A recently published paper in the Journal of Aging Studies has called for a “social revolution in residential care” in order to combat the ongoing persistence of loneliness and depression within senior living. The authors note that the psychosocial care offered to residents in order to address loneliness and depression are in the form of light social events such as games, trips, and social gatherings. They write that “Although these activities provide enjoyment for some, loneliness and depression persist and the lack of resident input perpetuates the stereotype of residents as passive recipients of care,” citing studies that report between 29 and 55 percent of residents in various senior living settings experiencing loneliness. They go on to note that many senior living residents continue to report lack of meaning in their lives, limited opportunities to contribute, and a frustration with a paternalistic treatment by staff.
In order to combat this state of affairs, the authors point to research on programs that encourage greater engagement and peer support among residents that can offer them opportunities to be socially productive and to create a valued social identity. The authors argue that the residents themselves are an untapped resource for increasing the quality of psychosocial care. They recommend overturning practices focused on entertainment and distraction with programming that centers on resident contributions and peer support. Such a change can advance a resident’s social identity, enhance relationships between residents, and increase social productivity. The authors suggest that this can “revolutionize psychosocial practice by moving from resident care to resident engagement.” So what would such a revolution in practice look like?
In contrast to what the authors describe as “institutionalized recreation,” they advocate for creating a space where residents can speak and be heard and programming that can enhance social identity through social productivity and peer support. Social productivity is based on the notion of reciprocity, and peer support is an approach that shifts the situation from “advice from on high to support from next door.” Part of the process of creating such an atmosphere can involve staff and caregivers helping facilitate friendships among residents, including those with dementia. Among residents with dementia, one study has shown that limited social interactions have more to do with social dynamics involving staff and family than other residents. Beyond fostering friendships, the article recommends creating opportunities for residents to create a stronger social identity through participation in relevant social groups. They note that once an individual has developed a sense of social identity within a group, that individual will go out of their way to advance the group by caring for its members and taking steps to keep the group positive and sustainable. In the process, this helps develop strong social bonds with others.
One example that the authors gave of how peer support can provide socially productive roles and a stronger social identity was an intergenerational therapeutic gardening program in Australia in which helping children led to reduced depression and agitation among residents, as well as improved quality of life scores. Another example was given was a study of mutual support groups formed through the Java Music Club program, which combines participatory music activities with discussion topics that foster engagement and peer support among residents. Here, as participants in the program took on supportive roles in the program’s group, they were also increasing their ability to be of help in their broader community as well.
For creating or fostering meaningful groups that can build peer support and social identity, the authors propose looking at programming through three main criteria. First is the meaningfulness of a group. What forms of group participation are meaningful for each resident? Second is how well a group fosters social relationships and valued shared identities. Third is how much a group or club focuses on being of service and helping others. An investigation into these criteria should both a) reveal how well current programming and groups fulfill these functions (and may provide insights into how these functions can be further supported or enhanced), and b) help in the development of new programs for residents based on what is meaningful to them. Through an ongoing assessment of programming in light of these criteria, staff can help identify existing or potential groups that are meaningful to residents and can help explore what contributions residents can make to such groups. The authors also suggest that this process can be adapted to work with individuals with dementia.
This model of resident engagement treats residents as resources who can help promote a positive psychosocial atmosphere within senior living, and helps senior living staff provide programming and facilitate interactions that residents find meaningful. The authors suggest that this approach “signifies a shift from providing calendars dominated by light social events to collaborating with residents on the development of group programs that provide meaning and strengthen shared identities as well as opportunities for contribution.”
Ideally, future research into a social engagement approach will shed more light on ways that challenges and barriers to such an approach can be overcome, as well as how such an approach can be most effectively implemented to provide the greatest possible benefit to residents in senior living.
Theurer K, Mortenson WB, Stone R, et al. The need for a social revolution in residential care. Journal of Aging Studies (2015); 35: 201–210.