Long-term effects of an intergenerational program on functional capacity in older adults: Results from a seven-year follow-up of the REPRINTS study
Introduction
In several developed countries, including Japan, the growing aged population and low birthrate is a critical social issue; the economic burden on the younger generation due to the expected growth of the older generation’s welfare and healthcare costs is immense. Early support is necessary to help older adults maintain functional health, reducing the need for long-term healthcare (e.g., bedridden individuals). Thus, developing an effective and sustainable program for health promotion among older adults is an important global issue.
Regarding functional health in older adults, previous studies have suggested that social engagement, such as community volunteer activities, may positively contribute to maintaining/improved health status (Antonucci, Fuhrer, & Dartigues, 1997; Arbuckle, Gold, Andres, Schwartzman, & Chaikelson, 1992; Fried et al., 2004). Experience Corps®—designed to train and place volunteers in participating elementary schools for an academic year during which time they assist teachers in grades kindergarten-third grade with literacy and library functions—is one good example (Fried et al., 2004). Experience Corps® was associated with improved risk factors of increased physical, cognitive, and social activities and generative fulfillment (Barron et al., 2009, Carlson et al., 2008, Fried et al., 2004, Glass et al., 2004, Tan et al., 2006); and Experience Corps® participants reported fewer functional limitations after 2 years of participation in the program, compared to controls (Hong and Morrow-Howell, 2010). Furthermore, children whose schools were randomly selected for Experience Corps® had significantly higher scores on a standardized reading test than children in the control schools (Rebok et al., 2004). These results indicate that an intergenerational program has the potential of maintaining/improved older adults’ health status as well as improving the academic success of young children.
In older adults, maintaining functional capacity is critically important for independent living. Functional capacity consists of three subscales based on Lawton’s model (1972) that categorize stages of competence from the most basic functions to the most advanced: Instrumental Activities of Daily Living (IADL, i.e., instrumental self-maintenance), intellectual activity, and social function (Lawton, 1972). Older adults need to maintain intellectual activity and social function for general health because these decline with advancing age, prior to reduced IADL (Fujiwara et al., 2003a, Fujiwara et al., 2003b). Effective intergenerational programs which could be designed to provide older adults with generative roles that help children grow up may be meaningful for older adults’ functional capacity. With this theoretical background, we launched “REPRINTS” (Research of Productivity by Intergenerational Sympathy) in 2004, an intergenerational program that focuses on increasing intellectual activity and social function (Fujiwara et al., 2006).
Health promotion efforts for older adults must meet social policy in the creation of meaningful service programs for older adults on a large social scale (Fried, Freedman, Endres, & Wasik, 1997). REPRINTS involves engaging older adults in reading picture books to kindergarten and elementary school-aged children, with the expectation that it will maintain/improve their functional capacity, social networks (e.g., with friends and children), and physical/psychological functioning as well as healthy upbringing of children. REPRINTS has demonstrated relatively short-term interventional effects (within three years) on grip strength (Fujiwara et al., 2006), social network (e.g., frequency of interchange with grandchildren) (Fujiwara et al., 2009b), subjective health (Fujiwara et al., 2009b) and sense of coherence (Murayama et al., 2015) among older adults, and on stress reduction for school children (Takeuchi et al., 2012). However, these studies have not reported interventional effects on functional capacity because participants in both the REPRINTS and control group were extremely healthy, and there were negligible differences in their functional capacities. This suggests that long-term follow-ups that amplify aging-related individual differences could help accurately determine whether REPRINTS helps maintain/improve functional capacity in older adults.
The present study investigated the long-term effects of REPRINTS, focusing on functional capacity and physical function. We conducted a follow-up for REPRINTS and observation group (i.e., control-group) participants after seven years. At the baseline and follow-up assessments, participants were examined for functional capacity using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) (Koyano, Shibata, Nakazato, Haga, & Suyama, 1991), a questionnaire comprising three subscales that measure older adults’ functional capacity: IADL, intellectual activity, and social function. We also measured physical functioning, and psychological and social variables.
Section snippets
Participants
The study protocol was similar to a previous study (Fujiwara et al., 2006, Fujiwara et al., 2009b, Murayama et al., 2015). Both the REPRINTS and control-group participants were community-dwelling older adults recruited from three types of areas—urban (Chuo Ward, Tokyo), suburban (Kawasaki city, Kanagawa), and rural (Nagahama city, Shiga)—from 2004 to 2006, through community newsletters and meetings. Control-group participants were only administered annual assessments. We included participants
Participants’ transition and its characteristics
During the 7-year intervention period and follow-up, 54 REPRINTS participants and 64 control-group participants declined participation due to health problems (chronic disease aggravation, onset of Alzheimer’s disease, death), schedules, relocation, and personal reasons (e.g., caring for family). Participants who changed groups (i.e. those who changed from the REPRINTS to the control group and from the control to the REPRINTS group), REPRINTS participants who did not regularly engage in
Discussion
The present study aimed at examining the long-term effects of an intergenerational program on older adults, focusing on functional capacity and physical function. The results showed that, compared to the REPRINTS group, the control group had higher odds for developing intellectual activity impairments and was less likely to interact with neighborhood children at the 7-year follow-up, regardless of baseline status. This indicates that REPRINTS participants’ intellectual activity and active
Conclusion
Our results show that the REPRINTS intergenerational program, that involves reading picture books to children, facilitates the maintenance of intellectual activity by fostering cognitive vitality, physical functioning, and intergenerational exchange which may also contribute to children’s growth. This indicates the importance of developing intergenerational social engagement program in older adults to help maintain their functional health, as well as to promote healthy child growth and
Conflict of interest
The authors have no conflicts of interest to report.
Acknowledgements
This study was supported by Health Labour Sciences Research Grant (Comprehensive Research on Aging and Health H16-Choujyu-031; H23-Ninchisho-Ippan-001); Mitsui Sumitomo Insurance Welfare Foundation Research Grant; Nippon Life Insurance Foundation Research Grant; and Tokyo Metropolitan Institute of Gerontology Grant for Annual Studies (2004–2014).
The authors thank members of the REPRINTS project team for their support: Taiko Ueda and Yukiko Kumagai (instructors of REPRINTS program), Tomoya
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