Background: Interventions to support a more “age friendly” world is a key objective set out by the World Health Organisation with health and wellbeing benefits being increasingly identified for both young and old. Intergenerational programs are designed to provide meaningful activities that are mutually beneficial and foster cooperation, interaction and exchange between two or more generations (Kaplan & Sánchez, 2014). Cohen-Mansfield and Jensen (2017) further described intergenerational programs as social vehicles that were designed to share knowledge, skills, and experiences between two or more generations. Whilst multiple studies have explored intergenerational engagement between kindergarten aged children and older people (Giraudeau & Bailly, 2019), there is limited knowledge of program design and the potential impact that intergenerational programs have on adolescents engaging with older people in the residential aged care setting. To address these gaps, we have engaged with Catherine McCauley College and Mercy Health to support the development, implementation and evaluation of an intergenerational program (iGEN) engaging adolescents and older people in the residential aged care setting in regional Victoria. In this report we present the following: In this report we present the findings from our research over the past two years inclusive of the following phases: a) A mixed studies systematic review exploring the delivery and impact intergenerational programs; b) Building consensus on intergenerational program design for adolescents and older people living in residential aged care: a Delphi study; c) A qualitative descriptive study exploring the impact of iGEN on adolescents and older people in the residential aged care setting; d) A mixed methods pre-post exploratory study exploring Intergenerational engagement between adolescents and older people in a residential care facility in regional Australia.

An overview of each phase of research and their findings are provided below:

1. Exploring the delivery and impact intergenerational programs: a mixed studies systematic review

Aims The aims of the systematic review were to: a) examine intergenerational program development and delivery in the residential aged care setting b) report on the impact of intergenerational engagement on adolescents and older people. Design Convergent qualitative synthesis design. Data source MEDLINE, CINAHL, Embase, PsycINFO, Scopus and ERIC (1995 and 2021) and reference lists were hand-searched. Results Ten studies were identified for review (six qualitative studies, two quantitative studies and two mixed methods studies). Inconsistencies in the inclusion criteria for older people limited opportunities to explore the benefits for people with or without dementia. Few studies described the process of program design and there were wide variations in program delivery. Programs ranged from six weeks to eight months with a variety of activities and interactions implemented. Engaging in intergenerational programs resulted in improved wellbeing and perceptions of social inclusion, and reduced ageism. No correlations between program design and impact were identified.

1. Building consensus on intergenerational program design for adolescents and older people living in residential aged care: a Delphi study

Aim: The aim of this study was to use Delphi methods to build consensus amongst experts regarding the content of pre-education sessions for adolescents and the ongoing supports needed for both adolescents and older people during the iGEN program. Design: A three round modified Delphi method was utilised in this study (Dalkey, 2017; Eubank et al., 2016), involving two rounds of questionnaires using the online survey tool, Qualtrics and one face-to-face discussion (Fruijtier et al., 2019; Lafave, Katz, & Butterwick, 2008). Setting: One residential aged care facility catering to 120 older people in regional Australian aged care and one secondary school in regional Victoria. Participants: A non-probability purposive sample of 18 participants were invited to participate in an expert. Findings: The expert panel reached consensus on nine key areas related to the risks and benefits of engaging in the iGEN program for both adolescents and older people along with the relevant pre-education and ongoing supports required. Pre-education components and ongoing support resources were identified for the following key areas: 1) adolescent and older peoples’ emotional and psychological development; 2) community engagement and desire to engage or not engage in iGEN; 3) opportunities for career development; 4) insight into the residential aged care setting; 5) respectful interactions in intergenerational engagement; 6) communicating with older people; 7) understanding of ageing and disease processes; 8) exposure to death and dying; and 9) standard safety procedures.

1. Influence of intergenerational engagement between adolescents and older people in the residential aged care setting: a qualitative descriptive study

Aim: The aim of this qualitative descriptive study was to explore the influence of an intergenerational program (iGEN) engaging adolescents with older people at a residential aged care facility in regional Victoria. Intervention: Adolescents visited older people at the residential aged care facility, however face-to-face contact needed to cease after the first six sessions due to the Covid-19. For the remaining six weeks, the program pivoted to virtual engagement via video conference, letter writing. Design: Descriptive qualitative study. Separate focus groups and interviews were undertaken with adolescents and older people in addition to teachers, residential aged care staff and parents following the iGEN program completion. Setting: One residential aged care facility catering to 120 older people in regional Australian aged care and one secondary school in regional Victoria. Participants Two focus groups and four semi-structured interviews were undertaken. The first focus group consisted of Year 10 students (aged 15-16 years) (n=6). The second focus group consisted of: teachers (n=3), residential aged care workers (n=3), and parents of students engaged in iGEN (n=2). Older people living in the residential aged care facility (n=4), including one person with dementia took part in individual interviews. Findings: Benefits for both adolescents and older people were identified including positive changes at the intrapersonal level for both adolescents and older people including enhanced mood, enhanced sense of purpose and enhanced sense of self. Wider institutional benefits were also identified, including enhanced person-centred care. It was also evident that adolescents gained confidence engaging with older people, resulting in enhanced engagement in the broader community and a reduction in ageist and ableist stereotyping. These findings provide early insights into the value of intergenerational programs to support a transformative shift in how younger generations engage with older people with high levels of dependency.

1. Intergenerational engagement between adolescents and older people in a residential care facility in regional Australia: a pre-post mixed methods exploratory study

Aim: The aim of this pre-post mixed methods exploratory study was to explore the impact of an intergenerational program (iGEN) on adolescents and older people in a residential care facility in regional Australia. In this study we evaluated individual outcomes for adolescents, their parent representative and older people living in residential aged care including: age stereotyping, empathy, perception of aged care work and career identity formation as well as community and societal outcomes such as community connectedness and place identity. Intervention: Adolescents engaged in ten face-to-face sessions, before transferring to virtual engagement on a few occasions and letter writing. Study Design: A convergent mixed methods design. Setting: one residential aged care facility and one secondary school in regional Victoria. Participants: There was a 67% response rate for adolescents (n=37) and 80% for parents (n=40) for the survey. Qualitative responses in the surveys were completed by parents and adolescents pre and post iGEN and adolescents (n=30) completed journal entries during iGEN. Adolescents (n=8) participated in one focus group post-iGEN. Older people living in residential aged care participated in semi-structured interviews pre (n=8) (Male n=3; Female n=5), and post interviews (n=6) engagement in iGEN (Male n=3; Female n=3), including one female with a formal diagnosis of dementia. Results/Findings: Six themes were identified: “stereotyping on the basis of age”; “valuing intergenerational engagement”; “empathy and intergenerational understanding”; “community connection and support”; and “perceptions of aged care work”. Conclusion: Adolescents and their parent representatives held positive perceptions of older people before and after iGEN. Some older people had more negative old age perceptions and these remained unchanged after their engagement in iGEN. Adolescents experienced increased empathy and understanding of older people and valued opportunities to develop their skills communicating and engaging with people with dementia and adjusting their behaviour and communication to support engagement with older people who had physical impairments. Older people reported feelings of isolation and disconnection from the community and engaging in iGEN provided them with a greater sense of community. Adolescents entered iGEN with strong preconceptions about their career preferences, and although these preferences were largely unchanged following engagement, however some adolescents reported that they were surprised by the variety of career opportunities in aged care. Engagement in iGEN was confirmatory for those adolescents who were considering aged care and healthcare as a potential career choice.

Summary: The findings from the systematic review and the two primary studies identified that intergenerational engagement between older people and adolescents is an important area of interest with positive socio-emotional impacts identified for both adolescents and older people that potentially have broader workforce and societal implications. Based on these findings, it is evident that as a society we need to re-consider aged-based divisions and continue to explore the potential of interventions designed to enable intergenerational connections.