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Increasing the Quality of Life (QoL) of residents in a Residential Home for the Elderly

Increasing the Quality of Life (QoL) of residents in a Residential Home for the Elderly

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15 May, 2017

Introduction

Improved quality of life (QoL) of the elderly in nursing homes is a desirable health outcome as it acts as a key determinant of the resident’s satisfaction with life and, by extension, their general health (Blackwell Publishing Ltd., 2007). The World Health Organization defines QoL as “individuals’ perceptions of their position in life in the context of the culture and value system in which they live in relationtheir goals, expectations, and standards” (n.p.). Nurses play a crucial role in elderly care by facilitating interventions aimed at increasing the quality of life for elderly patients in nursing homes. One of the health promotion activities that have been shown to increase the quality of life of elderly patients in nursing homes is physical activities. Chase (2013) has identified physical activity as a vital component in managing chronic illnesses among the elderly globally. According to a study conducted by Piedras-Jorge, Meléndez-Moral, and Tomás-Miguel (2010), the implementation of a physical activity program among elderly residents in two nursing homes was associated with positive effects on the functional, psychological, and physical aspects of the residents’ lives. To this end, this essay seeks to plan, implement, document, and evaluate a physical activity program aimed at elderly patients who are residents of a nursing home. 

Planning

There is strong evidence in existing literature to support the claim that physical activity, and more so exercise, plays a key role in reducing the risk factors for various chronic conditions among the elderly, including hypertension, stroke, type 2 diabetes, coronary heart disease, and osteoporosis, among others (Taylor, 2014). Some of the benefits associated with engagement in physical activity among the elderly in nursing homes include delayed functional loss and maintenance of independence, social interaction, positive mental health promotion, and a reduction in the use of health care (Piedras-Jorge et al., 2014). Creating awareness and communicating these various benefits to the residents of nursing homes is a key health promotion initiative. As an auxiliary nurse working with this group of people, it is important to develop effective communication strategies that entail the use of peer success stories or role models. There is also a also a need  to identify the barriers faced by the target population in getting and staying active, in addition to establishing solutions to such barriers (Reinhard and Stone, 2001). 

There are four determinants of physical activity among the elderly, including social determinants, personal factors, environmental factors, and regimen- or programme-based factors. Personal factors may include illnesses or reduced mobility, while social determinants might include a perception that older people should not engage in exercise (Taylor, 2014). On the other hand, regimen- or programme-based factors involve the nature and severity of the exercise programme planned, while environmental factors might include the availability of facilities such as space to exercise. The auxiliary nurse can play a key role in demystifying the perception that the elderly may not partake in exercise while also trying to tailor the exercise programme to suit the fitness level of the individual residents (Jansen et al., 2014). 

In designing or planning a physical activity intervention for the elderly, it is important to take into account the individual in question as well as how he or she interacts with the social environment. Therefore, the intensity, duration, and frequency of the programme ought to be suitable for the target group. Assessment of the individual entails factors impacting mobility, including nutritional status, pain, medical conditions, environment, motivation, stability of condition, and mental health (Jansen et al., 2014). 

Collaboration between the auxiliary nurse and other professional peers in the nursing home is also essential in undertaking a detailed evaluation of the individual needs of the residents before promoting physical activity or embarking on a detailed exercise regimen (Chase, 2013). This is important in order to identify an individual’s ability to partake in the exercise program. Those who need assistance or mobility aids, and also to enable suitable referrals to such allied health professionals as occupational therapists or physiotherapists. The auxiliary nurse also needs to collaborate with all the individual family members, as a consistent approach has been shown to lead to the realisation of set goals. 

Implementing

In implementing physical activities among the elderly in nursing homes, the intensity and type of physical activity are some of the key parameters to consider. van Uffelen et al. (2008) have identified four types of physical activity, namely, strength, aerobic, balance, and flexibility exercise. One could also implement a combination of these four types of physical activities. Encouraging individuals to partake in both resistance training and aerobic-based exercise training is important as it promotes “brain health” and “physical health” (Liu-Ambrose and Donaldson, 2009). Ashworth et al. (2005) argue that it is important to pay special attention to how the activity programme has been designed and how the programme is introduced to patients in the nursing home, as this helps to raise the attrition rate. Residents of the nursing home will attend 2 group sessions per week over a period of 6 months, each lasting 1 hour. The sessions shall entail a warm-up period of 10 minutes, stretching, and mobility. Thereafter, residents will engage in moderate-intensity exercise while seated for a duration of 10 minutes. Thereafter, they will be taken through progressive resistance work for both the lower and upper limbs for 15 minutes. The exercise will also assist in their core stability. The next session shall be supported by balanced work lasting for 15 minutes as well. However, residents who cannot perform this workout even with support will perform seated adaptations instead. Finally, the session will end with adapted Tai Chi moves as a cooldown, lasting for 10 minutes. The auxiliary nurse will assist the class, along with two other members of staff, in carrying out these exercises. 

Documenting

For each of the individuals involved in the planned physical activities at the nursing home, the auxiliary nurse will make sure that they record their progress in the identified types of physical activities and if they have encountered any complications that may warrant the attention of other healthcare professionals. Documenting such information is essential in order to identify challenges encountered and develop strategies for overcoming them. 

Evaluating

At the end of the programme, it is necessary to evaluate its effect on the residents. First, the evaluation shall entail assessing whether the exercise has enabled participants to become more independent in terms of carrying out their everyday routines on their own, which is an indication of improved QoL. It will also assess whether the residents’ functionality has improved since the start of the intervention, such as the ability to stand or move unaided or with minimal assistance. It is also important to explore the success of the exercise programme in boosting the confidence of participants. Increased control over one’s body and improved functionality have been shown to increase the happiness and joy of the elderly taking part in exercise. 

Conclusion

Improved QoL is a desirable health outcome for all, including the elderly in nursing homes. One way of achieving this is by developing an exercise programme to improve the physical activity of residents. Physical activities are associated with improved functional, psychological, and physical aspects of the lives of the elderly. Before implementing such a programme, it is important to consider the type and intensity of the exercise programme and the ability of residents to cope with it. Documenting the activities also aids in identifying challenges encountered, while evaluation is useful in identifying whether the intervention has been a success or not.

References

Ashworth, N.L., Chad, K.E., Harrison, E.L., Reeder, B.A. and Marshall, S.C., 2005. Home versus center based physical activity programs in older adults. Cochrane Library. [On.ine.] Available from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004017.pub2/abstract [Accessed 14 May 2017]. 

Liu-Ambrose, T., and Donaldson, M.G., 2009. Exercise and cognition in older adults: is there a role for resistance training programmes? Br J Sports Med., 43(1), 25-7.

Jansen, C.P., Claßen, K., Hauer, K., Diegelmann, M., and Wahl, H.W., 2014. Assessing the effect of a physical activity intervention in a nursing home ecology: a natural lab approach. BMC Geriatrics. [Online]. Available from https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-14-117 [Accessed 14 May 2017]. 

Chase, J.D., 2013. Physical Activity Interventions Among Older Adults: A Literature Review. Res Theory Nurs Pract., 27(1), 53-80.

Piedras-Jorge, C., Meléndez-Moral, J.C., and Tomás-Miguel, J.M., 2010. Benefits of physical activity in nursing home residents. Rev Esp Geriatr Gerontol., 45(3),131-5.

Reinhard, S., and Stone, R., 2001. Promoting quality in nursing homes: the wellspring model. [Online]. Available from http://www.commonwealthfund.org/usr_doc/reinhard_wellspring_432.pdf [Accessed 16 May 2017].

Taylor, D., 2014. Physical activity is medicine for older adults. BMJ, 90(1059), 26-32. 

Blackwell Publishing Ltd.. “Exercise In Elderly Improves Quality Of Life.” ScienceDaily. [Online]. Available from  www.sciencedaily.com/releases/2007/07/070705123157.htm. [Accessed 15 May 2017]. 

van Uffelen, J.G., Chin, A Paw, M.J., Hopman-Rock, M., and van Mechelen, W., 2008. The effects of exercise on cognition in older adults with and without cognitive decline: a systematic review. Clin J Sport Med., 18(6), 486-500.

World Health Organization. 2017. WHOQOL: Measuring Quality of Life. [Online]. Available from http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/  [Accessed 15 May 2017]. 

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