Weather, Built Environment, or Personal Factors: Predictors of Walking by Independent Living Residents With Frailty

Environmental factors influence older adult physical activity. However, the evidence about which factors lead to increased physical activity is mixed and few have studied how these factors affect those with frailty or living in retirement communities. This study investigated how environmental and weather factors influence physical activity among pre-frail and frail older adults residing in independent living retirement communities. We used ActivPal accelerometers to measure 7-day step counts among (n=108) pre-frail and frail residents in 9 independent living residences in metropolitan Chicago. We conducted environmental audits using the MAPS Abbreviated tool and collected National Weather Service Station data (temperature, precipitation, and daylight minutes) during the ActivPal periods. Participants were on average 80.0 years, 74% female, and average daily step count was 3,450 (range 151 - 11,663). Four buildings were in suburban areas and 5 in urban areas and four were private-pay residences while 5 offered subsidized rent. ANOVA results showed private-pay buildings had higher total MAPS scores than subsidized buildings (p=0.001), and urban buildings had higher total MAPS scores than suburban buildings (p < 0.000). Mean step differences were non-significant between different building types: (mean steps = 3,317 private-pay, 3,629 subsidized, 3,536 urban, 3,350 suburban). Pearson product-moment correlations showed a positive association between steps and MAPS positive streetscape features (p=0.011). Multiple regression analysis showed higher temperature days, precipitation, and more minutes of daylight were associated with higher step counts (p=.04). Given the dramatic variation in individual step counts, future research should investigate personal factors that contribute to activity among independent living residents.

Enhancing Collaborations between our Age-Friendly Community and University Initiatives

Community involvement and synergistic partnerships are key to fostering a holistic approach to programming and outreach that assess and meet the needs of the older adults in our communities. The University of Illinois Urbana-Champaign has created an Age-Friendly network to facilitate these partnerships featuring our designation of Age-Friendly City and Age-Friendly University as well as partnerships with our state and local governments, community aging services providers, and continuing care retirement communities. Through these partnerships, we have identified the landscape of the community, assessed the unique needs older adults, and identified novel solutions. We will discuss our plans for activities that will empower older adults in our community and at our university by promotion connection, collaboration, and inclusion.

Moves to age-restricted housing and functional health trajectories among independent living older adults

Where independent living older adults live has been found to have strong links with disability. For example, older adults living in age-restricted housing contexts (e.g., retirement communities) have been found to have worse functional health compared to those living in non-age-restricted settings. Theories and empirical research demonstrate positive and negative aspects of living in age-restricted housing. Recent availability of population-level longitudinal data with sufficiently large samples has made examination of this heterogeneity possible. In this study we examine whether a move to age-restricted housing is associated with functional health trajectories and whether age at time of move moderates this link. We examine these questions using nine waves of longitudinal data from a representative sample of 8,687 U.S. adults age 65 and older from the National Health and Aging Trends Study. Spline-like growth curve models were estimated to determine the intercept, slope prior to move to age-restricted housing, and slope after the move. We also tested whether these processes are conditional on age at time of move. Results indicate that regardless of age all respondents experienced a decline in functional health following a move to age-restricted housing. However, there is variation in the steepness of this decline by age at time of the move. People who move to age-restricted housing earlier experience a less steep decline in functional health post-move compared to those who move later. Findings suggest moving to age-restricted housing earlier may enable older adults to utilize resources often available in these settings to prevent steep health declines.

Malnutrition-Sarcopenia Syndrome and its Associated Factors Among Older Adults

Malnutrition and sarcopenia are present in parallel in older adults and characterized by a combination of inadequate nutrient intake and decreased muscle mass, strength, and/or function. The presence of both conditions has been termed Malnutrition-Sarcopenia Syndrome (MSS) and is associated with negative health outcomes. The objective of this correlational study was to identify the prevalence and factors associated with the malnutrition-sarcopenia syndrome among older adults living in continuing care retirement communities. A convenience sample of 104 older adults living in CCRCs participated in this study. Muscle mass, strength, and function were measured using bioimpedance analysis, Jamar digital hand dynamometer, and the Short Physical Performance Battery test, respectively. Physical activity, sedentary time, and nutritional status were measured using ActiGraph GT3X and Mini Nutritional Assessment, respectively. Questionnaires were used to measure self-efficacy for exercise and goal congruence for physical activity and protein intake. Of the 104 participants, 37 (35.2%) had sarcopenia, 19 (18.1%) had malnutrition, and 14 (13.5 %) had MSS. Compared with those without MSS, older adults with MSS were more than two times more likely to have a sedentary lifestyle (Odd ratio, 2.028; 95% confidence interval, 2.012–2.044). Findings showed that sarcopenia, malnutrition, and MSS are prevalent in older adults living in continuing care retirement communities. Older adults should be screened and assessed for both malnutrition and sarcopenia. The results also suggest that decreasing the sedentary time could help in preventing MSS among older adults living in continuing care retirement communities.

Intergenerational Programming During the Pandemic: Transformation During (Constantly) Changing Times

Implementing intergenerational programming amidst the COVID-19 pandemic has required creativity, partnership, and dedication to the work. Most intergenerational programs involving in-person meetings or events are accompanied by guidelines to protect participant health and safety. Programming is routinely cancelled or postponed due to poor weather or contagious illness, particularly when a vulnerable population is involved. The needs for safety precautions and continued intergenerational contact were both amplified during the pandemic, leading many to modify or innovate ways to engage generations rather than eliminate contact for extended periods. Technology has afforded new approaches to engage young people and older people with each other; non-technological ways have also proven effective. This symposium will address strategies used to implement intergenerational programs during the pandemic. Authors will highlight lessons learned and strategies they expect to retain in the future. The first paper describes a pivot in nutrition programming designed for a shared site with preschool children and frail older adults. In paper two, authors discuss their partnership-based approach shifting to remote offerings of Cyber-Seniors programming. Paper three addresses how MentorUp Service-Learning expanded its reach by adaptations to virtual programming for older adults in retirement communities. The final paper presents evaluation data comparing arts programming delivered in-person pre-pandemic and again virtually during the pandemic. In each case, researchers and community partners learned techniques to maintain their programmatic foci. Some projects developed strategies they plan to maintain post-pandemic. Donna Butts, Executive Director of Generations United serves as the symposium discussant.

‘They’re Going to Die at Some Point, but We’re all Going to Die’ – A Qualitative Exploration of Bereavement in Later Life

This article reports on a qualitative study to investigate what bereavement means to older people. Drawing upon 80 in-depth interviews collected from eight British and Australian retirement communities, our study revealed that facing bereavement while ageing includes experiences of losing both others and the wholeness of the self. Core themes identified how the experience of losing others can be compounded by ageing-related challenges, undermining older people’s defence from bereavement and frustrating their fundamental meaning and being. The older people’s dynamic responses were also captured, highlighting the importance of supporting their agency to deal with the deeper pain of loss. By extending the concept of bereavement in later life, we also called for a more grief literate culture to mitigate the multifaceted and often deeper distresses of bereavement that older people may face alongside ageing.

Naturally Occurring Retirement Communities: A Scoping Review (Preprint)

BACKGROUND As Canada’s population ages there is a need to explore community-based solutions to support older adults. Naturally Occurring Retirement Communities (NORCs), defined by Hunt and Gunter-Hunt in 1986 as buildings or areas not specifically designed for, but which attracts, older adults and associated supportive service programming (NORC-SSP) have been described as potential resources to support aging-in-place. However, while the body of literature on NORCs has been growing since the 1980s, no synthesis of this work has been done to date. OBJECTIVE The goal of this scoping review was to highlight the current state of NORC literature to inform future research and to offer a summarized description of NORCs and how they have and can support older adults to age-in-place. METHODS Using a published framework, a scoping review was conducted searching twelve databases (CINAHL, Ovid Medline, HealthSTAR, Embase, APA PsycInfo, AMED, Johanna Briggs Institute, REHABDATA, Sociofile, Education Source, ERIC, Urban Planning, and the Cochrane Library) from earliest date of coverage to July 2020. We included English peer and non-peer reviewed scholarly journal publications that described, critiqued, reflected on, or researched NORCs. Aging-in-place literature with little to no mention of NORCs were excluded, as were articles that recruited from NORCs but did not connect findings to the setting. A qualitative content analysis of the literature was conducted, guided by Greenfield et al.’s 2012 conceptual framework to examine the promise of NORC programs to promote aging-in-place. RESULTS From 762 publications, we included 61 articles. All publications were North American and most used a descriptive approach (49/61; 80.3%). Just over half provided a specific definition of a NORC (32/61; 52.5%); of those, almost half (14/32; 43.8%) used Hunt and Gunter-Hunt’s 1986 definition; yet there were discrepancies in the defined proportions of older adults that constitutes a NORC (e.g. 40%, 50%). Six articles (6/61; 9.8%) described processes for identifying NORCs. Thirty-seven articles (37/61; 60.7%) specifically described Articles about NORC SSPs, described both external partnerships with organizations for service delivery (30/61; 49.2%), and internal resources, including staff (19/61; 31.1%), volunteers (13/61; 21.3%), or neighbours (5/61; 8.2%). Identified key components of a NORC-SSP included activities fostering social relationships (24/61;39.3%) and access to resources and services (24/61;39.3%). Sustainability and funding of NORC-SSPs was described (25/61; 40.9%), particularly as challenges to success. Initial outcomes, including self-efficacy (6/61; 9.8%) and increased access to social and health supports (14/61; 22.9%) were cited; however, long-term outcomes were lacking. CONCLUSIONS This review synthesizes the NORC literature to date and demonstrates that NORCs with programming (NORC-SSPs) have potential as an alternative model of supporting aging-in-place. Longitudinal research exploring the impacts of both NORCs and NORC-SSPs on older adult health and well-being is recommended. Future research should also explore ways to improve the sustainability of NORC-SSPs.

The Relationship of Vaccine Uptake and COVID-19 Infections among Nursing Home Staff and Residents in Missouri

Introduction Older adults living in communal spaces, such as nursing or retirement communities are at greater risk of infection due to close proximity to others, advanced aging-related or medical conditions, and engagement with staff that support multiple clients and facilities. Mobility between residents and facilities may result in staff acting as vectors of COVID-19 infection in these spaces. Vaccine uptake has been shown to markedly reduce the spread of COVID-19, yet there is little data on vaccine uptake and the continued COVID-19 risk among residents. Methods Data for this study were extracted from two publicly available. First, Centers for Medicaid and Medicare Services (CMS) public data included characteristics of nursing homes, weekly reported observations of residential COVID-19 cases, and COVID-19 vaccine coverage of staff and residents. Second, the average weekly COVID-19 infection rates from the Missouri Department of Health and Senior Services (MDHSS) were extracted and aggregated. A zero-inflated Poisson (ZIP) regression model was constructed to predict (1) if COVID-19 infections were reported, and if so, (2) the number of cases reported using a priori variables as predictors. ZIP regression was used due to the count nature of the outcome and due to the pre-determined overdispersion of observations when zero COVID-19 cases were reported during the study period. Results A total of 504 nursing homes were included in the study and 1124 COVID-19 infections were reported during the study period. As the percent of vaccinated staff increased, the risk of COVID-19 infections among residents significantly decreased. Percent of residents vaccinated was not significantly associated with whether COVID-19 cases were reported, nor the number of cases reported. Other factors, such as county COVID-19 rate and CMS staff rating, were significantly associated with COVID-19 cases in nursing homes. Discussion This study identified that nursing home staff, likely due to greater mobility, are important to prioritize in vaccination efforts to protect themselves and residents of their facilities from COVID-19 infections. Further, the CMS staff ratings were significant predictors of infection as well, which highlight the structural challenges that exist within and outside the context of a highly infectious and deadly pandemic. These results also provide insights to optimizing vaccination roll-out to best protect vulnerable community residents

Sustainable Urban Development for Older Australians: Understanding the Formation of Naturally Occurring Retirement Communities in the Greater Brisbane Region

As most older Australians prefer to age-in-place, providing sustainable and age-friendly communities poses a significant challenge to urban policymakers. The naturally occurring retirement communities (NORCs) have organically emerged as a collaborative model of care to support older adults to age-in-place, but neither academic research nor government policies recognise this housing option for older Australians. This paper aims to analyse the distributions and temporal patterns of NORCs in the Greater Brisbane Region, Australia, to understand the formation and development of NORCs. The geovisualisation method was employed to identify the distribution changes of NORCs between 2006 and 2016. The Global Moran’s I and Local Moran’s I measures were utilised to analyse the spatial correlation and the clusters of NORCs. The results show that NORCs increased significantly from 2006 to 2016, and their distribution was mainly clustered or co-located along the coastline and Brisbane River areas. The evolvement of NORCs reflected the change of aggregation pattern of older population between 2006 and 2016. Understanding the distribution trend of NORCs informs government policy and decisions in addressing issues of service delivery and community cooperation, and eventually leads to sustainable urban development and successful ageing in place for older Australians.

A gradual separation from the world: a qualitative exploration of existential loneliness in old age

This study sought to explore qualitatively experiences of existential loneliness (EL) in 80 older people living in retirement communities across the United Kingdom and Australia. Qualitative semi-structured interviews permitted in-depth exploration of issues such as biographical narrative, close relationships, loss, feelings of loneliness and retirement living. It was our intention to conduct a large-scale, deep-listening exercise that would provide further clues about EL in older people and the circumstances that give rise to such feelings. Data provided rich insight into older people's inner lives. Core themes identified loss of close attachments, lack of physical touch and intimacy, deterioration of health and body, and lack of an emotional language through which to express EL as central to older people's experiences. Furthermore, there was a suggestion that the move to retirement living was for many people inextricably connected to their experience of EL. Our data further support and extend the notion that EL can be thought of as a gradual sense of separation from the world and that ageing intensifies a myriad of social, emotional and physical circumstances that prompt its emergence. This sense of existential isolation need not be thought of as exclusive to those experiencing extreme frailty or who face death imminently – our data pointed to a clear and gradual emergence of EL throughout later life.