior housing and to explore the associations between immigrant status, senior housing environments, and self-rated health among this population. Our survey data was collected from 18 subsidized senior housing communities in IL, MO, and NH (N=459). Bilingual surveyors fluent in Chinese, Russian, and Korean were also available for the participants with limited English proficiency as the sampled housings were the multi-ethnicity properties. Hierarchical Linear Modeling was employed for our analysis to address our participants were clustered within senior housing.More than a half (56%) of our sample lived in ethnically homogeneous senior housing (either all immigrants or all non-immigrants). Immigrants consist of 53% of our sample, and 48% of them lived in ethnically homogeneous housing. Our finding showed that immigrants were more likely to report low level of self-rated health (OR=0.885, p&amp;lt; 0.01). However, ethnically homogeneous senior housing environments positively influence the association between immigrant status and self-rated health (OR=1.219, p&amp;lt;.05).This study highlights the importance of ethnically homogeneous living environment for low-income older immigrants in senior housing. Although ethnic diversity may be beneficial in broader society, concentration of ethnic minority older immigrants could play an important role in terms of social support and service delivery.

Multilevel Factors for Life Satisfaction Among Residents in Non-Urban Subsidized Senior Housing

Although a quarter of HUD-assisted properties for older adults are located in rural/non-metropolitan areas, there is limited understanding of the population living in these locations. Advanced age and low income are known risk factors for poor physical and mental health. Older adults in rural subsidized housings may be at increased risk for poor health and social isolation due to their isolated locations and small-scale housing complexes. This presents the additional challenge of service provision for the residents’ needs. This study aims to explore multi-level factors affecting life satisfaction among residents in subsidized senior housing. Data were collected for five subsidized senior housings in New Hampshire: two in Coos county (rural, population=33,055) and three in Strafford county (suburban, population=128,613). Mixed-methods approaches were used: Community/organizational-level data were collected using semi-structured interviews conducted with the directors of senior housings. At the individual level, quantitative survey data were collected from 82 residents of five senior housings. Contrary to expectations, we found that residents in rural senior housings were likely to report better life satisfaction (Coef.=0.597, p<.01) than those in suburban areas despite controlling for individual-level factors such as age, gender, education, marital status, health, social relations, and service use. The most salient terms used in the interviews with directors of rural senior housings include limited resources, tight community, and emotional support. The last two may be protective factors positively influencing life satisfaction among their residents. Our results contribute to development strategies to improve quality of life among residents in rural/non-metropolitan subsidized senior housing.

The Feasibility of a Low Sodium Meal Plan for Residents of a Subsidized Senior Housing Facility: The SOTRUE Pilot Study

Abstract Objectives To determine the feasibility of a low sodium meal plan intervention aimed at reducing seated blood pressure (BP) in residents of a government-subsidized congregate, senior living facility. Methods The Satter House Trial of Reduced Sodium Meals (SOTRUE) was an individual-level, masked, randomized, controlled pilot study, testing the feasibility of administering a low versus typical sodium meal plan to adult residents of Jack Satter House, a section 202 congregate living facility in Revere, MA, subsidized by the Federal Department of Housing and Urban Development (HUD). Adults over age 60 years received 3 isocaloric meals with two snacks daily over a 14-day period. Both meal plans were equivalent in potassium and macronutrients, but differed in sodium density (&amp;lt;0.95 mg/kcal vs &amp;gt; 2 mg/kcal). The primary outcome was seated systolic BP (SBP) averaged over 2 visits (days 10 and 14) using an Omron HEM-907XL automated cuff. Our objective measure of compliance was morning urine sodium-creatinine ratio. Results We randomized 20 participants (95% women, 95% white, and mean age 78 +/− 8 years), beginning in October 7, 2019. Baseline characteristics were evenly distributed between groups. Dietary compliance was high (only 2 discontinued meals) and follow-up was 100% with the last participant ending November 4, 2019. Baseline SBP changed from 121 to 116 mm Hg on the typical sodium meal plan (N = 9; mean difference of −5 mm Hg; 95% CI: −18, 8) and 123 to 112 mm Hg on the low sodium meal plan (N = 11; mean difference of −11 mm Hg; 95% CI: −15.2, −7.7). Compared to the typical sodium meal plan, the low sodium meal plan non-significantly reduced SBP by 5 mm Hg (95% CI: −14, 4) and non-significantly reduced urine sodium-creatinine ratio (%-difference −36.0; 95% CI: −60.3, 3.4). Effects on SBP were greater in the subgroup using hypertension medications at baseline (−13 mm Hg; 95% CI: −26, −0) and changes in SBP from baseline were correlated with changes in urine sodium-creatinine ratio (Pearson's r = 0.31). Conclusions This trial represents an innovative, feasible, and practical approach to healthier eating by altering federally-mandated meal plans. A definitive study with a larger sample size is needed to establish the efficacy and safety of this approach in older adults who reside in section 202 housing. Funding Sources ISAC, Marcus Institute for Aging Research, Hebrew SeniorLife.

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.

Subsidized housing and geographic accessibility to neighborhood resources for low-income older people: From later year social exclusion perspective

ObjectivesDrawing on the perspective of later year social exclusion, this study (1) assessed geographic accessibility to health and social services in subsidized senior housing in Chicago. (2) examined the association between senior housing's accessibility to health/social services, and social exclusion at the neighborhood level. MethodsFirst, senior housing and social/health services data were geocoded and spatially merged with all accessible streets/roads in Chicago area. Second, using network analysis, an advanced GIS technique, we compared degree of accessibility based on the standardized distribution of health and social resources. Third, to examine social exclusion at a neighborhood level, we conducted an exploratory principal component analysis (PCA) to construct a composite score of social exclusion. Last, we ran bivariate analyses (ANOVA) to examine the association between service accessibility and social exclusion components. ResultsThere were 102 subsidized senior housing facilities, surrounded by 120 health service agencies and social services, including 80 libraries, 21 senior centers, and 28 family and support services. PCA analysis revealed five components from the original 16 social exclusion indicators: socio-economic disadvantage, low social integration, environmental hazard, lack of service availability marginalization. The socio-health accessibility was significantly related to two social exclusion factors: socio-economic disadvantage and low social integration. DiscussionAs the first study based on a geospatial approach that focuses on subsidized senior housing's accessibility neighborhood resources, our findings showed that subsidized senior housing not only has differential levels of service, but more importantly is embedded in a qualitatively different nature of social exclusion at neighborhood level.

Influence of senior housing types on cognitive decline and nursing home admission among lower-income older adults

Objectives: Focusing on unique ageing populations in subsidized senior housing for lower-income older adults, this study contributes to literature on housing and aging; provides initial understanding of existing housing types; and explores the extent to which living in different housing types may influence changes in cognitive function and likelihood of nursing home admission.Method: Data came from seven waves (2002–2014) of the Health and Retirement Study. A latent-class clustering approach was used to identify senior-housing types among lower-income older people;Results: We identified four discernible housing types among lower-income older adults: (1) High physical & Low service, (2) Low physical & Low service, (3) High physical & High service, and (4) Medium physical & High service. Individuals in Medium physical & High service and High physical & Low service types were likely to have higher cognitive-function levels at baseline (B = 0.58, p < .001; 0.58, p < .001) and slower rates of decline over time (B = 0.42, p < .001; B = 0.32, p < .01). Older adults in High physical & High service are significantly less likely to be admitted to a nursing home (OR = 0.55, p < .00).Conclusion: The mismatch between health needs and lack of service and support suggests that current residents in each housing type relocate, based on knowledge of subsidized housing or availability. Future studies should examine possible mismatches between health needs and housing environment.

Social Networks and Physical Activity in Senior Housing: A Pilot Feasibility Study.

Only 16% of people aged >65 years engage in recommended levels of physical activity, putting a vast majority at risk for multiple chronic conditions including heart disease. Physical activity is even lower among older adults with fewer economic resources. Research is needed to develop context-specific approaches to pair with physical activity interventions to increase effectiveness. In this pilot study, we examine social ties and physical activity levels of older adults living in a US Department of Housing and Urban Development subsidized senior housing community to test feasibility of a social network-based approach to physical activity interventions. This study is grounded in Social Contagion Theory and the Convoy Model of Social Relations, which argue health and health-related behaviors are facilitated through network ties. Data were collected through face-to-face interviews conducted over the course of three months (September-November 2018) with 46 residents living in a low-income senior housing community in southeast Michigan. Residents were asked about physical activity, people they know in the community, and their close social network composition. Residents reported knowing, on average, six other residents and approximately 28% of those in their close networks were also residents. Sociocentric network analysis identified two socially engaged (known by seven or more other residents) physically active residents, whereas ego-centric analysis identified four (60% or more of their network comprised residents). This study demonstrates potential feasibility of a strategic partnership that involves pairing social resources with physical activity interventions in affordable senior housing. Multiple approaches, which need to be evaluated, exist to identify socially engaged residents.