Systematic review
The effect of activity in the elderly
Systematic review
|Updated
In order to prioritize areas for possible enactment of preventive measures, the Directorate of Health has requested a summary of current knowledge about the effect of the use of senior centres.
Key message
The number of people in Norway over the age of 80 is expected to double by the year 2050. More knowledge about the prevention of illness and social isolation amongst the elderly and about how society can be organized is necessary to facilitate an active old age and good services for this sector of the population. In order to prioritize areas for possible enactment of preventive measures, the Directorate of Health has requested a summary of current knowledge about the effect of the use of senior centres.
It has been debated whether the use of the senior centres can be a preventive measure against illness and social isolation. In Norway, senior centres for elderly are not considered a public responsibility, in contrast to statutory care services such as home care, home nursing and institutional care in the Norwegian welfare system.
Figures from the Government Council for Seniors published in 2005 showed that in 2000 Norway had approximately 330 senior centres serving nearly 130,000 users, and run by an estimate of 10,000 volunteers. Every third municipality in Norway had at least one senior centre, and one out of three elderly in these municipalities used the centres.
Key messages:
Despite broad inclusion criteria related to study design we found no studies that measured the effect of the use of senior centres, but predominantly the effects of participation in physical exercise programs conducted at senior centres.
- Physical exercise programs for elderly may improve balance and increase muscle strength in the legs.
- It is uncertain whether physical exercise has effect on quality of life, endurance or improving activities of daily living (ADL)
- It is uncertain whether seniors who participate in creative activities are more satisfied compared with those who participate in other activities at the senior centre
The documentation for the included results was graded to low or very low quality. This does not imply that activities offered at the senior centres have no effect, but that the research we have found is so deficient that it is uncertain to what extent we can trust the results.
Summary
The effect of offering senior centre use to elderly above 67 years living at home
Background
The number of people in Norway over the age of 80 is expected to double by the year 2050. More knowledge about the prevention of illness and social isolation amongst the elderly and about how society can be organized is necessary to facilitate an active old age and good services for this sector of the population.
It has been debated whether the use of the senior centres can be a preventive measure against illness and social isolation. Senior centres for elderly are not considered a public responsibility, and thus not statutory care services in line with home care, home nursing and institutional care in the Norwegian welfare system. Figures from the Government Council for seniors in 2005 showed that in 2000 Norway had approximately 330 senior centres serving nearly 130,000 users, and run by an estimate of 10,000 volunteers. Every third municipality in Norway had a senior centre, and one out of three elderly in these municipalities used the centres.
According to a report from the Institute of Public Health in 2008, most senior centers in Norway were integrated in the municipal elderly care, but they were operated by private organizations. For example, 32 senior centres across the country were run by the National Association for Public Health ultimo 2000. These offer, inter alia , a cafeteria, often hairdresser and pedicures, various physical activities, language courses, various arts and crafts, as well as culture and entertainment. More women than men are users of senior centres and the predominant group of users are more than 80 years old. There is also a higher share of users that have been married, that have frail health and that need more assistance than non-users, in addition to having the smallest social network. The main aim of the senior centres is to prevent social isolation and maintain activity and mobility of users, both physically and mentally.
Method
We conducted a systematic literature search in the following databases: Medline, Embase, CRD Databases, Cochrane Database of Systematic Reviews, Dare, PsycINFO, ISI, British Nursing Index, SveMed and Central. We also searched reference lists, relevant websites and contacted experts to obtain current research.
The inclusion criteria
Study design: Systematic reviews, randomized controlled trials, prospective controlled trials/cohort studies or interrupted time series analysis.
Population: Elderly over 67 years living at home
Intervention: Access to a senior centre, activities provided in the context of a senior centre
Control: No use of senior centres or other alternative preventive health measures (for example preventive home visits)
Outcomes: Self-perceived health, quality of life, social participation, falls, other reported health outcomes
Language: English, Scandinavian
Two people independently screened the results of the systematic search. In case of doubt or disagreement, a third person was consulted. We evaluated each of the included studies with regard to risk of systematic bias according to the guidebook for the Norwegian Knowledge Centre for Health Services, and assessed the quality of the documentation for the most important outcomes by GRADE.
Results
We found 1845 unique titles in the systematic literature search. Of these, 13 single studies met the inclusion criteria. There were six randomized controlled studies, one crossover study and six controlled studies. There were no Scandinavian or European studies amongst these. Nine of the studies had been conducted in the USA, one in Brazil, one in Japan, one in Korea and one in Taiwan.
Our summary shows that participation in physical exercise for the elderly may provide an improvement of balance and increased muscle strength in the legs, but provide little or no effect on quality of life, coping with daily activities or endurance. It is uncertain whether physical exercise has any effect on self-perceived health or whether exercise and cognitive behavior exercise have any effect on falls. The summary indicated that participation in creative activities do not provide any improvement in life satisfaction (compared to participation in other activities at the senior centre). The documentation is of very low quality.
Discussion
This systematic review summarized the results from 13 separate studies that partly address our main question about the health effects of senior centres. Despite broad inclusion criteria in relation to study design, we found very little specifically about the use of senior centres. The studies we included examined effects of various activities that were provided at senior centres. None of the studies measured the effect on social isolation and participation. The included studies deal with people that already use senior centres. In only four of the studies the participants were all over 67 years. We have nevertheless chosen to include the remaining nine, because the average age of people who participated was over 67 years (except in Ferreira et al. where the average was 61 years, but with participants up to 72 years).
Physical exercise given at senior centres appears to improve balance and increase muscle strength. The results also showed that exercise training has little or no effect on quality of life, coping with activities of daily life or for endurance.
It must be noted that the results are uncertain because the evidence base in the included studies was of low quality. Another weakness in this review is that we did not find any Norwegian or Scandinavian studies that met the inclusion criteria. The included studies were performed in the United States, Japan, Korea, Taiwan and Brazil, where both culture and social structure is different than in Norway.
Our task was to determine the effect of senior centre use. Since the studies are only conducted on users of the senior centre, this may have led to a limitation of the study population / sample, because one can assume that the activities that have been examined are not unique to the senior centre. The studies we included were not primarily set to measure self-perceived health, quality of life or social isolation, but the first two were secondary outcomes in some studies. This means that our target outcome has not been examined and measured to a sufficient extent to provide relevant results.
Conclusion
We have found no research that compares residents living at home older than 67 years that use senior centres with elderly that are not users or that measured the effect of the use of senior centres, but we found studies that shed light on the effects of some activities, especially physical exercise programs, that senior centres offer to the home-living elderly population in the municipality and that already were users of the centers.
Our summary showed that participation in physical exercise programs for elderly may improve balance (standing on foot with eyes open or eyes closed) and increase muscle strength in the legs (measured by chair rise). It also showed that physical exercise has little or no effect on quality of life, endurance or improving activities of daily living (ADL). Participation in creative activities did not improve life satisfaction (relative to participation in other activities at the senior centre). The documentation for the included results was graded to low or very low quality. This does not imply that activities offered at the senior centres have no effect, but that the research we have found is so deficient that it is uncertain to what extent we can trust the results.
The need for further research
To be able to say whether access to a senior centre has a preventive effect on social isolation and/ or illness for elderly living at home, there is a need to conduct robust evaluations such as randomized controlled studies with follow-up studies, and that includes both users and non- users of senior centres. There is also a need to evaluate what measures have better effects than others and whether various staffing influences the effects. Cohort studies over a length of time or time series, with control for other concurrent life events, may also be suitable for measuring the impact the use of senior centres may have on self-perceived health, quality of life and social isolation.