Holistic Wellness Coaching for Older Adults: Preliminary Evidence for a Novel Wellness Intervention in Senior Living Communities

Abstract

Although resident wellness is increasingly a priority in senior living communities, there are few programs that promote holistic wellness in later life. A total of 79 residents (ages 71 to 97; M = 84.27, SD = 6.46) from eight senior living communities completed a pilot study of a novel, staff-led wellness coaching program consisting of resident-driven goals and individual and group coaching sessions. Participants completed surveys at three time points (pre-program, post-program, and 1-month follow-up). Repeated measures ANOVAs revealed positive changes in resident health satisfaction, physical quality of life (QOL), psychological QOL, loneliness, relatedness, competence, and sense of purpose. Some of these results (i.e., psychological QOL, loneliness) persisted at follow-up. Residents reported high satisfaction with the program. These findings have implications for the application of holistic wellness frameworks in later life, as well as the development and implementation of wellness coaching programs with older adults.

Keywords

wellness coaching holistic wellness retirement well-being wellness programming

What this paper adds

• The authors developed a wellness coaching program that is distinctive due to its use of a novel underlying wellness framework, structured curriculum, and incorporation of group coaching.

• The program resulted in positive changes to resident health satisfaction, physical quality of life (QOL), psychological QOL, loneliness, relatedness, competence, and sense of purpose.

• Benefits related to psychological QOL and loneliness were still present at 1-month follow-up.

Applications of study findings

• Wellness coaching may be an effective strategy to expand wellness offerings provided to older adults residing in independent living communities.

• Staff members who received a standardized wellness coaching curriculum were well-received as coaches, which may provide independent living communities with a convenient and cost-effective approach to providing wellness coaching.

Introduction

Promoting resident wellness is a priority in senior living communities, including among older adults residing in independent living (Mullaney, 2019). In fact, among a sample of U.S. senior living communities, 82% included wellness in their mission statements, and 78% used a multidimensional wellness framework to inform their programming (Edelman et al., 2010). In a study of 386 individuals with an average age of 65, 90.3% expressed interest in organized wellness pursuits on “purposeful living,” 90.8% on healthy eating, and 72.4% on stress management (Talley et al., 2019). Wellness is a multidimensional construct (i.e., inclusive of physical, psychological, and social domains) that corresponds to the pursuit of quality of life (QOL), personal growth and development, and lifestyle balance (Howard & Louvar, 2017). Wellness also consists of the presence of salutogenic factors that promote happier and healthier lifestyles (McMahon & Fleury, 2012). Although the study of wellness in older adulthood lags behind its application to other age groups (Fullen, 2019; Howard & Louvar, 2017), the pursuit of wellness is relevant at any age, making it an appealing objective for senior living communities and older adults.

Wellness programming, such as wellness coaching, has been effective in helping individuals clarify their priorities and develop strategies to meet goals (DeJesus et al., 2018; Wolever et al., 2013). Wellness coaching consists of a relationship between a coach trained in active listening, behavior change theory, and motivational interviewing, and coaching recipient(s) who select personalized wellness goals (Howard & Louvar, 2017; Wolever et al., 2013). Wellness coaching is predicated on concepts such as education and self-discovery (Wolever et al., 2013), with a collaborative, strengths-based focus (Howard & Louvar, 2017).

In a systematic review of health and wellness coaching programs, Wolever et al. (2013) described an array of issues addressed by coaching, including exercise, nutrition, general lifestyle and health education, smoking cessation, and providing specific disease or condition-based information (e.g., prediabetes, DeJesus et al., 2018; hypertension, heart disease, and other chronic health disorders, Sforzo et al., 2017). Whereas these programs emphasize physical dimensions of wellness, wellness scholars have historically used multidimensional, holistic, or whole-person definitions of wellness, in which additional dimensions of wellness (e.g., social; psychological; spiritual) are included (Myers & Sweeney, 2005). Senior living communities also appear to be moving toward more holistic wellness frameworks (Edelman et al., 2010), illustrating the need for more diverse wellness programming options.

Although wellness coaching interventions hold promise, applications of holistic wellness coaching with older adults as coaching recipients have been slow to develop (Howard & Louvar, 2017). Potential explanations include assumptions that older people gain less benefit from advice or instruction (Howard & Louvar, 2017), or limited holistic wellness frameworks focused on older adulthood (Fullen, 2019). More work is needed to develop and empirically validate wellness coaching programs focused on older adults in a variety of settings.

To better understand the wellness needs and interests of older adults in senior living communities, we conducted a survey of older adults to assess interest in wellness coaching and preferences for program structure (Fullen et al., 2020). Approximately 51% reported they would “benefit from wellness coaching,” with 40% indicating an interest in participating in such a program. These findings corroborated the need for multidimensional definitions of wellness, with respondents more likely to have participated in programs focused on physical, social, or intellectual wellness compared to other dimensions, such as emotional, spiritual, or vocational activities (Fullen et al., 2020). For example, 46% of respondents reported they had “never” taken part in wellness programs focused on sustaining emotional wellness.

Although this survey illuminated the need for and interest in wellness coaching programs in senior living communities, there are few empirically validated wellness coaching programs designed for older adults. One example, the Vitalize 360 program, is a person-centered approach consisting of a thorough assessment and occasional coaching sessions (i.e., once every 3 months) provided over the course of at least 12 months (Howard et al., 2016). Preliminary findings associated with the program suggest positive effects such as enhanced mood, life satisfaction, and contextual wellness (Howard et al., 2016). However, with increasing interest in wellness programming among senior living communities, alternative offerings that improve upon the Vitalize 360 model should be considered. Specifically, it would be optimal for a program to utilize (1) a specific, underlying wellness framework that is holistic and multidimensional, (2) a more structured program that meets regularly (i.e., weekly) and standardizes certain intervention experiences, and (3) both group and individual coaching sessions to enhance wellness.

The Resident Wellness Coaching Program

Given the potential of wellness coaching and limited empirically validated, we developed a 9-week wellness coaching program. The program was informed by empirical literature on wellness in later life (e.g., George, 2010) and Fullen et al.’s (2020) survey. It was also grounded in wellness coaching principles and skills such as co-constructing goals with the resident, continual evaluation of the resident’s progress, reflective listening, identifying and addressing obstacles to success, and helping the resident relate curriculum content to their own lives (Jordan et al., 2015; Sohl et al., 2021). The curriculum was structured using a multidimensional approach to wellness consisting of: Physical, or efforts to care for one’s body; Relational, or present engagement in supportive relationships; Cognitive, or self-efficacy and a sense of control over one’s life; Emotional, or the ability to cope with challenging emotions while enhancing positive emotions; Spiritual, or pursuing meaning and purpose; Vocational, or living out a sense of purpose; Developmental, or developing constructive views of aging and successfully navigating life transitions; and Contextual, or environmental wellness. Each of these dimensions of aging well is associated with constructs empirically linked with enhanced QOL and longevity in older adulthood (Fullen, 2019). Additionally, the program incorporated self-determination theory (SDT), which examines how internal and external motivations influence decision-making and behavior and relates to motivation to fulfill the basic psychological needs of autonomy (i.e., engaging in self-directed and internally motivated behaviors), relatedness (i.e., having warm, caring relationships), and competence (i.e., being and feeling effective in one’s environment) (Ryan & Deci, 2000). The curriculum emphasized how these three basic psychological needs are connected to the eight dimensions of wellness.

Rather than focusing the program on specific health challenges (e.g., managing a chronic disease; increasing exercise), participants identified two specific goals and used the program’s multi-week structure to make progress toward these goals. Selecting two goals provided versatility in the event goal progress was impeded. Although participants were asked to associate their goals with two of the eight wellness dimensions, a great deal of flexibility was provided to ensure goals were personalized to the interests of each participant. The program also included both individual and group coaching sessions. Group coaching sessions were included to build a sense of community, learn goal attainment strategies from others, and provide reciprocal accountability. Group wellness interventions have been used effectively to promote wellness among older adults in past research (e.g., Fullen & Gorby, 2016), and group coaching is a cost-effective way to advance access to health and wellness services (Armstrong et al., 2013). Individual coaching sessions were included to support residents’ understanding of wellness constructs and how to identify and attain personal goals, as well as to provide personalized feedback throughout the course of the program.

We utilized senior living community staff as wellness coaches to make coaching services accessible and sustainable within these communities. In our previous survey (Fullen et al., 2020), respondents preferred staff members at their senior living communities as their wellness coach. The coach role included supporting participants as they clarified preferred goals, motivating participants as they faced challenges related to goal attainment, and providing education related to holistic wellness across the eight dimensions of the program.

In sum, the wellness coaching program was developed and piloted to examine its feasibility and effectiveness within senior living communities. To measure the impact of the program on participants’ wellness, we explored the following research questions:

1. Does this novel wellness coaching program meet the needs and interests of residents of senior living communities?

2. Do residents experience improvements in different areas of wellness after participating in this program?

Method

Participants

The wellness coaching program was implemented with residents at eight senior living communities in different geographic regions across the United States, and the program was administered in two waves (Spring/Summer 2021). During each wave, participation was limited to a maximum of 10 residents per community to ensure adequate emphasis on the personalized nature of the program. To recruit participants, staff wellness coaches disseminated program information (e.g., flyers, newsletter blurbs, information sessions) to independent living residents at their communities. Prospective participants received a brief phone call from a member of the research team to obtain informed consent. A total of 92 residents participated in the program, including eight communities in Wave 1 (n = 62) and five communities in Wave 2 (n = 30). Three communities were unable to participate in Wave 2 due to recruitment and staffing challenges. Group sizes ranged from three to nine participants, averaging seven participants.

Measures

Participants were asked to complete surveys (pre-program, post-program, 1 month follow-up) consisting of program evaluation items, as well as a battery of measures assessing different components of holistic wellness.

Holistic Wellness Scale (HWS; Smith et al., 2022). The Holistic Wellness Scale is a 16-item measure assessing respondents’ perceived wellness using a 7-point scale (1 = Extremely bad, 7 = Extremely good; Cronbach’s αs: .90 for pre-program, .91 for post-program, .91 for follow-up). The HWS is based in Fullen (2019)’s holistic wellness framework for older adults, which identifies eight dimensions of wellness relevant to later life: physical, relational, cognitive, emotional, spiritual, vocational, contextual, and developmental (e.g., “Maintaining meaningful relationships with others” and “Being hopeful for the future”).

World Health Organization Quality of Life, Abbreviated (WHOQoL-BREF; The WHOQoL Group, 1998). The WHOQoL-BREF is a 26-item measure developed to assess QOL across four domains. Each item is scored on a 5-point scale, where 1 represents a negative response (e.g., “Not at all”) and 5 represents a positive response (e.g., “Completely”). Responses yield an overall QOL score, health satisfaction score, and composite score for four QOL domains: physical (e.g., “How well are you able to get around?”; αs: .83, .81, .77), psychological (e.g., “How satisfied are you with yourself?”; αs: .78, .83, .86), social (e.g., “How satisfied are you with your personal relationships?”; αs: .53, .61, .59), and environmental (e.g., “How satisfied are you with the conditions of your living place?”; αs: .82, .81, .82).

Life Engagement Test (LET; Scheier et al., 2006). The LET is a 6-item scale assessing respondents’ personal sense of purpose (e.g., “To me, the things I do are worthwhile”; αs: .85, .85, .82). Items are scored on a 5-point scale (1 = Strongly disagree, 5 = Strongly agree).

Three-Item Loneliness Scale (Hughes et al., 2004). Three items assessing loneliness (e.g., “How often do you feel that you lack companionship?”; αs: .87, .88, .84) are scored on a 4-point scale (0 = Never, 3 = Often).

Perceived Stress Scale-4 (PSS-4; Cohen et al., 1983). The PSS-4 measures perceived stress using four items (“In the last month, how often have you felt that you were unable to control the important things in your life?”; αs: .73, .75, .79). Participants responded using a 5-point scale (0 = Never, 4 = Very often).

Religiosity/Spirituality

The Religiosity/Spirituality scale from the Health and Retirement Study (HRS) Psychosocial and Lifestyle Questionnaire (Fetzer Institute, 2003; Smith et al., 2017; αs: .87, .92, .91) consists of four items related to religious beliefs and values (e.g., “I try hard to carry my religious beliefs over into all my other dealings in life”). Items are scored on a 6-point scale (1 = Strongly disagree, 6 = Strongly agree).

Brief Resilience Scale (BRS; Smith et al., 2008). The 6-item BRS measures a person’s ability to recover from challenges (e.g., “I have a hard time making it through stressful events”; αs: .91, .86, .88). It is scored on a 5-point scale (1 = Strongly disagree, 5 = Strongly agree).

Basic Psychological Needs Satisfaction and Frustration Scale (BPNSNF; Van der Kaap-Deeder et al., 2020). We utilized three 4-item subscales from the BPNSNF to assess satisfaction of each basic psychological need: autonomy (e.g., “I feel that my decisions reflect what I really want”; αs: .79, .74, .82); relatedness (e.g., “I feel that the people I care about also care about me”; αs: .82, .84, .78); and competence (e.g., “I feel confident that I can do things well”; αs: .85, .88, .89). Items are scored on a 5-point scale (1 = Not true at all, 5 = Completely true).

Attitudes to Aging Questionnaire-Short Form (AAQ-SF; Laidlaw et al., 2018). The 12-item AAQ measures perceptions of aging using a 5-point scale (1 = Strongly disagree, 5 = Strongly agree; αs: .77, .80, .79). The AAQ includes items that assess psychological growth, physical changes associated with aging, and psychosocial losses (e.g., “It is a privilege to grow old”).

Wellness Changes

To evaluate the perceived effect of the program, residents rated self-perceived changes to eight different wellness dimensions (e.g., “How has participating in the wellness coaching program affected each of the following aspects of your wellness?” followed by the eight wellness domains explored in the program). Items were rated on a 5-point scale (1 = Greatly reduced, 5 = Greatly improved).

Program Satisfaction

Program evaluation questions were included to gauge residents’ perceptions of the effectiveness of the program, the performance of their wellness coaches, and their engagement with wellness activities beyond the scope of the program. Items (e.g., “Overall, how satisfied are you with your progress towards achieving your health/wellness goals?”) were scored on 5-point scales.

Procedure

Coach Training

In each community, one or more staff were selected by their communities to serve as wellness coaches. No formal qualifications were required by the program developers; however, coaches were typically from wellness-related roles, including activities/engagement (n = 4), wellness services (n = 4), nursing (n = 2), and art therapy (n = 1). Coaches received standardized training (42 total hours) related to the wellness coach role, which exceeded the typical 6–40 hours of wellness coach training (cf. Wolever et al., 2013). Training topics included information on the program’s approach to wellness, coaching skills (e.g., active listening and group facilitation) based in Motivational Interviewing (Miller & Rollnick, 2013), and developing a wellness plan. Coaches completed a capstone experience as well in which they conducted a simulated coaching session with a trainer (see Table 1). Coaches participated in weekly consultation sessions with the research team throughout the pilot program, which provided ongoing training and program fidelity checks. Coaching responsibilities were incorporated into their daily work.

Table 1.

Training Summary.

Training Type	# Of hours	Activities
Asynchronous	16	Reviewing a manual developed for the program, watching brief video vignettes, and answering reflective questions
Synchronous	15	Didactic teaching, group discussion, and role play exercises
Consultation and support	11	Meetings held with one or more coaches and multiple training team members; discuss coaching program implementation

Note. Training was delivered over 6 weeks prior to the program launch and weekly throughout its implementation.

Resident Program

The resident program consisted of 9 weeks of standardized content (see Table 2) and a wellness plan consisting of two wellness goals, developed with the wellness coaches’ support. Over the course of the program, residents worked toward wellness goals and participated in wellness education/skill development activities. They were encouraged to spend 20–30 minutes daily on activities related to the program. Participants received a workbook that included educational materials, reflective exercises, and discussion questions focused on the eight dimensions of wellness, goal setting, and goal attainment. Coaches used a corresponding facilitation guide to provide a standardized structure across the study. Activities throughout the wellness coaching program were primarily centered on the resident wellness plans and workbook, which guided residents through activities between coaching sessions. When there were two coaches at one community, the coaches usually co-facilitated the group sessions and split the individual sessions between them.

Table 2.

Program Summary.

Week	Topic	Format	Program activities
1	Introduction to the program and goal setting	Individual	Review program expectations, develop two wellness goals, establish rapport
2	Introduction to group and current wellness	Group	Establish group norms and expectations, establish rapport (e.g., ice breakers), psychoeducational overview of wellness dimensions, share wellness goals
3	Physical and relational wellness	Group	Introduction to topic, psychoeducation related to wellness dimensions, physical wellness activity (e.g., self-care assessment), relational wellness activity (e.g., discussion of components of health relationships), wellness goal check-in
4	Cognitive and emotional wellness	Group	Introduction to topic, psychoeducation related to wellness dimensions, cognitive wellness activity (e.g., constructive cognitions practice activity), emotional wellness activity (e.g., discuss coping skills for emotion regulation), wellness goal check-in
5	Progress check and goal revision	Individual	Review progress on wellness goals, discuss barriers to goal attainment, revise wellness goals to address current needs
6	Spiritual and vocational wellness	Group	Introduction to topic, psychoeducation related to wellness dimensions, spiritual wellness activity (e.g., identifying meaning and purpose), vocational wellness activity (e.g., exploring ways to pursue one’s calling), wellness goal check-in
7	Developmental and contextual wellness	Group	Introduction to topic, psychoeducation related to wellness dimensions, developmental wellness activity (e.g., self-perceptions of aging activity), contextual wellness activity (e.g., financial wellness strategies activity), wellness goal check-in
8	Group termination and reflection on progress	Group	Group reflection activity on experience in the program, group process of activity, exploration of end of group experience and impact on wellness
9	Individual termination and plan for continued success	Individual	Reflect on experience in the program, review progress on goals, develop individualized plan to maintain wellness changes

Analytic Procedures

Items were coded so that higher scores reflect greater amounts of the construct. For multi-item scales, mean scores were calculated for participants who completed at least 66% of the items. Analyses used listwise deletion when responses were missing, and valid percentages are presented in the results. Repeated measures analyses of variance (ANOVAs) were conducted to examine changes in wellness outcomes across the three survey points, and a Greenhouse-Geisser correction was applied when Mauchly’s test indicated a lack of sphericity. Data review revealed extreme outliers (i.e., values more than three times the interquartile range) on psychological QOL, autonomy, relatedness, competence, and attitudes toward aging, and inspection of the outliers indicated that they were valid observations. Sensitivity analyses were conducted by excluding outliers from the analyses, and the same pattern of results was found; consequently, the outliers were retained in the dataset to represent the full sample of participants.

Results

Overall, 92 participants enrolled and 79 completed the wellness coaching program (86% completion rate). Participant ages ranged from 71 to 97 years (enrolled: M = 84.62, SD = 6.16; completed: M = 84.27, SD = 6.46). Demographic information is presented in Table 3. There were no significant differences between people who did or did not complete the program on baseline measures of physical, psychological, social, or environmental QOL, ability to concentrate, age, gender, marital status (married vs. not married), or education (graduate degree vs. less education). Participants who completed the program were predominantly White (97%) and two-thirds were female (67%). Half of the samples were widowed (52%), and most attained a Bachelor’s or graduate degree (89%). Overall, sample demographics were consistent with general trends among independent living residents (e.g., Smith et al., 2020).

Table 3.

Demographic Information.

Variables	Enrolled (N = 92)	Completed (n = 79)
Variables	n (%)	n (%)
Gender
Female	62 (67)	53 (67)
Male	30 (33)	26 (33)
Race
White, non-hispanic	89 (97)	77 (97)
Other race/ethnicity	3 (3)	2 (3)
Marital status
Widowed	48 (54)	40 (52)
Married	28 (31)	24 (31)
Divorced	7 (8)	7 (9)
Single	4 (5)	4 (5)
Other	2 (2)	2 (3)
Highest education
High school or less	1 (1)	1 (1)
Some college/associate’s degree	10 (11)	8 (10)
Bachelor’s degree	20 (22)	17 (22)
Master’s or doctoral degree	60 (66)	52 (67)

As part of a fidelity check, participants were asked to report how much time was spent on wellness outside of the coaching sessions. Approximately 35% of participants spent less than 2 hours each week on wellness outside of the program, 46% spent 2–4 hours, and 19% spent more than 4 hours. Additionally, coaches shared additional notes regarding the program facilitation, such as challenges they encountered or successes, which provided qualitative data regarding program implementation.

Goal Progress

Most participants chose to focus on goals related to physical (68%) or relational (47%) wellness. Additional goals were associated with the other wellness dimensions: 19% emotional, 17% cognitive, 14% contextual, 10% vocational, 7% spiritual, 3% developmental. Overall, 38% of participants reached or exceeded two goals, 43% one goal, 19% zero goals.

Program Satisfaction

Participants rated their satisfaction with the wellness coaching program overall as well as with specific components of the program (see Table 4). Ninety percent of participants indicated the program met or exceeded their expectations. Eighty percent indicated they would “probably” or “definitely” recommend wellness coaching to a friend. Approximately 73% of participants reported enjoying the program “a lot” or “very much so.”

Table 4.

Satisfaction with the Wellness Coaching Program.

	Mean (SD)	1	2	3	4	5
Overall program enjoyment^a	4.00 (.88)	0%	5%	22%	41%	32%
Satisfaction with individual^b sessions	4.51 (.74)	0%	1%	11%	23%	65%
Satisfaction with group sessions^b	4.27 (.74)	0%	4%	5%	51%	40%
Satisfaction with progress toward goals^b	3.96 (.74)	0%	4%	17%	57%	21%
Satisfaction with ability to apply learning^b	4.07 (.68)	0%	0%	20%	53%	27%
Overall program usefulness^a	3.50 (1.00)	3%	9%	42%	27%	19%
Usefulness of individual meetings^c	3.84 (.98)	3%	5%	25%	40%	28%
Usefulness of group meetings^c	3.61 (.97)	1%	11%	34%	34%	20%
Usefulness of workbook^c	3.18 (.98)	4%	17%	46%	22%	11%
Overall coach satisfaction^b	4.72 (.59)	0%	1%	3%	19%	77%
Communication skills^b	4.69 (.59)	0%	1%	3%	22%	74%
Organization^b	4.58 (.68)	0%	3%	3%	28%	66%
Professionalism^b	4.78 (.53)	0%	1%	1%	15%	82%
Listening skills^b	4.76 (.54)	0%	1%	1%	18%	80%
Met expectations^d	3.50 (.80)	0%	10%	40%	40%	10%
Willingness to recommend^e	4.12 (.84)	1%	1%	18%	43%	37%

^a1 = Not at all, 5 = Very much so.

^b1 = Extremely dissatisfied, 5 = Extremely satisfied.

^c1 = Not at all helpful, 5 = Extremely helpful.

^d1 = Fell far short of expectations; 5 = Far exceeded expectations.

^e1 = Definitely not, 5 = Definitely yes.

Regarding program components, participants reported high levels of satisfaction for the individual sessions (88% somewhat/extremely satisfied) and group coaching sessions (91%). Participants also tended to report that they were “somewhat” satisfied with their progress toward goals and with their ability to apply what they learned from wellness coaching. In addition, 96% of participants were somewhat or extremely satisfied with their coach overall, and satisfaction with specific coach skills was similarly high.

Usefulness ratings were highest for individual meetings (68% “very” or “extremely helpful”), followed by group meetings (54%) and the workbook (33%). When asked if the material taught in the program was useful in reaching their personal wellness goals, the most common participant response was “somewhat” (42%), followed by “a lot” (27%), or “very much so” (19%). Participants who completed both goals (M = 3.88, SD = .99) rated the overall usefulness significantly higher than participants who completed one or no goals (M = 3.31, SD = .95), t (69) = 2.41, p = .019. In contrast, overall program enjoyment did not differ between people who completed two goals (M = 4.07, SD = .92) compared to one or no goals (M = 4.00, SD = .84), t (69) = 0.35, p = .728.

Wellness Changes

After completing the program, participants were asked to report the extent to which the wellness coaching program impacted their wellness (see Table 5). Participants reported the greatest improvements in relational and physical wellness, corresponding with the most commonly selected wellness goals. On average, participants reported that their relational and physical wellness “somewhat improved.” Overall, 82% of participants reported that their relational wellness improved somewhat or greatly, and 76% of participants reported improvements in physical wellness.

Table 5.

Perceived Wellness Changes as a Result of Wellness Coaching Participation.

	Mean (SD)	Somewhat reduced, %	Neither improved or reduced, %	Somewhat improved, %	Greatly improved, %
Relational	4.00 (.69)	3	16	61	21
Physical	3.99 (.68)	0	24	54	22
Vocational	3.78 (.64)	0	34	54	12
Developmental	3.78 (.83)	4	36	40	21
Cognitive	3.74 (.72)	0	42	42	16
Emotional	3.68 (.72)	4	35	50	11
Spiritual	3.64 (.74)	1	47	37	15
Contextual	3.59 (.75)	1	53	32	15

Changes in wellness were also examined by comparing levels of wellness over time (see Table 6). There was a significant increase in overall health satisfaction pre- and post-program (p < .001). Although health satisfaction decreased between the post-program and follow-up surveys (p = .040), health satisfaction at the follow-up still remained greater than pre-program levels (p = .007). Participants’ overall QOL perceptions did not significantly differ from baseline at the post-program (p = .196) or follow-up survey (p = .117); although, overall QOL decreased between the post-program and follow-up (p = .005). However, participants reported a significant pre-post increase in physical QOL (p < .001); although, physical QOL at the follow-up did not differ from pre-program (p = .119). Psychological QOL significantly increased over the course of the program (p = .009) and remained higher than pre-program levels at the follow-up (p = .033).

Table 6.

Changes in Wellness across Time.

Outcome	Mean (SD)			ANOVA
Outcome	Time 1	Time 2	Time 3	df	F	p
Holistic wellness (1–7)	5.43 (.80)	5.39 (.86)	5.54 (.81)	2, 134	2.56	.081
Overall QOL (1–5)	4.40 (.72)	4.50 (.59)	4.28 (.79)	2, 134	4.21	.017
Health satisfaction (1–5)	3.38 (.99)	3.81 (.84)	3.65 (.87)	1.78, 121.29*	10.99	<.001
Physical QOL (0–100)	68.79 (16.58)	72.77 (15.02)	70.90 (14.25)	2, 134	5.37	.006
Psychological QOL (0–100)	71.79 (12.24)	75.09 (14.06)	74.51 (15.13)	2, 128	4.55	.012
Social QOL (0–100)	70.08 (15.84)	69.67 (16.16)	68.69 (18.69)	2, 130	0.30	.742
Environmental QOL (0–100)	86.73 (11.69)	88.52 (10.83)	87.24 (11.29)	2, 130	1.85	.161
Purpose (1–5)	3.97 (.70)	4.13 (.64)	4.04 (.65)	2, 132	3.08	.049
Loneliness (0–3)	1.22 (.80)	1.01 (.77)	1.07 (.77)	2, 130	5.47	.005
Stress (0–4)	.96 (.65)	.92 (.66)	.99 (.72)	2, 134	0.45	.638
Religiosity (1–6)	3.91 (1.68)	3.88 (1.76)	3.94 (1.73)	1.83, 118.93*	0.26	.749
Resilience (1–5)	3.85 (.70)	3.81 (.67)	3.86 (.63)	2, 138	0.27	.763
AAQ (1–5)	3.72 (.51)	3.76 (.53)	3.78 (.54)	2, 134	0.52	.597
Autonomy (1–5)	3.96 (.65)	4.09 (.54)	4.04 (.60)	2, 136	2.81	.063
Relatedness (1–5)	4.27 (.56)	4.41 (.52)	4.26 (.68)	2, 136	4.14	.018
Competence (1–5)	3.90 (.70)	4.09 (.69)	3.97 (.71)	1.73, 117.65*	5.61	.007

Note. The possible range of scores is provided in parentheses after the name of each measure. QOL = Quality of Life; AAQ = Attitudes to Aging Questionnaire.

Mauchly’s Test of Sphericity indicated a violation of the assumption of sphericity; therefore, the Greenhouse-Geisser correction was used.

On the remaining wellness measures, there was a significant increase in purpose on pre-post surveys (p = .020). Levels of purpose at the follow-up were similar to pre-program levels (p = .333). Compared to pre-program, there was a significant decrease in loneliness post-program (p = .001) and at the follow-up (p = .035). Relatedness and competence increased during the program (p = .011 and .006, respectively) but returned to baseline levels between the post-program and follow-up (p = .020 and .013). There were no significant differences across time for social QOL, environmental QOL, holistic wellness, stress, resilience, religiosity/spirituality, attitudes toward aging, or autonomy.

Discussion

Study findings support consideration of the resident wellness coaching program as an intervention for older adults in these settings. Goal-specific and universal benefits were reflected in the longitudinal analysis, highlighting positive changes in wellness dimensions (i.e., physical, emotional, and social), basic psychological need satisfaction, and sense of purpose. Study findings also have bearings on sustainability and feasibility of wellness programming and systemic changes that may benefit senior living communities.

High satisfaction with group and individual sessions supports the use of group coaching sessions to complement individual coaching, which differentiates the current program from Vitalize 360 (Howard et al., 2016; Howard & Louvar, 2017). Resident feedback was extremely positive regarding staff coaches, which suggests the presence of high-quality coaching relationships. The lower usefulness ratings, relative to satisfaction, may be related to goal achievement. Overall program enjoyment remained high regardless of goal achievement, which may be due to positive experiences during the coaching sessions.

Self-perceived improvements and longitudinal findings illustrate both improvements associated with goal-specific attainment and global benefits for residents. In terms of goal-specific benefits, residents most commonly selected physical and relational wellness goals, both of which saw statistically significant pre-post improvements (i.e., health satisfaction, physical QOL, loneliness). Other wellness dimensions, including developmental wellness (operationalized as attitudes toward aging), may have had significant results had a larger portion of residents pursued related wellness goals. In terms of universal benefits, improvements in psychological QOL may have been related to the structure of the program (e.g., purpose enhanced through personalized goal setting) or opportunities resulting from the program (e.g., self-reflection providing emotional and psychological benefits).

The program also enhanced residents’ attainment of basic psychological needs (Deci & Ryan, 2000). Combining a resident-driven approach to goals with a holistic wellness curriculum appeared to increase resident’ sense of purpose and competence. In addition, the program’s structure appeared to support relatedness through individual and group coaching relationships; this effect may have been enhanced given the number of residents who pursued relational wellness goals. Although scores related to autonomy approached significance, there was less evidence that this aspect of SDT was improved by the program. This may be due to challenges associated with goal attainment and participants’ reliance on program structure for accountability. Further inquiry should examine strategies to enhance autonomy in wellness coaching with older adults.

Both goal-specific and universal benefits support the program’s underlying holistic wellness framework. For example, self-perceived improvements in most wellness dimensions illustrate strengths of the multidimensional approach. Most of the existing research on wellness coaching in later life is topic-specific (e.g., DeJesus et al., 2018; Sforzo et al., 2017). Preliminary study results indicate that a broader application of wellness coaching may complement existing programming and enhance holistic well-being in older adults. Indeed, the application of holistic wellness frameworks is needed in later life (Fullen, 2019).

Although pre-post changes provide some evidence of the program’s impact, regressions at follow-up in most constructs reflect a limitation, in that some benefits may be short-lived without the structure of the program. Post-program discussions with affiliated personnel revealed potential challenges to sustained wellness changes, including changing COVID-19 restrictions, personal health challenges, and scheduling. Interestingly, this effect did not hold for improvements in loneliness or psychological QOL, both of which were still significant at follow-up. Given the prevalence of relational wellness goals among participants, sustained changes associated with goal attainment may have had a more lasting effect on loneliness. Similarly, the relationships formed in the program may have continued beyond its end, protecting against a regression in loneliness. The same effect may be observed for psychological QOL because of the structure of the program itself, which provided opportunities for learning, self-reflection, and self-efficacy. It is also important to note that in a small number of cases, participants reported a decrease in levels of wellness. Possible explanations for this may include factors outside of the program structure that impacted wellness (e.g., changes to health status or relationships), social comparison related to the group structure, or a reduction in life satisfaction coinciding with deeper self-reflection.

Overall, these study outcomes provide initial evidence for the use of wellness coaching in senior living communities. Communities should consider a range of wellness services targeting different needs, such as topic-driven programs (e.g., DeJesus et al., 2018; Sforzo et al., 2017), individual coaching (Howard & Louvar, 2017), and other approaches. Our program is novel in integrating a semi-structured curriculum based in a holistic wellness framework with resident-driven goal setting, which appears to be a useful addition to existing wellness programming. Using programs like this may help integrate multidimensional wellness frameworks into senior living communities by educating residents and staff, thereby benefitting the community.

Implications for Practice

Assessment of our program yielded important implications for the development and implementation of wellness programming in senior living communities. Our program expands the wellness program pool with important new additions including a holistic framework, semi-structured curriculum, and group coaching sessions. Our findings suggest that expanding wellness offerings to address a broad range of dimensions is merited (i.e., relational; emotional; cognitive). Providing more education about multidimensional wellness to community staff and residents, as well as programming such as wellness coaching, may enhance holistic well-being for older adults. Additionally, expanding the range of staff who are equipped to provide wellness coaching may be warranted, given the varied professional backgrounds of coaching staff.

An important consideration in wellness programming in senior living communities is feasibility and implementation. Our program structure increases the practicality of implementing coaching programs in such communities, given its organized protocol, ability to reach more residents through group coaching sessions, and rigorous training protocol. Furthermore, the use of staff coaches capitalized upon prior relationships with residents and site knowledge, which enriched the implementation of the program. Communities with a more established wellness culture (i.e., an organizational commitment to wellness) tend to have dedicated wellness staff, resident wellness committees, and staff wellness programs, among other indicators (e.g., Edelman et al., 2010). Additionally, investing in multiple staff coaches may make it more feasible to integrate this program into staff schedules. Incorporating wellness coaching program responsibilities into the staff member’s job requires an acknowledgment of the weekly time commitment associated with providing individual and group coaching sessions. Limiting the size of the program may be necessary in cases where coaches are concerned about having sufficient time; however, some coaches noted that having too few participants made group sessions less interactive. Anecdotally, a group size of 6 to 10 members may be ideal.

Revisions to the program, such as elucidating the goal setting process via additional examples and information for residents and coaches in the workbook and curriculum, editing the workbook to improve readability, and amending several activities so that they can occur during group rather than outside of group, were informed by the study findings and participant and coach feedback. To address regression in wellness progress, it may be advisable to offer individual or group coaching “booster sessions” periodically after the end of the program.

Limitations and Directions for Future Research

Despite the benefits of our program, there are limitations to note. Use of a control or comparison group in the future is necessary to strengthen claims about the impact of the program. Although efforts were made to increase consistency across communities, it is also likely there were slight variations across coaches and sites in terms of program implementation. The program was conducted during the COVID-19 pandemic. Over the course of the program, participating sites had changing restrictions to protect resident safety, which may have influenced goal attainment, effects of the group, and participation in the program. Some safety measures, such as masking and distancing, may have influenced group dynamics or created challenges with accessibility (i.e., difficulty hearing one another). This and other barriers to recruitment led to a smaller sample size, which may have limited our ability to detect significant changes in some constructs, particularly those related to the wellness dimensions less frequently selected for resident goals. There are also limitations regarding the generalizability of our results due to the sample being primarily White and well-educated. Further, our findings may be less applicable to older adults with higher support needs, such as those with cognitive impairment, or in other residential settings. Future research should explore wellness coaching with more diverse samples, as well as in alternative settings, such as adult day centers or assisted living facilities. Additionally, future research should examine program adjustments that might increase ongoing feasibility (e.g., shortened program length; post-program booster sessions; the use of peers as wellness coaches; program modifications related to use with more diverse populations).

Conclusion

Wellness coaching may be a cost-effective way to improve health and well-being in later life, but there are few applications with older adults. A novel wellness coaching program utilizing a holistic wellness framework, individual and group coaching sessions, and resident-driven goals was effective in both goal attainment and enhancing overall wellness. The current findings highlight benefits to sense of purpose, psychological QOL, and basic psychological need satisfaction, in addition to enhancing wellness dimensions tied to resident goals. This and similar programs may be useful additions to senior living community wellness programming.

Supplemental Material

Holistic Wellness Coaching for Older Adults: Preliminary Evidence for a Novel Wellness Intervention in Senior Living Communities

Supplemental Material forHolistic Wellness Coaching for Older Adults: Preliminary Evidence for a Novel Wellness Intervention in Senior Living Communities by Matthew C. Fullen, Jennifer L. Smith, Philip B. Clarke, Jordan B. Westcott, Regina McCoy, and Connie C. Tomlin in Journal of Applied Gerontology

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Mather Institute.

ORCID iDs

Matthew C. Fullen

Jennifer L. Smith

Supplemental Material

Supplemental material for this article is available online.

References

Armstrong

Wolever

R. Q.

Manning

Elam

III Moore

Frates

E. P.

Duskey

Anderson

Curts

E. L.

Masemer

Lawson

(2013). Group health coaching: Strengths, challenges, and next steps. Global Advances in Health and Medicine, 2(3), 95–102. https://doi.org/10.7453/gahmj.2013.019

Cohen

Kamarck

Mermelstein

(1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 386–396. https://doi.org/10.2307/2136404

Deci

E. L.

Ryan

R. M.

(2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268. https://doi.org/10.1207/S15327965PLI1104_01

DeJesus

R. S.

Clark

M. M.

Finney Rutten

L. J.

Hathaway

J. C.

Wilson

P. M.

Link

S. M.

St Sauver

(2018). Wellness coaching to improve lifestyle behaviors among adults with prediabetes: Patients’ experiences and perceptions to participation. Journal of Patient Experience, 5(4), 314–319. https://doi.org/10.1177%2F2374373518769118

Edelman

O’Brien

Loftus

E. M.

Engel

(2010). Whole-person wellness in senior living: Perspectives of 23 pioneering communities. Seniors Housing & Care Journal, 18(1), 53–65.

Fetzer Institute (2003). Brief multidimensional measure of religiousness/spirituality: 1999. In Group

N. W.

(Ed.), Multidimensional measurement of religiousness/spirituality for use in health research: A report of the fetzer institute/national Institute on aging working group (2nd ed., pp. 85–88). John E. Fetzer Institute.

Fullen

M. C.

(2019). Defining wellness in older adulthood: Toward a comprehensive framework. Journal of Counseling and Development, 97(1), 62–74. https://doi.org/10.1002/jcad.12236

Fullen

M. C.

Clarke

P. B.

Sayer

Smith

J. L.

(2020). Coaching review: Older adults’ motivators and barriers to holistic wellness and wellness coaching participation. Mather Institute. https://information.matherinstitute.com/wellness-coaching-older-adults-motivators-and-barriers

Fullen

M. C.

Gorby

S. R.

(2016). Reframing resilience: Pilot evaluation of a program to promote resilience in marginalized older adults. Educational Gerontology, 42(9), 660–671. https://doi.org/10.1080/03601277.2016.1205409

10.

George

L. K.

(2010). Still happy after all these years: Research frontiers on subjective well-being in later life. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65(3), 331–339. https://doi.org/10.1093/geronb/gbq006

11.

Howard

E. P.

Louvar

K. E.

(2017). Examining life goals of community-dwelling, low- income older adults. Research in Gerontological Nursing, 10(5), 205–214. https://doi.org/10.3928/19404921-20170831-02

12.

Howard

E. P.

Schreiber

Morris

J. N.

Russotto

Flashner-Fineman

(2016). Collage 360: A model of person-centered care to promote health among older adults. Journal of Ageing Research and Healthcare, 1(1), 21–30. https://doi.org/10.14302/issn.2474-7785.jarh-16-1123

13.

Hughes

M. E.

Waite

L. J.

Hawkley

L. C.

Cacioppo

J. T.

(2004). A short scale for measuring loneliness in large surveys. Research on Aging, 26(6), 655–672. https://doi.org/10.1177/0164027504268574

14.

Jordan

Wolever

R. Q.

Lawson

Moore

(2015). National training and education standards for health and wellness coaching: The path to national certification. Global Advances in Health and Medicine, 4(3), 46–56. https://doi.org/10.7453/gahmj.2015.039

15.

Laidlaw

Kishita

Shenkin

S. D.

Power

M. J.

(2018). Development of a short form of the attitudes to ageing Questionnaire (AAQ). International Journal of Geriatric Psychiatry, 33(1), 113–121. https://doi.org/10.1002/gps.4687

16.

McMahon

Fleury

(2012). Wellness in older adults: A concept analysis. Nursing Forum, 47(1), 39–51. https://doi.org/10.1111/j.1744-6198.2011.00254.x

17.

Miller

W. R.

Rollnick

(2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

18.

Mullaney

(2019). Wellness continues to replace care as main focus of senior living operations. https://seniorhousingnews.com/2019/01/06/wellness-continues-to-replace-care-as-main-focus-of-senior-living-operations/

19.

Myers

J. E.

Sweeney

T. J.

(2005). Counseling for wellness: Theory, research, and practice. American Counseling Association.

20.

Ryan

R. M.

Deci

E. L.

(2000). The darker and brighter sides of human existence: Basic psychological needs as a unifying concept. Psychological Inquiry, 11(4), 219–338. https://doi.org/10.1207/S15327965PLI1104_03

21.

Scheier

M. F.

Wrosch

Baum

Cohen

Martire

L. M.

Matthews

K. A.

Schulz

Zdaniuk

(2006). The life engagement test: Assessing purpose in life. Journal of Behavioral Medicine, 29(3), 291–298. https://doi.org/10.1007/s10865-005-9044-1

22.

Sforzo

G. A.

Kaye

M. P.

Todorova

Harenberg

Costello

Cobus-Kuo

Faber

Frates

Moore

(2017). Compendium of the health and wellness coaching literature. American Journal of Lifestyle Medicine, 12(6), 436–447. https://doi.org/10.1177/1559827617708562

23.

Smith

B. W.

Dalen

Wiggins

Tooley

Christopher

Bernard

(2008). The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine, 15(3), 194–200. https://doi.org/10.1080/10705500802222972

24.

Smith

Ryan

Fisher

G. G.

Sonnega

Weir

(2017). Psychosocial and lifestyle questionnaire 2006–2016. Survey Research Center, Institute for Social Research, University of Michigan.

25.

Smith

J. L.

Bihary

J. G.

O’Connor

Basic

O’Brien

(2020). Impact of savoring ability on the relationship between older adults’ activity engagement and well-being. Journal of Applied Gerontology, 39(3), 323–331. https://doi.org/10.1177/0733464819871876

26.

Smith

J. L.

Clarke

P. B.

Fullen

M. C.

(2022). Perceptions of aging and wellness engagement among life plan community residents. Educational Gerontology. Advance online publication. https://doi.org/10.1080/03601277.2022.2101313

27.

Sohl

S. J.

Lee

Davidson

Morriss

Weinand

Costa

E. H.

Lovato

Rothman

R. L.

Wolever

R. Q.

(2021). Development of an observational tool to assess health coaching fidelity. Patient Education and Counseling, 104(3), 642–648. https://doi.org/10.1016/j.pec.2020.08.040

28.

Talley

K. M.

Cheung

Mathiason

M. A.

Schorr

McMahon

Wyman

J. F.

(2019). Aging adults’ preferences for wellness program activities and delivery characteristics: A cross-sectional survey. Topics in Geriatric Rehabilitation, 35(4), 289–299. https://doi.org/10.1097/tgr.0000000000000247

29.

The WHOQoL Group (1998). Development of the world health organization WHOQoL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558. https://doi.org/10.1017/s0033291798006667

30.

Van der Kaap-Deeder

Soenens

Ryan

R. M.

Vansteenkiste

(2020). Manual of the basic psychological need satisfaction and frustration scale (BPNSFS). Ghent University.

31.

Wolever

R. Q.

Simmons

L. A.

Sforzo

G. A.

Dill

Kaye

Bechard

E. M.

Southard

M. E.

Kennedy

Vosloo

Yang

(2013). A systematic review of the literature on health and wellness coaching: Defining a key behavioral intervention in healthcare. Global Advances in Health and Medicine, 2(4), 38–57. https://doi.org/10.7453/gahmj.2013.042

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.36 MB