Managing Chronic Diseases among the Elderly with Inertial Training

Community Health Concern 

An increase in the aging population worldwide form significant health, economic, and social challenges. Maresova et al. (2019) affirm that with people expecting to live to their 60s and beyond, the elderly population will continue rising dramatically. Maresova et al. (2019), assert that the worldwide population aged 60 and over is projected to increase by 56% by 2030. The above demographic transitions show that there is a need to emphasize on the medical needs and preventive healthcare of the elderly population. Maresova et al. (2019) assert that the aging population in the whole world accounts for the highest percentage of chronic disease cases. For instance, in the US, in every ten adults, six have a chronic condition (Maresova et al., 2019). Therefore, chronic conditions such as hypertension, diabetes, and coronary heart disease have major financial repercussions to the healthcare institution, individuals, and society. This research project seeks to evaluate the effectiveness of inertial training as an approach to the management of chronic diseases among the elderly. 

Management of chronic diseases among the elderly is not just a mere interest but a passion that developed after understanding the projection of rising cases of diabetes, hypertension, and coronary heart disease which results from poor nutrition and physical inactivity. More so, factors such as social problems and mistreatments, nutritional and food needs, lack of awareness of the risk factors, financial problems, psycho-emotional issues, and healthcare system issues also influence the quality of living among elderly populations. Maresova et al. (2019) affirm that adult obesity in the US has increased in the last 30 years with two-thirds of the population segment overweight. 

Additionally, functional changes such as reduced muscle strength and neuromuscular coordination deterioration that results from the increased age influence quality of living (Naczk, Marszalek & Naczk, 2020). Many elders are likely to be physically inactive when their neuromuscular coordination deteriorates or their muscle strength decreases which cause their functional efficiency to diminish even faster while obesity kicks in with other chronic illnesses. Thus, inertia training can help the elderly with improving muscle strength and keeping physically fit to avoid the development of chronic diseases. Therefore, to implement a successful inertial training project among the elderly, identifying and involving key stakeholders is necessary. 

Literature Review 

With an increase in age, one becomes more prone to cardiovascular diseases, mobility disability, cancer, and type 2 diabetes. A study by Mcleod, Stokes, and Phillips (2019) emphasizes chronic diseases such as cancer and type 2 diabetes as the leading cause of mortality in the population aged above 65 years. The pharmacological agents are the common prescriptions in the treatment of the most common chronic conditions, however, highly prescribed means to either delay or treat most of the chronic conditions, with some even having major side effects or reducing the compliance with the prescribed doses. According to Mcleod, Stokes, and Philllipos (2019) the low-cost pharmaceutical interventions with few side effects capable of mitigating the common chronic conditions are in-existence. However, physical exercises have shown great effects in the mitigation of various age-related chronic conditions. 

Sarcopenia is the collective term describing the progressive decrease in strength and the skeletal muscle mass with the increase in age. Mcleod, Stokes, and Phillips' (2019) study compares resistance exercise to aerobic training in the primary prevention of chronic conditions. Mcleod, Stokes and Phillips’ (2019) study demonstrates that the resistance training in the frail and pre-frail elders is capable of significantly enhancing the gait speed, muscular strength as well as physical performance. In 33 randomized trials, the inertial training as part of the resistance training can significantly improve the physical functioning of the community-dwelling older people. Mcleod, Stokes, and Phillips' (2019) meta-analysis involving 49 controlled trials led to the conclusion that after an average of 20.5 weeks of the resistance type of training older people gained a lean body mass of 1.1 kg. However, the Mcleod, Stokes, and Phillips' (2019) are limited to the heterogeneity approach employed in the various studies such as the training variables, participants' characteristics, and the methods employed in the assessment of mobility. Therefore, in skeletal muscle strength, resistance training plays a key role in strengthening the elderly. 

The skeletal muscle in human beings comprises an adaptable tissue accounting for 30-40% total body mass, which seems to be highly affected by the aging process. Lavin et al. (2019), assert that loss of muscle mass is highly concerning, especially because of its involvement in signaling, movement, metabolism infection resistance, and independence. Moreover, a decrease in muscle health is highly correlated with premature mortality among community-dwelling older individuals. Lavin et al. (2019) confirm that inertial training is capable of reversing the age-related decrease in muscle functions. For example, in 8-12 weeks, there is an increase of about 25-35% in the leg muscle strength by employing resistance training in the elderly group (Lavin et al., 2019). Inertial training plays a crucial role in the improvement of neurological control, which takes part in the mass wasting of muscles responsible for maintaining balance, reduced falls as well as mortality among the elderly. 

In another study, there was an evaluation of the effect of inertia training on the lower and upper extremity strength among the elderly. The study involved fourteen men and six women between the age of 76.7-78.77 years to randomized training (Naczk, Marszalek & Naczk, 2020). The training group underwent training twice per week using an inertial device called Cyklotren for six weeks. According to Naczk, Marszalek, and Naczk (2020), every training session, there were sets of exercises that involved flexor and extensor, elbow, and knee flex muscles. In the lower limbs, the trainees applied the 20kg loads with the upper limbs using the 10kgs. Naczk, Marszalek, and Naczk (2020) study discovered that after the end of the training the trainees had an increased flexor and extensor, elbow, and knee flex muscle strength from 37.1-69.1%. Moreover, there was an improvement in the lower limb strength of 40.6%, while the upper strength increase was 23.3% (Naczk, Marszalek & Naczk, 2020). More so, there was an increase in the gait speed as well as functional abilities, while the control results remained constant. Therefore, it is recommendable to adapt inertial training among older adults to increase their independence as well as their safety. 

Identification and the Importance of Key Stakeholders 

The frail elderly population is high consumers of both formal and informal healthcare services. However, Avanzo et al. (2017) indicate that the older generations and their caregivers are highly reluctant to seek help even while acknowledging its necessity. More so, limited involvement in the decision-making processes on the services they are dependent on tends to elicit feelings of disempowerment and devaluation among the older people. Therefore, it is necessary to acknowledge older people's attitudes, views, and understanding of the care planning and coping strategies. On the other hand, despite the various supports the informal caregivers receive from various jurisdictions, they perceive it as originating from a specific formula instead of acquiring support capable of making a difference (Avanzo et al., 2017). Therefore, to get maximum positive results in the implementation of inertial training to the elderly, acknowledging the various stakeholders’ views would ensure everyone's satisfaction, thus more cooperative attitudes and behaviors. 

Stakeholder identification refers to the process of identifying organizations and people likely to affect a project activity, be affected by its decisions as well as its results (UNDP, 2017). The identification process analyzes significant information concerning stakeholders' influence, interest, interdependencies, participation, and their effect on the success of the project. The key stakeholders in the inertial intervention are the primary physicians and the elderly who benefit directly from the project. According to UNDP (2017), the inertial project is likely to be successful if only the target population acknowledges its importance, thus, consenting to take part in it. Helping the elderly understand the importance of the project in coping with their frailty problems would promote feelings of empowerment and value if involved in the decision-making process, thus making them more cooperative. With the idea of doctors’ competence on all matters of health among patients, they influence the project’s success by recommending the project to their respective patients. Nonetheless, doctors also impact the project's success to their patients by monitoring its impact on the patient. 

In the decision-making process of a certain project, stakeholders can be collaborative, empowered, consulted, informed, or consent (UNDP, 2017). Internal stakeholders in the inertial project refer to the trained instructors and caregivers, dealing directly with the elderly people. As only a little knowledge exists concerning the inertial project to the elderly the primary physicians can play the role of informing the patients of the project while the doctors explain the importance of the project to their potential candidates (UNDP, 2017). Nonetheless, professional caregivers spending a lot of time with patients is responsible for empowering and encouraging their patients to remain persistent in the project, which helps in improving the effectiveness of the project. 

External stakeholders in the inertial project are the insurance companies. Insurance companies view the elderly population as a high-risk client, thus, shying away from covering them. However, understanding the importance of the inertial project to the elderly, insurance companies are likely to be involved in the inertial project encouraging their enrollees within the particular age bracket to enroll. Therefore, identifying the various stakeholders before the implementation of the inertial project helps in the preparation of the various groups and organizations for their maximum engagement. 

As outlined above, the various stakeholders play different roles to help with the success of the inertia project. The elderly people as the key stakeholders need as much information as possible. The caregivers work hand in hand with the trained instructors, in which in their absence they offer necessary assistance to the elderly. The primary physicians develop an objective way of assessing the inertia project's success to the elderly through the application of objective tests. Nonetheless, nurses record all the clients’ vitals in the whole session of training as an objective measure of improving health. In the achievement of the project goals, the various stakeholders employ a certain communication mode in meeting their needs while aiding in the realization of the project’s goal. Below is a summary of communication with the various stakeholders on their involvement in the inertial project in Pacifica Senior Living Oceanside nursing home. 

The communication Name	Time and Frequency of communication	Method of Communication	Individuals responsible for delivering communication	Individuals Receiving information	The location of the communication
Outline of the inertial project and the required equipment	-At the beginning  -Once	Meeting	Project manager	The local government	The local government’s local offices
Overview of the inertial project and the expected results	Once every week	Email	Project manager doctors	Insurance Companies
Project introduction	-At the beginning of the project  -Once	Meeting	Project manager	Doctors  Instructors  Nurses  Caregivers  The elderly target group	Pacifica Senior Living Oceanside nursing home
Briefing on the day’s activities	Occurring every time before the beginning of the exercises	Meeting	Trained Instructors	The trainees	Pacifica Living Oceanside nursing home
Clients’ objective tests	-At the beginning  -Once	Meeting	Project managers	Doctors
Ways of measuring vitals and daily record-keeping	-At the beginning  -Once	Meeting	Project managers	Nurses	Pacifica Senior Living Oceanside nursing home
Project’s success evaluation	Every week once	Meeting	Project manager	Target group

The communication plan shows the willingness of the various groups to participate in the inertial project. However, the communication plan is prone to challenges such as people failing to show up to the set meeting to either give or receive communication. However, from communication with many stakeholders, there is a possibility of reaping good results from the project. Many stakeholders were willing to open up and explain to the project managers anything likely to hinder their attendance with others ready to compensate for the lost opportunities. Nonetheless, stakeholders such as the project managers in the inertial project are willing to reschedule some of the events that may be impossible to attend to. 

Research Gap this particular project seeks to cover 

Many behavioral interventions and clinical progress have improved care in chronic diseases such as congestive heart failure, hypertension, and diabetes. However, fewer people are capable of reaping the benefits from the various developments in the healthcare system. According to Avanzo et al. (2017), chronic diseases care conditions are poor because of the increased chronic disease cases and disorganization in the delivery system thus, affecting the application of modern technology. More so, the healthcare system is more organized in responding efficiently and rapidly to acute illnesses. They emphasize the immediate condition, its definition with the exclusion of the alternative diagnosis that is more serious. The patient role in their care is passive with no emphasis on developing self-management skills among the patient. 

Leaving out the elderly in their care processes is associated with their feelings of dissatisfaction resulting from the idea of being demeaned or less valued as elders. Elders who are dissatisfied with their relationship with other people’s treatment are likely to isolate themselves, which is highly related to the development of various types of chronic diseases. Therefore, the inertial training program in the management of chronic diseases among the elderly is developed from the holistic nursing theory. Jasemi, ValiZdeh, Zamanzadeh, and Keogh (2017) define the holistic nursing theory as that which is governed by the holism and humanism concepts. Thus in holistic nursing, the elderly individuals with chronic conditions receive a type of care to which they are fully consenting to with their caregivers. In this type of partnership, the nurse and the patient establish a partnership that encourages negotiations that lead to a better recovery process. Therefore, this research hopes to discuss inertia training as a holistic approach taking account of every stakeholder's views in the management of chronic illnesses among the elderly for better results. 

Potential Impact of the Project 

Research on inertial training in the management of chronic diseases will help in the simplification of the nurses' work particularly those addressing the homecare healthcare conditions. According to Naczk, Marszalek, and Naczk (2020), the inertial training project in the promotion of physical activity among the elderly helps in the management of chronic diseases and risk-reduction among the geriatrics. Kamada et al. (2017) assert that inertial training in the elderly reduces the bone and muscle mass losses thus increasing the functional health. More so, it reduces cardiovascular disease risk, hence helping in the overall improvement of the patient's wellbeing. More so, this project led to the discovery that young adults undertaking high-intensity inertial training increase their arterial stiffness, which is a potential risk of cardiovascular risk. Kamada et al. (2017), players with high inertial training tend to be at a higher risk of prehypertension and hypertension. With this information, nurses can easily develop safe ways of promoting healthy living among the elderly to manage chronic diseases. 

Introducing inertial training in the elderly population tends to have a positive impact on the strength training behaviors among the elderly. Kamada et al. (2017) confirm that strength training reduces significantly cardiac deaths and cancer, which is a positive indication of increased life expectancy. More so, muscle strengthening from the inertia training increases glucose transport, reduce body mass index, increase muscle mass as well as insulin sensitivity. Therefore, the inertial training program in the local area (Oceanside, California) helps in the improvement of the elderly overall health. 

Chronic conditions affecting most of the elderly population have significant economic challenges to the individuals, the healthcare system, as well as the community at large. Currently, chronic diseases in the US account for 86% of medical expenses, with the cost of growing higher worldwide (Maresova et al., 2019). The prevalence of more than one chronic condition in an individual tends to have immense effects on the utilization and the cost of healthcare. Therefore, the inertial project's impact on the reduction of the prevalence of chronic diseases among the elderly results in genuine returns to the government, individuals, and nurses' investments hence the need for this project. Nonetheless, the inertial project helps the government in the achievement of its goals of ensuring the safety and wellbeing of its citizens. 

References 

Avanzo, B., Shaw, R., Riva, S., Apostolo, J., Bobrowicz-Campos, E., Kurpas, D., ... & Holland, C. (2017). Stakeholders’ views and experiences of care and interventions for addressing frailty and pre-frailty: a meta-synthesis of qualitative evidence.  PLoS One ,  12 (7), e0180127. 

Jasemi, M., Valizadeh, L., Zamanzadeh, V., & Keogh, B. (2017). A concept analysis of holistic care by a hybrid model.  Indian journal of palliative care ,  23 (1), 71. DOI: 10.4103/0973-1075.197960 

Kamada, M., Shiroma, E. J., Buring, J. E., Miyachi, M., & Lee, I. M. (2017). Strength training and all‐cause, cardiovascular disease, and cancer mortality in older women: A cohort study.  Journal of the American Heart Association ,  6 (11), e007677. 

Maresova, P., Javanmardi, E., Barakovic, S., Husic, J. B., Tomsone, S., Krejcar, O., & Kuca, K. (2019). Consequences of chronic diseases and other limitations associated with old age–a scoping review.  BMC public health ,  19 (1), 1431. 

Mcleod, J. C., Stokes, T., & Phillips, S. M. (2019). Resistance exercise training as a primary countermeasure to age-related chronic disease.  Frontiers in Physiology ,  10 , 645. 

Naczk, M., Marszalek, S., & Naczk, A. (2020). Inertial training improves strength, balance, and gait speed in elderly nursing home residents.  Clinical interventions in aging ,  15 , 177. DOI: 10.2147/CIA.S234299 

UNDP, (2017). UNDP Social and Environmental Standards (SES): Stakeholder Engagement. Guidance Note.