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Vieira C. et al; (2020) Importance of movement for elderly people in a psychomotor reality, Journal of Aging & Innovation, 9 (3): 264- 278 REVISÃO SISTEMÁTICA: Vieira C. et al; (2020) Importance of movement for elderly people in a psychomotor reality, Journal of Aging & Innovation, 9 (3): 264- 278

 Revisão Sitemática

Importance of movement for elderly people in a psychomotor reality Importancia del movimiento para las personas mayores en una realidad psicomotora Importância do movimento para os idosos em uma realidade psicomotora

Ana Marques1, Carolina Sousa1, Catarina Mendes1, Joana Cavaco1, João Semedo1, Maria Raquel Ferreira1, Marina Andrade1, César Fonseca1,2 [0000-0001-6975-612X], Isabel Nunes3, Vítor Santos4 1

University of Évora, Portugal

2

University of Évora, Comprehensive Health Research Center, POCTEP 0499_4IE_PLUS_4_E, Évora, Portugal Polytechnic Institute of Portalegre, Portalegre, Portugal 3 ACES Loures-Odivelas, UCC Saúde a Seu Lado, Odivelas, Portugal 3

4

RN, CNS, MsC, São Peregrino, Centro Hospitalar do Oeste

Corresponding Author: vitorsantos.speregrino@gmail.com

Abstract Aging can cause various changes at the physical, motor and cognitive levels. These deficits will, in the long run, cause a loss of autonomy and functionality of the individual. We intend to emphasize the importance of psychomotor practice, through its various aspects and possibilities of action that will bring benefits to the elderly. Thus, for the gains of psychomotor intervention to be demonstrated, explained and understood, it is expected that there will be a greater adherence and probably a greater recognition and investment in the area.

Objective: To understand the gains that people 65 years and older can have with psychomotor intervention.

Methods: A systematic literature review was performed through the EBSCO host (MEDLINE with Full Text, CINAHL with Full Text) and Google Scholar. As inclusion criteria, articles focused on psychomotor intervention that clarified the gains of this intervention in the quality of life of the elderly were given priority.

Results: Psychomotor intervention has numerous benefits in the elderly population, whether physical, motor or cognitive. This intervention provides a better quality of life, helps in the prevention of diseases, enabling the elderly to interact socially and live different experiences.

Conclusion: Psychomotor intervention is a very significant resource that should be used in the intervention with elderly people.

Keywords: aging; elderly; psychomotor intervention; gerontomotricity; cognitive functions; motor functions; quality of life

Resumo O envelhecimento pode causar diversas alterações nos níveis físico, motor e cognitivo. Esses déficits irão, a longo prazo, causar uma perda de autonomia e funcionalidade do indivíduo. Pretendemos enfatizar a importância da prática psicomotora, por meio de seus diversos aspectos e possibilidades de atuação que trarão benefícios aos idosos. Assim, para que os ganhos da intervenção psicomotora sejam demonstrados, explicados e compreendidos, espera-se que haja uma maior adesão e provavelmente um maior reconhecimento e investimento na área.

Objetivo: compreender os ganhos que pessoas com 65 anos ou mais podem ter com a intervenção psicomotora.

JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3)  ISSN: 2182-696X  http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-16

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REVISÃO SISTEMÁTICA: Vieira C. et al; (2020) Importance of movement for elderly people in a psychomotor reality, Journal of Aging & Innovation, 9 (3): 264- 278 Métodos: Foi realizada uma revisão sistemática da literatura por meio do host EBSCO (MEDLINE com Texto Completo, CINAHL com Texto Completo) e Google Scholar. Como critérios de inclusão, foram priorizados artigos com enfoque na intervenção psicomotora que esclarecessem os ganhos dessa intervenção na qualidade de vida dos idosos.

Resultados: A intervenção psicomotora traz inúmeros benefícios na população idosa, sejam eles físicos, motores ou cognitivos.

Essa intervenção proporciona uma melhor qualidade de vida, auxilia na prevenção de doenças, possibilitando ao idoso a convivência social e a vivência de diferentes experiências.

Conclusão: A intervenção psicomotora é um recurso muito significativo que deve ser utilizado na intervenção com pessoas idosas.

Palavras-chave: envelhecimento; idosos; intervenção psicomotora; gerontomotricidade; Funções cognitivas; funções motoras; qualidade de vida

1) Introduction In 2018, Portugal had 2,228,750 people over 65 years, in 1971 this population was 836,058 (1), with a clear growth, expected to triple by 2050 (2). Socio-economic development has led to an increase in the elderly population due to a steady reduction in fertility rates and an increase in average life expectancy (3). This increase results from the improvement of the health system in the country, which consequently faces new challenges in terms of health care for elderly people (4).

Aging brings about countless changes in the lifestyle of each individual, sometimes disabling, which result in maladaptation and inability to respond to these changes, causing a decrease in the quality of life of the elderly (3,5,6). Quality of life is defined as the individual's perception of life, taking into account the cultural context and its principles, as well as goals, expectations and ideas, being influenced by physical and psychological health and degree of dependence, social relationships, personal beliefs and relationships with the environment.

This population is fragile, being more vulnerable to adverse health states and consequently to greater dependency (7). We have seen an increase in the development of chronic diseases and a decrease in functional capacity, which implies both the structures and functions of the body and the limitations of activity and participation (8). All these factors have as consequence and at the same time are a consequence, of a less active, more sedentary lifestyle (9,10). Valuing care and interventions in this population not only contributes to improving the quality of life of the elderly but also that of their caregivers, many of them also being elderly (11). Thus, it becomes essential to intervene in self-care, since it allows to maintain the health and well-being of the elderly person (12,13).

Most of the disabilities to which the elderly are subject can be prevented, postponed or treated (9), through therapies and practices, namely psychomotricity. This seeks to promote not only the motor area, but also cognitive and emotional (at the level of executive functions and emotions).

JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3)  ISSN: 2182-696X  http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-16

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For the intervention to be effective it is necessary to take into account that the effects of activities, which combine both the motor and cognitive aspects, contribute to a greater success of the interventions (10), and each elderly person should have an intervention specifically tailored to their needs.

The interest in this research comes from the knowledge that many times elderly people lose abilities, not only due to the inevitable action of time, but because it is not carried out with them a work of prevention and maintenance of motor skills, cognitive and affective/emotional (14). In fact, there are more and more cases of elderly people who lose function because they are not stimulated to act (9). Thus, an intervention focused on these areas could prevent the consequences of a sedentary lifestyle, delaying or even eliminating dependence.

Inactivity increases the possibility of developing depressions or other disorders (14) and psychomotor rehabilitation work can have a positive impact on this aspect, since the intervention gives primacy to the touch, as a mediator, and this "shapes the release of neurotransmitters, resulting in an increase in serotonin and dopamine and a decrease in the concentration of substance P, which can help relieve pain and depression"(15). Through psychomotor intervention it is possible to promote an activation of body structures and body consciousness which will allow the elderly to recognize their body limits as well as the new abilities resulting from the aging process (6) which will lead to an increase in the notion of their functional capabilities and thus a better and more adequate performance in daily activities.

Another important factor for this review is the fact that psychomotor skills is a comprehensive field, usually more associated with intervention with children, but it can have benefits in all age groups, especially the elderly, and it is in our interest and responsibility to warn of this fact. Gerontopsychomotrocity is the psychomotor practice for elderly people, "which allows us to attenuate the inevitable changes of aging, assuming itself as a method of re-education of psychomotor, cognitive and emotional disorders" (16). It uses techniques of sensory stimulation, relaxation, therapeutic touch, artistic and emotional expression that not only promote motricity and cognition but also help to build and discover this 'new' identity that at this stage is formed/transformed (6).

It is important to mention that the main objectives of psychomotor rehabilitation, in this context, are the promotion of body consciousness, self-knowledge, since the "decrease in the amount of motor experiences will negatively influence self-esteem and body consciousness" (17), of functional capabilities and, consequently, of performance in daily activities. As future psychomotricists, we understand that it is necessary to intervene, through prevention or psychomotor reeducation.

JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3)  ISSN: 2182-696X  http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-16

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Faced with this scenario, it seems to us pertinent and necessary to carry out a systematic review of the literature, as we consider it to be of enormous importance to understand that gains and benefits can have people of 65 years or more, with psychomotor rehabilitation. As soon as the gains from psychomotor intervention are evidenced and understood, it is expected that there will be greater adherence and probably greater recognition and investment in the area. In this sense the objectives of this systematic review of the literature will be to highlight the importance of this practice, through its various aspects and possibilities of action, bringing benefits to the elderly and consequently to the population in general.

1.1) Concepts The definition of 'older persons' is not consensual and there is no standard United Nations numerical criterion. For statistical purposes, older people are usually referred to specific age groups and the currently agreed cutoff point for reference to this population is over 60 years, depending on cultural and individual factors (18,19) The elderly person is subject to decreased gnosopracic abilities, the ability to react to emotional, physical, and attentional processes. The elderly person may express psychomotor slowness, loss of strength, increased reaction time, gait problems; fall phobia, communication difficulties, abulia, emotional regulation problems, anguish, or devaluation of body image (6).

When talking about psychomotricity and elderly people we need to specify the concept of Gerontopsychomotricity. This concept involves the biological, psychological, sociocultural and corporal dimension, being in this last point the base of the psychomotricist's work (16).

Another author points out four characteristics that delimit Gerontopsychomotricity as a therapeutic practice of body mediation: the variety of pathologies that can benefit from the intervention of the psychomotricist; the specific objective being to improve the aged body, helping the elderly person to acquire new perceptions and representations of their real and imaginary body; the specificity of the psychomotricist-friendly relationship in which the therapeutic relationship is fundamental and, realizing that behind a physical problem may be a problem of psychological origin (6).

2) Methodology As a starting point for the present literature review, the following question was formulated in PICO format: What are the gains, in relation to people 65 years and older, from psychomotor intervention?

JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3)  ISSN: 2182-696X  http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-16

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The electronic databases used were EBSCO (MEDLINE with Full TEXT, CINAHL with Full Text), where the descriptors were searched in the following order: [(elderly*)] AND [(psychomotor*)] AND [(intervention)]. The descriptors were searched in full text (March/2020), retrospectively until 2009, resulting in a total of 21 articles; the Google Scholar search engine was also used where articles with the keywords [psychomotor intervention, elderly] were searched between 2005 and 2020.

As inclusion criteria, articles focused on psychomotor intervention, using quantitative and/or qualitative methodology that clarified the gains of this intervention in the quality of life of the elderly were given priority.

Regarding the participants, both elderly people with and without pathologies were included, as far as the intervention is concerned; interventions in both motor and cognitive areas were also included; articles demonstrating the results of non-specific psychomotricity interventions were also included.

The exclusion criteria include all articles with no correlation with the object of study and with a date prior to 2009, since although the literature recommends the insertion of the most current evidence, which corresponds to the last five years, the production of texts in this area is scarce.

3) Results Table 1 presents the results of the revision performed, in a systematized manner.

Table 1. Results of the literature review

Author / Level of Evidence Author: Rubira

Objectives

Results

Evaluate the effect of

After the psychomotor intervention, the

et al. (2014) (20) psychomotor intervention

elderly demonstrated improvements in

Methodology:

on the balance of the

surface area (cm²) and average load

experimental

elderly.

(gr/cm²), as well as a decrease in

study

oscillations, contributing to the

Level of

improvement of postural control. In

evidence: 3

addition, there were improvements in the

Participants:

average oscillatory speed (mm/s),

15 elderly

anteroposterior oscillation (mm/s) and the

people of both

oscillation area of the center of pressure;

JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3)  ISSN: 2182-696X  http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-16

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genders, aged

consequently, there was an improvement

between 65 and

in the dynamic balance decreasing the risk

70, with physical

of fall and a greater gait speed during

and social

making it more dynamic after the

independence.

psychomotor intervention program.

Author: Canon,

Describe a protocol of

Initially all patients suffered functional loss,

& Couto (2014)

action in elderly

but after the intervention, a significant

(21)

hospitalized with

increase in functional capacity was

Methodology:

diagnosis of chronic

observed, and consequently in feeding,

experimental

diseases, addressing

with a greater performance in activities of

study

sensory, cognitive,

daily life. Thus, the total score of the motor

Level of

psychomotor and

part increased when compared to the

evidence: 5

functional aspects, thus

beginning of hospitalization. However, it

Participants:

analyzing whether this

decreased in relation to the period before

Six elderly

protocol maximizes the

the internment.

hospitalized with

independence in the

diagnosis of

activity of feeding.

chronic diseases Author: Ferrer,

Assess the effect of a

The application of the program has led to

Collado, &

psychomotor re-

significant improvements in the quality of

Àvila-Castells,

education program

life and motor skills of Alzheimer's

(2013) (22)

(PSEG) on cognitive and

patients. However, cognitive abilities have

Methodology:

functional parameters in

suffered a decline with the progression of

experimental

Alzheimer's patients

the disease. In the mild and moderate

study

.

states of the disease, this program

Level of

improves the motor quality and quality of

evidence: 5

life, allowing the realization of the basic

Participants:

activities of daily life in these phases.

64 patients with

Thus, functional capacity improves in the

Alzheimer's

mild phase and remains stable in the

(from 64 to 87

moderate phase, but in the severe phase

years)

no improvements were identified in the variables observed.

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Author:

Examine the relationship

The cognitive-motor training performed

Hagovská, &

between balance control,

during 10 weeks compared to the motor-

Olekszyová

cognitive functions, gait

only intervention allowed to establish

(2016). (23)

speed and the execution

significant relationships between balance

Methodology:

of daily life activities.

control, cognitive functions, gait speed and

experimental

the execution of daily life activities. Motor-

study

only interventions demonstrated a less

Level of

significant effect on these relationships.

evidence: 5

Cognitive interventions should be an

Participants: 80

important part in motor interventions in the

elderly with

treatment of balance disorders.

cognitive impairment Author: Pereira, To examine the reliability

In this study, improvements in planning

et al.

and effect of a

ability (25-32%), selective attention (19-

(2018). (24)

psychomotor intervention

67%), as well as physical function (aerobic

Methodology:

- a multi-modal exercise

resistance, lower limb strength, agility,

Experimental

program that promotes

balance, gait and mobility (19-41%)) were

study,

cognitive and motor

observed.

application of a

stimulation

Psychomotor intervention also contributed

multi-modal

simultaneously - on the

to combat the sedentary lifestyle typical of

exercise

executive functions

home residents, reducing the risk of falls,

program for ten

(capacity for planning

making them more physically independent

weeks

and selective attention)

and, consequently, increasing the quality

Level of

and physical functions of

of life of this population.

evidence: 5

the residents of a nursing

Participants:

home.

17 institutionalized idols

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Author: Peralta,

How psychomotor

This study demonstrates that psychomotor

Gascón, Latorre

intervention can help

intervention contributes to slow the

(2017). (25)

prevent or slow cognitive

progression of cognitive decline in

Methodology:

decline.

institutionalized elderly. Thus, the number

experimental

of weekly hours of psychomotor

study

intervention is related to the maintenance

Level of

or even increase of cognitive abilities,

evidence: 5

which in turn can be related to the

Participants:

increase of physical capacity to perform

94 Elderly

activities of daily life. The results are

people, both

according to recent studies that

genders, over

demonstrate the importance of cognitive

60 years of age,

training. However, they are only based on

living in two

the meem and the Barthel Index, so other

long-term care

scales and assessments should be

institutions,

considered for inclusion in future studies.

divided into three clusters, one group without psychomotor therapy, the other with two hours a week of psychomotor therapy and the last with ten hours a week.

Author: Oliveira

Describe the experiences

In this study, some activities were carried

et al. (2018).

of health education

out that allowed the elderly to perceive

(26)

activities performed with

how they acquire knowledge and how they

Methodology:

the elderly, having as

use it to improve their self-care. Physical

experimental

difficulties active aging

activity and eating assume an extremely

study

and self-care.

important role in the perception of self-

Level of

care, contributing to a change in lifestyle,

evidence: 5

and consequently to the prevention of

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Participants:

numerous diseases, including

25 elderly

cardiovascular diseases and type II

women, aged

diabetes. In addition, memory activities

between 60 and

were essential for the elderly to remain

83 years old

more active and perform cognitive activities. Thus, physical and cognitive activities were very important for independence, as well as for a more active participation.

Author:

Examine the influence of

Both in relation to muscle strength and

Rebelatto et al.

an extended exercise

flexibility the data point to the absence of

(2006). (27)

program (two years) on

significant differences. The program

Methodology:

muscle strength and

contributed to the maintenance of the

experimental

body flexibility of elderly

manual grip strength in the period of two

study

women.

years and, in relation to the corporal

Level of

flexibility, the data indicate the necessity of

evidence: 5

reprogramming the exercises destined to

Participants:

the development of such capacity.

32 female individuals, aged between 60 and 80 years, not institutionalized.

4) Discussion In one of the studies, the psychomotor intervention demonstrated a decrease in oscillations, resulting in an improvement in postural control. There was also an increase in the balance, as a result of the improvement in the average oscillatory speed (mm/s), anteroposterior oscillation (mm/s) and the oscillation area of the pressure center, contributing to the increase in the gait speed (20). The same was the case in another study, where significant improvements were observed in both balance control and driving speed (23).

Following the same approach, another study revealed, after the psychomotor intervention, improvements from the point of view of physical function, namely in terms of aerobic resistance, limb strength, balance, agility and also gait and mobility (24), which contribute to the reduction of the risk of fall and, subsequently, to the increase of the quality of life of the JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3)  ISSN: 2182-696X  http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-16

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individual (22). It also reinforces the idea that psychomotor intervention contributes to reduce not only the risk of falls but also physical dependence, contributing to an increase in the quality of life and a decrease in sedentariness (24).

On the other hand, regarding Rebelatto, Orejuela, & Portillo, (2006), the program of regular and long-term physical activity, even though it was not idealized for the development of muscle strength, contributed to the maintenance of bilateral grip strength in the hands of elderly women. Regarding body flexibility data, the absence of statistical significance indicates the need for reprogramming exercises aimed at gaining flexibility (27).

According to Pereira et al. (2017), after the psychomotor intervention, improvements in planning capacity and selective attention were observed. In addition, the intervention also promoted simultaneous cognitive and motor stimulation, since improvements were observed in the executive and physical functions of residents of a nursing home (24). In the same perspective, Hagovská and Olekszyová (2016) have established significant relationships between balance control, executive functions, gait speed and the execution of daily life activities in a cognitive-motor intervention (23). Thus, both studies combined that in a motoronly intervention these relationships demonstrated a less significant effect, compared to a cognitive and motor intervention. Therefore, cognitive interventions should be an important part in motor interventions in the treatment of balance disorders (23) .

In the article by Ferrer, Collado & Àvila-Castells (2013) improvements in motor and functional capacities and consequently in the quality of life are mentioned after a guide for psychomotor re-education has been implemented with the purpose of rehabilitating motor, cognitive, affective and social functions through physical exercise, cognitive re-education and psychomotor stimulation. This intervention allowed the maintenance of the activities of daily life, thus contributing to the increase of the quality of life of this population. It is considered that these results, occurred due to the character of experiential and intentional expression of the physical, psychological, social and emotional capacities of the psychomotor intervention (22).

As for the improvement in autonomy in feeding activities, Canon and Couto (2014), after intervention with elderly people diagnosed with different disorders, verified that it is necessary to promote autonomy and decrease dependence on third parties, especially in feeding tasks, which by the way, consume a lot of time in the caregivers' routine (21).

The body is the origin of cognitive and affective acquisitions and therefore, through these experiences, psychomotricity contributes to the normalization of the individual's general behavior, improving the body's awareness. In this way, through functional training and the movement of the body in relation, the elderly understand their capacities of action and possibilities of acting with the other, with objects and with themselves, thus not only seeing JOURNAL OF AGING AND INNOVATION, DEZEMBRO, 2020, 9 (3)  ISSN: 2182-696X  http://journalofagingandinnovation.org/ DOI: 10.36957/jai.2182-696X.v9i3-16

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an improvement in nutrition, but also in movement. They also emphasize the importance of transmitting practical and adequate information to the elderly, contributing to their quality of life. Through a program based on healthy eating, after the implementation of an intervention plan, there was a greater concern, on the part of the elderly population, regarding food (25).

In one of the studies, the results indicated that psychomotor intervention, at an appropriate dosage, can significantly prevent the decrease or even increase cognitive abilities, as is the case with two-hour therapies per week, which can improve long-term memory, selfconfidence and mood, verbal fluency and attention (25). However, these results demonstrate that a greater number of hours per week of intervention can significantly improve cognitive skills. Defending also the increase of cognitive abilities, other authors, after one year of memory activities, found an increase in reading frequency, an increase in home outings and also an increase in cognitive activities (26). The same authors also argue that after activities, namely physical activities, there was an increase in the perception of self-care, promoting an improvement in the lifestyle of the elderly (26).

Thus, it is notorious that psychomotor intervention has numerous benefits with respect to the elderly population, whether in the physical or cognitive domains. Therefore, it is essential that this type of intervention is increasingly used by this population, providing them with a better quality of life, as well as disease prevention, enabling them to interact socially and live different experiences.

In table 2 the result indicators extracted from this review can be checked.

Table 2. Performance Indicators Variables

Indicators

Functional status

Increased average gait speed; (20) (23)

and physical

Improvement of gait dynamics; (20)

capacity

Improvements in balance; (20) (23) (24) Improvements in aerobic resistance, (24) Improvements in lower limb strength, (24) Improvements in agility; (24) Improvements in mobility; (24) Decreased risk of falling (22)

Nutrition

Improvement in healthy eating; (26)

Cognitive function

Improvement in cognitive skills; (23) (25) (24)

Functional state

Improvement in functional capacity; (22) Improvement of the quality of life; (22) (26) Improvement of instrumental activities of daily living; (21) (23) (26)

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5) Conclusion For the elderly to remain active, movement is fundamental, so psychomotor intervention is very important at this stage, contributing not only to the improvement of movement but also to the autonomy of the elderly. The psychomotor intervention, in these ages, must be done not only in elderly people with pathologies and/or limitations, but also in elderly people without any kind of limitation, acting as a form of prevention, contributing to an active aging of the population and an improvement of the quality of life.

Moreover, the psychomotor intervention encompasses benefits not only at the motor level, but also at the psychological and affective level, and the greater the number of interventions, the greater the results. At the motor level, the psychomotor intervention reveals improvements in postural control, balance, increased gait speed, aerobic resistance, agility, limb strength and mobility, thus contributing to the reduction of the risk of falling. On the other hand, at a cognitive level, it reveals improvements in planning, long-term memory, selfconfidence, mood and verbal fluency.

The psychomotor intervention aims at an improvement in the capacities of the elderly, and through this review of the literature, we can show that this improvement occurs both at the physical and cognitive levels, allowing them to perform well in the execution of the activities of daily life, which contribute to their independence and also to their active participation in society.

6) Implications for professional practice

Based on the above, our clinical practice can be applied in different cases with different objectives, promoting well-being and taking into account the individual characteristics of each elderly person. Thus, this practice can be integrated in any phase of aging as well as in most diagnoses, working with the elderly and maintaining their skills and abilities, in order to prevent the loss of them.

There is an enormous need for new studies, since it is of enormous importance to highlight the numerous benefits of this practice, as well as the different interventions in various clinical cases.

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