Patricia M. Burbank

Exercise and older adults: changing behavior with the transtheoretical model.

The loss of muscle strength, decreased flexibility and range of motion, and decreased sense of balance that frequently accompany aging contribute to falls and functional decline. Even in advanced old age, one can improve strength, decrease the risk of falls, improve cardiorespiratory fitness, and improve ability to live independently. The Transtheoretical Model (TTM) of behavior change is an internationally recognized model that holds much promise for health behavior changes of all types. This article outlines the effects of exercise on age-related changes in the musculoskeletal system and describes the TTM as a model useful to help older adults change their exercise behavior. Research studies are documented that support the effectiveness of the TTM in changing behavior. Application of the model is described with specific examples illustrated in two case studies.

Changing health behaviors of older adults

1. Changing lifelong unhealthy habits can have a positive effect on health for older adults. 2. The Transtheoretical Model of behavior change proposes people move through a series of five stages and use a variety of processes as they attempt to change a behavior. 3. Research has shown that tailoring interventions to a individuals stage of change is most effective in promoting behavior change. 4. Specific stage-based strategies are recommended for nurses to use with both individuals and groups of older adults.

Physical activity, physical function, and stages of change in older adults.

OBJECTIVE To characterize physical activity and physical function by stage of change and age in older adults. METHODS One thousand two hundred thirty-four individuals completed The Yale physical activity survey (YPAS), stage of change for exercise, and the Up-and-Go physical function test. RESULTS Most subjects were in the maintenance (50.4%) or precontemplation stages (21/0%). YPAS scores were higher and Upand-Go scores were lower as exercise stage increased. Physical activity and physical function scores were lower in older age groups. CONCLUSION Higher stages were positively associated with physical activity and physical function. Age was a significant moderator variable affecting stage, physical activity, and physical function.

Accumulation of Behavioral Validation Evidence for Physical Activity Stage of Change

OBJECTIVE The purpose of this study was to accumulate behavioral validity evidence for physical activity Stage of Change (SOC). DESIGN Nine studies used a common physical activity SOC measure and examined self-report, objective, and performance physical activity indicators to accumulate behavioral validity evidence for SOC. Type of measure, the strength of the expected relationship between the measure and SOC, and the predicted SOC differences were examined. Validity evidence for the SOC was also examined by population and sampling method. MAIN OUTCOME MEASURES Validity evidence for physical activity SOC was classified with respect to the type of measurement instrument and the hypothesized magnitude of the relationship between the measure and the SOC. RESULTS Physical activity SOC was found to be behaviorally valid as evidenced by self-reported physical activity, self-reported exercise, self-reported sedentary behaviors, pedometers, and physical functioning. Physical activity SOC does not appear to be related to physical fitness or weight indicators. CONCLUSIONS This study highlights a successful multi-site collaboration. Physical activity data from nine large-scale, health trials was combined and accumulated behavioral validation evidence for the physical activity SOC.

An Exploratory Study: ASSESSING THE MEANING IN LIFE AMONG OLDER ADULT CLIENTS

Meaning in life has been intimately linked to health, but it has not been explored in an elderly population. The factors that elderly people perceive as being meaningful must be identified, as well as the extent to which they experience fulfillment of meaning in their lives. The majority of study participants indicated that relationships give meaning to their lives; however, nurses must individually assess clients regarding what is most meaningful to them. Clients without meaning or low levels of meaning need to be identified. As nurses become more aware of what is meaningful to older people, they can plan and carry out interventions based on interaction to support or improve areas meaningful to the older person.

Psychosocial theories of aging: a critical evaluation.

Three major psychosocial theories of aging—activity theory, disengagement theory, and continuity theory—are summarized and evaluated. Some important problems are identified with each of the theories when the criteria of intersubjectivity of meaning, testability, and empirical adequacy are utilized in the evaluation process. An analysis of relevant research shows that none of these three theories is clearly supported by empirical evidence. Because of the tentative nature and lack of conclusive support for each of these theories, further exploration and theory development is needed. It is suggested here that a phenomenological approach may be a more productive way to study the psychosocial aspects of aging.

What Do We Know About Resilience in Older Adults? An Exploration of Some Facts, Factors, and Facets

As the field of gerontology has become better established and developed more historical perspective and interdisciplinary depth, we can note a progression in thinking about concepts and theories of aging, what the experience of getting older means, and how it can be shaped as a process (e.g. Bengtson et al. 2008). Conceptual theses generate antitheses resulting in syntheses and new directions for research. So it is with the development of the concept of resilience with respect to older adults. Just as early research characterizing “normal” aging led to the excitement and enthusiasm surrounding the concept of “successful” aging, so, too, has this latter concept given way to the more recent concept of “resilience” in aging.

SENIOR CISE : A PRINT EXERCISE INTERVENTION FOR OLDER ADULTS

This study was conducted to examine the efficacy of an inexpensive educational print exercise intervention based on the Transtheoretical Model (TTM) for older adults. Secondary objectives of this study were to examine the quality of the print intervention and possible ways to improve it through survey techniques. This was a posttest survey design. Information about the Senior cise booklet was distributed to senior housing communities and recreation centers throughout Rhode Island. One hundred thirty-three posters and 5,280 pamphlets with return postcards for ordering the Senior cise booklet were delivered over a period of nine months. Individuals who requested the booklet were contacted via telephone two weeks following mailing to assess the efficacy and quality of the booklet. Ninety-eight individuals requested the booklet and 61 participants completed the evaluation (mean age = 73 - 5.3 years; 77.1% female). The majority of participants found the booklet of good quality, stated that it created an interest, and said it inspired them to actually engage in physical activity. Survey participants cited only a few main good points and negative points about the booklet in general. The use of an inexpensive educational print intervention (Senior cise ) based on the TTM was well received and successful in engaging older adults to consider and participate in physical activity. The positive and negative points cited about the booklet will allow other researchers a better insight into what can make educational print interventions successful. Experimental research designs are recommended to evaluate more fully the efficacy of future exercise based print interventions.This study was conducted to examine the efficacy of an inexpensive educational print exercise intervention based on the Transtheoretical Model (TTM) for older adults. Secondary objectives of this study were to examine the quality of the print intervention and possible ways to improve it through survey techniques. This was a posttest survey design. Information about the Senior cise booklet was distributed to senior housing communities and recreation centers throughout Rhode Island. One hundred thirty-three posters and 5,280 pamphlets with return postcards for ordering the Senior cise booklet were delivered over a period of nine months. Individuals who requested the booklet were contacted via telephone two weeks following mailing to assess the efficacy and quality of the booklet. Ninety-eight individuals requested the booklet and 61 participants completed the evaluation (mean age = 73 - 5.3 years; 77.1% female). The majority of participants found the booklet of good quality, stated that it created an intere...

Application of Critical Reflective Inquiry in Nursing Education

Critical reflective inquiry (CRI) is a method of inquiry developed by Kim (1999) to be applied in clinical practice to improve one’s practice as well as discover knowledge embedded in practitioner’s practice. The method is based on the philosophies and tenets of action science and critical philosophy, and encompasses three phases: descriptive, reflective, and critical. This chapter describes the application of CRI in a nursing education program with aims of instilling in students the mode of reflective practice and to learn not only through practicing in clinical situations but also from reflecting on and critiquing their clinical experiences. A qualitative analysis of a set of CRI reports revealed five themes in clinical practice that represented specific concerns and problems for the students. These five thematic areas are (a) client–nurse interaction and communication, (b) knowing the patient or patient identity, (c) nursing care, (d) ethics, and (e) interpersonal relationships with other health-care professionals. While these CRIs revealed the students’ insights into their own practice, students needed inputs from the faculty members to enrich their reflections and critiques. The findings of this analysis suggest that faculty members should consider these five areas as the basis for varying students’ clinical experiences so that students would gain experiences in a variety of problematic situations.

Health Correlates of Exercise Behavior and Stage Change in a Community-Based Exercise Intervention for the Elderly: A Pilot Study

The effects of a community-based physical activity intervention grounded in the Transtheoretical Model were investigated in a sample of older adults. The residents (n = 48, mean age = 78.24 ± 6.69, 90% female) of an independent living complex completed pre-and postintervention assessments, including physical, mental, and general health; nutrition; bodily pain; and stages of exercise behavior change. The intervention included posters with stage-based pamphlets (for inactive stages) and in-house exercise sessions (for active participants). The intervention resulted in high exercise maintenance and more progression than regression in exercise stage. More maintainers and progressers improved on the measured variables compared to relapsers. The stage model is a promising framework on which to base and evaluate interventions for this population. The overall impact of the intervention was positive, whether by providing the actual opportunity to exercise or by motivating other physical activity. These results also support the potential quality-of-life impact for this type of intervention in older adults.