If you based your opinion on television commercials airing during the evening news, you’d be forgiven for concluding that the greatest problems facing older adults are easily managed by one or another medication. Weight loss, bladder control, sexual ability, COPD – all these and more are presented as the primary concern of an otherwise happy-looking senior. While voice-over disclaimers chronicle the medication’s possible side-effects and implore a conversation with one’s doctor prior to taking the miracle pill, the senior is depicted (presumably after having taken the medication in question) enjoying a live of fulfilling connectedness – playing with the family dog, snuggling with a life partner, practicing Tai Chi on a beach, attending a grandson’s baseball game, or navigating a restored convertible from one antique shop to another.
Medical providers are typically called upon to attend to these sorts of aging-related concerns. Often enough, a medication or therapeutic intervention is sufficient to get the concern under control. But a growing body of research is showing that family, social and community connectedness may play a larger role than previously thought in promoting and preserving the well-being of older adults. The inadvertent wisdom of the typical medication commercial turns out to be that seniors who’ve got a life partner or grandchild with whom to practice Tai Chi or cruise the coast in a classic car have much better health outcomes than those who simply take a pill.
Most patient’s lives don’t resemble those portrayed in an average medication commercial. Younger family members are often busy with their own lives. Spouses and peers may be facing their own medical complications. Still, it’s possible for almost all older adults to cultivate connected relationships. Here are three tools that work.
April was National Volunteer Month, and we explored some of the interesting statistics and trends in volunteerism in a prior post. In 2012, the Corporation for National and Community Service released “A Review of Recent Research (pdf),” a succinct two-page guide to the value of volunteering for seniors.
Among the reported findings were several encouraging notes about how seniors’ well-being and connectedness is improved through volunteer service.
A study of Americans over age 60 found that those who volunteer reported lower disability and higher levels of well-being relative to nonvolunteers. The effects of volunteering were found to be greater than other factors including income, education level, or marriage (Morrow-Howell et al., 2003). All of these studies were designed to control for factors associated with health, mortality, and disability.
These benefits flow to older adults regardless of demographics. Seniors at risk of isolation living in rural communities meet new people and stay more active than their peers who do not volunteer. One study even suggested that “the health benefits of volunteering are strongest among rural retirees, and those who do not drive or are limited drivers (Lee et al 2010).” With some communities working to fund small stipends to reimburse transportation expenses for volunteers living at a distance from the service site, the barriers to participation are slowly coming down.
But even seniors who live in nursing facilities can get involved. From making telephone calls to producing crafts to organizing other residents in the completion of meaningful tasks for local charities, there are many ways for seniors of every ability level to participate. The key is to take the first step and get involved – and this can be a challenge.
When facing new diagnoses, your older patients may resist adding another new routine to their lifestyle. So, don’t wait until they have a health concern. Encourage your healthy older and middle-aged patients to get involved in volunteering before they face aging-related decline. They’ll have better health outcomes, and provide a resource for other patients who need a way to build community connectedness.
A recent study discussed in the Journal of the American Medical Association asked seniors, “When you think of old persons, what are the first 5 words or phrases that come to mind?” Responses ran the gamut, from the “most negative [eg, decrepit] to … most positive [eg, spry].” After controlling for complications, the ten-year study found that, “older persons with positive age stereotypes were 44% more likely to fully recover from severe disability than those with negative age stereotypes.”
Many age-related stereotypes are related to physical decline. Terms such as decrepit, frail, fragile and slow all relate to negative perceptions about the physical abilities of seniors. The study above suggests that holding fast to negative age-related stereotypes puts seniors at a substantial disadvantage when attempting to recover from a physical or medical problem. Consequently, it’s crucial to help older patients see their peer group in a more positive frame. The best way to combat this is to help your patients get more physically active.
As with volunteerism, it’s easier to establish a routine of physical activity while relatively young and healthy. Group activities such as Tai Chi and yoga are adaptable to any physical ability level, and offer a social environment where older adults can feel a connectedness with their peers. Since rigorous physical activity often brings about a sense of euphoria, it’s not uncommon for strong friendships to form among participants in activities that stimulate such feelings. After all, people like being around people who make them feel their best.
In nursing homes, there are many ways boost the physical activity of residents. An editorial in the February 2014 issue of JAMDA noted the following:
Physical exercise can be enjoyable and improve outcomes in nursing home residents. It can enhance gait speed, decrease falls, decrease fear of falling, decrease dysphonia, improve cognition, decrease health service utilization, and slow the deterioration of functional decline. Exercise is particularly useful in preventing disability in persons with frailty and sarcopenia. Singh et al have shown remarkable effects of exercise on outcomes during rehabilitation for hip fracture. Both Mahjong and Tai Chi have been shown to maintain function in Hong Kong nursing homes. Restorative care, when the persons doing it are appropriately trained, can delay both functional and cognitive deterioration. Mental practice sessions between rehabilitation improves outcome in persons with stroke. Pedometers can be used to stimulate persons to increase their walking. Wii games are also useful. One nursing home has residents walking from unit to unit where they obtain signatures in a log book. After sufficient signatures are obtained, they are eligible for a prize. Virtual reality exercises with robot assisted intervention can also improve outcomes. This not only increases physical activity but forces social interaction with the nurses on each unit.
These types of activities serve not only to improve upon the physical condition of the participants, but also to help residents be social and connected with staff members and one another.