When Does Old Age Begin? Unpacking the Perceptions Across Generations 

Old age is a concept deeply entrenched in societal and cultural beliefs, often varying significantly across different demographics and over time. Recent studies have illuminated these shifting perceptions, revealing that the age at which people consider themselves to be ‘old’ is steadily increasing. This article delves into the nuances of these findings, drawing on extensive research to provide a comprehensive view of how old age is perceived today. 

Shifting Perceptions of Old Age 

Historically, old age was often perceived to begin around the age of 50. However, contemporary studies indicate that this threshold has moved significantly. According to a study published by the American Psychological Association, “later-born participants reported a later perceived onset of old age.” For instance, individuals born in 1911 perceived old age to start at 71, whereas more recent generations view old age as beginning even later. 

This shift is supported by findings from NBC News, which reported that participants’ perceptions of old age have been consistently delayed over the past 25 years. The study highlighted that for every four to five years that passed, the perceived onset of old age shifted correspondingly later. 

Factors Influencing Perceptions 

Several factors contribute to these evolving perceptions of old age. Health, gender, and personal experiences play pivotal roles. Neuroscience News noted that “personal health, loneliness, and gender influence individual perceptions of when old age begins, with women generally perceiving old age to start later than men”. This aligns with findings from The Hill, which reported that “age, gender, and health status all played a role in a person’s perception of old age”. 

Health deterioration remains a significant marker of old age. The Journal of the American Geriatrics Society found that “worse health status and life satisfaction are associated with perceiving earlier onset of old age”. This suggests that individuals in better health and with higher life satisfaction tend to view old age as starting later. 

Cultural and Societal Impacts 

Cultural and societal factors also significantly influence perceptions of aging. Earth.com highlighted that “modern adults perceive the onset of old age to be later compared to previous generations,” a shift attributed to improved healthcare, better living standards, and more active lifestyles among older adults today. 

Furthermore, a global perspective reveals that cultural differences shape how aging is perceived. A study by the Center for Healthy Aging noted that younger people’s views on aging vary widely across cultures, indicating that societal norms and values deeply influence these perceptions. 

Psychological and Quality of Life Implications 

Positive perceptions of aging are strongly linked to better psychological health and quality of life. Research published in The Gerontologist demonstrated that “positive perception of aging is strongly associated with increased quality of life”.  Similarly, a study on rural older adults published by MDPI found that positive perceptions of aging are linked to better self-rated health, suggesting that how individuals perceive their own aging process can have tangible impacts on their well-being. 

Implications for Care Providers 

Understanding these shifting perceptions is crucial for those providing care to older adults. Service providers must recognize that the age at which individuals consider themselves ‘old’ is not static and can vary significantly based on personal and societal factors. Tailoring services to reflect these perceptions can enhance the effectiveness of care and improve the overall well-being of older adults. 

In conclusion, the perception of when old age begins is a complex and evolving concept influenced by health, societal changes, and cultural norms. As these perceptions shift, it is essential for society, and particularly those involved in the care of older adults, to adapt and respond to these changes. Embracing a more dynamic understanding of aging can lead to more effective care strategies and better quality of life for older individuals. 


  • “Perceptions of Old Age Starting Later.” Neuroscience News, 22 Apr. 2024, neurosciencenews.com/aging-perception-psychology-25963/. 
  • “How old is old? Identifying a chronological age and factors related.” Journal of the American Geriatrics Society, 26 Jul. 2021, agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.17379. 
  • “People now think old age starts at 75: Study.” The Hill, 24 Apr. 2024, thehill.com/changing-america/well-being/longevity/4619382-people-now-think-old-age-now-starts-at-75-study/. 
  • “Association of Self-Perception of Aging and Quality of Life in Older.” The Gerontologist, vol. 64, no. 4, 2024, academic.oup.com/gerontologist/article/64/4/gnad041/7111206. 

Nurturing Resilience: How Programs to Boost Positive Emotions are Revolutionizing Healthcare 

The COVID-19 pandemic cast a harsh light on the fragile state of mental well-being among healthcare workers. Overwhelmed by unprecedented demands, many found themselves battling burnout, anxiety, and emotional exhaustion. Amidst this crisis, innovative programs designed to boost positive emotions have emerged as critical interventions, aiming to foster resilience and improve the mental health of healthcare professionals.

The Emergence of Positive Emotion Regulation Programs

One of the prominent initiatives, the Positive Affect Regulation sKills (PARK) program, demonstrated promising results during its trial phase. Conducted with 554 healthcare workers across various facilities in Chicago, the study aimed to mitigate burnout by enhancing positive emotions. As reported in PLOS ONE, participants who immediately engaged with the program exhibited significant reductions in anxiety compared to those who delayed participation. Despite these encouraging outcomes, the study also highlighted a common challenge: low completion rates. Only 9.4% of participants completed all five weekly lessons, underscoring the difficulty of engaging healthcare workers in such programs.

Addressing Low Engagement Rates

The struggle to maintain high engagement levels is not unique to the PARK program. Research consistently shows that participation in mental health and well-being programs among healthcare workers tends to be low. A study exploring the relationship between patient satisfaction and nurses’ mental well-being, published in the Journal of Palliative Care, revealed similar trends. It emphasized that while interventions are beneficial, their success hinges on the active participation of the workforce.

The Role of Nature and Personalized Interventions

One innovative approach to enhance engagement involves integrating nature into mental health interventions. A research article conducted by C. Ong (2024) at the Swedish University of Agricultural Sciences explored the impact of nature experiences on the mental well-being of professionals. The findings suggested that nature-based activities significantly improve mental health, providing a refreshing and accessible way to combat burnout.

Examples of Nature-Based Activities:

  1. Garden Therapy: Engaging in gardening activities, such as planting flowers, vegetables, or simply tending to a garden, was shown to have a calming effect and improve mood. Garden therapy helps participants reconnect with nature, fostering a sense of accomplishment and peace.
  2. Nature Walks: Regular walks in natural settings, such as parks or forests, were found to reduce stress and enhance mental clarity. Participants reported feeling more relaxed and rejuvenated after spending time walking amidst greenery.
  3. Outdoor Meditation: Practicing mindfulness and meditation in outdoor environments, like a park or garden, significantly reduced anxiety and increased overall well-being. The natural surroundings provided a serene backdrop that enhanced the meditative experience.
  4. Nature-Based Art Therapy: Activities such as drawing, painting, or crafting with natural materials (e.g., leaves, stones) were effective in promoting creativity and reducing stress. This form of therapy allowed participants to express themselves creatively while benefiting from the therapeutic effects of nature.
  5. Animal-Assisted Activities: Interacting with animals in natural settings, such as farms or sanctuaries, helped reduce feelings of loneliness and stress. Participants found comfort and joy in spending time with animals, which contributed to their emotional well-being.

These nature-based activities highlight the potential of integrating the natural environment into mental health interventions. By providing diverse and engaging ways to connect with nature, these activities offer practical solutions to improve mental health and combat burnout among healthcare professionals.

Furthermore, personalized interventions tailored to the specific needs of healthcare workers have shown potential. In Ethiopia, a study on job satisfaction among nurses highlighted the importance of targeted training programs. These programs not only improved job satisfaction but also enhanced the overall quality of care provided.

Virtual Training and Resilience

Virtual training programs have also gained traction, particularly in the field of palliative care. According to a study published in Educación Médica, virtual interventions significantly improved the quality of life for palliative care providers by enhancing positive feelings and self-care practices. These findings align with the broader narrative that accessible, well-designed programs can play a crucial role in supporting the mental health of healthcare workers.

Compassion Fatigue and Mental Health Support

Compassion fatigue remains a pervasive issue among healthcare professionals, particularly those in mental health and caregiving roles. This condition, often described as the “cost of caring,” manifests as physical, emotional, and mental exhaustion resulting from prolonged exposure to the suffering of others. Addressing compassion fatigue effectively requires comprehensive support systems and innovative training programs tailored to the unique challenges faced by caregivers.

One promising approach is the implementation of virtual skills training programs, which offer flexibility and accessibility for healthcare workers and caregivers. Virtual training can significantly alleviate compassion fatigue by providing caregivers with practical tools and strategies to manage their emotional well-being.

Virtual Skills Training for Caregivers

Programs such as the Engage with® Older Adults and the Engage with® Older Adults at Home exemplify how virtual training can be leveraged to support caregivers and professionals that engage with older adults. These programs provide a fully immersive virtual learning experience designed to enhance caregivers’ skills in managing stress, improving communication, and fostering emotional resilience. By offering an interactive learning experience and real-time training with a certified trainer, such programs ensure that caregivers can access the training they need, regardless of their geographical location.

Key Features and Benefits:

  • Flexibility and Accessibility: Virtual training programs can be accessed from anywhere with an Internet-accessible device, allowing caregivers to learn from any geographic preference, allowing them to skip travel time and costly expenses often associated with in-person training. This is particularly beneficial for professionals with demanding and irregular schedules.
  • Interactive Learning: Programs like Engage with® Older Adults incorporate interactive elements such as videos, engaging quizzes, and live, virtual simulations. These features enhance engagement and retention, making the training more effective.
  • Practical Tools and Techniques: Caregivers are equipped with practical strategies to manage stress and prevent burnout. These include mindfulness exercises, communication techniques, and problem-solving skills tailored to the challenges of caregiving.
  • Real-Time Support: Many virtual training programs offer real-time support through online forums, chat features, and virtual coaching sessions. Programs like Engage with® Older Adults provides a unique experience of learning from a live, certified instructor in real-time. This immediate access to support helps caregivers address issues as they arise, reducing feelings of isolation and helplessness.
  • Focused Content: The content is specifically designed to address common issues faced by caregivers, such as compassion fatigue, emotional burnout, and effective patient interaction. This targeted approach ensures that the training is relevant and immediately applicable.

Impact on Compassion Fatigue

Virtual skills training has been shown to have a positive impact on caregivers experiencing compassion fatigue. According to a study on virtual interventions in palliative care, these programs significantly improved the quality of life for healthcare providers by enhancing positive feelings and self-care practices. Similarly, the Engage with® programs equips caregivers with the skills to manage their emotional well-being, ultimately reducing the risk of burnout.

Dr. Jasmeet Singh’s research on compassion fatigue among mental health professionals emphasizes the need for resilience-building programs. Singh notes that “tailored mental health support systems are crucial for helping professionals cope with the emotional demands of their work”. Virtual training programs align with this recommendation by providing personalized, accessible support that caregivers can integrate into their daily routines.

Bridging the Gap: Effective Implementation

To truly harness the benefits of these programs, healthcare organizations must address the barriers to participation. This includes creating flexible, engaging, and easily accessible interventions that fit seamlessly into the demanding schedules of healthcare workers. The integration of nature-based activities, personalized training, and virtual programs offers a multifaceted approach to enhancing engagement and effectiveness.

Conclusion: A Path Forward

The collective findings from recent studies underscore a critical message: supporting the mental well-being of healthcare workers is not just beneficial but essential. As healthcare systems continue to grapple with the lingering effects of the pandemic, implementing robust, engaging, and accessible positive emotion regulation programs can make a profound difference. By nurturing resilience and fostering positive emotions, we can build a healthier, more sustainable healthcare workforce capable of providing the best care possible.


  • Cuartero-Castañer, E., Cañas-Lerma, AJ., and Casado, T. “Enhancing professional quality of life in palliative care through a virtual training program.” Educación Médica, 2024.
  • Jung, OS., Aiken, LH., Sloane, DM., Fridkin, SK., and Li, Y. “Studying the Relationship between Patients’ Satisfaction and Mental Well-Being of Nurses with the Job Burnout Mediating Role.” Journal of Palliative Care, 2023.
  • Moskowitz, JT., Jackson, KL., and Cummings, P. “Feasibility, acceptability, and efficacy of a positive emotion regulation intervention to promote resilience for healthcare workers during the COVID-19 pandemic: A randomized waitlist-controlled trial.” PLOS ONE, 2024.
  • Ong, C. “Off work to unwind in nature.” SLU Studies, 2024.
  • Saliya, SA., Ashine, TM., and Heliso, AZ. “Professional quality of life and job satisfaction among nurses working at tertiary hospitals in central Ethiopia.” BMC Nursing, 2024.
  • Singh, J. “Compassion fatigue in mental health professionals in the United Kingdom: an occupational perspective, a qualitative exploration, and a psychometric evaluation.” Nottingham Trent University Repository, 2024.

Welcoming New Talent: Engage with® Skills Training Program Expands Its Team

In a significant move to bolster its mission of enhancing the lives of older adults through equipping those that care for and engage with them the necessary skills of empathy, respect, and effective communication, the Engage with® Skills Training Program has welcomed four new Certified Skills Trainers. This strategic expansion is set to increase the program’s capacity to meet the growing training needs of partnering organizations, particularly the Maryland Department of Aging and their State Longevity Ready Initiative. With their extensive experience and diverse backgrounds, these new trainers are poised to make a substantial impact on the program’s effectiveness and reach.

Building a Stronger Foundation for Older Adult Care

The Engage with® Skills Training Program, a national non-profit initiative of the Mental Health Association of Maryland (MHAMD), focuses on equipping direct care workers and service providers with crucial skills that improve the lives of older adults they serve. As Amanda Krisher, Senior Director of the program, emphasized in a recent podcast interview, the program’s core values are rooted in empathy, respect, and effective communication. The integration of these values into training modules helps create a more compassionate and understanding workforce, ultimately enhancing the quality of care provided to older adults and improving the overall job satisfaction for the staff members.

Our training is conducted on a virtual platform built on a gaming system, where participants create and customize avatars to represent themselves. Our Certified Skills Trainers guide them through interactive conversations in real-time.
Unlike many traditional long-term care and aging services training curricula, which often rely on brief videos and quizzes, our unique approach focuses on providing a comprehensive experience. Our Certified Skills Trainers ensure that participants have ample opportunities to practice the skills we teach, which is crucial for effective learning and understanding how to respectfully engage with older adults. The success of this program would not be possible without the team of talented skills trainers that we’ve developed here at Engage with!

Amanda Krisher, LCSW-C, Senior Director,
     Engage with® Skills Training Programs

Meet the New Certified Skills Trainers

Jill Kluesner, MA, CRC, Certified Skills Trainer (Contractor)

With over 15 years of experience in public health programming, Jill Kluesner brings a wealth of knowledge to the Engage with® team. Her expertise spans curriculum development, public health education, and program implementation. Jill has worked with the National Council for Mental Wellbeing to create and pilot diverse training experiences, including Mental Health First Aid (MHFA) programs. Her commitment to advancing public health education and supporting instructor development is evident in her role as a mentor and national trainer. Jill’s background in Rehabilitation Counseling and Public Health, combined with her practical experience, makes her a valuable asset to the team.

Soumya Palreddy, PhD, Certified Skills Trainer (Contractor)

Soumya Palreddy is a licensed psychologist and restorative justice practitioner with a passion for promoting transformative change in communities. Her experience includes facilitating restorative justice implementation, addressing inequities, and fostering cultures of care in various settings. As a National Trainer for MHFA, Soumya has been instrumental in updating training programs and developing train-the-trainer initiatives. Her previous roles, including Associate Director at University Health Services at the University of Wisconsin-Madison, highlight her leadership and expertise in mental health education.

Suzanne Perlman, MA, Certified Skills Trainer (Contractor)

An expert in curricula development and training program facilitation, Suzanne Perlman has over 20 years of experience in promoting equity and access. Her work focuses on designing innovative curricula for diverse communities, including Indigenous, older adult, and rural populations. Suzanne’s national training efforts have reached thousands, providing mentorship and technical assistance to ensure programs meet the evolving needs of various groups. Her background in behavioral health system transformation further underscores her ability to drive meaningful change in public health education.

Rachel Taube, MSW, Certified Skills Trainer (Contractor)

Rachel Taube’s dedication to mental health education and community engagement is reflected in her extensive experience as a national facilitator. With a strong foundation in social work, Rachel specializes in bridging the gap between theory and practice, connecting communities with evidence-based tools. Her educational journey, which includes degrees from Valparaiso University and Washington University in St. Louis, has equipped her with the skills to effectively translate knowledge into practice, enhancing the overall impact of training programs.

Enhancing Training through Technology and Empathy

Engage with® Skills Training Program leverages technology to create immersive and scalable training experiences. By using a virtual platform that allows participants to interact through avatars, the program provides a unique environment for older adult care workers and service providers to practice and refine their skills. This method not only enhances engagement but also ensures that training is accessible and impactful.

Looking Ahead

With the addition of these highly skilled trainers, the Engage with® Skills Training Program is well-positioned to expand its reach and effectiveness. The program’s commitment to fostering empathy, respect, and effective communication remains at the forefront of its mission, ensuring that direct care workers and service providers are well-equipped to meet the needs of the aging population. The expertise and dedication of the new skills trainers will undoubtedly contribute to the program’s continued success and its positive impact on the older adult care industry.

The Silent Crisis: Addressing Behavioral Health Challenges Among Older Adults

As the older generation continues to age, the demographic landscape of the United States is shifting dramatically. As of 2024, there are currently approximately 62 million adults ages 65 and older living in the U.S., according to the research released by the Pew Research Center, leading to Older adults now making up over 18 percent of the population.  Recent studies predict that the U.S. Centenarian population is expected to quadruple over the next 30 years and with this growth comes a critical need to address their behavioral health concerns. The recent SAMHSA report, “Behavioral Health among Older Adults: Results from the 2021 and 2022 National Surveys on Drug Use and Health,” sheds light on the pressing issues of substance use and mental health in this age group, revealing a silent crisis that demands our attention.

Unveiling the Statistics

The SAMHSA report provides a comprehensive analysis of substance use and mental health issues among older adults. According to the report, approximately 12.5% of older adults had a mental illness in the past year, with serious mental illness affecting around 2%. Substance use disorders were prevalent in 9.1% of this population, with 5.6% experiencing alcohol use disorder and 4.1% facing drug use disorder.

  • About 1 in 25 older adults had a drug use disorder (DUD) in the past year.
  • Fewer than 1 in 3 older adults that were classified as needing substance use treatments actually received it.
  • Of the older adults that received substance use treatments, nearly all (97%) did not think they needed it.
  • 2.7 million older adults had a major depressive episode in the past year, with females being twice as likely to experience one over their male counterparts.
  • About 1 in 50 older adults had serious thoughts of suicide in the past year.

These statistics are alarming, yet they reflect only a portion of the problem. Older adult females are more likely to suffer from mental illness, while older adult males have higher rates of substance use disorders. This gender disparity underscores the need for tailored interventions that address the specific needs of men and women in this age group.

Barriers to Treatment

Despite the high prevalence of mental health and substance use disorders, treatment remains elusive for many older adults. The SAMHSA report highlights that fewer than one-third of older adults who needed substance use treatment received it in the past year. Similarly, only about 46% of those living with any mental illness received treatment.

Several factors contribute to this treatment gap. Medical conditions associated with aging, significant life changes, and social isolation can exacerbate mental health issues. Additionally, stigma, cost, transportation difficulties, and challenges navigating the healthcare system pose significant barriers to accessing care. As noted in the report, “Older adults who might benefit from treatment also typically did not perceive that they needed it.”

The Impact of Loneliness

Loneliness is a significant concern for older adults, as highlighted in both the SAMHSA report and a study by researchers at the Indiana University School of Medicine. The study found that loneliness is significantly associated with lower mental and physical quality of life among older adults. This finding aligns with the broader themes of the SAMHSA report, which emphasizes the adverse effects of social isolation on mental health.

The U.S. Surgeon General’s 2023 report on social connection further underscores the importance of addressing loneliness. It emphasizes the need for supportive connections, including friendships, community involvement, and the mental health benefits of connecting with pets. As we celebrated the first inauguration of Older Americans Month in May, this year’s theme, “Powered by Connection,” aptly highlights the multifaceted benefits of social interactions.

Gender Differences in Behavioral Health

The SAMHSA report and other studies consistently show gender differences in behavioral health among older adults. Women are more likely to experience mental health issues, while men have higher rates of substance use disorders. Understanding these differences is crucial for developing effective interventions.

In a comprehensive review by the University  of St. Augustine for Health Sciences (USAHS), it was noted that “33.5% of adults with a mental illness also reported a substance use disorder in 2021.” This statistic highlights the complex interplay between mental health and substance use, particularly among older adults. Addressing these co-occurring disorders requires a holistic approach that considers both mental and physical health.

The Role of Primary Care

Primary care clinicians play a pivotal role in addressing the behavioral health needs of older adults. As suggested by the Indiana University study, clinicians should actively discuss loneliness with their older patients and provide resources to help them develop and maintain meaningful social relationships. This proactive approach can help mitigate the adverse effects of loneliness and improve overall mental health.

Moving Forward

Addressing the behavioral health challenges among older adults requires a multifaceted approach that includes increasing awareness, reducing stigma, and improving access to care. Service providers must focus on:

  1. Education and Awareness: Educating older adults about the risks of substance use and the importance of mental health care is crucial. Reducing stigma around these issues can encourage more individuals to seek help.
  2. Improving Access: Addressing barriers such as cost, transportation, and healthcare navigation is essential to ensure that older adults receive the care they need.
  3. Targeted Interventions: Developing interventions tailored to high-risk groups, particularly older males for substance use disorders and older females for mental health issues, can help mitigate these problems effectively.
  4. Support for Caregivers: Providing resources and support for caregivers is vital, as they play a key role in the well-being of older adults.

As the population of older adults continues to grow, addressing their behavioral health needs becomes increasingly urgent. By understanding and addressing the challenges highlighted in the SAMHSA report and other studies, we can improve the quality of life for this vulnerable population and ensure they receive the care and support they deserve.


Navigating the Delicate Balance: Antihypertensive Medications and the Risk of Falls and Fractures in Older Adults

In the intricate landscape of older adult care, the management of hypertension presents a significant challenge, especially when weighed against the risks of falls and fractures. Recent studies have shed light on the delicate balance healthcare providers must maintain to safeguard the health of older adults, particularly those residing in long-term care centers and those with dementia.

Elevated Risks with Antihypertensive Medications

A comprehensive study published in JAMA Internal Medicine highlights a stark reality: aging adults in long-term care centers who start antihypertensive medications face significantly higher risks of falls and fractures. This study, involving data from over 29,000 older adults in long-term care centers in the Veterans Health Administration, revealed that the incidence rate of fractures in those initiating antihypertensive therapy was 5.4 per 100 person-years, compared to just 2.2 in those not on these medications.

Dr. Muna Thalji Canales, a researcher at the Malcom Randall VA Medical Center, emphasized the need for caution. “Ultimately, the question of how to treat blood pressure in older adults remains one that must be individualized,” she noted. The study’s findings underscore the necessity for additional monitoring and a tailored approach when managing hypertension in this vulnerable population.

Specific Vulnerabilities: Dementia and Blood Pressure Thresholds

The risks are particularly pronounced among older adults with dementia. The same study found that for those with dementia, the hazard ratio for fractures skyrocketed to 3.28. Additionally, older adults with systolic blood pressure of 140 mm Hg or higher and diastolic blood pressure of 80 mm Hg or higher faced even greater risks, with hazard ratios of 3.12 and 4.41, respectively.

These statistics are echoed in multiple other studies, including one from HCPLive, which linked antihypertensive medication with an increased fracture risk among older adults. Similarly, research published in Wiley Online Library highlighted that hypertensive older adults are at a heightened risk of falls and fractures following the initiation of these drugs.

Practical Implications for Long-term Care Centers

The practical implications of these findings are profound. As Dr. Thalji Canales suggests, healthcare practitioners in long-term care centers should avoid rapid intensification of antihypertensive medication, allowing at least a month for older adults to acclimate to new doses. Monitoring orthostatic vitals around changes in blood pressure management, particularly in the first week, is also recommended. However, these ideal practices often face the harsh reality of limited staffing and resources in many long-term care centers.

A study published on BMJ Open supports these recommendations, showing that older adults face an increased risk of injurious falls when initiating antihypertensive medication. The necessity for continuous and thorough medication management cannot be overstated, especially in settings where older adults safety is paramount.

Balancing Benefits and Risks

The overarching theme across these studies is the critical need to balance the benefits of antihypertensive medications against their potential risks. While controlling high blood pressure is essential to prevent strokes and other cardiovascular events, the accompanying increase in fall and fracture risks must be carefully managed.

A thought-provoking commentary in Pharmacy Times stresses the importance of reviewing older adults histories before prescribing antihypertensive medications. This step is crucial to tailor treatment plans, a primary tenet of person-centered care, that minimize risks while effectively managing hypertension.

Moving Forward: Individualized Care Plans

The path forward involves a commitment to individualized care plans, where the unique health profiles and needs of older adults are meticulously considered. Healthcare providers must be person-centered focused, and vigilant in monitoring and adjusting treatment plans, ensuring that the initiation of antihypertensive medication does not inadvertently compromise patient safety.

In conclusion, the intersection of antihypertensive medication use and fall/fracture risks in older adults, especially those living with dementia, highlights a critical area of older adult care. By embracing a patient-centric approach and advocating for the necessary resources and staffing, we can better navigate this delicate balance, ultimately enhancing the quality of life and safety for our elderly population.


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Empowering Older Adult Care Through Game-Based Learning: Interview with Filament Games at CES 2024

In the bustling atmosphere of this year’s Consumer Electronics Show (CES) in Las Vegas, innovation takes center stage, showcasing the latest breakthroughs in technology. Amidst the cutting-edge displays and high-tech demonstrations, one interview stands out for its profound impact on a critical aspect of society: the care of older adults. In the premiere episode of Season 7 of the Filament Games Podcast, Jennifer Javornik, Chief Partnerships Officer, sits down with Amanda Krisher, Senior Director of the Engage with® Skills Training Programs at the Mental Health Association of Maryland (MHAMD).

Krisher, who has over a decade of experience in direct practice and program management, brings a wealth of knowledge to the Engage with® program, a national non-profit initiative. The program focuses on training older adult care workers in empathy, respect, and effective communication. Her enthusiasm for CES is palpable, noting the event’s overwhelming yet inspiring atmosphere, particularly the innovations in gaming and older adult care.

Building Empathy Through Experience

Krisher’s experiences at CES underscore the importance of empathy in older adult care. She highlights an exercise she participated in, organized by AARP and the MIT Agelab, which simulated the physical challenges faced by older adults. This hands-on experience is crucial, she explains, in understanding the unique needs of the aging population. “It’s harder to maneuver, hear things, or see things,” Krisher notes, emphasizing the necessity of designing technology with these challenges in mind.

Leveraging Technology for Scalable Training

The Engage with® Skills Training Programs have embraced technology to enhance and scale their training initiatives. Originally conducted in person, the program transitioned to an online virtual platform in 2020. This shift allowed for greater scalability and accessibility. Built on a gaming platform, the training features avatars and interactive scenarios, providing a unique and engaging learning experience. Krisher explains, “Our training takes place in a virtual platform… everyone comes in as an avatar. They have a chance to customize that avatar and find somebody that really represents them.”

This approach diverges from traditional microlearning methods, focusing instead on creating immersive experiences where participants can practice skills in a safe environment. This method allows for mistakes to be made and learned from without real-world consequences.

Game-Based Learning in Action

A standout feature of the skills training program is the “Demonstrating Respect” game, which uses a choose-your-own-adventure format to teach respect and effective care. Participants interact with virtual older adults, making choices that influence the outcome of the scenario. This interactive method helps care workers understand the diverse needs and preferences of older adults. One memorable character, Joe, a stern army veteran, requires a different approach compared to Sally, a cheerful and friendly character. This diversity in interactions teaches care workers to tailor their approach to each individual.

Impact and Results

The results of this game-based learning approach are significant. Studies conducted by independent evaluators contracted by MHAMD show a reduction in staff turnover rates and improvements in customer service skills. Krisher shares that after implementing the training, staff members felt better equipped to handle challenging situations without immediately resorting to medication. This has led to a notable decrease in PRN (pro re nata) medication use, particularly in assisted living centers.

Moreover, staff retention rates have improved dramatically. In one study, 76% of staff members who received the training were still employed over a year later, a remarkable achievement in an industry known for high turnover rates. This retention is attributed to staff feeling valued and better prepared for their roles.

Advice for Implementing Game-Based Learning

For those considering a game-based learning approach, Krisher advises balancing information delivery with interactive experiences. “Game-based training is how we move the needle,” she asserts, highlighting the importance of providing opportunities for practice and small wins. This approach not only makes training more engaging but also ensures that participants can apply what they have learned effectively.


Amanda Krisher’s insights from the CES interview reveal the transformative potential of game-based learning in older adult care. By leveraging technology and focusing on empathy and respect, the Engage with® Skills Training Programs are setting a new standard in the industry. As Krisher aptly summarizes, empowering care workers through innovative training methods ultimately leads to better care for older adults, fostering a culture of respect and understanding that benefits everyone.

Harnessing the Power of Psychological Therapies to Combat Depression in Older Adults Living in Long-Term Care

Depression among older adults in long-term care centers is a pervasive issue, challenging the wellbeing and quality of life of an aging population. Traditional approaches, predominantly pharmacological, have been the linchpin in managing these symptoms. However, an emerging body of research advocates a paradigm shift towards psychological therapies, which are proving to be not only effective but also possibly more humane and attuned to the psychological needs of older adults.

A systematic review conducted by the Cochrane Library sheds considerable light on the potential of psychological therapies to mitigate depression symptoms better than traditional non-therapy approaches in long-term care settings. The findings suggest that interventions like cognitive behavioral therapy (CBT), behavioral therapy, and reminiscence therapy can significantly improve outcomes immediately after therapy and sustain these improvements for up to six months.

The compelling evidence from Cochrane’s extensive review aligns with findings from other notable studies. For instance, a 2016 systematic review published in PLoS One emphasizes that problem-solving therapy (PST) is a promising treatment for older people with depressive symptoms, which complements the broader narrative that psychological therapies could serve as viable alternatives to medication. This is particularly pertinent given the common side effects and often diminished efficacy of antidepressants in older adults as highlighted by a 2019 study in the British Journal of General Practice.

Moreover, research highlighted in Maturitas (2014) and International Psychogeriatrics (2023) corroborates the notion that psychological interventions are not only safe but effective in treating depression among the older adult population in long-term care. These interventions offer a dual benefit—a reduction in depression symptoms and an enhancement in the overall quality of life and psychological well-being of older adults.

Dr. Yvonne Wells from the Cambridge study underscores the significance of these findings, “Our systematic review demonstrated the positive impacts of psychological therapies on symptoms of depression in older people living in long-term care, both immediately after therapy and in the long term.”

However, despite the promising outcomes, the research consistently points out the scarcity of high-quality clinical trials and the need for more robust methodologies to solidify these findings. The Cochrane review itself notes the limited confidence in the evidence, due to the small sample sizes and inconsistent methods employed across studies. This calls for an urgent need to invest in comprehensive, well-designed clinical trials to further validate and refine these psychological interventions.

As we look to the future, it becomes increasingly clear that an integrated approach, involving a mix of psychological therapies tailored to the individual needs of older adults, could revolutionize the way depression is treated in long-term care settings. This could not only alleviate the burden of depression on our aging population but also enhance their quality of life.

In summary, the shift towards psychological therapies represents a critical evolution in the care of older adults with depression. It is an approach that aligns with a broader, more holistic view of health care—one that considers the mental, emotional, and social needs of individuals as integral to their overall health and wellbeing. As this field continues to evolve, it is imperative that all stakeholders from healthcare providers to policymakers take heed of the evidence and push forward with the necessary research and resources to implement these changes effectively.


  1. Cochrane Library. “Are psychological therapies effective in reducing depression in older adults living in long-term care?” Accessed from: Cochrane Library Review
  2. Jonsson, U., Bertilsson, G., Allard, P., Gyllensvärd, H., Söderlund, A., Tham, A., Andersson, G. (2016). “Psychological treatment of depression in people aged 65 years and over: a systematic review of efficacy, safety, and cost-effectiveness.” PLoS One. Accessed from: PLoS One Article
  3. Cuijpers, P., Karyotaki, E., Pot, A.M., Park, M., Reynolds, C.F. (2014). “Managing depression in older age: psychological interventions.” Maturitas. Accessed from: Maturitas
  4. Wells, Y., Davison, T., Bhar, S., Doyle, C., You, E., Barson, F. (2023). “Psychological therapies for depression in older adults residing in long-term care settings: Are they effective?” International Psychogeriatrics. Accessed from: International Psychogeriatrics
  5. Frost, R., Beattie, A., Bhanu, C., Walters, K. (2019). “Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies.” British Journal of General Practice. Accessed from: British Journal of General Practice

A Key to Keeping Caregivers: Transformative Onboarding Practices in Older Adult Care

In the post-pandemic era, the long-term care sector faces a critical challenge: high turnover rates among caregivers. The stakes are especially high in environments caring for older adults, where continuity and quality of care are paramount. Emerging studies, including Viventium’s 2024 Caregiver Onboarding Experience Report and the research by Yu-Jung Chang, provide compelling evidence that refining the onboarding process could be the linchpin in retaining skilled care staff.

The Critical Link: Onboarding and Retention

Viventium’s report reveals a stark reality: the bar for what passes as a “good” onboarding experience in home-based and facility/community-based care remains disconcertingly low. However, there’s a silver lining. “Staffing shortages and high turnover rates within post-acute care are recurring issues in need of solutions,” states Navin Gupta, CEO of Viventium. He adds, “Our research illuminates a crucial pathway towards addressing these persistent challenges, and it begins with onboarding.”

Similarly, Yu-Jung Chang’s study underscores that a well-designed onboarding process not only enhances job satisfaction but crucially leads to long-term employee retention. Chang’s approach utilizes service design tools to create effective and smooth onboarding, emphasizing the perspective of new hires to identify and mitigate challenges early in their career journey.

Simplicity and Impact

One of the striking findings from the Viventium report is the simplicity of effective solutions. William A. Dombi, President of the National Association for Home Care & Hospice, reflects on the study’s implications: “Many of the elements of successful onboarding are simple improvements in the process that bring a real return on investment.”

This sentiment is echoed in Chang’s study, which demonstrates that straightforward enhancements, such as reducing paperwork and customizing materials to be culturally and linguistically appropriate, can make significant differences. Both studies illustrate that these changes are within the control of the employer and do not necessitate extensive resources or overhaul.

The Managerial Role: Catalyst for Change

Both pieces of research highlight the pivotal role of management in the success of onboarding programs. Effective leadership is not just about overseeing operations but actively engaging in the creation of a nurturing and welcoming environment for new hires. Managers are instrumental in implementing the best practices that define a successful onboarding experience.

Industry-Specific Strategies

For the long-term care sector, adapting onboarding strategies that address specific industry challenges—such as emotional demands of the job, the need for compassionate caregiving, and continuous professional development—is crucial. These tailored strategies can ensure that caregivers feel valued and understood, which is essential for their retention.

Conclusion: A Call to Action

The evidence is clear: improving onboarding processes in post-acute care settings can significantly boost retention rates. This is not just beneficial for the careg staff and their patients/residents but also for the broader health system, which relies on the stability and expertise of its workforce to deliver quality care.

Leaders in the care sector are encouraged to view onboarding not just as a procedural necessity but as a strategic tool for workforce stabilization and enhancement. As the industry continues to evolve, the organizations that prioritize thoughtful, well-structured onboarding processes will be better positioned to attract, retain, and empower the caregivers who are so vital to our society.

By bridging the gap between emerging research and practical application, the long-term care sector can transform a perennial challenge into a remarkable opportunity for growth and improvement.


  1. Viventium’s 2024 Caregiver Onboarding Experience Report – Viventium. (2024). Retrieved from Viventium’s Website
  2. Building An Effective Hiring and Smooth Employee Boarding Process – Company X – Chang, Yu-Jung. (2023). Master’s Thesis, Turku University of Applied Sciences. Retrieved from Theseus

The Older Years Reimagined: Volunteering as a Pathway to Health and Happiness

In a society that often equates youth with vitality and contribution, a growing body of research is painting a different picture of the older years—one where aging not only brings wisdom but also an unexpected key to health and happiness: volunteering. Far from being merely a noble endeavor, volunteering emerges as a potent means to enhance one’s physical, mental, and emotional well-being, particularly among the older adult population.

A pivotal new study published in the European Journal of Public Health underscores this connection, revealing the reciprocal benefits of volunteering on health and daily life functioning among middle-aged and older adults across 15 European countries. This research isn’t alone in its findings; similar studies from the American Journal of Preventative Medicine and reports by the Corporation for National and Community Service (CNCS) in the United States corroborate these benefits, highlighting a global resonance in the health impacts of volunteering.

The Science of Giving Back

Imagine your neighbor, Mrs. Thompson, who, at 70, decides to volunteer at the local library. Twice a week, she helps children with their reading. It’s a simple act of giving back, but the benefits extend far beyond the library’s walls. Studies have revealed that engaging in volunteer work, like Mrs. Thompson’s reading sessions, does wonders for the health and happiness of older adults.

Latest research uncovers that activities such as volunteering are associated with significant health benefits for the elderly. For example, Mrs. Thompson’s weekly commitment to the library is not just a generous use of her time; it’s likely improving her emotional well-being, keeping daily life limitations at bay, and even reducing her risk of Alzheimer’s disease.

Harvard T.H. Chan School of Public Health further supports these findings, highlighting that older adults who volunteer just two hours a week are at a significantly lower risk of premature death compared to their non-volunteering counterparts. They also enjoy better physical activity levels and overall well-being.

Think of volunteering as Mrs. Thompson does as an opportunity to stay active, both mentally and physically. It’s a chance to connect with others, learn new things, and find joy in helping. When she assists a child in reading, she’s not only contributing to that child’s future success; she’s invigorating her own life, staying engaged, and maintaining her health.

By intertwining real-world examples with data from these studies, the impact of volunteering becomes clear. It’s more than a moral or social responsibility; it’s a pathway to a healthier, more fulfilling life for older adults. Whether it’s at a library, a community garden, or a local school, volunteering offers a unique blend of benefits, contributing to physical health, mental sharpness, and emotional fulfillment.

So, for those considering how to enrich their lives or the lives of older adults in their care, the answer could be as simple as volunteering. Just like Mrs. Thompson, finding purpose and community connection through volunteering not only benefits those around them but significantly enhances their own quality of life.

A Two-way Street: Health Benefits and Barriers

Consider Mr. Lee, a retired school teacher who lives in a small community. Mr. Lee has always been active in his community, but after retirement, he found himself facing some health issues and feeling the pinch of a tighter budget. Despite his eagerness to contribute, these challenges threatened to sideline him from participating in volunteer activities he loves, such as tutoring children at the local community center.

This is where the concept of a “virtuous cycle” of volunteering comes into play, as described by research. Engaging in volunteer work, like Mr. Lee’s tutoring, isn’t just a way to give back. It also boosts his health—both mental and physical—creating a positive feedback loop. As Mr. Lee feels better from volunteering, he’s more motivated and physically capable of continuing his volunteer work, which in turn keeps contributing to his well-being.

However, the reality is that challenges such as chronic health issues or financial constraints can hinder participation in volunteer activities. This is where programs like the AmeriCorps Seniors RSVP program step in​​. These programs are designed to be inclusive, offering volunteer opportunities that are accessible to older adults regardless of their health status or financial situation. For instance, the AmeriCorps Seniors provides stipends to volunteers who need financial support, and it designs roles that are accommodating for those with physical limitations.

In Mr. Lee’s case, finding a volunteer role that aligns with his skills as a teacher, while also considering his physical and financial circumstances, allows him to continue making a meaningful contribution without compromising his health or financial security. This inclusive approach ensures that more people like Mr. Lee can participate in volunteer work, benefiting from the health improvements it brings and, in turn, contributing to a cycle of positive community impact and personal well-being.

By understanding these dynamics, we see the importance of creating and supporting volunteer opportunities that are accessible and accommodating to the diverse needs of older adults. This not only enriches their lives but also strengthens communities through the valuable contributions of experienced individuals. Programs like the AmeriCorps Seniors exemplify how with the right support, the barriers to volunteering can be overcome, allowing every individual to partake in the virtuous cycle of health benefits and community service.

Social Connectivity: An Antidote to Isolation

Beyond physical health, volunteering addresses a critical challenge of aging: social isolation. The CNCS study found that AmeriCorps volunteers report feeling less isolated and depressed, underscoring volunteering’s role in building social connections and community belonging. This sense of companionship and community is pivotal, as isolation can have profound adverse effects on health, comparable to high-risk behaviors like smoking.

Imagine Maria, a 68-year-old widow who recently retired. Since her husband passed away and her children moved to different states, she’s felt increasingly isolated, spending days without meaningful social interactions. Concerned about her well-being, her daughter encourages her to join a local volunteering group through the AmeriCorps program—a decision that transforms Maria’s life.

Studies have shown that volunteering significantly reduces feelings of isolation and depression among older adults like Maria​​. This isn’t just about keeping busy; it’s about the profound human need for connection and the role volunteering plays in fulfilling this need. By joining the AmeriCorps, Maria starts tutoring at a local school, where she forms bonds with students and staff, making her feel valued and part of a community again.

This connection to community and the decrease in feelings of loneliness are crucial. Research has shown that social isolation can have severe health impacts, being as detrimental as smoking in terms of increasing mortality risk​​​​. The AmeriCorps’ focus on creating opportunities that cater to the physical and financial situations of older adults ensures that more people like Maria can find a path back to social engagement, regardless of their circumstances.

Moreover, the positive feedback loop of volunteering benefits both the volunteer and their community. As Maria feels more connected and happier, she’s likely to continue volunteering, which keeps her engaged and healthy, while also contributing to the educational support of local children. This cycle exemplifies how tailored volunteer programs can address the critical challenge of social isolation among older adults, turning their later years into a time of growth, connection, and contribution.

Through Maria’s story, we see the power of volunteering to combat social isolation and support mental health in older adults. It highlights the importance of programs like the AmeriCorps that offer accessible and meaningful volunteer opportunities, demonstrating that everyone has something valuable to contribute, regardless of age or life stage.


Volunteering as the Key to Health, Happiness, and Community Connection

In reimagining the older years through the lens of volunteering, we uncover a profound truth: aging is a vibrant opportunity for growth, contribution, and fulfillment. The stories of Mrs. Thompson, Mr. Lee, and Maria illustrate that volunteering is not merely an act of giving but a key to unlocking health, happiness, and a sense of belonging. These narratives, backed by compelling research, highlight the mutual benefits of volunteering for both the individual and the community. It is clear that engaging in volunteer work enriches the lives of older adults, offering them a pathway to maintain physical health, mental acuity, and emotional well-being, while combating social isolation.

As we reflect on the insights from this exploration, it is evident that volunteering embodies a powerful antidote to the challenges of aging. It fosters a virtuous cycle of health and happiness, proving that in giving, we receive. Therefore, the call to action is clear: for individuals, especially those in their older years, to embrace volunteering as a means to enhance their quality of life; for communities and organizations to create more accessible and meaningful opportunities for engagement; and for policymakers to recognize and support the vital contributions of older adults through volunteerism.

In doing so, we not only enrich the lives of older adults but also strengthen the fabric of our society, making the older years not a period of decline but a time of active, meaningful participation. Let us then embrace this opportunity, transforming the narrative of aging into one of continuous contribution and connection, ensuring that our older years are fulfilling.


  • AmeriCorps. “Volunteering Helps Keep Seniors Healthy, New Study Suggests.” AmeriCorps, 2019, https://americorps.gov/newsroom/official-press-releases/volunteering-helps-keep-seniors-healthy-new-study-suggests . Accessed 24 Mar. 2024.
  • Dorota Weziak-Bialowolska, Regina Skiba, Piotr Bialowolski, Longitudinal reciprocal associations between volunteering, health and well-being: evidence for middle-aged and older adults in Europe, European Journal of Public Health, 2024;, ckae014, https://doi.org/10.1093/eurpub/ckae014
  • Kim, E. S., PhD, Whillans, A. V., PhD, Lee, M. T., PhD, & Chen, Y., ScD (2020). Volunteering and Subsequent Health and Well-Being in Older Adults: An Outcome-Wide Longitudinal Approach. American Journal of Preventative Medicine, 59(2), 176-186. https://doi.org/10.1016/j.amepre.2020.03.004

Embracing Technology: Revolutionizing Dementia Care Through Patient Portals

In an era where healthcare increasingly intersects with technology, patient portals stand at the forefront of a significant transformation in managing dementia care. A recent study published in the Journal of the American Geriatrics Society has shed light on the pivotal role these digital platforms play in fostering an age-friendly health system for persons living with dementia and their care partners.

The Rise of Patient Portals in Dementia Care

Patient portals, secure online platforms that allow patients and their care partners to access health information and communicate with healthcare providers, are becoming indispensable in the landscape of dementia care. The study conducted by Gleason and colleagues underscores the portal’s utility in addressing the critical domains of medications, mentation, mobility, and what matters — collectively known as the 4Ms framework in age-friendly healthcare.

A striking revelation from the study is that a substantial portion of messages sent through these portals by older adults were actually composed by care partners, highlighting the integral role family members and caregivers play in the healthcare dialogue. The automation of care partner identification via natural language processing not only emphasizes the technological strides in healthcare but also marks a step forward in recognizing and validating the care partner’s role in the patient’s health journey.

Key Findings and Implications

The observational study revealed that 60% of messages contained content relevant to the 4Ms, with medications and what matters to the patient being the most frequently discussed topics. This data suggests patient portals are more than mere communication tools; they are lifelines that connect care partners to crucial health information and decision-making processes.

The effectiveness of patient portal messaging in dementia care is not just a matter of convenience but a testament to the evolving dynamics of patient-centered care. The study’s natural language processing model demonstrated an impressive AUC of 0.90 in identifying messages sent by nonpatient authors, indicating high accuracy in distinguishing care partner communications (Gleason et al., 2024).

Let’s simplify these findings with a real-world example to make it more relatable:

Imagine a scenario where Sarah, who is 75 years old and living with dementia, has a routine doctor’s appointment coming up. Instead of navigating the complexities of her patient portal herself, her daughter, Emily, takes on the task. Emily logs into Sarah’s patient portal and sends a message to the doctor, detailing her mother’s recent symptoms and asking for advice. This action is quite common, as the study reveals that many messages in patient portals, which are supposed to come from patients like Sarah, are actually written by care partners like Emily.

Now, here’s where technology comes into play. Using something called natural language processing—a type of artificial intelligence—healthcare systems can automatically detect when a message is likely sent by a care partner rather than the patient themselves. This is significant because it recognizes Emily’s crucial role in managing her mother’s healthcare. It’s not just about acknowledging that family members and caregivers often communicate on behalf of patients; it’s about officially integrating them into the healthcare conversation.

In simpler terms, think of natural language processing as a smart assistant that can tell whether Sarah or Emily is writing. When it understands Emily is the one sending messages about Sarah’s health, the healthcare providers can better appreciate the full picture of Sarah’s support system. This technology respects and values the input of family members like Emily, seeing them as key partners in the patient’s health journey.

So, for anyone caring for an older adult, this means the healthcare system is evolving not just to recognize but to support the vital role you play in your loved one’s health. Your efforts are becoming more visible and acknowledged, making the care process more collaborative and supportive.

Bridging Gaps and Fostering Inclusivity

While patient portals are transforming dementia care by offering a direct line to healthcare providers, several hurdles still stand in the way of their full potential. For instance, not everyone is equally comfortable or familiar with using digital tools. This “digital divide” means that some older adults and their caregivers might find it challenging to navigate these platforms, especially if they’re not tech-savvy. Additionally, some portals aren’t as user-friendly as they could be, making it hard for users to find the information they need or communicate effectively with healthcare providers.

Another significant issue is making sure these digital tools are accessible to everyone, regardless of their physical abilities or tech skills. This includes designing patient portals that are easy to read, navigate, and use for people with varying levels of physical ability and technological literacy.

But it’s not all about overcoming barriers. The real power of patient portals lies in their ability to bring caregivers’ insights and the personal health goals of the patients into the spotlight. Imagine a scenario where a care partner can easily share updates about their loved one’s condition, set reminders for medication, or schedule appointments—all aligned with what the patient values most in their care. This could mean ensuring a patient who loves gardening can maintain mobility to continue enjoying this hobby, or making sure someone who values family time can manage their medications in a way that doesn’t interfere with these moments.

As we tackle these challenges, patient portals stand as a symbol of hope. They promise a future where healthcare is not just about treating symptoms but about crafting a care experience that respects and incorporates the individual needs and preferences of older adults and their caregivers. This vision for a more inclusive, responsive, and personalized healthcare system is not only achievable but essential as we move forward in our journey to support those navigating the complexities of aging and dementia.

Looking Ahead

The conversation around patient portals in dementia care is only beginning. As technology evolves, so too will the ways in which we engage with it to improve health outcomes for older adults. The intersection of healthcare, technology, and caregiver involvement holds the key to unlocking a future where dementia care is not just about managing symptoms but about enhancing the quality of life for patients and their families.

In closing, the journey towards an age-friendly health system is a collaborative endeavor. By leveraging technology like patient portals, we can create a more connected, informed, and compassionate healthcare ecosystem that truly meets the needs of people living with dementia and those who care for them.


Gleason, K. T., Powell, D., DeGennaro, A. P., et al. (2024). Patient portal messages to support an age‐friendly health system for persons with dementia. Journal of the American Geriatrics Society. Link to article