Older adults who joined group exercise classes experienced decreased loneliness and social isolation, according to a new Cedars-Sinai study conducted before the COVID-19 pandemic. The classes have continued virtually since March, and early results suggest the online versions are also effective.
Seniors face increased risk for developing serious health issues or even death if they lack social connections or feel alone. Loneliness is connected to higher rates of depression, anxiety and suicide. Experts say social isolation can have the same impact on an older person's health as smoking 15 cigarettes a day.
Both loneliness and social isolation are widespread issues in the U.S., where more than a third of adults 45 and older feel lonely and nearly a quarter of those 65 and older are socially isolated, according to the National Academies of Sciences, Engineering, and Medicine. But few studies have examined the most effective ways to improve social connectedness among seniors.
As the demographics of our country shift, more people are living alone than ever before. The number of adults over the age of 65 in the U.S. is expected to reach more than 70 million by 2030 – double what it is now. We need sustainable ways to help this burgeoning population thrive as they age, or there will be widespread consequences."
Allison Moser Mays, MD, study's lead author, Cedars-Sinai geriatrician
Mays and her co-investigators partnered with local community groups to enroll participants in evidence-based exercise and health management classes for people over 50 at nine sites in Los Angeles neighborhoods with a known concentration of low-income older adults. All locations – which included libraries, senior centers and recreation centers – were accessible for those with mobility limitations and had access to parking and public transit.
The study tracked 382 participants ages 52 to 104 from July 2018 through March 2020, when the pandemic forced the classes to move online. Some people were referred by their Cedars-Sinai physician during an office visit. Others found the program through community outreach.
All participants met with a health coach who assessed their needs and helped them select one of four courses, which research has shown improve other aspects of health: Arthritis Exercise, EnhancedFitness, Tai Chi for Arthritis, and Chronic Disease Self-Management. The three exercise classes proved the most popular, and individuals had to attend at least one session to be included in the study.
Participants completed questionnaires about their social connections and loneliness prior to starting their course and after six months. At the end of that period, investigators found a 6.9% decrease in loneliness and a 3.3% improvement in social connectedness, after adjusting for age, gender and other characteristics. The study was published in the American Journal of Geriatric Psychiatry.
"These classes had already been shown to reduce the risk of falls in seniors, and this was the first demonstration that they also reduce social isolation, to the best of our knowledge," Mays said.
The Leveraging Exercise to Age in Place (LEAP) classes have been supported by a three-year grant from the AARP Foundation. Cedars-Sinai has adopted the successful programming under the Community Engagement Department.
"The results of this study are very exciting because we've provided a model that other health systems can easily replicate by integrating evidence-based programs in the community with their organizations. They don't need to reinvent the wheel," said senior study author Sonja Rosen, MD, chief of Geriatric Medicine at Cedars-Sinai. "The health coach is the key ingredient because they make sure that nobody falls through the cracks."
The health coach has been especially crucial since the pandemic began when classes moved online and participants sometimes have needed help figuring out how to log on to the platform. That effort has been paying off.
Of the 59 participants who continued with the virtual workouts, there has not been a statistically significant change in loneliness or social isolation one month after stay at home orders began, according to data Mays presented over the weekend at the Gerontological Society of America's annual meeting. The investigators will analyze further data as the classes continue. They're also piloting another program that pairs older adults with younger participants for one-on-one workout sessions online.
"Cedars-Sinai treats more patients over the age of 80 than any other academic health system in the country," Rosen said. "We're really at the epicenter of this growing population of older adults and figuring out the best ways to care for them so they can successfully age in place."
Rosen said efforts like the LEAP program helped Cedars-Sinai earn its designation as an Age-Friendly Health System Committed to Care Excellence earlier this year. The distinction, which highlights care tailored to older adults, is part of a national initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States.
Mays, A.M., et al. (2020) The Leveraging Exercise to Age in Place (LEAP) Study: Engaging Older Adults in Community-Based Exercise Classes to Impact Loneliness and Social Isolation. American Journal of Geriatric Psychiatry. doi.org/10.1016/j.jagp.2020.10.006.