A pilot programme evaluation of social farming horticultural and occupational activities for older people in Italy

Nature-based interventions for older adults: a systematic review of intervention types and methods, health effects and pathways

BACKGROUND

Nature-based interventions (NBIs) may support older adults' health and well-being, but it remains unclear which interventions are most effective, for whom and in which contexts. The existing Wilkie and Davinson framework explains the pathways between NBIs and health outcomes but underemphasises the effects of environmental qualities. Therefore, the study aims to critically examine existing NBIs and their associated health outcomes, with a focus on identifying the environmental qualities and pathways that are either facilitating or impeding.

METHODS

The review sought 16 databases for any nature-based interventions aimed at enhancing health outcomes where participants are older adults aged ≥65. The Mixed Methods Appraisal Tool assessed risk of bias. Narrative synthesis was used for result presentation.

RESULTS

Of 6143 articles retrieved, 84 studies were included. Participants were primarily community dwelling without specific conditions. Most studies were quantitative experiments. Interventions were predominantly multicomponent, with restoring psychological capacities as the most common pathway. Spiritual, behavioural and socioecological changes were identified. Some health mechanisms were specific to outdoor interventions, but indoor interventions showed comparable outcomes.

CONCLUSIONS

The study predominantly included community-dwelling participants without specific health conditions, potentially limiting the generalisability of findings to older adults with multimorbidity or those in alternative living environments. Multicomponent interventions challenged direct associations between pathways and outcomes. Results extend existing frameworks by identifying spiritual, behavioural and socioecological benefits. Limited detailing of environmental qualities warrants further research to associate them with specific health outcomes.

REGISTRATION

The protocol was registered on PROSPERO (CRD42024496114).

Impact of a Discontinuous Training Program on Sedentary Behavior in Italian Type 2 Diabetes Older Patients: The Results of the TRIPL-A Randomized Controlled Trial

Background: Physical activity is an important predictor of quality of life in older adults with type 2 diabetes (T2D). Unfortunately, most T2D adults adopt a sedentary lifestyle. The randomized, controlled TRIPL-A trial aims to verify the effect of a personalized, discontinuous exercise program on a sedentary lifestyle of T2D older adults. Methods: A total of 305 T2D patients (mean age ± SD: 68.8 ± 3.3 years) were divided into a control arm receiving only behavioral counseling and an intervention arm of an 18-month supervised discontinuous exercise program (ERS). The primary outcomes were the changes in sitting time (ST) and metabolic equivalent (MET) values, both evaluated by the International Physical Activity Questionnaire short form. A repeated measures ANOVA with Bonferroni correction for multiple comparisons was used to compare study outcomes. Results: The ST and MET differed significantly during the study compared to the control group (p = 0.028 and p = 0.004, respectively). In the intervention group, a decrease from baseline in ST at 6 months (p = 0.01) and an increase in MET values at 6 months (p = 0.01) up to 12 months (p < 0.01) were found. No significant differences were found for the other variables. Conclusions: Beneficial lifestyle changes were found within the first year of intervention. These results align with the theory of change.

Positive impact of social relationships fostered by physical and/or cognitive group activity on older people's quality of life: PRISMA systematic review

Introduction

This review identified and examined the research literature on the effect of participating in physical and/or cognitive activities on older people's quality of life, to establish whether the social relationships fostered by these activities can be a vector of better physical, mental and social quality of life.

Method

A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched four databases (MEDLINE, APA PsycArticles/PsycInfo, PubMed, and Web of Science) for articles published between 1975 and 2022 using search terms related to psychosocial, population, and intervention topics. Studies were eligible if they involved older adults, participation in at least one activity (physical or cognitive), and at least one quality of life related outcome measure.

Results

We selected 20 articles published between 1990 and 2021, the majority concerning studies conducted in English-speaking countries. Ten studies were interventional (introduction of program of activities), and 10 studies were observational (60% quantitative, 40% qualitative). Overall, results revealed a positive impact of the activities on every aspect of quality of life (i.e., cognitive, physical, social, psychological, and quality of life in general).

Conclusion

The present review confirmed the beneficial impact of practicing physical and/or cognitive group activities on older people's quality of life, but the contribution of social factors and social relationships remains underestimated and not well defined in researches.

A scoping review of friendship intervention for older adults: lessons for designing intervention for people with aphasia

PURPOSE

Map the landscape of friendship interventions/programs for older adults to guide intervention/program development inclusive of the unique needs of older people with aphasia (PWA).

METHODS

A search query of multiple databases was completed for articles published before 4 January 2021. Studies included all the following: (1) participants aged 55 years or older; (2) addressed an intervention/program designed to prevent social isolation and/or friendship loss; (3) used an outcome variable related to social isolation and/or friendship; and (4) published in a peer-reviewed journal. Title and abstract screening were conducted using Covidence software, which tracked disagreements across the study team. All studies included in the full-text review were identified as relevant by a minimum of two study authors, and a consensus was reached on all full-text reviews. Data were extracted according to (1) theoretical frameworks used; (2) interventionist and discipline; (3) participant characteristics; (4) intervention/program replicability; (5) format of intervention/program; (6) measures used in the intervention/programs; (7) and, reported effects of intervention/programs on individuals.

RESULTS

A total of 40 articles with 42 intervention/programs were included and represented 4584 intervention/program participants ranging in age from 40 to 104 years. Intervention/programs involved a wide range of theoretical frameworks (e.g., theories of loneliness, feminist theory, positive psychology). Disciplines such as psychology and exercise science informed intervention/programs. Interventionists included many types of individuals like therapists, volunteers and home health aides. Intervention/programs often lacked adequate description for replication and included individual and group formats, most commonly delievered in the participants homes. Outcomes usually included self-report measures of loneliness, social networks, or well-being, and intervention/programming was primarily educational, activity-based, or networking-based in nature.

CONCLUSIONS

The intervention/programs reviewed yield important lessons to support innovation in developing friendship intervention/programs for older PWA as most yielded positive results and were acceptable to participants.IMPLICATIONS FOR REHABILITATIONPeople with aphasia want their friendships addressed as part of their rehabilitation; however, the research literature has little guidance in this area.Studies reviewed of friendship intervention/programs for older adults yielded helpful lessons for consideration in developing this type of intervention/programming for people with aphasia.Interprofessional teams made up of rehabilitation professionals should address friendship for people with aphasia in both research and clinical practice.

Interventions simultaneously promoting social participation and physical activity in community living older adults: A systematic review

Background

In recent years, there has been a global trend toward an increase in life expectancy and the proportion of elderly people among the population. In this regard, it becomes important to promote active and healthy aging. Physical inactivity and social isolation are both risk factors of many chronic illnesses and highly prevalent in older adults. This challenges communities to develop interventions that reduce these risk factors among elderly populations. The main aims of this study were to summarize community-based interventions that aim to simultaneously promote social participation and physical activity in older adults and to examine their effects.

Methods

We performed a systematic review based on the PRISMA standards. Literature searches were conducted in six scientific databases in July 2021. Articles were included if they had an interventional design, focused on older adults living in the community and measured social participation and physical activity as an outcome. The data were summarized narratively due to the heterogeneity of studies and the variety of outcome measures.

Results

Overall, 46 articles published in English were included. The studies were grouped in (1) interventions with main focus on physical activity promotion; (2) social activities that included a physical activity component; (3) health behavior interventions/ health education interventions; (4) multicomponent interventions; (5) environmental interventions. The majority of the reviewed studies reported positive effects of interventions on physical activity and/or social participation. No study reported negative effects. Analysis of quantitative studies showed that multicomponent interventions have great positive effects on both outcomes. In qualitative studies positive effects were found regardless of intervention type.

Conclusion

This review summarizes the evidence about the effects of community-based interventions that aim to promote social participation and physical activity in older adults. Multicomponent interventions seem to be most suitable for simultaneous promotion of physical activity and social participation. However, high variability in measurement methods used to assess both social participation and physical activity in the included studies made it difficult to compare studies and to indicate the most effective.

Systematic review registration

www.crd.york.ac.uk, identifier: PROSPERO [CRD42021268270].

Drivers and Barriers towards Social Farming: A Systematic Review

Social farming (SF) spread across Europe in recent decades. It represents an expression of agriculture diversification and performs a social function expressed through vulnerable individuals’ social inclusion. As a result, SF is able to generate positive externalities and thus contribute to social wellbeing. Despite benefits, SF faces several issues related to its dissemination. Although in recent years scholars have been approaching this topic, much remains to be researched. Therefore, the purpose of this study was to investigate, through a systematic review, drivers and barriers related to the spread of this phenomenon. Results showed that factors such as the lack of information on SF, farmers’ mental limitations and the lack of economic resources, as well as excessive bureaucratization, could hamper the spread of SF. On the other hand, ethical production, new income sources, sustainable rural development and new employment opportunities can encourage the dissemination of such practices. In order to overcome the barriers and emphasize the drivers pointed out by this study, the role of policymakers is essential, as they should promote information and training activities for farmers and consumers in order to increase awareness of SF social value and encourage a collective approach to SF practices.

Animal Assisted Interventions in the Green Care Framework: A Literature Review

Green Care (GC) and Animal Assisted Interventions (AAI) are recognised practices useful to enhance the wellbeing of people through interaction with nature and animals. This study aims at understanding the interconnections between GC and AAI by analysing deeply which interaction with animals is conducted. Therefore, we carried out a literature search through Web of Science and Google Scholar that allowed retrieval of 993 records; after the PRISMA selection process, 42 were included. Relevant information was extracted: year of publication, geographical location, objectives, settings in agricultural environment, animal species, characteristics of users involved, type of human–animal interaction, coexistence of other activities without animals, animal health and welfare issues. From the review emerged that research on GC with animals is common in high-income countries and that the line between AAI and occupational therapy is often vague. Moreover, the most common setting for these interventions appears to be the farm, and frequently animals involved are not selected according to their ethological characteristics. Users in this context are extremely various and not only involved in activities with animals. Within the included studies, we noted a lack in the consideration of animal welfare that indicates the need for increased awareness among practitioners and a more ethical approach when animals are involved.

Improvements to Healthspan Through Environmental Enrichment and Lifestyle Interventions: Where Are We Now?

Environmental enrichment (EE) is an experimental paradigm that is used to explore how a complex, stimulating environment can impact overall health. In laboratory animal experiments, EE housing conditions typically include larger-than-standard cages, abundant bedding, running wheels, mazes, toys, and shelters which are rearranged regularly to further increase stimulation. EE has been shown to improve multiple aspects of health, including but not limited to metabolism, learning and cognition, anxiety and depression, and immunocompetence. Recent advances in lifespan have led some researchers to consider aging as a risk factor for disease. As such, there is a pressing need to understand the processes by which healthspan can be increased. The natural and predictable changes during aging can be reversed or decreased through EE and its underlying mechanisms. Here, we review the use of EE in laboratory animals to understand mechanisms involved in aging, and comment on relative areas of strength and weakness in the current literature. We additionally address current efforts toward applying EE-like lifestyle interventions to human health to extend healthspan. Although increasing lifespan is a clear goal of medical research, improving the quality of this added time also deserves significant attention. Despite hurdles in translating experimental results toward clinical application, we argue there is great potential in using features of EE toward improving human healthy life expectancy or healthspan, especially in the context of increased global longevity.

Can a Green Care Informal Learning Program Foster Active Aging in Older Adults? Results From a Qualitative Pilot Study in Central Italy

Due to population aging worldwide, it is important for Health Care Systems to design new services fostering Active Aging dimensions (e.g., physical health, psychological well-being, social engagement, and lifelong learning). The aim of this pilot study was to develop new services fostering Active Aging dimensions by means of a 12-month green care informal learning program targeting 112 individuals among community-dwelling older people and day care center users. The impact of the intervention was assessed through three rounds of focus groups. Individuals' perception of the training benefits depended on their health and social condition at baseline. The program improved the social participation and learning attitudes of community-dwelling older people and the perceived well-being and health of day care center users. Green care activities triggered an Active Aging virtuous spiral where learning new practical and relational competencies helped older people recognize their value. Thus, it is recommendable to include green care therapy within the practice of services for older people, especially day care centers.

Social Farming: An Inclusive Environment Conducive to Participant Personal Growth

Social farming can ameliorate the everyday life of people engaged in farming activities, including perceived changes in mood or behavior. It can also be therapeutic, as it can address a range of public health and service provision issues. This paper presents the findings of an Italian project that explored the impact of social farming on the well-being of the participants and their ability to perform certain tasks linked to agricultural activities. In addition, this paper tries to evaluate how the organization of the network system around the participants helps them to improve their relational capabilities. Participant observations were made in class rooms and farms where the participants carried out their agricultural activities. Such observations focused on the way in which participants and other subjects (i.e., tutors and training staff) inside the network system interacted. A number of in-depth interviews were carried out with tutors and trainers in order to understand if the participants would play a relevant role in social farming activities and what that role would be.