Every month, the leadership team at the Gerontological Advanced Practice Nurses Association (GAPNA) highlights the most important published literature that impacts geriatric practice. This month, Valerie K. Sabol, PhD, MBA, ACNP, GNP, ANEF, FAANP, FAAN, GAPNA’s Past President (2018-2019), discusses how researchers are advocating for older adults to consider attending universities. Other research reviewed includes an international organization that has improved seniors’ self-reported health scores and how drama therapy increases quality of life at adult daycare centers.

Making the Case for Age-Diverse Universities

Gerontologist. 2020;60(7):1187-1193.

Researchers present an argument that encourages older adults to attend universities; reasons for promoting university attendance for seniors include a better educated labor force, improved diversity in higher education, and fostering innovation in an aging society.1

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Commentary by Dr Sabol:

Past research has suggested that intergenerational classrooms and workforce teams improve group performance and productivity. Advanced practice providers (APPs) are well-positioned to be advocates for lifelong learning. In addition to encouraging clients to engage in courses at institutions of higher education, APPs could also be policy advocates for age integration rather than age segregation by endorsing the importance of meaningful engagement, social connection, and cognitive health in later life.

With lower birth rates and longer life expectancy, the workforce will shift towards an older segment of the population. Coupled with this demographic shift, the economic reality is that 48% of the US population over 55 years of age has no retirement savings and will likely continue working.2

More adults aged 50 years and older will need to enroll in universities if we, as a nation, are to remain competitive in a rapidly changing, technology-driven world. Institutions of higher education can play a major role in ensuring the capacity of individual workers and the labor force, as well as lead innovation needed in an aging society. Universities themselves benefit by ensuring enrollment is met from a greater age-diverse applicant pool.

APNs should serve as local and national policy advocates and endorse higher education opportunities during individual health encounters. Intergenerational infrastructures designed to support lifelong learning is a win-win situation for society, young and older adults as individuals, and for the economic sustainment of higher education institutions themselves.

Health Aging and the University of the Third Age — Health Behavior and Subjective Health Outcomes in Older Adults

Arch Gerontol Geriatr. 2020;90:104126.

The University of the Third Age (U3A) is an international group that advocates for the education and intellectual development of older adults. A total of 277 adults aged 60 to 92 years (130 U3A members, 147 non-members) completed a self-assessment of their physical health, sense of their own health responsibility, health behaviors, and satisfaction with life. Members of U3A had significantly higher mean scores for overall health behaviors compared with non-members (97.1 vs 90.1, P = .00), behaviors associated with physical health (23.2 vs 20.8, P = .00), attention to mental health (17.4 vs 15.2, P= .00), environmental behavior (16.1 vs 15.0, P = .002), and self-rated health (6.5 vs 6.1, P = .042).3

Commentary by Dr Sabol:  

Theories on active aging indicate that participation in educational activities has positive effects on physical and psychological well-being in late life. Indeed, research has long suggested healthy aging can be supported through a process of developing and maintaining functional ability, and this study sought comparison of retirees who participated in lifelong learning through the U3A compared with retirees not engaged in similar activities.

The U3A, adopted in several countries (to include Poland where the study data was gathered), organizes and conducts lectures, seminars, and regular workshops to increase quality of life through education, social, and sporting activities. APPs should take heed not only of the results but also predictive factors for engaging in learning opportunities such as U3A. For example, U3A participants in this study tended to be better educated, female, and widowed.

APPs would be well-advised to embed inquiries about life-long learning engagement into all provider-client health encounters. Not only does this help develop rapport and understanding of an individual’s past and current social history, but they may be better positioned to knowledgeably encourage retiree participation either as a new or ongoing learner.

Retirees may not fully appreciate the benefits and/or be aware that such opportunities within the community even exist.  In addition, sharing common findings — individuals who have participated in life-long learning activities often have higher self-reported health and satisfaction with life compared with those who do not participate — may pique enough interest for retirees to enroll.    

Playback Theatre in Adult Day Centers: A Creative Group Intervention for Community-Dwelling Older Adults

PLoS One. 2020;15(10):e0239812.

Residents of adult day centers (ADCs) participated in 12 drama therapy sessions conducted on a weekly basis. The 27 participants ranged in age from 63 to 91 years, and the theater activities were facilitated by 13 ADC staff members. Analysis of the therapy sessions coupled with post-intervention interviews led researchers to conclude that drama therapy and other creative interventions have the potential to expand social engagement for older adults and should be considered as a possible supplement to routine care in ADCs.4

Commentary by Dr Sabol:

As tools for communication and lifelong learning, visual arts, music, dance-movement, drama, and theater-based interventions have the potential to improve older adults’ well-being and health, expansion of social engagement, and evolution of life stories.

This qualitative study was an opportunity for older adult daycare members to be active and productive contributors in their own communities by engaging in Playback Theater, a non-scripted theater activity based on personal memories or experiences that are acted out by other group members as the story unfolds by the participant narrator. Within this group dynamic process, this underutilized care approach allowed participants an opportunity for artistic expression, playfulness (for example, exploring the potential for expression, meaning-making, relationship building), and exploration of personal stories, often as a form of therapy or healing.

Results suggest that older adults may not solely benefit from these non-traditional engagement interventions as individuals; it may also help create community cohesiveness. Inclusion of family members and/or staff as playback theater actors may be particularly powerful. Importantly, as drama and theater promote communication of ideas and behaviors within the safety of role-play, APPs could potentially lead similar activities in various care settings as appropriate — inclusion of older adults living with dementia or other neurodegenerative conditions, who may benefit from exploration of life review and self-defining memories, requires further investigation.


  1. Morrow Howell N, Lawlor EF, Macias ES, Swinford E, Brandt J. Making the case for age-diverse universities. Gerontologist. 2020;60(7):1187-1193.
  2. Most households approaching retirement have low savings. US Government Accountability Office. Published May 12, 2015. Accessed October 30, 2020. https://www.gao.gov/products/GAO-15-419.
  3. Zadworna M. Healthy aging and the University of the Third Age – health behavior and subjective health outcomes in older adults. Arch Gerontol Geriatr. 2020;90:104126.
  4. Keisari S, Gesser-Edelsburg A, Yaniv D, Palgi Y. Playback theatre in adult day centers: A creative group intervention for community-dwelling older adults. PLoS One. 2020;15(10):e0239812.