Novel Approaches to Teaching Aging and Disability: Active Learning Through Design and Exploration

Course Overview and Learning Objectives

The Aging and Disability course is a core course within an academic minor titled Aging and Health (AGH) and also within a Bachelor of Arts program on Health and Society. The AGH program at our campus (University of Massachusetts Dartmouth, North Dartmouth, MA) is a gerontology education program housed in the College of Arts and Sciences. The purpose of the active learning course on Aging and Disability is to provide an empirically and theoretically based exploration of major topics in the field. From a scientific research perspective, the course examines the etiology (genetic and environmental), management, and known treatment approaches of disabling conditions. Particular emphasis is placed on the importance of social relationships with peers and others, social support, and social outlets through social media. This course also includes coverage of the American Disabilities Act (ADA) and related laws, which relate to health for many and the importance of maintaining and constructing safe environments.

The course is designed to foster an understanding of how disabilities impact the aging process and how chronic health can lead to disability. By the end of the course, learning outcomes for the student include the ability to:

The course is based on a combination of an experiential learning approach (e.g., Gugliucci & Weiner, 2013) and the flipped classroom (Roehl et al., 2013) approach, which are methods of active learning. Specifically, in these learning environments, students are engaged to be active participants generating their own ideas and solutions in a supportive atmosphere. At the beginning of the semester, the student teams select a disability condition to become familiar with throughout the term. There are four parts to the process. First, the essential biopsychosocial perspective (Whitbourne & Whitbourne, 2011) is introduced as it applies to the team’s selected disability condition. The biopsychosocial perspective emphasized the interactions among biology (genetics and physiology), psychosocial (cognitive ability, emotions, and personality), and social (social, historical, and cultural) factors. This perspective provides a scaffolding to view the particular disability through which the students learn about affected processes in relation change over the lifespan (e.g., loss of hearing, vision, muscle strength, and dexterity). Second, class exercises provide a forum for practicing the applications of disability (e.g., on age group, in combination with secondary health conditions; generating a Public Service Announcement [PSA]). Third, students engage in journaling with computer drawings of potential solutions to age-specific issues (e.g., loss of dexterity may require pencils with thicker grips, inability to play soccer standing, yet possible with a power soccer wheelchair). Finally, students are given in-class time for “hack” practice when they generate prototype solutions in small teams and present to class members and visitors for evaluation and device improvement recommendations.

Context for the End-User

One crucial component of the course is to understand how the ultimate adaptive device would fit within the environmental context for the end-user. This can be particularly challenging for a student who is unfamiliar with aging or disability. Within the context of this course, students can take one of two approaches. First, using building assessment checklists adapted from those in use by the Commonwealth of Massachusetts, the students evaluate their campus setting for accessible features in the same manner a state inspector would. For example, how would a student, visitor, or employee navigate from one building to another if he or she was using a cane, walker, or wheelchair. To emphasize the importance of safety and accuracy, a toolkit is provided with yellow safety headwear, measuring tools for doorways, and clipboards for tracking the checklist progress. Student teams chart areas of concern and take photographs of problematic areas needing repair. The second approach for learning in a real-world context about accessibility features is by having the opportunity to operate manual wheelchairs on the campus. The manual wheelchairs are provided on loan by a local medical supply company. Each team is provided with a wheelchair to learn to use in the classroom and outside on campus grounds. Students are encouraged to explore campus to find different terrains since uneven surfaces, rough grass, and ramps with differing slope angles can provide unique learning experiences. Doing this allows the student teams to experience first-hand the challenges that individuals with mobility disabilities face.

Acquiring a firm grasp of the experiences of those aging in the community is particularly helpful because having objective knowledge of aging is associated with reducing ageism and improving aging related attitudes. Ageism is defined as the stereotypical views of older adults and old age and is often harmful as it can negatively influence the recipient’s views of their aging (Ayalon et al., 2018). Conversely, positive self-perceptions about aging is related to increased longevity (Levy et al., 2002). To further educate others in our institutions and communities about the importance of aging-related services, needs, and lifelong changes, the World Health Organization launched a global effort on age-friendly environments to “tap the potential that older persons represent for humanity” (Kalache & Plouffe, 2007, p. 1). There are organizations such as the American Association of Retired Persons (AARP) that are involved in aiding municipalities in becoming aging-friendly and helping to design livable communities (Kochera et al., 2005). Likewise, the Aging-Friendly University (AFU; Montepare, 2019) is helping to address specific aging elements in our university communities to help determine how to become more aware, open, and encouraging of age-friendly practices. Our on-campus exercise as part of this course further informs our students and community of the accessible features of our campus grounds as an Age-Friendly University (University of Massachusetts, Office of Communications, 2019).

Semester Project

The student teams are tasked with using the insight over the semester to create a functional device that solves an issue for an individual with the disabling condition their group had selected that semester. The thoughtful invention of a functional device (hack) is emphasized throughout the course, while the speeded (thon) feature is less crucial for those new to this field of study. The innovativeness of the device is evaluated with a grading rubric and by student and visitor evaluations on presentation day. The student teams bring their device to class, distribute a one-page summary of its construction, projected cost, and design, and then demonstrate how the device functions or would operate in the case of a computer-aided device. A paper is submitted covering the biopsychosocial elements and how the device concept was conceived, trialed, and determined by the student innovators. Project ideas over the past three semesters have emphasized inclusivity for young people and those with active lifestyles. There have been adaptive fishing poles, adaptive mounts for outdoor photographers, an adaptive clothing line for individuals with limited hand dexterity (shirt buttons replaced with magnets), and improvements to existing disability aids (attachments to a wheelchair to enable participation in sports, improved apps on smartphones, and improved folding tables to attach to a wheelchair).

Classroom Design, Composition, and Evaluation

The course is generally held in an accessible classroom with exterior door access for easy use and assessment of the outdoor spaces. The interior of the classroom has moveable tables and outlets for laptop use when working in teams. The course is intended for undergraduates and is open to students in the academic minor program and for undergraduates who are interested in exploring the minor. Maximum enrollment is quickly met during the registration process. The composition of students has included business and marketing majors, as well as nursing, psychology, sociology, biology, crime and justice, medical laboratory science, undeclared, and multidisciplinary majors. The largest groups of students are generally psychology and nursing majors, and the enrollment is highest among seniors, then juniors and sophomores.

At the beginning of the semester, student information sheets are distributed where students are asked: “how do you view the aging process on a scale from 1 to 5, with five being the most positive.” In general, students in this course who are also enrolled in the Aging and Health academic minor (M = 4.00, SD = 0.535) report a more positive view (t(13) = 2.844, p = .014) than those not in the minor program (M = 3.00, SD = 0.816). Students are also asked to provide a definition and examples of disability at the start of the semester, with most students being able to do so successfully. On faculty-generated end-of-the-semester evaluation forms in past semesters, students report the active-learning elements as extremely helpful in reaching course objectives, particularly the campus accessibility site reports, weekly activities, off-campus accessibility mapping, creating the adaptive aid prototype, oral presentations, and working in groups. Student responses indicate acquisition of essential content, with statements such as “I learned that people with disabilities want to be independent,” and on the value of this course, students often repeat emphasized content from the course such as, “preserve it to conserve it.” Students also report that they enjoy the course. For example, students report that “I enjoyed exploring the world differently and being able to see what it’s like for someone with a disability, especially physical. I loved that we applied it to our world now and everyday life (the access app).” The student appears to have valued the skills provided in the course, which has led to producing an adaptive device application. Comments like these were common among those participating in the course on teams to create novel devices for those with disabilities.

Future Implementation

The “hack-a-thon” approach to active learning will also be implemented in a graduate course on health through the life span in an upcoming semester. A similar method will be used, but there will be more direct contact with community organizations, and students will be strongly encouraged to explore their topics in the community. We hope that the experiences of the students will lead them to explore these topics during their graduate projects where more time and resources can be dedicated to the development of their ideas. Also, we will be adding assessment measures that address knowledge, empathy, and the likelihood of entering a career field related to aging and disability.

Conclusion

The benefits of active learning are clear. However, it is not always easy to implement these practices in a course in which students might not have first-hand experience with the topic. The hack-a-thon approach allows students to have a simulated experience that highlights issues with the environment that might otherwise not be obvious. Furthermore, this approach provides students with the opportunity to engage in critical thinking and problem-solving in a collaborative and open environment. Since there are no “wrong” answers, students can be creative and not be afraid of any unfavorable evaluations. Overall, students report finding the activities informational and rewarding. In the future, we hope to expand the program to other courses and extend the range of the projects to more community-based organizations.