Hundreds of millions of people of all ages worldwide live with two or more chronic conditions – commonly defined as multi-morbidity.  Those living with it are found to have poorer physical and mental health, a high risk of being admitted to hospital and a higher risk of dying prematurely compared to people with only one chronic condition.
 
Given that the number of people living with multi-morbidity is only expected to rise in the future, finding better treatments is considered the next major health priority.
 
But despite multi-morbidity being a leading cause of disability, research on treatments is still in its relative infancy.  Few studies have investigated the long-term treatment options – and unfortunately the results of the studies done most often offer negligible improvements.
 
People with multi-morbidity require treatments that will improve their physical, mental, emotional and social heath, and of late more and more research is showing that exercise may actually be a broad-spectrum treatment for those living with multi-morbidity and offer many of the improvements patients want.
 
Currently, multi-morbidity is managed by treating each chronic condition separately using available medicines.  However, this approach may not reduce symptoms sufficiently, and can have additional adverse health effects.  As many people consult several health care providers, and also end up taking multiple drugs (often at least one for each condition) there is a risk of adverse events that can be inconvenient and unsatisfactory for patients.

Exercise as medicine
 
Research has shown that exercise is an effective treatment for more than 26 chronic conditions, including psychiatric diseases such as depression, anxiety, stress and schizophrenia; neurological diseases including dementia, Parkinson’s disease, multiple sclerosis; metabolic diseases including adiposity, hyperlipidaemia, metabolic syndrome, polycystic ovarian syndrome, type 1 and 2 diabetes; cardiovascular diseases including hypertension, coronary heart disease, heart failure, cerebral apoplexy, and intermittent claudication; pulmonary disease including chronic obstructive pulmonary disease, asthma, cystic fibrosis; musculoskeletal disorders including osteoarthritis, osteoporosis, back pain, rheumatoid arthritis; and cancer.  Research also shows exercise could potentially prevent at least 35 chronic conditions from developing.
 
Thanks to the overall effects on health such as lowering blood pressure, improving joint health and cognitive function, exercise therapy can benefit a range of chronic conditions.  It also has a lower risk of negative side effects compared to pharmalogical treatments.  What should be noted, however, is that exercise requires physical effort, and like pharmalogical treatments, the effects will diminish if the patient stops partaking.
The real question, could exercise therapy benefit people with multiple chronic conditions as well?
 
A recent review assessed the effect of exercise therapy on the physical and mental health of people with at least two of the following chronic conditions: osteoarthritis of the knee or hip, hypertension, type 2 diabetes, depression, heart failure ischemic heart disease and chronic obstructive pulmonary disease.  The review established 23 studies that looked at adults 50 to 80 years of age.
 
The exercise therapy interventions used in the studies were at least partially supervised by a physiotherapist or an exercise physiologist.  Most lasted 12 weeks on average and exercise was performed two to three times week, starting from low intensity and progressing to moderate to high intensity.  The exercise therapies included were aquatic exercise, strength training, aerobic training and tai chi.
 
The review results showed unequivocally that exercise therapy improved quality of life, and reduced anxiety and depression symptoms.  The benefits were higher in younger patients and patients who had higher depression symptoms before starting exercise therapy.  This highlights that people with severe depression - often considered ineligible for exercise due to their depression severity – may benefit highly from exercise therapy.
 
Patients who participated in exercise therapy were also able to walk longer.  Those taking part walked on average 43 metres more over six minutes than those not taking part in the exercise interventions.  This improvement appeared to be important for the patient and it reduced their disability to a noticeable level.  Exercise therapy also didn’t increase the risk of non-serious side effects, such as knee, arm or back pain, or falls and fatigue.  What’s more, it reduced the risk of hospitalisation, pneumonia and extreme fatigue.
 
The benefits were similar across all the combinations of chronic conditions included in the study, effectively concluding that exercise could be a safe and effective therapy instead of increasing drug prescription in people with multiple chronic conditions.
 
Together with patients and healthcare professionals, many aged care facilities have or are developing and testing exercise therapy and self management programmes to help carers understand whether personalised exercise therapy and self management is effective in managing and treating multi morbidity conditions in their patients.
 
 
In the meantime, people with multi morbidity can improve mental and physical health by exercising two to three times a week.  Aerobic workouts, strength training or a combination of the two can promote similar health benefits regardless of the conditions a person lives with.
 
 
 
Authors:
      Alessio Bricca, Postdoc, University of Southern Denmark
       Søren T. Skou, Professor, University of Southern Denmark
 
From Aged Care NZ Issue 02 2021
 
 

When we hear about autism spectrum disorder (ASD), we often think about small children and the challenges they will need to face throughout their lives, but most often than not we forget that these children will grow up and turn into young adults and then seniors.
Although autism can’t be cured, there are many approaches that you, as a caregiver –whether you are a beloved family member or a paid professional - can make to facilitate the life of an elderly that has been diagnosed with ASD.

Autism Spectrum Disorder can be diagnosed at any stage in life, however, when it is rather later than earlier, it can be a little more challenging - but not impossible - to adjust. If diagnosed at a later stage in life, usually, a series of changes in the daily routine and care needs to be made.
If the diagnosis was made in the early years, this is something that you will be more accustomed to and dealing with a senior with Autism could be a little less changeling for the family.
We must all agree that one of the most important aspects of our existence is having a good quality of life, and so, with that in mind, here are some great tips on how to take care of seniors with ASD.
Keeping a daily routine 
 
In general, individuals with ASD need a healthy daily routine. These simple everyday tasks will be extremely powerful as they will reinforce a feeling of happiness, stability and overall well-being. When these feelings are surfaced and experienced, it will be much easier for them to accept and handle other changes when needed.

A great proactive plan is to sit down and make a morning schedule or a to-do list with the ASD senior. The routine must be straightforward and easy to follow. Some examples can include healthy meal times, short walks - if possible, an art class, medication at a specific time of the day, attending a support group, quality family time.

Also, keep in mind that a hygiene routine should be included. Reminding the senior with ASD of the good points of their appearance can be a good way of encouraging healthy hygiene habits.
 
A safe environment for everyone
It is imperative to ensure that the environment is prepared according to the difficulties of each individual. 

For example, if the elderly person has difficulty moving around, it is essential to avoid slippery rugs, floors and cluttered spaces. Another idea is to install wall bars around so they can walk freely when needed.

Sociability is a must
To improve the individual's quality of life diagnosed with Autism, a key element is social interaction.
Whenever possible, seniors should attend a support group. Support groups can be a great place for them to identify with other people that face the same everyday challenges.

Always go slow and see how they feel - they don’t like being pushed too hard into doing something they are not 100% comfortable with and sure about. A good idea is to start nice and easy, with an easy topic and then add someone else into the conversation.

Since social interaction can be harder for seniors with ASD, support groups could be added to the routine.

Family support can be life-changing
To ensure good self-esteem and results in individuals with autism in older stages in life, it is important to have a good, caring and healthy family environment.

Although it is not always easy to deal with elderly and autistic patients, the family is one of the most important roles in this process.

Be kind to their sensitivities
People with autism are far more sensitive as their senses are sharper than normal. Music and general noises will sound louder in their ears, lights can appear much brighter for them and smells can feel stronger.

With this in mind, try to find out which one of these senses can be a trigger and work towards minimizing it. A lower TV and radio can be more accommodating while dimming the light or using side lamps can do the trick for avoiding distractions and stress.
Watch out for the non-spoken language

Autism affects the way people communicate, especially seniors, so you will need to be extra sensitive when it comes to understanding what they need and figure out what is going on with them.

Simple questions such as “How are you feeling?” should be avoided and replaced with more specific questions such as “Are you happy/sad today?” “Are you feeling leg cramps or stiff joints?” Specific questions are more prompted to result in clear replies.
​
Some ASD seniors may panic one day when they realize that they have lost their hearing or can no longer see, so all eyes should be on them to understand the unspoken words of what is happening.
 
Reference:  https://www.parentgiving.com/elder-care/caring-for-seniors-with-autism/