Lifestyle Consultant, Prestigious Retirement Villages plc

Although there are currently only a few retirement villages in the UK, their popularity is being established by the satisfaction of residents and local communities (Joseph Rowntree Foundation, 2006). Within these villages, it would be helpful to provide information that can be utilised to improve residents˘ quality of life. Good nutrition and regular exercise are both cost-effective ways of improving health status, functioning and longevity, even when done in very late adulthood (Fillenbaum et al, 2007) and need to be emphasised to the older population.

Nutrition

Older people are especially vulnerable to nutritional inadequacy due to physiological stresses; such as a decline in lean body mass and taking medications, and psychosocial factors; for instance, relying on others to go food shopping, social isolation and depression (Holmes, 2006). It is important to address this issue as nutritional status impacts the quality of life and the health of older people (Brownie, 2006). It is estimated that 5-10% of adults living independently are suffering from malnutrition (Brownie, 2006) so this is an important consideration for adults who are moving into a retirement village. Holmes (2006) recommends the use of the Malnutrition Universal Screening Tool (MUST) to screen older people on a weekly basis who have been found to be malnourished or who are at risk for under nutrition. Being overweight or underweight can negatively affect health and quality of life and a change in either direction should be checked out by a physician (Food Standards Agency). Older adults also need to ensure they have regular dental checkups a contributing factor to malnutrition is poor dental health (Food Standards Agency).

Weight loss, muscle wasting and poor appetite in the elderly both contribute to and are caused by insufficient diets (Brownie, 2006). Brownie states that "dietary guidelines aimed at meeting the nutritional needs of ageing people should emphasize the value of high-quality, nutrient-dense foods, with particular focus on the preservation of muscles mass" (2006, p113). Older people need to ensure they are eating foods rich in iron, starch, fibre, folic acid, calcium and vitamins A and D, and avoiding too much salt, to promote their general health and prevent osteoporosis (Food Standards Agency). Fresh foods have greater nutritional quality than food which is cooked for an extended period of time (Brownie, 2006). It is also important to ensure that older people have an adequate fluid intake (Brownie, 2006).

It has been noted that eating in company contributes to greater food consumption and a healthier diet (Brownie, 2006), so promoting a communal eating area for use by residents of a retirement village would be beneficial. It would also be helpful to educate older adults on dietary recommendations as described above.

Exercise

One of the factors contributing to under nutrition in older people is their sedentary lifestyle (Brownie, 2006) which can be addressed through exercise. Exercise promotes good health, improves functional status, and, along with a healthy diet, may even reverse existing disease and increase life expectancy (Fillenbaum et al, 2007). One study examining the effects of group exercise found it significantly decreased the risk of falls in frail elderly adults (Lord et al, 2003) and another that progressive resistance muscle strength training increased muscle mass and strength in frail older people (Sullivan, 2006). An exercise programme for older adults that involved brisk walking and moderate resistance training found that exercise can also be used as a treatment for sleep problems, which can be a common issue in the elderly population (Montgomery and Dennis, 2002).

Physicians need to ensure they counsel their older patients regarding exercise as this has been found to be highly influential (Schonberg et al, 2006). A doctor based in a retirement community would need to be particularly aware of this, especially as studies have found that physician counselling relating to exercise is low for all age groups but can be especially helpful for older people and result in significantly increased activity for up to a year after counselling (Schonberg et al, 2006).

The types of exercise recommended for older adults should involve strength, flexibility, endurance, and balance activities (Schonberg et al, 2006). While various land-based exercise programmes have been found to have many benefits for older people, water exercise programmes may be better for those with limited mobility and arthritis (Lord et al, 2006).

Images including older people that promote physical activity are important as they are rarely seen and older adults may be getting the message that exercise can be harmful for them, (Schonberg et al, 2006). It would therefore be useful for a retirement community to prominently display positive images of older adults participating in exercise.

Laughter Programmes

Laughter therapy first came to researchers attention in 1979 after Norman Cousins wrote a book entitled 'Anatomy of an Illness', which described how he used laughter as part of his treatment and healing process from a crippling and painful disease (ankylosing spondylitis). Cousins found that after laughing out loud at funny movies he was able to achieve a couple of hours of pain-free sleep and he believed the use of humour contributed greatly to reducing painful inflammation and his overall healing process (Gallozzi; MacDonald, 2004).

The benefits of laughter continue to be researched gradually, and studies have indicated it reduces anxiety and pain, promotes feelings of well-being, decreases stress and muscle tension, and boosts the immune system (MacDonald, 2004; Mallett, 1995; Traynor, 1997). Humour has also been found to improve clinical outcomes in cases of heart disease, asthma, cancer (MacDonald, 2004) and diabetes (Nasir et al, 2005).

Laughter can also be used as an icebreaker (Mallett, 1995), as a means of a support system (Traynor, 1997), and it improves coping skills (MacDonald, 2004), all of which could be particularly useful to new residents in a retirement village. A laughter programme can take the form of laughter yoga or meditation, humour therapy, laughter therapy, or a laughter club, all of which involve different techniques, advantages and disadvantages, as described by MacDonald (2004).

Laughter yoga, laughter clubs and hospital ?humour rooms? are now coming into the mainstream in various parts of the world (MacDonald, 2004; Traynor, 1997; Wikipedia), and a retirement community would be an ideal setting to introduce this life-enhancing activity to our older citizens.

References

Brownie, S. (2006). Why are elderly individuals at risk of nutritional deficiency? [Electronic version]. International Journal of Nursing Practice, 12, 110-118.

Fillenbaum, G.G., Burchett, B.M., Kuchibhatla, M.N., Cohen, H.J., & Blazer, D.G. (2007). Effect of cancer screening and desirable health behaviours on functional status, self-rated health, health service use and mortality [Electronic version]. Journal of the American Geriatric Society (Online early).

Food Standards Agency. Older people. Retrieved 10th January 2007 from: http://www.eatwell.gov.uk/agesandstages/olderpeople/

Gallozzi, C. Benefits of laughter. Retrieved 9th January 2007 from: http://www.personal-development.com/chuck/laughter.htm

Holmes, S. (2006). Barriers to effective nutritional care for older adults [Electronic version]. Nursing Standard, 21(3), 50-54.

Joseph Rowntree Foundation. (2006). Retirement villages are 'hits' with older people - and benefit local communities too. Retrieved 10th January 2007 from: http://www.jrf.org.uk/pressroom/releases/060406.asp

Lord, S.R., Castell, S., Corcoran, J., Dayhew, J., Matters, B., Shan, A., & Williams, P. (2003). The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial [Electronic version]. Journal of the American Geriatric Society, 51(12), 1685-1692.

Lord, S.R., Matters, B., St George, R., Thomas, M., Bindon, J., Chan, D.K., Collings, A. & Haren, L. (2006). The effects of water exercise on physical functioning in older people [Electronic version]. Australasian Journal on Ageing, 25(1), 36-41.

Mallett, J. (1995). Humour and laughter therapy [Electronic version]. Complementary Therapies in Nursing & Midwifery, 1(3), 73-76.

MacDonald, C.M. (2004). A chuckle a day keeps the doctor away: therapeutic humor & laughter [Electronic version]. Journal of Psychosocial Nursing & Mental Health Services, 42(3), 18-25.

Montgomery, P., & Dennis, J. (2002). Physical exercise for sleep problems in adults aged 60+ (Review) [Electronic version]. Cochrane Database of Systematic Reviews, 4, 1-9.

Nasir, U.M., Iwanaga, S., Nabi, A.H.M.N., Urayama, O., Hayashi, K., Hayashi, T., Kawai, K., Sultana, A., & Murakami, K., Suzuki, F. (2005). Laugher therapy modulates the parameters of renin-angiotensin system in patients with type 2 diabetes [Electronic version]. International Journal of Molecular Medicine 16(6), 1077-1081.

Schonberg, M.A, Marcantonio, E.R., & Wee. C.C. (2006). Receipt of exercise counseling by older women [Electronic version]. Journal of the American Geriatric Society, 54(4), 619-626.

Sullivan, D.H., Roberson, P.K., Smith, E.S., Price, J.A., & Bopp, M.M. (2007). Effects of muscle strength training and megestrol acetate on strength, muscle mass, and function in frail older people [Electronic version]. Journal of the American Geriatric Society (Online early).

Traynor, D. (1997). Laugh if off: laughter therapy provides the latest alternative to aid stress management [Electronic version]. American Fitness, 15(3), 56-58.

Wikipedia. Laughter. Retrieved 9th January 2007 from: http://en.wikipedia.org/wiki/Laughter#Therapeutic_effects_of_laughter