Physical activity in community-dwelling older people: a review of systematic reviews of interventions and context

BackgroundResearch evidence on the importance of physical activity for prevention and delay of long-term conditions is strong. However, activity rates decline substantially over the life course, particularly around later life. This review is part of a comprehensive evidence synthesis of preventive interventions in older age, with a focus on healthy behaviours to identify evidence gaps and inform policy relating to ageing well and cognitive health. An overview of systematic reviews of physical activity was conducted to explore in adults aged 55 years and older: (review 1) the effectiveness of physical activity for primary prevention of cognitive decline and dementia; (review 2) interventions effective for increasing physical activity uptake and maintenance; and (review 3) barriers and facilitators to physical activity.MethodsMultiple databases were searched for studies in English from Organisation for Economic Co-operation and Development countries between 2000 and 2014 (Medline, Embase, PsycINFO, CINAHL, Social Science Index, the Cochrane Collaboration and Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and York CRD Database). Search strategy covered the following domains and concepts: ageing and older people; health behaviours and risk reduction relating to diet, physical activity, inactivity, alcohol, smoking; and risk reduction relating to loneliness and isolation, sun exposure, hearing, and vision. The quality of reviews 1 and 2 were assessed with AMSTAR.Findings35 systematic reviews were included. In review 1 (12 systematic reviews, 7751 participants), physical activity conferred mild, positive effects on cognition in older adults with and without previous cognitive impairment. However, evidence of a dose–response association was insufficient, and evidence on the effects of physical activity on delay of cognitive decline and dementia onset was inconclusive. The evidence in review 2 (16, 75 194) supported the effectiveness of various interventions, including group-delivered, centre-based, and cognitive approaches on short-term uptake of physical activity behaviour. In review 3 (7, 15 921), barriers included health status, previous physical activity habits and experiences, and cultural sensitivity, whereas facilitators included enjoyable activities and convenient scheduling.InterpretationPhysical activity can offer small benefits to brain health, but evidence on how much activity is required to produce this effect is lacking. Interventions aimed at increasing physical activity in older people should be encouraged while considering barriers and facilitators to behaviour change. In the absence of evidence on the minimum physical activity effective for maintaining brain health and increasing participation, public health messages should be aimed at promoting acceptable levels of physical activity above normal daily activities in older people. To maintain long-term participation in physical activity, individualised interventions modelled using behavioural theories may be required.FundingNational Institute for Health Research (NIHR) School for Public Health Research Ageing Well Programme and the NIHR Collaborations for Leadership in Applied Health Research and Care East of England.     

A Qualitative Study on the Types and Purposes of Social Activities in Late Life

This qualitative study examines older adults’ subjective views on the types and purposes of social activities. In-depth interviews were conducted with a purposive sample of 20 older adults, with low (n = 10) and high (n = 10) memory performance. We used grounded theory methods to analyze the narrative data. Four types of social activities—altruism, creativity, game, and motion—were identified. The purpose of social activities included enjoyment, relaxation, stimulation, and belongingness. Those in the low memory group seemed to face more barriers to participation. Different types of social activities may be important for cognitive health and well-being.     

The Long Baby Boom: An Optimistic Vision for a Graying Generation,by Jeff Goldsmith

Experience Corps^® places teams of trained volunteers in elementary school classrooms to promote academic achievement in children and serves as a health-promotion intervention for older adults. Prior to randomization, individuals reported participation in several activities of varying cognitive, physical, and social demands. Maintaining an active lifestyle, particularly in intellectually demanding activities, was associated with physical, mental, and cognitive health in adulthood. Establishing how individuals allocated their time before randomization to this program provides insight into prevalent health behaviors for at-risk older adults, and can provide the basis for examining intervention-related changes in lifestyle as a result of volunteer participation.     

Hearing loss is a risk factor of disability in older adults: A systematic review

Background and ObjectivesHearing loss (HL) is a public health problem affecting older adults. HL is not only a health condition but also a complex, dynamic phenomenon related to disability. Previous studies identified associations between HL and undesirable outcomes; however, their correlation remains inconclusive. Hearing loss can have profound impact on daily life in the elderly, and an understanding of how HL contributes to disability is needed. A systematic review was conducted to comprehensively examine current evidence and determine the association between HL and disability regarding impairment, activity and participation in older adults.Research Design and MethodsThe Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines were applied in this systematic review. Quality assessment was conducted using the Newcastle-Ottawa Scale for longitudinal studies and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional studies.ResultsIn this systematic review of 20 studies, HL was associated with mobility limitation, activity limitation and participation restriction. The severity of HL was associated with impaired mobility and physical performance, but the association was only found in persons with severe/major HL. HL was also associated with activities of daily living (ADL) dependency, however these findings were mainly based on cross-sectional studies.Discussion and ImplicationsHL is related to disability by impairment, activity limitations or participation restrictions in older adults. Future studies should include participation restrictions as a mediation factor to better understand this association. Consistent and accurate hearing measurements and hearing loss criteria are also required to determine the impact of HL on disability.     

Social networks and cognitive function in older adults receiving home- and community-based aged care

ObjectivesSocial engagement has been linked to preserved cognitive functioning in later life. Yet, little is known about the specific network factors that best predict cognitive function in older adults. This study aimed to (i) characterize the quality and quantity of interpersonal relationships and (ii) explore the relationship between social network types and cognitive function in older adults receiving home- and community-based aged care services.MethodsParticipants (n = 175) receiving aged care services participated in a structured interview regarding their cognitive function (Telephone Interview for Cognitive Status-Modified), social networks (Lubben Social Network Scale-12) and quality of life (European Quality of Life Scale). Socio-demographic and aged care service use factors were obtained from provider electronic management systems. Multiple regression analyses were conducted to examine the relationships between the size and composition of clients’ social networks, aged care service use and cognition.ResultsThe sample had a median age of 81 years (range 61-96) and most were women (65.8%). Over a third (37.6%) had cognitive impairment and reported moderately high social networks. Males had higher social networks, were receiving fewer hours but more types of services, and had significantly better cognitive performance. Age, network size and composition were not associated with cognitive performance.DiscussionMore extensive social networks were associated with maintenance of cognitive health for older adults in community aged care. Whether this is causal or a marker of better cognitive health requires a longitudinal approach, and ideally should be tested with interventions at community levels.     

Leisure time activities and cognitive functioning in middle European population-based study

PurposePhysical, cognitive, and social leisure activities are associated with a lower conversion to dementia. We examined whether single components of thirteen physical, five cognitive, and six social activities, or their combined effect are related to non-conversion or performance in episodic or verbal memory, executive functioning, and language.SubjectsA prospective five-year study in community dwelling cohort of 75-year-old adults (N = 399) without dementia at baseline from the Vienna Transdanube Aging Study (VITA).ResultsUsing the self-reported leisure activities during the year prior to the baseline examination, later converters to dementia already had lower composite scores of leisure activities. In the adjusted analysis, hiking and summation of all physical activities predicted a lower conversion to dementia (P = 0.019, OR = 0.56; 95%CI: 0.34–0.91 and P = 0.035, OR = 0.88; 95%CI: 0.77–0.99). Cognitive activities such as reading and writing, were associated with a lower rate of conversion to dementia; in contrast, television (TV) viewing showed a trend towards increase in conversion (P = 0.053, OR = 1.8; 95%CI: 0.9–3.4). In multiple comparisons, physical, cognitive, and social activities lead to improvements in episodic, visual memory, executive function, and naming ability. TV viewing predicted a worse performance in executive function at five-year follow-up.ConclusionsThese results from a middle European population-based study support a protective effect of leisure time activities on lower conversion to dementia and identify an association between the passive activity of TV viewing and low executive functioning.     

Patterns of social participation among older adults with disabilities and the relationship with well-being: A latent class analysis

AimLiving with a chronic condition or a disability at older age impacts social participation. Social connections and social activities seem interrelated leading to heterogeneous patterns in social participation. The aim of this study was to identify a typology in social participation among older adults with disabilities, and to relate this typology to their background characteristics and well-being measures.MethodsA total of 1775 older adults with disabilities or chronic conditions aged 65–97 were sampled from a nationwide panel study in the Netherlands. Social participation was assessed by various measures related to social connections, social informal activities, voluntary work, effort to increase social participation, and online social participation. A latent class analysis was carried out to identify a typology of social participation. Differences between these classes were explored with multinomial regression analyses and pairwise comparisons.ResultsFour classes were found: social withdrawers (22.5%, n = 399), proximate social dwellers (14.5%, n = 257), moderately active social dwellers (37.2%, n = 660) and pro-active social dwellers (25.9%, n = 459). Background characteristics, such as living alone and severity of disability, differed significantly among classes. Regarding well-being measures, it appeared that pro-active social dwellers had the most positive scores. Social withdrawers were most prone to reduced life satisfaction and health related quality of life and increased loneliness and experienced participation restrictions.ConclusionsA typology with four patterns based on a wide spectrum of social participation aspects in older adults with disabilities was identified. This typology may help to assess the risk for reduced well-being of older adults with disabilities.     

Physical Activity and Social Network Contacts in Community Dwelling Older Adults

Abstract

Maintaining social network contacts is an important and challenging factor in successful aging. This study examines how physical activity level is associated with network contacts in an interview survey of 6,596 adults 60 and over. The number of telephone calls, family gatherings, and visits with neighbors were used to measure social contacts. Physical activity was operationalized by the frequency and intensity of the five most common activities in the past month. Regression results demonstrated that gardening, walking, and biking were positively associated with all three measures of social contacts, even after controlling for sociodemographic, health and ADL factors. These findings suggest that social network contacts may be positively influenced by participation in physical activity. Reducing barriers to physical activity may be an appropriate strategy for promoting social network contacts in older individuals.     

Factors Associated with Hopelessness and the Role of Social Networks Among Chinese Older Adults

ObjectiveThe levels of hopelessness affect older adults’ physical and mental health. However, there has been a lack of research on the hopelessness among Chinese older adults. The aims of this study were to explore factors associated with hopelessness and the moderating role of social networks among Chinese older adults.MethodWe conducted a cross-sectional study among older adults (n = 837) from nine communities in Xi’an and Beijing in China, and collected the participants’ levels of hopelessness, demographic information (age and gender), socioeconomic status (marital status, education, monthly income, living status, and alimony), life satisfaction, health information (self-rated health and sleep quality), and quality of social networks.ResultsOf the participants, 61.9% reported different levels of hopelessness symptoms; 71.2% reported poor sleep quality, and 21.1% reported low levels of social networks. A hierarchical multiple regression analysis showed that marital status, monthly income, alimony, life satisfaction, and sleep quality were significantly associated with hopelessness. A PROCESS analysis demonstrated that social networks played a moderating role in the relationship between sleep quality and hopelessness.ConclusionChinese older adults who had no spouse, had lower incomes, and were dissatisfied with life were more likely to have higher levels of hopelessness. Furthermore, older adults who did not receive financial support from their children reported higher levels of hopelessness. In addition, the worse the sleep quality the higher levels of hopelessness in older adults. However, high levels of social networks could weaken the negative effect of sleep quality on hopelessness.     

Trends and gender associations in social exclusion in older adults in Sweden over two decades

BackgroundSocial exclusion in older adults is associated with lower well-being and poorer health. To date there has been little research on whether the level of social exclusion in older adults changes over time, and its association with gender.AimTo examine trends and gender associations in social exclusion indicators in older adults for the years 1992, 2002 and 2011.MethodsThree waves of data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a national survey of adults aged 77 years or older, were analysed: 1992 (n = 537), 2002 (n = 621), and 2011 (n = 904). Summative scales were created for four domains of social exclusion: material resources, social relations and leisure activities, civic participation, and services. Associations between gender and social exclusion within waves were examined as were trends in social exclusion across years.ResultsThe analyses of trends found significant reductions in exclusion in the domains of material resources and services. Higher levels of exclusion from material resources and civic participation were found in women than men. Within domains, significant trends and gender associations in exclusion were found on several indicators, with indicators showing opposing trends.ConclusionAlthough levels of social exclusion have reduced in certain domains during the years examined, our results reflect the persistence of social exclusion in the population of older adults. This underlines the continuing importance of a well-developed welfare and social security system to ensure the social inclusion of vulnerable groups such as older adults.     

Effect of physio-cognitive dual-task training on cognition in pre-ageing and older adults with neurocognitive disorders: A meta-analysis and meta-regression of randomized controlled trial

Declines in cognitive performance, such as those seen in neurocognitive disorders (NCDs) are often associated with ageing. Both physical activity and cognitive training are common interventional strategies that can mitigate the decline in cognitive and physical performance. This review aims to (1) to evaluate the effects of Physio-Cognitive Dual-task Training (PCDT) intervention on cognition, physical performance, activities of daily living (ADL) and health-related quality of life (HRQoL) in pre-ageing and older adults with neurocognitive disorders, (2) explore the effects of covariates on intervention outcomes. A systematic search was conducted in eight databases. Cochrane's Risk of Bias Tool version 1 and GRADE criteria were used to assess risk of bias and certainty of evidence, respectively. Meta-analysis and meta-regression analyses were conducted using R software. Twenty-six randomized controlled trials involving 1,949 pre-ageing and older adults with NCDs were included in the meta-analysis. PCDT interventions had small-to-medium effect size on all cognition outcomes (g = 0.40-0.52) and instrumental ADL (g == 0.42), and a large effect size on HRQoL (g = 0.72). The quality of evidence was rated moderate to low for the outcome measures in pre-ageing and older adults with NCDs. These findings highlight the importance of PCDT interventions in preventing and slowing down cognitive impairment in pre-ageing and older adults.Registration: PROSPERO Number (CRD42020213962)     

Corrigendum to ‘Tangible dynamic changes in resilience,nutrition, and leisure activity of older patients with cardiovascular disease and possible sarcopenia: A longitudinal study’ [Archives of Gerontology and Geriatrics AGG,Volume 91, July-August 2021, 104416]

Aim and objectivesThe purpose of this study was to explore the inter-relationships among resilience, nutrition, and leisure activity of older patients with cardiovascular disease and possible sarcopenia. Besides, the patterns of these three variables over a long-term follow-up was examine.Material and MethodsQuantitative longitudinal study design was used in this study. Sarcopenia is related to aging, lack of physical activity, and malnutrition. Complex inter-relationships exist in patients with regards to their resilience, nutritional status, leisure activities. A generalized estimating equation (GEE) was used for long-term follow-up observations, and data were collected form one month (T1), three months (T2) and six months (T3). A demographic questionnaire and the Chinese versions of the Resilience Scale (CRS), the Mini-Nutritional Assessment (MNA), and the Leisure Time Activities Scale (LTAS), were used to collect data.ResultsA total of 267 eligible participants were enrolled in this study, of whom 53% were men and 47% were women. The interactions among resilience, nutrition, and leisure activity were reported. Resilience was positively correlated with nutrition. Higher resilience was developed higher participation in leisure activities was found in older adults with possible sarcopenia.ConclusionResilience is a key factor for greater participation in leisure activities. Health professionals should develop feasible resilience interventions that would enhance patient's participation in leisure activities. Nutritional consulting and physical activity interventions should be combined in the case of older adults to prevent the occurrence of possible sarcopenia.     

Comparison of the physical fitness levels in nursing home residents and community-dwelling older adults

PurposeThis study aimed to compare the physical fitness levels of nursing home residents and community-dwelling older adults.Materials and methodsThe 118 older adults aged between 65–85 living in a nursing home or community participated in the study. The Senior Fitness Test assessed the physical fitness levels of older adults. The older adults performed the chair stand test, arm curl test, 2-min step test, chair sit and reach test, back-scratch test, 8-foot up, and go test.ResultsThe age, cognitive status, gender, body weight, height, smoking, and education status were similar between the groups (p > 0.05). Aerobic endurance, balance, and agility were higher in nursing home residents than in the community-dwelling older adults (p < 0.05). Strength, flexibility, and BMI did not differ between groups ​​(p > 0.05).ConclusionAerobic endurance, balance, and agility may vary depending on the living environment of older adults. The determination of differences in physical fitness between community-dwelling older adults and nursing home residents could provide objective information to develop a physical activity program for older adults.     

Life-space mobility in older persons with cognitive impairment after discharge from geriatric rehabilitation

ObjectivesTo describe life-space mobility and identify its determinants in older persons with cognitive impairment after discharge from geriatric rehabilitation.MethodsA cross-sectional study in older community-dwelling persons with mild to moderate cognitive impairment (Mini-Mental State Examination, MMSE: 17–26) following geriatric rehabilitation was conducted. Life-space mobility (LSM) was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment (LSA-CI). Bivariate analyses and multivariate regression analyses were used to investigate associations between LSM and physical, cognitive, psychosocial, environmental, financial and demographic characteristics, and physical activity behavior.ResultsLSM in 118 older, multimorbid participants (age: 82.3 ± 6.0 years) with cognitive impairment (MMSE score: 23.3 ± 2.4 points) was substantially limited, depending on availability of personal support and equipment. More than 30% of participants were confined to the neighborhood and half of all patients could not leave the bedroom without equipment or assistance. Motor performance, social activities, physical activity, and gender were identified as independent determinants of LSM and explained 42.4% (adjusted R²) of the LSA-CI variance in the regression model.ConclusionThe study documents the highly restricted LSM in older persons with CI following geriatric rehabilitation. The identified modifiable determinants of LSM show potential for future interventions to increase LSM in such a vulnerable population at high risk for restrictions in LSM by targeting motor performance, social activities, and physical activity. A gender-specific approach may help to address more advanced restrictions in women.     

Parkinson's Disease: A Complete Guide for Patients and Families,by William J. Weiner,Lisa M. Shulman,and Anthony E. Lang

The study aims to evaluate the effects of a physical activity program and a cognitive training program on the long-term memory and selective attention of older adults by comparing the effects of the activities. Twenty-four older adults participated in a physical activity program, 24 in a cognitive training program, and 24 were considered the control group. The physical activity and the cognitive training had a significant effect on long-term memory but no difference between the interventions was found. Only the physical activity improved selective attention. Physical activity programs appear to be the most effective interventions in the promotion of older adults cognitive functions.     

Rural Older Adults’ Perspectives of Activities to Support Cognitive Health

ABSTRACT

Existing cognitive health literature focuses predominately on understanding the pathology and clinical treatment of older adults with dementia rather than cognitive health promotion and preventative activities. In addition, most of the work in the area remains urban-centric with little focus on cognitive health in rural communities. This study examined rural seniors’ perspectives of activities that they identified as supporting their cognitive health.

Using community-based research and an ethnographic methodology, participant observation and semi-structured interviews were conducted with 42 older adults in rural Saskatchewan, Canada. Participants discussed a variety of activities that they viewed as supporting their cognitive health. In particular, cognitive health promotion was identified as being strongly linked to keeping one’s brain active, thinking positively, mingling with others, and managing daily affairs. This study’s findings suggest that there is a need to move beyond focusing solely on clinical interventions to including older adults’ perspectives of preventative activities and cognitive health promotion.     

Personalized citizen assistance for social participation (APIC): A promising intervention for increasing mobility,accomplishment of social activities and frequency of leisure activities in older adults having disabilities

BackgroundSocial participation, a determinant of health in older adults, requires innovative interventions. The personalised citizen assistance for social participation (APIC) involves weekly three-hour personalised stimulation sessions targeting significant social and leisure activities difficult to accomplish. Recently adapted for older adults, the APIC’s impact on this population is unknown.ObjectiveThis study explored the impact of APIC on older adults with disabilities.MethodsA mixed-method design including a pre-experimental component was used with 16 participants (11 women) aged 66–91 (79.4 ± 8.7) with disabilities, living at home. They completed functional autonomy, social participation, leisure and quality of life questionnaires, and semi-structured interviews.ResultsAPIC increased older adults’ functional autonomy (p = 0.02), accomplishment (p < 0.01) and satisfaction (p = 0.02) with social participation, and frequency of leisure practice (p < 0.01). Post-intervention, participants wished to modify the practice (p < 0.01) and frequency (p < 0.01) of leisure activities, and difficulties in their social environment diminished (p = 0.03). Their attitude toward leisure (p = 0.04) as well as their health (p < 0.01) and psychological (p = 0.03) quality of life improved. Older adults thought APIC helped them resume, maintain, explore and experiment with significant social activities. It also increased their psychological and physical well-being, feeling of control, connectedness, self-esteem and motivation to accomplish activities. Finally, APIC can compensate for an unavailable and crumbling social network.ConclusionAPIC is a promising intervention that leads to new opportunities for older adults to increase community integration and enhance the social component of their lives. It can also optimise how the needs of older adults are met, including utilisation of personal and environmental resources.     

Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy with Older Adults: A Qualitative Review of Randomized Controlled Outcome Research

Objective: Many older adults cope with various chronic physical health conditions, and in some cases, with mental health and/or cognitive difficulties. Mindfulness-based interventions offer an evidence-based, mind-body complementary treatment approach for a wide range of comorbidities, yet most investigations were conducted with young or middle-aged adults. The purpose of this review was to identify randomized controlled trials (RCTs) of two leading mindfulness-based interventions conducted with older adults.

Methods: Our search of five databases identified seven RCT investigations of either Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT) conducted exclusively with older adults.

Results: Results generally supported the use of MBSR for chronic low back pain, chronic insomnia, improved sleep quality, enhanced positive affect, reduced symptoms of anxiety and depression, and improved memory and executive functioning. In a sample of older adults exhibiting elevated anxiety in the absence of elevated depression, MBCT effectively reduced symptoms of anxiety.

Conclusions: This review highlights the feasibility and possible benefits of MBSR and MBCT for older adults. Additional large scale RCTs conducted with older adults coping with the range of physical, behavioral, and cognitive challenges older adults commonly face still are needed.

Clinical Implications: MBSR may be a promising intervention for older adults experiencing a variety of health concerns and possibly even cognitive decline. MBCT may reduce geriatric anxiety, although its effects on geriatric depression were not measured.     

Physical activity and cognitive functioning in the oldest old: within- and between-person cognitive activity and psychosocial mediators

The current study examines the role of social contact intensity, cognitive activity, and depressive symptoms as within- and between-person mediators for the relationships between physical activity and cognitive functioning. All three types of mediators were considered simultaneously using multilevel structural equations modeling with longitudinal data. The sample consisted of 470 adults ranging from 79.37 to 97.92 years of age (M = 83.4; SD = 3.2) at the first occasion. Between-person differences in cognitive activity mediated the relationship between physical activity and cognitive functioning, such that individuals who participated in more physical activities, on average, engaged in more cognitive activities and, in turn, showed better cognitive functioning. Mediation of between-person associations between physical activity and memory through social contact intensity was also significant. At the within-person level, only cognitive activity mediated the relationship between physical activity and change in cognition; however, the indirect effect was small. Depressive symptomatology was not found to significantly mediate within- or between-person effects on cognitive change. Our findings highlight the implications of physical activity participation for the prevention of cognitive decline and the importance of meditational processes at the between-person level. Physical activity can provide older adults with an avenue to make new friendships and engage in more cognitive activities which, in turn, attenuates cognitive decline.