Virtual Intergenerational Therapy: New Platforms for Engagement of Older Adults During The COVID 19 Crisis.

Intergenerational programs havebeen shown to bring benefits to all groups involved and have been implemented internationally.1Gualano MR Voglino G Bert F et al.The impact of intergenerational programs on children and older adults: a review.Int Psychogeriatr. 2018; 30: 451-468Crossref PubMed Scopus (73) Google Scholar Activities implemented during intergenerational sessions are highly varied and involve diverse groups from children,2Morita K Kobayashi M. Interactive programs with preschool children bring smiles and conversation to older adults: time-sampling study.BMC Geriatr. 2013; 13: 111Crossref PubMed Scopus (26) Google Scholar volunteers3Horowitz BP Wong SD Dechello K Intergenerational service learning: to promote active aging, and occupational therapy gerontology practice.Gerontol Geriatr Educ. 2010; 31: 75-91Crossref PubMed Scopus (30) Google Scholar to college students. Kindergartens and child care centers have been co-located4Yasunaga M Murayama Y Takahashi T et al.Multiple impacts of an intergenerational program in Japan: evidence from the research on productivity through Intergenerational Sympathy Project.Geriatr Gerontol Int. 2016; 16: 98-109Crossref PubMed Scopus (36) Google Scholar in the same building to facilitate intergenerational interactions and activities. The coronavirus disease 2019 pandemic has led to unprecedented public health measures being implemented such as the restriction of gatherings and closure of elder care facilities. Social distancing has led to social isolation with many older adults experiencing higher levels of depression, anxiety, poor sleep, and functional decline during this period of social isolation.5Armitage R Nellums LB. COVID-19 and the consequences of isolating the elderly.Lancet Public Health. 2020; 5: e256Abstract Full Text Full Text PDF PubMed Scopus (837) Google Scholar Despite the challenges, this “new normal” is an opportunity for programs to innovate. Virtual and tele-delivered programs6Choi NG Pepin R Marti CN et al.Improving social connectedness for homebound older adults: randomized controlled trial of tele-delivered behavioral activation versus tele-delivered friendly visits.Am J Geriatr Psychiatry. 2020; 28: 698-708Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar have been shown to be effective in alleviating social isolation and mood symptoms.7Teo AR Markwardt S Hinton L Using skype to beat the blues: longitudinal datafrom a national representative sample.Am J Geriatr Psychiatry. 2019; 27: 254-262Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar Due to social distancing measures, the intergenerational program run at our geriatric center which is part of a tertiary public hospital in Singapore had to cease. Before the pandemic, there was a weekly intergenerational program for older adults admitted to our geriatric ward. Patients who consented to participate and were assessed to be suitable by the healthcare team are selected for this weekly program. The program is run by a multidisciplinary team together with the child care teachers and administration. The 1 hour program usually starts off with an ice breaker for participants to warm up to each other. This is followed by a structured activity that is curated on a weekly basis by the healthcare team and child care teachers. The activities are planned to ensure suitability for older adults and to meet the teaching curriculum and goals of the child care. These activities include craftwork, simple games, music and movement, and reading. Special programs are planned during festivals such as Chinese New Year and National Day. With social distancing measures likely to remain for some time, the program team decided to hold the sessions virtually. These sessions are conducted weekly over the Zoom virtual meeting platform. Large digital screens are brought in for the elderly to view the children over Zoom. The team had to adapt some of the activities to suit a virtual platform. Activities such as exercise, dance, charades, bingo, and pictionary can be conducted over a virtual platform, whereas craftwork and one-to-one reading are less suitable. In addition, we have reduced the activity time from 1 hour to 45 minutes due to the reduced attention span of both older and younger participants on a virtual platform. Older adults with significant cognitive, hearing, and visual impairment are less able to engage on this platform and are thus less likely to be selected to participate in this program. The similarities and differences between the two platforms are summarized in Table 1.TABLE 1Differences and Similarities Between In-Person and Virtual Platforms for Intergenerational ProgramsIn-Person InteractionVirtual InteractionEngagement•Presence of physical touch and greater intimacy•Nonverbal cues from both older and younger groups present during interactions•Virtual platform lacks physical touch•Those with significant hearing, visual, and functional impairment are excluded from a virtual platformResources•More resource intensive as staff have to be on hand to supervise both older and younger participants•Interaction and activities limited by physical space•Requirement of IT infrastructure and digital connectivity•Manpower resources not as intensive as participants focus on and interact over a digital platformTravel•Participants have to travel to another location, hence limiting the catchment of possible groups for intergenerational activities•Participants do not have to travel, saving on transportation time, and arrangements. Can be challenging arranging two-way transportation for young childrenInfection control•Participants have to be screened prior to interaction. Children with even mild infective symptoms have to be excluded from the session•No risk of cross-infection between older and younger groups as there is no physical interactionScalability•Limited by manpower and logistics. Co-location is encouraged and convenient•Program has potential to be scaled up readily. Able to reach more wards and groups and more rural or remote areas Open table in a new tab There are however benefits to holding intergenerational activities on a virtual platform. These include being able to engage more participants per session. Previously, the program was limited to one ward due to manpower and resource constraints. With a digital platform, multiple wards can be engaged at the same time and without the fear of cross-infection especially with the current coronavirus disease 2019 pandemic. Co-location of centers is also not necessary with a virtual platform and the program has been expanded to engage children and youth from other places such as schools and volunteer groups. This allows programs catering to older adults to expand their network and pool of volunteers and activities. Apart from interactions with children, our program has expanded to include leisure music classes, musical and arts performances, and even virtual tours of various landmarks around the country. Virtual intergenerational therapy has benefits and limitations. Virtual programs will never be able to fully replicate in-person sessions that have physical touch that enables older adults with cognitive, visual, or functional impairments to be engaged. Nevertheless, in the present “new normal,” it is likely that technology will be an enabler for more of such programs to continue which would otherwise be halted due to social distancing measures. Moreover, innovation during a pandemic can allow for the benefits of such programs to reach an even wider audience. The authors have no conflicts of interest to declare. No funding was received for this manuscript.