Perceptions of Senior Center and Psychosocial Wellbeing During COVID-19

ABSTRACT

With the globally aging population, neighborhood senior activity centers (SACs) provide a platform for older adults to remain active and socially connected to the community, maintaining psychosocial wellbeing for successful aging. We studied perceptions and participation of members from a neighborhood SAC, their psychosocial wellbeing and living experiences during the COVID-19 pandemic. We adopted a sequential mixed-methods study design: 49 members of a SAC, aged ≥ 60, were recruited, and 13 of them were subsequently selected for focus group discussions. Participants revealed that the center and its programs provided them with opportunities to learn something new, occupy time meaningfully, receive care and support, engage with others and increase social interaction, especially through health-related programs. Majority of participants felt increased social isolation with COVID-19 restrictions, due to increased restrictions, boredom, fear and reluctance in engaging in programs outside of their homes. Our quantitative results suggest no associations between frequency of participation in center’s programs and psychosocial wellbeing. Nevertheless, the center appears to play an important role in improving psychosocial wellbeing, providing structure and social engagement among older adults in the community.

KEYWORDS:

• psychological wellbeing
• social network
• community-dwelling
• senior center
• older adults

Introduction

According to the World Health Organisation (WHO), the world’s population aged 60 years and over is projected to increase from 12% to 22% between 2015 and 2050 (World Health Organisation, 2021). This global phenomenon of an aging population raised the importance to support older adults to “age in place” within their local neighborhood and communities (Wiles et al., 2012). The WHO active aging framework accelerates a paradigm shift from viewing older adults as passive recipients of care to active participants and contributors in the society (World Health, 2002). Different community supports have evolved to empower and support older adults to age in place (Jeste et al., 2016). These include community senior centers which provide recreational and social programs and/or promote healthy behaviors and wellbeing (Song et al., 2017).

Senior centers offer a wide range of recreational, educational, health support and social networking opportunities to their local communities, making them one of the most widely utilized resources for older adults (Siegler et al., 2015). These centers provide a wealth of volunteer opportunities, social programs, and classes and services aimed at promoting overall well-being. By facilitating socialization, senior centers can help increase social integration and engagement, thereby reducing isolation and loneliness (Aday et al., 2019; Marquet et al., 2020; Kim & Kim, 2021). As the number of older adults continues to rise, senior centers will play an important role in reaching and supporting this demographic by providing opportunities for educational, exercise classes, and volunteer initiatives.

In Singapore, under the purview of the Ministry of Social and Family Development (MSF), the “Many Helping Hands” policy approach offers physical spaces for Voluntary Welfare Organisations or nonprofits to provide community-based recreational, social and be-friending services for older adults in living in rental or studio apartment-type public housing (Liu et al., 2015; Subramaniam et al., 2019). In April 2018, MSF transferred oversight of these senior activity centers (SACs) to the Ministry of Health (MOH) (Ministry of Health, 2018). The transfer of oversight presents the opportunity to integrate the active aging, befriending, and care and support services that these operators provide with that of the other eldercare centers under MOH’s purview that offer rehabilitative, supportive and care services for older adults who need more formal care support to age in place (Ministry of Health, 2020). Under the Health Ministry’s purview, more physical sites for SACs, also recently referred to as Active Ageing Centers (AACs), are being offered to operators, extending the reach to older adults beyond those living in rental or senior studio apartments (Ministry of Health, 2021).

Successful aging is a multidimensional construct including not only physiological but also psychological and social domains (Teo et al., 2019). Psychological and social determinants play addictive and complementary role to biological factors in preserving functional health in old age (Teo et al., 2019). Psychological wellbeing is associated positively with both short- and long-term health outcomes, including quality of life, lower morbidity and mortality and decreased pain (Howell et al., 2007; Pressman & Cohen, 2005). With age, social connections, participation and sense of belonging to a community become critical, for better function, self-esteem and satisfaction, lower depressive symptoms and mortality (Menec, 2003; Michèle et al., 2019). Socially connected individuals are also more likely to adopt healthy behaviors such as adherence to medical treatments, as well as participation in physical and mentally stimulating programs (Huppert et al., 2004; undefined). It is hence imperative for SACs/AACs to consider psychosocial wellbeing of older adults in the community.

Despite the growing amount of literature on the feasibility and effectiveness of senior center-based health interventions on physical and cognitive health and wellbeing (Liu et al., 2019, 2020; Ng et al., 2021; Tou et al., 2021; Yeo et al., 2021), few studies have investigated the perceptions of older adults toward senior centers and its programs on wellbeing. In addition, the COVID-19 pandemic has been a global challenge, especially for older adults due to increased vulnerability of COVID-19-related death (Calderón-Larrañaga et al., 2020; Wu & McGoogan, 2020). With the introduction of general physical distancing policies to curb the spread of COVID-19, extra containment measures implemented in senior centers, such as restricted programs and visiting arrangements, may impact older adults disproportionately (Orsega-Smith, Beiman & Wolfle, 2022), amplifying existing issues plausibly present in older adults including loneliness and anxiety (Lebrasseur et al., 2021). Therefore, insights into the unique lived experiences of older adults during the COVID-19 pandemic can inform the initiatives and practice of SAC/AACs.

This exploratory study involves the membership of a single SAC within a public housing estate in Singapore. We evaluated the perceptions and participation of members in the center’s initiatives, their psychosocial wellbeing, and their living experiences during the COVID-19 pandemic.

Materials and methods

Study design

The exploratory evaluation adopted a sequential mixed methods design (Table 1).

Table 1. Sequential Mixed Methods Research Approach.

	Quantitative followed by Qualitative studies
1. Quantitative	Quantify the nature and participation at senior center, and explore its relationship with the psychosocial well-being of participants (n = 49)
2. Qualitative	Gather insights on the perceptions and attitudes toward the center including the implementation of COVID-19 restrictions (n = 13, subset of participants from quantitative study with different frequencies of attendance at the center)

Quantitative followed by qualitative research methods were used to collect related information through a survey administered in-person at the center and in-depth qualitative online interviews with older adults. When used in combination, quantitative and qualitative methods complement each other and allow for a more robust analysis, taking advantage of the strengths of each (Ivankova, Creswell & Stick 2006).

Ethical approval was obtained from the institutional review board of Singapore Institute of Technology (IRB-2021035). Study participation was voluntary and written informed consent was obtained. The interviews were recorded with the consent of participants, with the privacy and confidentiality ensured.

Setting

Tzu Chi is a not-for-profit global community Buddhist organization. Its healthcare arm in Singapore operates medical clinics, day rehabilitation center, home and palliative care services and SACs. Tzu Chi’s SAC or Seniors Engagement & Enabling Node at Bukit Batok (Singapore) provides education, physical, social and recreational programs, as well as befriending and care services to older adults living in nearby studio apartments and surrounding neighborhood. Tzu Chi aims to increase social connection, provide support and promote physical, psychological and social wellbeing in older adults. Some examples of these programs include gardening, culinary arts, cognitive training games and strength training (Lee et al., 2021; Merchant et al., 2021).

Quantitative data collection

Participants were recruited from a sample of members visiting the senior center, as well as via telephone calls to members. A sample size of N = 80 (~80% of the total members (N = 100) enrolled at Tzu Chi SAC) was targeted for recruitment in this exploratory evaluation study. However, due to resource and time constraints with the COVID-19 pandemic, we recruited a total of 53 participants, with 4 participants excluded due to study criteria, resulting in a final sample of 49 participants included in the study. Participants were older adults aged ≥60 years, excluding individuals who were unable to speak English/Mandarin, with cognitive (participants aged 60–74: MMSE < 20 [0–6 years formal education] or 23 [more than 6 years formal education]; participants ≥75 years old: MMSE < 18 [0–6 years formal education] or 22 [more than 6 years formal education]), self-reported hearing or speech impairment. Cognitive function was determined using mini-mental state examination (Tombaugh & McIntyre, 1992). The survey was carried out by trained investigators according to standardized assessment protocols from April to September 2021. The questionnaire explored frequency of center program participation (less than once per week, once per week or more than once a week), and improvement in participants physical, psychological and social wellbeing based on a five-point Likert scale from “Strongly agree (1)” to “Strongly disagree (5).” Regarding the impact of COVID-19, participants were similarly asked on a five-point Likert scale, whether they felt “socially isolated with the current COVID-19 restrictions at the center” and whether their “experience at the center has been negatively affected due to COVID-19 restrictions (e.g., mask wearing, gathering in small groups).”

Psychosocial wellbeing outcome variables included depression, assessed using the Geriatric Depression Scale (D’Ath et al., 1994), psychological wellbeing using the Ryff’s psychological wellbeing scale (Ryff & Keyes, 1995) and social networks and support using Lubben social network scale (Lubben et al., 2006). A higher score indicates better performance on all scales, except for Geriatric Depression Scale, where a score of ≥ 5 indicates mild depression.

Qualitative data collection

Subsequently, qualitative data were collected in focus group discussions utilizing a semi-structured interview format. Fifteen older adults who completed the quantitative study (with different frequencies of attendance) were invited to share about their experiences across four focus groups. The results of qualitative data, although not generalizable, reveal subjective views of individuals and provide an opportunity for participants to disclose knowledge that might be overlooked through quantitative research (Flick, 2009). A semi-structured interview guide and the use of open-ended questions elicited broad discussion around health and wellbeing changes through center program participation (Flick, 2009). Purposive sampling was used for participant recruitment with maximum variation in consideration of frequency of participation in center programs and psychological wellbeing score. This aimed at selecting information-rich cases to reach data saturation (Francis et al., 2010). The semi-structured interview guide focused on the satisfaction, perceptions and attitudes of respondents toward the center and programs, as well as the impact on their wellbeing. Participants were also encouraged to share about their living experience and the center’s role in supporting their wellbeing during COVID-19. The online interviews were facilitated by two researchers and each interview lasted for around 45–60 min and was conducted in Mandarin or English. All online interviews were video-recorded, then transcribed into text.

Statistical analysis

Quantitative data analysis was performed using R V.3.6.2 (R Foundation for statistical computing, Vienna, Austria). To examine the associations between frequency of participation in center programs and wellbeing, a one-way analysis of variance was used. Numerical variables are presented as mean and standard deviation (SD) in text and figures unless otherwise stated. A p value of < 0.05 was considered statistically significant. Apart from quantitative analyses, the inductive thematic analysis approach, guided by Braun & Clarke (Braun & Clarke, 2012), was also employed to explore the perceptions and experiences of older adults during the COVID-19 pandemic via qualitative analyses using NVivo software (Release 1.4.1). Two researchers transcribed and translated the transcripts independently. Researchers read the transcripts independently for several times to gain an overall understanding of their experience. The researchers identified emerging codes from the data, where direct quotes from participants were used to support codes. Codes were then further grouped into meaningful themes. Different opinions on the coding and themes were resolved by discussion between researchers. Credibility was established by data triangulation (i.e., checking data in field notes) and investigator triangulation (i.e., peer debriefing). Transferability was also achieved by considering the characteristics and experience of participants through in-depth interviews.

Results

Participant characteristics

Sociodemographic characteristics of the participants are presented in Table 2. The mean age was 70 (range 61 to 89) and 33 (67%) were female. Participants were mostly married (65%), living with others (76%) and were not working (80%). Participants were also cognitively normal, with an average mini-mental state examination score of 29.

Table 2. Socio-Demographic Characteristics of the Sample (N = 49).

	N (%)
Gender
Male	16 (32.7)
Female	33 (67.3)
Age, Mean (SD)	70.4 (6.3)
Mini-mental state examination (Cognitive function), Mean (SD)	29.1 (1.2)
Marital status
Single	6 (12.2)
Married	32 (65.3)
Divorced	6 (12.2)
Widowed	5 (10.2)
Living status
Alone	12 (24.5)
With others	37 (75.5)
Employment status
Working	10 (20.4)
Not working	39 (79.6)

Quantitative analyses

A total of 17 participants engaged in less than once per week of center’s programs, 14 participants engaged in once per week of programs and 18 participants engaged in more than once per week of programs in the center. While associations between center program participation frequency and perceptions on wellbeing were not statistically significant, participation in at least once per week of center’s programs was generally associated with better experiences, including active and healthy lifestyles, social interaction and positive emotions.

Twenty-four participants (49%) agreed or strongly agreed that they felt increased social isolation due to COVID-19 restrictions (e.g., having to wear a mask, gather in smaller groups, contact tracing mobile applications/devices), while 15 participants (31%) were neutral, and 10 participants (20%) disagreed or strongly disagreed. Similarly, majority of participants agreed (N = 17 [35%]) or strongly agreed (N = 8 [16%]) that their experience has been negatively affected due to COVID-19 restrictions, while 13 participants (26.5%) either disagreed or strongly disagreed. Frequency of participation in center’s programs were not associated with impact of COVID-19 restrictions on social engagement and experiences (Table 3).

Table 3. Mean (SD) of Descriptive Questionnaire Results Across Frequency of Participation in Centre Activities Groups.

	<1× per week (N = 17)	1× per week (N = 14)	>1× per week (N = 18)	P value
Perceptions of center’s activities on wellbeing (1=Strongly Agree; 5=Strongly Disagree)
The activities at Tzu Chi help me stay active	2.0 (.6)	1.7 (.6)	1.8 (1.0)	0.586
The activities at Tzu Chi help me stay healthy	2.1 (.7)	1.7 (.6)	1.8 (1.0)	0.427
The activities at Tzu Chi provide me with the opportunities to meet people/friends more often	2.2 (.5)	2.1 (.7)	1.9 (.9)	0.643
I feel happier after attending the activities at Tzu Chi	2.2 (.6)	1.7 (.6)	1.8 (.9)	0.204
Impact of COVID-19 (1=Strongly Agree; 5=Strongly Disagree)
I feel more socially isolated with the current COVID-19 restrictions at the center	2.5 (.6)	2.4 (.8)	3.2 (1.3)	0.051
My experience at the center has been negatively affected due to COVID-19 restrictions	2.4 (.9)	2.9 (1.3)	2.9 (1.5)	0.348
Psychological and social wellbeing
Geriatric Depression Scale	3.3 (1.9)	3.1 (1.6)	3.9 (4.0)	0.687
Ryff’s Psychological Wellbeing Scale	89.1 (9.9)	93.1 (13.8)	88.3 (14.0)	0.541
Lubben Social Network Scale	14.2 (6.9)	15.9 (6.8)	11.4 (6.0)	0.166

Depression, psychological wellbeing and social networks and support scores did not differ across program participation groups (P = .687; P = .541; P = .166 respectively) (Table 3).

Qualitative analyses

Given the above quantitative results, we conducted qualitative interviews to further explore the perceptions and attitudes toward the center and programs on wellbeing, as well as the living experiences of older adults during COVID-19. Among 15 older adults invited to participate in the qualitative study, 2 participants dropped out, resulting in a total of 13 participants aged 65 to 84 years, 9 of whom were females (Table 4). During the focus group discussions, three themes emerged as follows:

Table 4. Profile of Participants in Qualitative Interviews.

Participant (Focus Group)	Sex	Age	Marital status	Living status	Employment status	Frequency of activity	RPWBS
A (4)	Female	74	Married	With others	Not working	<1× per week	94
B (3)	Male	73	Married	With others	Not working	<1× per week	85
C (2)	Female	68	Married	With others	Not working	>1× per week	111
D (1)	Female	65	Married	With others	Not working	>1× per week	77
E (2)	Female	66	Married	With others	Not working	>1× per week	97
F (1)	Male	84	Married	With others	Not working	>1× per week	82
G (1)	Female	73	Married	With others	Not working	>1× per week	77
H (1)	Female	73	Married	With others	Not working	>1× per week	78
I (2)	Female	82	Widowed	With others	Not working	>1× per week	97
J (2)	Male	76	Married	Alone	Not working	>1× per week	103
K (4)	Male	73	Married	With others	Not working	<1× per week	104
L (3)	Female	71	Married	With others	Not working	<1× per week	72
M (4)	Female	76	Widowed	Alone	Not working	<1× per week	106

*RPWBS = Ryff’s Psychological Wellbeing Scale.

Theme 1: Role of center on wellbeing

Majority of participants reported positive perceptions about the center and felt that the center provided them with a platform to occupy time meaningfully in a comfortable environment. For example, Case A and B expressed that the center provided a preferrable alternative to being at home, which can be dull and uneventful.

Very comfortable instead of you cooped in your house … you spend your day at Tzu Chi ah very open you see very what you call comfortable … I gain a lot I achieve a lot … We are retirees ah, a group of retirees… you can spend your time more meaningfully you see. Then you mix with new friends, socialise yourself, keep yourself occupied, then make you more what you call alert (Case B, Male, 73)

Stay at home, do nothing, just watch TV. At least we got something to do, pass our time. As … we all old people live alone then really boring. (Case A, Female, 74)

Most older adults felt that the center provided them with opportunities to learn something new and emphasized the importance of learning or pursuing interests that they were unable to in the past due to other commitments. Case I, an eighty-two-year-old female, said that the center staff would teach her patiently, despite her “getting older” and “not (being) able to remember.” Another older adult, Case M, also expressed that she felt happier through learning “different things every day,” resulting in a less monotonous life.

Tzu Chi they will teach me … very kindly teach me how to do it, and I will listen and do it … they have been slowly teaching us when we come here. It doesn’t matter if you don’t know, slowly, don’t be afraid (Case I, Female, 82)

There are some things you wanted to learn in the past but because of work, you can’t allocate time to learn. Now you (we) are very free, we have plenty of time now, so if there are more of these activities, you can learn different things every day, especially the things you like, and you will feel a lot happier. (Case M, Female, 76)

Older adults also expressed that the center enabled them to engage with others and increase social interaction. For example, Cases F, L and M shared that the center provides a platform to gather and discuss about problems, reduce loneliness, improve mood and interpersonal skills amongst older adults living in the same neighborhood.

With this place, everyone comes here ah, to participate in some activities, and then we interact. Sometimes, when everyone has something to do or has other issues, everyone can come and introduce or discuss with each other (Case F, Male, 84)

Especially if you have no one to speak to, what do you do by yourself? (No matter) how much we walk around, it’s just that house. (Case M, Female, 76)

… talk more to friends, uh I’m more happy physically and spiritually. (Case L, Female, 71)

Furthermore, the center also provided care services, such as calling in to check on them, which made the older adults feel supported, especially amongst those who live alone. Most participants also expressed appreciation regarding center’s staffs’ readiness to offer help with their daily activities. For example, Cases M, G and J shared that the staff were enthusiastic, patient and willing to assist members when they encountered difficulties, including navigating mobile phones and interpreting medical documents.

Especially elderly like me who live alone and are not feeling well, they will know that you are not feeling well. They will ask you the next day. At least there’s someone who cares about us ah … Care is more important than material things. I think what we need now is care. The children are all busy with work (Case M, Female, 76)

Every time we encounter something about our mobile phones that we don’t understand, they will explain it to you immediately, very good, they are very enthusiastic about helping us (Case G, Female, 73)

For my medical expenses from National University Hospital, I don’t understand English. I will bring it here and ask them to explain it to me (Case J, Male, 73)

Theme 2: Experience and perceptions about center’s programs

Health-related programs dominated the discussions when asked about their experience and perceptions about the center’s programs. These programs included physical and cognitive training exercises, educational health talks, health screening and allied health services such as physiotherapy. These programs were perceived to be beneficial in improving subjective mental and physical wellbeing, especially among older adults. Case M said that “Now that we are old, nothing matters, health is the most important thing.” They understood and recognized the importance of staying physically and mentally active and alert to maintain health and wellbeing. Two female participants aged 65 and 73 (Cases D and H) also shared that there were “a lot of opportunities to exercise” at the center and that it is “healthy to do exercise.”

Apart from health-related programs, crafts-related programs were also of interest to participants and were commonly discussed as a medium to exchange ideas and occupy time meaningfully. Case E felt that handicrafts had a lower barrier to entry for those with lesser education, and that handicraft programs provided an iterative process of learning from one another.

I like to do handicrafts. I don’t like studying, so I didn’t succeed in studying … (some old people) they teach me things, and I will make and show them (Case E, Female, 66)

For example, like doing handicrafts … because I am retired now and like to learn more things to pass the time. So when they organize activities I am interested in, I come to participate (Case L, Female, 71)

Nonetheless, some participants expressed reasons for not participating in handicraft programs including “hand pain” (Case I, Female, 82) and feeling “that is for more for ladies” (Case B, Male, 73).

Theme 3: Experiences under COVID-19 pandemic

During the COVID-19 pandemic, safe management measures were in place to minimize the risk of COVID-19 transmission in the community. These measures include safe distancing, mandatory mask wearing, limitations on the number of people in the center and suspension of programs. Older adults were generally more afraid of visiting the center, due to increased susceptibility to COVID-19. For example, Case F, 84-year-old male, mentioned that “If you go to visit people, or if everyone is together, everyone is a little scared psychologically. Especially us older people, … everyone is saying that ugh, you are the easiest to be infected.” Case L, a 71-year-old female, also expressed heightened fear and reluctance to carry out activities outside of their home, such as going to the market, exercising in public places and visiting the center.

A simple task like going to the market also scares me. It’s not like it was before … buy things also rushing … Currently there is pandemic, I do not want to participate. It seems like they opened the class ah, but because of the pandemic ah, I just don’t, I don’t really want to come. (Case L, Female, 71)

Reduced programs at senior centers resulting from COVID-19 pandemic affected most participants negatively, especially their psychosocial wellbeing. For example, Cases A, M and F reported significant reductions in social activities, negative impact on lifestyle routines, feelings of boredom and lack of social engagement due to COVID-19 pandemic.

If you come around and mix with people, you also scared you contract the disease, then you don’t come down, you feel bored. (Case A, Female, 74)

Because we rarely go out now, especially we elderly who live alone, we will just be watching the 4 walls at home or watching TV, which is more boring. (Case M, Female, 51)

In the past, we had some social activities with these people, and we could go sing karaoke, can drink, eat. Everyone can have a time to get together when they go to activities every day. Then due to the current pandemic situation … we rarely can get together (Case F, Male, 84)

Discussion

This mixed-methods study highlights the significant role the SAC in promoting wellbeing among older adults in the neighborhood community. Our qualitative findings revealed that the older adults felt supported and cared for through the center’s services, potentially leading to improvement in mood and psychosocial wellbeing. These findings are in line with studies that reported positive relationships between caregiving in senior centers and physical health, social support, general wellbeing and happiness with personal life (Fitzpatrick et al., 2005; Skarupski & Pelkowski, 2003). Senior center staff members were also able to prevent deterioration of health and wellbeing among its users by establishing close and trusting relationships, facilitating community feeling and utilizing joint collaboration (Langergaard et al., 2022). Positive psychosocial outcomes were also commonly reported with senior center attendance and associated with increased overall quality of life (León et al., 2020). We also observed that older adults perceived the SAC as a place to occupy time meaningfully, a platform to pursue their interest or learn something new and to engage socially with others. Therefore, our study support aspects of the voluntary organizational model (Schneider et al., 1985) attributing benefits to the significance of opportunity for self-expression, social activities and recreation at the center (Fitzpatrick et al., 2006). Senior centers globally largely provide social contact, preventive services or programs to improve or maintain health, as well as to introduce structure in their lives and promote senses of belonging and usefulness among older adults (Fulbright, 2010; Iecovich & Biderman, 2013; Ingvaldsen & Balandin, 2011; Lund & Engelsrud, 2008). Social participation in senior centers enabled people to gain a better perspective of their own abilities, feel more stimulated, confident and contented (Dabelko-Schoeny & King, 2010; Fawcett, 2014). It also appeared to encourage programs outside senior centers, with new friends or existing networks, resulting in improvement in perceived wellbeing (Fawcett, 2014). It is therefore crucial for senior centers to understand and cater to the needs and interests of its members, in order to better facilitate meaningful participation, promote social interactions, positive mood, life satisfaction and purpose (Hooker et al., 2020).

Older adults perceived the center as a platform that offers health-related programs and services, including education, screening, physical and cognitive exercises, which were essential to promote healthy lifestyles, behaviors and wellbeing. Earlier research has stressed the importance of interventions provided at senior centers, in promoting health education, improving physical health to maintain and increase functional capacity, maintaining or improving self-care and stimulating social network (Golinowska et al., 2016; Richard et al., 2005; Song et al., 2017). These interventions include recreational and fitness programs (exercise, dance, etc.), meals and nutrition, cognitive and psychological training (memory, anxiety) and education (language, computer, art, music, etc.) (Song et al., 2017). Given that health promotion programs are feasible and widely accepted by participants at senior centers, it is imperative to consider the delivery of these services and interventions (Wallace et al., 1998). Therefore, apart from improving knowledge and increasing awareness, health-related interventions and programs at senior centers should also consider techniques for behavioral change and adherence, to promote longer-term benefits on health and wellbeing in older adults (Kwok et al., 2021) For example, strengthening beliefs and attitudes (e.g., self-efficacy and beliefs of being qualified and significant contributor to society), determining structure and content of goals (e.g., performance or learning outcomes, promotion or prevention outcomes), self-regulation and nudging (Klusmann et al., 2021). Given the heterogeneity of demands and challenges concerning healthy aging, and the individual differences among older adults, tailored and personalized approaches to promote wellbeing and sustain healthy behaviors are needed.

Our quantitative results suggest no associations between frequency of participation in center’s programs and psychosocial wellbeing (including depression, psychological wellbeing and social networks and support); as well as socially isolating effects of COVID-19. This points to the need to respect the autonomy and different needs of the members in the different programs, which can be offered to them with tailored support. Indeed, another study reported that attendance at day centers and length and frequency of use were not associated with loneliness in physically frail older adults, which was explained by other factors such as poorer self-rated health, physical function and socioeconomic status (Iecovich & Biderman, 2012). A systematic review also showed that higher subjective cognitive impairment was related to lower levels of physical and social activities participation in older adults, suggesting that other confounding factors could affect engagement in programs at senior centers (Wion et al., 2020). Yet, attendance at day centers was associated with better quality of life among depressed community dwelling older adults and socially isolated older people with mobility restrictions (Bilotta et al., 2010; Orellana et al., 2020). Notably, while overall lifestyle activity was not associated with incident depressive symptoms, participation in specific domain such as creative activities, was associated with reduced risk of depressive symptoms (Parisi et al., 2014). Even though the government mandated closure of SAC during certain periods of COVID-19, some members still gathered in the common and gardening spaces near the SAC, with adherence to physical distancing measures. This could plausibly explain the trend toward frequent center participation and the lack of effect on social isolation (neutral feelings) due to COVID-19 restrictions at the center, suggesting the importance of social networks and communities beyond the center; as well as ability of older adults to adjust. Another study reported that older adults in Singapore had better mental health, perceived less stress and were more adaptable psychosocially as compared to younger adults (Yu, Tou & Low 2022). Our results suggest that associations between center program participation and wellbeing are plausibly dependent on participant characteristics such as socio-economic status and other social opportunities (Tadai, Staughan & Cheong 2023), with larger magnitude of associations observed among older adults at risk of declining independence or social wellbeing.

Majority of participants indicated greater social isolation with COVID-19 restrictions due to program suspensions, increased boredom, fear and reluctance in carrying out activities beyond their homes. Consistent with our findings, increased loneliness and decreased physical activity were observed among community-dwelling older adults in Singapore during a “lockdown” period due to the COVID-19 pandemic (Lee et al., 2021), suggesting potential impact on physical and mental health such as anxiety, depression and poor sleep quality (Sepúlveda-Loyola et al., 2020). Perceived fear of COVID-19 was also observed in older adults in Poland, especially among women and those with higher anxiety levels (Agrawal et al., 2021). With the rise of social media and digitalization, related statistics of COVID-19 could possibly spread faster than the virus itself, leading to a “digital epidemic.” It is therefore important to consider only relevant and updated information about the situation, to relieve anxiety, fear and prevent the virus from affecting mental wellbeing of older adults (Banerjee & Rai, 2020). Older adults are vulnerable to environmental changes, and it is critical to provide a structure for their daily lives, in case of further lockdowns or crisis. Some examples include weekly telephonic sessions to reduce anxiety, simple exchange of greetings with neighbors or strangers to facilitate bonding, as well as training and facilitation on digital technology to meet some social and communication needs (Banerjee & Rai, 2020; Chen, 2021). COVID-19 has also opened opportunities for potential digital alternatives to in-person options for older adults, which may be useful to reduce loneliness and increase engagement in older adults (Lim & Bowman, 2022).

There are several limitations in this study of a single SAC. Firstly, due to the cross-sectional study design, it is not possible to establish causal relationships and to measure changes in behavior due to the COVID-19 pandemic. As the data was collected after the earliest phase of COVID-19 outbreak, given the fluctuating nature of the pandemic, the perceptions and wellbeing of participants may vary across different stages of the pandemic. Secondly, participation in programs were self-reported via a questionnaire, which could be subjected to recall accuracies, plausibly explaining the lack of associations observed with psychosocial wellbeing. Heterogeneity of the nature and type of program participation among respondents may be responsible for a low power in estimating psychosocial wellbeing effects. For example, group-based physical activity could have positive effects on reducing loneliness and improving social support and networks, while craft-based programs could improve psychological outcomes (Lindsay Smith et al., 2017; Stuckey & Nobel, 2010). Larger longitudinal cohort studies with more objective measures of program participation are required to establish causal relationships between program participation and psychosocial wellbeing. Thirdly, given the limited sample size and nonrandom sampling of interviewees, it is possible that heterogeneity in their experience exist. Our results were in community-dwelling older adults and are not generalizable to other populations with different demographic and cultural backgrounds. Fourthly, the participants in the qualitative study were largely female, and married, and may not reflect the views of male or single or divorced individuals.

To conclude, the center and its programs played an important role on participant’s psychosocial wellbeing, through providing them with opportunities to learn something new, occupy time meaningfully, engage socially and by providing care and support. The negative impact of COVID-19 on psychosocial wellbeing further reinforces the value of senior centers in providing health-related interventions and support to improve social engagement and psychological wellbeing among older adults at risk of isolation.

Acknowledgments

The authors would like to thank all the participants for their contribution.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was partly supported by Ministry of Education Innovation Capability Fund under Grant (R-MOE-A404-F024).