Physical activity and social isolation in community-dwelling older adults

Abstract

Population ageing is a major global health concern due to the rising numbers of people living longer. With increased age there is a likelihood of decline in physical health and mental wellbeing. Social isolation in particular has been identified as leading to a number of detrimental health outcomes and can create an increased demand on health services. Conversely, adequate social relationships have been demonstrated to be protective against many negative health consequences. The objective of this thesis was to investigate whether there is potential for physical activity interventions to have an effect on reducing social isolation amongst community-dwelling older adults. It sought to explore older adult perspectives of the benefits of and barriers to both group- and home-based physical activity interventions, investigated correlations between physical activity, including both recreational and household-based types, and social isolation and between physical capacity and social isolation. Additionally, whether older adults discuss social isolation with their health professional was explored. Six papers were developed utilising qualitative and quantitative designs to address the aims of the thesis. The first paper was a systematic review and meta-analysis of existing research that investigated the impact of physical activity interventions on social isolation amongst community-dwelling older adults. The second paper was a qualitative analysis of older adults’ responses to questions regarding the benefits of and barriers to participating in group- and home-based falls prevention exercise programs. The third paper was a cross-sectional analysis of the relationship between recreational, household-based, and total physical activity and social isolation. This paper investigated whether there was an association between participation in group- or home-based falls prevention exercise and social isolation. The fourth paper was a cohort study nested within a randomised controlled trial. This paper measured the correlation between physical capacity and physical activity and between physical activity and social isolation over 12 months in a sample of adults with chronic conditions. The fifth paper was a cohort study of older community-dwelling adults following discharge from hospital and examined the effect of physical activity levels (recreational, household-based and total) on social isolation and the impact of physical capacity on social isolation. The final paper was a qualitative investigation of whether older adults reported discussing social isolation with their health professional, the details of what was discussed or the reasons such conversations had not occurred. Recommendations were able to be made based on the findings of these six papers for physical activity interventions to address social isolation. First, interventions targeted at improving physical capacity and increasing levels of household-based physical activity were demonstrated to present a viable option for reducing social isolation. Second, the current lack of discussion between health care professionals and older adults would need to be remedied in order to promote a successful intervention. Finally, health care practitioners referring older adults to physical activity-based interventions might want to consider the patients’ preferences for group-based interventions compared to those they might perform alone, based on their perspective of whether the social element of group-based physical activity presents a benefit or a barrier to participating.