A pragmatic trial of a group intervention in senior housing communities to increase resilience.

Emily B H Treichler, Danielle Glorioso, Ellen E Lee, Tsung-Chin Wu, Xin M Tu, Rebecca Daly, Catherine O'Brien, Jennifer L Smith, Dilip V Jeste

Journal: International psychogeriatrics 2021;32(2):173-182

PMID: 32017867

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Abstract

BACKGROUND

Aging is associated with numerous stressors that negatively impact older adults' well-being. Resilience improves ability to cope with stressors and can be enhanced in older adults. Senior housing communities are promising settings to deliver positive psychiatry interventions due to rising resident populations and potential impact of delivering interventions directly in the community. However, few intervention studies have been conducted in these communities. We present a pragmatic stepped-wedge trial of a novel psychological group intervention intended to improve resilience among older adults in senior housing communities.

DESIGN

A pragmatic modified stepped-wedge trial design.

SETTING

Five senior housing communities in three states in the US.

PARTICIPANTS

Eighty-nine adults over age 60 years residing in independent living sector of senior housing communities.

INTERVENTION

Raise Your Resilience, a manualized 1-month group intervention that incorporated savoring, gratitude, and engagement in value-based activities, administered by unlicensed residential staff trained by researchers. There was a 1-month control period and a 3-month post-intervention follow-up.

MEASUREMENTS

Validated self-report measures of resilience, perceived stress, well-being, and wisdom collected at months 0 (baseline), 1 (pre-intervention), 2 (post-intervention), and 5 (follow-up).

RESULTS

Treatment adherence and satisfaction were high. Compared to the control period, perceived stress and wisdom improved from pre-intervention to post-intervention, while resilience improved from pre-intervention to follow-up. Effect sizes were small in this sample, which had relatively high baseline resilience. Physical and mental well-being did not improve significantly, and no significant moderators of change in resilience were identified.

CONCLUSION

This study demonstrates feasibility of conducting pragmatic intervention trials in senior housing communities. The intervention resulted in significant improvement in several measures despite ceiling effects. The study included several features that suggest high potential for its implementation and dissemination across similar communities nationally. Future studies are warranted, particularly in samples with lower baseline resilience or in assisted living facilities.

Address: Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA.; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, San Diego, CA, USA.; Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, San Diego, CA, USA.; Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA.; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, San Diego, CA, USA.; Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA.; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, San Diego, CA, USA.; VA San Diego Healthcare System, San Diego, CA, USA.; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, San Diego, CA, USA.; Department of Mathematics, University of California San Diego, La Jolla, San Diego, CA, USA.; Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA.; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, San Diego, CA, USA.; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, San Diego, CA, USA.; Mather Institute, Evanston, IL, USA.; Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA.; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, San Diego, CA, USA.; Department of Neurosciences, University of California San Diego, La Jolla, San Diego, CA, USA.

DOI: 10.1017/S1041610219002096

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MeSH Terms: Adaptation, Psychological, Aged, Aged, 80 and over, Cognitive Behavioral Therapy, Female, Healthy Aging, Housing for the Elderly, Humans, Independent Living, Male, Psychiatric Status Rating Scales, Psychotherapy, Group, Quality of Life, Resilience, Psychological, Self Report, Stress, Psychological, United States