INTErGenerational intervention to Reduce fraIlTY trial (INTEGRITY)

Background

It is a huge achievement that we are living longer than before but sometimes older age also comes with poorer health. Frailty, defined as having an increased vulnerability, and dementia or cognitive decline are more common at older ages and often result in heightened care requirements and transition to aged care. Approximately 12-24 percent of older adults are identified as frail, while an additional 40 percent are categorized as 'prefrail' or mildly frail, and around 10% of adults over 65 have a diagnosis of dementia.

But what if we could reduce the risk of becoming frail and help to protect our brain health and thinking or cognitive skills? We know that having greater physical activity, social engagement and using our brains in cognitive activities are linked to lowering the risk of developing frailty and cognitive decline. Increasing these aspects of our day to day life may help us. A fun way to do this can be through intergenerational practice.

Intergenerational practice unites different generations to bring mutual benefit to both generations, for example, brining together older adults residing in the community with preschoolers like the television program ‘Old People’s Home for Four Year Olds’ (ABC). The TV show highlights the potential for positive outcomes of non-familial intergenerational initiatives and the success of the show has inspired communities across Australia to implement comparable intergenerational programs. Nevertheless, our recent systematic review reveals limited, predominantly qualitative evidence supporting the effectiveness of such intergenerational practices, with most studies being small-scale in nature. It means we lack empirical measures of the benefit that this kind of intergenerational practice might bring!

We need the research to measure the impact of intergenerational practice. We know that facilitating regular contact in small, structured groups between different generations provides an opportunity to offer support to both older adults and children. We think that this approach will allow us to enhance social, physical, and cognitive engagement for the older adults, foster friendships among older adults and across age groups, and contribute to language and emotional development as well as school readiness in children.

This is particularly significant for our societies now because families are often geographically dispersed, with a majority of older adults residing in the community, and many living alone. Moreover, older adults and preschool children, being outside of full-time schooling and, in most cases, no longer engaged in full-time employment, possess the time to participate in these activities.
Our research is a clinical trial structured to investigate the outcomes of involving community-dwelling older adults and preschool children in organised intergenerational activities. The success of this study could potentially prompt other communities to initiate similar programs.

Externally to the research, members of the team participated in a series of videos that showcase intergenerational practice. These videos were produced separately from our ongoing research program and highlight the perspectives of some wonderful individuals involved, offering a deeper look into its potential impact and the meaningful connections it fosters.

Video: Intergenerational Practice in Action

Video: Intergenerational Playgroups - Real voices on why you should get involved

Aim

The aim of this study is to see whether intergenerational programs can improve health benefits for older adults and developmental skills for young children.

To determine the effectiveness of a community-based intergenerational practice program in:

• Reducing older adult frailty 
• Improving older-adult quality of life and reducing healthcare resources
• Improving preschool age child developmental skills, such as oral language, communication, and empathy skills.

Research Methodology

We are evaluating the impact of intergenerational activities, involving the regular interaction of older adults and preschool children in mutually engaging tasks.

The INTErGenerational Intervention to Reduce fraIlTY (INTEGRITY) trial rigorously tests an intergenerational practice program using a cluster randomised, blinded endpoints clinical trial bringing community-dwelling older adults and preschool children together in 44 clusters.
Each of the 44 clusters will bring together 10-12 community-dwelling older adults and 10-12 children recruited from a participating Sydney-located preschool. The trial intervention consists of 20 weeks of intergenerational sessions with one 2-hour session per week.

The control group will receive an online questionnaire from the research team every 4 weeks to check on their current health/living arrangements/transition to aged care status, healthcare service usage and falls. The control group will commence their intergenerational sessions in the same format as the intervention group after the follow up assessments have been completed (i.e., a waitlist control group).

Information on joining our study for adults

What does it involve:
A 2 hour weekly program that brings older adults and preschoolers together for a range of fun activities.

Time: 
Same day and time each week (for 20 weeks)

Location: 
Participating preschool in your local community (Sydney area)

Completion of assessments at the start and end of the program including:

• Questions on thinking skills and mood
• Simple health-related problems
• Strength, mobility and balance tests

Eligibility criteria:

• Aged 65+
• Residing in the community
• Able to walk 6 metres (with or without a walking aid)
• Able to sit and stand from an armed chair
• Have a valid Working With Children Check (free to obtain)
• Have no speech or sensory difficulties that may prevent interaction
• Have an up-to-date vaccination status against covid-19 and other current infectious diseases
• Attain a baseline Montreal Cognitive Assessment Score of 19+ (this will be assessed over the phone).

You can express interest here: https://redcap.link/integrity.trial.eoi

If you would like to see a video of the program that took place at one of our pilot sites, St Nic’s Christian Preschool (Coogee), and hear about the previous participants’ experiences of participating in our program, please click here.

Information on joining our study for children (parents)

What does it involve?
Join a 2-hour weekly intergenerational program bringing older adults and preschoolers together in a range of fun activities for 20 weeks.

Completion of assessments at the start and end of the program including: 

• Understanding of emotion
• Pearson's expressive Vocabulary test

Eligibility criteria:

• Aged 3-4 and not attending school the following year
• Attending the preschool at the study site or affiliated preschool
• Fully toilet trained
• Able to participate in group activities without additional behavioural support

You can express interest here: https://redcap.link/integrity.trial.eoi 

Current Status

Human Research Ethics Committee approval for the trial has been obtained. This trial has several sites completed, underway, and several actively recruiting. Please reach out if you are interested in participating in our research.

Contact

Contact the Intergrity team if you are interesting in hearing more about the project.
Contact the team