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

“What Does ‘Age-Friendly’ Mean to You?”: The Role of Microaggressions in a Retirement and Assisted Living Community

Dec 1, 2024
Background and Objectives: In conversations about expanding age-friendly ecosystems, the concept of “age-friendliness” has not been explored in relation to residential settings. Research Design and Methods: This multiple-case study compared four residents’ perspectives on the age-friendliness of a retirement and assisted living community, combining individual semi-structured interviews with observational data and organizational document analyses in […]

“What Does ‘Age-Friendly’ Mean to You?”: The Role of Microaggressions in a Retirement and Assisted Living Community

by Lea Efird-Green

Background and Objectives: In conversations about expanding age-friendly ecosystems, the concept of “age-friendliness” has not been explored in relation to residential settings. Research Design and Methods: This multiple-case study compared four residents’ perspectives on the age-friendliness of a retirement and assisted living community, combining individual semi-structured interviews with observational data and organizational document analyses in […]

Examining Engagement Calendar Deviations in Assisted Living: A Focus on Residents With Dementia

Dec 1, 2024
Early in our longitudinal qualitative study on meaningful engagement and quality of life among assisted living (AL) residents with dementia, researchers observed differences between the activities scheduled on monthly engagement calendars and those taking place. Yet, we were unable to identify any research examining such deviations or their implications. Thus, drawing on data from three […]

Examining Engagement Calendar Deviations in Assisted Living: A Focus on Residents With Dementia

by Lea Efird-Green

Early in our longitudinal qualitative study on meaningful engagement and quality of life among assisted living (AL) residents with dementia, researchers observed differences between the activities scheduled on monthly engagement calendars and those taking place. Yet, we were unable to identify any research examining such deviations or their implications. Thus, drawing on data from three […]

The Relationship between Perceived Engagement in Meaningful Activity and Behavioral and Psychological Symptoms of Dementia among Assisted Living Residents

Nov 1, 2024
The purpose of this study is to assess the relationship between engagement in meaningful activities and behavioral and psychological symptoms of dementia (BPSD), including agitation, apathy, irritability, and depression among 71 assisted living (AL) residents with moderate to severe dementia. This secondary analysis used baseline data from a randomized controlled trial, Meaningful Activity for Managing […]

The Relationship between Perceived Engagement in Meaningful Activity and Behavioral and Psychological Symptoms of Dementia among Assisted Living Residents

by Lea Efird-Green

The purpose of this study is to assess the relationship between engagement in meaningful activities and behavioral and psychological symptoms of dementia (BPSD), including agitation, apathy, irritability, and depression among 71 assisted living (AL) residents with moderate to severe dementia. This secondary analysis used baseline data from a randomized controlled trial, Meaningful Activity for Managing […]

Participants’ Baseline Characteristics and Feedback of the Nature-Based Social Intervention “Friends in Nature” among Lonely Older Adults in Assisted Living Facilities in Finland: A Randomised Controlled Trial of the RECETAS EU-Project

Oct 1, 2024
Background Loneliness is common among older adults in institutional settings. It leads to adverse effects on health and wellbeing, for which nature contact with peers in turn may have positive impact. However, the effects of nature engagement among older adults have not been studied in randomised controlled trials (RCT). The “Friends in Nature” (FIN) group […]

Participants’ Baseline Characteristics and Feedback of the Nature-Based Social Intervention “Friends in Nature” among Lonely Older Adults in Assisted Living Facilities in Finland: A Randomised Controlled Trial of the RECETAS EU-Project

by Lea Efird-Green

Background Loneliness is common among older adults in institutional settings. It leads to adverse effects on health and wellbeing, for which nature contact with peers in turn may have positive impact. However, the effects of nature engagement among older adults have not been studied in randomised controlled trials (RCT). The “Friends in Nature” (FIN) group […]

Aging in Isolation: Sexual Orientation Differences in Navigating Cognitive Decline

Sep 1, 2024
Introduction: Subjective cognitive decline is a self-reported measure of worsening memory and day-to-day decision making. Cognitive decline may impair an individual’s ability to complete instrumental activities of daily living (IADL) such as preparing meals or taking medication, ultimately limiting one’s ability to live independently. People with IADL impairments typically rely on informal care from spouses […]

Aging in Isolation: Sexual Orientation Differences in Navigating Cognitive Decline

by Lea Efird-Green

Introduction: Subjective cognitive decline is a self-reported measure of worsening memory and day-to-day decision making. Cognitive decline may impair an individual’s ability to complete instrumental activities of daily living (IADL) such as preparing meals or taking medication, ultimately limiting one’s ability to live independently. People with IADL impairments typically rely on informal care from spouses […]

Well-Being Outcomes from the Delivery of RASCALs, a Group Activity Intervention Using Nature-Focused Livestream Broadcasts

Aug 1, 2024
Group activities and connection with nature are associated with improved well-being for older adults. This quasi-experiment tests the effectiveness of RASCALs, an innovative program of group activities using nature-focused livestream broadcasts. Assisted living residents in the experimental group (n = 16) lived in buildings that received RASCALs programming twice a week for 3 months. Compared to residents in […]

Well-Being Outcomes from the Delivery of RASCALs, a Group Activity Intervention Using Nature-Focused Livestream Broadcasts

by Lea Efird-Green

Group activities and connection with nature are associated with improved well-being for older adults. This quasi-experiment tests the effectiveness of RASCALs, an innovative program of group activities using nature-focused livestream broadcasts. Assisted living residents in the experimental group (n = 16) lived in buildings that received RASCALs programming twice a week for 3 months. Compared to residents in […]

Family Involvement among Oregon Adult Foster Home Residents, 2018-2023

Aug 1, 2024
Objectives: To track the changes that occurred in family involvement among Oregon Adult Foster Home (AFH) residents following the COVID-19 pandemic and to examine the associations between home and resident characteristics and family involvement. Design: Retrospective analysis of repeated cross-sectional data. Setting and Participants: A total of 2027 responses from AFH providers that replied to […]

Family Involvement among Oregon Adult Foster Home Residents, 2018-2023

by Lea Efird-Green

Objectives: To track the changes that occurred in family involvement among Oregon Adult Foster Home (AFH) residents following the COVID-19 pandemic and to examine the associations between home and resident characteristics and family involvement. Design: Retrospective analysis of repeated cross-sectional data. Setting and Participants: A total of 2027 responses from AFH providers that replied to […]

A Qualitative Study of a Sporting Memories Program in South Australia: Belonging, Participation, and Social Connection

Jul 1, 2024
Background Older people can experience health and social challenges such as loneliness, depression, and lack of social connectedness. There is need for programs and approaches that address the growing incidence of social isolation and loneliness for older people. One initiative that aims to address these challenges is the Sporting Memories program. This program was developed […]

A Qualitative Study of a Sporting Memories Program in South Australia: Belonging, Participation, and Social Connection

by Lea Efird-Green

Background Older people can experience health and social challenges such as loneliness, depression, and lack of social connectedness. There is need for programs and approaches that address the growing incidence of social isolation and loneliness for older people. One initiative that aims to address these challenges is the Sporting Memories program. This program was developed […]

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
WHAT THIS MEANS FOR YOU: Two related studies examined the experiences of 245 assisted living and nursing homes residents across 10 US states who used virtual reality (VR), as well as 39 caregiving staff who facilitated the VR experiences. Older residents enjoyed VR less, a result that was less strong when asked about other technologies such as phones and voice assistants. Staff who facilitated the experiences saw VR as generally enjoyable compared to other work activities and felt it improved their relationships with 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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Two related studies examined the experiences of 245 assisted living and nursing homes residents across 10 US states who used virtual reality (VR), as well as 39 caregiving staff who facilitated the VR experiences. Older residents enjoyed VR less, a result that was less strong when asked about other technologies such as phones and voice assistants. Staff who facilitated the experiences saw VR as generally enjoyable compared to other work activities and felt it improved their relationships with residents.

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

Dec 1, 2023
WHAT THIS MEANS FOR YOU: A study of 54 assisted living residents and 66 community-dwelling older adults in Nigeria found assisted living residents had more limited social participation compared to those in the community; however, both groups perceived a similar amount of social support. Assisted living residents also felt that they had lower life accomplishment than community-dwelling participants. Promoting social participation, especially in assisted living, might improve both social wellbeing and self-perception.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A study of 54 assisted living residents and 66 community-dwelling older adults in Nigeria found assisted living residents had more limited social participation compared to those in the community; however, both groups perceived a similar amount of social support. Assisted living residents also felt that they had lower life accomplishment than community-dwelling participants. Promoting social participation, especially in assisted living, might improve both social wellbeing and self-perception.

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

Sep 1, 2023
WHAT THIS MEANS FOR YOU: A literature review examined the social activities preferred by assisted living residents, finding that residents preferred social activities organized by the community, such as games and outings. They also preferred civic life activities (e.g., volunteering) to connect with the broader community. Older residents and those living in larger communities tended to prefer activities provided by the community, while younger residents preferred more demanding physical activities.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A literature review examined the social activities preferred by assisted living residents, finding that residents preferred social activities organized by the community, such as games and outings. They also preferred civic life activities (e.g., volunteering) to connect with the broader community. Older residents and those living in larger communities tended to prefer activities provided by the community, while younger residents preferred more demanding physical activities.

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
WHAT THIS MEANS FOR YOU: Through qualitative observations of an AL community and interviews with ten residents, those who perceived the assisted living community as a home reported more meaningful, informal relationships. When the community was perceived as an institution, residents reported impersonal, formal interactions.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Through qualitative observations of an AL community and interviews with ten residents, those who perceived the assisted living community as a home reported more meaningful, informal relationships. When the community was perceived as an institution, residents reported impersonal, formal interactions.

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
WHAT THIS MEANS FOR YOU: This qualitative study of social connections among 16 women aged 75 and older found that those living in the community focus on feeling connected to the world at large, while those in assisted living have more casual interactions and feel like they are a part of the community. Most women in both groups did not experience perceived isolation; they had adjusted their expectations about socializing to fit their living situation.

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

WHAT THIS MEANS FOR YOU: This qualitative study of social connections among 16 women aged 75 and older found that those living in the community focus on feeling connected to the world at large, while those in assisted living have more casual interactions and feel like they are a part of the community. Most women in both groups did not experience perceived isolation; they had adjusted their expectations about socializing to fit their living situation.

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

Apr 1, 2022
WHAT THIS MEANS FOR YOU: This qualitative study of observation and 61 interviews with assisted living residents, family members, staff, and external care workers in one large community in Atlanta, found that while sharing health information could strengthen social bonds among residents, there were concerns about privacy; for example, when inappropriate public exchanges occurred, they hindered social relationship building. Barriers to communicating health information contributed to resident isolation, but negotiating privacy boundaries to share such information may promote resident wellbeing.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This qualitative study of observation and 61 interviews with assisted living residents, family members, staff, and external care workers in one large community in Atlanta, found that while sharing health information could strengthen social bonds among residents, there were concerns about privacy; for example, when inappropriate public exchanges occurred, they hindered social relationship building. Barriers to communicating health information contributed to resident isolation, but negotiating privacy boundaries to share such information may promote resident wellbeing.

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.

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

Mar 1, 2022
WHAT THIS MEANS FOR YOU: In a qualitative study including interviews with 18 residents in 21 assisted living communities, as well as reviews of community documents and observational field notes, residents reported that staff communication and community-level memorials following residents’ death were not consistent with a “family-like” atmosphere, and residents’ grief took many forms.

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

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In a qualitative study including interviews with 18 residents in 21 assisted living communities, as well as reviews of community documents and observational field notes, residents reported that staff communication and community-level memorials following residents’ death were not consistent with a “family-like” atmosphere, and residents’ grief took many forms.

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.

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.