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From Aging Wiki 10
 Group #10
- 1.Colin Meincke
- 2.Kate Dionne
- 3.Maygan Bosma
 Assisted Living Facilities and The Elderly
As the average life expectancy increases, the need for assisted living facilities will increase. The continuous need for more elderly assisted living homes is real (Huang & Shanklin, 2008). Assisted living facilities are often located in areas that do not allow residents access to shopping centres and grocery stores (Hatfield, 2003). The design of the buildings, in order to maximize land use, mimic apartment or hotel designs instead of smaller individual housing which have a more “home-like feel” to them (Street, Burge, Quadagno, & Barrett, 2007). Within these facilities, different activities have shown to improve the lives of the residents who participate in them. Increased exercise has been associated with an increase in physiological functioning which further effects physical and cognitive health (Cafiero & Martiz, 2003). With specific changes to the conventional design of gardening tools, gardening can be an activity that allows residents to regain some indepedence that may have been loss to phsyical deficiencies (Kwack, Relf, & Rudolph, 2005). Increases in social interactions and decreases in loneliness in residents have been linked to Pet Assisted Therapy (Saylor, 1998). Also, current research on psychological well-being and the mental health of elderly residents in assisted living facilities has focused on a number of predictors such as, social relations, group therapy, and coping methods. Such predictors have been linked to a development of social relationships with other residents and staff members (Barrett, Burge, Street & Quadango, 2007) and meaningful ways of coping with depression (Cummings, 2002).
 Designs in Assisted Living Facilities
The need for more assisted living homes has created an increase in the amount of research investigating which specific designs or structures create the most well-being and which do not. Unfortunately, as it stands, the average assisted living facility is not living up to the expectations of its residents. In comparison, the facility designs that are linked to an increase in well-being and a more "home-like feeling" are the larger, less common, more expensive assisted living facilities (Street et al., 2007). However, with a population of the elderly closely matching that of the young and a group of Baby Boomers on the verge of retirement, the architecture and design of assisted-living facilities will become a booming business (Huang & Shanklin, 2008).
 What is Working with Assisted Living Facilities
 Location and Design
Assisted living facilities with a dining area where residents share common meal times show negative affects (Street et al., 2007). Higher quality assited living facilities have an on foot accessible shopping centre, containing a grocery store, drug store, and a small mall on location. Because of higher expenses to build such a facility, this layout is less common, even though such a facility design promotes more physical activity in residents (Hatfield, 2003).
A rare assisted living structural design has one or two floor homes set up side by side with a small yard in the front. Since residents have to go outside in order to go anywhere, they are more likely to interact socially with others in the facility. Past research has found that this facility layout promotes better well-being in residents because it provides larger living spaces and increased social activity, which is the most important determinant of well-being in the elderly (Street et al., 2007). As well, the on site assorted stores increases residents amount of walking. Increases in physical acitivty, such as walking, has been linked to benefits in well-being (i.e., decrease in depressive symptoms) (Cafiero & Martiz, 2003).
 The Interior
A room design that has been associated with increased well-being is a one bedroom with living area, bathroom, and small kitchen (Street et al., 2007). The increase in room size and the addition of a kitchen are often meant for residents that are still quite independent and who also live with their partner (Hoof & Kort, 2009). Residents that stay in these larger, private, individual homes are twice as likely to describe their place as having a more “home-like feeling”, in comparison to residencts who share a room (i.e, who is not a spouse or friend) that report a significant reduction in life satisfaction (Street et al., 2007).
 Problems with Current Assisted Living Facilities
 Location and Overall Design
In the Post World War II era, living in an outer city neighbourhood and owning a small piece of land surrounded by ever-green lawns and tree-lined streets with newly paved sidewalks became the North American dream. What the North American population of this time did not realize was that the benefits of the new suburban community would eventually create problems for future development elderly assisted living facilities and their residents (Hatfield, 2003). Since the layout of most cities is already chaotic and cramped, construction of new large facilities or buildings needs to take place on the city line, which is a problem, because that is where the suburban community is located (Hatfield, 2003). It is common for assisted living facilities to be built on the outside borders of the suburbs (i.e., The Royal Henley in Saint Catharines , away from the city's and suburb’s facilities (i.e., grocery stores, malls, parks, and leisure centres) (Hatfield, 2003). This is also a problem, because much of the elderly cannot drive a vehicle, making the city and suburb facilities inaccessible. Most assisted living facilities are multi-floored buildings with several rooms on each floor, very similar to an apartment or hotel . Residents of these facility types have shown a decrease in mood because such appartment-like designs are associated with a feeling of community housing (Street et al., 2007). These facilities have smaller properties and limit outside activities, such as walking, unless residents want to venture off the property, which some facilities restrict (Hatfield, 2003). In order to improve, assisted living facilites need to have an assorted number of shopping centres on site and use small indivdual side by side housing instead of an appartment style.
 The Interior
With the interior of assisted living facilities, as with most services, residents get what they pay for. Residents pay top dollar for private, individual homes which are more personalized and have more room. Unfortunately, most elderly people do not have sufficient funds and are forced to pay significantly less money for rooms that are smaller and that are even shared with other residents (i.e., not a spouse or friend) (Street et al., 2007). Street et al. (2007) stated that residents who have to share a room with another resident show a decrease in mood and well-being. The most common style of room assisted living facilities offer residents is a one bedroom with sitting area and bathroom. The decrease in size and lack of kitchen often mean the individual or couple lack the physical or cognitive resources necessary to be independent. This room layout is also used if the assisted living facility has a large dining room where all residents gather to eat prepared meals, which makes a kitchen unnecessary. Street et al. (2007) has found that, on average, residents in lower quality assisted living facilities dislike the timing of meals in large dining rooms and would prefer eating times that relfect personal schedules.
 Improvements for Assisted Living Facilities
Hoof and Kort (2009) created a room for assisted living facilities that is specifically meant for residents that have dementia. The design mimics the more expensive individual home with a front lawn and porch. The layout has an open concept feel to it, which allows an individual or a partner to see almost everything that is happening from any room. Therefore, this home is easier for a spouse who has to monitor their partner with dementia, or an individual resident with dementia, because less goes unnoticed in each room (i.e., left on stoves or taps) (Hoof & Kort, 2009). One of the drawbacks to this design is that it is very expensive, because it is an individual outside unit. However, the practicality of the inside design could very easily be applied to an apartment structure, which would still allow for the benefits of the open concept.
Past research has also looked at other interior design changes that could benefit residences in assisted living facilities. Sleep cycle research has discovered that during test trials, intensified lighting in the dining area improves circadian rhythm disturbances in residents that have moderate to severe dementia (Someren, Kessler, Mirmiran & Swaab, 1997). Increased lighting in assisted living facilities has also been shown to reduce cognitive deficits by 5% and decrease depressive symptoms by 19% in residents with dementia (Remersma-van der lek et al., 2008).
In conclusion, assisted living facilities are frequently located on the borders of cities, away from shopping centres and grocery stores. In order to maximize land use, assisted living facilities mimic apartment or hotel designs instead of smaller individual housing with a more “home-like feel” to it. Overall, assisted living facilities focus more on the assisted aspect and less on the living. Residents at assisted living facilities are often governed by many rules and are less likely to be allowed to live freely as they please. As the need for assisted living increases, even though there is some excellent research already, more qualitative and quantitative research on these facilities will need to be completed. Unfortunately as it stands now, the facilities and the amount of research needed for improvements are inadequate. However, here is a video example of a high quality assisted living facilitiy.
 Activities in Assisted Living Facilities
With the increasing aging of The Baby Boomers, an increased need for assisted living facilities and a rise in health care costs can be expected. Assisted living facilities have the ability to help in decreasing personal and governmental expenses, such as prescriptions and costs associated with preventable injuries, through the implementation of health maintaining and enhancing activities. Making a variety of activities available in assisted living facilities may prove beneficial for various aspects of well being in residents. For instance, exercise has been linked with maintenance and improvements in physical and cognitive health. In addition, gardening provides a sense of comfort and well being in residents experiencing a loss of independence due to physical or cognitive limitations. Finally, Pet Assisted Therapy has been associated with increased social interaction and decreased feelings of loneliness and depression in normally and abnormally aging older adults.
Older adults can maintain or improve physiological changes through consistent exercise. According to Cafiero and Maritz (2003), participation in exercises specific to health conditions can decrease risk of injury as a result of improved balance, flexibility and mobility. Although their findings do show links to improvements, it is important to tailor exercise regimens to suit outstanding health conditions to prevent the risk of injury during exercise o future injuries that result from an existing health condition. Cafiero and Maritz explain that those suffering with the chronic disease of osteoarthritis  can experience decreased range of motion resulting from joint and muscle degeneration. This causes pain in joints such as knees and fingers and can make simple tasks such as getting out of bed and brushing one's teeth very difficult. Improvements in flexibility, mobility and balance in these individuals can be achieved through low impact activities such as swimming, walking or weight training (Cafiero & Martiz, 2003). Older adults suffering from osteoperosis  also experience chronic pain as a result of decreased bone mass, which may be partially recovered through exercises that include resistance and weight training (Cafiero & Martiz, 2003). Resistance exercises include swimming and biking in which there is force acting against one's muscles producing tension. Lastly, exercise can have indirect effects on one's psychological health. Cafiero and Maritz (2003) point out that there are effects that take place during exercise that can alter one's well-being. For example, when chemicals such as serotonin are released, they have the ability to decrease depressive symptoms. Prior to participation in exercise, older adults should receive doctor’s clearance and seek information on which types of exercise are best for their condition. Taking these proactive steps can decrease the risk of injury before initiating the exercise routine.
Exercise not only benefits older adults physically, but it has the potential to improve their cognitive  abilities as well. Colcombe et al. (2006) found that older adults who participated in an exercise routine for 6 months showed increased white  and grey matter  in areas responsible for memory, higher order control and motor skills. Therefore, older adults may experience better memory and better physical functioning, which can facilitate increased participation in exercise and can promote injury reduction. It can also provide an opportunity for regaining some independence as their reliance on others can be decreased.
Gibson, Garuth, Clarke and Sixsmith (2007) state that older adults living at home have more opportunities to enjoy the outdoors and gardening than those living in a facility. Thus, increasing the opportunity to get outdoors in the garden at an assisted living facility may promote feelings of comfort and familiarity. People in assisted living facilities are often confined indoors by their physical and mental impairments however; with proper design and tools, this limitation can be overcome. According to Kwack et al. (2004) accessibility to gardening activities for normally and abnormally aging adults can be made possible through adjustments to regular gardening tools. Some adjustments put forth by Kwack et al. (2004) include customizing gardening tools by increasing grip size, using foam padding or using polyvinyl chloride pipe to lengthen the handle and create better mobility. Older adults may be unable to grip the small handles successfully due to complications of diseases such as osteoarthritis, and altering these tools can make holding the tool less painful. Modifying the length of a handle can provide an opportunity for those in a wheelchair to reach the ground. Presenting these older adults with the opportunity to do something they thought impossible will foster feelings of independence and accomplishment. Also, it provides another means of achieving the physical and cognitive benefits of exercise, as discussed in the previous section.
 Pet Assisted Therapy
Pet Assisted Therapy can be used as a tool in group therapy by providing elders with access to animals which in turn can increase social interaction amongst residents. Animals in shelters can get the much needed exercise and socialization they are lacking at the shelter by interacting with patients at the assisted living facilities who are lacking in the same areas. Firstly, Saylor (1998) pointed out that those in assisted living facilities experience loneliness, and the animals not only provide intrapersonal social benefits but also act as a liaison for interpersonal socialization by introducing a common topic among residents and nurses.. Residents can pet and talk to the animals alone or with others, and the animals can provide introductions and facilitate conversation between staff and other residents. Additionally, animals can encourage exercise in the older adults through playing, walking or grooming. These activities have been found to improve physiological and cognitive functioning (Cafiero & Maritz, 2006; Colcombe et al., 2006; Hinman & Heyl, 2002). Lastly, animals have the ability to evoke calmness and relaxation by regulating physiological functions such as heart rate, which can reduce feelings of anxiety and aid in sleep promotion (Stasi et al., 2004).
In closing, assisted living facilities have the opportunity to increase various aspects of well being in residents by implementing a range of activities. They have the ability to lower personal and governmental healthcare costs by providing low cost alternatives or compliments to medicine such as exercise, gardening and pet assisted therapy. These alternatives can increase physical and cognitive functioning, provide feelings of familiarity and independence and enhance socialization among facility residents.
 Psychological Well-being in Assisted Living Facilities
The aging population is increasing at a steady rate, thus requiring more assisted living facilities to be developed. However, this is not the only concern in regards to the aging baby boomers; the psychological well-being and mental health  of the elderly residents in assisted living facilities is an important area of research. Thus it is important to implement both home-like and cost-effective program and tools that influence residents’ psychological well-being. Because depression  is particularly prevalent among those who move into assisted living facilities, either because of loss of a spouse or illness, it is important to consider the areas that promote psychological well-being (Cummings, 2003) . Current research on psychological well-being of the elderly within assisted living facilities has focused on three specific issues:
- Social relations
- Group therapy
- Coping methods
 Social Relations
Having social relationships is an important aspect of life, one that may actually increase with age in terms of its role in and promoting psychological well-being (Barrett, Burge, Street & Quadango, 2007) . Social support itself provides better psychological well-being. It also provides a buffer against negative health outcomes
such as depression or cognitive impairment (Nicassio & Schanowitz, 2006). Therefore, having social relationships while living in an assisted living facility should be regarded as just as important as having relationships when living alone. Recent research on assisted living facilities questions which relationships are most salient and influential on the elderly, and how they may enhance the well-being its residents (Barrett et al., 2007) . Living in an assisted living facility may be difficult to understand because it is likely that the number of individuals one interacts with is confined to a select few; mainly other residents and staff members. Therefore, it may be difficult to adjust to living in a confined space with less individuals to interact with. Thus finding meaning within these new relationships may be challenging. Recent research claims that the most important relationships a resident has while living in an assisted living facility, are with staff members and other residents’ (Barrett et al., 2007) . Those who were socially integrated within the facility, demonstrating internal social relationships and positive feelings towards staff members showed better psychological well-being than those who were not (Barrett et al., 2007) . Specifically, these residents reported better quality of life, higher life satisfaction, and reports of feeling at home, therefore emphasizing the importance of relationships within the assisted living facilities (Barrett et al., 2007) . Other findings suggest that enjoyment during mealtime also predicts greater psychological well-being, in addition to social support, reciprocal relationships, and activities (Park, 2009; Street et al., 2007). These findings suggest that those who adjusted well to life in assisted living facilities display better psychological well-being. However, further research should focus on whether this is applicable only to those who can adapt well to new environments, and easily form new relationships.
The following video-clip discusses some characteristics of employees at Sunshine Villa Passion that demonstrates ways in which assisted living facilities can enhance psychological well-being through the relationships with staff.
 Group Therapy
Group therapy is another way to connect socially that seems to predicts psychological well-being because it combats isolation, loneliness, and allows residents to express their feelings about age-related issues (Cummings, 2003). Group therapy may be an important method of intervention to employ within assisted living facilities because it encourages meaningful interactions and communication with residents, as opposed to having individuals be passive during activities (Cummings, 2003). Group therapy is designed to engage and attract residents (Cummings, 2003). This form of group therapy is unique because it is not the type of therapy we would think of when hearing the term "group therapy." It is unique in the sense that it allows for participants to engage in therapy outside of the typical therapy session. For instance, group therapy involves increased engagement with the environment by attracting participants through . Therefore, this form of therapy may be extremely beneficial for psychological well-being because it allows participants to intellectually engage in discussion, but also in activities that require a degree of skill. Thus they are utilizing their brain and skills with the added benefit of seeking out relationships. Research demonstrates that it is not the amount of programs one attends but the perception residents have of the programs attended, and the level of social support they receive from them (Cummings, 2002). Therefore as researchers suggest, it is not simply about implementing programs for residents to do in assisted living facilities, but it is the quality of programs that involve utilization of skill and and provide support that enhance psychological well-being (Cummings, 2002).
 Coping Mechanisms
Various coping mechanisms produce different results in terms of well-being (Nicassio & Schanowitz, 2006). Meaning-based coping methods, which involve positive re-appraisal, religious beliefs, and revision of goals in response to life stressors such as moving into an assisted living facility, are associated with better psychological well-being (Nicassio & Shanowitz, 2006). More specifically, positive reappraisal is associated with better social relationships, better self-acceptance, and higher positive affect in regards to a better sense of overall well-being (Nicassio & Shanowitz, 2006). Therefore meaning-based coping methods may be a good explanation of positive emotional adjustment, and thus, should be implemented in some form, possibly by teaching residents types of coping methods, and when to use which methods. This should be done in assisted living facilities so that residents may have the right tools to adjust to a new life within an assisted living facility.
In conclusion, it is clear that there is an increasing need for assisted living facilities to develop interventions that promote, and enhance the psychological well-being of their residents. Recent research suggests several ways to do so. Social support, which may include development of social relationships with other residents and staff members, group therapy, or meaning-based coping strategies all provide ways to enhance psychological well-being for residents in assisted living facilities.
With the increased need of assisted living facilities as a result of the aging Baby Boomers it is important to consider factors that will increase quality of life in elderly residents. This can be achieved through making differential changes in a number of components of the assisted living facility. Important factors to consider are the overall design and location, activity programs and psychological interventions. These factors all contribute to enhanced psychological, emotional and physical well-being of residents.
 Notes and References
- ↑ 1.0 1.1 Huang, H. & Shanklin, C. (2008). An integrated model to measure service management and physical constraints’ effect on food consumption in assisted living facilities. American Dietetic Association, 108, 785-792.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Hatfield, J. (2003). A community for the elderly and assisted living. New Urbanistic Architecture, 1-43.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 Street, D., Burge, S., Quadagno, J., & Barrett, A. (2007). The salience of social relationships for resident well-being in assisted living. Social Sciences, 62, 129-134.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Cafiero, A.C., & Maritz, C.A. (2003). The impact of exercise on age-related physiological changes and pathological manifestations. Journal of Pharmacy Practice, 16(1), 5-14.
- ↑ 5.0 5.1 5.2 5.3 Kwack, H., Relf, P.D., & Rudolph, J. (2005). Adapting garden activities for overcoming difficulties of individuals with dementia and physical limitations. Activities, Adapatation & Aging, 29(1), 1-13.
- ↑ 6.0 6.1 Saylor, K. (1998). Pet visitation program. Journal of Gerontological Nursing, 24(6), 36-38.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Barrett, A., Burge, S., Street, D., Quadango, J. (2007). The salience of social relationships for resident well-being in assisted living. Journal of Gerontology: Social Sciences, 62B, 129-134.
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Cummings, S., M. (2003). The efficacy of an integrated group treatment program for depressed assisted living residents. Research on Social Work Practice, 13, 608-621.
- ↑ 9.0 9.1 9.2 Hoof, J. & Kort, H. (2009). Supportive living environments: A first concept of a dwelling designed for older adults with dementia. Sage, 8, 293-316.
- ↑ Someren, V., Kessler, A., Mirmiran, M., & Swaab, D.F. (1997). Also indirect bright light improves circadian rest-activity rhythm disturbances in demented patients. Biological Psychiatry, 41, 955-963.
- ↑ Remersma-van der lek, R., Swaab, D., Twisk, J., Holg, E., Hoogendijk, W., & Van Someren, E. (2008). Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: A randomized controlled trial. Jama, 299, 2642-2655.
- ↑ 12.0 12.1 Colcombe, S.J., Erickson, K.I., Scalf, P.E., Kim, J.S., Prakash, R., McAuley, E., … Kramer, A.F. (2006). Aerobic exercise training increases brain volume in aging humans. The Journals of Gerontology, 61A(11), 1166-1170.
- ↑ Gibson, G., Garuth, E.C., Clarke, P.D., & Sixsmith, A.J. (2007). Housing and connection to nature for people with dementia. Journal of Housing for the Elderly, 21(1-2), 55-72.
- ↑ Hinman, M.R., & Heyl, D.M. (2002). Influence of the Eden Alternative of the functional status of nursing home residents. Physical & Occupational Therapy in Geriatrics, 20(2), 1-20.
- ↑ Stasi, M.F., Amati, D., Costa, C., Resta, D., Senepa, G., Scarafioiti, C., … Molaschi, M. (2004). Arch Gerontol Geriatr Suppl, 9, 407-412.
- ↑ Park, N., S. (2009) <ref></ref>. The relationship of social engagement to psychological well-being of older adults in assisted living facilities. Journal of Applied Gerontology, 28, 461-481.
- ↑ 17.0 17.1 Cummings, S., M. (2002). Predictors of psychological well-being among assisted-living residents. Health & Social Work, 27, 293-302.
- ↑ 18.0 18.1 18.2 Nicassio, P. M., Schanowitz, J. Y. (2006). Predictors of positive psychosocial functioning of older adults in residential care facilities. Journal of Behavioral Medicine, 29, 191-201.