Innovation, Best Practice, or Normal Life?

ABSTRACT

In many aging environments, the experience has shifted from normalcy to institutional rigidity, often prioritizing operational demands over individual preferences. Such a framework reduces autonomy for older adults, deterring many from choosing such settings. The international culture change movement underscores rampant normalcy, emphasizing the need for a return to everyday life experiences and breaking away from regimented routines. Transitioning homes are now focusing on natural rhythms, such as uninterrupted sleep and flexible dining, aligning with individual needs rather than institutional constraints. While these changes may be labeled as innovative or best practice, they are merely a restoration of normal life. The goal is to ensure that aging settings reflect the day-to-day experiences common to all, advocating for a life free from imposed schedules and restrictions. This perspective is supported by research highlighted in this issue of Activities, Adaptations, and Aging: Dignified and Purposeful Living for Older Adults.

KEYWORDS:

• Quality of life
• wellbeing
• normal life
• rampant normalcy
• home
• non-institutional
• cooking
• choir
• proactive aging
• optimism
• variety
• volunteering

Introduction

Much of life in aging settings, such as assisted living and nursing homes, is no longer normal but institutional, manifesting as spaces of rigidity rather than residence. Indeed, this transition from personal comfort to operational efficiency is evident in spaces that resemble hospitals more than homes. In such rigid settings, daily routines prioritize institutional demands over individual preferences, resulting in what can be aptly termed as “the almighty schedule”. Tragically, in these settings, older adults’ sense of autonomy is often relinquished, having little say in their day-to-day lives. The consequence? A growing number of older adults expressing a strong reluctance to even consider living in such places (John A. Hartford Foundation, 2021) or as a place of choice to age (Lim & Bowman, 2022).

The undesirable situation becomes even more alarming in the face of rapid population aging (Chua et al., 2023; Lim & Bowman, 2022). Recognizing this looming crisis, the international culture change movement champions the notion of “rampant normalcy” (Bowman, 2010; Bowman & Lim, 2021, 2022; Bump, 2023; Elliot et al., 2023; Sheilds, 2004), which emphatically pushes for a return to the familiar comforts of everyday life, counteracting the sterile regimentation that has become pervasive.

Transitioning homes, in line with this movement, are prioritizing human needs. They emphasize uninterrupted sleep, recognizing its healing properties, and offer flexible dining based on individual preferences. While these shifts might be applauded as “innovations” or tout them as “best practices”, are they not simply the tenets of life? True, they defy institutional norms, but the objective is not mere innovation; it is about recapturing the essence of normalcy. The goal? Ensuring that the settings in which older adults choose to age in place genuinely reflect the lives we all live daily, free from institutional constraints such as rigid schedules and groupings. This crucial shift toward authentic living is well-supported by research, as highlighted in this issue of Activities, Adaptations, and Aging: Dignified and Purposeful Living for Older Adults.

In this edition

Cooking is normal

A quasi-experimental study by Rueankam et al. (2023) involving 19 older adults participating in 10 cooking sessions exhibited improved cognitive, emotional, psychomotor, and interpersonal performance. One participant observed that cooking was a good use of free time – meaningful and valuable. By engaging in cooking, participants showed improvements in cooperation, cognitive functions, reaction time, and emotional expression. Notice, cooking, which happens as part of a normal life, has many benefits.

While cooking offers numerous benefits, it is essential to ensure its normalcy. After all, how often do we gather friends and collectively stir a bowl of cookie dough by passing it around the circle? It is therefore crucial to replicate the natural environment and process of cooking as closely as possible. Various places, from one’s immediate or vacation home, have functional kitchens. Taking advantage of kitchens aligns with the ethos of the culture change movement. In fact, this is one of the 134 normal life practices outlined in Artifacts of Culture Change 2.0, which is designed to assist communities in transitioning from institutions to homes (Elliot et al., 2023).

The objective is not merely to teach cooking techniques but to empower older adults to continue the culinary activities they have cherished throughout their lives. By doing so, we can help them preserve their legacy – whether it is a famed baked good or a signature dish they are renowned for (Bowman & Norton, 2008).

Being in a choir equalizes

In a qualitative study by Mabire et al. (2023), the formation of an inclusive choir in a daycare was observed. Comprising individuals with dementia, their caregivers, and volunteers, all members sang harmoniously as equals. Over the span of 14 rehearsals culminating in a Christmas concert, 12 people with dementia, four caregivers, and one volunteer came together under the guidance of a choirmaster. Notably, participants with dementia exuded confidence, enjoyment, consistency, learning, empowerment, and engagement. Volunteers, initially influenced by the pervasive stigma surrounding dementia, naturally socially integrated their co-choir members. Caregivers transitioned from their primary role as carers to equal participants, singing side by side with those they cared for. This choir experience fostered group cohesion and a profound sense of connection. Notice, enabling people with dementia to partake in activities like choirs with others equalizes by fostering a sense of normalcy (Bowman & Krugh, 2009; Bowman & Lim, 2023a). The distinctions blur – they are no longer defined as people with dementia, caregivers, or volunteers, but simply as choir members singing in unison. Wonderful normal living like this diminishes stigmas and promotes the natural and seamless inclusion of older adults, and notice, even older individuals with dementia. Thompson et al. (2023) reinforced this observation with a study on a similar choir, which likewise yielded positive outcomes of acceptance, diminished stigma, safety, and social support.

Our five senses and the feeling of being “at home”

Solé et al. (2023) investigated the efficacy of the Snoezelen room for older adults with dementia living in nursing homes. The Snoezelen environment is designed to alleviate stress and enhance relaxation, targeting all five senses: sight, smell, hearing, taste, and touch. Over a span of 12 weeks, a group of older people attended bi-weekly sessions in the Snoezelen room while a control group of the same engaged in reminiscence instead. The results revealed that participants exposed to the Snoezelen environment consistently displayed higher relaxation levels post-sessions than those in the reminiscence group. Significant improvements in anxiety, depression, and relaxation were observed. Intriguingly, while people in more advanced dementia stages exhibited lesser engagement, those in the early stages seem to be more alert and showed a greater ability to answer and engage constructively. This study underscores a fundamental principle: our senses are continually stimulated in daily life, often without conscious realization. Thus, when older adults age in a place of choice outside their own homes that offer the normalcy of home life, the more relaxed, or more aptly, “at home” they feel (Bowman & Lim, 2022; Sheilds, 2004).

Productive aging drives driving

Productive aging refers to the potential of older adults to contribute to both society and themselves through active engagement. While driving is known to facilitate participation in productive aging, the reciprocal relationship—i.e., the influence of productive aging and its perceived importance on driving – has been understudied. Cao and Vivoda’s (2023) research applied the social ecological model to assess how productive aging affects driving frequency. Using ordinal regression analysis on data from the National Health and Aging Trends Study, their research found a correlation between higher driving frequency and older adults who worked for pay, provided care, visited friends and family, and went out for enjoyment. Furthermore, those who perceived productive aging as important also exhibited frequent driving habits. Driving, a ubiquitous aspect of adult life, undeniably supports productive aging. The study reaffirms a widely held belief: when driving ceases, quality of life often declines. Embracing the significance of productive aging is therefore pivotal to aging well.

Optimism as a pathway to life satisfaction

Mathur and Moschis (2023) conducted an online survey of 267 older adults to investigate the antecedents and consequences of optimism through structural equation modeling. Their findings substantiated three hypotheses. First, a direct positive relationship exists between personal control and optimism. Second, a pronounced optimistic outlook positively fosters future-oriented behaviors, including volunteering, financial planning, and saving for retirement. Third, optimism directly correlates with enhanced life satisfaction. These findings underscore the paramount importance of fostering an optimistic mind-set throughout our lives.

Plan-do-study-act creates confidence

The plan-do-study-act (PDSA) cycle was applied to older Thai adults in a study conducted by Wongsala et al. (2023). Through qualitative thematic analysis of focus group interviews with eight male and five female participants, initial challenges were overcome with the support from both the moderator and family members. The study revealed that introducing older adults to the PDSA cycle can bolster their sense of personal responsibility and ability to drive their active aging. Moreover, their ability to independently managing lifestyle changes boosted their confidence to explore and adopt new strategies, underlining the PDSA’s universal applicability across ages.

Variety is the spice of life at all ages

Jansen et al. (2023) delve into the significance of variety in daily life, especially concerning its impact on wellbeing among older adults. Their study, drawing from interviews with 34 community-dwelling older adults, reveals six key categories highlighting the importance of variety: its contributions to mental health, its role in making life enjoyable and interesting, its maintenance of overall health and wellness, its boost to motivation and activity, its enhancement of mental sharpness and alertness, and its ability to foster empathy by diverting focus from self-centric tendencies. Notably, these perceptions of variety were found to have robust correlations with indicators such as quality of life, life outlook, and depression levels. Corroborating this perspective, the Eden Alternative (2020), a model for culture change in long-term care homes, asserts that humans, irrespective of age, flourish in environments infused with variety, spontaneity, and unexpected happenings – a profound counter to boredom and monotony.

Volunteering in one’s later years has many benefits

Ling et al. (2023) analyzing 193 volunteers aged 51 and above revealed that older participants reported heightened mental wellness, satisfaction, and motivation than their younger peers. This demographic deeply cherishes the impactful contributions they make, fostering a fulfilling sense of purpose. Post-retirement, older adults often seek enriched social connections, and affiliations with organizations significantly bolster their wellbeing. Progressive leaders in aging settings understand this; they prioritize creating diverse volunteering opportunities catering to all ages and abilities, as emphasized in the Artifacts of Culture Change 2.0 (Elliot et al., 2023). This shift in perspective challenges traditional views and highlights the importance of recognizing people who live in a home and/or volunteers as active contributors, rather than just helpers (Hull, 2023), underscoring the need for equitable recognition and language in addressing the roles that people play (Bowman & Lim, 2022).

Respecting individual differences in aging

The study by Karakaş et al. (2023) explored the quality of life among people aged 90 and above in Turkey, employing the World Health Organization Quality of Life Scale Elderly Module (WHOQOL-OLD) with a sample of 879 participants. Key determinants like economic status, social security, and local security emerged as influential factors on their quality of life. These factors resonate with the general preferences people hold for their homes. This emphasizes the imperative need to reorient our perspectives, shifting from institutional settings to fostering genuine homes, and avoiding superficial “homelike” environments or mere “facilities” (Bowman & Lim, 2022; Elliot et al., 2023).

Conclusion

This issue of Activities, Adaptation and Aging: Dignified and Purposeful Living underlines our fundamental mission: to advocate for the inherent rights of older adults to live lives filled with dignity and purpose. The highlighted research illustrates the significance of activities like cooking, choir singing, sensory engagements, productive aging, embracing optimism, diversifying experiences, and volunteering – all contributing to a good, normal life. However, it is vital to recognize that these activities should not be hailed as “innovations” or “best practices.” They are, in fact, typical facets of daily life that everyone, regardless of age, should enjoy (Bowman & Lim, 2023b). Our intention is not to celebrate these aspects but to emphasize their inherent nature in our lives. We are championing a shift away from institutional culture for older adults, advocating instead for the regular, unrestricted lives we all value. The call for such a return to normalcy is solidly backed by the research featured in this issue.

Disclosure statement

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