Review articleIntergenerational communities: A systematic literature review of intergenerational interactions and older adults’ health-related outcomes
Introduction
Demographic aging, as a result of the decline in fertility rates and the increase in life expectancy, has brought serious economic and health challenges. The population of 65 years and over in the US is estimated to almost double from 47.6 million in 2015 to 86.5 million in 2050, corresponding to an increasing share of the total population from 14.8% to 22.2% (United Nations, 2015). Aging in place, “the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level” (Centers for Disease Control and Prevention, 2009), is an increasingly popular concept to respond to these challenges and trends. As aging takes place within one's physical and social contexts, interdependence and intergenerational solidarity are particularly important for supporting aging in place, promoting active lifestyles in old age, and reducing negative aging stereotypes (i.e. ageism), loneliness, and social isolation.
Ageism, first introduced by Robert Butler, refers to a typically negative aging stereotype that includes prejudicial attitudes or discriminatory practices against older populations (Butler, 1980). Experiencing ageism has been shown to be associated with poor mental health among older adults (Lyons et al., 2018). Studies also suggested that positive self-stereotypes of aging improved memory and cognitive performance (Levy, 1996), reduced cardiovascular stress (Levy et al., 2000), decreased the mortality risk (Kotter-Gruhn et al., 2009; Sargent-Cox et al., 2014), and increased the average lifespan of approximately 7.5 years (Levy et al., 2002).
According to the widely accepted human motivation theory (Maslow, 1943), social relationship/interaction represents one of the universal human needs. Humans are social creatures and inherently search for social interactions with others across lifespans. In most cases, social networks or relationships decrease as people age, making aging populations more vulnerable to loneliness and social isolation (Antonucci et al., 2014). Older adults living alone are more likely to be socially isolated. As of 2018, approximately 28% (14.3 million) of community-dwelling older adults of 65 years or older lived alone in the US, including 9.5 million of older females and 4.8 million of older males (Administration for Community Living, 2018). Furthermore, the percentage of aging populations living alone increases with age (e.g. females of 75 years or older living alone accounted for 44% in 2018) (Administration for Community Living, 2018).
Increasing empirical evidence demonstrates that loneliness and social isolation are significant risk factors for poor health and premature mortality in old age (Ong et al., 2016). Steptoe, Shankar, Demakakos, and Wardle (2013) reported that loneliness and social isolation were positively correlated with mortality among the older participants in their study. Coyle and Dugan (2012) indicated that social isolation was correlated with lower perceived health conditions, and loneliness was associated with increased odds of reporting mental health problems. Another study by Theeke (2010) revealed that loneliness was linked to decreased exercise as well as increased chronic illnesses, depression, and nursing home stays among older adults.
Many studies indicate the significance of an age-friendly community (i.e. a place with supportive social and physical environments that can encourage residents of all ages to actively age in place) in promoting and maintaining older adults’ health (Nieboer and Cramm, 2018; Tiraphat et al., 2017; World Health Organization, 2007). An intergenerational community is a type of age-friendly communities with a particular emphasis on social and physical environments supporting social interactions, exchange, and cooperation across different generations (Generations United, 2016; Lee and Zhong, 2019). Building intergenerational communities has also been popularly promoted as a way to promote aging in place. Examples of initiatives by American Association of Retired Persons (AARP) and Generations United showed strong potential for such communities to help fight against ageism and social isolations and therefore leading to promote aging in place (AARP, 2015; Lee and Zhong, 2019).
Empirical evidence on the impacts of intergenerational communities, especially their physical environmental features, on older adults’ health-related outcomes is sparse. Current efforts on intergenerational communities (e.g. Bridge Meadows in Portland, Oregon) focus more on assessing the intervention effects of supportive services or programs (e.g. art or reading classes) designed to foster the relationship building and interactions across different generations (Eheart et al., 2009). Many researchers have also recognized intergenerational interactions as key contributors to reducing ageism (Belgrave, 2011; Burnes et al., 2019). Furthermore, intergenerational interactions are important for reducing social isolation (Nicholson and Shellman, 2013), promoting health (Gruenewald et al., 2016; Hong and Morrow-Howell, 2010), and increasing social and physical activities (Parisi et al., 2015; Tan et al., 2009) among older adults.
Despite the growing interest in intergenerational communities and intergenerational interactions, only a small number of review studies have synthesized the status of knowledge about their specific benefits (Gualano et al., 2018; Knight et al., 2014). One systematic review paper focused on reviewing studies examining intergenerational program interventions (Canedo-Garcia et al., 2017). This review concluded that intergenerational programs with more empirically based interventions led to the greatest effectiveness, measured by calculating the standardized difference of the means between the control and intervention groups or between the pre- and post-intervention outcomes (e.g. ageism and older adults’ generativity and psychological well-being). We also found a scoping review that focused on people with dementia and summarized benefits of intergenerational programs on their sense of self, active behavior, mood (e.g. decreased anxiety), and social engagement (Galbraith et al., 2015). No review studies are available to provide a systematic and comprehensive review of the empirical studies addressing health benefits of participating in intergenerational interactions/activities.
In this systematic review, we synthesize the studies investigating the correlations between intergenerational interactions and older adults' health-related outcomes. Going beyond the scope of previous reviews on intergenerational interactions, this review considers the social interactions of older adults with different age groups (e.g. children, young adults) and includes multiple health-related outcomes important for older adults. This study aims to provide a comprehensive examination of the significant roles of intergenerational interactions in promoting older adults’ health outcomes and behaviors. By providing a systematic and critical review of the current state of knowledge on this topic, this review aims to assist researchers, practitioners, and policymakers with their efforts toward creating intergenerational and age-friendly communities as a way to cope with the many challenges of aging societies.
Section snippets
Eligibility criteria
First, we selected studies focusing on intergenerational interactions and older adults' health-related outcomes that had (a) older adults aged 50 and over as the study population, (b) intergenerational interactions with nonfamily members as independent variables, and (c) older adults’ health-related outcome variables. We used 50 years as the age threshold in this study to be inclusive as a comprehensive review study and also because this threshold is used by major aging service organizations
Identification of studies
The literature selection and data extraction results between the two reviewers were mostly consistent, with less than 1% of disagreements in the title, abstract, and full-text sorting results; less than 5% in the quality assessments; and less than 2% in the extracted records. The discrepancies identified were mostly minor, such as missing confounding/control variables, and resolved through consensus discussions between the two reviewers.
Fig. 1 shows the literature search and selection process,
Discussion
This systematic literature review showed solid evidence that program-based intergenerational interactions can bring significant health-related benefits to older adults. Social interactions with young children (kindergarten to third graders) showed the most significant and the broadest range of health benefits for older adults, covering physical health, psychosocial health, cognitive function, social relationships, physical activity, and social activity. In addition, one study indicated a
Conclusions
This review provided solid evidence supporting the significance of program-based interventions in promoting intergenerational activities and associated health benefits. It also identified several major knowledge gaps, including the lack of studies examining intergenerational interactions beyond those related to program-based activities and those that are part of one's daily routines and are location-specific (destination-derived). Such studies can contribute to creating intergenerational
Declaration of competing interest
None.
Acknowledgment
This research was supported by a fellowship from Texas A&M University and another fellowship from the American Institute of Architects' Design for Aging Knowledge Community. We thank the senior editor, Professor Catherine Panter-Brick, and four anonymous reviewers for their valuable comments during the revision process.
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