Yoga Intervention Program for Elderly: A Health Promotion Report

This report outlines a comprehensive yoga intervention program designed to improve the health and wellbeing of elderly residents in a residential care setting. The program aims to enhance balance and gait, thereby reducing the risk of falls, a significant cause of morbidity and mortality among the elderly. The report includes a detailed background on the problem, a literature review supporting the use of yoga, and a statement of need for the program. It specifies the aims and objectives, which include improving balance, joint health, flexibility, and mental wellbeing. The study method involves a 10-month yoga program tailored for the elderly, with a sample size of 100 residents. The intervention includes two 60-minute yoga classes per week, with supervised practice. The report also details ethical considerations, data analysis methods, an action plan, a proposed budget, and anticipated outcomes. The program anticipates improvements in physical and mental health, and strategies to evaluate these outcomes are outlined. Finally, the report discusses future implications and provides staff and organizational information, along with references.

Running head: HEALTH ADVANCEMENT AND PROMOTION
HEALTH ADVANCEMENT AND PROMOTION
Name of the Student
Name of the university
Author’s note

1HEALTH ADVANCEMENT AND PROMOTION
Table of Contents
Background, Brief Literature and rationale:....................................................................................2
Statement of need............................................................................................................................4
Aims and Objectives:.......................................................................................................................5
Study method...................................................................................................................................6
Sample size and power....................................................................................................................6
Sampling method.............................................................................................................................7
Interventions....................................................................................................................................7
Ethical approval...............................................................................................................................8
Data analysis....................................................................................................................................9
Action plan and the program description.........................................................................................9
Yoga program and duration.......................................................................................................10
Anticipated outcomes and significances........................................................................................11
Strategies to Evaluate Outcomes...................................................................................................12
Proposed Timeline:........................................................................................................................13
Proposed Budget and Justification of the Budget:.........................................................................14
Future implication of Yoga –based intervention program.............................................................14
Staff and the organizational information.......................................................................................15
References......................................................................................................................................16

2HEALTH ADVANCEMENT AND PROMOTION
Yoga based interventions- improving balances of the elderly people in a residential care
unit
Background, Brief Literature and rationale:
Fall related injuries are one of the most significant contributors towards morbidity and
mortality among the elderly. According to Alshammari et al. (2018) fall related injuries are the
second biggest cause of accidental deaths after road accidents. The risks of falling have been
found to be higher among elderly people with problematic gait and balance. Studies have shown
that elderly patients who have poor gait and balance caused due to musculoskeletal disorders,
arthritis, reduction of lower body strength, muscular atrophy, obesity as well as mental health
problems such as dementia, Multiple/Lateral Sclerosis, Parkinson’s disease and Alzheimer’s.
According to the World Health Organization, every year approximately 646,000 people
die every year due to accidental fall related injuries, a majority of whom are elderly people, and
the risks of falls are highest among adults above 65 years of age (who.int, 2018). According to
the Australian Institute of health and Welfare, more than 1000 elderly people (above 65 years
age) die every year in Australia due to fall related injuries and is the cause of 45,000
hospitalizations, representing 54% of all injury related hospitalizations in the country. The
statistics also show that elderly people above the age of 85 years have 40 times the risk of fall
related injuries compared to individuals between 65 to 69 years of age. Moreover, 48% of the fall
related accidents occur at homes and residential setups (aihw.gov.au, 2018). It has been
suggested by many authors that increase in the risks of falling and fall related injuries is
correlated with a reduction in the muscular tone, strength and fitness among the elderly and a
corresponding physical inactivity. Inactivity also leads to muscular degeneration which can
further affect the movement of the people. Moreover due to musculoskeletal disorders and

3HEALTH ADVANCEMENT AND PROMOTION
arthritis, the elderly people might experience painful joints that can significantly inhibit their
movement. Another factor that can also increase the risks of injuries such as fractures due to
accidental falls is osteoporosis which can generally occurs among elderly people and affects their
bone density thereby making them more brittle and prone to breakage. Falls among the elderly
has been related to a reduction in the quality of life and functionality and can impair the ability of
the elderly patients to conduct their activities of daily living, all of which can increase the risks
of depressive symptoms and mental health problems. It can also be added that these fall related
injuries resulted in the expenditure of AUD 498.2 million in Australia (as of 2001) and is
estimated to increase to AUD 1375 million by 2051. This shows how fall related injuries are a
significant stressor on the health and wellbeing of the elderly people as well as lead to a
significant financial burden on both the patients as well as Australian healthcare
(safetyandquality.gov.au, 2009).
According to the Australian Commission on Safety and Quality of care, the main reasons
for fall among the elderly includes postural instability and muscular weakness due to which it is
important to improve the gait and balance of the elderly to reduce the risks of falling
(safetyandquality.gov.au, 2009). Several studies show that interventions such as yoga can
improve the functional gait and balance among the elderly. Studies by Phillips et al. (2016) show
that an eight week yoga session can significantly improve the functional gait of elderly residents
and their health related quality of life. This has also been supported by Youkhana et al. (2015)
who proposed that exercise routines based on yoga can improve the balance and mobility among
individuals over the age of 60 years and thus help in the reduction in the risks of falls among
them. According to the authors, yoga can help to improve muscle strength and joint flexibility
which helps in the improvement of balance and mobility and prevent several co morbidities

4HEALTH ADVANCEMENT AND PROMOTION
associated with old age such as arthritis, musculoskeletal problem and anxiety. Similarly,
according to Nick et al. (2016), yoga can also help to reduce the fear of falling among the elderly
people, which in turn can help to improve their quality of life and anxiety levels. Spiewak et al.
(2017) also opined that therapeutic yoga not only helps to reduce the risks of falling, but also
helps to reduce anxiety and improve sleep quality among elderly. Impact of yoga therapy and
meditation on the mental health of people due to the reduction of anxiety and depressive
disorders have also been proposed by Klatte et al. (2016) and de Manincor et al. (2016) which
clearly shows that yoga and meditation are effective strategies not only to improve gait and
balance but also mental health of elderly residents. Hegde et al. (2017) further pointed out that
individuals living with chronic aimlemts such as osteoarthritis, diabetes, musculoskeletal
disorders, cardiovascular diseases, dementia and hypertension not only affects the physical
wellbeing but also impacts their mental health being, quality of life and impairs their ability to
socialize with others. Their studies also supported that yoga can help to improve their mental
health condition and quality of life.
Statement of need
The X residential care setting has 200 elderly residents, 120 of which had been
determined to be at risk of slips and falls for a variety of needs including the gait impairment,
side effects of the medications, neuromuscular weaknesses, joint pain and more. Based on the
secondary research that has already been conducted, it can be anticipated that Yoga programs
would help in improving the gait impairments. Hence, in order to conduct a Yoga program for 10
months and for evaluating the effectiveness of the program a funding of about $ 48000 will be
required. Hence an amount of $ 48000 is requested for the purchasing the required yoga
equipment, fees of the trainers and arrangement of a yoga room.

5HEALTH ADVANCEMENT AND PROMOTION
The intervention that has been chosen for the program has been done on the basis of a
literature research that has already been conducted. Based on those evidences, it has been
planned to conduct a yoga program for the elderly patients of a residential care center.
Aims and Objectives:
The main aims and objectives of the intervention of providing yoga and meditation for
the elderly patients in a residential care are:
Improving Balance and Gait: By addressing this objective it can be possible to reduce the risks
of falling and fall related injuries which as prevalent among elderly residents and thereby helping
to improve their health and wellbeing.
Improving the health of the joints and flexibility: This can help to improve the mobility of the
elderly residents as well as improve their ability to perform the various ‘activities of daily
living’. By increasing flexibility, problems related to musculoskeletal disorders and
musculoskeletal degenerative diseases can also be overcome.
The intervention also has two additional objectives which are:
Reduction of anxiety: Through meditative techniques, the intervention will aim to reduce stress
and anxiety levels among the residents and reduce the risks of depressive symptoms and anxiety
disorders. Since anxiety has been identified to be the cause of several mental health problems, it
can be assumed that by reducing anxiety the risks of these diseases can be reduced too.
Improving memory: Medication will also aim to improve memory of the residents, thereby
helping to overcome the effects of dementia which is prevalent among elderly people. By
improving memory, the ability of the residents to take care of themselves can also develop.

6HEALTH ADVANCEMENT AND PROMOTION
Study method
Initially a secondary literary reach has already been conducted based upon which an
intervention has been planned. The study is intended to be conducted in a residential care center
in Australia, providing shelter to about 200 elderly residents. The main reason for the selecting
this age group and this facility is that a high rate of the mortality and morbidity is found among
the elderly people in this residential care due to fall due to gait disturbances. Furthermore as per
the secondary research that has already been conducted, it has been found the Yoga and the other
physical exercises improves the physical and the mental health of the elderly (DiBenedetto et al.,
2015). Results presented in an articles shows that most of the health care professionals in the
residential care units are poorly acquainted with the occupational therapy.
This study will be a primary research where some physical interventions will be
administered on a group of elderly individuals followed by a recording of the subsequent
outcome of the interventions.
Sample size and power
An estimation of about 100 elderly patients of a residential care should be chosen for the
study. The choice of the institution will be done by the conduction of an internal survey to find
out the average occurrence of the slips and falls occurring some of the chosen residential care
and one name of the residential care has been chosen for the study among the probable names.
Before the starting of the interventions, permission should be obtained from the institution
regarding the initiation of the study informing them about all the pros and the cons.

7HEALTH ADVANCEMENT AND PROMOTION
Sampling method
Elderly residents within the age group 55- 69 will be considered for this program. The
rationale for choosing this age group is due to the fact that most of the studies have reported this
age group to be vulnerable to slips and falls and a growing body of researches have supported the
fact that regular yoga based interventions are readily accepted by the older adults of this age
group and has been found to improve a wide range of the health outcomes in the older
population. Yoga programs have been found to improve the mood, quality of life, sleep
disturbances, metabolic profiles, balance and mobility.
Eligibility to participate in the yoga program will be determined by screening
questionnaires and physical assessment. The exclusion criteria for the study should include
asymmetric gait, evidence of congestive heart failure, one with a hip, knee or shoulder injury or
with the one with replacement, major orthopedic diagnosis in the pelvis or the lower extremities,
acute medical illness or some form of osteoarthritis that might cause discomfort while the yoga
exercises. Frail elderly adults above the age of 85 would not be considered for this intervention.
There would be other mild exercise regimen for them which will not be considered in this
program.
Interventions
A 10 month yoga program specifically tailored for the elderly patients will be designed
for improving the lower body strength and the flexibility. Based on the assessment each of the
participants will be attending two 60 minutes yoga classes each week and will be instructed to
complete at least twenty minutes of yoga practice within the residential care under the
surveillance of the nurses. Each group session would include a standard yoga session of gentle

8HEALTH ADVANCEMENT AND PROMOTION
and supervised yoga postures and relaxation techniques that has been designed for the beginners
and specifically tailored for the older patients. Props like chairs, blankets, yoga mats would be
provided to all the elderly patients for supporting them in any yoga positions that were difficult
or uncomfortable for them and to minimize the risk of this injuries due to over stretching. Each
of the yoga session would begin with a yoga warm up session and centering poses, which will be
followed by more active yoga exercises. Yoga postures that will be included in the program are –
Centering (cross legged position), tadasana (mountain pose), vajrasana( thunderbolt pose), table
pose ( with the leg lifting), virasana ( the hero pose), padangithasana ( holding the big toe). Each
of the yoga sessions would initiate with breathing yoga exercises (pranayama) and every session
of the yoga would be terminated by the corpse pose: the sabasana. Poses that specifically
targeted the pelvic region were included in yoga regimen.
The home practice sessions would alternate between 2 standard beginner’s yoga
regimens, each consisting of a subset of the group sessions. All the patient taking part in the yoga
program would receive a complete and illustrated homework assignments after each yoga
sessions. A daily log will also be maintained by the participants for monitoring the duration and
the frequency of the practice and for the documentation of the problems, progress, deterioration
or the other experiences.
Ethical approval
Ethical approval is an important part of the any interventions applied to a target group
and generally involves informing the participants about all the outcomes of the research such that
they can contribute to the program without any bias (Hariprasad et al., 2013). At first consent
should be taken from the authority of the residential care center officially for the conduction of

9HEALTH ADVANCEMENT AND PROMOTION
such a health promotion program. All the residents of the residential care will be invited
verbally as well as in writing to participate in the program informing about the advantages and
the disadvantages of the program. Sealed envelope should be sent to each of the participants.
Each of the participants will be allowed to leave the intervention program as per their wish and
their health conditions. Furthermore, ethical approval should also be taken from the ethics
approval committee or the institutional review board, before the conduction of the Yoga based
interventions.
Data analysis
Data analysis is the step that helps in inspecting, clean and transform the remodeled data
in order to reach a certain conclusion for a given intervention (Brannen, 2017). It is mainly of
two kind, the qualitative and the quantitative. The QOL and the perception of the patients and the
caregivers that has been found out by the help of the interviews will be analyzed thematically.
The interview texts will be coded for generating broader themes relevant to the topic (Hariprasad
et al. 2013). Furthermore, the data will be analyzed by the use of SPSS, version 11.2 (Brannen,
2017). The potential differences in the baseline data will be measured by using the student t tests.
The instruments that will be used for measuring the outcomes are Geriatric anxiety scale (GAS),
Quality of life questionnaire (QOL), and KATZ index for measuring the ADL, dynamic gait
index (DGI), Short physical performance battery and the Berg scale. The data will be analyzed
by comparing the baseline data obtained before the starting of the interventions and the
commencement of the interventions.

10HEALTH ADVANCEMENT AND PROMOTION
Action plan and the program description
In order to conduct a comprehensive yoga program for the elderly people, there has to be
an effective planning before the implementation of the interventions. Planning would include
choosing of suitable yoga postures as per the age group chosen for this interventions. The yoga
postures will be approved by a registered occupational expert before their implementation.
This should be followed by buying of the equipment needed for the conduction of the
yoga classes such as yoga mat, a yoga mat towel, comfortable and stretchable clothing for the
participants ,blankets and mattresses, a weighing machine for assessing the loss in weight
especially in the obese patients. Some modifications should be done for the yoga room, such as
provision of wide space to accommodate 100 patients, with effective lighting and audible sound
system. Two instructors will be present at the time of the yoga training.
Yoga program and duration
Day 1-
Warm up session- Free hand stretches and breathing exercises [ 10 minutes]
Asanas-
 Centering
 Virasana
 Vajrasana
 Padangusthasana
 Tadasana
 Parvotasana
 Sun salutation (using a chair)

11HEALTH ADVANCEMENT AND PROMOTION
 Modified sun salutation (using a prop)
[ Each postures to be maintained for 2 minutes ]
3 minutes rest will be given after the conduction of three asana at a time and the entire asana
cycle is repeated twice in each sessions.
Day 2-
 Salabhasana (locust pose)
 uttitha hasta padangustasana (extended holding
 the big toe pose)
 eka pada bhekasana (1-leg frog pose)
 supta baddha konasana (lying down bound
 angle pose)
[Each of the asana for two minutes each and repeated twice within the session]
At the end of the sessions sabasana (corpse pose) will be repeated.
Anticipated outcomes and significances
A large number of literary resources have proved that that yoga based interventions improves
balance and mobility in older people and have been found to be one of the precursor to prevent
falls. This done by increasing the muscular strength, flexibility and balance, reduction of the
stressors, anxiety and depression and overall enhancement of the well-being and the quality of
life (Gothe, Kramer & McAuley, 2014). Hence some of the anticipated outcomes after the
interventions are –

12HEALTH ADVANCEMENT AND PROMOTION
 Improvement in the quality of life (QOL)
 Improvement in the mobility of the adults
 Improvement in the balance
 Reduction of age related anxiety stressors
Strategies to Evaluate Outcomes
In order to evaluate the outcome of the 12 month intervention of yoga and meditation for
elderly residents, the following measures can be used to understand whether the intervention was
able to achieve the objectives of the study. These measures include:
Dynamic gait Index: This measure is used to assess the likelihood of falling among elderly
people through an eight item test that measures the dynamic balance of the people and identify
whether an individual has normal gait or are experiencing mild, moderate or severe impairment
of gait.
Short Physical Performance battery (SPPB): This measure combines tests on gait speed, chair
stand and balance of the individual through a series of activities one has to conduct in a given
time and thus help to assess the mobility of the person.
Berg Balance Scale (BBS): This measure assesses the ability of elderly patients to balance them
while conducting a series of predetermined activities and measures the standing balance, sitting
balance and dynamic balance of the patients.
Quality Of life Questionnaire (WHOQOL-100): This questionnaire has been developed by the
World Health Organization that helps to measure the Quality Of Life among elderly people
through 24 Quality of Life related questions.

13HEALTH ADVANCEMENT AND PROMOTION
Geriatric Anxiety Scale (GAS 10): This scale can be used to measure anxiety levels among the
elderly people through 10 questions.
These values will be collected first during the baseline measurement and then compared
with the measures taken at the final evaluation. Comparison between the baseline data and final
data can help to understand if the intervention was able to improve the gait, mobility, balance,
quality of life and anxiety levels among the participants and thus understand if the intervention
was successful or not to achieve its objectives.
Proposed Timeline:
The study will be conducted for 12 month during which data collection will be done on
the residential care setting to identify the potential participants and residents who are in need of
this particular intervention in the first two weeks of the month. After this the rest of the month
will be used to seek for the grant for the study. Baseline measures will be taken from the
participants using the evaluation metrics on the second month which can be compared to the
final evaluation data collected at the end of the month 12. From month 3 to month 12 for a total
of 10 months the intervention will be conducted for the selected residents in the aged care setup.
The Gantt chart below shows the proposed timelines for the project.
Activity Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12
Data Collection
Grant
Baseline Measures
Intervention
Evaluation

14HEALTH ADVANCEMENT AND PROMOTION
Proposed Budget and Justification of the Budget:
Elements Price Quantity Total (AUD)
Yoga Mats AUD 5.00 100 500
Yoga Blankets AUD10.00 100 1000
Computer AUD 1000.00 1 1000
Home Modifications AUD 500.00 1 500
Yoga Instructors AUD 150 per hour 100 hours 15000
Visiting Nurses AUD 100 per hour 100 hours 10000
Training Costs AUD 200 per hour 100 hours 20000
Total Cost in AUD 48000
Equipments such as yoga mats and blankets would be needed for every participant on
whom they can practice yoga and meditation daily. Since the intervention does not necessary
depend upon the need of many equipment, it can be assumed that the mattress and blankets
would suffice the needs. A computer is required for maintenance and computation of the data
generated during the study and thus helps in its final evaluation using data processing software.
Home modifications are needed to ensure the area where the intervention will be conducted in
properly ventilated, has adequate lighting and is safe for the participants. Yoga Instructors will
be hired for 100 hours (10 hours per month for 10 months) who would help the residents to
follow the Yoga and Meditation routines. Visiting nurses would also visit the facility every week
to assess changes in the health and wellbeing of the participants and understand if they are facing
any troubles with the program.
Future implication of Yoga –based intervention program
The future implication for such a study and the such a program is that yoga interventions can
be actively introduced in the treatment regimen of most of the residential care as, that would
improve the quality of life of these people and the would encourage them in carrying out their

15HEALTH ADVANCEMENT AND PROMOTION
daily chores of life (Patel et al., 2012) . Additionally such yoga programs are likely to facilitate
social interactions among the members of the residential care that again might prove to be
refreshing for this elderly people as most of them are susceptible to depression due to isolation
and loneliness (Gothe, Kramer & McAuley, 2014).
Staff and the organizational information
The staffs for this study and the yoga based interventions would include investigators
with special degree in Yoga and physical education having an extensive experience working with
the elderly people having gait impairments and has played a pioneering role in the conduction of
several yoga programs before. The investigators are proficient with the physical activities and
occupational therapies.

16HEALTH ADVANCEMENT AND PROMOTION
References
Australian Institute of Health and Welfare (2018). Deaths from falls in the elderly top 1,000 a
year - Australian Institute of Health and Welfare. Retrieved from
https://www.aihw.gov.au/news-media/media-releases/2001-1/nov/deaths-from-falls-in-
the-elderly-top-1-000-a-year
Alshammari, S. A., Alhassan, A. M., Aldawsari, M. A., Bazuhair, F. O., Alotaibi, F. K.,
Aldakhil, A. A., & Abdulfattah, F. W. (2018). Falls among elderly and its relation with
their health problems and surrounding environmental factors in Riyadh. Journal of
family & community medicine, 25(1), 29.
Brannen, J. (2017). Mixing methods: Qualitative and quantitative research. Routledge.
de Manincor, M., Bensoussan, A., Smith, C. A., Barr, K., Schweickle, M., Donoghoe, L. L., ...
& Fahey, P. (2016). Individualized yoga for reducing depression and anxiety, and
improving well‐being: A randomized controlled trial. Depression and anxiety, 33(9),
816-828.
DiBenedetto, M., Innes, K. E., Taylor, A. G., Rodeheaver, P. F., Boxer, J. A., Wright, H. J., &
Kerrigan, D. C. (2015). Effect of a gentle Iyengar yoga program on gait in the elderly:
an exploratory study. Archives of physical medicine and rehabilitation, 86(9), 1830-
1837.

17HEALTH ADVANCEMENT AND PROMOTION
Gothe, N. P., Kramer, A. F., & McAuley, E. (2014). The effects of an 8-week Hatha yoga
intervention on executive function in older adults. Journals of Gerontology Series A:
Biomedical Sciences and Medical Sciences, 69(9), 1109-1116.
Hariprasad, V. R., Varambally, S., Varambally, P. T., Thirthalli, J., Basavaraddi, I. V., &
Gangadhar, B. N. (2013). Designing, validation and feasibility of a yoga-based
intervention for elderly. Indian journal of psychiatry, 55(Suppl 3), S344.
Hegde, A., Metri, K., Chwadhary, P., Babu, N., & Nagendra, H. R. (2017). Effects Of Yoga
On Cardiac Health Sleep Quality, Mental Health And Quality Of Life Of Elderly
Individuals With Chronic Ailments: A Single Arm Pilot Study (No. 2017-06-07).
Klatte, R., Pabst, S., Beelmann, A., & Rosendahl, J. (2016). The Efficacy of Body-Oriented
Yoga in Mental Disorders: A Systematic Review and Meta-Analysis. Deutsches
Ärzteblatt International, 113(12), 195.
Nick, N., Petramfar, P., Ghodsbin, F., Keshavarzi, S., & Jahanbin, I. (2016). The effect of
yoga on balance and fear of falling in older adults. PM&R, 8(2), 145-151.
Patel, N. K., Newstead, A. H., & Ferrer, R. L. (2012). The effects of yoga on physical
functioning and health related quality of life in older adults: a systematic review and
meta-analysis. The journal of alternative and complementary medicine, 18(10), 902-
917.
Phillips, C., Schmid, A., & Willis, L. (2016). Effects of Yoga on Functional Gait and Health-
Related Quality of Life for Adults With Diabetic Peripheral Neuropathy. American

18HEALTH ADVANCEMENT AND PROMOTION
Journal of Occupational Therapy, 70(4_Supplement_1), 7011515269p1-
7011515269p1.
ACSQHC (2009). Preventing Falls and Harm From Falls in Older People. Retrieved from
https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Guidelines-
HOSP1.pdf
Spiewak, C., Steffen, S., Hicks, B., Little, K., & Pickett, K. (2017). A Systematic Review of
the Outcomes of Therapeutic Yoga With Older Adults. American Journal of
Occupational Therapy, 71(4_Supplement_1), 7111505134p1-7111505134p1.
WHO (2018). Falls. Retrieved from http://www.who.int/news-room/fact-sheets/detail/falls
Youkhana, S., Dean, C. M., Wolff, M., Sherrington, C., & Tiedemann, A. (2015). Yoga-based
exercise improves balance and mobility in people aged 60 and over: a systematic
review and meta-analysis. Age and ageing, 45(1), 21-29.