Research – Java Mentorship Program
A significant number of those living in residential care experience loneliness and depression. Individuals engaged in peer mentoring draw benefits from the social and emotional connection; however, this approach is rare within these settings. The objectives of this study were to develop a new model of psychosocial care based on peer mentoring, describe the development of a novel peer mentoring intervention; and collect feasibility data associated with its implementation (e.g., assessment of recruitment and sample; outcome measures and data collection; retention, intervention adherence and acceptability; and residents’ responses).
The Peer Support Centered Care Model, which has its foundations in social citizenship, provided the basis for a peer mentoring intervention in which community volunteers (community mentors) and resident volunteers (resident mentors) formed a supportive team and provided visits and guidance to other residents that were lonely or socially isolated (visitees).
For the mixed-methods feasibility study, we enrolled community mentors (n = 65), resident mentors (n = 48) staff facilitators (n = 24) and visitees (n = 74) in 10 sites. Among resident mentors at six months (n = 28), a significant reduction in loneliness scores (p = .014; d = .23) and in depression scores (p = .048; d = .30) were noted. In-depth interviews with a sample of resident mentors (n = 8) revealed positive perceptions of the intervention. Most of the feasibility objectives were met; however, low retention rates among resident mentors were noted as well as time and resource challenges.
At six months, among the visitees from whom data could be obtained (n = 43), we found a significant reduction in loneliness (p = 0.02; d = .76) and depression (p = 0.02; d = .76), and a 60% increase in the number of monthly programs attended (p = 0.01; d = .37). Interviews with visitees (n = 32) indicated perceptions of the program were also positive. The study findings reveal a role that mentorship can play as a new model of psychosocial care and lay the groundwork for future research.
Research – Java Music Club
The initial research for the Java Music Club program was carried out through the Department of Gerontology at Simon Fraser University in British Columbia, Canada. The study was funded in part by the Michael Smith Foundation for Health Research and the Social Sciences and Humanities Research Council of Canada.
A mixed methods qualitative process evaluation was used, encompassing focus groups, systematic observation of six resident groups, individual resident interviews (N=65) and staff interviews (N=7) in three long-term care homes and an adult day centre. Staff received training and followed a manual which enhanced their ability to facilitate standardized group sessions.
Study participants reported positive benefits and themes generated included spending time together (versus being lonely), getting to know one another better, gaining new respect and understanding for one another, giving and receiving support, unloading their burdens and learning new coping skills. Group observations showed increased active participation during and after the sessions. In their interviews, staff revealed an overall positive experience and described how the unique program structure fostered sharing on a deeper level and how it empowered residents with moderate to severe cognitive impairment.
Read the abstract of the research published in the Journal of Applied Gerontology here: http://jag.sagepub.com/content/early/2012/06/13/0733464812446866
Participation of those with Cognitive Impairment
Almost all participants in the research study had some form of cognitive impairment and close to half had moderate to severe cognitive impairment. Observations of six individuals with indicators of severe cognitive impairment revealed that they were comfortable in the groups even though their communication skills were limited. They were able to respond to concrete questions, engage with the music and remain attentive to the sharing as it went around the group. There were observed signs of empathy from the more able residents toward those with impairment and this appeared to contribute to the positive engagement of all participants.
Since the completion of the study in 2010, the Java Music Club program has been implemented across Canada and in the US in over 1000 organizations. These include long term care homes (including memory care), adult day centres, assisted living and retirement centres, affordable housing, independent living and hospitals.
(2014) Schlegel-University of Waterloo Research Institute for Aging—Ontario, Canada
A one-year follow-up study on the Java Music Club was conducted by the Schlegel-UW Research Institute for Aging with six care homes as research sites and six as controls. A mixed methods evaluation design was used. InterRAI’s self-reported Quality of Life Survey was used as an outcome measure, with analysis revealing significant changes in participants’ ratings on several items. Downward trends on the Depression Rating Scale were also found. Results were presented at the Canadian Culture Change Conference 2014.
(2015) Holiday Retirement Homes—United States
Holiday Retirement conducted a mixed methods qualitative evaluation in a pilot examining the impact of the Java Music Club among residents living in 14 Memory Care homes and 7 Continuing Care homes. The evaluation included individual interviews of the program participants along with a survey completed by staff facilitators. A majority of the residents reported positive benefits with themes generated around increased engagement and friendships, support and empowerment. In their surveys, staff revealed an overall positive experience, that the program was easy to execute, and the training effective and program materials were easy to follow. Staff also reported observed benefits among program participants that included increased engagement of quieter residents, improving bonding between group members and increased supportive/helping behaviors. Some facilitators indicated the need for additional training beyond the initial implementation webinar. The majority (90%) of the homes indicated that they saw a future for Java Music Club in their communities. Results were presented at ALFA 2015 Annual Conference.
(2015) National Church Residences—United States
National Church Residences conducted a one-year qualitative evaluation of the Java Music Club in three affordable housing and permanent supportive housing sites using a structured evaluation to explore three perspectives: participant evaluations, structure observations and a staff evaluation. Content analysis revealed that the participants enjoyed the program and felt more socially connected and supported: “[It] fills a part of my day that might otherwise be empty and lonely” and “I feel supported—absolutely. I feel comfortable revealing intimate specific pains and joys.” Staff noted that although the participants were ‘wary’ of sharing at first, but that they became supportive of one another and “…they expressed themselves when they normally would not.” Staff also describe how the residents were able to facilitate the program themselves and that they were inviting neighbours and new residents to attend. Results were presented at 2015 LeadingAge Conference. National Church Residences has subsequently applied for funding for an additional 6 sites and produced a video:
(2016) University of Alaska Anchorage—United States
The University of Alaska Anchorage conducted an experimental designed, random assignment, assessment of the participation effects of eight (8) clients for 26, one-hour sessions, in an Adult Day Center using the facilitated Java Music Club group program. Assignment to the control and experimental groups were random and drawn from the 55 clients who participate in the day care program. Mental status, level of depression, quality of life, and caregiver burden were measured prior to and following completion of the study. Quality of life was achieved as measured by a process evaluation. The study participants experienced less cognitive decline and depression when compared to the control group. There was no difference in caregiver burden among both groups. The results of this pilot study presented at the Alzheimer’s Association International Conference in Copenhagen, Denmark (2014), and demonstrated the value of the Java Music Club Program in providing the participants with the opportunity of sharing their feelings and providing peer support to one another, adding to their quality of life. Results also were published in the HSOA Journal of Alzheimer’s and Neurodegenerative Diseases.
Ryerson University. (2017-2018) Dr. Alexandra J. Fiocco at the Department of Psychology at Ryerson University, has launched a study examining the outcomes of the Java Music Club among residents living in 4 retirement communities in Toronto, Ontario.
Research – Java Memory Care (2014 – 2018)
Following the implementation of the Java Music Club in numerous homes across Canada and the US, repeated request were made by the staff facilitators for an adaptation of this program for those living with more advanced dementia.
The Java Memory Care program was created by Kristine Theurer and was in development over a period of two years with input from staff in several long term care homes in British Columbia, Canada. Although there were anecdotal indications of the benefits of the program, more rigorous empirical evidence was needed to produce credible evidence about the outcomes that it produced with residents living with more advanced cognitive impairment.
Thus, a two-month pilot in four nursing homes was launched in early January of 2015 to further evaluate the program and provide input for revisions. Recently, Carleton University and the Bruyère Research Institute have received a $250,000 grant awarded by the Centre for Aging + Brain Health Innovation led by Baycrest Health Sciences. This project was launched in September 2017 as a knowledge mobilization and research partnership examining the impact of both the Java Music Club and Java Memory Care among residents living in 39 homes in Ontario, Canada.
University of Alaska. Further research is also underway (2016-2018) examining the Java Memory Care program, the subject of a randomized controlled trial in three long term care homes in Anchorage, Alaska.
Published Refereed Papers – Kristine Theurer
Theurer, K., Wister, A., Sixsmith, A., Chaudhury, H., & Lovegreen, L. (2012). The development and evaluation of mutual support groups in long-term care homes. Journal of Applied Gerontology, 33(4), 387-415. doi: 10.1177/0733464812446866
Theurer, K., Mortenson, B., Stone, R., Suto, M., Timonen, V., & Rozanova, J. (2015). The need for a social revolution in residential care. Journal of Aging Studies, 35, 201-210. doi: 10.1016/j.jaging.2015.08.011
Theurer, K., & Wister, A. (2010). Altruistic behavior and social capital as predictors of well-being among older Canadians. Ageing & Society, 30(1), 157-181. doi: 10.1017/S0144686X09008848
Cook, M., Gutman, G. M., O’Rourke, N., Theurer, K., Bachner, Y., & Kasprow, P. (2007). Cognitive status and the psychological well-being of long-term care residents over time. Paper presented at the Annual Conference of the Canadian Association on Gerontology, Calgary, Alberta.
O’Rourke, N., Gutman, G. M., Theurer, K., Cook, M., Kasprow, P., Bachner, Y. G., & Caspar, S. (2009). Cognitive status and the psychological well-being of long-term care residents over time. Aging & Mental Health, 13(2), 280-287. doi: 10.1080/13607860802154549
Theurer, K. (2002). The bells are ringing: The Magic of Using Handchimes in Music Therapy for People Living with Dementia. RR Donnelley, Vancouver.