Christopher Ball

UNC DPT c/o 2015

## Increasing Physical Activity and Prevention of Frailty in the Elderly Dual-Task Senior-Based Hiking Groups and Community Gardening Programs

## Statement of Need:

“Health and aging are social and cultural concepts in addition to being biologically determined.”4 Health promotion programs and the interventions they employ such as community gardening and walk/hike groups are a valuable resource for older-adults to maintain and improve attributes constituting good health and quality of life. The magnitude of these benefits within the rural and underserved “high-country” communities of North Carolina (NC) such as Mills-River NC could be exponential. Frailty is classified as a multi-system disorder and considered one of the three central geriatric syndromes.(1) Frailty can be triggered by multiple pathophysiological processes such as malnutrition, hormonal imbalances or multi- morbidity and lead to rapid deterioration of functional reserve physical/cognitive function, mobility status, healing response.4 Clinical presentation associated with frailty include, acute/unintentional weight loss (>10 lbs/year), self- reported exhaustion, decreased activity level, undue weakness, decreased lean-body mass, decreased gait speed, history of falls and recurrent loss of balance.5 Clinical depression can easily be manifested and catalyze these comorbid interactions, further increasing healthcare usage and risk becoming homebound which account for roughly 70% of the Medicare cost annually.(6) Malnutrition has been shown to play a prominent role in the development or progression of immobility and functional decline in older adults who are frail.1,2,3,5 Furthermore, malnutrition is more prevalent within the rural and underserved population.1,2,3,5 Malnutrition can result from decreased total caloric intake as well as macronutrient deficiencies and include vitamins, anti-oxidants, protein/amino-acids and trace minerals.1 At the cellular level, macronutrient deficiencies lead to greater proliferation of free radicals and increased levels of oxidative stress which accelerate the age-based deterioration of cells and thus contribute to the reduction in motor performance and decreased cognitive function.1 Elderly individuals who are malnourished may present with decreased energy reserve, diminished activity tolerance, low body weight, as well as severe atrophy and degeneration of skeletal muscle, bone, and collagenous tissues.5 As such, elderly individuals who are malnourished are at greater risk of becoming frail, or development of chronic diseases such as osteoporosis, osteopenia and sarcopenia, incurring a fall- related trauma and acute or chronic musculoskeletal pathology.5 A 2007 study by Houston et al. found strong cause- effect relationship as well as positive correlation regarding the presence and quantity of macronutrient deficiencies in older-adults who are frail. Fifty percent of frail subjects had blood-serum levels constituting at least one macronutrient deficiency with incidence of frailty coinciding with increased number of macronutrient deficiencies.6 The most effective treatment for frailty is the prevention of the condition all together. This can be more easily achieved by identifying factors that facilitate and hinder the implementation of early intervention, patient education and effective behavior change strategies.1,2,3,5 The extent to which health promotion focuses on the individual and individual choices while ignoring social and organizational contexts of health related behaviors may also affect a prospective programs ability to reach its population of focus.3 The socio-ecological model (SEM) operates under the assumption that appropriate changes in the social environment will produce greater change of behavior.3 Health promotion and wellness programs are more apt to promote individual adoption and maintenance of positive health-behavior through focusing on individual, social and environmental determinants with development and implementation of health promotion interventions. 3 Older adults residing in rural and underserved communities like Mills-River typically have higher rates of tobacco/alcohol abuse, obesity and malnutrition.3 Also, preconceived notions about their personal health, prior or current physical activity level or dietary intake have been highly reinforced.1 As such, older adults can be resistant to modifications in health behaviors, further contributing to a greater incidence of chronic diseases such as cardiovascular disease, stroke, chronic obstructive pulmonary disease, congestive heart failure, diabetes mellitus or multi-morbidity.1 The incorporation of functional tasks of moderate intensity or activities promoting targeted health behaviors in a functional environment indicate awareness of intrapersonal determinants of behavior change. Thus the implementation of community gardening and senior hiking groups more apt to provide positive reinforcement motivation, feelings of self-efficacy, and provides a rewarding experience of learning or re-learning a new skill helps to ensure the continuation of healthy dietary intake and adequate levels of moderate physical activity. (1)(2)(3)(5)