Effects of acupressure on the quality of life of frail older adults : a study of comfy acupressure on frail older adults in community dwellings & residential care

Abstract

The prevalence of frailty increases in all ageing societies, and poses great challenge to the public health system. Geriatric researchers are convinced that frailty is a multi-dimensional and dynamic process. Its progression can be managed with targeted interventions. Such interventions include physical exercise program, medical management of unstable health conditions, and resilience boosting efforts to improve older adults’ wellbeing and general quality of life (QoL). From the viewpoint of Traditional Chinese Medicine (TCM), the symptoms suffered by frail older adults can be understood as qi deficiency syndromes. And yet, the weakened functions can be strengthened through tonifying the visceral functions and rebalancing the qi in the meridian system. The objective of this research is to investigate whether acupressure, a non-pharmacological, non-invasive TCM treatment can improve the QoL of frail older adults. A 15 minutes’ acupressure protocol (Comfy Acupressure for the Elderly) was designed with the needs of frail older adults in mind. Two multi-centre randomized control trials were conducted. One targeted to frail older adults in community dwellings, and the other targeted to frail older adults under residential care. The treatment group received acupressure treatment 4 times a week for 12 weeks while the control group attended a regular program offered by the institutions. The pre-treatment, post-treatment and 3 months’ post-treatment data were collected for between-group comparison. The measurement instruments included standardized QoL questionnaires, Pittsburgh Sleep Quality Index (PSQI), Geriatric Depression Scale-short form (GDS-15) and Visual Analogue Scale for Pain. Differences of the intervention effects were assessed using generalized mixed-effect models. The mean age of subjects in the community dwelling study was 76.12 ± 7.08, with a mean Tilburg frailty index score of 7.13 ± 1.76. Significant between-group differences were found in the changes of all domains of WHOQOL-BREF in favor of the treatment group, most significantly in the physical domain (P = 0.001). Significant differences were also detected in the change of PSQI (P < 0.001), GDS-15 score (P = 0.002) and pain intensity (P = 0.006) with the treatment group demonstrating greater improvement. The mean age of subjects in the residential care study was 82.98±6.88, with a mean Tilburg frailty index score of 7.71±1.98. Comparing to the control group, participants in the intervention group reported significant improvement in their sleep quality (P=0.029) and Happiness (P=0.012). The between-group difference in the change of scores in Social Function domains of SF-12v2 was also significant but not the change of physical and mental component summary scores. The findings indicated that ‘Comfy Acupressure for the Elderly’ can improve the psychological well-being, social functioning and sleep quality of frail older adults in both community and residential settings. It also helps to relieve the pain of frail older adults living in community dwellings. Some of these benefits, however, subsided after the treatment ceased. The protocol was designed to be adminstered by trained informal caregivers to enhance its sustainability and cost-effectiveness. It is recommended that the protocol be promoted in the community or integrated into care plans of residential care facilities for the selected residents.