Build It and They Will Come: Interdisciplinary Wellness Clinics in Low-Income Senior Housing.

PURPOSE: The purpose of this study was to describe the first 4 months of implementation of the University of Maryland Interdisciplinary Wellness Clinic (UM-IWC). The UM-IWC provided health care services that are difficult for older adults in low-income senior housing communities to access. DESIGN: This was a descriptive study including four low-income communities. METHODS: Measures included health information, participation, and services provided. FINDINGS: A total of 165 residents were seen (44%). The residents were mostly female (80%), Black (63%), and non-Hispanic (83%), with an average age of 77 years. We provided 253 patient visits with 98 residents seen once, 38 twice, 19 three times, and 10 four times. Visits included 165 intake assessments, 61 immunizations, 193 blood pressure checks, 28 foot care treatments, 12 cerumen removals, 12 completions of advance directives, 14 Annual Wellness Visits, and 3 home visits for acute medical problems. CONCLUSIONS: There was strong engagement of the residents, and we were able to provide a large number of services that were not easily accessible to these individuals. Future work will focus on increasing and maintaining the engagement of residents and sustainability of the clinics.

Feasibility of aging in place clinics in low income senior housing.

The purpose of this study was to describe the feasibility of implementing interdisciplinary senior housing clinics. Feasibility was based on evidence of resident participation, services provided, improvement in clinical outcomes and sustaining clinics over time. Data were collected prospectively in four senior housing communities which included approximately 375 residents 60 years of age and older. Over the 12-month implementation period, 228 residents were seen, 61 % of all residents. We gave 131 immunizations, checked 576 blood pressures, completed 92 foot care treatments, 69 hearing evaluations and cerumen removal, completed 16 advance directives, 119 Annual Wellness Visits, and 13 assessments for acute medical problems. Overall, 87 individuals (38 %) had a decrease in their blood pressures, 121 (54 %) maintained their pressures and 19 (8 %) had increases in blood pressures. We reached over half of the residents living in these communities and estimated we could financially maintain the clinics with reimbursement based on billing.

Mental Health Impact of Bullying by Ethnic Peers in Senior Housing: A Study with Older Korean American Residents in the Greater Los Angeles Area.

Using data from Korean-American residents (N = 343) in subsidized senior housing in the Los Angeles area, we examined the effect of peer bullying on mental health. About 18% of the sample had been a target of bullying, and over 31% had witnessed someone being bullied. Being a target of bullying was a significant predictor for both depressive symptoms and anxiety, whereas witnessing other residents being bullied was a significant predictor for anxiety only. Findings shed light on the adverse mental health impacts of peer bullying among ethnic minority older residents in senior housing.

Lonely in a crowd: loneliness in New Zealand retirement village residents.

OBJECTIVES: The number of older people choosing to relocate to retirement villages (RVs) is increasing rapidly. This choice is often a way to decrease social isolation while still living independently. Loneliness is a significant health issue and contributes to overall frailty, yet RV resident loneliness is poorly understood. Our aim is to describe the prevalence of loneliness and associated factors in a New Zealand RV population. DESIGN: A resident survey was used to collect demographics, social engagement, loneliness, and function, as well as a comprehensive geriatric assessment (international Resident Assessment Instrument [interRAI]) as part of the "Older People in Retirement Villages Study." SETTING: RVs, Auckland, New Zealand. PARTICIPANTS: Participants included RV residents living in 33 RVs (n = 578). MEASUREMENTS: Two types of recruitment: randomly sampled cohort (n = 217) and volunteer sample (n = 361). Independently associated factors for loneliness were determined through multiple logistic regression with odds ratios (ORs). RESULTS: Of the participants, 420 (72.7%) were female, 353 (61.1%) lived alone, with the mean age of 81.3 years. InterRAI assessment loneliness (yes/no question) was 25.8% (n = 149), and the resident survey found that 37.4% (n = 216) feel lonely sometimes/often/always. Factors independently associated with interRAI loneliness included being widowed (adjusted OR 8.27; 95% confidence interval [CI] 4.15-16.48), being divorced/separated/never married (OR 4.76; 95% CI 2.15-10.54), poor/fair quality of life (OR 3.37; 95% CI 1.43-7.94), moving to an RV to gain more social connections (OR 1.55; 95% CI 0.99-2.43), and depression risk (medium risk: OR 2.58, 95% CI 1.53-4.35; high risk: OR 4.20, 95% CI 1.47-11.95). CONCLUSION: A considerable proportion of older people living in RVs reported feelings of loneliness, particularly those who were without partners, at risk of depression and decreased quality of life and those who had moved into RVs to increase social connections. Early identification of factors for loneliness in RV residents could support interventions to improve quality of life and positively impact RV resident health and well-being.

Provision and related factors of end-of-life care in elderly housing with care services in collaboration with home-visiting nurse agencies: a nationwide survey.

BACKGROUND: Japan has the largest population of older adults in the world; it is only growing as life expectancy increases worldwide. As such, solutions to potential obstacles must be studied to maintain healthy, productive lives for older adults. In 2011, the Japanese government has started a policy to increase "Elderly Housing with Care Services (EHCS)", which is one of a private rental housing, as a place where safe and secure end-of-life care can be provided. The government expect for them to provide end-of-life care by collaborating with the Home-Visit Nursing Agencies (HVNA). The purpose of this study is to clarify the situation of the end-of-life care provision in EHCS in collaboration with HVNA and to examine the factors that associate with the provision of the end-of-life care in EHCS. METHODS: A two-stage nationwide survey (fax and mail surveys) were conducted. Of the 5,172 HVNA of the National Association for Visiting Nurse Services members, members from 359 agencies visited EHCS. Logistic regression analysis was conducted with the provision of end-of-life care to EHCS in 2017 as the dependent variable, and the following as independent variables: characteristics of HVNA and EHCS; characteristics of residents; collaborations between HVNA and EHCS; and the reasons for starting home-visit nursing. RESULTS: Of the 342 HVNA who responded to the collaborations with EHCS, 21.6% provided end-of-life care. The following factors were significantly associated with the provision of end-of-life care to inmates in elderly care facilities: being affiliated with a HVNA, admitting many residents using long-term care insurance, collaborating with each other for more than three years, and started visiting-nurse services after being requested by a resident's physician. CONCLUSIONS: This study clarified the situation of the provision of end-of-life care in EHCS in collaboration with HVNA and the related factors that help in providing end-of-life care in EHCS.

Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study.

BACKGROUND: Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data. OBJECTIVE: This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions. METHODS: Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes. RESULTS: During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use. CONCLUSIONS: Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.

Homes Too Large for Household Needs? Under-Occupancy as Policy Problem and Lived Experience among Older Social Housing Tenants.

Rising demand for social housing has induced housing authorities to find ways to increase the utilisation of existing housing stock, including targeting households thought to be living in homes that are larger than they need. This "under-occupation" of social housing is common among older tenants who, as with other under-occupiers, have been subject to unpopular measures designed to encourage downsizing. Yet little attention has been given to the housing needs of under-occupying older tenants and the ability of the social housing sector to meet those needs. In reviewing a new housing initiative for older under-occupying social housing tenants in Brisbane, Australia, this paper explores the housing needs and experience of this cohort. It shows that under-occupancy is a lived experience for some tenants and that downsizing to a smaller property is an attractive, albeit limited option. This suggests that policy prescriptions about the problem of older under-occupiers in the social housing sector should be reframed around the issue of tenants housing needs as they age.

Detection of SARS-CoV-2 Among Residents and Staff Members of an Independent and Assisted Living Community for Older Adults - Seattle, Washington, 2020.

In the Seattle, Washington metropolitan area, where the first case of novel coronavirus 2019 disease (COVID-19) in the United States was reported (1), a community-level outbreak is ongoing with evidence of rapid spread and high morbidity and mortality among older adults in long-term care skilled nursing facilities (SNFs) (2,3). However, COVID-19 morbidity among residents of senior independent and assisted living communities, in which residents do not live as closely together as do residents in SNFs and do not require skilled nursing services, has not been described. During March 5-9, 2020, two residents of a senior independent and assisted living community in Seattle (facility 1) were hospitalized with confirmed COVID-19 infection; on March 6, social distancing and other preventive measures were implemented in the community. UW Medicine (the health system linked to the University of Washington), Public Health - Seattle & King County, and CDC conducted an investigation at the facility. On March 10, all residents and staff members at facility 1 were tested for SARS-CoV-2, the virus that causes COVID-19, and asked to complete a questionnaire about their symptoms; all residents were tested again 7 days later. Among 142 residents and staff members tested during the initial phase, three of 80 residents (3.8%) and two of 62 staff members (3.2%) had positive test results. The three residents had no symptoms at the time of testing, although one reported an earlier cough that had resolved. A fourth resident, who had negative test results in the initial phase, had positive test results 7 days later. This resident was asymptomatic on both days. Possible explanations for so few cases of COVID-19 in this residential community compared with those in several Seattle SNFs with high morbidity and mortality include more social distancing among residents and less contact with health care providers. In addition, early implementation of stringent isolation and protective measures after identification of two COVID-19 cases might have been effective in minimizing spread of the virus in this type of setting. When investigating a potential outbreak of COVID-19 in senior independent and assisted living communities, symptom screening is unlikely to be sufficient to identify all persons infected with SARS-CoV-2. Adherence to CDC guidance to prevent COVID-19 transmission in senior independent and assisted living communities (4) could be instrumental in preventing a facility outbreak.

A pragmatic trial of a group intervention in senior housing communities to increase resilience.

BACKGROUND: Aging is associated with numerous stressors that negatively impact older adults' well-being. Resilience improves ability to cope with stressors and can be enhanced in older adults. Senior housing communities are promising settings to deliver positive psychiatry interventions due to rising resident populations and potential impact of delivering interventions directly in the community. However, few intervention studies have been conducted in these communities. We present a pragmatic stepped-wedge trial of a novel psychological group intervention intended to improve resilience among older adults in senior housing communities. DESIGN: A pragmatic modified stepped-wedge trial design. SETTING: Five senior housing communities in three states in the US. PARTICIPANTS: Eighty-nine adults over age 60 years residing in independent living sector of senior housing communities. INTERVENTION: Raise Your Resilience, a manualized 1-month group intervention that incorporated savoring, gratitude, and engagement in value-based activities, administered by unlicensed residential staff trained by researchers. There was a 1-month control period and a 3-month post-intervention follow-up. MEASUREMENTS: Validated self-report measures of resilience, perceived stress, well-being, and wisdom collected at months 0 (baseline), 1 (pre-intervention), 2 (post-intervention), and 5 (follow-up). RESULTS: Treatment adherence and satisfaction were high. Compared to the control period, perceived stress and wisdom improved from pre-intervention to post-intervention, while resilience improved from pre-intervention to follow-up. Effect sizes were small in this sample, which had relatively high baseline resilience. Physical and mental well-being did not improve significantly, and no significant moderators of change in resilience were identified. CONCLUSION: This study demonstrates feasibility of conducting pragmatic intervention trials in senior housing communities. The intervention resulted in significant improvement in several measures despite ceiling effects. The study included several features that suggest high potential for its implementation and dissemination across similar communities nationally. Future studies are warranted, particularly in samples with lower baseline resilience or in assisted living facilities.

Poverty and food insecurity of older adults living in social housing in Ontario: a cross-sectional study.

BACKGROUND: Poverty and food insecurity have been linked to poor health and morbidity, especially in older adults. Housing is recognized as a social determinant of health, and very little is known about subjective poverty and food insecurity in the marginalized population of older adults living in subsidized social housing. We sought to understand poverty and food insecurity, as well as the risk factors associated with both outcomes, in older adults living in social housing in Ontario. METHODS: This was a cross-sectional study using data collected from the Community Paramedicine at Clinic (CP@clinic) program. A total of 806 adult participants residing in designated seniors' or mixed family-seniors' social housing buildings attended CP@clinic within 14 communities across Ontario, Canada. RESULTS: The proportion of older adults reporting poverty and food insecurity were 14.9 and 5.1%, respectively. Statistically significant risk factors associated with poverty were being a smoker (AOR = 2.38, 95% CI: 1.23-4.62), self-reporting feeling extremely anxious and/or depressed (AOR = 3.39, 95% CI: 1.34-8.62), and being food insecure (AOR = 23.52, 95% CI: 8.75-63.22). Statistically significant risk factors associated with food insecurity were being underweight (AOR = 19.79, 95% CI: 1.91-204.80) and self-reporting experiencing poverty (AOR = 23.87, 95% CI: 8.78-64.90). In those who self-reported being food secure, the dietary habits reported were consistent with a poor diet. CONCLUSION: The poverty rate was lower than expected which could be related to the surrounding environment and perceptions around wealth. Food insecurity was approximately twice that of the general population of older adults in Canada, which could be related to inaccessibility and increased barriers to healthy foods. For those who reported being food secure, dietary habits were considered poor. While social housing may function as a financial benefit and reduce perceived poverty, future interventions are needed to improve the quality of diet consumed by this vulnerable population.

Helpful Approaches for Older Adults Living in a Retirement Community to Move Forward After the Death of a Significant Other.

The loss of a significant other often creates emotional distress for family members that can hamper the ability to meet everyday challenges and pursue wellness. The aim of this qualitative study was to understand the challenge of losing a significant other for older adult family members and the approaches identified as most helpful to promote their own well-being after this person dies. Story inquiry method guided the interview process with 15 older adult bereaved family members residing in a continuing care retirement community. Theory-guided content analysis was used for data analysis. Two themes described the challenges: uneasiness that permeates everyday living and precious memories and patterns of disconnect that breed discontent. Appreciating the rhythmic flow of everyday connecting and separating and embracing reality as situated in one's lifelong journey are the themes that encompass the helpful approaches used by participants. This study provided insights about the benefits of living in this community such as social networking and a possible drawback such as the frequency of death among residents. Future research should continue to investigate social service resources that older adults find most helpful after a significant other dies and the use of reminiscence groups as a form of bereavement support.

Experiences of participating in intergenerational interventions in older people's care settings: A systematic review and meta-synthesis of qualitative literature.

AIMS: To synthesize the findings of qualitative research exploring the experiences of being involved in intergenerational interventions in older people's care settings. DESIGN: A meta-synthesis of the qualitative literature, employing Sandelowski and Barroso's method, was conducted. DATA SOURCES: Eight databases were searched in March 2017. REVIEW METHODS: The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method. RESULTS: Four qualitative studies were included in the meta-synthesis. Thematic analysis revealed four themes: 'Recreating the family'; 'Building intergenerational empathy and respect'; 'Uplifting and energizing'; and 'Engagement risks and challenges'. CONCLUSION: The meta-synthesis strengthens the evidence that intergenerational interventions can be positive. However, it also shows that there may also be some negative aspects if not planned or managed carefully. IMPACT: This review contributes to the body of evidence by synthesizing the experiences of older people and children involved in intergenerational interventions. Although qualitative literature supports the quantitative evidence that intergenerational interventions can have a positive effect, intergenerational interventions could also have negative effects on some participants. Older people may feel tired, or experience feelings of infantilization. Practitioners need to be more aware of the potential negative effects of intergenerational interventions and include risk assessment, possibly by requiring ethical scrutiny.

Well-being and thriving in sheltered housing versus ageing in place: Results from the U-age sheltered housing study.

AIMS: To explore to what extent type of residence (sheltered housing or ageing in place) contributes to thriving and well-being in older adults, when controlling for age, sex, living alone, being a widow and adjusting for functional status, self-rated health, and depressive mood. DESIGN: A matched cohort study. METHODS: A self-report survey was sent out to a total population of residents in all sheltered housings in Sweden and a matched control group ageing in place (N = 3,805). The data collection took place between October 2016-January 2017. RESULTS: The interaction analyses related to thriving showed that with increasing level of depressive mood and decreasing levels of self-rated health and functional status, those residing in sheltered housing generally reported higher levels of thriving, as compared with those ageing in place. Well-being was not found to be significantly associated with type of accommodation. CONCLUSION: There may be features in sheltered housing that are associated with resident thriving especially among individuals with impairments of function, health or mood, although further studies are required to identify these specific features. IMPACT: This study informs staff and policymakers about thriving and well-being in sheltered housing accommodations. These findings may be used to further the development of sheltered housing accommodations.

Sense of belonging to the community in continuing care retirement communities and adult day care centers: The role of the social network.

AIM: This study examined the contribution of the social network to one's sense of belonging to the community (SCB) in two different long-term care settings: Continuing care retirement communities (CCRCs) and adult day care centers (ADCCs). METHODS: Overall, 245 respondents participated in both waves of the study that were spaced about 1 year apart. RESULTS: Results show that constraint in the social network (e.g., being socially invested in a single group of interconnected ties) is particularly detrimental for CCRC residents, but not for ADCC participants. Betweenness, defined as the number of shortest paths that pass through the focal person, was not significantly related to SCB. In addition, the size of the egocentric network, obtained through a name generator of a list of all potentially meaningful individuals identified by respondents, was directly correlated with SCB at follow-up. CONCLUSIONS: The findings are discussed in light of differences between the two long-term care settings and the different social network indicators examined in this study.

[Remapping age(ing) : Additional value of an affect-based and inequality-sensitive determination of the relationship between space and age(ing)]. / Neuvermessung des Alter(n)s : Zum Mehrwert einer affektbasierten und ungleichheitssensiblen Bestimmung des Verhältnisses von Raum und Alter(n).

BACKGROUND: The study of housing and living spaces has always played a central role in sociogerontological research. For example, living environments are seen as essential influencing factors on the quality of life and personal well-being (or the lack of it) of older people. The study of the relationship between space and age(ing) is dominated by psychologically influenced environmental gerontological approaches and social area-oriented research. While environmental perspectives in gerontology focus in particular on perceptions, experiences and affects to identify the relationships between space and age(ing), social area-oriented research tends to focus on social inequalities and strategies of participation. OBJECTIVE: The results of ecogerontological approaches to affects and social area-oriented research on social inequalities are combined by means of a praxiological approach. A relational understanding of space and age is developed, which is able to focus on affects and is also sensitive to spatial exclusions based on social inequalities and which also have an affective component. This combination enables new insights into a gerontological designation of the relationship between space and age(ing). RESULTS AND CONCLUSION: Such a remapping of age(ing) makes it possible to formulate other research questions regarding constructions of space through age or age through space and to provide impulses for gerontological research perspectives that take the complex interplay of humans, artefacts and spatial arrangements into account and explore the consequences for individual persons and also for their living spaces.

Prevalence of acute and chronic wounds - with emphasis on pressure ulcers - in integrated continuing care units in Alentejo, Portugal.

The aim of the study was to describe the prevalence and general characteristics of acute and chronic wounds in 2018 in Alentejo (Portugal) continuing care units. In order to look at associations, wound characteristics studied were location, type, place of acquisition, number, and duration, and patient characteristics were sex, age, and presence of risk factors. During the first 2 weeks of February 2018, a total of 770 patients were assessed at continuing care units of Alentejo. Of these, 135 exhibited wounds, a prevalence of 17.5%. Almost two out of three patients (63%) had arterial hypertension, slightly more than one in three (37%) had a stroke and/or immobility and 30% had diabetes. Of the total wounds identified, 18% were acute wounds and 82% were chronic wounds. Of the 24 acute wounds, traumatic wounds (76%), and surgical wounds (22%) were the most prevalent. The four types of pressure ulcers represented 80% of the chronic wounds. The median duration of the pressure ulcers was 5.5 months and 25% had duration over 10 months.

Sense of community, loneliness, and satisfaction in five elder cohousing neighborhoods.

Data were collected at five elder cohousing neighborhoods to understand more about who lives in these communities, their reasons for moving, their satisfaction, and to explore the intersection between loneliness and sense of community. The average age of the predominantly white, female, and well-educated sample (n = 86, 56% response rate), was 68 ± 6.573 at move-in. Respondents moved in search of a sense of community and were generally satisfied with their experiences. Prevalence of loneliness was lower than the national average, but still affected 24% of the sample. Findings suggest that senior cohousing is delivering on the promise to promote sense of community.

The effect of living in communal homes on the depressive symptoms of older women living in rural areas: the mediating role of the socio-physical environment.

This study examined the effects of the village communal living model on depressive symptoms, focusing on mediating roles of perceived environment among rural older women in South Korea. Data came from the sample of residents in 18 housings and their peers in the conventional housing (n = 168). Propensity score analysis and structural equation modeling were used. The results showed the effect of living in VCH on depressive symptoms was mediated distinct aspect of socio-physical environment.

Study of Independent Living Residents of a Continuing Care Senior Housing Community: Sociodemographic and Clinical Associations of Cognitive, Physical, and Mental Health.

OBJECTIVE: To examine associations of sociodemographic and clinical factors with cognitive, physical, and mental health among independent living older adults in a continuing care senior housing community (CCSHC). METHODS: This was a cross-sectional study at the independent living sector of a CCSHC in San Diego County, California. Participants included English-speaking adults aged 65-95 years, of which two-thirds were women. Of the 112 subjects recruited, 104 completed basic study assessments. The authors computed composite measures of cognitive, physical, and mental health. The authors also assessed relevant clinical correlates including psychosocial factors such as resilience, loneliness, wisdom, and social support. RESULTS: The CCSHC residents were similar to a randomly selected community-based sample of older adults on most standardized clinical measures. In the CCSHC, physical health correlated with both cognitive function and mental health, but there was no significant correlation between cognitive and mental health. Cognitive function was significantly associated with physical mobility, satisfaction with life, and wisdom, whereas physical health was associated with age, self-rated physical functioning, mental well-being, and resilience. Mental health was significantly associated with income, optimism, self-compassion, loneliness, and sleep disturbances. CONCLUSION: Different psychosocial factors are significantly associated with cognitive, physical, and mental health. Longitudinal studies of diverse samples of older adults are necessary to determine risk factors and protective factors for specific domains of health. With rapidly growing numbers of older adults who require healthcare as well as supportive housing, CCSHCs will become increasingly important sites for studying and promoting the health of older adults.

The stress and coping experiences among Chinese rural older adults in welfare housing: through the lens of life review.

Purposes: Responding to the growing needs of the largest aging population in the world, China has been experimenting interventions introduced from other countries to serve its older citizens. Using the life review approach, this study aimed to understand stress and coping experiences of a group of rural older adults living in public welfare housing, and to identify the effect of life review on their perceptions of quality of life. Methods: This study used an experimental research design with qualitative interviews. Analyses mainly focused on qualitative interview data of participants in the experimental group (n=24). Quantitative analyses were conducted to compare changes in the measure of quality of life between the experimental group and the control group (n=22). Results: Qualitative analyses indicated that salient life course stressors among rural Chinese old adults included financial strains, health concerns, and loss of loved ones. Such stressors were intertwined with historical and social changes they experienced in China. Coping strategies developed to survive a harsh young adulthood were used to deal with aging challenges and adaption to the welfare housing. Quantitative analysis found those who went through life review reported significant improvement in perceived quality of life compared to the control group. Discussion: Life review showed preliminary acceptability and effectiveness among the most disadvantaged and marginalized older group in China. It suggests this approach can be adapted to help understand life experience of older adults from different socioeconomic and cultural backgrounds, and to bring about positive changes in their wellbeing.