Dias A. et al (2020) Psychomotor intervention in various areas of daily life of the elderly, Journal of Aging & Innovation, 9 (3): 184- 193 REVISÃO DE LITERATURA: Dias A. et al (2020) Psychomotor intervention in various areas of daily life of the elderly, Journal of Aging & Innovation, 9 (3): 184- 193
Revisão Literatura
Psychomotor intervention in various areas of daily life of the elderly Intervención psicomotora en diversos ámbitos de la vida diaria De las personas mayores Intervenção psicomotora em várias áreas da vida quotidiana do idoso Ana Dias1, Andreia Abalroado1, Inês Oliveira1, Madalena Grilo1, César Fonseca1,2 [0000-0001-6975-612X], Isabel Nunes3, Vítor Santos 4 1
University of Évora, Portugal
2
University of Évora, Comprehensive Health Research Center, POCTEP 0499_4IE_PLUS_4_E, Évora, Portugal ACES Loures-Odivelas, UCC Saúde a Seu Lado, Odivelas, Portugal. 4 RN, CNS, MsC, São Peregrino, Centro Hospitalar do Oeste Corresponding Author: isabel.nunes.fonseca@gmail.com 3
Abstract Nowadays, the population is getting older and older, at an accelerated pace, thus compromising skills in the basic activities of daily life due to the presence of pathologies and/or the accumulation of physical, cognitive and emotional deficits. Thus, our concern was to realize the benefits obtained by psychomotor intervention in this population in order to facilitate the performance of daily life activities. Objective: To understand how psychomotor intervention in different contexts can be beneficial in the daily life activities of the elderly. Methodology: The electronic database used focused on EBSCO, where the following descriptors were researched: [(elderly)] AND [(psychomotor)] AND [(intervention)]. It included interventions mainly focused on motor areas as well as cognitive areas, highlighting the activities of daily living of the elderly (ADL'S), balance control, executive functions and emotions. Results: Through the studies analyzed and taking into account the objective of this review, it is verified that there are gains and reduction of difficulties due to the interventions made. It is also possible to describe some difficulties experienced by the elderly in ADL's and difficulties due to locomotor disorders. Conclusions: A motor-only intervention does not prove to be beneficial, and there is a need to combine motor and cognitive intervention, using devices for help, personal assistance and accommodation of living conditions. Keywords: Psychomotor intervention; elderly; executive functions; balance; emotions.
Resumo Atualmente, a população está envelhecendo cada vez mais, em ritmo acelerado, comprometendo as habilidades nas atividades básicas da vida diária devido à presença de patologias e / ou ao acúmulo de déficits físicos, cognitivos e emocionais. Assim, nossa preocupação foi perceber os benefícios obtidos pela intervenção psicomotora nessa população a fim de facilitar o desempenho das atividades de vida diária. Objetivo: Compreender como a intervenção psicomotora em diferentes contextos pode ser benéfica nas atividades de vida diária de idosos. Metodologia: O banco de dados eletrônico utilizado teve como foco a EBSCO, onde foram pesquisados os seguintes descritores: [(idosos)] AND [(psicomotor)] AND [(intervenção)]. Incluiu intervenções voltadas principalmente para as áreas motoras e também cognitivas, com destaque para as atividades de vida diária do idoso (AVD's), controle do equilíbrio, funções executivas e emoções. Resultados: Por meio dos estudos analisados e levando em consideração o objetivo desta revisão, verifica-se que há ganhos e redução das dificuldades em decorrência das intervenções realizadas. Também é possível descrever algumas dificuldades vivenciadas pelos idosos nas AVD's e dificuldades devido aos distúrbios locomotores. Conclusões: A intervenção apenas motora não se mostra benéfica, havendo necessidade de conjugar intervenção motora e cognitiva, utilizando dispositivos de ajuda, assistência pessoal e acomodação das condições de vida. Palavras-chave: Intervenção psicomotora; idosos; Funções executivas; Saldo; emoções.
JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3) ISSN: 2182-696X http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-10
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INTRODUÇÃO
Aging is a process that occurs throughout the life cycle and affects all human beings. More than chronological age, this is a complex and dynamic process where biological, psychological and social changes occur [1]. It is determined by intrinsic and extrinsic factors to the individual, that is, it is a process conditioned by biological, psychic and social factors and, the interaction between them [1]. It can also be characterized as a dynamic, progressive and irreversible phenomenon. The passage of time results in the loss of certain functionalities that had been acquired during the maturation process, and is reflected in a biopsychosocial approach. The biological aging results from the changes operated in the organism due to the effects of the advanced age, making the individual more difficult to maintain the balance, the posture, the easiness in the movement and, that there is a decrease of the organic functions. In this perspective, the organism has a greater difficulty in responding to the challenges it faces daily, efficiently. On a psychological level, aging is associated with decadence and alteration of psychological aptitudes. These changes are the result of emotional and cognitive changes that occur in the individual. Regarding the social level, this is affected by the society in which the individual is inserted and is reflected in the transformation of social roles in the context [2]. The aging process can still be understood through three subdivisions being them: primary aging, secondary aging and tertiary aging. The first, also known as normal or healthy aging, concerns the intrinsic and irreversible changes that occur along this developmental period and, reach the organism in a gradual and progressive way [3]. The secondary or pathological aging, is related to the diseases that appear in the course of the process and that are associated to the age, but that are reversible or of possible prevention [3]. Tertiary or terminal aging, on the other hand, refers to the changes that occur precipitously in old age and that imply that just before death there is a rapid and sharp decline [4]. According to WHO (2002), autonomy is the perceived ability to control/deal with situations and make decisions about daily life, according to one's own rules and preferences [5]. Thus, the elderly need greater autonomy to acquire a better quality of life. The concept of quality of life is defined as an individual perception of position in life, in the context of the cultural system and values in which people live and related to their objectives, expectations, norms and concerns [6]. It is a broad, subjective concept, which includes in a complex way physical health, psychological state, level of independence, social relations of the person, personal beliefs and convictions and its relationship with the important aspects of the environment [6].
JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3) ISSN: 2182-696X http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-10
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These two concepts, of autonomy and quality of life, have a direct relationship, as well as the concept of independence. Independence, according to WHO, is the ability to perform functions related to daily life, that is, the ability to live independently in the community without or with little help from others [5]. The United Nations reports that 14% of people aged 60 and over were 80 or older in 2015, and this percentage is expected to rise to 21% by 2050. In Portugal, individuals aged 80 and over represent 5.6% of the total population and 26.5% of the elderly population. [7] Older people constitute a group in which physical reserves are decreasing and their participation in the basic activities of daily living deteriorates with increasing fragility. [8] One of the main factors limiting the life of the elderly on a daily basis is the imbalance. In 80% of cases it cannot be attributed to a specific cause, but to a compromise of the balance system as a whole. In more than half of the cases, the imbalance originates between 65 and 75 years old approximately and about 30% of the elderly present the symptoms at this age [9]. A study aimed at characterizing the causes and consequences of falls among the elderly, associating them with a socio-demographic and health profile, interviewed 73 elderly at home, with a trauma diagnosis (
ICD-10). Most of the falls occurred among women
(67.1%) with an average age of 76.2 years. There was a predominance of trauma in lower limbs (73.9%), surgical treatment (91.8%) and a mean hospital stay of 14.2 days. 41.1% referred to a single fall at home, 35.6% while walking and 80.8% of their own height; 60.6% referred to the environmental factor as causing the event. The main consequences cited were: fear of falling again (75.3%), loss of independence (50.7%) and change of habits (45.2%) [10] The current literature review aims to see how psychomotor intervention significantly improves the practice of the activities of daily life of the elderly, and consequently, in the execution of their basic daily tasks. Thus, it would be pertinent to realize how this intervention contributes to the executive functions, emotions and balance of elderly. As future psychomotricists we will be able to intervene in all age groups including, therefore, the older population, which makes us interested in the gains that the psychomotor intervention can obtain in the various contexts of daily life of this population. Subsequent paragraphs, however, are indented. Methodology For the elaboration of the present literature review, the following PICO question was first elaborated: For people 65 years old and older, what are the psychomotor gains that influence the activities of daily life in promoting quality of life and autonomy?
JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3) ISSN: 2182-696X http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-10
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The electronic database used was EBSCO (MEDLINE with Full TEXT, CINAHL with Full Text), where the following descriptors were searched: [(elderly)] AND [(psychomotor)] AND [(intervention)]. The descriptors were researched in full text since 2020, retrospectively until 2014, and four articles were selected. According to the inclusion criteria, articles focused on the dependence of the elderly in daily life, using a quantitative and/or qualitative methodology that clarifies the intervention in the elderly. Regarding the participants (P) were included elderly with pathologies and without associated pathologies; regarding the intervention, were included interventions mainly focused on motor areas as well as cognitive areas, highlighting the activities of daily life of the elderly (ADL'S), balance control, executive functions and emotions. Regarding the intervention (I), the interventions in the daily life activities of the elderly were included, articles demonstrating the results of the interventions in the dependence of the elderly in the ADL'S. The exclusion criteria include all articles with ambiguous or repeated methodology in both databases, all those with no correlation with the subject of study and with a date prior to 2014.
Results In table 1 the main results found are systematized. Table 1. Summary of articles included Author / Level of evidence
Objectives
Results
Author: Sakamoto et al.,
Present algorithms
A total of 38 participants (22.1%)
2014 [11]
for use in clinical
had difficulty in performing basic
Methodology:
practice and field
ADL after two years. The
experimental study
scenarios to detect
analyses of each basic ADL item
Participants: 172 senior
elderly individuals
showed that 36 participants
citizens ≥ 75 years
who should take
(20.9%) had difficulty in going up
Level of evidence: V
disability precautions
and down stairs, 25 (14.5%) in
within a few years.
walking, 11 (6.4%) in bathing, nine (5.2%) in dressings, nine participants (5.2%) with hygiene, five participants (2.9%) with food and five participants (2.9%) with the bathroom.
JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3) ISSN: 2182-696X http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-10
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Author: Hagovská &
Examine the
After the training, five significant
Olekszyová, 2016. [12]
relationship between
correlations were found in the
Methodology:
balance control and
experimental group (balance
experimental study
cognitive functions,
control and visuomotor
Participants: 80 elderly
walking speed and
coordination, psychomotor
with mild cognitive
the activities of daily
speed, walking speed with and
impairment Level of
life
without cognitive tasks and
evidence: III
activities of daily life), in the control group, a significant correlation between balance control and walking speed was found.
Author: Iwaya et al., 2017
Report the
The number of activity limitations
[13]
characteristics of
and the degrees of each activity
Methodology:
activities of daily
limitation were significantly
experimental study
living deficiencies in
higher at high levels than at low
Participants: 314 people
elderly people with
levels. Difficulties in mobility
aged 65 and over, from five
locomotor disorders
appeared at a less severe level,
orthopedic clinics or nursing
in terms of number
difficulties in domestic and social
care facilities.
and degree of
life appeared at a moderately
Level of evidence: V
activity limitation.
severe level and difficulties in self-care appeared at an advanced level.
Author: Piadehkouhsar et
To investigate the
There were differences in the
al., 2019 [14]
effect of the ADL-
intervention group regarding
Methodology :
based orientation
depression, anxiety and stress
experimental study
program on
after one month of intervention
Participants: 65 elderly
depression, anxiety
and two months after compared
people from five homes in
and stress among
to the pre-intervention reality.
Tehran. 32 in the control
the elderly.
The intervention with daily life
group and 33 in the
activities significantly reduced
experimental group.
stress, but did not show
Level of evidence: III
improvements in depression.
JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3) ISSN: 2182-696X http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-10
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Discussion In the study by Sakamoto et al. (2014) no significant relationships were observed between functional parameters in the elderly and hypertension, diabetes, dyslipidemia, smoking and obesity. [11] Among the various geriatric goals, it was reported that elderly patients prioritized "reducing disability" and "improving QL" rather than "reducing mortality. This study and its results demonstrate that they should "treat not a disability, but a person". [11] Elderly people aged 85 years or older are a significant predictor of difficulties in performing basic ADL's.[15] The implications of an age ≥ 85 years may vary according to time, area and history, genetic, among others. In fact, some authors indicate that a person's functional profile is interrelated with their sociodemographic context, which includes age [15], [16] Hagovská & Olekszyová (2015), aimed to understand the relationships between balance control and cognitive functions, during a 10-week cognitive-motor program, and the speed of walking and activities of daily living (ADL) were also taken into account. In this study both the experimental group (EG) and the control group (CG) were submitted to interventions, although different. All participants had a mild cognitive impairment. The following physical tasks were part of the program: motor training, walking over obstacles, walking with changes in direction and speed, walking with a load, and finally going up and down stairs. At the cognitive level the following components were evaluated: attention intensity, long-term memory and working memory, executive functions and visuomotor coordination. After the program ended five significant correlations were found in the EG, in the capacity of balance control and visuomotor coordination, psychomotor speed, walking speed with and without cognitive tasks and, activities of daily life. In the CG, a correlation was found between balance and walking speed. In the EG a relationship between acceleration of psychomotor rhythm and reduction of reaction time and improvement in balance could be observed, and also a relationship between reduction of reaction time in the visuomotor coordination test and balance control. In both groups the improvement in walking speed, having increased, and in equilibrium were registered in unique tasks. In double task, only in the EG there were improvements in running speed in equilibrium. These improvements are due to the training of attention intensity and executive functions. Still in this group, it was found that improvements in balance interfered in ADL, and its execution also improved [12]. Another study found that the deceleration of the walking speed was related to the decrease of the executive functions which led to an inability to perform the ADL. A relationship was also found between increasing the control of the balance and improving the execution of ADL [17] Iwaya et al. (2017) included in their study elderly people with locomotor disorders and presented difficulties in the activities of daily life. The participants in this study were considered adapted to people who were in the condition corresponding to the concept of JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3) ISSN: 2182-696X http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-10
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locomotive syndrome [13]. Disability in daily life activities is an adverse result of the fragility that overloads the elderly, families, caregivers and the care system. Physical fragility is a special form of fragility defined as a medical syndrome with multiple causes and contributors, characterized by decreased strength, endurance and reduced physiological function that increases the individual and vulnerability to the development of greater dependence and/or death. The concept of locomotive syndrome (LoS) is one of the potential causes of physical fragility and the target state in locomotor organs, developed to control the increase of elderly people who need assistance from others. The results of the study show significant relationships of the level of disability with the number and severity of activity limitation. The results also show that the worsening of the level of disability for the activities of daily life is associated with the number of activity limitations and the deterioration of the difficulty in performing activities. Reducing the number of activity limitations and/or improving the difficulties in daily activities may contribute to the recovery of disability. The results of the study revealed that people with mild limitations in daily life activities experienced mild difficulties in mobility activity and people with advanced limitations revealed moderate to severe difficulties in mobility activity and mild difficulty in self-care activities [13]. Piadehkouhsar et al. (2019) demonstrated that demographic characteristics and ADLs can have an influence on depression, anxiety and stress and were therefore distributed between the control group and the experimental group. The program used was effective in reducing the level of stress in the elderly. The decrease in the average stress in the experimental group may be related to the fact that the program includes ADL's. This program also had a positive effect on the anxiety of the elderly, and reduced in the intervention group, which may be due to the presence of regular activities. However, the decrease in anxiety may be because there is anxiety only in the performance of ADL's and not as a general trait of anxiety. The results also showed the reduction of depression symptoms in the experimental group. They concluded that by increasing the activity and mobility of the elderly during one month of follow-up, they reduce their psychological problems such as anxiety, stress and depression. However, the effect of the program on depression is not stable which can be due to the home/day center where the elderly meet, since their routines are conditioned by the times stipulated in these centers such as eating, sleeping, getting up, among others. They also have less freedom, less support from family and friends, which can influence the results. The fact that they are accompanied during the intervention program has reduced their loneliness, lowering the levels of depression. After the program they are no longer accompanied, which causes the depression levels to rise again. It can be concluded that the elderly need a permanent follow-up, in addition it takes a long time for the depression to
JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3) ISSN: 2182-696X http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-10
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decrease and this program is not very effective in the long term due to its duration. Individual and personality differences can also have an influence on [14]. Through the studies mentioned above and taking into account the objective of this review, it can be seen that there are gains [14] and reduction of difficulties due to the interventions made [12]. It is also possible to describe some difficulties experienced by the elderly in ADL's [11] and difficulties arising from locomotor disorders [13].
We also extract some result indicators that can be visualized in table 2. Table 2 - Variables and result indicators of the articles VARIABLES Physical capacity
Self-care
Cognitive function
INDICATORS •
Mobility[11] o
Climb stairs
o
Go down the stairs
o
Walk
•
Balance control [11]
•
Gait velocity [11]
•
Visuomotor coordination [12]
•
Bath [11]
•
Dressings [11]
•
Hygiene [11]
•
Eating [11]
•
Independent bathroom [11]
•
Depression [14]
•
Anxiety [14]
•
Stress [14]
Conclusion
Based on the articles analyzed, we concluded that physical exercise, with the objective of regaining the ability to walk, is efficient to avoid the deterioration of disability in activities of daily life and that, together with the orientation program based on these, it can be beneficial in depression, anxiety and stress in the elderly. The disability may deteriorate as the activity limitation increases and worsens. This can occur in a certain order such as: sports activity, walking, transference and self-care.
JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3) ISSN: 2182-696X http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-10
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There is a significant relationship between balance control, cognitive functions, walking speed and execution in ADL's. A motor-only intervention does not prove beneficial, there is a need to combine motor intervention with the cognitive, using devices for help, personal assistance and accommodation of living conditions.
Implications for the practice In a psychomotor intervention, we intend to work at the level of the various psychomotor factors and the most varied difficulties of the elderly. However, and taking into account the results obtained in the analyzed studies, there is a great need for work at the level of physical capacity (mobility, balance, postural control, coordination, etc.) and self-care (bath, hygiene, food, etc.). It is also necessary to intervene at a cognitive level since there is a high prevalence of depression, anxiety and stress in the elderly population. Regarding future studies, there is a need for more research on the role of motivation of the elderly and its consequence in the realization of ADL'S.
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JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3) ISSN: 2182-696X http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-10
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