Long-term care communities can boost social engagement in older adults

A new study from the University of Colorado Anschutz Medical Campus finds that older adults become more socially active after moving into long-term care communities like nursing homes or assisted living facilities but we might not all benefit equally.

The study was published today in JAMA Internal Medicine.

Researchers analyzed data from more than 600 Americans aged 65 and older who moved into a nursing home or assisted living facility between 2011 and 2019 through the National Health and Aging Trends Study. The average participant was 85-years-old when they moved.

Long-term care communities can be an important source of help as we get older, but many are afraid of how moving to one could affect their social life. This made us want to look at the data to see what actually happens to social participation when people move."

Kenneth Lam, MD, lead author, assistant professor of geriatric medicine, University of Colorado School of Medicine

Researchers examined five aspects of social participation including visiting friends or family, going out for enjoyment, attending religious services, joining clubs or group activities and volunteering. Before moving into a facility, engagement in all five areas declined steadily. But after moving, participation in group activities rose by 15.6%, and attendance at religious services increased by 12.6%. Going out for enjoyment decreased by 14.1%.

"The overall picture is that people move after their world had already started to get smaller. Facilities provide structured social opportunities that residents may have struggled to access when they were living at home," said Lam. "These can include on-site religious services, clubs or organized events that can reduce isolation."

But the gains weren't shared equally. Participation remained lower among men and among, nursing home residents identifying as Black, Hispanic or other racial and ethnic groups. Women, by contrast, were more likely to maintain family and friend connections. They also began attending religious services after moving in. Nursing home residents were also less likely to go out for enjoyment or attend religious services.

"Facilities have the potential to be vibrant and inclusive communities," said Lam. "But access to those social opportunities is not evenly distributed."

Lam said social participation isn't just a preference. It's also a public health issue.

"Loneliness has been declared a national health crisis by the former U.S. Surgeon General. Despite the stigma facing long-term care communities, our study shows that they are a key part of the solution." he said. "But we need to do more to make sure that access is equitable and activity is meaningful."

The team hopes their findings will help families, care providers and policymakers think differently about long-term care. Patients and other participants in Lam's studies have told him that connection with others is more important than physical health. "That's what motivated this study. This is about dignity, quality of life and making sure that we help people live rather than just not die," said Lam.