Publication Date

Fall 11-10-2021

Item Type

Text

Executive Summary

Background and Significance

According to Berridge et al. (2020), Covid-19 has created a “double pandemic.” In addition to the virus, significant declines in the physical and mental health of senior community members, the reduction in the management of chronic conditions, and social isolation due to pandemic protocols preventing community members to gather have created a health care crisis. Based on research by Bae et al. (2019) there is evidence that a multicomponent intervention that includes socialization, physical conditioning, and cognitive activities show an improvement in working memory and improved physical conditioning.

Problem and Purpose Statement

The inability to socially interact during Covid-19 has been reported as being a contributing factor to reduced quality of life, increased depression, and a reduction in physical activity (Lebrasseur et al., 2021). According to Nicholson (2012), social isolation creates a cascade of negative social and physical health outcomes that involve not just loneliness, but declining cognitive function, and frankly, de-conditioning of social abilities.

Hanson & Jones (2015) found that walking groups improve older adults' health, quality of life, and compliance with exercise programs. According to Zubala et al. (2017), safe, effective, and inclusive programs that include social support and enjoyable physical activity encourage long-term participation.

The purpose of this program is to initiate scheduled socialization events at the clinical site, culminating in a monthly event that combines physical activity and socialization that is within the activity level of the residents to reduce social isolation as well as improve physical conditioning.

Methods

Using Lewin’s Change Model, the project was organized in a way that would encourage a letting go, or unfreezing, of old patterns followed by a change period (Lewin, 1947). Finally, relearned replacement behavior would be the new normal. The unfreezing portion of our program included several weeks of socialization and involvement of the residents in the planning. The goal was to reduce individual resistance and build community ownership of the event and improve resident cognition. Residents provided feedback that indicates that they are currently in the change phase of the model with feedback that included a desire to replicate the program and make it a regular event. The refreezing process will occur as the community site takes up the mantle and continues to implement social exercise activities.

Using a survey, outcomes were measured only once after exposing the group of participants to the intervention. The objective was to evaluate if the residents were negatively or positively affected by the weekly scheduled social time and if they felt that they had benefited from combining social time with physical activity at the once-monthly exercise intervention. The survey was conducted via electronic format (Google Form). Participants were interviewed and answers were entered by hosts of the event. The survey utilized an evidence-based method to assess participants (Davis et al., 2018) and assessed quantitative data regarding completion of the course loop of walking as well as likelihood to participate again using a Likert scale model for quantitative analysis (Polit et al., 2017).

Results/Outcomes

The project was successfully implemented in a low-income senior housing facility and has provided important post-intervention assessment information for the development of sustainable social exercise programs. Results were measured by a single post-intervention survey. The total number of survey samples taken from participants was 17. In the survey results, 13 participants (81.3%) agreed that they completed the course loop, and 8 participants (47.1%) agreed that the course loop was enough exercise for the day. In terms of promoting social interaction, 9 participants (52.9%) either met at least one resident or interacted with another resident while they are in the course loop. Lastly, 16 participants (94.1%) overall agreed that they would participate in another Wednesday walk in the future. These percentages reveal that majority of participants successfully completed the exercise program while also socializing with other residents.

In the post-intervention survey, participant comments and suggestions include “make the walk longer,” “avoid going down the steep path,” “too many germs,” “I like to walk by myself,” “create groups to walk together would be better,” and “announcement was helpful.” This feedback will be considered when planning an additional walk in the future.

Limitations

Limitations included communication barriers with residents and site management. There were also language barriers that prevented residents from participating in the project. The cold weather was a big factor in the residents not wanting to participate or do additional laps around the walking course. Another limitation was that residents preferred to go to a location away from the clinical site. The nearby park was considered unsafe to have the event due to a large homeless population that had taken over the grounds, so the event occurred on clinical site grounds. After surveying some of the residents who couldn’t join the event, we found that those residents were not joining due to a schedule conflict where they were trying to do errands and were otherwise occupied.

Sustainability

Almost all necessary project tools were sourced from the community site, except for poster board, markers, and chalk for advertising. The outlined course for the walk remained on the site grounds. All refreshments, tables, and carafes involved in the event were donated by onsite dining facilities. Therefore, all costs associated with the event were under the $30 allocated budget. Due to the low cost, any replication of the event will have minimal fiscal impact on the organizer. According to the post-test survey administered to staff on site, the staff agreed the walk was successful and made an impact on the community. Additionally, an outline of project interventions, methods for data collection, and sourcing of tools were provided to the community site if replication is desired. Advertising and communication with residents regarding the event were done through previously existing methods of communication in the community: monthly newsletter, morning announcements via PA system, event flyers, and large poster boards. The event activity, budget, and location are replicable using the same communication methods already present at the facility, resulting in this to be a highly replicable and sustainable project.

Implications for Practice

In the rise of the pandemic, isolation was a strategy that was utilized to prevent the transmission of Covid-19. During these unprecedented times, older adults are at risk for social and physical de-conditioning that negatively impacts their health. Our project’s goal was to create an event that targeted improvement in quality of physical health and social wellbeing. The findings from our research suggest a continuation of a socializing event that promotes physical activity for the residents at the community site. Implications for practice include prioritizing communication with management, utilizing on-site resources, and advertising the event to the residents. A liaison interacting directly with management provides a consistent spokesperson for the project with little error for miscommunication between the team. With a maximum budget of $30 for the project, we highly suggest utilizing resources on-site. To welcome residents to our event, we provided refreshments courtesy of on-site dining services. To announce and advertise our events, we utilized an overhead speaker system to deliver information to the residents, courtesy of security services. We had the desire to invite outside volunteers for more community involvement with the event, however due to time restraints and policies in place for Covid-19, we were unable to do so. In the absence of a pandemic, we recommend incorporating additional community members to assist with the event. Per the feedback from staff and residents, it was suggested that we incorporate a scheduled weekly walk with cascading start times for groups to limit the number of walkers on the course. It was also suggested that we create permanent signage for advertisement and to reflect the conditions of the walk for unpredictable weather. Overall, the organization of an event that promotes physical health and social wellbeing is highly recommended for this population.

References

Bae, S., Lee, S., Lee, S., Jung, S., Makino, K., Harada, K., Harada, K., Shinkai, Y., Chiba, I., & Shimada, H. (2019). The effect of a multicomponent intervention to promote community activity on cognitive function in older adults with mild cognitive impairment: A randomized controlled trial. https://doi.org/10.1016/j.ctim.2018.11.011

Berridge, C., Parsey, C.M., Ramirez, M., Freitag, C., Johnson, I.M., Allard, S.W. (2020). Caring for Washington’s older adults in the COVID-19 pandemic: Interviews with organization leaders about the state of social and healthcare services.

Davis, G.C., Baral, R., Strayer, T., Serrano, E.L. (2018). Using pre- and post-survey instruments in interventions: determining the random response benchmark and its implications for measuring effectiveness. Public Health Nutr. (6):1043-1047. https://doi.org/10.1017/S1368980017003639. Epub 2017 Dec 21. PMID: 29262871

Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J., Rahimi, K. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet, 387(10022), 957–967. https://doi.org/10.1016/s0140-6736(15)01225-8

Hanson, S., & Jones, A., (2015). Is there evidence that walking groups have health benefits? A systematic review and meta-analysis. British Journal of Sports Medicine 49(710-715).

Lebrasseur, A., Fortin-Bédard, N., Lettre, J., Raymond E, Bussières, E.L., Lapierre, N., Faieta, J., Vincent, C., Duchesne, L., Ouellet, M.C., Gagnon, E., Tourigny, A., Lamontagne, M.È., Routhierm, F. (2021). Impact of the COVID-19 Pandemic on Older Adults: Rapid Review. JMIR Aging. (2). https://doi.org/10.2196/26474. PMID: 33720839; PMCID: PMC8043147

Lee, L. L., Mulvaney, C. A., Wong, Y. K. Y., Chan, E. S., Watson, M. C., & Lin, H. H. (2021). Walking for hypertension. Cochrane Database of Systematic Reviews, 2. https://doi.org/10.1002/14651858.CD008823.pub2

Lewin, K. (1947). Frontiers in group dynamics: Concept, method and reality in social science; equilibrium and social change. Human Relations 1(1): 5–41.

Nicholson, N.R. (2012). A review of social isolation: an important but underassessed condition in older adults. J Prim Prev. 33(2–3):137–52.

Polit, D. F., Beck, C. T. (2017). Lippincott CoursePoint for Polit’s Essentials of Nursing Research. https://coursepoint.vitalsource.com/reader/books/9781496375612/epubcfi/6/136[%3Bvnd.vst.idref%3Dch010-sec02]!/4/2[main_container]/2/62/1:183[onl%2Cy.

Zubala, A., MacGillivray, S., Frost, H., Kroll, T., Skelton, D. A., Gavine, A., Gray, N. M., Toma, M., & Morris, J. (2017). Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews. PloS one, 12(7), e0180902. https://doi.org/10.1371/journal.pone.0180902

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