Promoting health and quality of life among rural older people has received little attention, especially in Spain where the number of interventions designed specifically for the rural elderly is sparse. The aim of this study was to explore the effectiveness of an intervention program aiming at improving quality of life in a group of community-dwelling older adults living in a depopulated rural area in Orense, Galicia, Spain. The sample of this study comprised 86 people (78 people in the intervention group and 8 people in the control group) aged 65 and older (M=70.82; SD=6.35). The evaluation included the MEC, the CDT, and the WHOQOL-Bref questionnaire. The intervention was applied for a period of nine months and consisted of three weekly workshops with a mean duration of four hours that included cognitive stimulation, crafts, and physical activity. The results of the ANCOVA revealed that independently of the age, educational level, gender, and pretest scores, the participants of the intervention group had a lower risk of cognitive impairment. Also they maintained their score on the Psychological health dimension of the WHOQOL-Bref questionnaire while the participants in the control group slightly decreased their score. The intervention program had a positive effect on the participants’ perception with regards to their opportunities to participate in leisure activities and improved their cognitive functioning, which in turn contributed to their more positive perception of their psychological health.
La promoción de la salud y la calidad de vida entre las personas mayores del medio rural ha recibido poca atención, especialmente en España donde el número de intervenciones designadas específicamente para la población mayor rural es escasa. El objetivo de este estudio fue explorar la efectividad de un programa de intervención para incrementar la calidad de vida en un grupo de personas mayores que vivían en la comunidad en un área rural despoblada en Orense, Galicia, España. La muestra de este estudio estuvo compuesta por 86 personas (78 en el grupo de intervención y 8 en el grupo control) de 65 o más años (M=70.82; DT=6.35). La evaluación incluyó los cuestionarios MEC, CDT y WHOQOL-Bref. La intervención fue aplicada durante un periodo de nueve meses y consistió en tres sesiones semanales con una duración media de cuatro horas que incluían estimulación cognitiva, actividades físicas y creativas. Los resultados del ANCOVA revelan que independientemente de la edad, nivel educativo, género y puntuaciones pretest, los participantes del grupo de intervención tenían menos riesgo de deterioro cognitivo. Asimismo mantuvieron sus puntuaciones en la dimensión de salud psicológica en el WHOQOL-Bref mientras que los participantes del grupo control disminuyeron ligeramente su puntuación. El programa de intervención tuvo un efecto positivo en la percepción de los participantes respecto a sus oportunidades de participar en actividades de ocio y mejoró su funcionamiento cognitivo lo que finalmente contribuía a una percepción más positiva de su salud psicológica.
Currently many individuals enjoy high life expectancy although, nevertheless, living longer implies, in many cases, a higher probability of health problems, functional capacity, and quality of life deterioration (
This new reality represents an increasing concern for governments worldwide due to the impact that aging has at an economic level in terms of pensions, health, and social security expenditure (
Quality of life is defined as “the individuals’ perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns” (
Quality of life is a complex construct that comprises many different aspects (
At the same time the overlap between the quality of life and subjective indicators of quality of life must also be underlined (
According to
Some of the factors that are directly related to quality of life coincide with the determinants of active aging. These variables can be categorized into three different groups: a biomedical category that includes health and functional status; a psychological group comprising cognitive functioning, emotional functioning, and personality; and a social one that comprehends social relations, social support, social engagement, the environment, and its characteristics.
Physical health and functional status have a major impact on quality of life (
Among the psychological predictors of quality of life, cognitive functioning stands out as a relevant factor. For example, older people who experience an abrupt deterioration of cognitive capacities are more impaired when it comes to perform daily activities and tasks, and have a higher mortality risk compared to those with good cognitive functioning (
Social relations, social support, the resources available in the neighboring contexts, accessibility, satisfaction with the neighborhood, and social participation are also prominent determinants of quality of life (
Numerous programs developed in the gerontological context were aimed at maintaining and improving cognitive functioning, or at preserving a good physical status. Meanwhile only a limited number of interventions include other aspects that have also been found to improve quality of life, like leisure activities (
Regarding interventions that include cognitive or physical activities, review studies (e.g.
Promoting health and quality of life among rural older people has received little attention (
The unbalanced distribution of resources offered to older people that live in rural and urban areas is noteworthy in Spain. While the elderly from urban contexts are provided with more resources and have more possibilities to be socially engaged and to take part in leisure activities, rural older adults count on a limited offer of this kind of activities (
Conversely, Spanish aging polices do not give specific recommendations about older people from rural areas and the number of interventions designed specifically for them is sparse (
Until recently, the quality of life intervention programs developed in rural areas in Spain (
Considering all it has been previously discussed, the goal of this study is to analyze the effectiveness of an intervention program aiming at improving quality of life through cognitive stimulation, physical, and crafts activities in a group of community-dwelling older adults living in a rural context in Orense, Galicia, Spain.
The sample comprised 86 older adults (78 participants in the intervention group; 8 participants in the control group) aged 65 and older from 11 villages of a rural area with high rates of depopulation and aging in Orense, Spain. The control group was considerably reduced due to the terms and conditions of the sponsoring organisms that could only provide finance for the intervention program to be implemented for a limited period of time.
This research was approved by the committee and head of the foundation that sponsored the study,
Demographic characteristics included gender, age, educational level, income, and living arrangements.
Mini-Examen Cognoscitivo (MEC) (
The pre-test assessment was conducted during January 1st 2011 using the questionnaire on demographic characteristics, the MEC, the CDT, and the WHOQOL-BREF. The intervention program was developed between March and December 2011, four hours a week for each workshop. After finishing the intervention program the MEC, the CDT, and the WHOQOL-BREF were administered for the post-test assessment. The assessment of each participant lasted between 45 and 60 minutes, and data collection and implementation of the intervention program were conducted by previously trained staff.
A
cross-sectional correlational of non-equivalent groups design was used. Preliminary analyses were performed to test differences between the
control and the intervention group with respect to their demographic
characteristics and the pretest scores for the MEC, CDT, and the WHOQOL-BREF. Also, the effect of age and
educational levels on the MEC, the CDT, and the WHOQOL-BREF dimensions were analyzed using T-tests and analysis of variance
(ANOVA). In order to determine if there were significant differences
between the intervention and the control group in posttest WHOQOL-BREF, MEC,
and CDT regardless of covariates, several analysis of
covariance (
Preliminary analysis revealed that educational level was associated with statistically significant differences in the pre-test MEC score (
Educational level was also associated with statistically significant differences in the WHOQOL-BREF physical health domain (
Similarly educational level had a statistically significant effect on MEC post-test (
The ANCOVA analysis revealed that after removing the covariate influence of age, educational level, gender, and the pretest scores, statistically significant differences in the posttest scores were found between the participants in the intervention and the control group. Participants in the intervention group had significantly higher scores in posttest MEC (
After the nine months intervention program, significant differences in pre-test and post-test scores were found in the intervention group, both for the MEC (
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At the same time, while the intervention group obtained similar scores in the pre-test and the post-test score for the psychological health, the control group slightly decreased their score (
On the contrary, the score in the Environment dimension of the WHOQOL-BREF significantly decreased for both the intervention (
Also, when each question of the WHOQOL-BREF was analyzed independently, it was found that, when asked about the opportunities for leisure activities, participants in the intervention group scored higher in the post-test evaluation (
The aim of this study was to analyze the effectiveness of an intervention program aiming at improving quality of life through cognitive stimulation, physical, and group crafts activities in a group of community-dwelling older adults living in a rural context.
It was found that after the intervention, the participants in the intervention group considered they had more opportunities for performing leisure activities. As some authors have emphasized (
Regarding quality of life, we found that when age, educational level, gender, and pretest scores were controlled, the intervention group also maintained a more positive perception of their psychological health than the control group. These results are in tune with findings from the review studies on the effectiveness of cognitive stimulation programs (
At the same time, the results of this study provide evidence with regard to the effectiveness of multicomponent interventions when aiming at maintaining cognitive functioning.
On the contrary, no effect was found for the rest of the quality of life dimensions and on the environment dimension the participants even obtained a lower score after the intervention. This result could be explained by the fact that participants’ initial expectation, their motivations to participate in the program, their self-efficacy, and their personality have not been considered. Several authors stress the importance of psychological and subjective perceptions of individuals when explaining quality of life (
In addition, macro-societal aspects, such as economic and social resources, housing or the social cohesion that characterize the environment where the participants live have not been considered in the intervention, and this aspect might explain why the participants obtained lower scores on the environment domain of the WHOQOL-BREF after the intervention. The intervention program did not contemplate improving the formal support available, therefore the participants continued to feel dissatisfied with their environment, and maybe they even changed their expectation with regards to their access to information and services after the program, which could explain why they scored lower. As some authors have underlined, environmental aspects could significantly influence older people’s quality of life (
Other limitations must also be acknowledged. The frequency of participation in the intervention program of the elderly taking part in this study has not been controlled. This aspect could influence the results obtained, as attending more frequently the proposed activities could have a stronger effect on quality of life; therefore future studies should contemplate this aspect.
At the same time, the effect that each type of activity has cannot be decomposed, since there was only one intervention group that took part in all the activities proposed. Interventions that last longer, have larger control groups and several interventional groups would allow studying the composed and separated effect of the different activities proposed in our study. Likewise the control group was excessively reduced and the design used in this study did not allow a random assignment of the participants to the intervention and the control group, thus it might be possible that participants with a better cognitive functioning and a higher quality of life, or more motivated to participate have self-selected themselves to take part in the study. The lack of randomization is a weakness to this study that limits its generalizability. Owing to it, future interventional studies should use random procedures to select participants, have several intervention groups, and a wider control group.
With regard to the instruments we used, it is important to highlight the fact that the MEC is sensible to age and educational effect. At the same time, because it is a screening tool, it only assesses the absence or presence of cognitive impairment and does not evaluate cognitive functioning; therefore the impact of the intervention on different cognitive functions cannot be assessed. Similarly, the WHOQOL-BREF is a self-reported instrument and it only evaluates the participants’ perception with regards with several domains of quality of life. Because of the limitations of the self-reported instruments, it would be advisable that future studies should include objective measures of both cognitive functioning and quality of life.
Another limitation of the present study is the fact that the intervention sessions were designed as group activities. As
Despite limitations, the present study contributes to extending the knowledge on quality of life promotion. It highlights the positive effect of multicomponent interventions to maintain good cognitive functioning and foster a positive perception with regard to leisure opportunities and psychological health among the elderly. It is desirable to continue developing interventions that promote active aging and quality of life in rural settings in order to allow the rural older adults to be socially engaged and generate new strategies to deal with the changing circumstances they have to face.
The Active Aging program developed in Orense was financed by Fundación Barrié and Cáritas Diocesana Orense, and carried out by Cáritas Diocesana Orense and the research group HUM867: Gerontology of University of Granada.
Research article.