Maintaining Independence and Aging Well Through Exercise

Maintaining Independence and Aging Well Through Exercise

Developed by:  James Andrew Foster, II SPT
Thank you for visiting my DPT Capstone Site

 

Meeting a real need

The number of older adults 65+ years of age living in the US is rapidly increasing, topping roughly 41 million or an increase of almost 20% over the last decade.¹ The US Department of Health and Human Services projects this population to continue increasing to 79.7 million by the year 2040.¹ While numerous older adults 65+ years of age face significant physical and mental health problems, including chronic and degenerative diseases, research demonstrates that disability and decline are not inevitable results of aging.² The challenge exists to provide quality services and program interventions that promote adequate physical and mental strength and stability in order for adults to age well with dignity and independence within the confines of their own homes.

For older adults living in the greater Chapel Hill area and surrounding counties, the meaning of independence can be as diverse as the individuals themselves; but ultimately independence is the continuation of engaging in the activities and relationships that are important to them throughout life. Many older adults perceive aging and physical decline as a barrier to maintaining their independence in daily activities, however, it is essential for these individuals to recognize the significance of maintaining their decision making autonomy, exercising preferences and choices, and upholding social interactions and relationships for sustaining independence throughout the rest of life.

Thus beckons the need for this service project, which is modeled around an individualized-centered approach to aging well throughout the individual’s lifespan through the promotion of exercise and daily physical activity while additionally setting goals and sticking to a plan.

 

Overview

The development of this Capstone project stems from my keen interest in working with older adults. I have always enjoyed working on both ends of the spectrum, that being pediatrics and older adults. However, as a personal trainer and water aerobics instructor, the majority of my clientele was made up of older adults 65+ years of age. I am very passionate about working with this population because although I get the opportunity to help these individuals better their health, I feel at the same time they are always educating and helping me become a better person.

As an Eagle Scout I have been privileged with opportunities to work with older adults in the community who are less fortunate, underserved, and feeble shut-ins. During that time I was able to use the skills and knowledge gained through scouting to provide assistance to these individuals, through different service projects such as helping construct home and community/church modifications including building wheel-chair ramps for improved accessibility.

In order to stay true to the values I was taught when growing up, I wanted to continue using the new knowledge and skills I have gained in physical therapy school to provide a service that I feel will benefit older adults living in the community. In addition, I watched my grandparents’ healths deteriorate and they slowly lost their independence due to poor health choices and a lack of physical activity following retirement. I developed this Capstone to bring about awareness that aging throughout the life-span does not mean accepting the loss of independence and physical decline. However, these factors can be maintained by adhering to an individualized plan that is centered around physical activities the individual enjoys participating in on a daily basis.

 

The Project

I created a PowerPoint presentation that I will be presenting to the older-adult residents of Stratford House Retirement Home. In planning the presentation I incorporated ideas and knowledge gained from the evidence and research I found in EBP II while designing my critically appraised topic. My first evidence table (Effects of progressive resistance and balance training for preventing falls in older adults 65+ years-old) summarizes this research. After discussion with my advisor, Carol Giuliani, on incorporating new evidence, I decided to take an approach that focused on what it means to be independent and the effects exercise and developing a lifestyle of being physically active have on maintaining independence and good health throughout the life-span. I designed a second short evidence table summarizing this research (The quantity and quality of Exercise for maintaining good health).

Carol Giuliani helped to guide me in designing an appropriate and meaningful presentation for the residents of Carol Woods. Due to uncontrolled complications at this time, I am unable to present at Carol Woods, however, in the future I would like to share this information with the residents as a means to promote a healthier and independent lifestyle. I will now be presenting my presentation to the residents of the Stratford House Retirement Home located in Danville, Virginia. My committee member, Ricky Hollie, PTA, and his wife, Rhonda Hollie, staff member of the Stratford House, have graciously assisted me in setting up a day and time to present upon my return from the Guatemala service learning trip. Ricky and Rhonda have helped promote and advertise the topic of my presentation within the community center in order for the best audience turnout.

The presentation identifies background information highlighting the importance of what it means to live well and independent, the health consequences limited activity has on aging well, and the benefits an active lifestyle has on improving and maintaining strength, endurance, balance, and cognition as it relates to independence. I will also explain the importance of setting goals and how to design an individualized plan that not only revolves around physical activity but most importantly incorporates activities that the individual enjoys and wants to do. Throughout the presentation I will encourage audience interaction by questioning and asking for opinion and feedback on information presented. Lastly, I will provide some general exercise recommendations and guidelines to help my audience succeed with their plan.

I also will provide a 1-page written handout reiterating the main clarifiers and take home messages I want for my audience (The Secret of Healthy Aging-handout). Furthermore, I will provide pamphlets, which Carol Giuliani has supplied, with information on determining potential fall risks and a home safety check list, which are essential for maintaining independence and continued living at home.

To assure my written material and PowerPoint presentation were justifiably designed at a level that is appropriate for my older adult audience, I performed a review of presentation guidelines/health literacy assessment (Health Literacy-Foster).

 

Evaluation

Personal learning objectives/goals:

• Successfully develop an educational program for older adults to live independently by incorporating evidence on the effects of exercise for improving strength, endurance, balance, and cognition.
• Successfully communicate with the attending community dwelling older adults.
• Develop and provide handout materials that are easy to comprehend and effectively communicates exercises that community-dwelling older adults can perform in the comfort of their home to stay independent.

Presentation learning objectives/goals:

• Participants will be able to identify strategies to live well and independently.
• Participants will be able to identify the consequences of limited physical activity on aging well
• Participants will be able to understand the effects physical activity and exercises have on improving strength, endurance, balance, and cognition as it relates to maintaining independence.
• Participants will be able to design or choose an enjoyable program centered on regular physical activities to promote your ability to live at home.

Following the conclusion of my presentation I will provide my attending older adult audience with a survey that they use to evaluate my performance; providing any additional feedback that can be useful for modifying the presentation for future audiences (Evaluation form-Foster). Overall I feel that I have achieved my educational and presentation goals I introduced at the beginning of designing my Capstone.

 

Self-assessment           

Overall I enjoyed the process of designing my Capstone because I got to delve deeper into an area of practice that I am passionate about and have learned new ideas in communicating with my older-adult patients. The process has taught me a lot about myself in terms of setting deadlines and capably being able to achieve daily tasks in order to ultimately accomplish my overall goal. As I reflect over the process and all of the other tasks I had to juggle during the course of the semester, I am excited with my capability of facing and working through conflicts which I know have and will continue to help me grow as an individual and future clinician. In addition, all the information I have reviewed and countless meetings with Carol Giuliani have further fueled my desire to pursue working with older adults and continue educating my patients with the information I have learned in order to help them live a healthy and independent life as they age. I hope to continue improving upon this knowledge with new evidence as it comes to light so that I can continue to become a valuable autonomous physical therapist and further give back to the profession and individuals/families that I serve.

 

Acknowledgements

I would like to thank each one of my committee members: Carol Giuliani, PT, PhD, Karen McCulloch, PT, PhD, NSC and Ricky Hollie, PTA, for their input, support, and assistance on this journey developing and presenting my Capstone. I would like to give a special thank you to Karen McCulloch for meeting with me long before the semester began and guiding me in the right direction for success in focusing on an area I am passionate about, as well as connecting me with Carol Giuliani. I would also like to thank Karen McCulloch for her compassion and words of wisdom when times got a bit stressful and overwhelming. I would like to thank my advisor, Carol Giuliani, for accepting my numerous requests to meet and helping me create a clear plan for implementing and succeeding with my project. Thank you for all of your advice and help increasing my knowledge and communication skills when working with my older adult patients. I would like to thank Ricky Hollie and Rhonda Hollie for your feedback, providing a space for me to come in and present at the Stratford House, and advertising my presentation so that I could have an appropriate audience to present to. Lastly, I would like to thank my beautiful fiancé, Kelly Durdock, for helping with the construction and logistics of my project and being there for me every step of the way as I have worked through this journey.
 

References

1. A Profile of Older Americans: 2012. (n.d.). Retrieved April 13, 2016, from http://www.aoa.gov/Aging_Statistics/Profile/2012/docs/2012profile.pdf
2. Keeping the Aging Population Healthy. (n.d.). Retrieved April 13, 2016, from http://www.giaging.org/documents/CDC_Healthy_States_Initiative.pdf
3. The Voice of older people on . . . Independence. Retrieved January 26, 2016, from http://cotavic.org.au/wp-content/uploads/2011/02/Voice-of-older-people-on-Indpendence.pdf
4. Barker AL, Bird ML, Talevski J. Effect of pilates exercise for improving balance in older adults: a systematic review with meta-analysis. Arch Phys Med Rehabil. 2015 Apr;96(4):715-23. doi: 10.1016/j.apmr.2014.11.021. Epub 2014 Dec 12. Review. PubMed PMID: 25511371.
5. Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res. 2013 Apr;16(2):105-14. doi: 10.1089/rej.2012.1397. Review. PubMed PMID: 23327448; PubMed Central PMCID: PMC3634155.
6. Huang Y, Liu X. Improvement of balance control ability and flexibility in the elderly Tai Chi Chuan (TCC) practitioners: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2015 Mar-Apr;60(2):233-8. doi: 10.1016/j.archger.2014.10.016. Epub 2014 Nov 18. Review. PubMed PMID: 25497683.
7. de Vries NM, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Staal JB, Nijhuis-van der Sanden MW. Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: a meta-analysis. Ageing Res Rev. 2012 Jan;11(1):136-49. doi: 10.1016/j.arr.2011.11.002. Epub 2011 Nov 11. Review. PubMed PMID: 22101330.
8. Bean JF, Herman S, Kiely DK, Frey IC, Leveille SG, Fielding RA, Frontera WR. Increased Velocity Exercise Specific to Task (InVEST) training: a pilot study exploring effects on leg power, balance, and mobility in community-dwelling older women. J Am Geriatr Soc. 2004 May;52(5):799-804. PubMed PMID: 15086665.
9. Kang S, Hwang S, Klein AB, Kim SH. Multicomponent exercise for physical fitness of community-dwelling elderly women. J Phys Ther Sci. 2015 Mar;27(3):911-5. doi: 10.1589/jpts.27.911. Epub 2015 Mar 31. PubMed PMID: 25931757; PubMed Central PMCID: PMC4395741.
10. Valenzuela T. Efficacy of progressive resistance training interventions in older adults in nursing homes: a systematic review. J Am Med Dir Assoc. 2012 Jun;13(5):418-28. doi: 10.1016/j.jamda.2011.11.001. Epub 2011 Dec 14. Review. PubMed PMID: 22169509.
11. Orr R, Raymond J, Fiatarone Singh M. Efficacy of progressive resistance training on balance performance in older adults : a systematic review of randomized controlled trials. Sports Med. 2008;38(4):317-43. Review. PubMed PMID: 18348591.
12. Latham N, Anderson C, Bennett D, Stretton C. Progressive resistance strength training for physical disability in older people. Cochrane Database Syst Rev. 2003;(2):CD002759. Review. Update in: Cochrane Database Syst Rev. 2009;(3):CD002759. PubMed PMID: 12804434.
13. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012 Sep 12;9:CD007146. doi: 10.1002/14651858.CD007146.pub3. Review. PubMed PMID: 22972103

14. Qin L, Choy W, Leung K, Leung PC, Au S, Hung W, Dambacher M, Chan K. Beneficial effects of regular Tai Chi exercise on musculoskeletal system. J Bone Miner Metab. 2005;23(2):186-90. PubMed PMID: 15750699.
15. Why strength training? Retrieved February 07, 2016, from http://www.cdc.gov/physicalactivity/growingstronger/why/index.html
16. Physical Inactivity May Be as Deadly as Smoking. (as reported on WebMD) Retrieved February 11, 2016, from http://www.webmd.com/fitness-exercise/20120717/physical-inactivity-may-be-deadly-as-smoking
17. ACSM Releases New Exercise Guidelines. Retrieved March 13, 2016, from http://greatist.com/fitness/acsm-releases-new-exercise-guidelines
18. Elsawy B, Higgins KE. Physical activity guidelines for older adults. Am Fam Physician. 2010 Jan 1;81(1):55-9. PubMed PMID: 20052963.
19. Centers for Disease Control and Prevention (CDC). Adult participation in recommended levels of physical activity–United States, 2001 and 2003. MMWR Morb Mortal Wkly Rep. 2005 Dec 2;54(47):1208-12. PubMed PMID: 16319815.