With the conclusion of the Summer Olympics last month, there is an opportunity to reflect on the accomplishments and physical prowess of the athletes who competed. Sports and wellness are important for the human body especially given the decreasing participation rates in physical activity and increasing rates of chronic disease worldwide.
While the benefits of regular participation in physical activity on both physical and mental health have been widely established, participation rates remain low among older adults. It has been shown that participation in organized sports typically peaks in early adulthood and steadily decreases as a person ages. In addition, when viewed in light of gender, men typically report higher levels of participation in sport compared to women, regardless of age.
In Australia, the participation rate in organized sports among older adults is estimated at around 6.8 percent for males aged 55 to 64 and 8.9 percent among females 55-64. Among men 65 and older, participation in sport is estimated around 9.1 percent for men and 8.9 percent for women. Though rates are low, the benefits of regular participation in sports for older adults have been identified. In a 2012 cohort study, it was shown that older adults who participated in popular organized sports experienced a 20-40 percent reduction in all-cause mortality compared with older adults who did not participate in sports. Social benefits of participation in organized sports also include decreased feelings of isolation and reports of stronger support systems, two important contributors to quality of life in older adults.
The benefits of participation in organized sports are many, however, it is important to address potential barriers that might prevent an older adult from getting involved. While one third of older adults who report they are physically active are participating in organized sports in some form, older adults who are not commonly report lack of time, lack of opportunity, and physical limitations as reasons why they do not. It has been acknowledged within Australia that creating more opportunities for older adults to participate in organized sports through targeted programming should be a priority.
There is an opportunity to engage older adults both physically and socially through organized sports. Perceived barriers should be addressed to make physical activity through organized sports accessible to older adults.
Diana Kingsbury is a doctoral student and Graduate Assistant in Prevention Science at Kent State University College of Public Health.
Old age homes are no longer a taboo! The waiting lists of nursing homes in Korea are at three times their capacity and the number of elder care homes in Nanjing, China has increased from 27 in 1990 and 52 in 2000 to 148 in 2009!
In Asia, people are seeing a shift in the traditional roles for elderly care. Changes in family structure, urbanization, and other factors of contemporary lifestyles often compel older members to seek care outside of the family. Elderly residential facilities, such as old age homes, retirement villages, and other forms of institutionalized care for the elderly, have become increasingly popular in Asia. Given the high demand for such facilities, there is a need to monitor its growth and the quality of care provided.
Thailand, Malaysia, and Sri Lanka are among the Asian countries that offer renewable visas to older expatriates. Private companies and developers in India and Malaysia are investing in senior citizen villages and assisted living infrastructure such as temples, spas and golf courses to attract the wealthy older population. There are some financially well-off older adults who choose to retire in such elderly villages. However, not many can afford this kind of lifestyle.
Two cross-sectional studies from India surveyed elderly residents of old-age homes to understand their reasons for opting to live in one. It is interesting to note that poor health was not cited as a reason explicitly. The cross-sectional study in Madhya Pradesh, India reported that the top reasons for the elderly to opt for old age homes are because there was no one to look after them (68.2 percent), they did not have a place to live (56.4 percent) and to meet like-minded people (53.8 percent). The other cross-sectional study in Uttar Pradesh, India found that the two most common reasons were misbehavior by son and/or daughter-in-law (29.8 percent) and poverty (29.3 percent). This survey data hints that moving to an old age home was more a necessity than a voluntary life choice.
In addition to lifestyle changes, the surge in dementia and other health conditions among the elderly is driving the need for high quality care. Caring for such long-term conditions places huge emotional, physical and financial burdens on families. For instance, the symptoms of dementia can include hallucinations and depression which require swift and expert medical care. Many institutions are hence better able and equipped to provide timely care and rehabilitation.
Asian countries can learn a lot from studying trends in elderly residential facilities in developed nations of the Western world. A study in the UK reported that the overall standard of care in both nursing and residential homes was highly deficient when judging against quality indicators. This study serves as a warning to the rapidly aging countries in Asia: Provide adequate regulation to ensure a high standard of quality care in elderly residential facilities.
Namratha Rao recently graduated with a MSPH in Social and Behavioral Interventions from the Johns Hopkins University Bloomberg School of Public Health.
The McMaster Health Forum, with support from the Labarge Optimal Aging Initiative, recently hosted a public talk to examine the latest research and evidence into risks, prevention and treatment of Alzheimer’s disease. This talk featured presentations by Jay Ingram, one of Canada’s best-known and most popular science personalities, and Dr. Christopher Patterson, an expert on the diagnosis and treatment of dementia.
“My experience is that when you talk to people about Alzheimer’s, they have three questions,” said Ingram. “The first one is always ‘am I going to get it?’ The second is ‘If it looks like I’m likely to get it, what can I do to lower that risk?’ And the third question is ‘if that doesn’t work and I do get it, what are the prospects?’”
Will I get Alzheimer’s?
Early-onset familial Alzheimer’s
“There are two kinds of Alzheimer’s disease – early onset familial Alzheimer’s, which you inherit and is a dominant gene. If you had a parent with this kind of Alzheimer’s, you have a 50/50 chance of getting it yourself,” said Ingram.
But, he cautioned, “That’s so not the norm. There’s really only three genes that have been absolutely identified as early onset familial genes. They represent something less than 1% of all Alzheimer’s.”
Also, not every case of early-onset Alzheimer’s is genetic.
“Yes, there’s a risk but it’s a very tiny risk. For the most part, I think you could set that aside,” said Ingram.
“There’s really only one gene that has been unambiguously associated with late-onset Alzheimer’s (that is 65-70 years old and older),” said Ingram. “It comes in three varieties. One is bad, one is neutral and one is actually beneficial.”
“Let’s say, worst case scenario, I’m carrying two copies of the bad gene called APOE4. The most pessimistic of studies would say that that my risk is now 15-fold greater than it would have been. So you might think I’m terrified, but there are some other facts to consider. About half of the people who have the two bad genes never get Alzheimer’s. Plus, a good percentage doesn’t have those genes and do get it.”
“As far as late-onset, it’s so ambiguous for my money, it’s not worth worrying about.”
What can I do to prevent Alzheimer’s?
“There’s this whole constellation of effects, but when you put them together, I think they boil down to some pretty commonsense things,” said Ingram. “Exercise, watch your weight, watch your blood pressure, engage socially and keep your mind active. These are all sort of commonsense things that one should do in life.”
“Education has been shown to be clearly related to your risk of dementia. The further you go in school, the less likely you are to become demented,” said Ingram. “If you continue on in what is defined as a mentally stimulating job, you’re also better off.”
The single most important thing that older adults can do to prevent dementia is to walk 35 or 40 minutes a day.
“Exercise. Why is that important? Cardiovascular health, the health of your circulatory system and, maybe most importantly, your blood pressure are all risk factors, if they’re in decline, for Alzheimer’s disease,” said Ingram.
“There have been studies that show that it’s not even the kind of activities you do, its the number of them that you engage in and the number of people with whom you engage,” said Ingram.
There is good epidemiological evidence that people who adhere to a Mediterranean-type diet are least likely to develop Alzheimer’s.
People who watch a lot of TV are more likely to become demented.
Obesity and diabetes are risk factors for Alzheimer’s
Does having diabetes increase the risk for Alzheimer’s disease?
“If you have diabetes, your risk of developing dementia is about twice that compared to if you don’t have diabetes. Certainly, management of blood sugar is important. Whether that actually changes the progression of the disease, I don’t think we know but we would suspect that it would because appropriate management delays other vascular complications,” said Dr. Patterson.
Can cognitive exercises help improve brain function?
“The evidence for enhancing your memory by doing those memory exercises is not nearly as solid as the evidence for physical activity,” said Ingram.
“The evidence is that, in earlier stages of cognitive impairment, you see improvements in those domains in which you practice. If you do memory tests, it may not necessarily improve executive function,” said Dr. Patterson.
How does dementia impact the quality of life for caregivers?
Dr. Patterson commented that in a research project, in which he was involved, quality of life did not diminish in individuals over different stages of the disease whereas for caregivers it clearly did.
“While we talk about memory loss so much , the most disturbing change to families is not the memory loss but the change of mood or affect or personality. That’s where people feel they’ve lost the person,” added Ingram.
If I do get Alzheimer’s, what can I do about it?
“Understanding the disease and what’s going to happen to that person overtime is extremely important,” said Dr. Patterson. “Also, learning how to deal with some of the behaviors that may evolve as the disease progresses is by far the most important part of management of individuals with dementia.”
Dr. Patterson highlighted that it is important to recognize “that being a caregiver for an individual with dementia is extremely stressful.”
Case management is a way of supporting families through this journey.
“Of the whole management of individuals with dementia, medications really play the least part.”
“The single medication that is commonly prescribed these days, will stabilize cognition for 9-12 months,” said Ingram. “As the cells generating neurotransmitters die, to a degree, you can replace them chemically. But, the cells are still dying and eventually you can’t make it up chemically.”
Patients may be prescribed medications to help with other symptoms of the disease.
“In the future, there may be medications that can literally interrupt the sequence of the disease,” said Dr. Patterson.
“So what do we do in the meantime? We can do lots of things that make us healthier and happier people. We hope that with increasing general health, reduction of diabetes, and daily exercise slow down the obesity train. That may be, at least in the short-term, the most effective thing we can do,” said Ingram.
The rest of the summary is available here and the video below presents highlights from the event.
Steven Lott is the Senior Lead, Communications for the McMaster Health Forum. He leads the Forum’s communications initiatives including the dissemination of Forum products and information, coordination of public talks, social media engagement, media relations, and website management. Steven has worked with a variety of patient advocates, non-governmental organizations, think tanks, academics and other health system stakeholders in Canada, USA, South America, Europe and Africa to promote strategic health policies.
In honor of National Physical Therapy Month, Global Health Aging is presenting a weekly four-part article series on water aerobics. This is Part 1 in this series. Click here to read Part 2.
Welcome to the 21st century and a new American Healthcare System. The advent of the Affordable Care Act (ACA) and its gaining foothold of functional acceptance in America presents an interesting opportunity for citizens who are making a paradigm shift: movement from managed health care to managed self care. Who will be making this shift? Citizens are moving into a realm of do-it-yourself healthcare management through many fields of allied health.
One such allied healthcare service is becoming more commonly prescribed and sought after: Aquatic Therapy. National collegiate teams and professional franchises have led the way as it is most commonly used in sports medicine. Patrons in private and public clubs, especially non-profits like YMCAs, are blazing new trails in aquatic practices, catching up with other countries around the world.
Whether it is prescribed or not, many patrons now choose to seek services outside the coverage of their insurance. In the 21st century, aquatic exercise and therapies are steadily growing with the aging of the baby boomer population. The trend is growing more rapidly in younger populations where an overuse injury from a favorite sport may occur. The younger “weekend warriors” are aware of the conditioning and rehabilitative outcomes from employing aquatic exercise and therapies in support of their favorite sport.
In today’s aquatic marketplace, how can new patrons, of any generation or experience, determine what is desirable in an aquatic program, facility or instructor? The industry is so new that standardization in practice is far from being established and even farther from being commonly known or accepted. Insurance regulations governing those who may be reimbursed for services are sorely misaligned. This means that many aquatic therapy participants can get insurance coverage for “aquatic therapy” but it may not be the best available instruction and care.
Knowing this about the industry now, three questions come to mind: What do you look for in an aquatic facility or program? And thirdly, who or what kind of person with what skill-set or credentials is most important when becoming a patron of aquatic therapy?
Since university degree programs and licensing in physical therapy do not instruct or test students in this aquatic modality, aquatic patrons need be guarded in their pursuit of care. Water exercise can be performed anywhere between high impact and totally suspended, meaning no contact with the pool floor. This variance assures that there is some effective form of aquatic therapy for all ages, most types of injuries, and almost any physical condition a person may need to address. Even speech pathologists are gaining advancements through aquatic environments.
Water therapies can be passive or active. An active therapy is something the patron does in response to the therapist’s instruction and it may ultimately become an exercise. A passive therapy is a physical maneuver or manipulation that the therapist does to the patron’s trunk, limb or extremity. More often than not, passive therapies are practiced only by those aquatic professionals specifically trained in aquatic therapies. They may or may not hold a degree or license in physical therapy.
As the aquatic industry continues to evolve, it can very well become its own discipline in colleges. Presently, there needs to be a lot more work put toward the effort of standardizing practices, quantifying outcomes and modifying insurance coverages. This will allow certified professionals even without degrees in physical therapy to be compensated or reimbursed for their services.
When practitioners universally understand and consistently use the properties of water to their fullest potential, then best outcomes for patrons will emerge. Aquatic therapies will then become a first line application for preventative and restorative allied healthcare. For instance, physicians will prescribe pre-operative aquatic conditioning to keep the muscles, ligaments and tendons surrounding a surgical site as strong and healthy as possible. Doctors will also place post-op patients in water before commencing land- or weight-bearing exercises so that the supporting muscles, tendons and ligaments can begin moving sooner and speed the healing and recovery process from the surgery performed. The efficacy of aquatic therapy is growing exponentially, thanks to the wisdom of experience; once relegated to senior citizens. The positive experiences of seniors may now be shared by all ages with varying abilities and health constraints.
Felecia Fischell is an Aquatic Specialist with twenty-three years experience in aquatics. She leads aquatic classes and consults as an aquatic personal trainer and a swim instructor at the Franklin County Family YMCA in Virginia. Formerly the Founder of FunLife Aquatics Consulting in Maryland, Felecia presents at health fairs and has given aquatic presentations to high schools, Howard County Board of Education, Howard County General Hospital and Howard County Community College.