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Increasing Social Activity Attendance in Assisted Living Residents Using Personalized Prompts and Positive Social Attention

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Low levels of social activity involvement may have negative implications on overall quality of life for older adults living in residential care settings. Despite the recent growth of assisted living (AL) facilities, few studies have examined social activity participation in this environment. The present study assessed the effects of two prompt procedures that included different amounts of positive social attention (personalized prompts alone and combined with brief conversation) on the social activity attendance of 8 AL residents. Personalized prompts were designed to appeal to each participant on the basis of preference assessments regarding activity interests and preferred types of activity participation. During treatment conditions, increases in attendance occurred not only following treatment prompts but also during activities that were not preceded by treatment prompts. Similar effects were observed for both treatment prompts. Results suggest that personalized prompts and positive social attention can increase weekly social activity attendance in AL residents.
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Journal of Applied Gerontology
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DOI: 10.1177/0733464811427444
December 2011
2013 32: 515 originally published online 26Journal of Applied Gerontology
Courtney Allyn Polenick and Stephen Ray Flora
Using Personalized Prompts and Positive Social Attention
Increasing Social Activity Attendance in Assisted Living Residents
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Journal of Applied Gerontology
32(5) 515 –539
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DOI: 10.1177/0733464811427444
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Manuscript received: July 1, 2011; nal revision received: September 22, 2011;
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1Youngstown State University, Youngstown, OH, USA
Corresponding Author:
Stephen Ray Flora, Department of Psychology, Youngstown State University, Youngstown, OH
44555, USA.
Email: srflora@ysu.edu
Increasing Social Activity
Attendance in Assisted
Living Residents Using
Personalized Prompts and
Positive Social Attention
Courtney Allyn Polenick1 and
Stephen Ray Flora1
Abstract
Low levels of social activity involvement may have negative implications on overall
quality of life for older adults living in residential care settings. Despite the recent
growth of assisted living (AL) facilities, few studies have examined social activity
participation in this environment. The present study assessed the effects of two
prompt procedures that included different amounts of positive social attention
(personalized prompts alone and combined with brief conversation) on the social
activity attendance of 8 AL residents. Personalized prompts were designed to ap-
peal to each participant on the basis of preference assessments regarding activity
interests and preferred types of activity participation. During treatment condi-
tions, increases in attendance occurred not only following treatment prompts
but also during activities that were not preceded by treatment prompts. Similar
effects were observed for both treatment prompts. Results suggest that person-
alized prompts and positive social attention can increase weekly social activity
attendance in AL residents.
Article
516 Journal of Applied Gerontology 32(5)
Keywords
assisted living facilities, activity attendance, prompts, positive social attention,
preference assessment
Poor social activity involvement among older adults living in residential care set-
tings represents an area of serious concern (Tsai et al., 2009). Inadequate levels of
social activity in this population may lead to declines in verbal and self-care skills
(McClannahan & Risley, 1975) and has been associated with an increased risk of
cognitive decline (Winningham & Pike, 2007), motor decline (Buchman et al.,
2009), and depression (Tsai et al., 2009). Conversely, social activity participation
in residential care environments has been associated with greater life satisfaction
(Park, 2009; Park, Zimmerman, Kinslow, Shin, & Roff, 2010; Street, Burge,
Quadagno, & Barrett, 2007), higher health-related quality of life (Jenkins, Pienta,
& Horgas, 2002), reduced maladaptive behaviors (Spira, Koven, & Edelstein,
2004), and longer survival (Kiely & Flacker, 2003).
Involvement in social activities has been defined in numerous ways and includes
various interrelated concepts (Levasseur, Richard, Gauvin, & Raymond, 2010).
One important aspect of social activity involvement is social engagement, which
has been described as maintaining social connections and participation in social
activities (Bassuk, Glass, & Berkman, 1999). Social engagement is related to social
interaction, social integration, and social support (Park et al., 2010), which have
been shown to have a positive influence on both physical health (Cherry et al.,
2011; Everard, Lach, Fisher, & Baum, 2000; Mendes de Leon, Glass, & Berkman,
2003; Tomaka, Thompson, & Palacios, 2006) and psychological well-being
(Cummings & Cockerham, 2004; Jang, Mortimer, Haley, & Borenstein Graves,
2004; Park, 2009; Winningham & Pike, 2007) in older adults and may reduce the
risk of age-related dependency in activities of daily living (James, Boyle, Buchman,
& Bennett, 2011; Rubio, Lazaro, & Sanchez-Sanchez, 2009). As it is mentally
stimulating, social engagement may also help to protect against cognitive decline
(Bassuk et al., 1999; Williams & Kemper, 2010). Although some amount of social
engagement appears to be an integral part of social activities, Levasseur et al.
(2010) contended that an individual’s involvement with others during these activi-
ties can be viewed as a continuum from passive to active roles. Likewise, Maier
and Klumb (2005) concluded that social participation involves “both time spent in
social interaction as well as time spent in the presence of others” (p. 31). On the
basis of these perspectives, participation during social activities in a residential care
facility can include (a) being with others but not directly interacting with them, (b)
interacting with others but not doing a specific activity with them, and (c) interact-
ing with others while doing an activity with them.
Polenick and Flora 517
Over the last decade, the growth of assisted living (AL) facilities has been one of
the most significant trends in residential care for older adults (Cummings &
Cockerham, 2004; Park et al., 2010; Street et al., 2007). However, relatively few
studies have examined social activity participation in AL settings. In an investiga-
tion examining 198 residents of 22 AL facilities, relative to residents with lower
levels of activity participation, residents who spent more time participating in activ-
ities had a longer mean time to discharge (i.e., length of time between the resident’s
evaluation and time of death or transfer to another living environment; Tighe et al.,
2008). This study suggests that higher activity involvement in AL residents may
help to prevent or delay nursing home placement.
One potential barrier to activity participation in AL settings involves difficulties
with social interaction within the facility. Park et al. (2010) suggested that social
engagement in AL facilities often presents challenges for residents because the
social context and environment are unfamiliar and dissimilar to past social net-
works. Although AL residents may continue to receive social support from interac-
tion with family members and friends living in the community, Street et al. (2007)
found that positive social interaction with other residents and facility staff was
the most consistent indicator of self-reported life satisfaction, stable or improved
quality of life, and a sense of feeling at home. These findings indicate that social
interaction within the facility becomes more salient to resident well-being rela-
tive to interaction with those in the outside community. Therefore, regular
involvement in social activities with fellow AL residents may contribute to over-
all well-being, whereas infrequent involvement in these activities may have nega-
tive effects on well-being, such as low perceived social support. Low levels of
perceived social support can contribute to depression (Cummings & Cockerham,
2004), which has been found to be significantly more prevalent in AL residents
compared with community-dwelling older adults (Grayson, Lubin, & Van
Whitlock, 1995). Although low rates of social activity involvement do not neces-
sarily indicate depression, behavioral symptoms of depressed AL residents com-
monly include social withdrawal and a reduced likelihood of activity attendance
(Cummings & Cockerham, 2004). Tsai et al. (2009) suggested that depression is
the strongest risk factor for low levels of social engagement not only during the
adjustment period for new AL residents but also for residents who have already
become accustomed to their living environment. Thus, it is important to develop
and use interventions to increase social activity involvement within the facility
among both newly admitted and established AL residents. Even for residents who
do not interact with others or actively participate during social activities (e.g.,
playing a board game), simply spending time in a social context (i.e., being in the
presence of others) may have positive effects on overall health and longevity
(Maier & Klumb, 2005). Considering the potential benefits of being around
518 Journal of Applied Gerontology 32(5)
others and having the opportunity to engage in social interaction, increasing
attendance during social activities is an important goal in promoting social activ-
ity involvement in AL settings.
Previous behavioral interventions to increase activity attendance and/or par-
ticipation in residential care settings have included providing contingent access to
preferred edibles (Spira et al., 2004), stimulus control procedures involving the
provision of refreshments at activities (Blackman, Howe, & Pinkston, 1976;
Carstensen & Erickson, 1986; Quattrochi-Tubin & Jason, 1980), prompts and
contingent praise (Engelman, Altus, & Mathews, 1999), and prompts alone
(Brenske, Rudrud, Schulze, & Rapp, 2008). Brenske et al. (2008) found that
descriptive prompts (i.e., a description of available activities known to be of inter-
est to the resident) increased both time spent in an activity area and unstructured
activity engagement in nursing care residents with dementia. Such prompts may
be ineffective for organized group social activities because, unlike informal activ-
ity engagement, they may infrequently involve specific activities of interest to
each resident (e.g., jigsaw puzzles). However, positive social attention combined
with similar prompts may be effective in increasing social activity attendance, as
positive staff interaction has been associated with higher levels of resident activity
involvement (Dobbs et al., 2005; Meeks & Looney, 2011). The purpose of the
present study was to extend the current literature on the use of antecedent inter-
ventions to increase activity involvement in older adults living in residential care
settings. The comparative effects of two prompt procedures that included different
amounts of positive social attention (personalized prompts alone and combined
with brief conversation) were assessed on the weekly social activity attendance of
older adults living in an AL facility. It was hypothesized that personalized prompts
designed to appeal to each participant based on his or her activity preferences
would increase social activity attendance by evoking behavioral responses neces-
sary for activity participation (e.g., attending the activity). It was further hypoth-
esized that brief conversation would evoke behavioral responses associated with
engagement in social interaction (e.g., attending a social activity), which may
result in greater increases in social activity attendance relative to personalized
prompts delivered alone.
Method
Participants, Setting, and Materials
Participants were 8 AL residents (6 women and 2 men) ranging from 78 to 90
years of age (M = 84.38, SD = 4.63). At the time of baseline data collection, three
residents were newly admitted to the facility and five participants had lived at the
Polenick and Flora 519
facility for 1.25 to 4.33 years (M = 2.38, SD = 1.17). Five participants ambulated
using a walker and 3 participants ambulated independently. According to facility
records, three participants suffered from dementia at the time of the study. Due
to frailty and/or occasional confusion, physical assistance to the activity area was
required for these participants. All participants were capable of verbally express-
ing their preference to attend or not to attend an activity.
The intervention took place at a 66-unit suburban AL facility that served resi-
dents with and without dementia. Residents with dementia were located on a floor
that provided a higher level of staff assistance with activities of daily living. Each
resident lived in a private unit that consisted of a bedroom, a living room, and a
small kitchen.
The first author was placed at the facility during a supervised practicum and
was asked by activity staff to assist in increasing resident attendance at social
activities. Activity staff identified eight residents who generally displayed low
rates of social activity attendance and who were reported by nursing staff to
spend the majority of the day alone in their units. In addition, activity staff
reported that previous attempts to increase social activity attendance in these resi-
dents using nonpersonalized individual prompts (e.g., “Would you like to play
bingo today?”) had not been effective. Therefore, participant selection was based
on pragmatic concerns of the facility.
Prior to intervention, the first author (who was also the experimenter) con-
ducted an individual interview with each of the eight residents to determine their
activity interests and preferred types of activity participation (i.e., playing games,
watching/listening to others, and visiting/being around others). Activity interest
questions were taken directly from an activity preference assessment used by the
facility and required residents to state whether or not they enjoyed a given activity
(e.g., bingo). Inclusion criteria required that, during this interview, residents (a)
were able to clearly indicate their likes and dislikes and (b) stated that they enjoyed
watching/listening to others and/or visiting/being around others during social
activities. The latter requirement was included to ensure that participants were
receptive to being in the presence of others in the facility. None of the original
eight residents were excluded from participation based on these criteria.
Social activities were defined as organized group activities that took place at
the facility during which residents had the opportunity to (a) engage in active or
passive activity participation and (b) spend time in the presence of other residents
and facility staff. Active participation refers to direct involvement with the
planned social activity (e.g., playing bingo or calling out responses during a trivia
game). Passive participation refers to indirect involvement with the planned
social activity (e.g., watching others play a game or listening to others tell stories).
A few activities allowed for passive participation only (e.g., music recitals or
520 Journal of Applied Gerontology 32(5)
movies). Although the nature of some activities necessitated social interaction
more than others (e.g., playing a card game requires social interaction, whereas
attending a music recital does not), all social activities involved the opportunity
to spend time in the presence of others and engage in social interaction. Common
activities included arts and crafts, bingo, board games, card games, music recitals,
and parties. Activities were generally offered throughout the week during the fol-
lowing times: 10:00 a.m. to 11:00 a.m.; 1:30 p.m. to 3:00 p.m.; and 6:00 p.m. to
8:00 p.m. The number of available weekly social activities during data collection
ranged from 18 to 21.
In addition to the experimenter interview, activity preference assessments previ-
ously completed by activity staff were used as a reference for each participant’s
activity preferences. These assessments were routinely used by the facility to deter-
mine each resident’s activity interests (e.g., playing games, listening to music,
animal visits, etc.). Activity interests and participation preferences for each par-
ticipant were recorded on a data sheet that was used as a reference for the delivery
of personalized prompts (see appendix). Activity attendance data were regularly
recorded and stored by activity staff.
Target Behavior and Interobserver Agreement
Activity attendance was defined as the participant’s physical presence in the
designated activity area at the designated activity time. For each participant, the per-
centage of weekly social activity attendance was determined by dividing the
number of activities attended each week by the number of available activities for
that week. In addition, the percentage of weekly social activities attended follow-
ing treatment prompts was determined along with the percentage of weekly
social activities attended following general prompts (i.e., group prompts at meal-
times, daily activity schedule postings in the dining areas, and activity calendars
in each resident’s unit). For Participants 1, 2, 5, 6, and 7, interobserver agreement
between attendance data collected by the experimenter and facility attendance
records was collected for 20% of activities during baseline, 36.63% of activities
during the first treatment condition, and 33.70% of activities during the second
treatment condition. For Participant 3, interobserver agreement was collected for
30% of activities during baseline, 38.75% of activities during the first treatment
condition, and 35.62% of activities during the second treatment condition. For
Participant 4, interobserver agreement was collected for 18.63% of baseline
activities, 36.63% of activities during the first treatment condition, and 47.37%
of activities during the second treatment condition. For Participant 8, interob-
server agreement was collected for 18.31% of baseline activities, 36.63% of
activities during the first treatment condition, and 29.35% of activities during the
Polenick and Flora 521
second treatment condition. Interobserver agreement was not assessed for
follow-up data. Agreement was determined by dividing the number of agree-
ments by the total number of possible agreements and multiplying that number
by 100. For all participants, agreement was 100% during baseline and both treat-
ment conditions.
Experimental Design and Procedure
A counterbalanced within-subjects design was used to evaluate the comparative
effects of two prompt procedures (personalized prompts alone and combined
with brief conversation) relative to baseline social activity attendance. Eight
weeks of baseline data were collected for the 5 participants who were estab-
lished residents (Participants 1, 2, 5, 6, and 7). For participants who were newly
admitted to the facility, 3, 5, and 7 weeks of baseline data were collected
(Participants 3, 4, and 8, respectively). Following baseline, 4 to 5 weeks of per-
sonalized prompts followed by 4 to 5 weeks of personalized prompts combined
with brief conversation were planned for Participants 1 to 4. For Participants 5
through 8, the same procedure was followed with the reverse prompt condition
sequence. Due to an injury, only 1 week of data collection was available for
Participant 4 during the second treatment condition. Following treatment condi-
tions, 4 to 5 weeks of follow-up data were collected for all participants except
Participants 4 and 7, who suffered complications from injuries and were thus
unable to attend activities.
The baseline condition represented typical facility efforts to increase activity
attendance. During baseline, only general prompts were used. General prompts
consisted of a group announcement delivered by activity staff during mealtimes,
which informed residents of the time and location of activities following each
mealtime (e.g., “We are playing cards today at 1:30 p.m. on the second floor.”). For
the 3 participants who had dementia and who required physical assistance to move
from one area of the facility to another (Participants 2, 3, and 8), nonpersonalized
individual prompts (e.g., “Would you like to go play cards?”) were also delivered
by staff, although this was not done in a systematic manner (i.e., prompts may not
have been given for all available activities, and the frequency of prompt delivery
was not recorded). In addition, social activities, times, and locations were dis-
played on a sign placed near the dining areas on each floor that was updated daily.
Staff also placed current monthly activity calendars in a salient location (e.g., on
the refrigerator) in each resident’s unit that included the day, time, and location of
all available social activities.
During treatment conditions, individual treatment prompts (i.e., personal-
ized prompts alone or combined with brief conversation) were delivered to each
522 Journal of Applied Gerontology 32(5)
participant by the experimenter for three to four activities each week. Although
four treatment prompts were planned for each participant, this range was used
because circumstances did not always allow for the delivery of prompts as
planned (e.g., if a participant was sleeping, at a doctor’s appointment, or visit-
ing with family). In both treatment conditions, staff continued general prompt-
ing procedures as described during baseline; thus, both general prompts and
treatment prompts were delivered during treatment conditions. No more than
two treatment prompts were provided in one day. The nature of the prompted
activities depended on the activity schedule and varied each week. Treatment
prompts were delivered face-to-face between 20 and 30 min prior to the time
that the activity was scheduled to begin. The experimenter either knocked on
the door of the participant’s unit and waited for permission to enter or directly
approached the participant if he or she was in a common area. In addition to
positive verbal attention, smiles and eye contact were included during the deliv-
ery of treatment prompts. If a participant was sleeping, he or she was not awak-
ened for prompt delivery. Assistance to the activity area was provided for the 3
participants who required it.
Personalized prompts. During this treatment condition, personalized prompts
were similar to the descriptive prompts used by Brenske et al. (2008), which
specifically described activities that were known to be of interest to participants
based on either responses given during a preference questionnaire or previous
observations of activity engagement. Personalized prompts consisted of a brief
greeting that used the participant’s name along with a description of the social
activity in a manner that was designed to appeal to the participant based on his or
her responses on an activity preference assessment used by the facility and
answers to the experimenter’s questions regarding types of preferred activity par-
ticipation (e.g., “Hi Martha, I just wanted to stop by and remind you that we have
arts and crafts today. We are making flower arrangements.”). If the prompted
activity was not indicated as an interest on the assessment (e.g., crafts, playing
board games), the prompt included an option for passive participation in a man-
ner that was previously indicated as preferred by the participant (e.g., “Hi John, I
wanted to let you know that we will be playing a board game today. You can play
or you can just come and watch.” or “Hi Otto, we are working on some crafts
today. You can work with us or just come and visit with us.”). If the participant
said that he or she will attend the activity, the experimenter made a positive state-
ment regarding activity attendance and stated the time and location of the activity
(e.g., “Great! The activity will be at 1:30 p.m. on the second floor. I’ll look for-
ward to seeing you there!”). Similarly, if the participant did not indicate whether
he or she will attend, the experimenter made a positive statement about atten-
dance and stated the time and location of the activity (e.g., “Hope to see you
Polenick and Flora 523
there! We will be on the second floor and will start at 1:30 p.m.”). If the partici-
pant said that he or she did not want to attend the activity, the experimenter made
a positive statement that included the time and location of the activity (e.g.,
“That’s OK. We will start at 1:30 p.m. and we’ll be on the second floor if you
change your mind!”). If the participant asked the experimenter if she could talk
for a few minutes, the experimenter replied that she is not able to stay and talk
right now because she needs to help with activity setup.
Personalized prompts + brief conversation. In addition to personalized prompts,
brief conversation was initiated with each participant during this treatment condi-
tion. The entire interaction (i.e., personalized prompt and conversation) lasted no
more than 1 min. To ensure that the interaction did not exceed 1 min, the experi-
menter used a stopwatch on her cell phone, which was placed discretely on top of
a clipboard. In order for the conversation to be natural and sincere, it was not
scripted. However, this additional interaction included several consistent ele-
ments. First, the participant was given a greeting that used his or her name and
was asked how he or she was doing (e.g., “Hi Jennie! How is your day going
today?”). Second, the experimenter made at least one positive statement about the
participant (e.g., “It’s great to see you!” or “I love your sweater! That color looks
great on you!”). Third, if the participant verbally indicated that he or she will attend
the activity, the experimenter made at least one additional positive statement about
attendance (e.g., “I’m so glad you are coming! It will be great to get out a little bit
and see what’s going on!”). The experimenter also made at least one additional
positive statement about attendance if the participant did not indicate whether he or
she will attend (e.g., “It’s going to be a lot of fun today! I hope you’ll come and
join us!”). Similarly, if the participant indicated that he or she will not be attend-
ing the activity, the experimenter made at least one additional positive statement
regarding attendance (e.g., “Are you sure? You might enjoy getting out for a
bit!”). To end the interaction, the experimenter told the participant that she has to
go and help set up the activity, but she hopes to see him or her at the activity.
Results
Figures 1 to 8 show individual social activity attendance data and relevant infor-
mation for each participant. For Figures 1 to 8, solid mean lines represent mean
weekly social activity attendance following general prompts and dashed mean
lines represent mean social activity attendance following treatment prompts.
General prompts represent typical facility efforts to increase attendance (i.e.,
group prompts at mealtimes, daily activity schedule postings in the dining areas,
and activity calendars in each resident’s unit), and treatment prompts represent
experimenter-initiated prompts (i.e., personalized prompts alone or combined
524 Journal of Applied Gerontology 32(5)
Table 1. Percentage of Mean Attendance Across Conditions Following General
Prompts and Treatment Prompts.
General Treatment
Participant Baseline PP PP + BC PP PP + BC
1 13.28 (5.84) 14.22 (6.39) 20.12 (9.01) 35.00 (25.27) 35.00 (9.13)
2 6.79 (4.55) 20.78 (7.24) 3.92 (5.92) 75.00 (17.68) 56.66 (27.89)
3 0.00 1.56 (3.13) 1.79 (3.57) 22.92 (15.77) 6.25 (12.50)
4 5.90 (2.29) 16.58 (9.36) 13.33 35.00 (26.61) 50.00
5 13.14 (5.95) 20.12 (4.76) 17.83 (3.80) 58.33 (16.67) 36.66 (24.72)
6 4.44 (5.64) 2.50 (3.42) 4.58 (7.27) 23.33 (22.36) 25.00 (14.43)
7 4.32 (4.01) 0.00 5.01 (5.24) 54.17 (36.32) 38.33 (31.51)
8 6.39 (9.00) 2.58 (3.54) 3.62 (3.33) 0.00 11.66 (16.24)
Note. Standard deviations are in parentheses. During baseline, only general prompts were
given. For treatment conditions, mean attendance following general prompts and mean atten-
dance following treatment prompts is shown. PP = personalized prompt condition; PP + BC =
personalized prompt plus brief conversation condition.
with brief conversation). The mean weekly percentages of attendance for social
activities following both types of prompts are shown. Baseline and follow-up
data (general prompts only) are also included. Follow-up data were not available
for Participants 4 and 7. Participants 1 to 4 received the personalized prompt
condition (PP) first and the personalized prompt plus brief conversation condi-
tion (PP + BC) second, whereas the reverse sequence was presented to
Participants 5 to 8. Table 1 shows the mean percentages of social activity atten-
dance for each participant during baseline and following both general and treat-
ment prompts during treatment conditions. During one or both treatment
conditions, attendance following treatment prompts was higher relative to gen-
eral prompts for all 8 participants. Compared with baseline, mean increases in
attendance following general prompts were observed in one or both treatment
conditions for all participants except Participant 8 and in both treatment condi-
tions for 4 participants (Participants 1, 3, 4, and 5).
The mean percentages of overall social activity attendance for each participant
across conditions are displayed in Table 2. Overall social activity attendance
included activities that followed both general prompts (all conditions) and treat-
ment prompts (treatment conditions only). With the exception of Participant 8,
one or both treatment conditions were associated with increases in overall atten-
dance for all participants. For the sample of participants, the difference in mean
attendance following treatment prompts during the PP condition (M = 37.97%,
Polenick and Flora 525
SD = 23.75) and the PP + BC condition (M = 32.45%, SD = 17.43) was not sig-
nificant, t(7) = 1.08, p = .314, 95% CI [–6.53, 17.57]. Out of the 6 participants for
whom follow-up data were available (Participants 1, 2, 3, 5, 6, and 8), mean
overall attendance at follow-up increased from baseline means in 4 participants
(Participants 1, 3, 5, and 6).
Figure 9 shows mean overall social activity attendance across conditions for
the sample of participants. Overall means include attendance following both gen-
eral prompts and treatment prompts. Compared with attendance during baseline
(M = 6.78%, SD = 4.49), increases in overall mean attendance for the sample of
participants reached significant levels for both the PP condition (M = 15.12%, SD
0
10
20
30
40
50
60
70
80
90
100
1357911 13 15 17 19 21 23
Percentage of Activities Attended
Consecutive Weeks
General
Prompts
Treatment
Prompts
PP + BCBaseline PP Follow-up
Figure 1. Mean weekly social activity attendance for Participant 1, an 85-year-old
woman residing at the facility for 1.25 years.
Note. The mean number of treatment prompts delivered during both treatment conditions
was 3.40. A tooth extraction and the death of a friend occurred during Weeks 12 and 17,
respectively.
526 Journal of Applied Gerontology 32(5)
0
10
20
30
40
50
60
70
80
90
100
1357911 13 15 17 19 21 23
Percentage of Activities Attended
Consecutive Weeks
General
Prompts
Treatment
Prompts
PP + BCBaseline PP Follow-up
Figure 2. Mean weekly social activity attendance for Participant 2, a 78-year-old man
residing at the facility for 1.92 years.
Note. The mean number of treatment prompts delivered during treatment conditions was 3.80
for PP and 3.40 for PP + BC.
= 10.41), t(7) = –2.74, p = .029, 95% CI [–15.54, –1.13] and the PP + BC condi-
tion (M = 13.11%, SD = 7.78), t(7) = –3.61, p = .009, 95% CI [–10.47, –2.19].
The difference in overall mean attendance between the two treatment conditions
was not significant, t(7) = 0.82, p = .440, 95% CI [–3.78, 7.79].
Discussion
The results indicate that personalized prompts and positive social attention can
increase social activity attendance in AL residents. One or both treatment condi-
tions were associated with increases in mean overall social activity attendance for
7 out of 8 participants. Compared with baseline, data for the sample of participants
Polenick and Flora 527
revealed significant increases in overall attendance during both treatment condi-
tions. In addition to positive social attention, personalized prompts included a
description of the activity in a manner that was designed to appeal to each par-
ticipant based on his or her responses on an activity preference assessment and
answers to the experimenter’s questions regarding preferred types of activity
participation. Thus, as in Brenske et al. (2008), prompts may have evoked behav-
ior (i.e., attending the activity) that resulted in contact with sources of natural
reinforcement derived through activity participation, social engagement, or both.
The latter possibility may explain increases in attendance following general
prompts during both treatment conditions that were observed in 5 out of 8
0
10
20
30
40
50
60
70
80
90
100
12345678910 11 12 13 14 15
Percentage of Activities Attended
Consecutive Weeks
General
Prompts
Treatment
Prompts
PP + BCBaseline PP Follow-up
Figure 3. Mean weekly social activity attendance for Participant 3, a 78-year-old
woman newly admitted to the facility.
Note. The mean number of treatment prompts delivered during treatment conditions was 3.25
for PP and 3.50 for PP + BC.
528 Journal of Applied Gerontology 32(5)
participants. For these participants, increased levels of attendance may have been
maintained by reinforcement associated with previous activity attendance.
Additional support for this explanation is suggested by follow-up data. Of the 6
participants for whom follow-up data were available, 4 participants displayed
higher mean overall activity attendance at follow-up compared with baseline.
However, a downward trend in follow-up data for Participant 1 (see Figure 1)
and lower levels of attendance at follow-up relative to baseline for Participants 2
and 8 (see Figures 2 and 8) suggest that, for some residents, the continuation of
prompting procedures may be required for long-term maintenance of increased
levels of attendance.
Although both treatment prompts were effective at increasing social activity
attendance for most participants, the results suggest that the brief conversation
0
10
20
30
40
50
60
70
80
90
100
12345678910 11
Percentage of Activities Attended
Consecutive Weeks
Treatment
Prompts
General
Prompts
PP +
BC
PPBaseline
Figure 4. Mean weekly social activity attendance for Participant 4, an 85-year-old
woman newly admitted to the facility.
Note. The mean number of treatment prompts delivered during treatment conditions was 3.40
for PP and 4.00 for PP + BC. Due to a back injury, only one data point was available for PP +
BC and follow-up data were not available.
Polenick and Flora 529
during the PP + BC condition provided no additional benefit. It was hypothesized
that brief conversation would evoke behavioral responses associated with engage-
ment in social interaction (e.g., attending a social activity) and personalized
prompts would evoke activity participation, but the support for this hypothesis
was not definitive. Depending on the individual, the motivation to engage in
social interaction or the motivation to participate in the current activity for nonso-
cial reasons could have resulted in increased social activity attendance. Although
this investigation did not assess motivations for participant activity attendance,
similar effects were associated with both treatment conditions, suggesting that the
differences between the two treatment prompts were not substantial enough to
yield differential results. Specifically, the positive social attention included during
0
10
20
30
40
50
60
70
80
90
100
1357911 13 15 17 19 21 23
Percentage of Activities Attended
Consecutive Weeks
General
Prompts
Treatment
Prompts
PP + BCBaseline PP Follow-up
Figure 5. Mean weekly social activity attendance for Participant 5, a 90-year-old
woman residing at the facility for 4.33 years.
Note. The mean number of treatment prompts delivered during both treatment conditions
was 3.40.
530 Journal of Applied Gerontology 32(5)
brief conversation in the PP + BC condition did not provide benefit beyond the
positive social attention included in the PP condition.
This study demonstrates that a relatively simple prompting procedure that uses
preference assessment information can increase weekly social activity attendance
in older adults living in an AL setting. For most participants, the systematic deliv-
ery of personalized prompts preceding just three to four activities a week was
associated with increases in attendance following both treatment prompts and gen-
eral prompts. Attendance data collection and preference assessment involved pro-
cedures that were currently in use by the facility. Therefore, this intervention
would be feasible for activity staff to implement and may provide an effective way
0
10
20
30
40
50
60
70
80
90
100
1357911 13 15 17 19 21 23
Percentage of Activities Attended
Consecutive Weeks
General
Prompts
Treatment
Prompts
PP + BCBaseline PP Follow-up
Figure 6. Mean weekly social activity attendance for Participant 6, an 86-year-old
woman residing at the facility for 2.00 years.
Note. The mean number of treatment prompts delivered during both treatment conditions
was 3.40.
Polenick and Flora 531
to use such information to better reach out to residents who may be at risk of inac-
tivity and social isolation. In addition to activity interest information obtained
from facility preference assessments, the experimenter determined activity partici-
pation preferences by directly asking participants about the types of activity par-
ticipation that they enjoyed. Social activities may infrequently involve specific
resident activity interests. However, preferred types of social activity participation
(e.g., playing games or watching/listening to others) can be applied to nearly all
organized group activities. Thus, the assessment of activity participation prefer-
ences may be particularly useful for facility efforts to increase attendance during
0
10
20
30
40
50
60
70
80
90
100
1234567891011121314151617
Percentage of Activities Attended
Consecutive Weeks
General
Prompts
Treatment
Prompts
PP + BCBaseline PP
Figure 7. Mean weekly social activity attendance for Participant 7, an 83-year-old
woman residing at the facility for 2.42 years.
Note. The mean number of treatment prompts delivered during treatment conditions was
3.80 for PP + BC and 3.50 for PP. Due to complications from a fall, data could not be collected
for Week 18 and follow-up data were not available.
532 Journal of Applied Gerontology 32(5)
social activities. As no added benefit was determined from the use of brief conver-
sation, personalized prompts alone may be sufficient in increasing social activity
attendance in this population.
The present study supports the efficacy of behavioral procedures in increasing
the activity involvement of older adults living in residential care facilities (e.g.,
Blackman et al., 1976; Carstensen & Erickson, 1986; Spira et al., 2004). Previous
applications of antecedent interventions involved prompts to increase engage-
ment in daily activities (Engelman et al., 1999) and descriptive prompts to
increase both presence in an activity area and participation during unstructured
recreational activities (Brenske et al., 2008). Similar to the descriptive prompts
used by Brenske et al. (2008), personalized prompts included a description of
0
10
20
30
40
50
60
70
80
90
100
13579111315171921
Percentage of Activities Attended
Consecutive Weeks
General
Prompts
Treatment
Prompts
PP + BCBaseline PP Follow-up
Figure 8. Mean weekly social activity attendance for Participant 8, a 90-year-old
man newly admitted to the facility.
Note. The mean number of treatment prompts delivered during treatment conditions was
3.40 for PP + BC and 3.20 for PP.
Polenick and Flora 533
Table 2. Percentage of Overall Mean Attendance Across Conditions Following
Both General Prompts and Treatment Prompts.
Participant Baseline PP PP + BC Follow-up
1 13.28 (5.84) 17.68 (6.90) 22.90 (7.87) 20.61 (10.57)
2 6.79 (4.55) 30.70 (5.36) 13.88 (10.73) 5.22 (3.55)
3 0.00 5.08 (4.10) 2.70 (3.12) 2.63 (5.27)
4 5.90 (2.29) 19.68 (5.40) 21.05
5 13.14 (5.95) 27.11 (4.52) 20.69 (5.85) 21.86 (6.93)
6 4.44 (5.64) 7.57 (4.62) 7.86 (7.19) 6.36 (5.42)
7 4.32 (4.01) 11.02 (7.51) 10.81 (6.20)
8 6.39 (9.00) 2.10 (2.88) 5.01 (5.03) 1.11 (2.48)
Note. Standard deviations are in parentheses. During baseline and follow-up, only general
prompts were given. During treatment conditions, overall means include attendance following
both general prompts and treatment prompts. PP = personalized prompt condition; PP + BC =
personalized prompts plus brief conversation condition.
activity participation in a manner that was designed to appeal to each participant
based on prior assessments of activity preferences. This investigation extends
past research by demonstrating that personalized prompts and positive social
attention were associated with increased attendance during group social activities
in AL residents. These findings indicate that positive social attention may be
related to increased activity involvement in older adults living in residential care
settings as has been suggested by other studies (Dobbs et al., 2005; Meeks &
Looney, 2011).
Practical implications may be somewhat limited due to the small sample size,
which had low statistical power. However, a small number of participants permit-
ted the examination of individual behavior change across conditions; thus, the
within-subjects design allowed for the observation and comparison of intervention
effects on an individual level. Although greater reliability would have been estab-
lished with an ABAB design that ended with a reinstatement of the intervention (B)
as opposed to ending on a return to baseline (A), the ABA design used in this study
allowed for a strong demonstration that the intervention was responsible for increases
in attendance. The replication of this design across participants strengthened these
conclusions (Barlow, Nock, & Hersen, 2009, p. 145) and provides support for the
generalizability of these findings. Baselines of varying lengths in the newly
admitted residents provided additional evidence that increases in attendance
occurred when the intervention was introduced. As general prompting procedures
were held constant throughout data collection, and because it is unlikely that any
uncontrolled variables would have resulted in increased attendance during treat-
ment conditions in 7 out of 8 participants, it can be inferred with a reasonable
534 Journal of Applied Gerontology 32(5)
amount of confidence that the intervention was responsible for the observed
increases in attendance.
Although the intervention was successful in increasing social activity atten-
dance, outcome measures of increased attendance were not assessed. Consequently,
it is not known whether this intervention had any effect on participation or social
interaction during activities or whether it contributed to improvements in resident
quality of life. In addition, types of participation during social activities (e.g.,
being around others without engaging in social interaction, interacting with others
without engaging in the activity, and interacting with others while engaging in the
activity) were not examined. Therefore, the effects of personalized prompts and
positive social attention on levels of active and passive activity participation are
not known. Despite these limitations, this study provides evidence that this inter-
vention can increase social activity attendance in AL residents who typically spend
0
2
4
6
8
10
12
14
16
18
20
Baseline PP PP + BC Follow-up
Percentage of Activities Attended
Conditions
*
**
Figure 9. Mean overall social activity attendance across conditions for the sample
of participants.
Note. Relative to baseline (M = 6.78%, SD = 4.49), attendance was significantly higher during
PP (M = 15.12%, SD = 10.41) and PP + BC (M = 13.11%, SD = 7.78) conditions.*
*p < .05. **p < .01.
Polenick and Flora 535
the majority of the day alone, thus increasing time spent in the presence of others
and increasing opportunities for social interaction with other residents and facility
staff. Moreover, because attendance is an essential prerequisite to participation
during social activities in AL settings, the investigation of interventions to increase
attendance is an appropriate and needed area of research. To examine the potential
benefits of increased social activity attendance in AL residents, it is necessary to
develop interventions that are successful in increasing attendance.
Future replications of this intervention could focus on the examination of its
efficacy with AL residents who have specific characteristics (e.g., gender, physi-
cal or psychological health diagnoses, length of residency). Studies could also
compare residents with differing characteristics (e.g., male and female residents,
newly admitted and established residents, residents with and without physical
disabilities) to determine potential differential treatment results. The effects of
increased social activity attendance in AL residents on both subjective and
objective outcome measures would be another interesting area of investigation.
Pre- and postintervention subjective measures (e.g., perceived social support,
depressive symptoms, overall life satisfaction) could be assessed to determine if
increased social activity attendance is associated with changes in these mea-
sures. Likewise, objective measures collected by observers could be examined
to determine if increased social activity attendance results in corresponding
increases in measures of participation during social activities (e.g., social inter-
action, active activity participation). In addition, the effects of different types of
social activity participation (e.g., active and passive participation) on various
resident outcome measures could be investigated. Participants could also be
observed outside of social activities to determine if increased attendance is asso-
ciated with increases in social interaction and time spent in the presence of oth-
ers in different settings (e.g., social interaction during mealtimes, time spent in
common areas of the facility).
Considering the potential deleterious consequences of poor social activity
involvement on resident health and well-being (e.g., Tsai et al., 2009; Winningham
& Pike, 2007) along with the challenges of social integration that face many AL
residents (e.g., Park et al., 2010), additional research is needed to determine effi-
cacious ways to engage AL residents who may be at risk of social isolation. Social
activity participation offers many benefits to older adults living in residential care
settings (e.g., Jenkins et al., 2002; Park, 2009; Street et al., 2007) and may con-
tribute to a higher overall quality of life. As demonstrated by the present investi-
gation, personalized prompts that use preference assessment information and
include positive social attention can increase weekly social activity attendance in
AL residents. The results of this study suggest that a simple antecedent interven-
tion may offer an effective means for staff to increase social activity involvement
in AL settings.
536 Journal of Applied Gerontology 32(5)
Appendix
Activity Interests and Participation Preferences
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or pub-
lication of this article.
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Preferences Participants
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Playing games X X
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Activity interests
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Trivia
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Author Biographies
Courtney Allyn Polenick, MS, received her master’s degree in applied behavior
analysis from Youngstown State University in Youngstown, Ohio. Her research
interests include late-life social engagement, and interventions to enhance health,
quality of life, and everyday functioning in older adults.
Stephen Ray Flora, PhD, BCBA, is a professor in the Department of Psychology at
Youngstown State University in Youngstown, Ohio. His research interests include
behavior analysis, persistence, self-control, optimizing human performance, and
behavioral alternatives to pharmaceutical treatments.
... The identified instruments (n = 67) are mainly from the United States of America (USA) (n = 33). 30,34,[36][37][38]40,42,47,48,[50][51][52]56,60,61,65,69,[74][75][76][79][80][81][82][83][84][85][86][87][88]92,94,96 The remaining instruments are from Canada (n = 6), 43,45,53,68,72,91 the Netherlands (n = 6), 39,46,57,62,63,90 the United Kingdom (n = 5), 67,70,77,89,93 Australia (n = 5), 35,58,59,71,78 Germany (n = 2), 32,55 Poland (n =2), 64,97 Austria (n = 1), 49 China (n = 1), 41 France (n =1) 33 , Norway (n = 1) 73 , Portugal (n = 1) 54 , Sweden (n =1), 66 Switzerland (n =1) 44 and Israel (n =1). 95 Most of the identified instruments focus on older people with various care needs (n = 16) 30,[32][33][34]47,48,50,52,56,59,60,62,66,[74][75][76] or older people with care needs caused by specific diseases (n = 51). ...
... Of the 17 instruments, most (n = 10) focus on preferences related to activities in general. 36,37,[79][80][81][82][83][84]92,96 Two instruments assess more specific preferred activities (group activities and physical activities), 76,95 and another assesses the preferred context of physical activities. 35 The other four instruments focus on assessing preferences regarding games, 75 arts and humanities, 34 humor, 93 and music. ...
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Considering the preferences for everyday living of older people with various care needs across different care settings is important in nursing care. Currently, there is no systematic overview of the various instruments, and it is unclear what instruments exist, and which preferences they measure. We systematically searched for studies in the electronic databases MEDLINE, CINAHL and PsycInfo. Title/abstract and full text screening were performed independently by two researchers. We mapped and described the identified instruments in two tables and one interactive evidence atlas. We identified 67 instruments for assessing the preferences for everyday living of older people with various care needs across different care settings. We clustered the identified instruments into two main categories: broad and specific. The results show a wide range of instrument types and assessment methods. Research gaps exist, for instruments developed for assessing preferences comprehensively for a particular topic for everyday living, particular populations, and settings.
... Liking to participate in groups was significantly correlated with number of sessions attended, 23 and personalized prompts for activities on the basis of resident preferences increased social activity attendance. 30 The limitations of the study are the small sample size whose participants were from one nursing home only. The validity of the results needs to be checked with larger samples and in other venues. ...
... Various kinds of prompts have been used to try to increase attendance at nursing home activities: for example, descriptive prompts, 38 personal invitations from the recreation director or direct prompts from the nursing staff, 37 and personalized prompts based on resident activity preferences. 30 Reitz and Hawkins, 37 using personal invitations, and Brenske et al, 38 with descriptive prompts, reported increases in attendance to just under 50% and 75%, respectively. Yet, when the prompts were discontinued, attendance fell to baseline levels. ...
Article
Objectives: Participation in group activities can benefit persons with dementia, alleviating boredom, improving affect, maintaining function, and decreasing problematic behaviors. Methods: We describe patterns of attendance of residents with dementia at nursing home activity groups and investigate stimulus and environmental factors that may affect attendance. Results: Residents participated in 60.8% of the activities, with reasons for nonattendance including refusal (9.7%), not being on the unit (7.8%), being asleep (6.8%), and being involved in activities of daily living and other activities (8.3%). On average, 3.5 other residents not recruited for the study chose to participate in each group session. Group attendance was significantly related to group topic. Implication: The need for activities was evident by the attendance of both invited and other residents. Understanding the factors that affect attendance is the first step toward developing procedures to maximize participation in activities in order to decrease loneliness and boredom in this population.
... Prompting procedures may be useful for these situations. Positive social attention and personalized prompts designed to describe activities in terms of individual preferences were found to increase social activity attendance in assisted living residents with low baseline levels of participation (Polenick & Flora, 2011). This study also incorporated activity preference assessment and data-collection procedures that were already used by facility staff, which reduced the amount of additional effort required to implement the intervention and monitor progress. ...
... Behavior analysts could also examine the potential role of establishing operations during behavioral activation. For instance, antecedent events such as prompts to engage in an activity (Brenske, Rudrud, Schulze, & Rapp, 2008;Engelman, Altus, & Mathews, 1999), activity prompts that include positive social attention (Polenick & Flora, 2011), or the presentation of activity materials in a salient location may momentarily establish the reinforcing effectiveness of activity engagement or social interaction, and may evoke behaviors associated with these events (Michael, 1993). Positive staff engagement has been significantly correlated with levels of interest, pleasure, and participation during activities for older nursing home residents (Meeks & Looney, 2011); thus, the social engagement of caregivers or family members may further increase activity participation and enjoyment. ...
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Late-life depression (LLD) is a major public health concern that can have devastating effects on older individuals and their families. Behavioral theories predict that decreases in response contingent positive reinforcement and increases in negatively reinforced avoidance behaviors, often accompanied by aversive life events, result in the selection and maintenance of depression. Based on these theories, behavioral activation treatments for depression are designed to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement. We discuss the applicability of behavioral models for LLD, and we briefly review current behavioral activation interventions for LLD with an emphasis on implications for future behavior-analytic research. Behavioral activation has been demonstrated to be effective in reducing depression and increasing healthy behavior in older adults. Potential challenges and considerations for future research are discussed. We suggest that applied behavior analysts and clinical behavior analysts are particularly well suited to expand on the knowledge base and practical application of behavioral activation interventions with this population.
... Factors constraining elderly participation in socially beneficial activities include frailty, reduced quality of life, and more dissatisfaction with one's status in life [19]. On the other hand, social capital factors which promote social participation of older people include the enabling environment [20], social integration with the local community and social support [21]. Citizen attitudes toward government responsibility [22], democratic institutions [23] and welfare state services are also important determinants of civic engagement among the elderly [24,25]. ...
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Purpose Several studies revealed the importance of older persons’ contribution to society. The enhancement of their potential to engage in civic activities should be encouraged. The purpose of this paper is to investigate factors associated with their civic engagement potential. Design/methodology/approach Data are from Thailand’s National Survey of Older Persons conducted by the National Statistical Office in 2011. A sample of 24,433 persons aged 60 years or older was analyzed to assess their engagement in four community activities. The data were subjected to logistic regression analysis. Findings This study found that the readiness and willingness to engage in socially productive activities of Thai older persons ranged from 7 to 23 percent depending on type of activities. The factors of ageing health, confidence in their family’s ability to assist them, and satisfaction with government services were significantly associated with their readiness and willingness to engage in socially productive activities. Inadequacy of income was not found to be an obstructing factor toward their readiness and willingness to engage in civic life in general, it inhibited only the sharing of knowledge and skills with others. Originality/value The findings reflect the impact of internal constraining factors and external enhancing factors on engagement of Thai older persons in civic activities. Policy implications on the role of the government to promote active ageing are discussed.
... In addition, health and social factors relate to activity participation (Kemp, Ball, Hollingsworth, & Perkins, 2012;Park et al., 2012;Shura, Siders, & Dannefer, 2011;Simone & Haas, 2013;Winningham & Pike, 2007). The environment can also promote or constrain participation through space, staff, resources, and prompting (Baert et al., 2015;Harmer & Orrell, 2008;Love, 2007;Polenick & Flora, 2013). The research on activity participation in AL considers individual and environmental correlates, but ignores activity-related factors, such as task demands. ...
Article
This article describes a framework for measuring activity demands and the psychometric properties of a related measurement tool, the Multidimensional Activities Demand Strength for Assisted Living (MADS-AL). Nine experts—three in physical, cognitive, and social domains, respectively—rated demands of 37 common assisted-living activities. Interrater reliability and internal consistency for physical, intraclass correlation coefficient (ICC)(2, 3) = .96, Cronbach's α = .97, cognitive, ICC(2, 3) = .71, α = .93, and social, ICC(2, 3) = .80, α = .86, scales give preliminary support for reliability of the MADS-AL tool. Overall, this article moves the field toward considering task demands as a relevant variable to inform future activities research and practice.
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Dementia often leads to behavior changes such as deficits in communication and social interaction; one effective antecedent strategy for improving communication involves rearranged or supplemental stimuli. In the present study, researchers placed individualized textual prompts on the dinner table of three women at an assisted-living facility. Textual stimuli included prompts such as "Debbie, ask Pat where she liked to travel," and led to increases in conversation duration. The results suggest that antecedent interventions can improve social interactions for individuals with dementia with minimal involvement of caregivers.Textual prompts may improve social communication between individuals with dementia.Salient stimuli, such as participants' names, may be necessary to facilitate conversation.The textual intervention requires minimal training and response effort from caregivers and care staff.Improvements in conversation duration maintained at 6 months post-study. Textual prompts may improve social communication between individuals with dementia. Salient stimuli, such as participants' names, may be necessary to facilitate conversation. The textual intervention requires minimal training and response effort from caregivers and care staff. Improvements in conversation duration maintained at 6 months post-study.
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Assisted living and similar residential care is an important source of care for elders, including those with dementia. Meaningful activities may help residents maintain function, improve self-esteem, and enhance quality of life. Using data from the 2010 National Survey of Residential Care Facilities, this study identifies the extent of resident engagement in different types of activities; examines the extent to which cognitive status, other resident characteristics, and residential care community characteristics relate to activity engagement; and, among cognitively impaired residents, assesses whether being in dementia-specific settings is associated with activity engagement. Compared with persons without cognitive impairment, those with severe cognitive impairment are less likely to go on outings (79% versus 36%) and talk with family and friends (85% versus 72%). Residents with mild to severe cognitive impairment have higher participation in leisure activities than other residents if they live in dementia-specific settings (73% higher) than those who do not.
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This article traces characteristics and patterns of friendship for Summer of Love participants when they were young, in middle-age, and now in older age. Research on friendships of persons at the leading edge of the baby boomer cohort reveals continuity in preferences for friends, interactions with friends, and effects of friendships on health and well-being in adulthood. Friendships may be particularly salient and central in late life when family and work obligations are less prominent. Professionals can apply lessons from the research in efforts to enhance older adults' friendships and sustain quality of life.
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Dementia is a growing public health issue. Activity, a positive therapeutic modality, has potential to enhance quality of life and reduce behavioral symptoms in persons with dementia-outcomes eluding pharmacological treatments. However, it is unclear how to effectively engage persons with dementia in activities for them to derive desired benefits. We present a systematic review of 28 studies involving 50 tests of different ways of modifying activities to enhance engagement and reduce behavioral and psychological symptoms for this group. Of 50 tests, 22 (44%) evaluated changes to objects and properties (e.g., introducing activities with intrinsic interest), 6 (12%) evaluated changes to space demands (e.g., lighting, noise levels), 8 (16%) evaluated changes to social demands (e.g., prompts, praise), and 14 (28%) combined two or more activity modifications. No modifications were made to the sequence and timing of activities. Although modifications to objects and properties were the most common, outcomes for engagement and behaviors were mixed. Modifications to space and social demands were less frequently tested, but consistently yielded positive outcomes. No modifications resulted in negative behavioral outcomes or decreased engagement. Methodological strengths of studies included direct observation of outcomes and fidelity assessments. Few studies however involved persons with dementia at home. Our review revealed a growing evidentiary base for different modifications to foster engagement in activities and reduce behavioral and psychological symptoms. Future studies should evaluate how contextual factors (e.g., physical environment, activity type) and caregiver ability to employ activity modifications affect engagement.
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Assisted Living is the fastest growing residential option for elders in this country. The purpose of this study was to examine levels of depression and life satisfaction among assisted living residents and to explore factors predicting these variables. Face-to-face interviews were conducted with 145 assisted living elders. Depression and life satisfaction were associated with self-rated health, functional impairment, perceived social support, satisfaction with living environment, and satisfaction with social contacts. Perceived social support, satisfaction with social contacts, and functional impairment were significant predictors of depression. Predictors of life satisfaction included perceived social support and satisfaction with current living situation. Practice and policy implications are discussed.
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Social support has been shown to influence health outcomes in later life. In this study, we focus on social engagement as an umbrella construct that covers select social behaviors in a lifespan sample that included oldest-old adults, a segment of the adult population for whom very little data currently exist. We examined relationships among social engagement, positive health behaviors, and physical health to provide new evidence that addresses gaps in the extant literature concerning social engagement and healthy aging in very old adults. Participants were younger (21-59 years), older (60-89 years), and oldest-old (90-97 years) adults (N = 364) in the Louisiana Healthy Aging Study (LHAS). Linear regression analyses indicated that age, gender, and hours spent outside of the house were significantly associated with self-reported health. The number of clubs and hours outside of home were more important factors in the analyses of objective health status than positive health behaviors, after considering age group and education level. These data strongly suggest that social engagement remains an important determinant of physical health into very late adulthood. The discussion focuses on practical applications of these results including social support interventions to maintain or improve late life health.
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The purpose of this study is to explore social engagement and its relationship to the psychological well-being of older adults residing in assisted living facilities (ALFs). Drawing on activity theory, the study focuses on the salience of social relationships on residents' life satisfaction and depressive symptoms. A total of 82 residents were interviewed face-to-face in eight ALFs in a southern state of the United States. The data were analyzed using hierarchical regression models in that demographic and health variables, site characteristics, and social engagement variables were entered into the model in successive steps. Results indicate that perceived friendliness of residents and staff was significantly associated with life satisfaction and depressive symptoms controlling for other variables, and enjoyment of mealtimes was related to low depressive symptoms. Findings suggest that ALFs could promote residents' psychological well-being by encouraging residents to develop meaningful relationships within the facility and by designing enjoyable mealtimes.
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While it is known that social engagement is important for the well-being of older people, its role among residents in assisted living (AL) residences has not been well explored. The purposes of this study were to explore the experiences of social engagement among AL residents and explain its components and processes as unique to this setting. Qualitative data were collected via semistructured, in-depth interviews with 29 residents in four AL residences in a Southern state. Salient themes were derived using the grounded theory approach. Findings revealed the complexity of social engagement and were organized around five themes related to characteristics of desired social relationships, the perspective of time and loss, barriers to and resources for social engagement, and strategies to develop or modify relationships. AL providers could make concerted efforts to develop practices to provide residents with more social and emotional resources and help them engage in meaningful social interactions.
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The present study examines social engagement (social network and participationin social activities) and its relation to life satisfaction among 354 community-dwelling, cognitively intact older individuals (M age = 72.4 years) with different combinations of disease and disability. Specifically, the analysis focused on individuals with disease but no disability (N = 186) and those with both disease and disability (N = 168). Individuals with both disease and disability had significantly lower levels of participation in social activities and life satisfaction; however, their level of social engagement was more strongly associated with life satisfaction as compared with individuals with disease but no disability. Disabled individuals may compensate for their lower physical function by placing more emphasis on social networks and social activities. Implications for enhancing social engagement and improving the quality of life among disabled older individuals are discussed.
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This study tested the hypothesis that time spent on social activities (i.e., in direct interaction with others) and time spent in social contexts (i.e., while others are present) is associated with survival in persons aged 70 and older. An observational study with mortality follow-ups was carried out in the former West Berlin, Germany (Berlin Aging Study). The sample was stratified by age and sex, and consisted of 473 persons aged 70 to 103years. Social activity and social context measures were assessed in 1990–1993 by structured interviews in the participants homes. Cox regression was used to model survival from time of interview. The main outcome measure was survival on 1 August 2003. Time spent on social activities was revealed as a predictor of survival only in analyses that did not control for confounding factors. In contrast, time spent in context with friends was significantly related to increased survival (relative risk=0.76, 95% confidence interval 0.59 to 0.99) even after several confounding factors were controlled for. This study suggests that time spent with friends affords a survival advantage among older adults, above and beyond the effects of other leisure activities. Future research on social participation and survival may benefit from an examination of the interaction between activity content and social context.
Article
The present study examines social engagement (social network and participationin social activities) and its relation to life satisfaction among 354 community-dwelling, cognitively intact older individuals (M age = 72.4 years) with different combinations of disease and disability. Specifically, the analysis focused on individuals with disease but no disability (N = 186) and those with both disease and disability (N = 168). Individuals with both disease and disability had significantly lower levels of participation in social activities and life satisfaction; however, their level of social engagement was more strongly associated with life satisfaction as compared with individuals with disease but no disability. Disabled individuals may compensate for their lower physical function by placing more emphasis on social networks and social activities. Implications for enhancing social engagement and improving the quality of life among disabled older individuals are discussed.
Article
Social engagement, which is defined as the maintenance of many social connections and a high level of participation in social activities, has been thought to prevent cognitive decline in elderly persons. Associations between a socially engaged lifestyle and higher scores on memory and intelligence tests have been observed among community-dwelling older persons (1–5). Short-term interventions to foster social and intellectual engagement have enhanced cognition among nursing home residents (6) and patients with dementia (7). In animal studies (8), mature rodents exposed to complex social and inanimate environments showed better maze-learning ability than those in sparser surroundings. Social engagement challenges persons to communicate effectively and participate in complex interpersonal exchanges. Besides providing a dynamic environment that requires the mobilization of cognitive faculties, social engagement may also indicate a commitment to community and family and engender a health-promoting sense of purpose and fulfillment. Another putative benefit of social engagement is greater availability of emotional support from relatives and friends. Lack of such support can predict adverse health outcomes (9), but its influence on cognitive decline has not been examined.
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This study examines the relationships between health-related quality of life and activity engagement among residents in two continuing care retirement communities (CCRCs). Prior research indicates that involvement in activity is an important correlate of healthy aging among other community-dwelling elders, and this finding is expected to hold in CCRCs. Time spent engaged in discretionary activities, specifically active, passive, and outside retirement community activities are expected to be associated with better health-related quality of life across multiple dimensions. Data were collected from 167 independent living and assisted living residents in two CCRCs in a large Midwestern metropolitan area. Activity engagement was measured via a self-report questionnaire. Health-related quality of life was measured using the Medical Outcomes Study Short-Form Health Survey (SF-36), which generates eight health subscales (e.g., physical functioning, social functioning, pain). Based on ordinary least squares regression models, the results indicate that discretionary activities, in particular more active types of activity, are positively associated with higher health-related quality of life. These findings have implications for health and activity promotion in CCRCs.
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The case of Donna, a nursing home resident, is presented. Donna engaged in seemingly intractable behaviors, including compulsive theft and prostitution. A variety of behavioral interventions failed to reduce these target behaviors. A differential reinforcement of incompatible responding (DRI) procedurewas implemented following functional assessment. Specifically, Donna’s attendance at structured recreational programs was reinforced with preferred edibles. Treatment resulted in significant increases in recreational programattendance and a concomitant reduction in the incompatible targeted behaviors.