Importance of Activity: What the Research Shows in Support of Senior Center Programming

1. Importance of Activity: What the Research Shows in Support of Senior Center Programming Laura N. Gitlin, Ph.D. Director Jefferson Center for Applied Research on Aging and Health Professor, Department of Occupational Therapy Thomas Jefferson University Prepared for the Pennsylvania Association in Senior Centers Friday, April 18, 2008

2. OVERVIEW I. Changing Dynamics of Age and Health Structure • Select age structure and health status statistics • Implications for senior center program planning II. Evidence Supporting Importance of Senior Centers • Meaning of Activities for Older Adults • Results from select studies III. Looking Forward • Challenges in developing programming • Importance of evidence-based or evidence-informed programs • Demonstrating success

3. I. CHANGING AGE AND HEALTH STRUCTURE IN THE UNITED STATES What are implications for programming?

4. Number of Older Americans (Older Americans 2008: Indicators of Well-being)

5. Racial and Ethnic Composition (Older Americans 2008: Indicators of Well-being)

6. Nursing Home Utilization (Older Americans 2008: Indicators of Well-being)

7. Chronic Health Conditions (Older Americans 2008: Indicators of Well-being)

8. Functional Limitations

9. Sensory Impairments and Oral Health

10. Depressive Symptoms

11. Educational Attainment

12. Use of Time

13. Physical Activity

14. EMERGING PROFILE OF AGING INDIVIDUALS • More people aging in place at home and community • Healthier but living with chronic illness and functional difficulties • Increasing race/ethnic diversity • Increasing heterogeneity: • Age • Education • Interests • Cognitive and physical capacities • Participation in leisure activities remains relatively flat across age groups and over time with sedentary activity favored over more active

15. II. Evidence Supporting Importance of Senior Centers and Activity Engagement

16. Research on Senior Centers • Drs. Miltiades and Grove, Shippensburg University “Understanding the Impact of Senior Community Center Participation on Elders’ Health and Well-being • Funded by Commonwealth of PA – Department of Aging (undated report – possibly 2003) http://www.aging.state.pa.us/aging/lib/aging/SeniorCenterstudy.pdf

17. Paucity of Research on Senior Centers • Research focuses primarily on profiles of participants versus consequences of participation • Benefits of health programs in senior centers well established • Outcomes of other aspects of senior center participation have not been examined systematically • Limitations: • Cross-sectional (one point in time) • No control or comparison groups • Reliance on self-report versus objective assessments (e.g., physical and mental health indicators)

18. Time Line of Research on Senior Centers • 1970’s – focus on how centers maintained and created social ties • Voluntary organization model – assumes that older adults who are more active in the community will use senior centers more • 1980’s-1990s – focus on profiles of participants (versus benefits) • 1995+ - focus on senior center as unique in each community (e.g., participation patterns, profiles of participants) • 2000+ - Senior centers as research centers; evaluation of evidence-based programs; developing and testing supportive services

19. Important Questions about Senior Center Participation that need to be Answered in On-going Research • Comparison of senior center participants to non senior center users • What is the reach of senior centers? • Marketing and activity planning implications • On-going evaluation of risk profiles of senior center members • Systematic assessment of program outcomes for quality control and identification of program benefits • Development and testing of effectiveness of innovative programming

20. Importance of Activity

21. What the Research Shows • Cognitive Benefits: • Cognitive activities associated with lower risk of developing Mild Cognitive Impairment • Leisure activities associated with lower risk of dementia and reduced global cognitive decline • Affective Benefits: • Low leisure activity participation is associated with depression • Activity central to reducing depression: • Primary approach in cognitive behavioral interventions • Relationship of functional decline and depression mediated by activity engagement • Brain Health/Heart Health/Reduction in Risk of Diabetes, Falls etc • Physical activity shown to have health multiple benefits • Balance/muscle strengthening – critical to fall risk reduction programs • Regular walking found to increase reserve, improve overall well-being

22. Other Proven Benefits of Activity Engagement • Improves ability to process and integrate sensory information • Anticipate and react quickly and efficiently to changes in task demands • Enhances attention

23. Why Does Activity Engagement Have Positive Effects?What are the Potential Mechanisms • Enhances physiological reserve • Social connectedness • Reduces social isolation • Concept of “flow” – leads to happiness and well-being • Enables individual to reach personal goals • Novelty and ingenuity contributes to neurogenesis

24. Project ABLE • Community dwelling • 70+ years of age • 47% African American • One or more functional difficulties Gitlin et al., 2006; Gitlin et al., in press

25. Leisure Activity Participation (N = 127)

26. Leisure Activity Participation (N = 127)

27. Outcomes of Activity Participation • Mild cognitive impairment scores associated with lower leisure activity participation, greater difficulty using the telephone, and receiving help from others at baseline • Greater participation in activities associated with less cognitive impairment 12 months later • Number of activities more important than frequency of participation in any one activity • No differences by type of activity (cognitive versus social versus physical) Winter and Gitlin (manuscript in progress)

28. Effects of Tailoring Activities to Preserved Capabilities of Individuals with Dementia Gitlin et al., Amer. Journal of Geriatric Psychiatry, 2008

29. NIMH supported randomized trial (N=60); 8 OT home sessions Combined Allen’s diagnostic tools with neuropsychological testing and clinical interviewing to identify preserved capabilities Developed 3 activity choices and instructed family caregivers in using each activity: Communication Environmental set-up Task simplification Relaxing the rules Tailored Activity Program

33. Meaning of Activity In Touch: Mind Body and Spirit Collaborative Program of Research between Center in the Park and CARAH, Thomas Jefferson University Funded by National Institute of Mental Health (manuscript in progress)

34. Benefits of Activity Participation in Center in the Park Focus Groups/In-depth interviews: • Safe place to try new things • Safe place to reach out for help • Being involved with others is “elevating” • “Keeping busy” and engaging in activities as a critical coping mechanism • Structures daily life and gives it meaning

35. A Safe Place to Explore New Areas • Technology class: “I feel like I’m like forty years behind; some of us are more advanced, but the class is so comfortable that you never know what bracket anybody’s in as far as computer technology. .. That means a lot… I was afraid of the computers before….” (Male CIP member) • I know I won’t be a Picasso or anything, but I, you know, it’s something [to keep you busy].

36. Keeping Busy – Cognitively Challenged • “As being a senior… it’s helpful… to continue to use our minds...sitting around…doesn’t help… everybody has a pain…but just sitting and just moping… doesn’t help.” • I like the idea of looking forward to having something to do.

37. Protection against Isolation and Depression; Being Connected • One of our dancers…lost a mother…and she said, ‘I don’t feel like doing nothing,’ well I was so happy she came to class Tuesday…we had told her get out of that house as much as possible…cause when you’re there by yourself…this is when you get all these thoughts. • ….I was just elevated, just being in the room with these guys…remembering some of the events that took place and…they’ll rejuvenate my mind…and we can share similar problems and come up with solutions

38. Challenges of Growing Old: Activity as Antidote • …when I am in the house for two days, it’s like the walls come in on me and I’ll just go out for breakfast, and walk around, sometimes I go to a movie • …I’m a member here at Center in the Park, I’m a member… I just have to make myself get going more.”

39. III. Looking Forward

40. PROGRAM CHALLENGES FOR SENIOR CENTERS • Accommodating extreme diversity: • Cognitive abilities • Education level • Preferences/interests • Social psychological needs • Higher level of educated seniors and more physically active • A wider range of different needs: • Service • Health • Leisure activity • Cognitive stimulation • Socialization

41. Evidence-informed Programming • Activity as therapeutic • Offer a variety of activities • Encourage participation in novel experiences • One type of activity not better/worse than another • Act of engagement is more important than frequency • Older adults with a range of physical and cognitive abilities can participate in activities: • Environmental set-up and task simplification • Setting up activity to accommodate range of abilities

42. Make positive changes in my life Develop new skills Feel self-fulfilled Feel more healthy Reduce my stress Have more energy Have more fun I enjoyed this class Socialize and relate to others Feel more connected to my community Feel supported by my peers Connect with others in this class Think differently Assert my opinions Be more decisive Have more self-confidence Increase my self-awareness Evaluation: Going Beyond SatisfactionTo What extent did this class/activity help you: In Touch Evaluation used at CIP

43. Membership Surveys to Assess Need and Risk • Interest inventories • Depression and anxiety screening • Fear of falling and fall risk • Social isolation • Memory • Personal Concerns

44. Conclusion • Activity participation is essential to quality of life • Activity has important life benefits: • Reduces risk of depression • Reduces global cognitive decline • Enhances social connectedness • The role of senior centers will continue to expand and have an increasing impact on structuring the quality of life of older adults • Need for more systematic evaluation of programs, members and partnering with researchers to evaluate program effectiveness

45. Key References • Federal Interagency Forum on Aging-Related Statistics. Older Americans 2008: Key indicators of well-being. Available at: http://www.agingstats.gov/chartbook2000/OlderAmericans2000.pdf • Winter, L., and Gitlin, L.N. (manuscript in preparation). Activity and Physical Function as Predictors of Mild Cognitive Impairment: A Closer Look. 3. Gitlin, L. N., Winter, L., Dennis, M. P. & Hauck, W. (in press). Who benefits more from a home intervention to reduce functional difficulties? Moderator effects by gender, race, age, and education. Journal of Gerontology: Medical Sciences. • Gitlin, L. N., Winter, L., Dennis, M., Corcoran, M., Schinfeld, S. & Hauck, W. (2006). A randomized trial of a multi-component home intervention to reduce functional difficulties in older adults. The Journal of the American Geriatrics Society, 54, 809-816. • Gitlin, L. N., Winter, L., Burke, J., Chernett, N., Dennis, M. & Hauck, W. W. (2008). Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: A randomized pilot study. American Journal of Geriatric Psychiatry. 16, 229-239

46. References cont. 6. Ghisletta et la., 2006. Does Activity engagement protect against cognitive decline in old age? Methodological and analytical considerations. J. of Gerontology: Psychological Sciences, 61B P253-261. 7. Verghese et al., 2006. Leisure activities and the risk of amnestic mild cognitive impairment in the elderly. Neurology, 66, 821-827. 8. Bielak, et al., 2007. It’s never too late to engage in lifestyle activities: Significant concurrent but not change relationships between lifestyle activities and cognitive speed. J. of Gerontology: Psychological Sciences, 62B, P331-P339.