Summary

Residents in care homes are usually physically and mentally frail. They therefore need support and encouragement to maintain their level of functioning and to avoid problems like falls. But it is not clear what the best interventions are. A new study from New Zealand showed that one program involving goal setting and individualized activities did not achieve its aims. Clearly such interventions need to be carefully targeted and designed.

Introduction

We already know that older people who stay physically active have higher levels of health and general wellbeing than those who do not. But for the physically frail, especially those in residential care, keeping up regular exercise is difficult, if not impossible. The best way forward in helping them maintain quality of life and a reasonable level of functioning, in the absence of exercise, hasn't yet been found. If such a program could be shown to work, the benefits to older people in care homes would be massive.

What was done

Researchers at the University of Auckland studied a group of residents in care homes who were known to be capable of discussions about setting goals. Trained geriatric nurses worked with the participants to agree goals which promoted progressive physical activity. An agreed program of activity was devised including items such as additional walking, getting up from a chair and so on. While 330 residents took part in the program, another 352 acted as controls and just received social visits. Mobility, frequency of falls, depressive symptoms and hospital admissions were measured as outcomes.

What was found

Overall, the activity program had no impact on the residents. However, those with normal cognition seemed to have an overall slight improvement in their general functioning although no real improvement in quality of life was noted. But depression seemed to increase in those who did have some degree of cognitive impairment. So, surprisingly perhaps, such well-intentioned interventions do not help care home residents and may even be harmful. All is not lost, though. This program was part of the daily activity routine in the home and it may be that more intensive work is needed, focusing on specific problems like muscle weakness and pinpointing those residents who are the most likely to respond to a program designed to improve their level of functioning.