Future Challenges for Senior Center Programming to Serve Younger and More Active Baby Boomers

ABSTRACT

Misconceptions and myths regarding the image of senior centers need to be overcome especially among the baby boom generation. Although past research and programming have addressed the traditional model of senior centers, little attention has focused on senior center programs and activities that address the needs of younger and more active older adults. Aging and adult services, specifically, senior centers, face challenges in maintaining their role in the community through and beyond the next decade. This article discusses the challenges senior centers face and suggests new approaches for programming and activities that will enable senior centers to make the transition whereby they engage baby boomers in utilizing their services while continuing to address the needs of the present users of senior centers.     

Living life to the fullest: Well elders’ views of hip fracture

Using a sample of 60 healthy older adults attending senior centers, this study examines elders’ perceptions of the consequences of hip fracture, reports of their physical health, feelings of efficacy in avoiding falls, and reports of depression. Results indicate that these active older adults generally do not feel vulnerable to hip fracture and expect to recover and regain mobility and independence in a timely fashion should they suffer a hip fracture. Moreover, elders in the study who do not view hip fracture as having substantial negative impact on their lives also report lower levels of depression and higher levels of perceived falls efficacy than do elders who view future hip fracture as a more debilitating health event. Study results are discussed in the context of theories of perceived invulnerability as a form of adaptive coping for elders. Implications of findings for caregivers, researchers, and practitioners are also discussed. Catherine H. Stein, Ph.D. is a clinical-community psychologist whose research focuses on marginalized population.     

Step by step: integrating evidence-based fall-risk management into senior centers

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

Happiness and Humor Group Promotes Life Satisfaction for Senior Center Participants

ABSTRACT

The impact of positive psychological attitudes on physical health and healthy aging has been well documented through research. This study assessed whether a therapeutic recreation program specifically addressing happiness and humor could promote life satisfaction among older adults. The Happiness and Humor Group was a 10-week program conducted once a week at an urban senior center. The Life Satisfaction Scale (LSS) was administered as a pretest and posttest to 15 people who participated in the entire program. Scores from this self-rated assessment showed significant improvement in life satisfaction for the program participants. Anecdotal evidence also shows participants' outlook changed significantly as a result of program participation. An overview of the Happiness and Humor Group program is provided as a model that can be replicated in senior centers.     

Two conceptual models of the senior center.

Two models of the senior center are examined: (1) the social agency model, which views senior centers as programs designed to meet the needs of the elderly and postulates that the poor and the disengaged are the most likely candidates for participation in senior centers; (2) the voluntary organization model, which hypothesizes that the elderly who are more active in voluntary organizations and who manifest strong attachments to the community are also the ones who make use of senior centers. Personal interviews were conducted with a random sample (920 respondents) of 40 elderly men and women in each of 23 New York State communities. The findings support the voluntary organization model: (1) a high score on the Chapin Social Participation Scale is associated with membership in a senior center; (2) a high score on the Community Attachment Scale is associated with membership in a senior center; (3) there is no association between social class and participation in senior centers; and (4) senior center members do not differ from nonmembers in age identification or in a preference for organizations exclusively for the elderly.     

Social Networks and Participation in Social Activities at a New Senior Center: Reaching Out to Older Adults Who Could Benefit the Most

ABSTRACT

This study examined social network characteristics associated with older adults' intentions to participate and actual participation in social activities at a new senior center. Face-to-face interviews (N?=?126) were conducted prior to the opening of a senior center in the participants' community. Measures included social network characteristics, social support, social connectedness, and demographic characteristics. Actual participation was assessed approximately 14 months after the senior center's opening. Smaller proportions of network members living in close proximity, having 10% or more network members be children, higher perceived availability of social support, and lower perceived levels of social connectedness were associated with higher intentions to participate in social activities. Levels of intention did not significantly predict actual participation. Older adults with little social support may not perceive senior centers as places to gain desired support. However, individuals who lack companionship may perceive them as a resource for boosting their social engagement.     

Senior center utilization by black elderly adults: social, attitudinal and knowledge correlates

This study examined factors that affect utilization of senior centers by three groups of black elderly adults: attenders (n = 46) and nonattenders (n = 33) of a neighborhood senior center in one community and nonattenders (n = 27) in a comparable community without a neighborhood senior center. Variables investigated included social contact (with family and with friends), attitudes (disengagement potential, acceptability to others, commitment to become involved in senior centers) and knowledge (perception of senior centers). Results of the multivariate analysis of variance showed that sex, age, marital status, health, and transportation did not have a significant effect on the six variables studied. The three groups differed in commitment to become involved in senior centers, perception of senior centers, contact with family, and contact with friends. Similarities between the attenders and nonattenders in the comparable community suggest that the latter group are potential senior center participants.     

Treatment outcome of tuberculosis patients under directly observed treatment in Addis Ababa,Ethiopia

BackgroundTuberculosis is one of the leading causes of mortality among infectious diseases worldwide. For effective tuberculosis control, it is a pre-requisite to detect the cases as early as possible, and to ensure that the tuberculosis patients complete their treatment and get cured. However, in many resource-constrained settings treatment outcome for tuberculosis has not been satisfactory.ObjectiveThe aim of the study was to assess the treatment outcome of tuberculosis patients and investigate the association of demographic and clinical factors with treatment success of patients enrolled in Directly Observed Treatment Short Course program in government owned health centers over the course of five consecutive years in Addis Ababa, Ethiopia.MethodsA register based historical cohort study covering the period of July 2004 to June 2009 was conducted to determine the treatment outcome of Directly Observed Treatment Short Course in government owned health centers in Addis Ababa. Sex and age of tuberculosis patients, health center at which the patient was treated, year of treatment, type of tuberculosis for which the patient was treated, type of treatment offered to the patient, follow-up status and documented treatment outcome were extracted from the Directly Observed Treatment Short Course clinics of three randomly selected health centers.ResultRecords of 6450 registered tuberculosis patients (n = 3147 males and 3433 females) were included in this document review. Of these patients 18.1% were reported as being cured, 64.6% were documented as treatment completed, 3.7% died during follow-up, 5.1% were reported as defaulters, 0.4% were documented as treatment failure and 8.2% were transferred out to another health institution. Treatment center and year of enrollment were significantly associated with treatment success.ConclusionYear of enrollment and treatment center were significantly associated with treatment success. Although the overall treatment success obtained in this study is in line with the World Health Organization (WHO) target, continuous follow-up of patients with frequent supportive supervision during the course of treatment, and further investigate the cause for the observed difference in treatment success across treatment centers are recommended.     

A senior center-based pilot trial of the effect of lifestyle intervention on blood pressure in minority elderly people with hypertension

OBJECTIVES: To test the feasibility, acceptability, and effect of a senior center–based behavioral counseling lifestyle intervention on systolic blood pressure (BP). DESIGN: A pre‐post design pilot trial of behavioral counseling for therapeutic lifestyle changes in minority elderly people with hypertension. Participants completed baseline visit, Visit 1 (approximately 6 weeks postbaseline), and a final study Visit 2 (approximately 14 weeks postbaseline) within 4 months. SETTING: The study took place in six community‐based senior centers in New York City with 65 seniors (mean age 72.29±6.92; 53.8% female; 84.6% African American). PARTICIPANTS: Sixty‐five minority elderly people. INTERVENTION: Six weekly and two monthly “booster” group sessions on lifestyle changes to improve BP (e.g., diet, exercise, adherence to prescribed antihypertensive medications). MEASUREMENTS: Primary outcome was systolic BP (SBP) measured using an automated BP monitor. Secondary outcomes were diastolic BP (DBP), physical activity, diet, and adherence to prescribed antihypertensive medications. RESULTS: There was a significant reduction in average SBP of 13.0±21.1 mmHg for the intervention group (t(25)=3.14, P=.004) and a nonsignificant reduction in mean SBP of 10.6±30.0 mmHg for the waitlist control group (t(29)=1.95, P=.06). For the intervention group, adherence improved 26% (t(23)=2.31, P=.03), and vegetable intake improved 23% (t(25)=2.29, P=.03). CONCLUSION: This senior center–based lifestyle intervention was associated with a significant reduction in SBP and adherence to prescribed antihypertensive medications and diet in the intervention group. Participant retention and group attendance rates suggest that implementing a group‐counseling intervention in senior centers is feasible.     

Activating Seniors to Improve Chronic Disease Care: Results from a Pilot Intervention Study

OBJECTIVES: To evaluate the effect of an activation intervention delivered in community senior centers to improve health outcomes for chronic diseases that disproportionately affect older adults. DESIGN: Two‐group quasi‐experimental study. SETTING: Two Los Angeles community senior centers. PARTICIPANTS: One hundred sixteen senior participants. INTERVENTION: Participants were invited to attend group screenings of video programs intended to inform about and motivate self‐management of chronic conditions common in seniors. Moderated discussions reinforcing active patient participation in chronic disease management followed screenings. Screenings were scheduled over the course of 12 weeks. MEASUREMENTS: One center was assigned by coin toss to an encouragement condition in which participants received a $50 gift card if they attended at least three group screenings. Participants in the nonencouraged center received no incentive for attendance. Validated study measures for patient activation, physical activity, and health‐related quality of life were completed at baseline and 12 weeks and 6 months after enrollment. RESULTS: Participants attending the encouraged senior center were more likely to attend three or more group screenings (77.8% vs 47.2%, P=.001). At 6‐month follow‐up, participants from either center who attended three or more group screenings (n=74, 64%) reported significantly greater activation (P<.001), more minutes walking (P<.001) and engaging in vigorous physical activity (P=.006), and better health‐related quality of life (Medical Outcomes Study 12‐item Short‐Form Survey (SF‐12) mental component summary, P<.001; SF‐12 physical component summary, P=.002). CONCLUSION: Delivering this pilot intervention in community senior centers is a potentially promising approach to activating seniors that warrants further investigation for improving chronic disease outcomes.     

Implementing DASH-aligned Congregate Meals and Self-Measured Blood Pressure in two senior centers: An open label study

Background and aimsCardiovascular Disease (CVD) poses significant health risks for seniors, especially among low-income and minority communities. Senior centers offer multiple services. We tested whether implementing two evidence-based interventions- DASH-aligned meals provided through an existing congregate meal program, and support for home Self-Measured Blood Pressure (SMBP) monitoring-lowers blood pressure among participants at two senior centers serving low-income, racially diverse communities.Methods and resultsOpen-label study, enrolling clients aged ≥60, eating ≥4 meals/week at two NYC senior centers. Participants received DASH-aligned congregate meals, and training in nutrition, BP management education, and personal SMBP device. Co-Primary outcomes: a) change in systolic BP measured by independent health professionals, and b) change in percent with “controlled BP” (Eighth Joint National Committee (JNC-8) Guidelines), at Month 1 compared to Baseline. Secondary outcomes: Changes in BP at Months 3 and 5/6 (last measure).We enrolled 94 participants; COVID closures interrupted implementation mid-study. Mean systolic BP at Month-1 changed by ?4.41 mmHg (n = 61 p = 0.07) compared to Baseline. Participants with controlled BP increased (15.7%) at Month 1. Change in mean BP at Month 1 was significantly correlated with BMI (p = 0.02), age (p = 0.04), and baseline BP (p < 0.001). Mean systolic SMBP changed by ?6.9 mmHg (p = 0.004) at Months 5/6.ConclusionsImplementing an evidence-based multi-component BP-lowering intervention within existing congregate meal programs at senior centers serving minority and low-income communities is feasible, and early findings show promising evidence of effectiveness. This approach to cardiovascular risk reduction should be further tested for widespread adoption and impact.Registered on ClinicalTrials.gov NCT03993808 (June 21st, 2019)     

Effects of Good Life Program on Singaporean Older Adults' Psychological Well-Being

ABSTRACT

Population aging is a demographic trend and a growing concern in Singapore. This article explores through a qualitative research method the psychological well-being of 12 ambulant older adults aged 60 and older, participating in a senior center program. The comparative study examining the effects of the Good Life program on regular and new members has yielded findings in line with activity theory and Ryff's psychological well-being model. Regular members have reported improved psychological well-being after their participation at Good Life as compared to new members. With the increase in life expectancy and better health condition of our older adults, future research on the well-being of older adults in the local context is to be encouraged so that they can be better integrated into society.     

Seasonal influenza vaccination in health-care workers: the influence of consultants on the uptake of vaccination by medical students and early career doctors

BackgroundThe Chief Medical Officer for England recommends that all health-care workers receive an influenza vaccination annually. Medical students are also encouraged to get vaccinated. High vaccination coverage is believed to be the best form of protection against the spread of influenza within hospital settings, protecting both staff and patients, and reducing virus transmission. However, uptake of seasonal influenza vaccination by health-care workers remains substantially lower than the target level of 75%. Our study aimed to provide a deeper insight into the influenza vaccination practices of health-care workers.MethodsAn opportunistic sampling strategy was used and participants recruited via compulsory teaching sessions. We conducted a series of semi-structured interviews with seven medical students and nine foundation doctors, to explore the factors informing their vaccination decisions. Interviews were transcribed and the data analysed thematically. Data collection and analysis took place as an iterative process, until theoretical saturation was achieved.FindingsOf the 16 participants, ten had been vaccinated during the 2015–16 season. A number of key themes emerged, and there were inconsistencies between an individual's opinion of the vaccine, their intentions, and their vaccination status. For example, someone reporting negative opinions of the vaccine could have been vaccinated. Moreover, individuals did not necessarily vaccinate year on year. Participants were influenced by senior staff as role models, demonstrating both positive and negative attitudes towards the vaccine. Participants often presented this observation in the context of their own conflicting ideals of medical professionalism. The decision making processes around influenza vaccination seem to be finely balanced, take place within a culture of relative ambivalence, and can easily be tipped one way or the other by factors such as convenience.InterpretationThe findings are drawn from a diverse sample, and are supported by the literature. This study suggests that senior staff have an important role in the vaccination practices of juniors. The influential role of consultants could be used as part of a future strategy to increase vaccination, since positive role models can facilitate a cultural shift in favour of vaccination uptake. Future research involving senior staff is necessary to understand the complexities behind their own vaccination practices.FundingColt Foundation.     

Management of Acute Coronary Syndrome During the MERS-CoV Outbreak – Single-Center Experience

BackgroundDuring the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreak of 2014, tertiary care cardiac centers shouldered the responsibility of caring for patients presenting with Acute Coronary Syndromes (ACS). This entailed designing algorithms that ensured timely management of patients with ACS in the setting of an emerging novel viral infection that was rapidly spreading within the community with a high infectivity and case fatality rate. The objective of this study is to describe a single center experience and the adopted pathway for the management of ACS.MethodsThis is a single center retrospective observational study of all patients who were admitted between March 1, 2014 and May 31, 2014 with an ACS. Total ACS admissions, bed turnover, procedures and healthcare personnels' infection rates were obtained from the annual statistics database and employee health records. All baseline characteristics, therapy received, outcomes and MERS-CoV status were obtained from the chart review.ResultsA total of 148 patients with a diagnosis of ACS were admitted during that period of time. Of those, 59 had STEMI, 42 had NSTEMI and 47 had unstable angina. PCI was performed in 74, coronary artery bypass grafting (CABG) in 28 and conservative therapy was prescribed for 46 patients. The bed turnover was no higher than the previous or subsequent two months suggesting no change in practice. The infection rate of MERS-CoV was zero for healthcare workers.ConclusionsIn times of a national health crisis it is imperative that best practices are upheld to sustain existing resources, reduce bed occupancy and preserve medical personnel. A key component of such a strategy depends on assigning centers dedicated to isolating and treating the highly infectious disease outbreak while allowing other centers to provide expeditious cardiac care.     

Effects of a cognitive rehabilitation program based on mnemonic skills and memory compensatory strategies for older adults: A pilot study

Background:With the aging of the population, the number of people with age-related memory complaints has also increased. The purpose of this study was to develop a cognitive rehabilitation program based on mnemonic skills and memory compensatory strategies (CRM) and to investigate the effects of CRM in community-dwelling older adults without dementia.Methods:This study was an open-label, single-arm, pilot study. We developed a CRM program comprising 8 weekly sessions. The study participants consisted of older adults with normal cognitive function and mild cognitive impairment (MCI). They were recruited from eight dementia counseling centers and one senior welfare center. To assess the effects of CRM, we administered the following tests at baseline and after completion of the program: Subjective Memory Complaints Questionnaire, the Short form of Geriatric Depression Scale, the Euro Quality of life–5 Dimension, and the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Assessment Battery.Results:Thirty-two participants completed the study. Among older adults with normal cognitive function, CRM showed significant improvement in verbal memory function. Among the older adults with MCI, CRM showed significant improvements in language ability, verbal recognition memory, nonverbal memory, attention, and processing speed.Conclusion:CRM improved cognitive function in two distinct populations, older adults with normal cognitive function and older adults with MCI. Additionally, our preliminary findings suggest that older adults with MCI show cognitive improvement in both the trained and non-trained cognitive domains.     

Senior Centers: Characteristics of Participants and Nonparticipants

This article examines the sociodemographic characteristics of senior center participants and nonparticipants, identifies differences between the two cohorts, and highlights their rationale for participation or nonparticipation. Few studies have attempted to delineate the demographic and choice predictors of senior center participation in the last 10 years. A population of 1,283 older adults residing in northwest Indiana was surveyed for this study. Bivariate analysis of study data found significant differences between participants and nonparticipants, and yielded valuable information about the changing needs and expectations of community-dwelling older adults. Implications of the study findings are relevant for the continued sustainability and relevance of senior centers nationwide. The results provide the framework for recommendations to senior centers with respect to both policy and practice.     

Managing Everyday Ethics in Assisted Living: A Research-Based Case Analysis for the Classroom

ABSTRACT

This paper presents a complex, but realistic, picture of the lived experience in assisted living (AL), and provokes thoughtful reflection about the operational and ethical challenges faced in the delivery of care to an increasingly frail population in a typical AL facility. Developed from the findings of a two-year qualitative research project, the case represents a composite of selected data collected at five AL facilities that participated in the study. Students will participate in individual and small group exercises that challenge them to identify everyday ethical concerns in AL, and to suggest ways that management can address these issues. The case is suitable for cross-disciplinary use, and can be effectively applied in the fields of management, health care administration, sociology, gerontology, social work, and nursing, either on the graduate or undergraduate level. It is especially well suited to courses that incorporate the topics of long-term care, senior housing, or ethics.     

Here's to the Belleville Ladies

Abstract

For the last six years the author has been meeting monthly with a group of older women at a senior center in Belleville, Wisconsin, a rural community of 1500 people. The focus of the two hour “Time Out” sessions is to provide mental stimulation, including the fostering of creativity.

The subjective experiences and observations that have come from working with the Belleville Ladies gives evidence that creativity is an innate, natural, and joyful part of growing older.     

Impact of Family Medicine Training on the Quality of Care for patients of diabetes in Saudi Arabia

IntroductionDiabetes mellitus (DM) is one of the challenging health problems worldwide. Primary care centers manage and treat most of DM cases. Diabetes requires ongoing, and evidence-based health care which should be provided by highly qualified physicians.AimThis study aims at evaluating the Family Medicine training efficacy on the quality of care for diabetic patients.MethodologyThis is a cross-sectional study conducted among patients with DM at the AlJafer training center situated in AlAhssa, Saudi Arabia. The data of diabetic patients who were followed up initially with general practitioners (GPs) and later with family physicians (FPs) collected from the patients’ electronic files. Clinical parameters including HbA1c, blood pressure, total cholesterol, LDL, and statin, aspirin initiation measured during initial visits and follow-ups to compare the quality of diabetic care between the two groups (FPs vs. GPs). All statistical analyses carried using SPSS version 21.ResultsEighty-three patients were included in the study. Regarding the measurement process, FPs more likely to measure HbA1c twice a year than GPs (P:<0.001). The number of patients with HbA1c level >8% decreased significantly during the period of follow-up with FPs (P:<0.001). Furthermore, a significant number of patients meet the BP target ≤130/85 during the follow-up period with FPs. The statin initiation is substantially achieved more by FPs (P < 0.001).ConclusionFamily medicine training has a significant influence on the clinical outcomes of patients with DM. This study’s findings suggest that FPs ensure a better quality of care in terms of clinical and process measures.     

Formal and informal network factors as sources of morale in a senior center population.

This study examined the relative effects of senior center factors and social network attributes on the morale of a sample of senior center participants in Israel (N = 85), controlling for respondents' background characteristics. The multivariate model accounted for 56 percent of the variance in morale scores. Respondents' health was the primary explanatory factor, followed by selected attributes of participants' informal social networks. The formal network factors had a minor and partly negative effect. The findings suggest that participants' morale was shaped more by the configuration of their interpersonal social networks than by factors related to the senior center environment.