'Dance to Health': an evaluation of health, social and dance interest outcomes of a dance programme for the prevention of falls

Interventions to Reduce Loneliness in Community-Living Older Adults: a Systematic Review and Meta-analysis

BACKGROUND

The problem of loneliness has garnered increased attention from policymakers, payors, and providers due to higher rates during the pandemic, particularly among seniors. Prior systematic reviews have in general not been able to reach conclusions about effectiveness of interventions.

METHODS

Computerized databases were searched using broad terms such as "loneliness" or "lonely" or "social isolation" or "social support" from Jan 1, 2011 to June 23, 2021. We reference mined existing systematic reviews for additional and older studies. The Social Interventions Research & Evaluation Network database and Google were searched for gray literature on Feb 4, 2022. Eligible studies were RCTs and observational studies of interventions to reduce loneliness in community-living adults that used a validated loneliness scale; studies from low- or middle-income countries were excluded, and studies were excluded if restricted to populations where all persons had the same disease (such as loneliness in persons with dementia).

RESULTS

A total of 5971 titles were reviewed and 60 studies were included in the analysis, 36 RCTs and 24 observational studies. Eleven RCTs and 5 observational studies provided moderate certainty evidence that group-based treatment was associated with reduced loneliness (standardized mean difference for RCTs =  - 0.27, 95% CI - 0.48, - 0.08). Five RCTs and 5 observational studies provided moderate certainty evidence that internet training was associated with reduced loneliness (standardized mean difference for RCTs =  - 0.22, 95% CI - 0.30, - 0.14). Low certainty evidence suggested that group exercises may be associated with very small reductions in loneliness. Evidence was insufficient to reach conclusions about group-based activities, individual in-person interactions, internet-delivered interventions, and telephone-delivered interventions.

DISCUSSION

Low-to-moderate certainty evidence exists that group-based treatments, internet training, and possibly group exercises are associated with modest reductions in loneliness in community-living older adults. These findings can inform the design of supplemental benefits and the implementation of evidence-based interventions to address loneliness.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO ( CRD42021272305 ).

Effectiveness of dance interventions for falls prevention in older adults: systematic review and meta-analysis

INTRODUCTION

Fall prevention is a global health priority. Strength and balance exercise programmes are effective at reducing falls. Emerging literature suggests dance is an enjoyable and sociable form of exercise. However, there is little evidence that dance reduces fall incidence.

METHODS

Systematic review and meta-analysis examining effectiveness and cost-effectiveness of dance for falls prevention in older adults. Five databases were searched with no restrictions on publication date or intervention settings. Risk of bias was assessed using variants of Cochrane Risk of bias tools, Mixed-Methods Appraisal and Drummond checklist as appropriate. Certainty of evidence was assessed using GRADE.

RESULTS

Forty-one studies were included (19 RCTs, 13 quasi-experimental, two mixed-method, seven observational studies, 2,451 participants). Five types of dance interventions were identified: ballroom and Latin dance, dance exercise, cultural dance, dance therapy, and low-impact dance. Meta-analysis was only possible for functional outcome measures: Timed-Up-and-Go (dance versus usual care, mean difference (MD) = 1.36; 95% CI -3.57 to 0.85), Sit-to-Stand (dance versus exercise MD = -0.85; 95% CI -2.64 to 0.93: dance versus education MD = -1.64; 95% CI -4.12 to 0.85), Berg Balance Scale (dance versus usual care MD = 0.61; 95% CI -4.26 to 5.47). There was unexplained variance in effects and no significant differences between intervention and control groups. Overall, certainty of evidence was very low; we are uncertain about the effect of dance interventions in reducing falls.

CONCLUSIONS

There is very low certainty evidence for dance as an alternative to strength and balance training if the aim is to prevent falls. No robust evidence on the cost-effectiveness of dance interventions for the prevention of falls was found.

PROSPERO REGISTRATION

CRD42022382908.

Qualitative inquiry of a community dance program for older adults in Singapore

Dance programs promote physical and psychosocial well-being. However, studies focusing on the experiences of older adults in dancing are limited. This study aims to develop a community dance program (CDP) for older adults at senior activity centers in Singapore, as well as to explore the older adults' and student instructors' experiences of the CDP. A qualitative inquiry of semi-structured and in-depth focus group discussions was conducted. In total, 20 older adults and 10 student dance instructors participated in the study. Student instructors who were undergraduate students from a dance society were trained in how to provide step-by-step instructions for the older adults. An inductive approach of thematic analysis was undertaken. Three main themes were identified: (i) promotion of physical, cognitive, and psychosocial health with dance; (ii) imagination is power-travel through dance; and (iii) further enhancement of the dance program. The themes highlighted the prominence of CDP in improving memory, physical health, mood, and social interactions-thus mitigating the risk of social isolation. The findings illustrated the benefits of CDP in cultivating intergenerational bonds amongst older adults and student instructors.

Dance on: a mixed-method study into the feasibility and effectiveness of a dance programme to increase physical activity levels and wellbeing in adults and older adults

BACKGROUND

Physical activity (PA) has beneficial effects on physical and mental health outcomes in older adults. However, a consistent decline in PA participation has been noted with increasing age, with older adults consistently being reported as the least physically active population. Previous evidence showed that dance is an appropriate form of PA in older adults as it integrates the body's movement with physical, cognitive, and social elements. This study investigated the feasibility and efficacy of a weekly dance programme over a 12-month period on PA levels and wellbeing.

METHODS

A mixed-method intervention design was used. Community-dwelling older adults aged 55 + years were recruited from local community groups in Yorkshire (UK). The programme comprised of a 60-min mixed genre dance class per week. Changes with carried forward data in self-reported measures of PA (min/week) and wellbeing with EuroQol visual analogue scale (EQ VAS) across four different time points (baseline, 3, 6 and 12 months) were assessed using the Friedman test. Feasibility was also assessed through class attendance and focus groups (N = 6-9) with participants. A thematic analysis of qualitative data was conducted.

RESULTS

A total of 685 participants (589-89.1% females and 72-10.9% males) took part in the study. The mean age was 75 ± 10 years, and 38% of the participants were classed as highly deprived as per the index of multiple deprivation. There was a statistically significant increase in both PA (X2(3) = 192.42, P < 0.001) and EQ VAS scores across the four time points (X2(3) = 19.66, P < 0.001). The mean adherence rate was consistent across the 12-month period of intervention (70%). Themes from the focus groups included reasons for participating in the programme, perceptions of how the dance programme affected the participants, and facilitators to participation in the programme.

CONCLUSIONS

The good adherence and favourability indicate that the dance programme is feasible as an intervention in community-dwelling participants from socially economically diverse communities. The dance intervention showed a positive effect on PA levels and wellbeing. A randomised-controlled trial with a control group is required to test this intervention further.

CORE STRENGTH TRAINING IMPACTS ON THE IMPROVEMENT OF MUSCLE COORDINATION IN SPORT DANCERS

ABSTRACT Introduction: Dance sport is an emerging sport activity. The number of college students devoted to the study of dance is increasing. Basic dance sport skills are inherent to performance. Basic skills training requires dancers to have a certain degree of flexibility, endurance, speed, etc. Currently, we know that CORE strength training can improve the physical function of athletes, but studies are scarce as to its true impact on proprioceptive skills in dance sports. Objective: The purpose of this study was to examine the effect of strengthening the CORE on muscle coordination in sport dancers. This paper examines the relationship between core strength training and dance skills in athletes. Methods: Undergraduate sport dance students were randomly and voluntarily selected. These students undergo a 4-month training protocol in CORE strengthening. The effect of this experiment was evaluated with biomarker and kinetic data collected before and after the experiment. These data were worked out statistically and the results were discussed according to the literature. Results: After the CORE training protocol, the sport dance students had significant differences in physical tests(P<0.05). Conclusion: CORE training can promote physical stability, explosive power and muscle coordination in sport dancers. Level of evidence II; Training research - outcome investigation.

The effectiveness of the Healthworks Staying Steady community-based falls prevention exercise programme to improve physical function in older adults: a 6-year service evaluation

Background

Falls prevention exercise programmes are evidence-based and recommended for improving physical function in older adults. However, few service evaluations exist to assess the effectiveness of community-delivered interventions in practice.

Methods

We conducted a six-year, retrospective evaluation of the community-delivered Staying Steady programme (Healthworks, United Kingdom). Staying Steady is a 27-week, tailored strength and balance programme delivered in a group setting (1-h, once/week) and at home (30–40 min, 2–3 times/week). Participants were referred by healthcare professionals, or self-referred, due to a history or risk of falling. Routinely collected outcome measures (30-s chair stand, Timed Up and Go, four-stage balance test, and patient reported outcomes; including ‘fear of falling’ and ‘ability to manage health’) were analysed. Factors associated with programme completion were reported. The intervention effect on physical function was analysed in subgroups: participants used arms to chair-stand or a walking-aid at both (‘aided’), neither (‘unaided’), or one assessment timepoint (‘aided at baseline only’ or ‘aided at follow-up only’).

Results

There were 1,426 referrals; 835 (67.3%) participants enrolled on to the Staying Steady programme, 406 (32.7%) declined, 185 (13.0%) were inappropriately referred and excluded from analysis. After enrolling, 451 (54.0%) participants completed, and 384 (46.0%) dropped out. Chair stand performance improved in participants who were unaided (n = 264; median 2.0 [1.0, 4.0] repetitions; P < 0.001), or aided at baseline, follow-up or both (n = 170, P < 0.05). Timed Up and Go performance improved in the unaided (n = 387; median ˗3.1 [˗5.4, ˗1.4] s, P < 0.001), and aided at baseline only (n = 32; median ˗4.9 [˗10.8, ˗3.4] s, P < 0.001) groups. Four-stage balance performance improved (n = 295; median 1.0 [0.0, 1.0] points, P < 0.001). After programme completion, participants self-reported an improved ability to manage their health and daily activities, improved confidence, and a reduced fear of falling. Presence of chronic obstructive pulmonary disease, fear of falling, prescribed nutritional support, disability and social deprivation influenced non-completion of Staying Steady.

Conclusions

Completing Staying Steady improved physical function in older adults. Methods to encourage retention of participants from groups associated with low uptake and adherence should be investigated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13832-3.

Qualitative research to inform economic modelling: a case study in older people's views on implementing the NICE falls prevention guideline

Background

High prevalence of falls among older persons makes falls prevention a public health priority. Yet community-based falls prevention face complexity in implementation and any commissioning strategy should be subject to economic evaluation to ensure cost-effective use of healthcare resources. The study aims to capture the views of older people on implementing the National Institute for Health and Care Excellence (NICE) guideline on community-based falls prevention and explore how the qualitative data can be used to inform commissioning strategies and conceptual modelling of falls prevention economic evaluation in the local area of Sheffield.

Methods

Focus group and interview participants (n = 27) were recruited from Sheffield, England, and comprised falls prevention service users and eligible non-users of varying falls risks. Topics concerned key components of the NICE-recommended falls prevention pathway, including falls risk screening, multifactorial risk assessment and treatment uptake and adherence. Views on other topics concerning falls prevention were also invited. Framework analysis was applied for data analysis, involving data familiarisation, identifying themes, indexing, charting and mapping and interpretation. The qualitative data were mapped to three frameworks: (1) facilitators and barriers to implementing the NICE-recommended pathway and contextual factors; (2) intervention-related causal mechanisms for formulating commissioning strategies spanning context, priority setting, need, supply and demand; and (3) methodological and evaluative challenges for public health economic modelling.

Results

Two cross-component factors were identified: health motives of older persons; and professional competence. Participants highlighted the need for intersectoral approaches and prioritising the vulnerable groups. The local commissioning strategy should consider the socioeconomic, linguistic, geographical, legal and cultural contexts, priority setting challenges, supply-side mechanisms spanning provider, organisation, funding and policy (including intersectoral) and health and non-health demand motives. Methodological and evaluative challenges identified included: incorporating non-health outcomes and societal intervention costs; considering dynamic complexity; considering social determinants of health; and conducting equity analyses.

Conclusions

Holistic qualitative research can inform how commissioned falls prevention pathways can be feasible and effective. Qualitative data can inform commissioning strategies and conceptual modelling for economic evaluations of falls prevention and other geriatric interventions. This would improve the structural validity of quantitative models used to inform geriatric public health policies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07056-1.

The Impact of an Intergenerational Dance Project on Older Adults' Social and Emotional Well-Being

There has been strong interest in intergenerational arts practice in the United Kingdom since the 1980s; however, there is a generally weak evidence base for the effectiveness of intergenerational practice regardless of the domain. The aim of this study was to investigate the outcomes of an intergenerational arts project on participants’ social and psychological well-being using a mixed-methods, short-term longitudinal design. Generations Dancing brought together community artists with students (n = 25) and older adults (n = 11) living in Bedford. Over an 11-week period, participants worked together to produce a new dance performance and photography exhibition. Focus groups were conducted with the participants to explore their feelings about the collaboration across generations and communities. Participants also completed a battery of questionnaires preproject and postproject, to assess any change in their levels of well-being. Results indicate that the older adults showed increased confidence and willingness to connect with others; they got immense enjoyment from talking about their experience with others. Furthermore, the project helped to address negative stereotypes that the older adults had of working with the young people. The older adults enjoyed the students’ company and felt encouraged and supported by the young people. While a small number of challenges were identified, including difficulties in traveling to the workshops for vulnerable participants, most challenges were overcome through the older adults’ engagement in the project. For example, initial anxieties regarding the performance seemed insufficient to affect the participants’ overall enjoyment of the project. The findings were supported by the increased scores in relatedness, affect, and social well-being over time, but were not statistically significant. The results of this study indicate that intergenerational dance and arts projects can have wide-reaching positive impacts on both social and psychological well-being. However, there were a number of methodological challenges, including difficulty in recruiting sufficient numbers of both experimental and control groups for a robust quantitative evaluation of the data. These challenges highlight that “real life” settings and scenarios can influence the amount, nature, validity, and reliability of data collected. Going forward we encourage researchers to continue to consider innovative ways to address such methodological challenges.