A 10-week intergenerational program bringing together community-living older adults and preschool children (INTERACTION): a pilot feasibility non-randomised clinical trial.

BACKGROUND: Social isolation and low levels of physical activity are strong drivers for frailty, which is linked to poor health outcomes and transition to long-term care. Frailty is multifactorial, and thus an integrated approach is needed to maintain older adults' health and well-being. Intergenerational programs represent a novel multifactorial approach to target frailty, social isolation and physical decline but these have not yet been rigorously tested in Australia. Here, we present the results of our pilot study which aimed to test the feasibility of a 10-week intergenerational program between older adults and preschool children. METHODS: A non-randomised wait-listed controlled trial was conducted. Participants were allocated to either the intervention or wait-list control group. The intervention group received 10 weekly 2-h intergenerational sessions led by trained child educators; the control group continued with their usual routine and received their intergenerational program after the 10-week control period. All participants were assessed at baseline and 10 weeks. The primary outcome was the feasibility and acceptability of the program including measures of recruitment eligibility, adherence and effective data collection across the multiple domains important for frailty, including functional mobility and balance, grip strength, cognitive function, mood, social engagement, quality of life and concerns about falling. RESULTS: Nineteen adults were included, with nine in the intervention and ten in the control group. A total of 42% of older adults screened were eligible, 75% of participants were present at each intervention session and the overall attrition rate was 21% (n = 4). The reasons for participant absence were primarily health-related. Missing data was minimal for the majority of assessments but more apparent for the cognitive testing where completion rates ranged from 53 to 79% for baseline tests and 73 to 100% for those who received follow-up testing. CONCLUSIONS: The high program compliance and low attrition show that a 10-week intergenerational program embedded in the local community, designed for community-living older adults and preschool children, is feasible and acceptable to older adults. Our next trial will test the efficacy of intergenerational programs in this setting.

Key Considerations to the Introduction of Intergenerational Practice to Australian Policy.

Intergenerational practice programs provide purposeful interactions between generations. While research reports improved social and behavioral outcomes for cohorts, no study has explored both expert and potential consumer perceptions of the implementation of intergenerational practice programs. This study conducted a Delphi study of expert opinions, as well as a national survey of potential consumers (N = 1020), to provide critical insights into the potential barriers to implementing intergenerational practice programs. Results revealed that 71.3% of potential consumers would participate in intergenerational practice programs if they were available and experts agreed that the program was of benefit to both populations. However, there were shared concerns regarding the transport, safety, and outcomes of the program for participants. Based on our findings we offer several policy considerations in the implementation of intergenerational programs.

The delivery of intergenerational programmes in the nursing home setting and impact on adolescents and older adults: A mixed studies systematic review.

BACKGROUND: Interventions to support a more "age friendly" world are a key objective set out by the World Health Organization with health and wellbeing benefits being increasingly identified for both young and old. Whilst multiple studies have explored intergenerational engagement between kindergarten aged children and older adults, there is limited collective knowledge of programme design and the potential impact that these programmes have on adolescents engaging with older adults in the nursing home setting. OBJECTIVES: The aims of this systematic review were to: a) examine intergenerational programme development and delivery in the nursing home setting and b) report on the impact of intergenerational engagement on adolescents and older adults. DESIGN: A systematic mixed studies review of intergenerational programmes targeting adolescents and older adults. DATA SOURCE: MEDLINE, CINAHL, Embase, PsycINFO, Scopus and ERIC (1995 and 2021) and reference lists were hand-searched. REVIEW METHODS: The first author conducted a review of the titles and abstracts based on inclusion and exclusion criteria. All authors then reviewed and discussed each paper to determine inclusion. Qualitative appraisal using the Mixed-Methods Appraisal Tool was conducted, and all evidence from the quantitative, qualitative, and mixed-methods studies was identified and thematically analysed using a convergent qualitative synthesis design. RESULTS: Ten papers were identified for review (six qualitative studies, two quantitative studies and two mixed methods studies). Inconsistencies in the inclusion criteria for older adults limited opportunities to explore the benefits for people with or without dementia. Few studies described the process of programme design, and there were wide variations in programme delivery. Programmes ranged from six weeks to eight months with a variety of activities and interactions implemented. Engaging in intergenerational programmes resulted in improved wellbeing and perceptions of social inclusion and reduced ageism. No correlations between programme design and impact were identified. CONCLUSIONS: Intergenerational programmes have important socio-emotional benefits for both adolescents and older adults. There is limited understanding of what meaningful intergenerational engagement entails as there is a lack of transparency surrounding the mechanics behind the programmes that are associated to positive change in the literature. In addition, there is currently no evidence of the longitudinal impacts or the broader social implications of these types of interventions. Future research is needed to explore programme design, the longitudinal effects, and the wider impacts of intergenerational programmes at a community and societal level. TWEETABLE ABSTRACT: Design and impact of intergenerational engagement between adolescents and older adults in the nursing home setting: a systematic review.

Intergenerational Programmes bringing together community dwelling non-familial older adults and children: A Systematic Review.

BACKGROUND: Social isolation is associated with an increased risk of adverse health outcomes, including functional decline, cognitive decline, and dementia. Intergenerational engagement, i.e. structured or semi structured interactions between non-familial older adults and younger generations is emerging as a tool to reduce social isolation in older adults and to benefit children and adults alike. This has great potential for our communities, however, the strength and breadth of the evidence for this is unclear. We undertook a systematic review to summarise the existing evidence for intergenerational interventions with community dwelling non-familial older adults and children, to identify the gaps and to make recommendations for the next steps. METHODS: Medline, Embase and PsychInfo were searched from inception to the 28th Sept 2020. Articles were included if they reported research studies evaluating the use of non-familial intergenerational interaction in community dwelling older adults. PROSPERO registration number CRD42020175927 RESULTS: Twenty articles reporting on 16 studies were included. Although all studies reported positive effects in general, numerical outcomes were not recorded in some cases, and outcomes and assessment tools varied and were administered un-blinded. Caution is needed when making interpretations about the efficacy of intergenerational programmes for improving social, health and cognitive outcomes. DISCUSSION: Overall, there is neither strong evidence for nor against community based intergenerational interventions. The increase in popularity of intergenerational programmes alongside the strong perception of potential benefit underscores the urgent need for evidence-based research.

Uniting generations: A research protocol examining the impacts of an intergenerational learning program on participants and organisations.

Economic, health and social issues associated with the ageing population and the disconnect between the generations call for novel approaches to care services. Intergenerational programs are known to enhance engagement between generations, improve health and well-being and create a stronger sense of community. While the health and social benefits are well documented, little attention has been given to the operational aspects of intergenerational programs within care facilities. This paper describes the research protocol used to develop, implement and evaluate an intergenerational learning program for preschool-aged children and older people attending care services. The research focuses on five key areas: (a) impact on older people and children; (b) intergenerational learning; (c) workforce development; (d) socio-economic implications and costs; and (e) program fidelity and sustainability. Findings from this research are expected to contribute to building age-friendly communities through the development of practical operational guidelines for intergenerational learning programs to be implemented more broadly across Australia.

Respite service use among caregivers of older people: comparative analysis of family dementia caregivers with musculoskeletal and circulatory system disorder caregivers.

OBJECTIVES: To identify the main drivers of the use of respite services and the need for respite services among caregivers of people experiencing dementia relative to family caregivers of people with other health conditions. METHOD: Based on nationally representative secondary data regression analysis was used to test the association between selected health conditions and the utilisation of and need for respite services. RESULTS: For a person living with dementia the odds of using respite care are higher than for a person with either a musculoskeletal or circulatory condition. Family caregivers of people living with dementia report the odds of the need for more respite as 5.3 times higher than for family caregivers of people with musculoskeletal conditions and 7.7 times higher than for family caregivers of people with circulatory conditions. The main reason for never using respite services is largely driven by the type of health condition, age of care recipient, existence of a spouse, and level of disability. CONCLUSIONS: Respite services that cater to the specific needs of families experiencing dementia at home should become a higher priority within the aged care sector. Alternative models of respite care that focus on prevention and early intervention would be cost effective.

Job satisfaction and intention to stay within community and residential aged care employees.

OBJECTIVE: This study investigated the different facets of job satisfaction that influence community care and residential care employees' intention to stay in the aged care workforce. METHODS: A survey of four organisations in Australia was undertaken. t-Tests were conducted to analyse differences between groups. Regression analyses were performed to examine the factors influencing intentions to stay in the workforce. RESULTS: Community care workers were more satisfied with various facets of job satisfaction including work on their present job, supervision, people in their present job and the job in general. There was a difference between how the various facets of job satisfaction influenced intentions to stay for residential care compared to community care workers. CONCLUSIONS: Both workers were satisfied with their work conditions and work to different extents. There is an opportunity for residential care to look to the practices within the community care sector to improve employees' intentions to stay.

The association between cognitive impairment and community service use patterns in older people living in Australia.

Family plays a vital role in supporting individuals with dementia to reside in the community, thus delaying institutionalisation. Existing research indicates that the burden of care-giving is particularly high for those caring for a person with dementia. Yet, little is known about the uptake of community services by people with a diagnosis of dementia. Therefore, this study aims to better understand the relationship between cognitive impairment and the receipt of community care services. In order to examine the relationship, secondary data collected across Queensland, Australia, from 59,352 home-care clients aged 65 and over during 2007-2008 are analysed. This cross-sectional study uses regression analyses to estimate the relationship between cognitive impairment and service mix, while controlling for socio-demographic characteristics. The dependent variables include formal services, informal care and total home-care service hours during a 12-month period. The findings of this study demonstrate that cognitive impairment is associated with accessing more hours of respite and day centre care but fewer hours of other formal care services. Additionally, the likelihood of support from an informal caregiver increases when a client becomes cognitively impaired. Therefore, this study demonstrates that there is an increased need for respite programmes to support informal caregivers in the future, as the population of people living with dementia increases. These findings support the need for investigations of new and innovative respite models in the future.

Personal care workers in Australian aged care: retention and turnover intentions.

AIM: This study examined factors influencing personal care workers' intentions to stay or leave Australian aged care employment - especially for older workers. BACKGROUND: Retention of personal care workers is particularly important in aged care as they provide the majority of the direct care via community aged care or long-term aged care environments. However, there is limited research on what drives their turnover and retention. METHOD: A survey was conducted during 2012 collecting 206 responses from workers within community and long-term aged care in four organisations in Australia. RESULT: Perceived supervisor support, on-the-job embeddedness and area of employment were identified as predictors of both intention to stay and to leave, although the relationship strength differed. Community care workers were more likely to stay and reported more supervisor support than long-term care workers. Unexpectedly, age and health status were not predictors of staying or leaving. CONCLUSION: While there are similarities between retention and turnover motivators, there are also differences. Within a global context of health worker shortages, such new knowledge is keenly sought to enhance organisational effectiveness and sustain the provision of quality aged care. IMPLICATIONS FOR NURSING MANAGEMENT: Retention strategies for older workers should involve increasing supervisor support, and seeking to embed workers more fully within their organisation.

Importance and performance of managerial skills in the Australian aged care sector - a middle managers' perspective.

AIM: This study examined the importance and performance of middle managers' skills to provide a starting point for a sector-wide leadership and management framework. BACKGROUND: There is an increasing consensus that the quality of management, leadership and performance of any organisation is directly linked to the capabilities of its middle managers and the preparation and on-going training they receive. METHOD: A total of 199 middle managers from three aged care organisations in Australia participated in a questionnaire conducted during 2010-2011. RESULT: This study found that middle managers perceived the need to develop their communication skills, self-awareness, change management, conflict resolution and leadership skills. CONCLUSION: Middle managers perceive a discrepancy between performance and importance of various managerial skills. This study demonstrated that provision of training needs to go beyond clinical skills development and further investigation into managers' needs is necessary, particularly considering the diversity of this critical group in organisations. IMPLICATIONS FOR NURSING MANAGEMENT: Future training opportunities provided to middle managers need to address the 'softer' skills (e.g. communication) rather than 'technical' skills (e.g. clinical skills). The provision of training in these skills may improve their performance, which may also lead to increased job satisfaction, continuity in leadership and management and ultimately improvements in the quality of care provided.