Exercise for Frail Older Adults
9.7 Promotion to Participation
Senior patient tends to become sedentary with age, as well as to progressively lose the will to perform physical exercise. Older people are frequently less motivated to improve their physical conditions and more interested in maintaining the residual abilities they possess. Therefore, they need to be encouraged by social workers, healthcare professionals, families, and friends. The most common barriers to partici- pation to physical activities are the economic cost, lack of time, physical limitations,
Fig. 9.8 Examples of coordination exercises: moving upper and lower limbs at the same time while walking
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and the frequent need to ask third parties for assistance to perform the exercises or to reach the gym. Social or communicative factors may also limit participation (e.g., the necessity to dress in a particular way or difficulties in verbal expression).
In order to encourage patient’s involvement, the exercise proposition should consist of low-cost activities, the training session should prove to be pleasant and funny, and the trainee should be often reassured of the safety and the harmlessness of the activity he is performing. Moreover, it would be better if the activity could become a moment of social sharing.
A significant factor related to the adhesion to an exercise program and its main- tenance in the long term is the increase of independence (self-efficacy). Self-efficacy is one’s belief he can succeed in doing specific tasks. It is therefore important for the trainee to perceive his improvement in performing exercises into a safe context and to be confirmed by the operator.
Another factor that favors the participation is witnessing how the activity is bringing positive results in relation to the predetermined goals: for example, on a functional level in the everyday activity, both in terms of quantity (being able to walk for longer) and in terms of quality (less fatigue in climbing the stairs), or even at a social level (new relationships created in the group activity).
When managing elderly patients, it is therefore essential to consider the pivotal role of the caregiver. He has a significant role in motivating older patients to continue physical activities. He plays a very important role in patient’s health, functionality, well-being, and quality of life. He also represents the crucial partner for seniors’
care, especially if frail, and in management of his life both inside and outside home.
According to the World Health Organization, the cooperation between the profes- sionals and the caregivers should be the base of the assistance to the elderly person.
In particular, many are so far the studies on the economic, social, and personal bur- den the caregiver and patient’s family have to bear for patient’s management. The main characteristics of the patient perceived as highly affecting the caregiver’s life are the risk of falls, depressive symptoms, and behavioral problems. It needs to be highlighted that the bigger the responsibility load (e.g., cohabitation, patient’s dis- ability, the presence of only one caregiver, etc.) for the caregiver, the higher the prob- abilities of patient’s frequent hospitalization or institutionalization are.
Assessing patient and level of autonomy is therefore not sufficient, as we have to consider the context where he lives, his personal characteristics, and if the persons who look after him are eager to collaborate. Helping the caregiver to understand the benefits of an exercise program for the patient, also in terms of reduction of the risk of falls and increase or support of his residual abilities, could prove a successful strategy [32].
Conclusions
Frailty is a very complex and impactful condition for an older adult. Early iden- tification of frailty conditions and pre-frail status is important to reduce adverse outcomes and premature mortality of older patient.
Although the best training program still remains unclear, international guide- lines highlighted the importance of reversing pre-frail and frail status, using a multimodal exercise approach, possibly in a fun and pleasant contest. Exercise
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interventions have many advantages: they can improve frail adult’s quality of life, balance, and mobility reduce the risk of institutionalization and hospitalization.
The caregiver is a very important figure in frail adult’s life and should be involved in the intervention, in order to facilitate patient’s participation and to reduce his own burden in caring the patient.
Acknowledgments Figures courtesy of Monteverde Filippo and Sette Beatrice, Liceo Artistico Selvatico, Padua, Italy.
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S. Masiero, U. Carraro (eds.), Rehabilitation Medicine for Elderly Patients, Practical Issues in Geriatrics, DOI 10.1007/978-3-319-57406-6_10 A. Musumeci (*) • L. Gobbo • S. Masiero
Neurorehabilitation Unit, Padua General Hospital, Padua, Italy
e-mail: [email protected]; [email protected]; [email protected] J.V. Papathanasiou
Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, Sofia, Bulgaria
Department of Medical Imaging, Allergology and Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
E. Lena • C. Assenza • C. Giordani • C. Foti
Clinical Medicine and Translational Medicine Department, Tor Vergata University, Rome, Italy