Center for Excellence in Assisted Living CEAL@UNC

Advancing the well-being of the people who live and work in assisted living through research, practice, and policy.

Social

Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living

May 1, 2024
Importance Resident-to-resident aggression in assisted living facilities can result in physical and psychological harm, but its prevalence is unknown. Objective To estimate the prevalence of resident-to-resident aggression, including physical, verbal, and sexual, among residents in assisted living facilities. Design, Setting, and Participants This study used cross-sectional, observational data from a clinical trial, in which residents […]

Estimated Prevalence of Resident-to-Resident Aggression in Assisted Living

by Lea Efird-Green

Importance Resident-to-resident aggression in assisted living facilities can result in physical and psychological harm, but its prevalence is unknown. Objective To estimate the prevalence of resident-to-resident aggression, including physical, verbal, and sexual, among residents in assisted living facilities. Design, Setting, and Participants This study used cross-sectional, observational data from a clinical trial, in which residents […]

From 65 to 103, Older Adults Experience Virtual Reality Differently Depending on Their Age: Evidence from a Large-Scale Field Study in Nursing Homes and Assisted Living Facilities

Dec 1, 2023
There is growing interest in applications of virtual reality (VR) to improve the lives of older adults, but the limited research on older adults and VR largely treats older adults as a monolith, ignoring the substantial differences across 65 to 100+ year olds that may affect their experience of VR. There are also few existing […]

From 65 to 103, Older Adults Experience Virtual Reality Differently Depending on Their Age: Evidence from a Large-Scale Field Study in Nursing Homes and Assisted Living Facilities

by Lea Efird-Green

There is growing interest in applications of virtual reality (VR) to improve the lives of older adults, but the limited research on older adults and VR largely treats older adults as a monolith, ignoring the substantial differences across 65 to 100+ year olds that may affect their experience of VR. There are also few existing […]

Social Support, Social Participation, and Life Accomplishment of Older Adult Residents of Assisted Living Facilities and Their Adjoining Communities

Dec 1, 2023
Objectives: To assess and compare levels of social support (SS), social participation (SP) and life accomplishment (LA) among older adults in some assisted-living facilities (ALFs) and their community-dwelling (CD) peers. Methods: One hundred twenty older adults (54 ALF, 66 CD) from a Nigerian population participated in this cross-sectional survey. The Multidimensional Scale for Perceived Social […]

Social Support, Social Participation, and Life Accomplishment of Older Adult Residents of Assisted Living Facilities and Their Adjoining Communities

by Lea Efird-Green

Objectives: To assess and compare levels of social support (SS), social participation (SP) and life accomplishment (LA) among older adults in some assisted-living facilities (ALFs) and their community-dwelling (CD) peers. Methods: One hundred twenty older adults (54 ALF, 66 CD) from a Nigerian population participated in this cross-sectional survey. The Multidimensional Scale for Perceived Social […]

Social Connectedness Resource Preferences of Older Adults in Assisted Living: A Scoping Review Based on the WHO-ICF Framework

Sep 1, 2023
The current scoping review identified emerging evidence on social connectedness resource preferences of older adults in assisted living facilities (ALFs) and the community. A literature search was performed using several databases. We included review articles published between January 2000 and September 2022 in English and related to social connectedness resources in ALFs and the community. […]

Social Connectedness Resource Preferences of Older Adults in Assisted Living: A Scoping Review Based on the WHO-ICF Framework

by Lea Efird-Green

The current scoping review identified emerging evidence on social connectedness resource preferences of older adults in assisted living facilities (ALFs) and the community. A literature search was performed using several databases. We included review articles published between January 2000 and September 2022 in English and related to social connectedness resources in ALFs and the community. […]

Experiences of Social Frailty Among Rural Community-Dwelling and Assisted-Living Older Adults: A Qualitative Study

Apr 1, 2023
WHAT THIS MEANS FOR YOU: Interviews were conducted with 38 older adults in rural villages and AL communities in the Netherlands to compare the effect of social frailty, measured by access to social resources and activities that fulfill social needs. Social frailty is the actual or potential loss of social resources and activities over time, leading to loneliness and isolation. Older adults who live independently in their own communities experienced self-reported loneliness, while those living in AL communities reported higher participation in social activities. Therefore, for some older adults, a residential setting may be preferable to aging in place to address loneliness and social frailty.

Experiences of Social Frailty Among Rural Community-Dwelling and Assisted-Living Older Adults: A Qualitative Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Interviews were conducted with 38 older adults in rural villages and AL communities in the Netherlands to compare the effect of social frailty, measured by access to social resources and activities that fulfill social needs. Social frailty is the actual or potential loss of social resources and activities over time, leading to loneliness and isolation. Older adults who live independently in their own communities experienced self-reported loneliness, while those living in AL communities reported higher participation in social activities. Therefore, for some older adults, a residential setting may be preferable to aging in place to address loneliness and social frailty.

A Home, an Institution and a Community – Frames of Social Relationships and Interaction in Assisted Living

Aug 1, 2022
Assisted living facilities are presented as the older person’s home but, at the same time, defined by institutional and communal characteristics. Using Goffman’s (1974/1986) concept of frame, we aim to find out how home, institution and community frames define social roles and shape social relationships and interaction in assisted living facilities. Directed content analysis was […]

A Home, an Institution and a Community – Frames of Social Relationships and Interaction in Assisted Living

by Lea Efird-Green

Assisted living facilities are presented as the older person’s home but, at the same time, defined by institutional and communal characteristics. Using Goffman’s (1974/1986) concept of frame, we aim to find out how home, institution and community frames define social roles and shape social relationships and interaction in assisted living facilities. Directed content analysis was […]

Interactions, Relationships and Belonging: Comparing Social Connectedness and Perceived Isolation among Older Women Living Alone in Private Homes and in Assisted Living

Jul 1, 2022
Age-related changes shape social connectedness, isolation and loneliness among older adults. Ageing often accompanies decisions about ageing in place or moving (i.e. senior living facility). Scant research compares these two living arrangements and even sparser research focuses on older women. This study, thus, poses the following questions: How do older women (aged 75+ years) experience […]

Interactions, Relationships and Belonging: Comparing Social Connectedness and Perceived Isolation among Older Women Living Alone in Private Homes and in Assisted Living

by Lea Efird-Green

Age-related changes shape social connectedness, isolation and loneliness among older adults. Ageing often accompanies decisions about ageing in place or moving (i.e. senior living facility). Scant research compares these two living arrangements and even sparser research focuses on older women. This study, thus, poses the following questions: How do older women (aged 75+ years) experience […]

Ethics of Health Information Sharing and Social Relationships at End of Life in Assisted Living

Apr 1, 2022
Given an observed tension between perceived privacy restrictions and meaningful social connection in assisted living (AL) and using a relational perspective, we conducted a secondary thematic analysis of health information sharing practices among residents and their care partners in one large urban AL community in metropolitan Atlanta. Data included in-depth interviews with residents (n = […]

Ethics of Health Information Sharing and Social Relationships at End of Life in Assisted Living

by Lea Efird-Green

Given an observed tension between perceived privacy restrictions and meaningful social connection in assisted living (AL) and using a relational perspective, we conducted a secondary thematic analysis of health information sharing practices among residents and their care partners in one large urban AL community in metropolitan Atlanta. Data included in-depth interviews with residents (n = […]

Exploring the Effectiveness of Virtual Compassionate Presence Sessions in Reducing Loneliness and Isolation among Assisted-Living Older Adults: A Pilot Study

Mar 1, 2022
WHAT THIS MEANS FOR YOU: A pilot study investigated the effectiveness of virtual compassionate presence (CP) sessions in reducing loneliness and isolation among older adults in AL when facilitated by college students trained in CP. CP involves deep, attentive, and nonjudgmental listening while being fully present. Eighteen older adults participated in CP sessions over 10 weeks and were interviewed 2 months after the last session. Semi-structured interview results revealed a self-reported decrease in participants’ feelings of isolation and loneliness and an increase in overall mood.

Exploring the Effectiveness of Virtual Compassionate Presence Sessions in Reducing Loneliness and Isolation among Assisted-Living Older Adults: A Pilot Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A pilot study investigated the effectiveness of virtual compassionate presence (CP) sessions in reducing loneliness and isolation among older adults in AL when facilitated by college students trained in CP. CP involves deep, attentive, and nonjudgmental listening while being fully present. Eighteen older adults participated in CP sessions over 10 weeks and were interviewed 2 months after the last session. Semi-structured interview results revealed a self-reported decrease in participants’ feelings of isolation and loneliness and an increase in overall mood.

“You Lose Some Good Friends”: Death and Grief in Assisted Living

Mar 1, 2022
The purpose of this study was to investigate responses to death at multiple levels within the assisted living (AL) system and to characterize the psychosocial impact of death on surviving residents. This study used secondary thematic analysis of multiple data sources collected as part of a larger quantitative-focused study with 21 ALs. Data sources included: […]

“You Lose Some Good Friends”: Death and Grief in Assisted Living

by Lea Efird-Green

The purpose of this study was to investigate responses to death at multiple levels within the assisted living (AL) system and to characterize the psychosocial impact of death on surviving residents. This study used secondary thematic analysis of multiple data sources collected as part of a larger quantitative-focused study with 21 ALs. Data sources included: […]

Assisted Living Residents With Dementia: Being Out in the World and Negotiating Connections

Mar 1, 2022
WHAT THIS MEANS FOR YOU: This year-long study observed 33 individuals and their caregivers in 4 assisted living communities, focusing on the significance of outdoor and offsite activities for persons living with dementia. Data included 1,560 observation hours, 114 interviews with residents, staff, family, and visitors, and resident record reviews. Qualitative findings suggested that engaging with others and with nature is important for better quality of life. Most residents were able to at least occasionally go out, and those who went outdoors generally had positive experiences, but not all experiences were positive.

Assisted Living Residents With Dementia: Being Out in the World and Negotiating Connections

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This year-long study observed 33 individuals and their caregivers in 4 assisted living communities, focusing on the significance of outdoor and offsite activities for persons living with dementia. Data included 1,560 observation hours, 114 interviews with residents, staff, family, and visitors, and resident record reviews. Qualitative findings suggested that engaging with others and with nature is important for better quality of life. Most residents were able to at least occasionally go out, and those who went outdoors generally had positive experiences, but not all experiences were positive.

Social Networks in Retirement and Assisted Living Communities: A Literature Review

Jan 1, 2022
WHAT THIS MEANS FOR YOU: A systematic review showed that from 2015 to 2020, older adults in AL or retirement communities who had stronger social connections experienced improved health, and that over-reliance on only family for social interactions was associated with loneliness. Related recommendations to reduce loneliness include fostering diverse social networks and overcoming barriers like the inability to select roommates, lack of phone access, and potentially isolating community layouts.

Social Networks in Retirement and Assisted Living Communities: A Literature Review

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A systematic review showed that from 2015 to 2020, older adults in AL or retirement communities who had stronger social connections experienced improved health, and that over-reliance on only family for social interactions was associated with loneliness. Related recommendations to reduce loneliness include fostering diverse social networks and overcoming barriers like the inability to select roommates, lack of phone access, and potentially isolating community layouts.