Environmental Features that Influence Social Engagement of Older Adults Residing in Congregate Living Facilities

Susan Stark, Ph.D.

Project Overview:
The purpose of this study is to examine the influence of physical and social features of a congregate living facility on social engagement patterns of older adult residents. Our central hypothesis is that the social engagement patterns of older adults with physical frailty are influenced by the social and physical environmental features in their congregate living environment. If this is the case, environmental features could become an important cost-effective approach to assist frail older adults aging in communities. To test our hypothesis, we will:

a. Identify the physical and social features of the environment that influence social engagement patterns of older adults living in congregate living facilities.
In preparation for a larger trial, this study will:
b. Refine the measurement protocol and select optimal primary and secondary measures for a multi-center trial.
c. Estimate power for a multi-center trial.
d. Determine the feasibility of a larger, controlled trial.

To achieve these goals, we will conduct a cross sectional pilot study in a new 89 unit congregate living facility in St. Louis that has an existing social program. We will interview a random sample of 50 older residents, 10 care providers and 4 administrative staff. We will also conduct an evaluation of the physical and social features of the environment. Since no large-scale multi-center randomized controlled trial has been published to date, we do not know which measure will provide the best assessment of social engagement. We will use multiple standardized assessments of social engagement such as the Assisted Living Social Activity Scale (Zimmerman et al, 2003), the Activity Card Sort (Everhard, Lach, Fisher & Baum, 2000) and summary measures of social engagement (Glass et al., 1999). We will also examine the features of the social and physical environment using the Multiphasic Environmental Assessment Procedure (Moos & Lemke, 1988) and the Universal Design Assessment (Sanford & Stark). We will also examine covariates such as health, functional ability, and impairments using standardized measures [e.g. the SF-36 Health Survey (Ware & Sherbourne, 1992), The Geriatric Depression Scale (Brink, Yesavage, Lum, Heersema, Adey & Rose, 1982), the Social Support Inventory, the Short-Blessed (Katzman , Brown , Fuld , Peck, Schechter & Schimmel, 1983)] etc.

The proposed research is innovative because it is the first study to investigate the effects of environmental features on the social engagement of frail older adults. The outcome of the proposed research would be significant because it could lead to changes in the design of housing facilities for older adults and potentially improve functional outcomes for frail community dwelling older adults.

Final Report:
The objective of this study was to describe how physical and social environmental features of assisted living facilities influence social engagement behaviors of older residents. A secondary objective was to identify the environmental features that were important to residents’ social engagement from their perspectives. 
Read the full Final Report.