Intergenerational Interaction Program for Nursing Home Residents and Nursing Students

Background Ageism is associated with poorer physical and mental health, lower quality of life, social isolation, and loneliness among older adults. The World Health Organization identifies education and intergenerational contact as evidence-based strategies to reduce ageism. Meta-analytic evidence indicates that interventions combining education and intergenerational contact have the largest effect on attitudes toward older adults. However, intergenerational programs vary widely in context, sample, intensity, and duration, and stronger study designs are needed. This study is designed on the basis of intergroup contact theory (Allport's contact conditions) and positions nursing students and older adults as equal partners who make decisions together and share experiences, rather than as care recipients and care providers.

Aim and Hypotheses The aim is to examine the effect of a 6-week intergenerational interaction program on joy of life and loneliness in older adults living in a nursing home and on ageism in nursing students.

H1: After the program, older adults in the intervention group will have significantly higher joy of life scores than those in the control group.

H1a: After the program, nursing students in the intervention group will have significantly lower ageism scores than those in the control group.

H1b: After the program, older adults in the intervention group will have significantly lower loneliness scores than those in the control group.

Design Pilot, parallel-group, two-arm randomized controlled trial with a pretest-posttest design. The study also explores how participants experience the program, how they describe the reciprocal relationship, and the facilitators and barriers encountered during implementation.

Setting and Participants The study will be conducted at Istanbul Darülaceze (Kayışdağı Darülaceze Nursing Home) in collaboration with the Department of Nursing, Acibadem Mehmet Ali Aydinlar University. A total of 30 older adults (15 intervention, 15 control) and 30 nursing students (15 intervention, 15 control) will be included. Sample size is limited by the institution's participant capacity. Older adults will be randomly assigned to groups at a 1:1 ratio.

Intervention The program lasts 6 weeks, with one session per week of about 2 hours (1 introductory week + 5 activity weeks). Before the first visit, students will receive brief training on aging, communication, and interacting with individuals with cognitive impairment. In week 1, pairs get to know each other and jointly decide on activities for the following weeks. Sessions in weeks 2-6 follow a fixed structure: welcome and conversation (15 min), activity selection (5-10 min), main activity (60-70 min, with breaks as needed), and reflection and closing (20-25 min). Activities are chosen jointly from four categories: games and problem solving; reading and cultural sharing; creative work; and sharing skills and experiences. The weekly focus moves from getting acquainted, to mutual learning, to shared decision-making and collaboration, to deepening the relationship, and finally to completion and planned closure. The program is structured around Allport's contact conditions: equal status, common goals, cooperation, institutional support, sustained contact (the same pair remains together for 6 weeks), and reciprocity. Any activities involving physical movement will be defined in advance and depend on approval by the institution's health team. Students will follow defined role boundaries (e.g., no medical or personal care, no health advice, no financial transactions, no unauthorized photos or recordings).

Control Group Older adults in the control group will continue their usual institutional routine and will be offered the same program after the study ends, if they wish.

Outcome Measures Older adults: Joy of Life in Old Age Scale (primary outcome; 23 items, 5-point Likert, 6 subscales) and Loneliness Scale for the Elderly (secondary outcome; 11 items, emotional and social loneliness subscales, total score 0-22).

Nursing students: Fraboni Scale of Ageism (primary outcome; 17 items, 4-point Likert, 3 subscales, total score 17-68).

Measurements will be taken at baseline (before the program) and after the 6-week program. A descriptive characteristics form will be completed at baseline. Session monitoring forms (attendance, duration, activity, deviations) and reflection record forms will be completed after each session.

Data Collection Scales will be administered to older adults face to face, with items read aloud verbatim when needed. Only the participant's own responses will be recorded; responses from staff or relatives will not be accepted in place of the participant's. Students will complete the scales individually, and their responses will not affect course or grade evaluations. Where feasible, outcome assessments will be conducted by an assessor blinded to group allocation. Posttest data will be sought from participants who discontinue the program but do not withdraw consent.

Data Analysis Descriptive statistics will be reported. Baseline equivalence will be tested with the independent-samples t-test, chi-square test, or Fisher's exact test. Between-group differences in change scores will be analyzed with the independent-samples t-test or Mann-Whitney U test, and within-group changes with the paired t-test or Wilcoxon signed-rank test. A mixed ANOVA or generalized estimating equations will be considered for group × time interaction. Significance will be set at α = .05 (SPSS v26 or later). Reflection records will be analyzed thematically and reported alongside the quantitative findings.

Ethics The study was approved by the Acibadem Mehmet Ali Aydinlar University Medical Research Evaluation Committee (ATADEK; decision no. 2026-15/721, 08.10.2026), and institutional permission was obtained from Istanbul Darülaceze. Written informed consent will be obtained from all participants. For older adults with cognitive limitations, consent will be obtained from a legal representative together with the participant's verbal or behavioral assent. Participants may withdraw at any time without any effect on their care or education.