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. Author manuscript; available in PMC: 2026 Jan 1.
Published in final edited form as: J Gerontol Soc Work. 2024 Jun 27;68(1):61–78. doi: 10.1080/01634372.2024.2373290

The Impact of an Intergenerational Service Learning Program on Psychological Distress for Homebound Older Adults

Keith T Chan 1, Christina N Marsack-Topolewski 2, Maggie Ratnayake 3, Daniel B Kaplan 4, K Alida Voet 5, Maddi Riemenschneider 3, Jillian Graves 2
PMCID: PMC11655261  NIHMSID: NIHMS2011303  PMID: 38934724

Abstract

Over 2 million older adults are homebound and 5 million need help leaving their homes. They often experience social isolation, food insecurity, and lack of connection to community resources, which has intensified since the pandemic. This study examined the benefits of an intergenerational home-based service learning program to reduce psychological distress for homebound older adults. Multivariate regression analyses were conducted with a sample of 182 to examine the association of living in one’s own home, disability status, presence of child and spousal caregivers, and length of services from the program with psychological distress. Findings indicated length of service (β = −0.15, p < 0.05) and having a child as a caregiver (β = −0.14, p < 0.05) were associated with lower psychological distress. Poor health status was associated with higher levels of psychological distress (β = 0.15, p < 0.05). Living in one’s own home, having a spouse as a caregiver, and disability status were not associated with psychological distress. Results suggest that this program can reduce psychological distress for homebound older adults. Policies and practice can support a pipeline of geriatric health professionals through innovative service learning models to benefit older adults, caregivers, and students.

An estimated 61 million, or 1 in 4 adults, in the United States are living with a disability (Centers for Disease Control and Prevention [CDC], 2020). Of those who reported at least one functional limitation, over 72% are age 50 or older (American Community Survey, 2020). As people are living longer, more individuals are managing chronic health conditions and disabilities (Verbrugge et al., 2017), which can make leaving their homes difficult. More than 2 million older adults are considered homebound, and 5 million need help leaving their homes due to physical limitations stemming from chronic conditions or cognitive impairments (Ornstein et al., 2015).

The Social Security Act (U.S. Congress, 1934) defined homebound status as having a condition that restricts one’s ability to leave their home due to an illness or injury, except with the assistance of another person or an assistive device which can include mobility devices such as a wheelchair, cane or a walker. Individuals are considered homebound if they have a condition where leaving their home is medically contraindicated or when leaving their home requires a considerable and/or taxing effort. For many homebound community-dwelling older adults with disabilities, mobility limitations or other challenges can pose difficulties for them in completing activities that are necessary to remain independent at home such as grocery shopping or housework. These challenges may prevent people from engaging in social opportunities they previously enjoyed, such as working, volunteering, attending religious services, visiting friends and family, or attending senior centers and clubs (Cheng et al., 2020).

Homebound persons can be of any age but tend to be older than 65, experience symptoms of depression and anxiety, and have more difficulties with activities of daily living (ADLs) and instrumental activities of daily living (IADLs; Cohens-Mansfield et al., 2010; Xiang et al., 2020). In addition, homebound older adults have higher health care utilization and expenditures (Musich et al., 2015) and are more likely to have unmet medical needs or experience inconsistent quality of care (Reckrey et al., 2020). Older adults who are homebound often experience social isolation, loneliness, food insecurity, lower perceived social support and a lack of connection to community resources compared to those who are not homebound (Cohens-Mansfield et al., 2010).

For homebound older adults, family members often assume daily caregiving tasks such as basic activities of daily living (ADLs) to assist their loved ones, navigate health care systems, and provide much needed emotional support (Schulz & Eden, 2016). Past research has found that there is a dearth of services and supports to meet their ADL needs (Gerolamo et al., 2021), particularly for those who are living alone and have low levels of access to environmental assets such as grocery stores, parks, and other public spaces (Emerson et al., 2021).

Although home and community-based programs for older adults have been a growing service sector (Chen & Berkowitz, 2012), recent research has found that the accelerated growth in the number of persons needing these services has outpaced the growth of the home care workforce (Krieder & Werner, 2023). Furthermore, there appears to be limited evidence in the success of these programs due to challenges in implementation and use of quality measurements that focus on those receiving home-based services (Medicaid and CHIP Payment and Access Commission, 2018). This study describes the impact of the Lori’s Hands SOCIAL Partnership program which provided home-based, practical support services to reduce psychological distress for a population of homebound older adults. This study provides important insight to addressing social isolation and loneliness and presents evidence to support the continued growth of much-needed community programming for a hard-to-reach population.

Psychological Distress, Social Isolation and Loneliness

Past research has found that community-dwelling homebound older adults are at higher risk for psychological distress (Fullen et al., 2021), and homebound status may augment the negative effects of depressive symptoms (Peng et al., 2022). Homebound older adults with functional limitations may experience increased psychological distress due to their social isolation and loneliness (Emerson, 2021). Over the past two decades, research has highlighted social isolation and loneliness as risk factors for chronic illness and mortality among older adults (Holt-Lunstad et al., 2015; Steptoe et al., 2013). Social isolation has been linked to increased risk of becoming physically frail (Gale et al., 2018), accelerated functional decline (Fujiwara et al., 2016) and memory loss (Read et al., 2020), as well as heightened severity of psychological distress (Findlay, 2003; Peng et al., 2022). Loneliness has been linked to a variety of chronic conditions, such as increased risk of cardiovascular disease, cancer, high blood pressure (Tomaka et al., 2006), cognitive impairment (Barnes et al., 2004), and dementia (Crooks et al., 2008). In addition, social disconnectedness is associated with perceived isolation, and is predictive of higher rates of depression and anxiety symptoms (Santini et al., 2020).

Despite attention on social isolation and loneliness as risk factors for a multitude of poor mental health outcomes for older adults, there appears to be a lack of conclusive research identifying interventions and policy solutions that can effectively address this public health problem (National Academies of Sciences, Engineering, and Medicine, 2020). Of concern is the lack of data providing insights on who are the most vulnerable and at risk, such as homebound older adults who are often not included in intervention research. Past research highlighted the benefits of intergenerational relationships to promote the health of older adults and more effective learning for younger populations (Fried et al., 2013). However, there continues to be an urgent need for evidence-based research on intergenerational interventions that can improve social and other health outcomes (Peter et al. 2021).

SOCIAL Partnership Intervention through Lori’s Hands

The SOCIAL Partnership through Lori’s Hands is an intergenerational program that trains undergraduate and graduate pre-health students to provide non-medical, in-home support for older adults living with chronic conditions and disabilities, almost all of whom are homebound due to their medical status. Students received training and college credits in disciplines such as social work, nursing, occupational therapy, physical therapy, psychology, public health, pre-med and other health-related disciplines (Chan et al., 2023). Students made weekly visits in pairs to assist with essential tasks for aging in place (i.e., shopping for groceries, picking up prescriptions, doing laundry, accessing technology, navigating community resources). Companionship care is central to the SOCIAL Partnership model, which can be defined as providing support for simple, day-to-day tasks that are non-medical while spending time and having conversations with an older adult (Halpert, 2023). In turn, older adults provide students with the opportunity to learn about health, illness, health care, and the aging process in a community setting. Furthermore, integrative service learning models can provide relief in addressing urgent needs such as food insecurity, medication management and care coordination in the community (Gresh et al., 2021).

Beginning in 2019, the SOCIAL Partnership through Lori’s Hands operated as a multi-site, home-based, practical support intervention to improve outcomes for older adults who are homebound or at risk of becoming homebound which was delivered in Delaware, Maryland, and Michigan. Specifically, we 1) evaluated the efficacy of the SOCIAL Partnership as an intervention to reduce psychological distress (measured as feeling downhearted, worried, or lonely) for older adults who are homebound or at risk for becoming homebound, 2) identified risk and protective factors for psychological distress for this population, and 3) developed and refined a gerontologically-focused curriculum for pre-health college and university students. This curriculum was designed to be interdisciplinary, equity-focused, evidence-based, and culturally sensitive in order to prepare future health care leaders to address health and mental health needs among diverse populations of older adults.

Study Purpose

The purpose of this study was to examine the effects of participation in the SOCIAL Partnership program through Lori’s Hands on the reduction of psychological distress, as measured by quantitative responses to three questions, 1) “During the past month, how often have you felt downhearted and blue?”, 2) “During the past month, how often have you felt worried?”, and 3) “During the past month, how often have you felt lonely?”. Furthermore, we examined the effect of caregiving support and health status on psychological distress while controlling for sociodemographic variables. We hypothesized that 1) program participants who are receiving services will have lower psychological distress compared to those who are in the waitlist control group who are not yet receiving services, and 2) length of service with the program will be associated with lower psychological distress, even when controlling for caregiving support, health status and sociodemographic variables.

Methods

Study Design and Procedures

A non-randomized waitlist control group design was used to compare the level of self-reported psychological distress for program participants who had been receiving services for at least 3 months with those who are on the waitlist for the SOCIAL Partnership program. This study design was employed due to the community-based approach in the evaluation of the SOCIAL Partnership program. Waitlist controlled designs may overestimate treatment effects due to difference in readiness to change and duration of the intervention (Cunningham et al., 2013). However, homebound older adults receiving services through the SOCIAL Partnership have no set end date, and many continue their relationships and communicate with students after the duration of their formal participation in the program. Due to these considerations, the limitations in a waitlist control design may have little to no impact on the validity of the current study.

Sample

The study sample consisted of older adults who were located in three different states (Delaware, Maryland, and Michigan) in the U.S., required home-based services, and had chronic conditions and/or disabilities. The inclusion criteria were aligned with the target population in many Area Agencies on Aging (AAAs), such as being 60 or older and having multiple chronic conditions which may require some assistance with practical, everyday tasks. Because one of our programmatic priorities is to provide services to older adults who are waitlisted for services with the AAAs, we targeted this group for the SOCIAL Partnership program.

Eligibility Criteria

All persons who agreed to receive services through the SOCIAL Partnership program through Lori’s Hands Hwere approached for consent to participate in this study. Program staff and the SOCIAL Partnership program team ensured that informed consent was obtained before participants were included in data collection and evaluation. Service recipients were assured that their decision to consent to participation in the study would not affect their services. The program conducted background checks on both students and service recipients, and participants were required to agree to provide a safe environment for home visits and actively engage in student learning goals.

Recruitment

Recruitment of program participants focused on reaching underserved populations who have limited support systems and were homebound and at higher risk of social isolation and loneliness along with the resulting negative effects due to their homebound status. The Lori’s Hands SOCIAL Partnership’s existing sites have become trusted service providers in their communities, regularly receiving referrals from local hospitals, dialysis clinics, homecare providers, care management agencies, advocacy organizations (e.g., ALS Association) and disability support service centers. The program has established these relationships with service providers through direct outreach and education, presentations, and through word-of-mouth referrals from existing clients. Beyond soliciting referrals from health care and service providers, the program conducted outreach to and within community institutions such as places of worship, neighborhood groups and associations, disease-specific support groups, senior centers, and service organizations. The program reached a broad audience of potential participants through presentations, health fair participation, meeting attendance, brochure dissemination, and partner education.

Ambassador Councils were also essential to the Lori’s Hands SOCIAL Partnership program’s outreach strategy. Made up of local representatives (including program participants and family members, providers, and business partners), Ambassador Councils in each chapter location advocated for increased community awareness and connections with strategic partners to advance the Lori’s Hands SOCIAL Partnership’s goals. Ambassador Councils currently exist in three sites located in Newark, Delaware, Baltimore, Maryland, and Metro Detroit, Michigan.

Additional recruitment strategies included op-eds, social media, targeted digital marketing, and word-of-mouth referrals from existing clients, which are major sources of recruitment. As the program launched each chapter, the team established partnerships with disability advocacy groups, local agencies and social service organizations that provide community-based services to older adults in order to assess the community need and to strengthen the program’s local network. These partnerships have been essential to the recruitment of older adults who have benefited from this program. In addition, the program intentionally over-enrolled individuals at risk for unmet needs due to financial strain and considered other factors such as limited support network, having multiple chronic conditions, living in community-dwelling spaces without long-term care support systems as well as diversity of neighborhoods.

Students were recruited through academic programs and faculty sponsors at the universities where they were enrolled. At the time of enrollment, all student participants complete an asynchronous training that covers topics like chronic illness symptoms and management, effective communication skills, empathy and rapport building, and parameters of service delivery. A learning library with focused training modules on topics such as caregiving and resource navigation was made available for all students to view during their involvement in the program; one specialized training is assigned at the start of each semester. Supervision and additional ad hoc training is delivered one-to-one by Lori’s Hands staff. Two students are assigned to make weekly visits to the same client for the duration of a semester. Visits typically last 1 to 1.5 hours. Students may elect to participate for longer than one semester, and, when they do, they are typically assigned to the same client. Some students and clients are paired together for as long as 3 – 4 years. During their visits, students provide participants with companionship and social engagement while also assisting them with grocery shopping, picking up prescriptions, completing household chores, and navigating community resources, among other instrumental activities of daily living. Services aim to address five domains: 1) home safety, 2) suitability and cleanliness, 3) community resource access, 4) physical activity, & 5) food access and nutrition. In turn, clients provide student participants with the opportunity to learn firsthand about the lived experience of chronic illness and aging in the community.

Data Collection

Data were collected via phone using a survey instrument by Lori’s Hands SOCIAL Partnership program staff who conducted the interviews. Program staff were trained on the purpose, content, and administration of the survey by the administrators of the grant (Community Care Corps, Administration for Community Living, U.S. Department of Health & Human Services). Program staff also trained students on effective data collection and survey administration techniques. Staff called clients and administered the survey over the phone. Staff entered client responses directly into an online form, which then stored responses into a database. If a client had access to the internet and preferred, a link to the survey was emailed or texted to them, and they completed the survey themselves using the online form. Information was gathered on sociodemographic characteristics of older adult program participants (i.e., race, ethnicity, gender, age, employment status, education, and home ownership), length of service with the program, and caregiving support as well as overall health and mental health. The demographic portion of the survey was designed by the program staff, and questions regarding caregiver support, overall health and mental health were required as outcome reporting from the grant that supported this program (Community Care Corps, Administration for Community Living, U.S. Department of Health & Human Services). Information on program participants was de-identified to protect their confidentiality, and IRB approval was obtained for this project.

Outcome Variable

Psychological distress as the outcome variable in this study was composed of 3 items, 1) “How often do you feel downhearted?”, 2) “How often do you feel worried?”, and 3) “How often do you feel lonely?” and were coded 0 as “Never,” 1 as “Some of the time,” 2 as “Most of the time,” and 3 as “All of the time.” This 3-question scale was required as outcome reporting on mental health status from the grant that supported this program (Community Care Corps, Administration for Community Living, U.S. Department of Health & Human Services). Reliability analysis was conducted for this three-item scale, and results indicated that the scale had good to adequate internal consistency (Cronbach’s α = 0.73). The three items were summed to create a composite score, and higher scores indicated greater psychological distress.

Sociodemographic variables

Sociodemographic variables were included as control variables in the analysis. Race/ethnicity was transformed into separate dummy variables for Black/African American, Asian, American Indian/Alaskan Native, Other, and prefer not to answer where each was coded as 1 and White coded as 0 for the reference group. Hispanic ethnicity was coded 1 for Hispanic, and 0 for non-Hispanic. Gender was coded 0 for male, 1 for female. Age was coded as 0 for under 64 years old, and 1 for 65 and older due to lack of variability on this variable. Employment status was coded 0 for retired (the largest group at 95.1%), and separate dummy variables were created for semi-retired, part-time student, employed part-time, and employed full-time. Education was coded 0 for not being a college graduate and 1 for being a college graduate. Owning their own home was coded 0 for not owning their own home and 1 for owning their own home.

Caregiving support

Caregiving support was captured using two variables to indicate who is providing care. Having a child as caregiver was coded 1 for yes, and 0 for no. Having a spouse as caregiver was coded 1 for yes, and 0 for no.

Health status

Health status was measured using three variables. Having a disability was coded 1 for yes, and 0 for no. Having a long-term condition was coded 1 for yes, and 0 for no. Reporting poor health was coded 1 for yes, and 0 for no.

Length of service with program

Length of service with the program was used to examine the impact of the SOCIAL Partnership on reduction of psychological distress as measured by the three-item scale. Not yet receiving services was coded as 0, less than 6 months was coded as 1, 6 months to 1 year was coded as 2, 1 to 3 years was coded as 3, and 4 years or more was coded as 4. This variable was categorized in this manner to reflect continued participation with support from students across multiple semesters.

Data Analysis

Data were de-identified and downloaded to an Excel file, and then imported and analyzed using Stata 15.0. Prior to beginning analyses, data were reviewed to ensure data accuracy and integrity. Initial descriptive analyses were conducted to provide a profile of 182 participants who were already receiving services and the waitlist control group. Chi-square tests for independence were conducted to examine differences in sociodemographic, caregiving and health status variables between the two groups. Cramer’s V tests were used to assess the effect size of these relationships. Independent sample t-test was conducted to examine differences in average psychological distress for those who are receiving services (n = 84) compared to those who are not yet receiving services (n = 98), and Cohen’s d test was used to assess the effect size of this difference. Multivariate regression analyses were conducted to examine the effect of length of service, caregiving support and health status on psychological distress while controlling for sociodemographic variables.

Results

From Table 1, descriptive findings indicated that on average, program participants who had been receiving services reported lower psychological distress compared to those who had not yet received services (Mean Difference = 0.68, t = 2.14, df = 180, p < 0.05, Cohen’s d = 0.35). Overall, participants were statistically similar in regard to race and Hispanic ethnicity for participants receiving services compared to those who were still on the waitlist. Most participants were female (81.9%) and identified as White (70.9%), followed by Black/African American (25.3%), Asian (1.1%), American Indian/Alaskan Native (0.6%), Other (0.6%), and prefer not to answer (1.7%). The full sample of participants were on average older (Mean = 75.8, SD = 11.09), with 85.7% who were 65 or above. Most were retired (95.1%), close to half had a college degree (45.1%), and most owned their own homes (89.0%). A substantial portion of the sample reported having a child as a caregiver (42.9%), and close to 1 in 10 reported having a spouse as a caregiver (9.3%). A third of the sample reported having a disability (33.5%), close to half reported having a long-term condition (45.1%), and 1 in 5 reported that their health was poor (21.4%). Participants who have been receiving services were similar in all these respects, except that the waitlist control group had more participants who were male, Black/African American, and 65 years of age and older, which was likely due to the expansion of the programs in Baltimore, Maryland which has a substantial African American older adult population. For those who have been receiving services, more than half (50.5%) reported having worked with the program for 1 to 3 years.

Table 1.

Descriptive Variables Characteristic of Program Participants (n = 182)

Variables Receiving Services (n = 84) Not yet receiving services (n = 98) Effect Size †
Mean (SD) Mean (SD) t (df)
Psychological Distress (Cronbach’s α = 0.73) 2.94 (2.01) 3.62 (2.25) 2.14 (180)* 0.35
Percentage Percentage χ2(df)
Socio-demographics
 Race
  White 78.6% 64.3% 5.62 (5) 0.18
  Black/African American 19.1% 30.6%
  Asian 1.2% 1.0%
  American Indian/Alaskan Native 0.0% 1.0%
  Other 0.0% 1.0%
  Prefer not to answer 1.2% 2.0%
 Hispanic ethnicity
  Yes 3.6% 1.0% 1.37 (1) 0.09
  No 96.4% 99.0%
 Gender
  Female 89.3% 75.5% 5.78 (1)* 0.18
  Male 10.7% 24.5%
 65 or older 90.5% 81.6% 2.89 (1) 0.13
 Employment status
  Retired 97.6% 92.9% 5.09 (4) 0.17
  Semi-retired 1.2% 5.1%
  Part-time student 1.2% 0.0%
  Employed part-time 0.0% 1.0%
  Employed full-time 0.0% 1.0%
 College graduate 44.1% 45.9% 0.06 (1) 0.02
 Own their own home 91.7% 86.7% 112 (1) 0.08
Caregiving support
 Have child as caregiver 45.2% 40.8% 0.36 (1) 0.04
 Have spouse as caregiver 6.0% 12.2% 2.11 (1) 0.11
Health status
 Reported a disability 32.1% 34.7% 0.13 (1) 0.03
 Reported a long term condition 51.2% 39.8% 2.37 (1) 0.11
 Reported poor health 19.1% 23.5% 0.53 (1) 0.05
Length of service with program
Not yet receive service 0.0% 100.0% 182.0 (1)*** 1.00
< 6 months 19.1% 0.0%
6 months to 1 year 11.9% 0.0%
1 to 3 years 53.6% 0.0%
4 years or more 15.5% 0.0%
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*

p-value <0.05

**

p-value <0.01

***

p-value <0.001

†

For effect sizes, Cohen’s D was calculated for the t-test comparing the psychological distress score between service recipients and non-service recipients. Cramer’s V was calculated for Chi-square tests of categorical variables with service recipients and non-service recipients.

Multivariate Regression Results

Multivariate ordinary least squares (OLS) regression analyses were conducted to examine the association of length of service in the program, caregiving support and health status with psychological distress, while controlling for sociodemographic variables. It was hypothesized that 1) program participants who were receiving services will have lower psychological distress compared to those who are in the waitlist control group, and 2) length of service with program will be associated with lower psychological distress, even when controlling for caregiving support, health status and sociodemographic variables. Results from Table 2 indicated that length of service was associated with a decrease in psychological distress for participants in the program (b = −0.22, SE = 0.11, 95% CI [−0.44; −0.01], β = −0.15, p < 0.05). Having a child as a caregiver was associated with lower psychological distress (b = −0.63, SE = 0.31, 95% CI [−1.27; −0.01], β = −0.14, p < 0.05). Having a spouse as a caregiver was not statistically significant. Having poor health was associated with higher psychological distress (b = 0.81, SE = 0.38, 95% CI [0.05; 1.57], β = 0.15, p < 0.05), while having a disability and a long-term condition were not statistically significant in the overall analysis. Being 65 and older was associated with lower psychological distress (b = −1.07, SE = 0.50, 95% CI [−2.06; −0.08], β = −0.17, p < 0.05). No other sociodemographic variables were observed to be significant with the exception of American Indian/Alaskan Native (n = 1) and the prefer not to answer (n = 3) categories, though this result lacked robustness due to the small number of participants who identified in these categories. Regression coefficients overall were fairly small, and the adjusted R-squared value was 0.11 which indicates that 11 percent of the variance in psychological distress was accounted for by predictors in the overall model.

Table 2.

Multivariate Regression Results for Psychological Distress among Program Participants (n = 182)

Variables B (SE) 95% CI β
Socio-demographics
 Race
  White (Ref.) --
  Black/African American 0.08 (0.38) (−0.67; 0.84) 0.16
  Asian −0.09 (1.50) (−3.04; 2.86) −0.004
  American Indian/Alaskan Native 5.16 (2.09)* (1.03; 9.28) 0.18
  Other 1.07 (2.13) (−3.14; 5.28) 0.04
  Prefer not to answer 3.21 (1.27)* (0.70; 5.71) 0.19
 Hispanic ethnicity
  No (Ref.) --
  Yes 0.16 (1.07) (−1.97; 2.28) 0.011
 Gender
  Male (Ref.) --
  Female −0.53 (0.43) (−1.38; 0.33) −0.09
 Under 65 (Ref.) --
 65 or older −1.07 (0.50)* (−2.06; −0.08) −0.17
 Employment status
  Retired (Ref.) --
  Semi-retired −0.65 (0.94) (−2.50; 1.20) −0.05
  Part-time student 2.31 (2.13) (−1.89; 6.51) 0.08
  Employed part-time −0.16 (2.14) (−4.39; 4.06) −0.006
  Employed full-time −0.61 (2.14) (−4.29; 4.06) −0.02
 College graduate −0.39 (0.32) (−1.02; 0.24) −0.09
 Own their own home 0.05 (0.54) (−1.26; 1.11) 0.007
Caregiving support
 No caregiver identified (Ref.) --
 Have child as caregiver −0.63 (0.31)* (−1.27; −0.01) −0.14
 Have spouse as caregiver −0.54 (0.55) (−1.63; 0.55) −0.07
Health status
 Reported a disability 0.25 (0.54) (−0.81; 1.31) 0.06
 Reported a long term condition −0.43 (0.51) (−1.44; 0.57) −0.10
 Reported poor health 0.81 (0.38)* (0.05; 1.57) 0.15
Length of service with program −0.22 (0.11)* (−0.44; −0.01) −0.15
R-Squared 0.20
Adj. R- Squared 0.11
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*

p-value <0.05

**

p-value <0.01

***

p-value <0.001

Discussion and Implications for Practice

The purpose of this study was to examine the effects of the Lori’s Hands SOCIAL Partnership program in reducing psychological distress for a sample of homebound older adults. Our findings indicated that overall, psychological distress was lower for program participants who were receiving services compared to those in the waitlist control group. Longer length of service in the program was associated with lower psychological distress for program participants, with each year of service having a cumulative effect in reducing psychological distress (see Figure 1). Findings from multivariate analyses indicated that the effects of caregiving support were dissimilar depending on the source of support. Having a child as a caregiver was protective against psychological distress as measured by frequency of feeling downhearted and blue, worried, and/or lonely in the past month. Having a spouse as a caregiver was not associated with lower psychological distress as measured by these three questions.

Figure 1.

Figure 1.

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Reduction of Psychological Distress Based on Length of Service

Past research has highlighted differences in caregiving and care recipient relationships among spouses and adult children, where spousal caregivers experienced greater burden and had to provide higher levels of care (Pinquart & Sorenson, 2011). These and other factors associated with caregiving roles and relationships may explain the psychological benefits of having a child as a caregiver, who may experience less overall burden compared to spousal caregivers who are providing a more direct and primary level of support. Of note, spousal caregivers who feel they have “no choice” but to serve as a caregiver may have strong, negative feelings regarding their role (Aloweni, 2019). This could lead to higher psychological distress for the caregiver as well as the homebound older adults. Past research has highlighted the effect of caregiver burden from a combination of stressors and challenges (Gräßel & Adabbo, 2011), which may be linked to lower quality of care for recipients (Schulz & Eden, 2016) as well as emotional distress and poor mental health for caregivers (Cooper et al., 2008; Di Mattei et al., 2008). Multiple factors such as high number of hours spent performing caregiving tasks can increase the risk for caregiver burden (Adelman et al., 2014; Shi et al., 2018). Although caregiver burden was not assessed in this study, services such as the Lori’s Hands SOCIAL Partnership program and other practical, in-home support interventions hold promise to ease caregiver burden, which may be beneficial to both caregivers and care recipients.

It is noteworthy to highlight that psychological distress in this study was measured by three questions which asked participants how often they felt downhearted and blue, worried, and/or lonely in the past month. A substantive body of research has highlighted the negative effects of social isolation and loneliness on overall health. Older adults who are homebound are at risk for decreased social networks and opportunities (Wang et al., 2018), and programs such as the Lori’s Hands SOCIAL Partnership have the potential to increase a sense of connectedness through meaningful, intergenerational interactions with student learners. Findings from the current study indicated that in addition to practical benefits, participation in programs such as the Lori’s Hands SOCIAL Partnership can confer psychological benefits through the enhancement of the social networks of homebound adults.

Strengths and Limitations

The current study examined the impact of an in-home, intergenerational program where student learners provided practical support to a hard-to-reach and underserved sample of homebound older adults with disabilities and/or chronic conditions. Our findings can help inform the evidence base of programming to reduce psychological distress using an intergenerational framework. While these findings are noteworthy, some limitations should be acknowledged. One limitation is that psychological distress was measured using 3 self-report question items. A more robust measure which includes additional constructs associated with psychological distress (e.g., loss of interest, restlessness, desperation, suicidal ideation) would provide a more comprehensive understanding of the experiences of homebound older adults in this program. Despite this limitation, the three-item measure used in this study had good internal consistency (Cronbach’s α= 0.73), which provides support in the robustness of findings on psychological distress in this study. Future studies can also further examine the nuances of psychological distress among homebound older adults using different quantitative and qualitative approaches.

The participants in this study were primarily female, retired, and non-Hispanic. In regard to racial composition, the study sample was majority White but also included a representative sample of Black/African American participants. A strength of this study is that participation in the Lori’s Hands SOCIAL Partnership was associated with lower psychological distress, and this effect did not differ based on race. Future research can examine the impact of this program on addressing the needs of a greater diversity of older adults who are aging in place with chronic illness in the context of risk factors for access to care.

Our overall findings are positive and demonstrate considerable promise in the psychological benefits of intergenerational programming such as the Lori’s Hands SOCIAL Partnership. The sample of participants were primarily identified through word-of-mouth and organization referrals, which would not include homebound older adults who may be the most isolated and disconnected. The emphasis on intergenerational connections and service learning offered through the Lori’s Hands SOCIAL Partnership model can be a natural fit for training social workers and other health professionals. Future efforts should seek further input from community stakeholders to engage homebound older adults who are at the highest risk for social isolation and poor mental health, especially among minority and underserved older adults who are not meaningfully and sufficiently connected to services and their community.

Conclusion

As more individuals reach older ages and continue to live longer with disability and multiple chronic conditions, the United States and other countries around the globe will continue to experience challenges in delivering quality care while supporting the mental health of older adults. Those who are homebound are particularly at risk for social isolation and the consequences of negative mental health sequelae from a lack of meaningful social interactions. The Lori’s Hands SOCIAL Partnership provided evidence of its efficacy to reduce psychological distress for homebound older adults through the use of intergenerational programming. Social workers and other health practitioners will continue to face demands to meet the myriad concerns of a growing older adult population. Evidence from this study suggests that this innovative program has promise to be a part of the solution in addressing the needs of an aging population while helping to build meaningful connections in an intergenerational context.

Funding:

This work was supported by the Michigan Health Endowment Fund [R-2108–149060]; the Administration for Community Living [90CCDG001–02-00]; the National Institute on Aging [P30AG0059304; 1L60AG079415–01]; the National Institute of Minority Health and Health Disparities [1P50MD017356]; the Health and Aging Policy Fellows [2018–0074]; and the Eastern Michigan University Summer Research Award.

Footnotes

Disclosure Statement

The authors of this study report no competing interests.

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

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