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Grandfriends, an Intergenerational Program for Nursing Home Residents and Pre-Schoolers: A Randomised Trial


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Intergenerational programs may improve meaningful engagement for people with dementia and for attitudes toward older people in youth. Grandfriends, a 12-week program increased passive engagement and enjoyment among nursing home residents when interacting with preschoolers (n = 21) in comparison to usual activities. Grandfriends participants (n = 20) did not show changes on quality of life, agitation, or sense of community in comparison to residents (n = 20) randomized to usual care. Suggestions for future programs are given.
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Journal of Intergenerational Relationships
ISSN: 1535-0770 (Print) 1535-0932 (Online) Journal homepage:
Grandfriends, an Intergenerational Program for
Nursing-Home Residents and Preschoolers: A
Randomized Trial
Lee-Fay Low PhD, Frances Russell MPH, Tracey McDonald PhD & Anne
Kauffman RN
To cite this article: Lee-Fay Low PhD, Frances Russell MPH, Tracey McDonald PhD & Anne
Kauffman RN (2015) Grandfriends, an Intergenerational Program for Nursing-Home Residents
and Preschoolers: A Randomized Trial, Journal of Intergenerational Relationships, 13:3,
227-240, DOI: 10.1080/15350770.2015.1067130
To link to this article:
Accepted author version posted online: 13
Jul 2015.
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Journal of Intergenerational Relationships, 13:227–240, 2015
Copyright © Taylor & Francis Group, LLC
ISSN: 1535-0770 print/1535-0932 online
DOI: 10.1080/15350770.2015.1067130
Grandfriends, an Intergenerational Program
for Nursing-Home Residents and Preschoolers:
A Randomized Trial
University of Sydney, Lidcombe, Australia
Australian Catholic University, North Sydney, Australia
RSL LifeCare, Narrabeen, Australia
Intergenerational programs may improve meaningful engagement
for people with dementia and for attitudes toward older peo-
ple in youth. Grandfriends, a 12-week program increased pas-
sive engagement and enjoyment among nursing home residents
when interacting with preschoolers (n =21) in comparison to
usual activities. Grandfriends participants (n =20) did not show
changes on quality of life, agitation, or sense of community in
comparison to residents (n =20) randomized to usual care.
Suggestions for future programs are given.
KEYWORDS dementia, engagement, intergenerational, nursing
home, preschoolers
Provision of meaningful activities is an indicator of residential, aged-care
service quality (Australian Aged Care Quality Agency, 2014; Department
of Health, 2003; Zimmerman, 2003). Engaging through meaningful activity
is associated with improved quality of life for older adults with dementia
(Moyle & O’Dwyer, 2012). However studies continue to report low levels of
meaningful or engaging activity in nursing homes (Casey, Low, Goodenough,
Address correspondence to Lee-Fay Low, PhD. E-mail:
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228 L.-F. Low et al.
Fletcher, & Brodaty, 2014; Harper Ice, 2002), and this represents a signifi-
cant unmet care need for people with dementia (Cadieux, Garcia, & Patrick,
Intergenerational programs bring together older adults and children or
adolescents to participate in a shared activity. These have been shown to
have benefits for the older participants such as improved depression and
quality of life; however, not all studies found benefits and many of the
programs were only evaluated qualitatively (Knight, Skouteris, Townsend,
& Hooley, 2014). It has been suggested that in order to maximize mutual
benefits across generations sharing activities, both groups need to give and
receive (Knight et al., 2014).
Intergenerational programs have been shown to be feasible and improve
outcomes for people with dementia; however, most evaluations have been
of low methodological quality. We identified only one randomized con-
trolled trial of an intergenerational program for people diagnosed with
dementia-causing conditions (n=15), in which they participated in hour-
long volunteer sessions with either a kindergarten or primary class over
5 months (George, 2011). This study reported significant decreases in stress
in the intervention group but no changes in cognitive function or depression
(George, 2011).
Noncontrolled studies showed that older adults with dementia
(n=12 and n=14, respectively) are effective teachers or mentors for
preschool children and intergenerational/interations resulted in more pos-
itive and less negative engagement compared with usual activities (Camp
et al., 1997; Lee, Camp, & Malone, 2007). An intergenerational group pro-
gram involving such older adults and preschoolers showed that affect was
higher during the intergenerational group (n=21) activities than during
usual activities (Jarrott & Bruno, 2003). A 12-session reminiscence program
for adults with dementia (n=49) facilitated by youth volunteers found
that quality of life and mood improved for the older participants and that
understanding of dementia increased in the younger participants (Chung,
2009). An 8-week intergenerational choir for people with Alzheimer Disease
(n=6) and college students was reported to decrease social isolation and
increase enjoyment (Harris & Caporella, 2014). An intergenerational play-
group in an aged-care facility found a significant decrease in fatigue in older
participants, who also reported experiencing meaningful engagement and a
sense of connectedness (Skropeta, Colvin, & Sladen, 2014).
Evaluations of the effects of intergenerational programs on the younger
generation have focused on their appreciation of the ageing experience and
their attitudes toward older adults. Children are more positive about older
people when they have more contact and are familiar with them (Robinson &
Howatson-Jones, 2014). Intergenerational programs have had mixed results
on children’s attitudes (Heyman, Gutheil, & White-Ryan, 2011; Middlecamp &
Gross, 2002). It has been argued that intergenerational programs that provide
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Preschoolers and Nursing-Home Residents 229
exposure to but only minimal interaction with older adults and without
planned curricula may result in a decrease in children’s positive attitudes
toward ageing and older people. Alternatively programs with higher quality,
frequency, and duration of intergenerational interactions may be more likely
to cultivate positive attitudes (Femia, Zarit, Blair, Jarrott, & Bruno, 2008).
Art students who worked with older adults in a dementia care unit to cre-
atively express their ideas through art, reported that the experience enhanced
their academic learning and improved their attitudes toward older adults in
this situation and that they felt rewarded for making a difference (Lokon,
Kinney, & Kunkel, 2012). Kindergarten and first- and second-grade children
from intergenerational programs have been reported to have higher levels
of social acceptance, have a greater willingness to help and greater empa-
thy for older people, have slightly more-positive attitudes, and are better
able to self-regulate their behavior than children from a matched school
without the intergenerational component (Femia et al., 2008). Preschoolers
have also been shown to improve their attitude toward older people after an
intergenerational program (Heyman et al., 2011).
The aim of this study was to evaluate outcomes of Grandfriends, an
intergenerational program for people living in nursing homes as a result
of their dementia symptoms and children attending a preschool colo-
cated within the facility precinct. We hypothesized that older adults with
dementia-causing conditions will be more engaged during the intergener-
ational program than during an activity provided as part of usual care at
which the children are not present. The rationale was that increased engage-
ment during the activity would meet needs for meaningful activity and social
engagement and result in improvements in quality of life and sense of com-
munity and in decreased agitation among those with dementia symptoms
who participate in Grandfriends in comparison to controls who receive usual
A randomized controlled design was utilized with residents in aged care
and a pre-post design with the preschool children. Ethics approval for
this study was obtained from the University of New South Wales Human
Research Ethics Committee (HC14012). The project was also registered
with the Australian Catholic University Human Research Ethics Committee
(2014/84 N).
This study was run in a residential aged-care facility on a large site with
a colocated preschool. The preschool children were familiar with visiting
elders at other facilities on the same site but had not visited the people in
the aged-care unit involved in this study.
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230 L.-F. Low et al.
All potentially eligible residents living in the aged-care facility, as well as
those in two other colocated aged-care facilities, were invited to participate
by facility staff. Proxy consent was obtained for residents judged not able
to provide their own written consent and verbal assent was obtained from
those residents at each evaluation and intergenerational session.
All children attending the preschool class of a day care center were
invited to participate by day care staff. Written consent to participate
in the research study was sought from parents. Participation in each
intergenerational and evaluation session was voluntary for children.
Inclusion criteria for residents were aged >65 years; having an ability to com-
municate verbally in English as judged by care staff; not severely depressed
as indicated by a chart score of Cornell Scale for Depression in Dementia
(Alexopolous, Abrams, Young, & Shamoian, 1988); not physically aggressive
as indicated by a frequency rating of very often as well as an occupational
disruptiveness rating of very severe or extreme on the Neuropsychiatric
Inventory (NPI) (Cummings, 1997); willing to participate in a program with
small children and able to provide informed consent or had a family carer
willing to consent on his/her behalf.
Inclusion criteria for children were between age 3 and 5 years; attend-
ing the preschool class; having a parent willing to provide consent for
participation; willing to participate on the day.
Assessments With Elders
Research and facility staff were not blind to group allocation. Observations
of engagement and mood of older participants were conducted using the
Menorah Park Engagement Scale (Camp et al., 1997) in weeks 2, 7, and
12 during an intergenerational session and during a structured activity the
same week. Three 5-minute observations were made of each resident dur-
ing the intergenerational activity. Trained experienced researchers rated the
duration (0 not at all, 1 =up to half the observation, 2 =more than
half the observation) on the following domains: active engagement (did
or commented on the activity), passive engagement (watched or listened
to the activity), self-engagement (did things other than the target activity),
disengagement (not engaged with any activity), pleasure, and sadness.
Baseline data on demographics, dementia diagnosis, and PAS score were
obtained from resident case notes. Baseline functional ability was rated by
facility staff on the Functional Assessment Staging Tool (FAST) (Reisberg,
1988), a 7-stage tool where 1 is normal and 7 indicates severe dementia.
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Preschoolers and Nursing-Home Residents 231
The other scales were administered before (week 0) and after the 12-
week program (week 13):
1. The Cohen-Mansfield Agitation Inventory (CMAI), a 29-item measure of
the frequency of agitated behaviors over the past 2 weeks rated on a
7-point scale (range 7–203 with higher scores indicating greater agita-
tion) (Cohen-Mansfield, 2005). This scale was completed by facility staff
2. The Brief Sense of Community Scale (BSCS) (Peterson, Speer, & McMillan,
2008) is an 8-item scale measuring psychological sense of community
such as group membership and shared emotional connection. This was
adapted for the residential care setting by replacing “neighbourhood” with
“care home” and involves a 5-point scale (range 8 to 40 with higher scores
indicating less sense of community). It was completed by residents with
the assistance of a researcher.
3. The Long Term Care Quality of Life Scale (LTC-QoL) (McDonald, 2013)
is a proxy-rated measure of quality of life for people living in long-term
care. It considers the domains of social capacity, self-efficacy, supportive
relationships, mood state, and the presence or absence of fear or distress.
It has been found to be valid across age, gender, and cognitive capacity
of participants.
Assessments With Children
We used an adaptation of the Children’s Attitudes to the Elderly Interview
(CATI) (Heyman et al., 2011; Middlecamp & Gross, 2002) to evaluate the
children’s attitudes toward older people. This 5-item scale elicits children’s
opinions about older people and their abilities.
However baseline assessments revealed that (a) the children answered
questions based on their prior experience of visiting older people within the
facility and (b) the children struggled to understand the interview questions
and said yes to many of the items in an apparent attempt to please the inter-
viewer. Given that children were not naïve to the intervention and the risk of
acquiescence bias, we decided that data obtained from the children would
not be valid, and interviews with children were not repeated at 13 weeks.
Process Evaluation
The process evaluation assessed context, dose delivered (i.e., number of ses-
sions run), dose received (i.e., number of sessions attended by participants),
and treatment fidelity (i.e., whether the content of sessions was delivered as
planned (Steckler & Linnan, 2002). Attendance and participation ratings for
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232 L.-F. Low et al.
intergenerational sessions were collected by facility staff for residents and by
preschool educators for the children.
Half the residents were allocated to the Grandfriends intervention group
and half to usual care. Randomization was conducted by a statistician with
de-identified resident data using the computerized minimization method
operationalized by the MINIM program (Scott, McPherson, Ramsay, &
Campbell, 2002). Resident age and gender were input during randomization
to ensure that these characteristics were balanced between groups.
The Grandfriends Program
The Grandfriends program was developed collaboratively between
preschool staff, nursing-home recreational staff, and the research team.
Grandfriends was designed to be enjoyable, encourage interaction, and
develop relationships between the generations by encouraging both groups
to work together toward a common goal. The program also had to meet the
programming needs of the aged-care facility and address outcomes in the
Australian early childhood framework. Program development was informed
by previous intergenerational research (Jarrott & Scheplsl, 2007). The pro-
gram involves pairing each child with a “grandfriend” and participating
in a range of activities together such as discussions (e.g., similarities and
differences), craft (e.g., collage), and games (e.g., bingo). Educators from
the day care center and nursing-home staff jointly facilitated the activities.
Grandfriends was run for 45 minutes each week for 12 weeks.
Power calculations were conducted using GPower. A sample size of 20 elders
was sufficient to achieve 80% power to detect a medium effect size
(d =0.45) between Grandfriends and usual activities on observational
engagement measures using a two-tailed test with alpha for significance set
at 0.05. A sample size of 40 elders was sufficient to achieve 80% power to
detect a medium effect size (f =0.5) between Grandfriends and usual care
conditions on quality of life, engagement, and sense of community using a
two-tailed test with alpha for significance set at 0.05.
Statistical analyses were conducted using IBM SPSS 22. Differences between
groups on baseline demographic and clinical variables were examined using
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Preschoolers and Nursing-Home Residents 233
ttests for continuous variables and chi-squared tests for categorical variables.
Outcome variables were normally distributed.
All elders were included in the analyses, even if they did not attend
some Grandfriends sessions or dropped out of the study. Differences in
engagement scores in the Grandfriends group between activity conditions
over time were analyzed using linear mixed models. Linear mixed models
were also utilized to examine changes in quality of life, agitation, and sense
of community between Grandfriends and usual care groups over time. Linear
mixed models allow for the clustering of repeated measures within individ-
uals, as well as inclusion of participants with incomplete data; missing data
was not imputed. Alpha for significance was set at 0.05 for all analyses.
Twenty-one children participated in the study; all were 4 years of age, and 10
(48%) were girls. Baseline characteristics of the 40 older adult participants are
presented in Table 1. The average age of older participants was 91 years, and
the majority were women (80%) with cognitive impairment (80%), with the
average FAST score suggesting moderate dementia. There were no baseline
differences between Grandfriends and control groups on demographic and
outcome variables.
Three participants assigned to the Grandfriends group dropped out, as
did two participants in the control group (see Figure 1).
TABLE 1 Baseline Characteristics by Intervention Group
mean ±SD or
mean ±SD or
n(%) Test for significance
Age 91.2 ±52.7 91.1 ±6.1 t=.067, p=.947
Number of women (%) 16 (80%) 16 (80%) χ2=0.000, p=1.000
Chart diagnosis of dementia 10 (50%) 13 (65%) χ2=0.921, p=.262
Length of stay (days) 792 ±628 715 ±769 t=.349, p=.729
Psychogeriatric Assessment
9.3 ±6.1 7.5 ±3.1 t=1.176 , p=.247
Cognitively impaired on PAS (>5) 15 (75%) 17 (85%) χ2=0.625, p=.695
Functional Assessment Staging Tool 5.3 ±1.9 5.3 ±1.9 t=0.000, p=1.000
Cornell Scale for Depression in
11.7 ±6.3 9.3 ±4.7 t=1.293, p=.203
Long Term Care Quality of Life
8.3 ±1.4 8.4 ±1.1 t=-.296, p=.769
Cohen-Mansfield Agitation
41.5 ±11.7 37.4 ±6.5 t=1.175, p=.250
Brief Sense of Community Scale 17.9 ±5.0 16.2 ±3.5 t=1.148, p=.260
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234 L.-F. Low et al.
Assessed for eligibility (n = 67)
Baseline data collection and
randomized (n = 40)
Allocated to Grandfriends (n = 20) Allocated to usual care control (n = 20)
Followed-up (n = 17)
Included in analysis (n = 20)
Followed-up (n = 18)
Included in analysis (n = 20)
Lost to follow-up:
Moved facilities (n = 1)
Deceased (n = 2)
Lost to follow-up:
Deceased (n = 2)
Excluded because did not meet
criteria (n = 27)
FIGURE 1 Flow chart of older participants.
Engagement, Quality of Life, Agitation, and Sense of Community
Passive engagement was significantly higher during the Grandfriends ses-
sions compared to usual activities averaged across time, and passive
engagement increased over time averaged between conditions (see Table 2).
Self-engagement was significantly lower during the Grandfriends sessions
compared to usual activities averaged across time. Enjoyment was signifi-
cantly higher during the Grandfriends sessions compared to usual activities
averaged across time, and there was a significant activity condition by time
interaction such that the decrease in the amount of observed enjoyment
was greater over time in the usual activity sessions in comparison to the
Grandfriends sessions.
There were no differences between Grandfriends and control groups
over time on quality of life, agitation, or sense of community (see
Table 3).
Process Evaluation
The content of the program had been developed with senior facility nurses,
and the recreational activity officers implementing the program had less own-
ership than the childcare staff who participated in developing the content
and also delivering the program.
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TABLE 2 Menorah Park Engagement Scale results by condition and week, and mixed linear model results
Week 2 Week 7 Week 12
Grandfriends Usual activity Grandfriends Usual activity Grandfriends Usual activity Statistical tests
Active engagement 1.3 ±0.6 1.1 ±0.7 1.5 ±0.5 1.1 ±0.8 0.6 ±0.6 1.1 ±1.0 pC=0.823, pT=0.097,
pCT =0.105
Passive engagement 1.0 ±0.5 0.8 ±0.7 0.8 ±0.4 0.6 ±0.5 1.5 ±0.9 0.9 ±0.6 pC=0.015, pT=0.024,
pCT =0.469
Self-engagement 0.0 ±0.0 0.4 ±0.7 0.0 ±0.0 0.2 ±0.4 0.1 ±0.3 0.2 ±0.4 pC=0.013, pT=0.548,
pCT =0.305
Disengagement 0.1 ±0.3 0.3 ±0.6 0.0 ±0.0 0.6 ±0.9 0.0 ±0.0 0.6 ±0.9 pC=0.823, pT=0.097,
pCT =0.105
Pleasure 1.1 ±0.5 0.5 ±0.5 1.5 ±0.7 0.1 ±0.3 0.9 ±0.7 0.5 ±0.5 pC<0.001, pT=0.919,
pCT =0.004
Sadness 0.1 ±0.3 0.0 ±0.0 0.1 ±0.3 0.0 ±0.0 0.0 ±0.0 0.0 ±0.0 pC=0.191, pT=0.656,
pCT =0.656
pCis the main effect of group; pTis the main effect of time; pCT is the interaction of group by time.
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236 L.-F. Low et al.
TABLE 3 Outcome Measures by Group by Time and Results of General Linear Models
Controls Grandfriends
Week 0 Week 13 Week 0 Week 13
Group by time
Long Term Care
Quality of Life
8.8 ±0.7 8.9 ±0.7 8.8 ±0.9 8.8 ±0.7 F=0.274,
41.5 ±11.7 37.4 ±6.5 33.4 ±5.8 31.8 ±3.5 F=0.614,
Brief Sense of
17.9 ±4.9 16.1 ±3.5 14.8 ±3.7 15.1 ±3.5 F=2.004,
The preschool staff were familiar with taking the children to visit elders,
though visits prior to the study had not been structured. The staff at the res-
idential aged-care facilities struggled to get residents ready and to the venue
for the sessions, which were all held at one of the care units. The preschool
and residential aged-care staff appeared to have different expectations of
what constituted a good session in terms of organization and interaction,
with higher expectations by preschool staff.
Twelve Grandfriends sessions were run as planned.
Of the 20 elders enrolled in the Grandfriends group, 2 did not attend any
sessions and 4 attended all of the 12 sessions (mean attendance =6±4).
Although activities were preplanned for the 12 weeks, these were adapted as
staff got to know the participants and their abilities. Changes to the activities
were mainly initiated by the preschool staff. Children were meant to be
paired with the same elder each session. However, absences by either older
participants or children meant that Grandfriend pairings were not consistent
and some older participants worked with multiple children within a single
Grandfriends increased passive engagement and enjoyment and reduced
self-engagement during sessions in comparison to other activities but did not
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Preschoolers and Nursing-Home Residents 237
improve longer term outcomes in comparison to usual care. This increase
in engagement was similar to the results of other intergenerational pro-
grams with young children (Camp, et al., 1997; Jarrott & Bruno, 2003;Lee
et al., 2007), however the benefits did not extend beyond the sessions as
was reported by intergenerational programs during which people with mild
dementia interacted with older youths (Chung, 2009; Harris & Caporella,
2014). It could be that the duration of the program of 45 minutes per
week was insufficient, that interactions with young children have fewer
extended benefits than those with older youths, or that the moderate level of
dementia in many of our older participants meant that most did not derive
the extended benefits.
Considering the active and passive engagement scores together, active
engagement was higher than passive engagement in the weeks 2 and 7 ses-
sions, whereas the opposite occurred in week 12, when a celebratory party
was held in the final Grandfriends session and the structured paired activi-
ties of the previous sessions were omitted. This emphasizes a requirement
for structured interactions between generations to maximize participation by
older adults with symptoms of dementia.
While all older participants agreed to be involved at the beginning of
the study, some refused to attend any sessions and some came only a few
times and then declined to participate further, with one expressing that she
thought that the children should be at home with their mothers. It is possible
that the program could have been better explained at recruitment and better
targeted to elders expressing a desire to interact with children.
Staff from both the aged-care facility and the preschool had been
involved in designing the content of the program. However, implementation
by staff from two organizations with differing expectations of participant
interactions during the program and their roles in facilitating these inter-
actions became apparent as the program progressed. Program execution
may have been improved through continued facilitation by research staff
of communication between organizations.
Limitations of this study are the small sample size, use of unblinded
assessors, participant attrition, and missing data. The results do not suggest
trends toward differences between Grandfriends and usual care controls,
which may have reached statistical significance with a larger sample, and
attrition was comparable to other studies over 3 months in residential aged-
care contexts (Low et al., 2013). Strengths are the randomized controlled
design and measurement of engagement during the sessions as well as the
longer-term effects of the program.
Future research may consider how the age and cognitive capacities of
both the younger and the older participants in intergenerational programs
impact on outcomes. Selection of individuals with greater interest in partici-
pating in such a program and with symptoms of depression or agitation may
increase potency of results.
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238 L.-F. Low et al.
By introducing structured interactions between elders and preschoolers,
the Grandfriends program is more engaging and pleasurable to elders than
usual activities in residential aged care. Like other psychosocial interventions
for people with dementia, the in-the-moment benefits may be sufficient jus-
tification to run the program (MacPherson, Bird, Anderson, Davis, & Blair,
2009), which required no additional staff or resources. Grandfriends may be
a cost-effective way of providing meaningful activity for aged-care residents.
Thanks to the residents, children and their families, and the staff of RSL
LifeCare and Little Diggers Kindergarten, particularly Shannon Sinclair and
Jessica Watton.
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... Ward et al. (1996) revealed that children and older adults singing together had a positive effect on the mental health of older adults. Using a 12-week intergenerational interaction program called Grandfriends, Low et al. (2015) reported in their study that nursing home residents who interacted with preschool children participated in daily activities more and had more fun compared to those who did not interact with the children. Teater (2016), who examined the perceived health status and well-being of older adults who participated in an intergenerational interaction program, found that their participation in the program resulted in improvement to their self-confidence, their social skills, and their emotional and general health and well-being and helped them to learn about other individuals in the community and feel more connected to the community. ...
... All the participants in the study stated that the intergenerational interaction activities were pleasing for the older adults and the children. Most intergenerational interaction studies have reached this same conclusion, reporting that intergenerational interaction activities entertained the older adults (Barbosa et al., 2021;Hernandez & Gonzales, 2008;Heyman & Gutheil, 2008;Low et al., 2015;Teater, 2016;Ward et al., 1996) and the children (Barbosa et al., 2021;Heyman & Gutheil, 2008). ...
... Another positive outcome of the intergenerational interaction practices on the older adults was the feeling of satisfaction it gave them. Similar to other studies that have found intergenerational interaction practices to have a positive effect on older adults (Barbosa et al., 2021;Gallahger & Fitzpatrick, 2018;Low et al., 2015), in the current study, the older adults expressed their satisfaction with taking part in the study through their words, their attitudes, and their interest in participating in the study again if another one were to be performed. ...
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This study aims to bring together a group of preschool children and older adults residing in a nursing home through some intergenerational interaction activities to examine the interaction between these two groups from the point of view of parents, teachers, older adults, and children. This basic qualitative research was carried out with a study group of 10 preschool children, 11 parents, 3 teachers, and 8 older adults residing in a nursing home, all of whom were determined via a criterion sampling method.Data were collected through semi-structured interviews with the participants and analyzed through an inductive approach. Intergenerational interaction practices provided in the context of the study were considered to be favorable, original, encouraging, positive experiences. The practices were found to be pleasing for both children and the older adults, as well as being awareness raising, interaction and empathy boosting, positive behavior yielding, educative, exciting for children and making them embrace of older adults and feel responsible. For the older adults, it has been concluded that intergenerational interaction practices were pleasing, fulfilling of longing for affection,satisfying, motivating and presenting different experiences. Moreover, adult participants made some suggestions regarding increasing the duration, extending the content and integrating intergenerational interaction activities with school program. As a result, it can be concluded that intergenerational interaction practices have yielded positive outcomes for all of the participants and initiatives and researches should be carried out to disseminate these studies.
... Previous research has mainly examined the impact of Intergenerational programmes for older people (Baker et al., 2017;Camp & Lee, 2011;Low et al., 2015;Skropeta et al., 2014). Outcomes have been measured using engagement, quality of life and depression scales. ...
... Less research explores the impact of Intergenerational programmes for younger people involved. Low et al. (2015) conducted 21 interviews with children to assess their attitudes towards older people following their participation in a 12-week Intergenerational programme. However, children tended to answer more generally about their overall experience with older people and struggled to understand the questions posed by researchers. ...
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Background Intergenerational programmes are formal activities bringing different generations together and have been identified as a way to help people living with dementia to stay socially connected. While there is some evidence from individual studies as to their benefits, there is no overall coherent account as to the perceptions and experiences of participants who engage in such programmes. This review synthesises qualitative evidence of the experiences and perceptions of young people and older people living with dementia of participating in such programmes. Methods We searched EBSCO CINAHL, OVID Medline, Embase, Ovid PsycINFO, the Web of Science, Epistemonikos and grey literature sources. We used thematic synthesis to analyse and synthesise the evidence in to four themes, with 11 key findings. We assessed our confidence in each of these findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. Findings Our review highlights the potential enjoyment for young people and older people living with dementia when participating in Intergenerational programmes, despite some initial trepidation. These programmes provide an opportunity to establish and develop relationships and for young people to learn about dementia, ageing and how to interact with older people living with dementia. However, it is important to have staff facilitators present to provide reassurance to both groups. It is also important to take the personal preferences of participants into account and to be considerate of noise levels and other aspects of programme delivery that may inhibit engagement. Conclusion This is the first qualitative evidence synthesis specifically exploring Intergenerational programmes aimed at older people living with dementia. We provide insights into the perspectives of those who have participated in Intergenerational programmes. It is important to consider these views, together with other evidence of effectiveness, when planning Intergenerational programmes. While our review is limited by a small number of studies from only a few countries, we have moderate to high confidence in our findings. Further research into the development of Intergenerational programmes specifically tailored for people living with dementia is needed. The findings also provide guidance for people planning to deliver or design future Intergenerational programmes.
... A final focus in the Early Years Coping Project is the Intergenerational Program, which has been occurring since 2016. Quality early childhood social and emotional development includes a focus on reducing young children's prejudice and preconceptions about ageing (Femia et al., 2008;Low et al., 2015). Other studies find that children who have participated in intergenerational programs have positive gains on their social emotional development, behaviour, school performance, and attitude towards older adults (Femia et al, 2008;Heyman, Gutheil, & Whiteman, 2011). ...
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There are numerous ways to construe positive education in the early years, particularly as it relates to wellbeing and positive emotional outcomes. The teaching of coping skills provides tools for wellbeing within a positivist framework through emphasising the use of productive coping strategies and reducing the use of unhelpful, non-productive strategies. This chapter provides an example of teaching coping skills in early childhood: the Early Years Coping Project. The project helped young children articulate and understand coping constructs and provided tools to help parents and teachers to assess children’s coping. Visual tools facilitated the development of children’s coping skills in classroom activities. Parents were encouraged to develop their parenting skills and their own coping, utilising the emotion and coping language that is common to them and their children. The parent program was subsequently adapted in a format that was readily communicated to a culturally diverse population, using the generic frameworks and constructs of coping. Coping concepts and constructs have subsequently been incorporated into a COPE-Resilience curriculum. We highlight several applications and extensions of the curriculum. Coping skills provide a template for healthy social-emotional development that can be utilised in different contexts throughout life.
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Background and objectives: Older adults in residential aged-care facilities (RACFs) experience segregation from society and face limited opportunities to meaningfully engage on a social and/or occupational level due to various structural and systemic challenges. An occupational therapy-coordinated intergenerational live-in student programme (ILiSP) with allied health students was successfully pioneered across Sydney (Australia) to facilitate ongoing intergenerational contact. We explored how ongoing intergenerational contact influenced meaningful engagement of older adults in RACFs by investigating routinely collected clinical data and exploring stakeholders' perspectives. Research design and methods: We employed a concurrent nested mixed-methods design. Residents' attendance in weekly organisational activities and students' monthly volunteer hour reports were analysed to produce statistics for demonstrating the changes in residents' activity attendance alongside ongoing intergenerational contact. Qualitative data from discussions directed by the nominal group technique (NGT) with staff, management and students, individual interviews with relatives and residents, and narrative clinical documentation were thematically analysed. Results: The Wilcoxon signed-rank test indicated that residents' activity attendance increased during intergenerational contact. Qualitative data yielded three main themes-interdependence, meaningful engagement, and kinship-all associated with intergenerational contact as part of established ongoing relationships. The NGT highlighted consensus on on-site living for maintaining a cohesive and supportive collective. Conclusion: Despite structural and systemic challenges within RACFs that dissuade community integration, ILiSP created opportunities for students to connect/reconnect residents to new/established networks and to support residents to maintain or re-engage with previous lifestyle preferences. Therefore, ongoing intergenerational contact fostered a cohesive collective in support of the social and occupational needs of residents, which should be capitalised on by policymakers (e.g., the National Aged Care Mandatory Quality Indicator Program) and interested organisations.
This is the first meta-analysis to examine the outcomes of nonfamilial, intergenerational programs (IGP) on youth and older adults. Relevant studies were identified by screening the abstracts from five systematic reviews on the impact of intergenerational programs on psychosocial outcomes. After all studies were screened 23 independent studies were included in the meta-analysis. An effect size, d, was calculated for the change in youth attitudes toward older adults, as well as older adults’ change in generativity, quality of life, depressive symptoms, and physical health. Results suggested that IGP have a small, but significant association with improved youth attitudes toward older adults (d = 0.42). For older adults IGP were associated with a small, significant, reduction in depressive symptoms (d = > −0.30) and increased generativity (d = 0.25), quality of life (d = 0.48) and physical health (d = 0.10). Nonsignificant heterogeneity precluded the use of moderator variables to explain variation among the studies. With a better understanding of the effectiveness of IGP, researchers can more effectively develop IGP and assess their outcomes.
Objectives: Residents living with dementia in residential aged care facilities (RACFs) have reduced access to, and opportunities for, participation in meaningful activities. This leads to increased social isolation and disengagement. Intergenerational programs aim to overcome these issues. Allied health students piloted a live-intergenerational program (LIP), living onsite at a residential aged care facility (RACF) while volunteering for 30 h a month. The purpose of this study was to explore the impact and practicalities for implementing a LIP in an Australian RACF. Methods: This qualitative descriptive pilot study was undertaken to explore the diverse perspectives of various stakeholders. Qualitative data were collected during group discussions directed by the nominal group technique with live-in-students. Interviews were conducted with staff members, relatives, facility management and volunteers. All qualitative data were analysed thematically. Results: Two overarching themes emerged. The first, community of care, indicated how care partners and the care context, organisational support and being a live-in-student supported the sustainability of the program. Live-in-students' accessibility promoted opportunities for occupational and social engagement of residents when staff was less available. The second, a collective based on belonging and shared doing, highlighted the program's potential impact and uncovered the development of a collective based on shared belonging. Conclusion: The LIP highlighted the potential for new dimensions to person-centred care. The pilot study demonstrated intergenerational contact within aged residential care supported the evolvement of a collective and promoted a social approach for ageing well. Further research is needed to identify the long-term impact of the LIP and explore the feasibility of expanding the program.
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This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson’s disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.
Purpose This paper aims to explore how food-focused social activities are a route for promoting intergenerational relationships, well-being and dietary benefits among residents in care homes and children in preschool/schools. Design/methodology/approach Using a case study methodology, this study undertook staff-focused research on a 26-month UK programme in 12 partnership clusters, involving a range of growing, cooking, eating and community activities. Findings Staff reported benefits for older people, including improved mood, surfacing positive memories, new personal connections and relief from feelings of boredom and loneliness. Children were reported to develop in-depth relationships, greater empathy and overcame negative preconceptions. Food-based activities enabled all parties to express caring and nurturing in tangible and often non-verbal ways. Originality/value Food-based activities appear to have specific material and emotive characteristics that resonate with the intergenerational interests of older people and children. Using mainly in-house resources, this study showed that it is feasible to generate novel food-based practices between children’s education and care home sectors. A “test-and-learn” programme model is recommended, given sensitivities and complexity associated with food-based activities and the limited organizational capacity of care home and early education service providers.
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Research fostering intergenerational interaction often promotes attitude change toward the other, social connectedness, service activities for younger adults, and older adults feeling purpose and valued. Research articles reporting projects designed using nonfamilial, reciprocal intergenerational interaction were systematically reviewed. Thirteen papers published between January 1990 and February 2012 in peer-reviewed, English-language publications met inclusion criteria. The review concluded that reciprocal giving needs to be structured into the methodology of future intergenerational studies for the full developmental opportunity of identity formation in younger adults, generativity in older adults, and psychosocial benefits for both generations to be realized.
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Background: Intergenerational playgroups in aged care are limited and little is known about the perceptions of individuals who have participated in such programs. Most research is focused on intergenerational programs that involved two generations of people--young people and older people or young people and people with dementia reported the significant outcomes for each group of participants. In this study a number of generations participated in the intergenerational playgroup intervention that included older people, child carers who were parents, grandparents or nannies and children aged 0-4 years old. The objective of this study was to explore the benefits of participating in an intergenerational playgroup program IPP in an aged care facility. Methods: This mixed methods quantitative and qualitative design explored the benefits of participating in an intergenerational playgroup program IPP in aged care settings. The intervention is an intergenerational playgroup program (IPP) offered in the aged care facility where intergenerational socialisation and interaction occurred between different generations. The SF36 and Geriatric Depression Scale (GDS) were used to collect pre-test post test data. The qualitative interpretive research approach used semi-structured interviews to develop the descriptive interpretation of the intergenerational playgroup experience. Interviews were conducted with aged care residents and child carers. Results: The pre-test post-test results for the SF36 revealed a declining trend in one scale only energy/fatigue and no significant differences on the Geriatric Depression Scale GDS. The interview analyses revealed the following themes (1) intergenerational experiences, (2) two-way contributions, (3) friendships work, (4) personal growth, and (5) environmental considerations and nineteen subthemes were extracted to provide meanings. Conclusions: The IPP provided a successful innovative intergenerational program intervention where older people and people with dementia interacted and connected with a number of people from different generations. The IPP provided meaningful engagement for all participants considered important for self-esteem and the ability to participate fully in society. This allowed people to develop a sense of connectedness and friendships in a safe and secure environment. This increased the dignity of older people and people with dementia within the community and increased public awareness about the existing care and support services available to them.
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The objectives of the current research were (1) to test and evaluate the investigator-designed Behavior, Engagement, and Affect Measure (BEAM) touchpad direct observational data collection tool, and (2) to implement this tool to investigate residents' patterns of behavioral agitation, engagement, affect, behaviors associated with positive mood, general time-activity use, and social interactions within long-term care. Raters collected cross-sectional observational data and conducted semistructured interviews with participants of the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) Study. Researchers tested the BEAM's reliability and validity and evaluated the instrument's discriminate validity for sampling resident behaviors. Data were collected in 36 long-term care homes. The sample included low-care hostels, high-care nursing homes, and residential facilities offering aging-in-place. Participants were 406 residents aged 52 to 105 years, with and without dementia. Researchers collected direct observational data using the BEAM and operationalized behavioral domains based largely on concepts from Kitwood's model of person-centered care. Care staff reported on resident behavior using standardized measures of agitation, depression, quality of life, and social engagement. The BEAM showed moderate-to-substantial interrater reliability and slight-to-moderate correlations with staff-report data gathered through standardized questionnaire measures. Observations showed that residents spent the greatest amount of time stationary and expressing little emotion, although actively engaged with their environment. Residents were observed to be coping adequately and experiencing a positive social and/or positive care interaction in approximately half of observations; however, close to a third of ratings identified "ill-being." Residents showed more positive behavior, appeared happier and less anxious, and exhibited higher "well-being" during structured activity than during free time or meals. The BEAM is a reliable and valid observational tool for measuring behavior in long-term care. Long-term care residents expressed little emotion and experienced limited positive social interaction in their daily routine. Increased provision of structured activities may increase resident experiences of positive behavior, affect, and well-being.
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The positive impact of intergenerational service learning experience on college students’ academic and personal development is well documented. However, it is not clear whether students engaged in such programs with elders who have dementia gain similar benefits. Qualitative analysis of 300 journals written by 59 students participating in the Opening Minds through Art (OMA) intergenerational art program for people with dementia revealed that facilitating the creative expressions of elders with dementia resulted in many positive gains for college students. The experience enhanced their academic learning and they felt rewarded for making a difference in the lives of others. Their attitudes toward the elders became more positive, and they were able to build genuine and reciprocal relationships with the elders. In the students’ eyes, the elders were artists, teachers, and friends. Further research is needed to analyze the impact of such intergenerational art program from the perspective of the elders.
The issue of life quality for older people admitted for long-term care is of concern to those keen to provide services that support an acceptable quality of life. This study investigates measurement characteristics of the long-term care quality of life (LTC-QoL) assessment scale developed to address a gap in quality in life assessment in such contexts, i.e. an easy to use single scale generating summary information on the life quality experienced by all older adults in care, indicating aspects requiring attention from direct care personnel and providing management information on individual and care unit outcomes in supporting residents' experiences of life quality. Analysis of repeated LTC-QoL data for 62 long-term residents in an Australian aged care facility establishes the instrument as having good reliability and validity. Exploratory factor analysis of nine items revealed high internal consistency, good test–retest reliability, and validity across age, gender, and cognitive capacity of participants. Findings establish that the LTC-QoL has adequate reliability and dimensionality. Content validity and management utility were verified by experts using and refining the scale over 7 years in long-term care contexts, resulting in an easy to use and reliable assessment tool for long-term care recipients.
Worldwide demographic change means that the responsibility for an aging population will fall to younger generations. This narrative literature review comprises an international examination of what has been published about children’s views of older people between 1980 and 2011. Sixty-nine academic articles were inductively analyzed, and the emerging themes were ageism, contact with older people, children’s media, children’s perceptions of older people, intergenerational studies, children’s perceptions of older people’s health conditions, and culture, ethnicity, and worldwide studies. Reports about children’s views were influenced by research methods, the children’s familiarity with whom they were being asked to describe, their prior relationships with grandparents and other significant older people, and their stage of development. Eighty percent of the articles were based on American research and were often guided by a concern about ageism. Although children adopt stereotypes, they do not appear to be ageist. Research needs to include a wider geographical and cultural spread of children, children’s understandings of the lived experiences of older people, and an exploration of the effects of culture, faith, and socioeconomic status on children’s views if it is to underpin effective education that equips the next generation to humanely support the older populations of the future.
The intergenerational choir was formed for the purpose of combating the stigma of Alzheimer's disease in college students, and in that process also lessening the social isolation of people with AD and their family members. The choir was composed of 13 college students and 13 people with AD and a family member. Data from the college students were gathered through semi-structured open-ended questions on attitudes and knowledge about AD, collected at three points in time over 8 weeks of rehearsals. Data were collected from the people with AD and their family members through a focus group and observations over 8 weeks of rehearsals. Results a show a decrease in social isolation for the older choir members, and for the college students: a decrease in negative attitudes, an increase in positive attitudes and themes of - recognizing capabilities, expanded understanding of AD, reduced stigma, and reduced social discomfort.
With the aging of the population and the projected increase of dementia in the coming years, it is crucial that we understand the needs of people with dementia (PWD) in order to provide appropriate care. The aim of this study is to determine, using the best evidence possible, the care needs of PWD living in long-term care (LTC). A total of 68 studies, published between January 2000 and September 2010, were identified from six databases. From the selected studies, 19 needs of PWD were identified. The existing evidence suggests that psychosocial needs such as the need to engage in daily individualized activities and care must not be ignored in LTC. This review aims to provide a clearer picture of the needs of this growing patient population.
Increasingly, attention has focused on the impact of intergenerational programming. Using a static group comparison design, this study examines preschoolers' attitudes toward older adults by comparing children in a shared site intergenerational program and those in traditional day care. Children were shown sketches of an older man and an older woman and were asked to describe them in terms of specific attributes. A two-group discriminant analysis was conducted to assess differences between the two programs yielding significant differences, with 82% of children correctly classified regarding program participation. Overall, attitudes toward older adults were more positive in the intergenerational program compared to the traditional program. In addition, preschoolers in the intergenerational program viewed older adults as healthy compared with preschoolers in a traditional program. Implications of these findings are examined.