Older adults are at risk of being socially isolated due to poor health, low morale, and communication difficulties [1]. Keeping older adults healthy and active as vital members of their communities is an emerging challenge of our aging society. Despite the importance of personal relationships to health and well-being [2, 3], changes in the family structure, including the emergence of nuclear families and a higher divorce rate, have resulted in a lower frequency of intergenerational interactions [4]. Even in countries with traditionally strong family ties, such as Japan, the proportion of three-generation-family households has decreased, while that of aged households has increased from 6.3% in 1986 to 20.5% in 2011 [5]. According to the International Comparison Survey on the Daily Life and Attitudes of Elderly Persons (2010), 51.9% of people aged 60 and over who live separately from their children reported having contact with their children ‘more than once a week’ in Japan, while this rate was approximately 80% in the United States and around 60% in Sweden, Korea and Germany [6].

Intergenerational (IG) programs were proposed as a way to develop bonds between two generations in the United States and have expanded to other regions of the world [4]. As defined by the International Consortium for Intergenerational Programs, “intergenerational programs” are “social vehicles that create purposeful and ongoing exchanges of resources and learning among older and younger generations” [7]. Intergenerational programs provide contact and communication between children and older adults. Communication enables older adults to help others by listening, reflecting and offering advice [8], and serves critical roles in the lives of older adults, including maintaining a sense of identity, and relieving loneliness, depression or anxiety [9]. The literature suggests that intergenerational programs benefit both older adults and children. For older adults, the effects of programs include increased self-esteem, improved well-being [10–12], increased social contact [10], decrease distress [13, 14], and gratification for their contribution to the community [15], while positive attitudes towards the elderly [16–19], and understanding of the aging process [11, 15] have been reported for children.

The Intergenerational School (TIS) in Ohio in the United States represents a model of intergenerational programs in which older adults in the community teach reading and mathematics to children as mentors [20]. In Japan, it was observed that healthy older adults can lead the interaction (e.g., help children with their studies and teach regional culture [21], and also read picture books to children [22]. These elder-led programs, which motivate older adults to participate in society, are still few. According to a recent study of adult day services in Tokyo, more than 80% of the day centres reported that the frequency of intergenerational programs with elementary school children was “a few time a year” [23].

The IG programs in current elder day services in Japan include a “performance-based IG program” (children sing songs and dance) and a “social-oriented IG program” (older adults and children play games together). Depending on the available exchange time, either program or a combination of both programs is implemented. The performance-based and social-oriented IG programs each have advantages and disadvantages. In the performance-based IG program, even physically vulnerable older adults (e.g., those using a wheel chair) can participate in the program. However, this program does not promote the older adults’ autonomy because the older adults are passive [24]. The social-oriented IG program generates conversation among individuals with different generations. However, if children do not show interest in the social-oriented IG program, fewer conversations and mutual exchanges occur between the children and older adults [25]. Interaction programs should be meaningful for both older adults and children, but there are few studies that have examined the differences between different interaction styles.

The present study aimed to compare the changes in visual attention, facial expression, engagement/behaviour, and intergenerational conversation in older participants in performance-based and social-oriented IG programs to determine a desirable interaction style for older adults.

In the present study, there were differences in the changes in visual attention, facial expression, engagement/behaviour and intergenerational conversation in association with the interaction style of intergenerational program. Smiles, constructive behaviour and intergenarational conversation were significantly higher in the social-oriented IG programming group than the performance-based IG programming group, while the visual attention occured between the generations was significantly higher in the performance-based IG programming group than the social-oriented IG programming group.

Smiles were observed in both the performance-based and social-oriented IG programming groups in this study. The older adults smiled just as a result of looking at the children’s faces in the performance-based IG program, while laughter was also heard in the social-oriented IG program, when the older adult picked up a good card, achieved a successful string figure, created a funny face in Fuku-warai, or played paper, rock and scissors. In general, social smiles sometimes occur, but laughter often breaks out when an individual is really enjoying something.

Laughter and smiles are means of non-verbal communication that express interpersonal attitudes. Laughter and smiling are usually produced as messages of good will to others, signalling acceptance. Laughter is believed to have evolved in humans to express a secure and safe message to others [30]. A chain reaction of smiling is known to occur in mother-child interaction when the mother smiles in response to the infant’s smile as a positive feedback [31]. Smiles and laughter allow both children and older adults to feel secure and connected, and help build a positive relationship even in a short interaction. Previous studies reported that following interpersonal contact, older adults showed more positive attitudes toward younger people [16], and also desired a meaningful relationship with younger people [18].

Effective intergenerational programs provide opportunities to plan and reflect on experiences [37]. Although little development can be expected after the completion of a performance in the performance-based IG program, one activity may trigger various conversation topics in the social-oriented IG program as shown by the results of the present study. Active engagement is found to create more opportunities to find and share common interests during the time that older adults and children spent together [37]. In the present study, the constructive behaviour rate was very high (90%) in the social-oriented IG program, and both older adults and children engaged in conversation and enjoyed traditional play together. Both generation groups have much to give and learn through interaction; children have a zest for learning, while older adults have a lifetime of experience [19].

When older adults are given meaningful roles such as the opportunity to nurture and mentor children, their self-esteem increases [11] in association with feeling needed, valued, and a sense of self-worth [10], and older adults are reminded of their role in society. In the present study, older adults not only responded to children’s questions, but also shared knowledge with children by teaching the rules of games and passing on cultural traditions though play. Traditional games invite conversation. Since Karuta and Fuku-warai are often played around the New Year holiday, playing these games presents a good opportunity for the adults to explain the cultural traditions engaged in at New Year’s. The older adults also learned new ways to play from the children regarding the “Cat’s cradle” and “Action Songs.” An intergenerational program is only effective when it supports mutually beneficial interactions [38].

Visual attention is also a form of non-verbal communication [39, 40]. In the performance-based IG programming group, older adults looked at children throughout the 5-minute observation period. Although these performance-based IG programs are adopted in a number of day services, the goal of intergenerational interaction is difficult to achieve with only the quiet watching of a performance [41]. It is rather note-worthy that the visual attention occurred between the generations was 87.5% in the present social-oriented IG program.

Close interaction and repeated contact make self-disclosure and other friendship-developing mechanisms possible [42]. It is very difficult to interpret the present findings without knowing whether the older adults and children had regular opportunities to interact with each other. The children participating in this study had visited the day centre on a regular basis since April 2011, and they were thus familiar faces among the older adults at the time of the survey in the winter of 2011. This sense of intimacy may have contributed to the generation of smiles in the results.

Intergenerational programs have the great potential to promote health and well-being of older adults. Given the limited number of such programs at present, we need to develop new programs which attract the participation of both older adults and children, with natural smiling and laughter. There are a variety of potential interactions including the pairing of older adults with children. Since the interest taken by older adults in activities is affected by their experience and character [43], programs utilizing their unique capacities and experience are desirable. For example, an older adult who has been a farmer can be a teacher of horticultural activity, while those who have a good knowledge of plants can be guides for children’s outdoor activities and those who are good at drawing can teach children to draw.

It is important for facilitators to assess whether older adults communicate well with children in the program and to provide support. It is the role of facilitators to offer a program which draws out the strengths of both generations and to promote sustained attention and self-motivated involvement [37], while ensuring that older adults and children are always the main focus of the intergenerational program. Future plans for intergenerational programs should be more research-based, and the principles of contact theory (support from authority, common goals, cooperation, equal group status, and opportunity for friendship) are essential for intergenerational programs [41, 42]. Future research – practice interactions may generate successful programs.

Intergenerational programs with preschool children bring smiles and conversation to older adults. Smiles and conversation correspond to interpersonal acceptance, which is a basic human need. The social-oriented IG program allows older adults to engage in more roles than the performance-based IG program. When older adults are given meaningful roles as mentors or role models, they are reminded of their ability to contribute to society. Intergenerational programs provide the opportunity to fulfil basic human needs and reintegrate older adults into society. Further development of beneficial programs is warranted.