July 27, 2020

Social Participation in Assisted Living Facilities: Occupational Therapy’s Role

Arkansas State University

By Amanda Mohler, OTD, OTR/L
Department of Occupational Therapy
Arkansas State University


The number of older adults residing in the United States is becoming unparalleled. Advances in medical care, aging baby boomers, and increased life expectancy are common causes related to an increase in the aging population. By 2030, all baby boomers will be older than age 65. In 2034, there will be approximately 77.0 million older adults (United States Census Bureau, 2018). As individuals grow old, they experience natural age-related changes such as decreased muscle strength and cardiorespiratory function, and poorer quality sleep (Goodpaster et al., 2006).  Older adults also experience cognitive changes, such as impaired memory, from the aging hippocampus and cortices (Grady, 2000). The natural age-related changes often result in physical limitations and the inability to live within one’s home. As a result, more older adults are transitioning to assisted living facilities.

Assisted living facilities are long-term care housing options commonly used by older adults. The facilities promote successful aging and autonomy while assisting with daily living activities. Common activities that assisted living facilities provide include bathing, dressing, meal preparation, transportation, and medication management. In addition to assisting with basic care, many assisted living facilities promote participation through various social and recreational activities. However, many residents are hesitant to participate in activities due to limitations experienced from aging and the transition process from home to an assisted living facility.

Transitioning to an assisted living facility often comes with challenges. When older adults leave their home, they must adapt to the changes associated with relocation. Many will experience changes to their roles, routines, habits, meaningful occupations, and social supports. The changes have the potential to result in a loss of meaningful occupations, depression, and decreased quality of life, resulting in a decline in social participation.

Social participation is the process of engaging in activities within a community, or with friends, family, or peers (American Occupational Therapy Association, 2014). Research shows that social participation is important for one’s health and well-being. Individuals will experience less physical and cognitive decline when they participate in social networks and engage in social activities (Stav, Hallenen, Lane, & Arbesman, 2012). Hajek and colleagues (2017) evaluated the impact of social engagement on depressive symptoms and health-related quality of life outcomes (e.g., physical, psychological, and social aspects of life). The study found that participating in social activities increased health-related quality of life and decreased depressive symptoms for participants. The study also linked social participation to increased quality of life and well-being.

Social participation is a crucial indicator associated with successful aging. One of the benefits of transitioning to an assisted living facility is forming a sense of connectedness and belonging with other residents residing in the facility. Residents who connect socially in assisted living facilities report increased happiness and quality of life, a robust social support system, and decreased risk of depression and loneliness (Umberson, & Montez, 2010). Therefore, social engagement promotes not only a sense of social connectedness but also well-being. Despite the evidence promoting social support, many residents continue to limit social interactions while residing in assisted living facilities. It is critical to promote social participation throughout assisted living facilities to promote successful aging.

Facilitating social participation does not mean increasing the number of social and recreational activities offered at assisted living facilities. Rather, skilled professionals should promote meaningful activities that address the age-related changes and the implications of the transition process. Occupational therapists play a critical role in helping older adults age successfully within an assisted living facility.  Occupational therapists are skilled in identifying barriers to participation. Using a holistic approach, occupational therapists, promote social participation by developing strategies that match the resident’s needs and environmental strengths. In assisted living facilities, the therapists use their unique skills to grade and adapt activities and engage residents in meaningful occupations to promote successful aging in place.

With the increase in life expectancy, the older adult population will increase astronomically, resulting in the utilization of more assisted living facilities. Once older adults transition to an assisted living facility, they face new challenges that can potentially impact their social participation. It is critical to ensure residents have the opportunity to engage in social participation to promote successful aging and quality of life.




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United States Census Bureau. (2018, March 3). Older People Projected to Outnumber Children for the First Time in U.S. History. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html