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5 Social Determinants That Can Impact Senior Exercise

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George knew his diabetes wasn’t well-controlled. The way he put it, he had “let himself go” a little bit after retirement, and now, at age 70, that 40 extra pounds was having a negative effect on his blood sugar numbers.

When George visited his doctor for a quarterly blood sugar check, he figured he’d be told to exercise more. So it came as no surprise when his primary care provider advised him to start taking a walk after dinner every night.

“That sounds great in theory, doc,” George replied, “but you don’t know my neighborhood.”

It can be easy for senior care professionals to forget that not every senior lives in a safe neighborhood. But the truth is many seniors do not.

Factors like living environment and economic status are called social determinants of health. These factors can negatively affect an older adult’s ability to participate in exercise activities that could promote wellness.

When making recommendations for the seniors you work with, it’s important to get to know what social determinants might be at play in their lives and tailor your suggestions accordingly. Here are five common social determinants that keep seniors from complying with an exercise plan—and how to overcome them. Also note exercise might not be possible for seniors with certain physical limitations.

1. Unsafe neighborhood

Before you make any exercise recommendations to a senior client, be sure to consider his or her living environment. If the client lives in a high-crime area, for example, then it’s probably inadvisable to recommend a post-dinner stroll, as George’s doctor did. Instead, encourage the senior to exercise indoors. The University of Nebraska in conjunction with Home Instead, Inc.® developed these six videos illustrating easy exercises a senior can perform in the safety of his own home.

2. Lack of financial resources

Many seniors live on a fixed income that does not leave them with enough discretionary income to purchase a health club membership or even buy exercise DVDs. You can help these seniors reap the benefits of fitness by advising them to pursue free activities like walking (outdoors or in a public space like a shopping mall), video streaming exercise routines via YouTube, checking out exercise DVDs from the library, or following printable exercise worksheets available for free online.

3. Poor literacy skills or primary language other than English

For clients with low literacy or those for whom English is a second language, avoid providing exercise recommendations in written form. These clients would benefit from personalized instruction from a physical therapist, if possible. Or, they can watch videos that illustrate appropriate fitness activities.

4. Lack of transportation

If an older adult does not drive or lives in an area poorly served by public transportation, then it does not make sense to recommend he or she take exercise classes at a recreation center a few miles away. You should assess the client’s ability to travel and recommend fitness activities accordingly.

5. Cultural devaluation of exercise

A client’s ethnic culture may devalue exercise, particularly for women. In some cultures, fitness is not seen as a “feminine” activity. Be sure to evaluate the client’s cultural attitudes toward exercise in order to recommend activities that will not subject her to stigmatization within her community.

As you can see, seniors may face many obstacles to pursuing fitness activities. By taking the client’s social determinants of health into consideration, you can make highly targeted recommendations for an exercise plan the client can comply with.

Last revised: May 9, 2017

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Thoughts and stories from others
  1. June 13, 2017 at 8:28 am | Posted by CAROL CARGILL

    Good article with common sense solutions. I particularly like the additional information posted by Bobbi Ciarfella.


  2. May 24, 2017 at 1:25 pm | Posted by Bobbi Ciarfella

    Our local mall provides safe and convenient space for walking and exercising. From 6 to 9 a.m. the mall is open, climate controlled and well lit. Bathrooms are available as are drinking fountains. Several walking clubs meet there every weekday morning to walk, stretch and socialize. Age range is from 28--80+ There is free parking underneath . . . so folks can walk in all kinds of weather. Several of the coffee shops open by 8 a.m., so many folks walk and then share coffee and conversation afterwards.


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