Changing Children's Perceptions of the Elderly:

Non-familial intergenerational interventions and their impact on social and mental wellbeing of both younger and older people-A mapping review and evidence and gap map

Background

Opportunities for social connection between generations in the UK have diminished over the last few decades because of changes in the way that we live and work. The decline in communal spaces such as libraries, youth clubs and community centres mean that there are fewer opportunities to meet and mix socially with other generations outside our own families. Increased working hours, improved technology, changes in family patterns, relationship breakdowns within families and migration are also believed to be contributory factors to generation segregation. There are many potential economic, social and political impacts of generations living separate and parallel lives, for example, higher health and social care costs, an undermining of trust between generations reduced social capital, a reliance on the media to form understanding of others' viewpoints and higher levels of anxiety and loneliness. Intergenerational programmes and activities can take many forms and are delivered in many settings.  Evidence suggests that intergenerational activity can have a positive impact on participants, for example, in reducing loneliness and exclusion for both older people and children and young people, improving mental health, increasing mutual understanding and addressing important issues such as ageism, housing and care. There are currently no other EGMs that exist that address this type of intervention; however, it would complement existing EGMs addressing child welfare.

Objectives

To identify, appraise and bring together the evidence on the use of intergenerational practice, to answer the following specific research questions: What is the volume, nature and diversity of research on, and evaluation of, intergenerational practice and learning?What approaches have been used to deliver intergenerational activities and programmes that may be relevant to providing such services during and in the subsequent recovery from the COVID-19 pandemic?What promising intergenerational activities and programmes have been developed and are being used but have not yet been subject to formal evaluation?

Search Methods

We searched MEDLINE (via OvidSp), EMBASE (via OvidSp), PsycINFO (via OvidSp), CINAHL (via EBSCOHost), Social Policy and Practice (via OvidSp), Health Management Information Consortium (via OvidSp), Ageline (via EBSCOhost), ASSIA (via ProQuest), Social Science Citations Index (via Web of Science), ERIC (via EBSCOhost), Community Care Inform Children, Research in Practice for Children, ChildData (via Social Policy and Practice), the Campbell Library, the Cochrane Database of Systematic Reviews and the CENTRAL database between 22 and 30 July 2021. We searched for additional grey literature via the Conference Proceedings Citation Index (via Web of Science) and ProQuest Dissertation & Theses Global and via relevant organisation websites, for example, Age UK, Age International, the Centre for Ageing Better, Barnado's, Children's Commission, UNICEF, Generations Working Together, the Intergenerational Foundation, Linking Generations and The Beth Johnson Foundation) and the Ottawa initiative called Older Adults and Students for Intergenerational support.

Selection Criteria

Any intervention that brings older and younger people together with the purpose of interacting to achieve positive health and/or social and/or educational outcomes from any study design including systematic reviews, randomised controlled studies, observational studies, surveys and qualitative studies are included. The titles and abstracts, and later full texts, of records identified by the search methods were screened against inclusion criteria by two independent reviewers.

Data Collection and Analysis

Data extraction was undertaken by one reviewer and checked by a second with any inconsistencies identified and resolved through discussion. The data extraction tool was developed on EPPI reviewer and was modified and tested through stakeholder and advisor consultation, and piloting of the process. The tool was informed by the research question and the structure of the map. We did not undertake quality appraisal of the included studies.

Main Results

Our searches identified 12,056 references, after screening 500 research articles were included in the evidence gap map conducted across 27 countries. We identified 26 systematic reviews, 236 quantitative comparative studies (of which 38 were randomised controlled trials), 227 were qualitative studies (or had a qualitative element), 105 were observational studies (or had elements of observational methods) and 82 used a mixed methods approach. The outcomes reported in the research cover mental health (n = 73), physical health (n = 62), attainment and knowledge (n = 165), agency (n = 174), mental wellbeing (n = 224), loneliness and social isolation (n = 54), attitudes towards the other generation (n = 283), intergenerational interactions (n = 196), peer interactions (n = 30) and health promotion (n = 23) and including mutual outcomes such as the impact on community (n = 37) and perceptions on the sense of community (n = 43). Gaps in the evidence that were identified include: research that reports on mutual, societal and community outcomes of intergenerational interventions; more research on interventions classified as levels 1-4 and level 7 on the Intergenerational Engagement Scale, mental health, loneliness, social isolation, peer interactions, physical health and health promotion outcomes in children and young people; health promotion in older people; outcomes centred on care giver wellbeing, mental health and attitudes; economic outcomes; process outcomes and adverse or unexpected outcomes.

Authors’ Conclusions

Whilst a substantional amount of research on intergenerational interventions has been identified in this EGM, as well as the gaps identified above, there is a need to explore promising interventions not yet formally evaluated. Research on this topic is gradually increasing, and systematic reviews will be important to determine how and why interventions are or are not beneficial. However, the primary research needs to build more cohesively so that the findings can be comparable and avoid research waste. The EGM presented here will nevertheless be a useful resource for decision-makers allowing them to explore the evidence with regard to the different interventions that may be relevant to their population needs and the settings or resources available to them.

Intergenerational Programmes bringing together community dwelling non-familial older adults and children: A Systematic Review

BACKGROUND

Social isolation is associated with an increased risk of adverse health outcomes, including functional decline, cognitive decline, and dementia. Intergenerational engagement, i.e. structured or semi structured interactions between non-familial older adults and younger generations is emerging as a tool to reduce social isolation in older adults and to benefit children and adults alike. This has great potential for our communities, however, the strength and breadth of the evidence for this is unclear. We undertook a systematic review to summarise the existing evidence for intergenerational interventions with community dwelling non-familial older adults and children, to identify the gaps and to make recommendations for the next steps.

METHODS

Medline, Embase and PsychInfo were searched from inception to the 28^th Sept 2020. Articles were included if they reported research studies evaluating the use of non-familial intergenerational interaction in community dwelling older adults. PROSPERO registration number CRD42020175927 RESULTS: Twenty articles reporting on 16 studies were included. Although all studies reported positive effects in general, numerical outcomes were not recorded in some cases, and outcomes and assessment tools varied and were administered un-blinded. Caution is needed when making interpretations about the efficacy of intergenerational programmes for improving social, health and cognitive outcomes.

DISCUSSION

Overall, there is neither strong evidence for nor against community based intergenerational interventions. The increase in popularity of intergenerational programmes alongside the strong perception of potential benefit underscores the urgent need for evidence-based research.

An intergenerational program based on psycho-motor activity promotes well-being and interaction between preschool children and older adults: results of a process and outcome evaluation study in Austria

BACKGROUND

Limited evidence exists for intergenerational interventions to promote health and well-being in older adults and preschool children. We therefore aimed to evaluate the implementation, feasibility and outcome of an intergenerational health promotion program based on psycho-motor activity.

METHODS

A multicenter mixed-methods study with preschool children and older adults as equivalent target-groups, and professionals and parents as additional informants was conducted in Austria. The study included a needs assessment, a pilot phase with a formative process evaluation and a subsequent rollout phase to evaluate the outcome and the adapted processes of the intervention program. To analyze the qualitative data, a modified form of the framework method was applied. Quantitative data were collected with a time-sampling method and were analyzed using descriptive and inferential statistical procedures.

RESULTS

One hundred ninety-six participants (93 older adults [54 to 96 years old, 83% female], 78 children [2 to 7 years old, 58% female], 13 professionals and 12 parents) from 16 institutions (eight kindergartens and eight geriatric facilities) were included in the study. The qualitative process evaluation revealed several aspects for improvement of the intervention program. Well-being as measured by observing spontaneous intergenerational contacts (p < 0.001) and facial expressions (effect size r = 0.34; p < 0.001) showed a significant increase between the rollout baseline and follow-up assessments.

CONCLUSIONS

Professionals in geriatric institutions and kindergartens could facilitate interactions between members of the different generations by offering an intergenerational intervention program based on psycho-motor activities in the future.

The Portrayal of Families across Generations in Disney Animated Films

Disney animated films continue to serve as an influential form of media that shapes children’s development of beliefs about the world surrounding them, including the construct of the family. However, a census analysis as to how Disney animated films represent depictions of families has yet to be conducted. To fill this gap, we assessed the qualities of family demographics, structure, and function in a census analysis of 85 Disney animated films from the years 1937–2018. Results indicated that single parent families (41.3%) was the most predominantly represented family structure, followed by nuclear (25%) and guardian (19.2%). We also observed that the first depiction of a non-Caucasian family was presented in the 1990s, with a growing number of ethnically diverse families since that time. However, minimal interactions between families of differing ethnicities are noted. Overall, over 75% of all Disney animated films depicted warm and supportive familial interactions, with 78.8% of the films illustrating a positive relationship between the protagonist and his/her family. Analysis and implications are offered for parents and educators who wish to further understand the content Disney animated films offer in depicting families.

Stereotypes and attitudes toward older people among children transitioning from middle childhood into adolescence: Time matters

Ageism is fueled by stereotypes and negative attitudes about aging and older adults, which can lead to individual-level prejudice and discrimination. Through survey methodology, this study explored stereotypes and ageist beliefs of youth transitioning from middle childhood into adolescence (age 11-13 years) (N = 69) in the southwest of England. The results indicate that positive more than negative stereotypes were acknowledged, and more positive stereotyping was positively correlated with more positive attitudes toward older adults. Contact with older adults and age that one considers "old" were significant in predicting attitudes toward older people. The results suggest that time matters, in terms of contact with an older adult and time to reach "old age" in shaping youths' attitudes and stereotypes. Intergenerational and educational programs that seek to address aging myths and increase contact between youth and older adults are discussed as ways to improve attitudes amongst youth transitioning from middle childhood into adolescence.

Intergenerational programs for persons with dementia: a scoping review

Participation in intergenerational programs can have a positive impact on quality of life and well-being across age groups. We sought to examine the characteristics, goals, and outcomes of intergenerational programs for persons with dementia and children or youth. Six hundred and seventy-nine unique abstracts were identified through a search of 7 medical databases, 16 social science databases, 2 gray literature databases, and other sources. Twenty-seven articles met criteria for review. Articles must have gathered information on program design, goals, outcomes, or participants' perceptions. Overall, 3 themes emerged: program design, outcomes for child or youth participants, and outcomes for persons with dementia. Music, arts-based, and narrative programs were most common. Outcomes include effects on perceptions of aging and dementia, behavior, mood, engagement and sense of self. The use of qualitative and quantitative data, as well as descriptive articles, provided a richer picture of the relational features of intergenerational programs to emerge. The type of program had less of an impact on positive outcomes than if the activity was meaningful for participants and supported shared opportunities for relationship building and growth. The relationship-based skill set and scope of social work practitioners provides opportunity for the development, facilitation, and evaluation of intergenerational programs. The difficulties of establishing best practices due to methodological challenges and implications for further research are presented.

Cross-group friendships and intergroup attitudes: a meta-analytic review

This work identifies how cross-group friendships are conceptualized and measured in intergroup research, investigates which operationalizations yield the strongest effects on intergroup attitudes, explores potential moderators, and discusses the theoretical importance of the findings. Prior meta-analyses have provided initial evidence that cross-group friendships are especially powerful forms of intergroup contact. Although studies of cross-group friendship have grown considerably in recent years, varied assessments leave us without a clear understanding of how different operationalizations affect relationships between friendship and attitudes. With a greatly expanded database of relevant studies, the authors compared friendship-attitude associations across a wide range of specific conceptualizations. Time spent and self-disclosure with outgroup friends yielded significantly greater associations with attitudes than other friendship measures, suggesting that attitudes are most likely to improve when cross-group friendships involve behavioral engagement. Processes underlying cross-group friendships are discussed, as are implications for future research and application.

Sentence Completion to Assess Children's Views About Aging

PURPOSE

Sentence completion exercises require students to give open-ended responses to prompts. The first purpose of this article is to describe the method of sentence completion to assess middle-school children's attitudes and beliefs about aging. The second purpose is to describe the patterns of characteristics that children associate with aging.

DESIGN AND METHODS

Two middle schools in San Antonio, TX agreed to have their students participate in the sentence completion exercises at the beginning of the 1998-1999 school year. Teachers asked students to write responses to the following prompts: "Old is.," "You know you are old when.," "You know your parents are old when.," "When I am old, I.," and "Old people." We coded the responses for their characteristics and whether they were positive, negative, or neutral.

RESULTS

Of the 2,476 students, 1,874 (75.6%) wrote responses to at least one prompt. Overall, we collected 3,700 responses and coded 9,438 characteristics (2.6 characteristics per response). The most common characteristics of aging were having wrinkles (21.1%), having gray hair or being bald (20.0%), and being less active (17.5%). Students had a much more positive view of their future (55.4%) compared with their view of aging elicited by the other prompts (range of 4.9-25.7% positive responses). Students infrequently associated old age with specific conditions; only 4.6% mentioned diseases, 6.0% mentioned being ill or taking medications, and 5.7% mentioned sensory problems.

IMPLICATIONS

Middle-school students view their futures much more positively than the changes they observe in their parents and other elders. Students infrequently identified specific diseases or impairments as responsible for the changes they observe with aging. These observed responses provide a starting point for educators to develop and deliver gerontologically based materials that teach about healthful habits to maintain independence across a life span.