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Key Factors in Caring for the Elderly

The elderly population is a large part of society both statistically and sociologically. People aged 65 and older are projected to make up 27% of the Canadian population by the year 2056.^[1] With this dramatic increase, it is important for the public to be aware of elderly people’s individual needs. Research has shown that social support and interactions are proven to benefit elderly individuals in terms of their overall health and well-being.^{[2][3][4][5][6]} It would be beneficial to those caring for elderly individuals to consider the following aspects of social activity in order to realize its importance in their lives.

When social support is established, it is then easier for an individual to increase an elders mental activity, which positively benefits overall health. In addition, just as mental health can be mediated by an elder's emotional and social suppport networks, keeping an elder physically active is essnetial in promotiong healthy mental activity.

As the World Health Organization states: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." ^[7]

Social Support and Its Benefits for Elderly Individuals

Types of Social Relationships

Parent-Child

An adult child caregiver can provide emotional support for their parent as well as encourage them to seek medical advice/utilize health services.

The relationship an elderly person has with their adult child can be vastly different from their relationship with a friend or acquaintance. In a recent study it was found adult children that provide support for their elderly parents often feel a sense of personal obligation to take care of their parents.^[6] This could be explained by the idea of reciprocity, meaning the adult child would want to show appreciation of their upbringing by caring for their parents in return.^[6] However, the most beneficial relationship was found when the elderly individual provided some kind of minor favours, such as childcare or cleaning, in return to the child’s assistance.^[6] By providing a balance in the parent-child relationship, it was shown that the elderly and the adult child caring for them were most satisfied.^[6]

Partner/Spouse

Having a partner or spouse living with an elderly person provides constant social support that can contribute to better well-being if the relationship is strong. In one study it was demonstrated how even if an individual become the primary caregiver for their spouse, perhaps with illness, the relationship is actually less likely to become strained in comparison to an adult child becoming the caregiver.^[2]

Friends and Community Involvement

Although elderly friends and acquaintances may not have relationships as intimate as those between parent and child or partner, they still show great importance to social support. Studies have shown that elderly men without a confidant, or someone they could talk to about various problems, were less likely to seek consultation for depression. ^[5] This kind of emotional support is an integral part of seeking help for the elderly. It is also consistent with the idea that individuals with high social support are more likely to utilize health services.^[5] In the same study it was found that depressed elderly individuals in urban areas sought consultation more frequently than those in rural areas.^[5] The lack of social support associated with living in a more isolated area can greatly impact older people and their ability to take care of themselves and can cause loneliness or feelings of inadequacy.^[3]

This video, sponsored by Friends of the Elderly, examines real-life cases of elderly individuals that have become socially isolated due to health problems or lack of resources. It shows how these individuals can benefit dramatically from simple activities such as going to the hairdresser. Most of all, this video demonstrates how the younger generation can help by simply volunteering to spend a few hours of their time with elderly people that otherwise may not have close family or other social relationships.

Social Support and Mortality

According to recent research, elderly individuals that have very little social support are more likely to die earlier than those who have a wide variety of relationships, networks, and community involvement.^[4] In a particular study, people over the age of 65 were assessed for overall social support based on their networks, relationships, and economic assistance and then asked to participate in an annual followup for 12 years.^[4] It was found that probability of survival for people with low social support was the lowest and continued to decrease every year when compared to those medium and high social support.^[4] This emphasizes the idea that having very little social connections such as family and friends can deeply impact the length of an elderly person’s lifespan. Even activities such as going to the theatre, volunteering, and having quick conversations with a neighbor are taken into account when determining social support, further implicating their importance.^[4] In this study it was noted that only 29.5% of the elderly individuals with low social support were still alive at the end of the 12-year followup compared to 54.5% of the high social support group.^[4] This suggests that low social support can also be a predictor for mortality in the elderly, which could be further explained by lack of resources, mental health, and low morale or loneliness. ^[4][5][3]

Benefits of Keeping Elderly Mentally Active

As a caregiver for an elderly adult, it is important to be aware of age related diseases which affect memory, like dementia. Dementia is a very prevalent disease and is still not fully understood but we do know that it does have links to genetics, heart health, brain injuries, HIV, Vitamin B12 deficiency, and an individual’s lifestyle (smoking/drug use).^{[8] [9]} So far there is no absolute cure for dementia, but we do have treatments we can use to help reduce the risks or delay the development of dementia.

Keeping a Cognitively Stimulating/Enriched Environment

A cognitively stimulating or enriched environment would be an environment which would keep your brain actively thinking.^[10] With a cognitively stimulating environment we can reduce the effects of dementia. As a caregiver for an elderly individual it is important to keep an elderly adult engage in preventive treatment for dementia. Activities which help to create an enriched environment are commonly referred to cognitive leisure activities. Here is a list of activities which help to keep the brain active and reduce the risk of dementia:

• Reading
• Crossword puzzles
• Playing a musical instrument
• Woodworking/home repairs
• Playing cards/board games
• Knitting
• Learning something new (language, musical instrument ect.)^[11]

Reading can be relaxing and mentally stimulating

Knitting it can also be a social activity

Musical instruments are very mentally stimulating and fun

Woodworking is both physically and mentally active

Why Should We Keep Elderly People Mentally Active?

Research has shown that cognitive leisure activities, like reading, card games, crosswords, and other mentally stimulating puzzles, have been linked to helping delay dementia.^[11] By keeping elderly engaged in cognitive leisure activities it stimulates their brain activity which is how it helps to reduce their risks for dementia.^[9] These activities give the best results when they occur within mid-life to late-life of an individual and continue throughout their life.^[11] Constant cognitive stimulation is important for the prevention of dementia.^[11] Another benefit of keeping an individual participating in cognitively stimulating activities other than it's ability to reduce the risk of developing dementia, it also does not have any negative symptoms for the individual.^[11] Keeping elderly people cognitively active has been a topic in research for some time now and has plenty of studies to help support the benefits which have been associated with it.^[10]

How You Can Make a Difference

These activities can be very easy to engage in as well. Find something they are interested in and help them keep mentally active. Make it something you can do together and make it fun. The more you can do the better. It could be anything from reading their favorite books, doing a crossword to woodwork/home repairs, playing cards or knitting. Any activity which keeps them having to think and use their mind is good for their mental health and can help reduce the risk of dementia.^[9] Just like the old saying says, "if you don’t use it you lose it." So as a caregiver, work with your elderly adults and keep them using their mind and you can help them reduce their risk for developing a form of dementia.^[9] Now with keeping this in mind it is also highly beneficial to keep an elderly individual physically active to help promote all round health. --

The Effects of Physical Activity on Mental Health in Elderly People

What is Physical Activity (PA)?

There are several ways to enhance the physical and mental health of an aging elder, and one important influential factor is physical activity (PA). Scientific researchers have defined PA as consisting of: walking, skiing, yard work (specifically gardening), jogging, cycling, climbing flights of stairs, steps per day, ballroom dancing, sports, and other recreational activities.^{[12][13][14][15][16][17]} In order to assess the effects of PA on mental health in the elderly population, PA was typically measured in terms of how many days a week a person exercised, how much time was spent exercising, and whether the exercise elicited low, moderate, or high levels of energy.

brisk walking!

Gardening can be mentally and physically stimulating!

join an exercise class for social support!

aquafit!

How might PA improve cognitive functioning?

A study showed that there are four specific ways PA may increase cognition:^[15]

1. PA may promote improved blood flow through the brain and decrease a persons risk of cognitive impairment
2. PA may increase and improve overall brain structure and serve as a protective factor against brain damage
3. PA may decrease the production of stress hormones (i.e., cortisol) harmful to the brain
4. PA increases the likelihood of social interaction which tends to stimulate increased brain functioning

Which Types of PA have been most effective?

The types of PA measured in the studies are certainly practiced by many elders, but there are four recommended types of PA that have a significant positive effect on overall health: endurance activities, strengthening exercises, stretching exercises, and balance exercises. For more information on these exercises, and ways you can get started at home: exercises for the elderly Furthermore, research has suggested an exercise prescription that is important to implement in the life of an elder; this includes aerobic or cardio induced activities, exercises targeting strength, and exercises that promote healthy levels of balance and flexibility^[18] It is highly recommended that persons interested in more thorough information on each type of exercise within the exercise prescription to locate the following research article: (Nied, R., & Franklin, B. (2002). Promoting and prescribing exercise for the elderly. American Family Physician, 65(3), 419-426)

What are the benefits of PA?

Maintaining quality of mental health in the elderly is important as it tends to predict lifestyle choices (i.e., exercise)^[17]. Research has shown that as the amount or frequency of PA increases, overall mental health typically increases^{[12][13][14][15][16][17]}. As an elder ages, their risk of contracting a detrimental immune system illnesses such as pneumonia or influenza, increases^[16]. A research study measured the production of saliva before and after a 20 minute, low level workout in elderly people over the age of 75. They found that a moderate level of PA was found to stimulate a protective mucus barrier associated with the immune system that serves as a protective agent against viruses; it appears that the protective mucus barrier is most effective prior to working out when the body is in a resting state. In contrast, they found that intense levels of exercise seem to have negative effects on the overall immune system. They concluded that a moderate level of PA is more effective in producing a stronger functioning immune system in the elderly population^[16].

Mental health threats also tend to increase with age, and one serious mental health disease that has been increasing within the elderly population is dementia (Alzheimer’s Disease (AD) and Vascular dementia (VaD)). A study found that individuals who engaged in a minimum of four types of PA within a 2-week period were more likely to decrease their risk of dementia than individuals who only engaged in 1 type. These effects were consistent at a 10-year follow-up^[13]. Similarly, elderly people who engaged in intense exercise on a regular basis were less likely to show evidence of cognitive decline, and this effect was maintained at 5-year follow-up^[14]. A moderate level of exercise (e.g., brisk walking) and overall participation in PA was linked to a lower risk of VaD and AD^[14][15]. A possible explanation for this relationship could be that an elderly person with better cognitive health is more likely to participate in physical activity; however, results indicated that a moderate level of exercise decreased the risk of developing dementia ^[13]. Finally, by staying physically and mentally active, an aging elder is more likely to avoid serious illnesses that may result in mortality. A study found that any type and amount of PA decreases an elder’s likelihood of developing cardiovascular disease and minimizes all-cause mortality risk^[12]. An elders life expectancy is likely to increase as both mental and physical health are maintained with regular PA^[13][15].

This video provides further insight into the importance of PA in reducing cognitive impairment(i.e., dementia) in the elderly. It outlines the signs and symptoms associated with dementia, and provides scientific evidence that supports the positive relationship between PA and mental health.

--Sz08to 13:01, 21 November 2011 (EST) --Kf08tu 13:06, 21 November 2011 (EST) --Ns06rt 13:02, 21 November 2011 (EST)

Notes and References

1. ↑ Statistics Canada. (2008). Seniors. Retrieved from http://www41.statcan.ca/2008/70000/ceb70000_000-eng.htm
2. ↑ ^{2.0 2.1} Deimling, G. T., Bass, D. M., Townsend, A. L., & Noelker, L. S. (1989). Care-related stress: A comparison of spouse and adult-child caregivers in shared and separate households. Journal of Aging and Health, 1(1), 67.
3. ↑ ^{3.0 3.1 3.2} Loke, S. C., Abdullah, S. S., Chai, S. T., Hamid, T. A., & Yahaya, N. (2011). Assessment of factors influencing morale in the elderly. PLoS ONE, 6(1)
4. ↑ ^{4.0 4.1 4.2 4.3 4.4 4.5 4.6} Mazzella, F., Cacciatore, F., Galizia, G., Della-Morte, D., Rossetti, M., Abbruzzese, R., . . .(2010). Social support and long-term mortality in the elderly: Role of comorbidity. Archives of Gerontology and Geriatrics, 51(3), 323.
5. ↑ ^{5.0 5.1 5.2 5.3 5.4} Mechakra-Tahiri, S., Zunzunegui, M. V., Dubé, M., & Préville, M. (2011). Associations of social relationships with consultation for symptoms of depression: A community study of depression in older men and women in Québec. Psychological Reports, 108(2), 537-552.
6. ↑ ^{6.0 6.1 6.2 6.3 6.4} Stuifbergen, M. C., Dykstra, P. A., Lanting, K. N., & van Delden, J.M. (2010). Autonomy in an ascribed relationship: The case of adult children and elderly parents. Journal of Aging Studies, 24(4), 257.
7. ↑ World Health Organization. (2010). Mental Health: stengthening our repsonse. Retrieved from http://www.who.int/mediacentre/factsheets/fs220/en/
8. ↑ Srikanth, S., & Nagaraja A. V., (2005). A prospective study of reversible dementias: frequency, causes, clinical profile and results of treatment. Neurology India,53(3),291-294.
9. ↑ ^{9.0 9.1 9.2 9.3} Jorm, A. F., (1994). Disability in dementia: assessment, prevention, and rehabilitation. Disability and Rehabilatation, 16(3), 98-109.
10. ↑ ^{10.0 10.1} Daffner, K. R., (2010). promoting successful cognitive aging: a comprehensive review. Journal of Alzheimer’s Disease, 19, 1101-1122.
11. ↑ ^{11.0 11.1 11.2 11.3 11.4} Munn, Z., & Stern, C., (2010). Cognitive leisure activities and their role in preventing dementia: a systematic review. Journal Compilation, 8, 2-17.
12. ↑ ^{12.0 12.1 12.2} Sundquist, K., Qvist, J., Sundquist, J., & Johansson, S-E. (2004). Frequent and occassional physical actvity in the elderly: A 12-year follow-up study of mortality. American Journal of Preventive Medicine, 27(1), 22-27.
13. ↑ ^{13.0 13.1 13.2 13.3 13.4} Jedrziewski, M. K., Ewbank, D. C., Wang, H., & Trojanowski, J. Q. (2004. Exercise and cognition: Results from the national long term care survey. Alzheimer's & Dementia, 6, 448-455.
14. ↑ ^{14.0 14.1 14.2 14.3} Laurin, D., Verreault, R., Lindsay, J., MacPherson, K., & Rockwood, K. (2001). Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol, 58, 498-504.
15. ↑ ^{15.0 15.1 15.2 15.3 15.4} Ravaglia, G., Forti, P., Luciesare, A., Pisacane, N., Rietti, E., Bianchin, M., & Dalmonte, E. (2008). Physical activity and dementia risk in elderly persons. Neurology, 70(1), 1786-1794.
16. ↑ ^{16.0 16.1 16.2 16.3} Sakamoto, Y., Ueki, S., Kasai, T., Takato, J., Shimanuki, H., Honda, H., Ito, T., & Haga, H. (2009). Effect of exercise, again and functional capacity on acute secretory immunogobulin A response in elderly people over 75 years of age. Geriatrics & Gerontology International, 9, 81-88.
17. ↑ ^{17.0 17.1 17.2} Parker, S. J., Strath. S. J., & Swartz, A. M. (2008). Physical activity measurement in older adults: Relationships with mental health. J Aging Phys Act, 16(4), 369-380.
18. ↑ Nied, R. J., & Franklin, B. (2002). Promoting and prescribing exercise for the elderly. American Family Physician, 65(3), 419-426.