SENIOR CENTER LITERATURE REVIEW

CALIFORNIA COMMISSION ON AGING

SENIOR CENTER

LITERATURE REVIEW

REFLECTING & RESPONDING TO

COMMUNITY NEEDS

TERESA S. DAL SANTO, PHD

February 4, 2009

Made possible by a grantfrom the Archstone Foundation

EXECUTIVE SUMMARY

As part of the California Commission on Aging Senior Center Initiative, the following

literature review was commissioned to examine the existing knowledge about senior centers.

Funding for this literature review was provided by the Archstone Foundation. The review

provides a cursory map of the 40 articles on senior centers published over the past twenty

years which can be summarized into the following categories: (1) characteristics of senior

centers; (2) services offered; (3) who participates, and (4) case studies of new programs and

associations. This review provides senior center directors, policy makers and researchers an

overview of the contributions senior centers have made to the lives older adults and a vision

for their future direction.

Senior centers are designated as community focal points that not only provide helpful

resources to older adults, but serve the entire community with information on aging; support

for family caregivers, training professionals and students; and developments of innovative

approaches to aging issues. Through their nutrition, fitness and social networking programs,

the 700 senior centers in California support successful aging by maintaining older adults’

mental and physical health. In addition, senior centers provide an essential service for our

most vulnerable populations in times of emergency and natural disaster. In light of all of the

accomplishments senior centers have made in servicing older adults, it was disappointing to

uncover such a small number of studies (n = 40) documenting their important service and

the quality of research was disheartening. Most of studies were cross-sectional, survey

analyses that were unable to demonstrate the long-term impact senior center services have

on the lives of older adults. The vast array of new services and programs that have been

developed by senior centers illustrates their responsiveness to community needs.

The success of the aging service network, including senior centers, has resulted in people

living longer in the community. This success has given rise to a new potential senior center

clientele that is fragmented across a much wider span of age groups, experiences and

interests. Fortunately, senior centers are designed to meet the challenges of a changing

environment because they are required to reflect and respond to the features and needs of

the communities they serve. No two communities are identical and each evolves differently,

thereby producing a wide array of variability. To continue to adapt, senior center will have to

draw on their strengths, continue their linkages with strategic partners and expand their

collaborations with other organizations to become more of a hub linking individuals to a

wider array of activities and services in their communities. A complete copy of this literature

review is available at the CCoA website.

FULL REPORT

INTRODUCTION

As part of the California Commission on Aging Senior Center Initiative, the following

literature review was commissioned to examine the existing knowledge about senior centers.

Funding for this literature review was provided by the Archstone Foundation. The review

provides a cursory map of the senior center research over the past twenty years. This

literature review can be summarized into the following categories: (1) characteristics of

senior centers; (2) services offered; (3) who participates, and (4) case studies of new

programs and associations. This review provides senior center directors, policy makers and

researchers an overview of the contributions senior centers have made to the lives older

adults and a vision for their future direction.

METHODOLOGY

To accomplish this goal, this literature review used an existing list of 98 published articles

that cited the term senior center from 1978 to 2008 (Pardasani, 2008). For purposes of this

review, abstracts were excluded if they were published prior to 1989 (n= 10), dissertation

abstracts (n= 10), Gerontological Society of America presentation abstracts (n = 9), abstracts

from research conducted outside the United States (n= 7), and abstracts with convenience

samples of older adults collected at senior center that did not focus on the impact of senior

centers (n = 22). The remaining 40 articles were reviewed and summarized and provide a

guide to the past two decades of senior center research. Two additional sources of

information were relied on for this review: the National Council on Aging (NCOA)/

National Institute of Senior Centers (NISC) website and the book Senior Centers: Opportunities

for Successful Aging (Beisgen and Kraitchman, 2003). All of this source information is used to

help guide senior centers as they respond to and reflect on the current and future needs of

their communities.

CHARACTERISTICS OF SENIOR CENTERS

Senior centers are designated as community focal points (Older American Act) or as a place

where “older adults come together for services and activities that reflect their experience and

skills, respond to their diverse needs and interests, enhance their dignity, support their

independence, and encourage their involvement in and with the center and the community”

(NCOA). Not only do senior centers offer helpful resources to older adults, they serve the

entire community with information on aging; support for family caregivers, training

professionals, lay leaders and students; and developments of innovative approaches to

addressing aging issues (NCOA).

The first senior center opened in New York City in 1943 under city sponsorship. Called the

William Hodson Community Center, it marked the beginning of the senior center

movement. By the late 1940s, there were senior centers in San Francisco and Philadelphia,

and by 1961, approximately 218 senior centers had opened nationwide (NCOA).

There are now some 15,000 centers across the country, serving close to 10 million older

adults annually. Many are supported by government and local non-profit organizations, while

others receive funds from organizations such as the YMCA, United Way and Catholic

Charities. Since 1965, the Older Americans Act has provided some funding support to over

6,000 senior centers through service contracts for program activities (U.S. Administration on

Aging). The term “senior center” includes large multipurpose service-provider organizations

with highly trained professional staff as well as small nutrition sites run by volunteers that

provide only occasional programming (Krout, 1989). Based on a sample of 219 different

types of senior service organizations in New York State, the range of senior center types

varies from multipurpose senior centers (57%), senior clubs (14%), senior centers (13%) to

nutrition sites (7%)(Pardasani, 2004a).

CALIFORNIA

In California, senior centers generally fall under the jurisdiction of local governments or

non-profit agencies. Currently, the Congress of California Seniors (CCS) has compiled an

electronic listing of the senior centers in California. Preliminary data provided by the CCS

indicates their web site will contain 727 listings for senior centers in the state with

approximately 405 (56%) of the identified senior centers operated by local governments

(CCS, 2008). The remaining centers are predominately non-profits. In addition to

operational differences, there is great diversity in California’s senior centers, including level

of services and range of programs provided, ethnicity, staffing, funding sources, volunteer

opportunities, hours of operation, structure, technology, ease of access and utilization.

SERVICES OFFERED

Senior centers typically provide nutrition, recreation, social and educational services, and

comprehensive information and referral, many centers are adding new programs such as

fitness activities and Internet training to meet the needs and interests of the new generation

of seniors. Data from a national survey of over 246 senior centers indicate that they offer an

average of 27 distinct programs (Krout, 1989).

Among the most common services offered at a senior center are (NISC, 2008):

* Health and wellness programs

* Arts and humanities

* Intergenerational programs

* Employment assistance

* Community action opportunities and social networking opportunities

* Transportation services

* Volunteer opportunities

* Educational opportunities

* Information and referral

* Financial assistance

* Meal and nutrition programs

* Leisure travel

A recent study using a large sample (n= 856) of senior center participants from 27 senior

centers in the Fort Worth, Texas (Tarrant County) area (Turner, 2004) investigated the

activities at senior centers and perceived benefits. For example, 51% of respondents

categorized the daily lunch as their most important source of nutritious food (72% of

African Americans and 78% of Hispanics). For 64% of frequent attendees, the senior center

was their only source for interaction during the day (72% of African Americans and 82% of

Hispanics). Participation rates for activities included cards/table games (66%), leisure travel

(61%), health assessments (56%), volunteer work (54%), physical fitness (52%),

dance/aerobics (36%), and chair exercises (47%). The proportion of senior center

participants who rated these activities as helpful was very high ranging from 84-91%. These

participants also participated in learning activities about legal, Social Security, and Medicare

program issues.

In the survey of New York State senior centers, Pardasani (2004a) found that senior centers

offered a wide array of recreational and socialization opportunities, in addition to essential

social services. Pardasani found that 64% offered opportunities for volunteering within the

facility or within the community and approximately 24% offered vocational training and/or

placement services. A significant majority of senior centers were found to offer heath

education (73%), health screening (61%) and exercise programs (72%) and nutritional

programs were offered by 80% of centers. The most frequently offered types of social

service included information and referrals (83%), consumer protection information (63%),

assistance with entitlements (58%), tax assistance (53%), telephone reassurance (46%) and

needs assessment (45%). Services less likely to be provided were caregiver services (26%),

home visiting services (23%), and social (16%) or medical (5%) day programs. The survey

also reported that perceived obstacles to participation among the elders included

transportation (31%), lack of interest (31%), lack of access (7%) and fear of stigmatization

(7%).

Two articles examined the role of the physical, organizational and social environments and

the impact of these components on negative social behaviors or withdrawal from programs

(Eaton and Salari, 2005; Salari, Brown and Eaton, 2006). Having the appropriate

environment for the activity facilitated active learning, showcased participant products and

provided an avenue for participants to share their knowledge and socialize (Eaton and Salari,

2005). Without adequate facilities for socialization and program participation, conflicts,

cliques and territorial behaviors can result (Salari, et al., 2006).

SERVICES ASSOCIATED WITH PHYSICAL WELL-BEING

Key features of successful aging are health and overall ability to function (Rowe and Kahn,

1998). Health and wellness programs are among the most common services offered at

senior centers (Beisgen and Kraitchman, 2003). Several of the most recent articles (n = 8)

evaluate senior center programs and their impact on seniors’ physical activity and

functioning, including Tai Chi (Li, et al., 2008), physical activity and exercise (Fitzpatrick, et

al., 2008, Reinsch, MacRae, Lachenbruch and Tobis, 1992), walking (Sarkisian, Prohaska,

Davis and Weiner, 2007), resistance training (Manini,et al., 2007), and line dancing (Hayes,

2006). Two additional studies evaluated programs to increase health behaviors such as fruit

and vegetable intake (Hendrix, 2008a) and diabetes self-management (Hendrix, 2008b).

These studies used pre-and post intervention assessments and showed improvement in such

health related outcome measures as walking speed, chair stands, physical function, step

counts, consumption of fruits and vegetables, pain levels, and sleep quality.

There is wide recognition that proven programs must be translated, implemented and

adopted to have widespread effect. However, despite the positive outcomes associated with

senior center exercise programs, challenges remain. Few of the studies used randomized

controls, and many experienced high dropout rates and uneven participation, which make

their evaluation difficult. The senior center location raises additional concerns about

implementing strenuous enough exercise to make an impact while minimizing medical risk

and need for medical supervision. Advice on how to attract more senior center members to

exercise includes linking exercise to daily function rather than future benefits, offering one

class that incorporates a range of movements to accommodate a wide range of physical

ability, and using role models to change behavior (Baker, Gottschalk, and Bianco, 2007).

Balancing the benefits and challenges of implementing senior center exercise programs is

further exasperated by the growing demand for these programs. A recent survey of 1624

targeted facilities offering physical activity programs for older adults across the United States

showed the following types of physical activity programs are typically offered: aerobic (73%)

flexibility (47%) and strength training (26%). Commercial gyms or YMCAs, senior centers,

parks or recreation centers and senior-housing facilities offered 90% of available programs.

They also found that the proportion of the older adult population participating in these

programs varied across the country from 3% to 28%. Conservative projections indicate that

the number of physical activity programs would have to increase by 78% to meet the future

needs of older adults (Hughes, et al., 2005).

To assist program implementation, one study documented the challenges and strategies for

integrating an evidence-based program into existing senior center services. The strategies

identified in this process include: delineation of authority over the program, engaging

administrators early in the process, engaging senior center members through opinion leaders,

using educational material in several languages and in large fonts, soliciting information from

local health care providers and role modeling (Baker, 2007). The study provides an

illustrative example of how senior centers can implement health assessment, education and

prevention interventions to impact older adults’ health.

SERVICES ASSOCIATED PSYCHOLOGICAL WELL-BEING

Being part of a social network is one of the most dependable predictors of mental and

physical health and longevity. Other important psychological characteristics of successful

aging include emotional support (e.g. love, esteem, and respect), positive mental attitude,

mental challenge and stimulation (Beisgen and Kraitchman, 2003). Many of the factors that

contribute to successful aging can be found at senior centers. Several articles (n = 4) have

used correlation studies using survey data to show that senior center participants have better

psychological well-being across several measures than non-participants, including depressive

symptoms (Choi & McDougall, 2007), friendship formations and associated well-being

(Aday, Kehoe, and Farney, 2006), and stress levels (Farone, Fitzpatrick and Tran, 2005,

Maton, 1989).

The development of a strong social network is important to the emotional well-being of

older women, especially those living alone. It is important to understand the role of older

adults’ existing social networks in their use of senior centers and in senior centers’ efforts to

attract new participants. For example, do supportive networks encourage older individuals to

participate or do those with good social skills experience more ease with participation at

senior centers? In addition, the physical, social and environmental features of the senior

center impact social behaviors. For example, seniors can become frustrated when the center

environment limits their ability to socialize.

Despite the important social interventions of senior centers, depression remains a prevalent

problem among older adults. In the studies examined here, only a small proportion of

depressed seniors sought professional help and that help was largely limited to consulting

their regular physician and social workers who may not have had professional training in

mental health interventions (Choi & McDougall, 2007). This illustrates the disparity between

the estimated need by 18-25% of the nation’s elderly and the minimal utilization of services

(Battle, 1989) and recognition that older adults are not well served by the existing system.

Models to improve, expand, and integrate service delivery for this population includes senior

centers (Persky, Taylor and Simson, 1989).

WHO PARTICIPATES AT SENIOR CENTERS?

It is important to understand the characteristics that make up the older adult population so

that senior centers can better serve their needs. Several studies have attempted to understand

the characteristics of senior center participants. The last national survey (1984) of older adult

senior center users showed that approximately 14% of those over age 60 had used a senior

center in the past 12 months (Krout, Cutler, Coward, 1990). The characteristics of the senior

center participants included: female gender, age (lower rates at the youngest and oldest ages),

living alone, lower incomes, education (lower levels of participation at lower and higher

levels of education), higher levels of social interaction, and lower number of ADL-IADL

difficulties. Finally, users were less likely to live in urban and farm areas.

Data from the same period (1984) looks at additional characteristics of 623 senior center

participants from 13 centers from a large metropolitan area with a population 300,000 and

two in rural communities in the county (Ralston, 1991). Frequency of participation was

related to living closer and the importance of the meal to daily food intake. Duration of

attendance was significantly related to being older. Activity participation was related to

higher education levels. Finally, participants who used more services used a walker or

crutches, had higher life satisfaction and had made friends at the center.

A more recent statewide survey of 4,900 older adults in Missouri found that 8.3% of the

sample was a senior center user and they were older, rural, had more social contacts, better

mental health, and fewer problems with activities of daily living. They also were more aware

of specific service agencies, more likely to consult formal resources in making service

decisions, and more likely to have used other services (Calsyn & Winter, 1999).

Several studies examined the characteristics of new participants who may be most interested

in joining senior center activities. One study found older adults most interested in joining a

shared interest group were more highly educated, lonelier and younger (Cohen-Mansfield,

Parpura-Gill., Campbell-Kotler, Vass, and Rosenberg, 2005). A second study also found that

intent to use a new senior center was associated with the existing level of social network

characteristics (Ashida and Heaney, 2008). Finally, in terms of promoting senior center

programs, first-time attendance in creative writing and painting activities showed that new

members were more likely to join right after public posting of the event (Xaverius, 1999). A

small sample of 25 in-depth needs assessment interviews with older adults from rural Texas

found that when asked about service use many older adults were reluctant to admit a need

for senior center services or accept help and may have even denied using services. However,

younger cohorts may have a different perspective about getting services (Sijuwad, 2001).

SPECIAL INTEREST POPULATIONS

ETHNICALLY DIVERSE POPULATIONS

There are few articles that focus specifically on the role of senior center programs and

services for ethnically diverse older adults. One article examined the successful establishment

of an exercise intervention that facilitated participation among members of the African

American population (Resnick, Vogel, and Luisi, 2006). A study using a large sample of

Mexican American women (n = 483) from a 1988 national survey found that this sample of

senior center users were less likely to live alone and more likely to attend group social events

(John and Dietz, 1997).

A survey of 220 senior organizations in New York State found that increasing the

representation of ethnically diverse staff and appropriate programming was associated with

increases in the level of participation of minority elders in senior centers (Pardasani, 2004b).

According to Pardasani, these results need to be confirmed by future longitudinal studies

that include the ethnic/racial distribution of the population served by the centers. The article

provides a framework for providing racially and ethnically appropriate services to an

increasingly diverse elderly population.

FRAIL ELDERLY

It is often stated that senior centers are not well suited to serve the needs of more frail,

isolated and financially disadvantaged older adults (Krout, 1996). However, it is difficult to

study this claim since little data are collected at senior centers regarding participants’

functional abilities (e.g. ADL, IADL levels). It has been shown that older people with

physical and mental impairments were less likely to attend a senior center than their healthier

counterparts by a ratio of between 3 and 5 to 1 (Krout, 1989). Yet, senior centers also have

been shown to be significantly involved with programming for frail older adults (Krout,

1989). In addition, national data suggest that 5-10% of the older persons attending senior

centers are vision or hearing -impaired, frail in health or cognitively impaired. One study

found that among older adults with Alzheimer’s disease, 11% of those living alone used

senior centers while 8% living with someone else did (Webber, Fox, & Burnette, 1994).

Senior centers might be more responsive to the needs of long-time participants who become

frail as opposed to new participants who come to the center with physical or mental

impairments, therefore becoming de facto providers of services to a growing segment of the

long-term care population (Cox & Monk, 1990).

Some of the challenges to offering programs for frail elders may be provision of certain

physical environment supports, such as special tables and chairs or bathroom facilities. Also,

linkages with other agencies and organizations in the community are fundamental to the

successful involvement of frail elders in senior centers, thus enabling the utilization of

existing service networks for both diagnostic and programmatic resources. Care management

services are often required in the process of locating and providing access to other services

for frail elders who are potential center participants (Krout, 1996).

CASE STUDIES, NEW PROGRAMS AND ASSOCIATIONS

The remaining articles in the literature review focus on case studies and interviews with

senior center staffs about new programs and associations. The case studies examine such

diverse topics as partnerships between university researchers and agencies benefiting older

adults (Wethington, et al., 2007); a process evaluation of 10 demonstration geriatric health

centers established through the development of partnerships among area agencies on aging,

senior centers, and medical providers at the local level (Iutcovich and Pratt, 2003); a

description of the goals, structure and services provided by the Jewish Association for

Services for the Aged (JASA) established in 1968 to serve the elderly of New York City and

Nassau and Suffolk counties; and a review of research on intergenerational share site

facilities and programs (Kuehne & Kaplan, 2001).

One particularly interesting case study summarized the activities to get county funding to

support an ambitious new program, Options in Long-Term Care, which provides a wide

array of home and community-based services for Ohioans who were not eligible for the

state’s Medicaid waiver program (Hornbostel, 2004). The article documents the successful

local initiative process implemented to obtain levy funds in one county that was quickly

replicated across the state. In Ohio, the typical senior levy costs about $30 per year for the

owner of a typical $100,000 home and provides services to older adults that are more readily

accessible than in counties where the aging network must rely solely on state and federal

funding.

The remaining articles examined the new programs and associations confronting senior

centers. One article focused on interviews with long-time recreation providers who discussed

the challenges of providing programs to meet the needs of several generations of

participants. They reported that the youngest cohort is looking for fun, fitness, adventure

and some structure, which requires programming adjustments, e.g. more strenuous exercise

programs, different locations and spiritual/mind/body elements (Milner, 2007). A second

article looks specifically at revisions being made to the traditional senior centers by the

Department of Health Services in Phoenix, Arizona where they are looking to refurbish

senior centers by augmenting the cafeteria-style meals and classes with a more hip look that

blends various boomer creations like fitness centers, coffee shops and computer terminals

(Young, 2006). Another study examines the impact of major organizational change through

the eyes of clients, who provided the following recommendations: communicate reason for

change; develop positive connection to new sponsor, create concrete improvements in

services, and recognize strong participant bond with prior operational methods (Nessoff,

1999). Finally, the renewed importance of senior centers’ role during manmade and natural

disasters is documented by the Director of a senior center in New Orleans after Hurricane

Katrina (Croom, Jenkins and Eddy, 2007).

One article examined how senior centers function within the larger community services

network from a survey of 246 senior center directors (Krout, 1989). It found that three

fourths of the senior centers work with other organizations, yet the degree of involvement

varied from minimal assistance (37%), half of their programming (18%) to almost all

activities and services (22%). The majority of such linkages among organizations were

informal. The center directors’ primary reasons for associating with other organizations were

to better meet the need of the elderly, increase the number of services provided, increase the

number of older adults served and provide more services for low-income or frail seniors.

While many of the articles examined through this literature review hint at the different needs

and interest of the younger cohort of eligible senior center participants, there is little research

about baby boomers’ attitudes to help forecast future needs for aging services and resources.

It is often argued that this group will avoid public services, yet others believe this younger

cohort, with its experiences of better times and a more liberal social atmosphere, will feel

increasingly needier and assertive about getting assistance (Sijuwade, 2001). One analysis of

the possible future is provided by Alt (1998) who examines the demographic trends that

show that a substantial portion of baby boomers will be caregivers for older relatives and will

want assistance from the local aging services agency. In addition, she points to the increase

in the age of Social Security eligibility and the potentially larger proportion of older boomers

working well into their 60s. Based on the analysis of the demographic trends, Alt projects

that future programming will have increasing focus on (1) caregiver support, (2) health

support; (3) information and referral, (4) volunteer opportunities, (5) employment and

retirement options, and (6) health insurance counseling.

CONCLUSION

This review of the literature provides a cursory map of the existing knowledge about senior

centers over the past twenty years. Senior centers are designated as community focal points

that not only provide helpful resources to older adults, but serve the entire community with

information on aging; support for family caregivers, training professionals, lay leaders and

students; and developments of innovative approaches to addressing aging issues (NCOA).

Through their nutrition, fitness and social networking programs, the 700 senior centers in

California support successful aging by maintaining older adults’ mental and physical health.

These services have been successfully implemented for many different segments of the older

adult population. In addition, senior centers provide an essential service for our most

vulnerable populations in times of emergency and natural disaster. The vast array of new

services and programs that have been developed throughout the history of senior centers

illustrate their responsiveness to community needs.

In light of all of the accomplishments senior centers have made in servicing older adults, it

was disappointing to uncover such a small number of studies (n = 40) documenting their

important service and the quality of research was disheartening. Most of studies were cross-

sectional, survey analyses that were unable to demonstrate the long-term impact senior

center services have on the lives of older adults. The majority of the studies provide an

overview of the basic elements of senior center functioning, including their characteristics,

services offered, and participant characteristics and case studies of pilot programs. Despite

the limited number and quality of studies, the review does begin to provide a vision of what

senior center directors, policy makers and researchers can work from to create a new vision

of senior centers for the future.

The success of the aging service network, including senior centers, has resulted in people

living longer in the community. As a result of this success there is a new potential senior

center clientele that is fragmented across a much wider span of age groups, experiences and

interests. Fortunately, senior centers are designed to meet the challenges of a changing

environment because they are required to reflect and respond to the features and needs of

the communities they serve. No two communities are identical and each evolves differently,

thereby producing a wide array of variability. To continue to adapt, senior center will have to

draw on their strengths, continue their linkages with strategic partners and expand their

collaborations with other organizations to become more of a hub linking individuals to a

wider array of activities and services in their communities. With the flexibility inherent in

senior centers’ operations they will continue to meet the needs of “target” groups, including,

the young-old, frail, ethnically diverse and low income populations. The literature shows that

senior centers have a long history of serving as the community focal points for service access

and will continue to adapt to changing demands.

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