# data[].attributes.headline
Favorite thing older parents like to eat

# data[].attributes.subject
Favorite thing older parents like to eat

# data[].attributes.body
Chicken

# data[].attributes.headline
Tv episode about grandparents, retirement, death of older parent 

# data[].attributes.subject
Tv episode about grandparents, retirement, death of older parent 

# data[].attributes.attachment_link.title
This Is Us - Saying Goodbye (Episode Highlight)

# data[].attributes.attachment_link.description
As William's condition worsens, Randall finds strength in Jack's legacy. " Subscribe for More: http://bit.ly/NBCThisisUs " Watch This Is Us Tuesdays 9/8c on NBC!

# data[].attributes.headline
Song about grandparents, life changes, getting older or loss of an older parent

# data[].attributes.subject
Song about grandparents, life changes, getting older or loss of an older parent

# data[].attributes.attachment_link.description
An uplifting song about loss and bereavement.

# data[].attributes.headline
Seniors doing physical activity/exercise 

# data[].attributes.subject
Seniors doing physical activity/exercise 

# data[].attributes.attachment_link.readable_text
Mid-life crisis has typically been defined as a period of emotional turmoil in middle age that generally hits around the ages of 40-60. This transitional period is characterized by a strong desire for change. There's some question as to whether mid-life inevitably equates to a mid-life crisis but we can all agree that in your mid life you start to question what it's all about...

This time of reflection comes at a time when the nest is emptying out and our hormones are changing. We start to worry about our careers, health, adult children, grandchildren, jobs and retirement.

For some, this time does become crisis time and can lead to depression or major life changes.But more and more baby boomers see mid-life as a time for transformation.

A time we start exploring the possibilities of our lives and taking time for us. Perhaps it's our last chance to transform ourselves, have a baby (my mid-life crisis), change careers, go back to school, travel around the world . We start exploring the possibilities!

Just as we start to find time for our own lives comes the realization that we can't rely on our parents for advice and a shoulder to lean on like we use to. In fact, our roles are starting to reverse and they are leaning on us emotionally, financially and physically to function.

Our mid-life plans get put on hold.

When we first realize our elderly parent needs help, we are confronted with our own mortality. We may look in the mirror and see our wrinkles, gray hair and age spots. We start to reflect back on how well we have lived our life so far. We see our elderly parents struggle day in and day out; we worry about our future. We want to make changes but find little time to reflect on what those changes could be.

The constant phone calls, trips to the doctor, worry over if they should move, long distant treks across the country to check on them. It all starts to wear us down and we hit crisis mode. The next thing you know our elderly parent's lives have become our mid-life crisis.

5 TIPS TO AVOID LETTING YOUR ELDERS BECOMING YOUR MID-LIFE CRISIS!

1. Do what's right for you and that will be what's right for them. My clients get so sick of hearing me say this but it's the foundation of my work. As an adult child, you must care for your elderly parent in your own unique way. You may get looks from others and your love may be questioned. But this is not the time to overcommit to something you're not capable of and this is not the time to not take your own needs in to account!

2. Avoid becoming enmeshed with their problems by setting healthy boundaries. It's real easy to become so busy dealing with your elderly parent's day to day life that it becomes hard to tell where their life ends and yours begins. Becoming the helicopter adult child can be a convenient way to avoid our own problems. If you can't learn to set a health boundary, you will hit a brick wall and their life will become your mid-life crisis. More about healthy boundaries here...

3. Be aware of the sadness you feel around them growing old and dying. Along with this, be clear on how you feel about your own mortality and your vision for the rest of your life. These two emotional pieces can collide and become messy in a big way. If these issues are bogging you down, I would recommend counselling or spiritual support.

4. Don't use your elderly parents as a scapegoat to avoid working on your own life. Are you using your elderly parents to avoid making some tough decisions about your own life? Is it easier for you to play the martyr versus be responsible for your own happiness in life? This is an easy trap to fall in to so be keenly aware when you are avoiding your own problems.

5. Don't do it alone. Whether it's deciding to get help with your recent arthritis diagnosis or help caring for your elderly parent, this transition will require help or it will become a crisis for you and your elderly parent. The ability to reach out and get help requires awareness, acceptance and flexibility. Start practising these attributes on a daily basis.

Chances are your mid-life transition will coincide with your elderly parent needing more of your time and help. It can be overwhelming and challenging but it can also provide you with the opportunity to explore your own aging process. Empower yourself to make new discoveries about growing old(er).

Your mid-life transition doesn't have to be put on hold completely as you care for your elderly parent. Take take the time to be clear on your own intentions and emotional transitions; don't let your elderly parent become our mid-life crisis!

Are you struggling to balance your mid-life needs with the needs of an elderly parent? A single clarity session can help!

OR

Follow me on Facebook to continue the conversation...

My Elder Care Consultant

# data[].attributes.attachment_link.title
Has Your Elderly Parent Become Your Mid-life Crisis?

# data[].attributes.attachment_link.description
Mid-life crisis has typically been defined as a period of emotional turmoil in middle age that generally hits around the ages of 40-60. This transitional period is characterized by a strong desire for change. There's some question as to whether mid-life inevitably equates to a mid-life crisis but we can all agree that in your [...]

# data[].attributes.headline
Info on what is, and how to apply for medicare 

# data[].attributes.subject
Info on what is, and how to apply for medicare 

# data[].attributes.attachment_link.title
Medicare Supplemental, Advantage, and Part D Plans | Medicare Info

# data[].attributes.attachment_link.description
Helps cover the cost of prescription drugs - and supplement either Original Medicare or, in some cases, a Medicare Advantage Part C plan. They have a Formulary or List of Covered Drugs. Only Formulary drugs count as out-of-pocket. They include three levels of covered expenses. Sometimes included in Medicare Advantage.

# data[].attributes.attachment_link.readable_text
A call for solutions

Across the country, lawmakers are starting to recognize the need to ensure better care for homebound seniors.

With money from the Affordable Care Act (ACA), six states, including Michigan and California, are working to develop more rigorous standards for training and assessing home-care workers. And several nonprofit groups have created registries to match the needs of seniors living at home with aides who have specialized skills, such as working with people with dementia or Alzheimer's.

The Elder Justice Act, which Congress approved as part of the ACA, called for spending $500 million to help state and local adult-protective services better detect and prevent elder abuse. But lawmakers have yet to authorize any money for the program. That lack of funding has also stalled plans to conduct a comprehensive study of elder abuse.

In what labor groups saw as a major step toward improving the lot of workers and their patients, the Obama administration approved regulations in 2013 that would require home-care agencies to start paying overtime to their employees, reversing a decades-old exemption under federal law. But the home-care industry filed suit, and a federal judge in Washington struck down the new rules, which were scheduled to go into effect Jan. 1, ruling that the Labor Department had exceeded its authority.

Phil Bongiorno, executive director of the Home Care Association of America, a trade group that represents 2,500 home-care businesses with some 300,000 employees, says the industry was concerned that the requirement to pay overtime would make care less affordable as higher costs were passed on to consumers. He adds that the trade group has developed "best practices" for training and screening employees, although they are not currently a condition of membership in the organization. "We are trying to set the standard in home care," Bongiorno says.

'She was like a sociopath'

Denise Goodwin, 47, had worked as an assistant in an animal hospital before seeing the profit potential in working with humans. Prosecutors say she preyed on older men, trolling online senior dating services to find victims. She applied at a San Diego home-care agency, specifically requesting hospice duty. After she passed a background check, the agency assigned her to the Rabourn home in 2010.

In short order, Goodwin plundered the estate, charming Gerald Rabourn into giving her control over his finances after his wife died. She sold the house and liquidated his stocks, pouring the money into condos. A suspicious neighbor called adult protective services, but the agency closed an investigation after Rabourn refused to cooperate.

Based on phone and bank records, police believe Goodwin murdered Rabourn a month after arriving on the scene, although his body has never been found. She covered her tracks for several months by telling people that Rabourn had remarried and was on vacation. Mary Weaver, Rabourn's daughter, who lived in Kansas City, filed a missing-persons report with San Diego authorities in February 2011 after her birthday passed without a card from her father, a missed ritual that to her was a telltale sign that something was profoundly wrong.

Goodwin was convicted of murder by a San Diego County jury last October. She was sentenced Jan. 30 to life imprisonment without parole. Weaver, a chaplain who ministers to people at assisted living facilities, attended the sentencing and used the occasion to eulogize her father. Weaver was hoping that Goodwin would reveal the location of her father's body so he could be laid to rest, but instead, Goodwin sat emotionless in the courtroom. "She was like a sociopath," Weaver says. "Most people should understand, when you are putting someone in your home, you need to be sure this is who they say they are."

# data[].attributes.attachment_link.title
Elder Abuse in Caregiving and Hospice Situations

# data[].attributes.attachment_link.description
Across the country, lawmakers are starting to recognize the need to ensure better care for homebound seniors. With money from the Affordable Care Act (ACA), six states, including Michigan and California, are working to develop more rigorous standards for training and assessing home-care workers.

# data[].attributes.attachment_link.readable_text
This final step is really important in helping us fight fraud and protect others from being targeted by the same scams. Unfortunately, the reality is that if you have been a victim of a fraud or a scam, the money is more than likely gone. It is incredibly rare for any funds to be returned to the victims. But that doesn't mean you are powerless. We still need you to report as many details as you can about these scams so that we can work to shut them down.

We encourage you to call us directly at 800-222-4444, option 2, to connect with an AARP ElderWatch specialist. Our volunteers can help talk you through your issue, gather information about it, and refer you to the appropriate agency to which you should file a complaint. You may also be interested in filing a complaint directly with the following agencies:

# data[].attributes.attachment_link.title
Report Fraud and Senior Scams with Help from ElderWatch - AARP

# data[].attributes.attachment_link.description
This final step is really important in helping us fight fraud and protect others from being targeted by the same scams. Unfortunately, the reality is that if you have been a victim of a fraud or a scam, the money is more than likely gone.

# data[].attributes.headline
Website for gym showing physical fitness classes just for seniors.

# data[].attributes.subject
Website for gym showing physical fitness classes just for seniors.

# data[].attributes.headline
Information on activities, hobbies for senior citizens 

# data[].attributes.subject
Information on activities, hobbies for senior citizens 

# data[].attributes.attachment_link.readable_text
We already know that a healthy lifestyle is a major factor in living a long life; but new studies show that having hobbies for seniors and staying socially active are equally important.
It has long been known that a nutritious diet, exercise and positive health choices all contribute to helping seniors feel more energetic. In fact, emerging research into longevity and good quality of life indicates that mental and social activity are just as critical as physical activity when it comes to healthy aging. Hobbies, leisure activities, and a rich social network are factors that correlate with living longer and avoiding isolation.

Healthy Hobbies for Seniors

Here are 11 healthy hobbies your aging loved one might want to consider:

1. Creating Art / Doing Crafts

More than providing something fun and artistic to stimulate the brain, creating art and doing crafts can also be soothing and cathartic. From painting, sculpting and scrapbooking to photographing, knitting or sewing - art is one of the best activities seniors can practice. Even better, art can also be done as a social activity with friends or family, so that mingling happens while stimulating the mind and soul. Engaging and fun, art is a great activity at any age, but is especially helpful and rewarding for retired seniors who have time and need activities to keep their minds alert. Art therapy is even used to help stimulate the brain, stir memories and give those with dementia a better quality of life.

2. Volunteering

If your loved one is still able to volunteer and does not suffer from cognitive decline, volunteering at the local department store, fundraising event, local association or senior center can provide not only great socialization, but also self-worth. Often when seniors retire and lose purpose, social and physical decline can happen; which is why staying engaged in the community is even more important. Feeling helpful is an important human emotion that helps keep seniors stimulated, rather than depressed or bored in monotonous day-to-day that can happen in the latter years.

3. Swimming

If your loved one suffers from a disease such as osteoarthritis, where the cartilage wears down between the joints and causes pain, swimming is likely their easiest form of exercise. Exercise is often recommended for people who suffer from osteoarthritis, but traditional exercise, such as walking or aerobics, can also be painful. Since swimming takes the pressure off the joints, it is one activity that they can participate in without aggravating their condition.

Swimming regularly can also help your senior loved one improve not only their cardiovascular fitness, flexibility and balance, but also give them greater muscle tone, better posture and less muscle tension. Swimming is also a great way to boost energy through natural fitness endorphins, that are easy on the joints, and also fun! If your loved one goes to a public pool or gym or is enrolled in a water aerobics program geared toward seniors, they also get the opportunity to meet other people, interact and socialize.

4. Walking

Walking is a tremendously good activity for senior citizens. It's cheap, it's simple and almost anybody can do it and it. Walking has a multitude of health benefits for everyone, but is especially helpful for seniors as the activity helps maintain mobility and independence. From walking at the mall, around the park, at the local health club and even in independent and assisted living communities; there's no activity that offers an inexpensive way to help seniors stay in shape. Walking with loved ones and friends is even a more fun and healthy option for seniors, to increase their socialization.

5. Playing Games / Cards

From playing Solitaire to Bridge to Scrabble, cards and games are an excellent way for seniors to keep their minds' sharp. In fact, research has shown that adults who enjoy mentally stimulating games may have bigger brains and sharper thinking skills than their peers. Higher education has been linked to decreased risk of cognitive decline. Researchers theorize that well-educated people have better connected synapses in their brain, which also helps compensate for the havoc wreaked within the brain by Alzheimer's and other dementias. Critical thinking and crossword puzzles are also great ways to keep the brain fit.

6. Dancing

Dancing is not only fun, but is also a great way for seniors to exercise and socialize. Dancing can improve senior balance, gait and overall body functioning, while also helping to reduce the risk of falls, fractures and immobility. Beyond those reasons, a study from Albert Einstein College of Medicine showed that ballroom dancing was associated with a lower risk of dementia. The researchers believed that the mental challenge of following complex dance steps and moving in time with the rhythm of the music are responsible.

7. Gardening

Gardening has many health and therapeutic benefits for older people. It's not only an enjoyable form of exercise, it also increases levels of physical activity and helps increase seniors' mobility and flexibility. It encourages use of motor skills while improving endurance and strength and even reduces stress levels by promoting relaxation. Gardening also provides stimulation and interest in nature and the outdoors. Many senior living communities offer gardening cubs for residents as the hobby is definitely a positive and popular hobby that helps promote resident happiness.

8. Practicing Yoga

Yoga can provide many physical and mental benefits to an elderly person. From minimizing stress and hypertension to helping to strengthen bones and build balance, yoga is a great hobby for seniors. Many senior centers, athletic clubs and senior care communities offer yoga for the elderly since the meditations offer so many wonderful benefits.

9. Golfing

There are many health benefits for seniors who golf. From improving flexibility, ease of motion and strength to also increasing happiness, socialization and an active lifestyle, golfing is a favorite hobby for many seniors. Since people can golf their entire life, it's an excellent hobby to keep through the years that provides not only satisfaction, but also helps seniors keep hand-eye coordination and improves mood. Golfing is a great hobby to keep your elderly loved one stimulated and happy.

10. Caring for a Pet

Pets provide a comfort system and actually produce a that helps to lower levels of of the stress-inducing hormone, cortisol, and increase the production of the feel-good hormone, serotonin. In fact, pets have been shown to reduce blood pressure and stress levels in humans and can actually help lower cholesterol, fight depression and help protect against heart conditions. All great reasons for chemical chain reaction in the brain seniors to have a pet!

Learn some of the best dog breeds for seniors.

11. Visiting Family and Friends

Visiting family and friends is one of the most important past-times for seniors as these catch-ups help combat senior isolation; one of the leading causes of mental and physical decline. Social isolation and loneliness have been associated with increased risk for depression, high blood pressure mental decline, and more. Visiting with family and friends not only helps to strengthen family bonds and heritage, it's also important for happiness. After all, humans are wired to interact and socialize, and they especially need these interactions as they age and sometimes lose spouses and social circles. One of the most important parts of life is about human interaction, emotional connections and having a reason to live.
How active are the seniors in your lives? How are you encouraging them to exercise and make social connections? We'd love to hear your stories and suggestions in the comments below. Related Articles:

# data[].attributes.attachment_link.description
We already know that a healthy lifestyle is a major factor in living a long life; but new studies show that having hobbies for seniors and staying socially active are equally important. It has long been known that a nutritious diet, exercise and positive health choices all contribute to helping seniors feel more energetic.

# data[].attributes.attachment_link.description
The term "baby boomer" is also used in a cultural context, so it is difficult to achieve broad consensus of a precise date definition. Different people, organizations, and scholars have varying opinions on who is a baby boomer, both technically and culturally.

# data[].attributes.attachment_link.description
Find your local government agency that helps the elderly with long term care planning. Search for financial resources to help pay for assisted living, home care or long term care.

# data[].attributes.headline
Information/article about decline in physical health as age

# data[].attributes.subject
Information/article about decline in physical health as age

# data[].attributes.attachment_link.readable_text
Abstract

Regular physical activity helps to improve physical and mental functions as well as reverse some effects of chronic disease to keep older people mobile and independent. Despite the highly publicised benefits of physical activity, the overwhelming majority of older people in the United Kingdom do not meet the minimum physical activity levels needed to maintain health. The sedentary lifestyles that predominate in older age results in premature onset of ill health, disease and frailty. Local authorities have a responsibility to promote physical activity amongst older people, but knowing how to stimulate regular activity at the population-level is challenging. The physiological rationale for physical activity, risks of adverse events, societal and psychological factors are discussed with a view to inform public health initiatives for the relatively healthy older person as well as those with physical frailty. The evidence shows that regular physical activity is safe for healthy and for frail older people and the risks of developing major cardiovascular and metabolic diseases, obesity, falls, cognitive impairments, osteoporosis and muscular weakness are decreased by regularly completing activities ranging from low intensity walking through to more vigorous sports and resistance exercises. Yet, participation in physical activities remains low amongst older adults, particularly those living in less affluent areas. Older people may be encouraged to increase their activities if influenced by clinicians, family or friends, keeping costs low and enjoyment high, facilitating group-based activities and raising self-efficacy for exercise.

Keywords: Exercise, Physical activity, Muscle, Falls, Health, Frailty

Background

Data from the UK Office for National Statistics (2012) project an increase in the population aged over 60 years from 17 % in 2010 to around 23 % by 2035. The most rapid rise is projected for the 'oldest' old, where the number of people aged over 85 years increases from 1.4 million to around 3.5 million. A general schematic representation of ageing is shown in Fig. 1 . After the age of around 40 years it is possible to detect deterioration of the function of physiological systems, with associated anatomical and ultrastructural changes. For instance, progressive cognitive declines affect memory and learning; skeletal muscle atrophies and becomes progressively weaker (known as sarcopenia) and ageing-related declines in bone mineral density lead to osteopenia and osteoporosis. Chronological age is a convenient and often very good predictor of health status, disease burden and physical capability, but there is considerable inter-individual variability, with some older people having very good health and others show accelerated onset of weakness, disability and frailty.

The lifestyle and medical advances that contribute to longevity are achievements to celebrate, but they also bring unintended and considerable social, economic and health challenges as life expectancy increases faster than the period of life spent in good health, termed 'healthy life years' (discussed in (Rechel et al. 2013)). For instance, in the UK the mean life expectancy for women at birth in 2008 was 81.8 and in men it was 77.7 years and by 2013 this had increased to 82.9 for women and 79.2 years for men. Over this same time period, the mean healthy life expectancy had changed little, or even decreased: for women in 2008 it was 66.3 and in men it was 65 years, but by 2013 it had fallen to 64.8 in women and 64.4 years in men (Eurostat 2015). Musculoskeletal disorders are the most common chronic, disabling conditions, affecting 14 % of people aged over 65 years. These are followed by heart and circulatory conditions affecting 10 %; respiratory conditions affecting 6 %; endocrine or metabolic conditions affecting 6 % and mental disorders affecting 4 % of people aged over 65 years. Incidence of these chronic diseases more than doubles in the 10 years that follow retirement. Of people aged over 75 years, 30 % report chronic musculoskeletal conditions; 32 % report heart and circulatory conditions and 13 % report endocrine or metabolic conditions (ONS 2013). Another of the concerns is that the 'old age dependency ratio' will change from four working-age persons for every one older retired person, to just two working-age persons for every one older retired person in Europe (Eurostat 2014). This change in the ratio of workforce to the overall population may strain economic, social and healthcare support systems, so it is important to implement strategies to improve the health of older people.

Healthy ageing and frailty

Healthy ageing has been defined as an ability to lead a healthy, socially inclusive lifestyle relatively free from illness or disability (age UK 2010), and this is more likely in those actively engaging in activities to improve their health and wellbeing (age UK 2015). Such people were recruited into the MYOAGE study (McPhee et al. 2013) and it was clear that despite no obvious difficulties with usual activities of daily living, the vast majority of older people aged in their 70 s had lower physiological function than young adults. For example, older adults had higher body mass index due to increased fatness, smaller and weaker muscles particularly in the legs, lower bone mineral density, reduced cardiorespiratory and metabolic function and performed worse in cognitive tests than young (Bijlsma et al. 2013a, b; Sillanpaa et al. 2014). Other studies have shown 30-50 % fewer motor neurons innervating leg muscles of healthy old compared with young, suggesting that motor unit remodelling is a part of the normal ageing process (Campbell et al. 1973; Piasecki et al. 2015a, b). The motor neuron and muscle fibre (Lexell et al. 1988) losses occurring during ageing can never be replaced, but the structure and function of cardiorespiratory, metabolic and musculoskeletal systems are amenable to improvement through exercise training, so it is informative to profile very athletic older people (master athletes). Master Athletes regularly compete in sports and demonstrate exceptional physical capability for their age (Rittweger et al. 2009). They usually retain greater bone, muscle, cardiorespiratory, metabolic and neuronal health compared with non-athletic people of similar age, but it is nevertheless evident that physiological systems decline in older age even in those who remain exceptionally active (Degens et al. 2013a, b; Ireland et al. 2014; Michaelis et al. 2008; Pearson et al. 2002; Power et al. 2010; Trappe et al. 2013; Wilks et al. 2009).

The progressive declines in physiological function that usually occur over decades are associated with slower walking speed and difficulties rising from a seated position and balancing. Standardised assessments have been developed to indicate physical capability in older age, including the 6-min walk (Rikli and Jones 1998) and the 30 s chair-rise test (Jones et al. 1999). The Short Physical Performance Battery assesses normal walking speed over 4 m, balancing in different foot positions and time to complete 5 chair-rises, and the maximum score of 12 is easily achieved by healthy older people, while a score less than 8 indicates sarcopenia and frailty (Pahor et al. 2006). Thus, a score of between 8 and 11 indicates the moderate physical impairments associated with sarcopenia (low muscle mass) and 'pre-frailty' (Bauer 2015). The Timed Up and Go (TUG) test involves standing from a seated position, walking around a cone placed 3 metres away and returning to a seated position on the original chair. Healthy men and women complete the task within 7 s (Bijlsma et al. 2013a) and frail people take >10 s (British Geriatric Society 2014), suggesting that a score between 7-10 s is indicative of pre-frailty.

Frailty is recognised clinically as a geriatric syndrome that arises due to multiple deficits to body systems. Frail people experience severe impairments to physical and mental function that restrict their ability to complete necessary activities of daily living. Frailty is usually diagnosed according to two classifications. The Rockwood scale describes frailty as an accumulation of 'deficits', including the number of medications taken, number of diseases, frequency of medical interventions and other psychosocial indicators (Rockwood et al. 2005). The Fried Frailty Phenotype recognises frailty in people presenting at least three of the following five conditions: unintentional weight loss; low physical activity levels; slow gait speed; exhaustion, and weakness (Fried et al. 2001). Around 10 % of people aged 65-75 years and half of all people aged over 80 years suffer from frailty, which is aggravated by a lower social status, comorbidities, medication use and lowered immunity (Ashfield et al. 2010; Clegg et al. 2013; Syddall et al. 2010; Yao et al. 2011). There is a wide spectrum of frailty, but typically, frail people have low physical activity, few social interactions as well as several chronic diseases that require medical attention (Marengoni et al. 2011). They are vulnerable to falling and may not fully recover from mild stressors or illness. Frailty can be a dynamic state, as some people with high levels of dependency or disability can recover independence, although they remain at higher risk of future mobility limitations than those who were never frail (Gill et al. 2006; Hardy and Gill 2004). Some recommended indicators of frailty are shown in Table 1 , which are possible predictors of future falls (Ganz et al. 2007).

Table 1

Indicator

Measurement

Reference

Walking

<0.8 m/s or taking more than 5 s to walk 4 m

BGS ( 2014)

Inability to walk half-a-mile or negotiate stairs

Dufour et al. ( 2013)

Standing

>10 s in the 'timed up and go' test

BGS ( 2014)

>30 s to complete 5 × chair rise

Muscle strength and power

Men grip strength: <37 kg

Sallinen et al. ( 2010)

Women grip strength: <21 kg

Standing jump <8 cm

Runge et al. ( 2004)

Balance

<10 s standing on one leg

Activities of daily living

Difficulties to complete heavy housework

Dufour et al. ( 2013)

Sedentary lifestyle and social isolation

Fried et al. ( 2001)

Poor coordination of movements

Daniels et al. ( 2008)

Self-reported health

Scoring >3 on the PRISMA 7 questionnaire

BGS ( 2014)

>3 kg unintentional weightloss in last 3 months

Chronic exhaustion or fatigue

Fried et al. 2001

Regular physical activity to promote healthy ageing

In general, the more often a person is physically active, the better their physical capability. This is due to adaptations of physiological systems, most notably within the neuromuscular system to coordinate movements, the cardiopulmonary system to more effectively distribute oxygen and nutrients around the body, and metabolic processes particularly those regulating glucose and fatty acid metabolism, which collectively increase overall aerobic power and physical capability. Thus, the trajectory towards frailty is directly modifiable through physical activity habits (Department of Health 2011; Health 2009; Tak et al. 2013).

A survey of >92,000 people in England showed that exercise participation declines progressively throughout adult life and so does the desire to participate (Department for Culture 2011). Indeed, only around half of all adults and just a quarter of people aged over 65 years meet the minimum recommended activity levels needed to maintain health (Department of Health 2011). Inactivity is the major cause of poor physiological fitness and disease in older age, at least equal to the effects of smoking, drinking excessive alcohol intake and obesity (Booth et al. 2000; Lee et al. 2012). Sedentary people aged 50 years and older had twice the risk of death compared with those who had the highest level of physical activity after adjusting for a range of risk factors (including age and socio-economic position) (Nazroo et al. 2008). For example, those who retire from work are more likely than those who remain in work to change to low levels of physical activity from both high and medium levels (Matthews et al. 2014) and people aged 70-79 years are about half as likely as those aged 50 to 59 years to be engaged in high levels of physical activity (Matthews et al. 2014). People aged >80 years are over 50 % less likely than those in their early 50 s to engage in sports or to want to increase their activity levels (Fig. 2 ).

The general aims of physical activity programmes

The National Institute for Health and Care Excellence recommend exercise as primary care (NICE 2009), but knowing how to encourage exercise participation at the population-level is challenging because a one-size-fits-all programme is not suitable. The intensity of exercise should be modified to appropriately match the individual's exercise experience and physical capability, as indicated in Fig. 1 . To be most effective, it is important that exercise programmes are appropriately designed and focus on a range of outcomes, not simply weight loss, as improved health and mobility in exercising older people can occur independently of changes to body mass index (Bruce et al. 2008). Achieving >150 min/week moderate-intensity aerobic exercise, such as walking or other moderate intensity aerobics-type activities, is associated with at least 30 % lower risk of morbidity, mortality and functional dependence compared with being inactive (Chou et al. 2014; Paterson and Warburton 2010). Walking 5-7 days per week was associated with 50-80 % lower risk of mobility impairments (Clark 1996; Roh and Park 2013) and increases longevity by around 4 years and disability-free life expectancy by around two years (Ferrucci et al. 1999). There is also evidence that sedentary people will benefit from regular short activity periods of as little as 1 min (Healy et al. 2008) or 10 min bouts (Powell et al. 2011) to break-up periods of sitting or lying.

Although vigorous activities are not advisable for sedentary older people, masters athletes can train and compete in very high intensity sports, with the risks of adverse events during competition being similar to those of younger adults (Ganse et al. 2014). Older people who maintained regular jogging postponed disability by almost 9 years and had three times lower risk of death compared to those who had never been a member of a running club (Wang et al. 2002). The risk of developing cardiovascular disease is also lower in those completing regular vigorous compared with moderate intensity exercise (Swain and Franklin 2006). Thus, there appears to be a dose-response relationship to indicate that higher intensity activities bring greater health benefits (Bruce et al. 2008; Ebrahim et al. 2000; Kim et al. 2013; Wannamethee et al. 2005), but it is important to note that older people must be suitably adapted to participate in the higher intensity activities, so this relationship might reflect the overall exercise history.

Risks and adverse events

The UK Department of Health (2011), US Department of Health ( 2009, 2011), American College of Sports Medicine ( 1998), World Health Organisation ( 2010) and European Association of Cardiovascular Prevention and Rehabilitation (Borjesson et al. 2011) guidelines state that exercise is generally safe for older people and they therefore need not consult a medical practitioner before increasing physical activity levels. Nevertheless, as cardiovascular risks, such as increased blood pressure, arrhythmia or myocardial infarction are concerns when taking up exercise, the European Association of Cardiovascular Prevention and Rehabilitation suggest self-assessment by a brief questionnaire (Borjesson et al. 2011) to determine the need for advice from health professionals. In most cases, this is precautionary and a medical practitioner will allow the person to proceed with moderate exercise. Training intensity or exercise duration should be increased modestly not more than once every 4 weeks (Huang et al. 2005).

Exercise classes to improve balance are not associated with increased risk of adverse events. However, more intense falls-prevention classes may have an increased risk of muscle soreness or swollen joints in sedentary people unaccustomed to exercise (Gillespie et al. 2012; Howe et al. 2007). Frail or sedentary older adults living in care may have a small increased risk of falls shortly after falls-prevention classes, possibly related to physical or mental fatigue, but there is no evidence of serious adverse outcomes, injury or cardiovascular events (Crocker et al. 2013). Exercise interventions to improve balance in those diagnosed with dementia bring numerous benefits without an increased risk of adverse outcomes (Forbes et al. 2013).

Risks associated with resistance training have been reviewed in two reports (Liu and Latham 2009, 2010). The vast majority of clinical trials did not report any adverse events after exercise. It is not possible to know whether this was because no adverse events occurred or whether they were not reported. In trials that did report adverse events, the most common were minor musculoskeletal problems such as pain in joints, bruising or sprains. Less common were cardiovascular events, with only one occurrence out of the 58 reviewed trials that included people aged >60 years that did report any adverse events (Liu and Latham 2010). There was a higher risk of any adverse event in older people after intense exercise in those who already experienced pre-existing health problems, were functionally limited or were sedentary (Liu and Latham 2010).

Low and moderate intensity aerobic exercise are low risk for older people and even more intense aerobic activities carry relatively little risk. Several studies reported no greater risk of adverse events from moderate exercise compared with those not participating in physical activities (Church et al. 2007; Dunn et al. 1999; King et al. 2002). In a study of 1635 older people with moderate mobility impairments, a large-scale mixed aerobic, resistance and balance exercise intervention reported a 8 % higher incidence of serious adverse events compared with a (sedentary) health education programme (Pahor et al. 2014). An aerobic exercise intervention aiming for 60 min intense cycling/walking/running/rowing exercise 6 days per week over 12 months for previously sedentary men aged 40-75 years found no increased risk of injury or adverse event. In the non-exercise control group, 27 % experienced an injury compared with 28 % in the exercise group (Campbell et al. 2012).

Cardiovascular events during intense exercise have been estimated to occur at a rate of around 1 event per 100 years of vigorous activity (Powell et al. 2011). Risks tend to be highest during the first few weeks of a new vigorous training programme (Mann et al. 1969). However, for older people well-accustomed to intense exercise, participating in competitive vigorous sports does not carry higher risk compared with those faced by younger adults (Ganse et al. 2014). Extreme endurance running, such as a marathon, carried just 0.0005 % risk of sudden cardiac arrest across the population of runners, including older runners, equivalent to around five incidents per one-million runners (Kim et al. 2012). Because exercise has many positive effects, the overall risk of adverse events (covering all activities in the day) was approximately halved in people who achieved >140 h vigorous activity per week compared with sedentary people (Siscovick et al. 1984), demonstrating a clear net decrease in adverse events in healthy and active people compared with sedentary.

Social, demographic and psychological considerations

In addition to the social and demographic associations with healthy behaviours, psychological factors are also important. The internal motivations for sports participation amongst older people include the health, social, mental and emotional benefits that help to maintain physical independence (Sport-England 2006). External motivation comes from the media, doctors, partners, friends and/or family. Provision of local opportunities and an exercise 'buddy' also help. The most common barriers to exercise are costs, lack of time, and physical limitations. Other limiting factors included cultural 'norms', language barriers and the need for clothing that may be deemed inappropriate (Sport-England 2006). Older people felt that the best way to increase participation would be to keep costs low, make sessions enjoyable, be reassured about the safety of activities and the opportunities to be physically active could be better advertised (raise awareness of local exercise classes) (Sport-England 2006).

Other less modifiable individual factors can predict initiation and maintenance of physical activity. For instance, a better physical and mental health, cognitive functioning, lower age, and higher baseline physical activity are associated with maintenance of physical activities (Koeneman et al. 2011; van Stralen et al. 2010). Of the individual factors investigated, the most consistent predictor of physical activity (this differs from sports participation) initiation and long-term maintenance is self-efficacy (French 2013; Koeneman et al. 2011; van Stralen et al. 2010). Self-efficacy for physical activity can be thought of as the belief in one's capabilities to organize and execute that behaviour, or the belief that performing physical activity is under one's control and may be easy (Bandura 1997). It is possible to increase people's self-efficacy by asking them to successfully perform a behaviour in a safe environment, recalling successfully performing it before, or seeing others perform the behaviour (Darker et al. 2010; French et al. 2014). Another factor that is important in the initiation of physical activity is a person's expectations that the activities will result in positive outcomes (van Stralen et al. 2010). These expectations may relate to health, social or other desired outcomes. People who have more social goals may choose activities such as group walks, whereas those who are concerned about falling may choose more structured programmes that directly address balance. Importantly, where people are satisfied with the outcomes they originally desired, they are more likely to continue regular physical activity (Kassavou et al. 2014).

As people get older, they are less interested in improving their health, but more interested in retaining the health and capacities they already possess (Lockenhoff and Carstensen 2004). Given this, it is important for physical activity programmes to reassure potential participants that they are unlikely to incur injuries or otherwise harm themselves. Equally, rather than promoting physical activity programmes on the basis of health improvements, many people will be more interested in activities that they view as being intrinsically enjoyable, such as interactions with other people who are also performing the activities (Devereux-Fitzgerald et al. 2016). These group activities are likely to be satisfying and become habitual through repetition (Gardner 2013). Women tend to engage more with walking groups (Kassavou et al. 2013), while men may tend to value sports, especially if it relates to teams they support (Hunt et al. 2014). As well as these individual factors, participation in physical activity is more likely when significant others approve, when people have larger social networks and when social norms amongst their peers includes being physically active (Koeneman et al. 2011; van Stralen et al. 2010). Similarly, at the wider societal level, more people are likely to be physical activity when costs are low and a wide variety of physical activity opportunities are available (Sallis and Owen 1998). Finally, physical activity can be stimulated by features of the built environment, such as safe foot- or cycle-paths and parks, and societal norms and practices that contribute to increased physical activity (Sallis and Owen 1998).

Conclusions

The evidence shows that regular physical activity is safe for healthy and for frail older people and the risks of developing major cardiovascular and metabolic diseases, obesity, falls, cognitive impairments, osteoporosis and muscular weakness are decreased by regularly completing activities ranging from low intensity walking through to more vigorous sports and resistance exercises. Yet, participation in physical activities remains low amongst older adults, particularly those living in less affluent areas. Older people may be encouraged to increase their activities if influenced by clinicians, family or friends, keeping costs low and enjoyment high, facilitating group-based activities and raising self-efficacy for exercise.

References

Age UK (2010) Healthy ageing evidence review. http://www.ageuk.org.uk/Documents/EN-GB/For-Professionals/Health-and-wellbeing/EvidenceReviewHealthyAgeingpdf?dtrk=true. Accessed 8 June 2015

Age UK (2015) A practical guide to healthy ageing. http://www.england.nhs.uk/wp-content/uploads/2015/01/pract-guid-hlthy-age.pdf. Accessed 08 July 2015

Bandura A. Self-efficacy: the exercise of control. New York: Freeman; 1997. [Google Scholar]

Banks J, Breeze E, Lessof C, Nazroo J (2006) Retirement, health and relationships of the older population in England: the 2004 English longitudinal study of ageing. The Institute for Fiscal Studies, London. ISBN 1 903274 46 X

British Geriatric Society (2014) Fit for frailty: consensus best practice guidance for the care of older people living with frailty in community and outpatient settings. http://www.bgs.org.uk/campaigns/fff/fff_full.pdf. Accessed Feb 2016

Campbell K, Foster-Schubert K, Xiao L, Alfano C, Bertram LC, Duggan C, Irwin M, McTiernan A. Injuries in sedentary individuals enrolled in a 12-month, randomized, controlled, exercise trial. J Phys Act Health. 2012;9:198-207. [[PMC free article] [PubMed] Google Scholar]

Department for Culture MaS (2011) Adult participation in sport: analysis of the taking part survey. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/137986/tp-adult-participation-sport-analysis.pdf. Accessed 10 July 2015

Department of Health UK (2011) Start active, stay active: UK Physical Activity Guidelines. Department of Health, UK http://www.dh.gov.uk/health/category/publications/

Devereux-Fitzgerald A, Powell R, Dewhurst A, French D (2016) The acceptability of physical activity interventions to older adults: a systematic review and meta-synthesis. Soc Sci Med (in press) [PubMed]

Eurostat (2014) Projected old-age dependency ratio (tsdde511)

Eurostat (2015) Deaths and life expectancy data. http://eceuropaeu/eurostat/web/population-demography-migration-projections/deaths-life-expectancy-data. Accessed 15 Feb 2016

Gardner B. Promoting habit formation. Health Psychol Rev. 2013;7(supplement):137-158. [Google Scholar]

Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146. [[PMC free article] [PubMed] Google Scholar]

Marmot M, Banks J, Blundell R, Lessof C, Nazroo J (2003) Health, wealth and lifestyles of the older population in England: the 2002 English longitudinal study of ageing. The Institute for Fiscal Studies, London. ISBN 1 903274 34 6

Matthews K, Demakakos P, Nazroo J, Shankar A (2014) The evolution of lifestyles in older age in England. In:, Banks J, Nazroo J, Steptoe A (eds) The dynamics of ageing: evidence from the English longitudinal study of ageing 2002-2012. The Institute for Fiscal Studies, London. ISBN 978-1-909463-58-5, 51-93

Nazroo J, Zaninotto P, Gjonça E. Mortality and healthy life expectancy. In: Banks J, Breeze E, Lessof C, Nazroo J, editors. Living in the 21st century: older people in England. The 2006 English longitudinal study of ageing. London: The Institute for Fiscal Studies; 2008. pp. 253-288. [Google Scholar]

NICE (2009) Rehabilitation after critical illness: NICE guideline National Institute for Health and Clinical Excellence. http://guidance.nice.org.uk/CG83/Guidance/pdf/English

ONS (2013) General health (General lifestyle survey overview-a report on the 2011 general lifestyle survey) Office for National Statistics (UK). http://www.ons.gov.uk/ons/dcp171776_302351.pdf. Accessed 17 Sep 2014

Rikli R, Jones C. The reliability and validity of a 6-min walk test as a measure of physical endurance in older adults. J Ageing Phys Act. 1998;6:363-375. [Google Scholar]

Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol. 2013;3:1-58. [[PMC free article] [PubMed] Google Scholar]

Sallis J, Owen N. Physical activity and behavioral medicine. Thousand Oaks: Sage; 1998. [Google Scholar]

Sport-England (2006) Understanding participation in sport: what determines sports participation among recently retired people? http://www.sportengland.org/media/39497/understanding-participation-among-recently-retired-people.pdf. Accessed 29 Sept 2014

WHO (2010) Global recommendations on physical activity for health World Health Organisation. http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/

Articles from Biogerontology are provided here courtesy of Springer

# data[].attributes.attachment_link.title
Physical activity in older age: perspectives for healthy ageing and frailty

# data[].attributes.attachment_link.description
Regular physical activity helps to improve physical and mental functions as well as reverse some effects of chronic disease to keep older people mobile and independent. Despite the highly publicised benefits of physical activity, the overwhelming majority ...

# data[].attributes.headline
Website/list of community resources for senior citizens 

# data[].attributes.subject
Website/list of community resources for senior citizens 

# data[].attributes.attachment_link.readable_text
Supervised Nursing Care

Under the direct supervision of our Wellness Director and Licensed Practical Nurses, each home at Heritage Point of Tulsa will be well-staffed with trained and experienced medication and nursing aides, 24 hours a day. Along with the nurses, these aides provide ongoing assistance with any needed care and services for each individual resident as well as engaging them in life activities every day.

We have a nurse call system that not only helps to keep our residents safe and secure, but also allows them the opportunity to get assistance quickly when needed. In addition, our smaller, home environment allows our nursing staff to be regularly interacting with our residents allowing for more personalized care and the opportunity for residents to form strong, trusting relationships with staff.

Offering Ongoing Care & Support

Operating within the guidelines provided by the State of Oklahoma, we offer ongoing nursing care for people up to and through end of life. Our goal is to make available whatever support services are necessary to provide our residents with a safe and comfortable environment that they can enjoy. Most often, our trained associates can directly provide these services and amenities. However, there are some circumstances where it may be necessary to have an outside service provide the extra attention needed to keep a resident safe. If that situation were to arise, our associates can be a helpful resource and will assist families in coordinating any additional assistance.

# data[].attributes.attachment_link.description
Nursing Care Supervised Nursing Care Under the direct supervision of our Wellness Director and Licensed Practical Nurses, each home at Heritage Point of Tulsa will be well-staffed with trained and experienced medication and nursing aides, 24 hours a day.

# data[].attributes.attachment_link.readable_text
You'll Get an Instant Cost Estimate for Your Funeral Plan

Complete a simple "Quick Plan" in just a few minutes. Save your plan!

You'll instantly get estimated funeral costs based on surveys of U.S. funeral home prices.

No Obligation - Do-It-yourself Planning. You will not be called.

Funeral Planning Your Way - the Smart Way to Plan.

Free Guides When You Complete a Quick Plan

Get Our Entire Series of Word to the Wise Guides. These handy reference guides cover a variety of topics in an easy-to-understand manner.

Just complete a Quick Plan (and save it) to receive your complementary guides.

See how to do your Funeral Planning with our Wise Planning System

Want more information? Check out this article on funeral planning.

# data[].attributes.attachment_link.title
Free Funeral Planner and Cost Estimator | Funeralwise.com

# data[].attributes.attachment_link.description
Complete a simple "Quick Plan" in just a few minutes. Save your plan! You'll instantly get estimated funeral costs based on surveys of U.S. funeral home prices. No Obligation - Do-It-yourself Planning. You will not be called. Funeral Planning Your Way - the Smart Way to Plan.

# data[].attributes.attachment_link.description
Find home health services in your area * Discuss insurance, Medicare and answer other concerns about eligibility, costs and payment options * Discuss your unique situation to determine your care options and the most appropriate types of services for you or a loved one

# data[].attributes.attachment_link.description
Hospice definition, a house of shelter or rest for pilgrims, strangers, etc., especially one kept by a religious order. See more.