Background: Age-related changes such as retirement and increased frailty leave older adults vulnerable to social isolation. Those who are socially isolated face additional health risks and Medicare costs. While group exercise programs have focused on falls prevention, their impact on social isolation has not been widely studied. Moreover, the implementation of such programs remains limited.
Objective: We seek to identify barriers to the enrollment of older adults into community exercise programs and to develop recruitment strategies targeting these barriers. Over three years, we aim to engage and enroll >2000 cognitively intact older adults (aged ≥50 years) within the Cedars-Sinai Community Benefit Service Area. We will examine whether participation in community-based exercise programs improves levels of social connectedness. We will also evaluate the effect on falls risk and healthcare utilization. Fear of falling and increased Medicare spending have been associated with social isolation; by considering these factors, we hope to capture the varied effects of social isolation.
Methods: A literature search was conducted using the PubMed database for established group exercise programs for older adults. Inclusion criteria were 1) being in the United States, 2) implemented from 2000-2018, and 3) discussed enrollment issues. Strategies were extracted, shared with stakeholders, and adopted into the L.E.A.P. study protocol. Launched in July 2018, L.E.A.P. will utilize a pre-post design to compare within-participant levels of social connectedness at baseline, six to eight weeks, and six months. The Duke Social Support Index and UCLA 3-Item Loneliness Scale will be used to quantify these levels.
Results: The search yielded 28 articles that met the criteria for full text review. Barriers can be categorized into participant barriers and program barriers. Participant barriers include transportation; fear of attending by oneself; desiring opportunities for socialization; and language and cultural barriers. Program barriers include determining appropriate community partners and maintaining program interest after initial recruitment. Three recruitment strategies in use include physician referral (“Exercise Prescriptions”); on-site tabling led by a Community Health Coach; and self-referral through flyers, friend(s), community leaders, and/or walk-ins. In the first week of recruitment, we have recruited 94 participants: 74 on-site and 20 physician referrals.
Conclusion: L.E.A.P. proposes a way for an existing, robust health system (Cedars-Sinai) to collaborate with community organizations to implement a longitudinal exercise program for older adults. We aim to demonstrate improved social connectedness, falls prevention, and healthcare savings. We also aim to develop a protocol addressing common barriers to enrollment so that L.E.A.P. can be adapted and sustained within the community. We expect recruitment efforts to increase in the following months and to see participant changes at follow-up. We strive to capture a sample of ≥50% low-income background, though language and cultural barriers pose several challenges. We anticipate continual modification of our recruitment and retention efforts to address these concerns.