Coaching as a strategy for the health promotion of the elderly: a systematic review

Graciele Reinert Casadei Eraldo Schunk Silva Leonardo Pestillo de Oliveira Rose Mari Bennemann About the authors

Abstract

Objective:

To evaluate the effect of the application of coaching on the health promotion of the elderly.

Method:

A systematic review was performed in the PubMed, MEDLINE and SciELO databases. The selection of articles followed the PRISMA guidelines, and the articles were published from 2008 to July 2018. The following descriptors were used: aged (idoso, anciano), elderly (idoso, anciano), coaching (tutoria, tutoría), mentoring (tutoria, tutoría) and health promotion (promoção da saúde, promoción de la salud). Boolean operators were used for all databases: (coaching OR mentoring) AND (health promotion) AND (aged OR elderly); (idoso) AND (tutoria OR coaching) AND (promoção da saúde); (anciano) AND (tutoría OR coaching) AND (promoción de la salud).

Results:

The final analysis included three articles. These evaluated coaching tools for changes in lifestyle and the reduction of health risks for the elderly. The results were positive, with a significant improvement in the quality of life (mental and physical), health status, goal attainment, self-efficacy and increased immunization of the evaluated elderly persons.

Conclusion:

The use of coaching in health promotion in elderly is still incipient, however, based on the results, health coaching proved to be an effective strategy to enable the elderly to reach the maximum potential of self-management in health.

Keywords:
Health of the Elderly; Coaching; Health Promotion; Quality of Life

Resumo

Objetivo:

Avaliar o efeito da aplicação do coaching na promoção da saúde do idoso.

Método:

Trata-se de uma revisão sistemática, realizada nas bases de dados PubMed, MEDLINE e SciELO. A seleção dos artigos seguiu as diretrizes do PRISMA, publicados no período de 2008 a julho de 2018. Foram utilizados os seguintes descritores: aged (idoso, anciano); elderly (idoso, anciano); coaching (tutoria, tutoría); mentoring (tutoria, tutoría) e health promotion (promoção da saúde, promoción de la salud). Operadores booleanos foram aplicados para todas as bases de dados: (coaching OR mentoring) AND (health promotion) AND (aged OR elderly); (idoso) AND (tutoria OR coaching) AND (promoção da saúde); (anciano) AND (tutoría OR coaching) AND (promoción de la salud).

Resultados:

A análise final contou com três artigos, os quais buscaram avaliar ferramentas de coaching para mudanças no estilo de vida e redução de riscos à saúde dos idosos. Os resultados alcançados foram positivos, com melhora significativa da qualidade de vida (mental e física), do estado de saúde, da obtenção de metas, autoeficácia e aumento da imunização dos idosos avaliados.

Conclusão:

A utilização do coaching na promoção da saúde em indivíduos idosos ainda é incipiente, porém com base nos resultados encontrados, o coaching em saúde mostrou-se uma estratégia eficaz para capacitar idosos a atingir o potencial máximo de autogerenciamento em saúde.

Palavras-chave:
Saúde do Idoso; Coaching; Promoção da Saúde; Qualidade de vida

INTRODUCTION

Coaching is an important strategy for encouraging personal development, and is a major driving force of responsibility, organization, quality of care, support and the affirmation of human potential. Its essence is the development of skills to achieve goals. Thus, coaching contributes to the sustainability of an organization and the growth of the individual, allowing managers to realize that constructive and proactive change generates emotionally intelligent leaders who seek improvement and the ability to overcome problems, promoting productivity and, consequently, quality of life11 Barosa Pereira A. Coaching em Portugal: Teoria e Prática. Lisboa: Edições Sílabo; 2008..

The development of coaching has been exponential around the world, with the emergence of diverse schools, various lines of thought, different views, approaches and applications for varied markets and publics22 Ustá V. Coaching na gestão de enfermagem [Dissertação]. Lisboa: Escola Superior de Enfermagem de Lisboa, Curso de Mestrado em Enfermagem; 2012.. One of the modalities of coaching is health coaching, which is a health intervention aimed at helping the individual to set goals that promote health, such as changes in behavior and lifestyle to reduce health risks and improve quality of life³. In other words, health coaching helps patients find the motivation to initiate and maintain change by offering a variety of perspectives, and the recognition that various factors contribute to achieving goals44 Wolever RQ, Dreusicke M, Fikkan J, Hawkins TV, Yeung S, Wakefield J, et al. Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial. Diabetes Educ. 2010;36(4):629-39..

Some studies55 Cadmus-Bertram L, Nelson SH, Hartman S, Patterson RE, Parker BA, Pierce JP. Randomized trial of a phone and web based weight loss program for women at elevated breast cancer risk: the HELP study. J Behav Med. 2016;39(4):551-9.

6 Broekhuizen K, de Gelder J, Wijsman CA, Wijsman LW, Westendorp RG, Verhagen E, et al. An Internet based physical acivity intervention to improve quality of life of inactive older adults: a randomized controlled trial. J Med Internet Res [Internet]. 2016 [acesso em 06 jul. 2018];18(4):e74 [16p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917725/
https://www.ncbi.nlm.nih.gov/pmc/article...
-77 Park YH, Moon SH, Ha JY, Lee MH. The long-term effects of the health coaching self-management program for nursing-homeresidents. Clin Interv Aging 2017;11:1079-88. that have evaluated health coaching identified positive results regarding behavior and lifestyle changes such as increased physical activity, improved nutrition and the improved management of chronic diseases.

Each year nearly 58 million individuals reach the age of 60, so the aging of the world’s population cannot be ignored, as it poses challenges to public health, particularly in health promotion88 Fundo de População das Nações Unidas. Envelhecimento no século XXI: celebração e desafio: resumo executivo. Nova York: UNFPA; 2012.. The postponement of chronic illness and the effective management of existing diseases and disabilities among the elderly are important if a positive impact on the quality of life of this age group is to be achieved.

Based on the above, the present study aimed to evaluate, through a systematic review, the effect of the application of coaching on health promotion in older individuals.

METHOD

The selection of articles included in this systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA)99 Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar Revisões sistemáticas e Meta-análises: a recomendação PRISMA. Epidemiol Serv Saúde. 2015;24(2):335-42.. The guiding question for the search was: What effect does coaching have on the health promotion of the elderly?

The PubMed database of the National Library of Medicine, Medical Literature Analysis and Retrieval System Online (MEDLINE) and the Scientific Electronic Library Online (SciELO) were used for the article search, which was carried out in July 2018, seeking articles published in Portuguese, Spanish and English between 2008 and July 2018. The Health Science Descriptors(or DeCS) were used, together with their equivalents in English from the Medical Subject Headings - MeSH list: aged (idoso, anciano); elderly (idoso, anciano); coaching (tutoria, tutoría); mentoring (tutoria, tutoría) and health promotion (promoção da saúde, promoción de la salud). Boolean operators were applied in all the databases: (coaching OR mentoring) AND (health promotion) AND (aged OR elderly); (idoso) AND (tutoria OR coaching) AND (promoção da saúde) and (anciano) AND (tutoría OR coaching) AND (promoción de la salud).

As eligibility criteria the review included articles that were available free and in full; which employed health coaching, regardless of the tool and delivery method (in person, by telephone or via the internet); conducted with older adults (age ≥60 years); and which evaluated the effect of the application of coaching on the promotion of health among the elderly. Duplicate articles were excluded, as well as those unavailable online; abstracts and reviews.

For the selection and evaluation of articles, an instrument was developed containing the following variables: authorship; year; country of publication; type of study; number of participants; age range; statistic; intervention period; objectives; type of coaching delivery; coaching tool used and results achieved.

Four phases were selected for article selection: 1) identification of articles in the databases; 2) screening for inclusion and exclusion of studies by reading of the titles and abstracts; 3) full reading of the selected articles; 4) final selection of articles that met the systematic review eligibility criteria.

The articles identified by the search strategy were independently evaluated by two researchers.

RESULTS

The search resulted in 317 publications, 178 (56.2%) in PubMED, 139 (43.8%) in MEDLINE and zero (0%) in SciELO. From the titles and abstracts of the articles, 42 articles met the eligibility criteria, of which 21 were removed as they were duplicates, i.e. articles found in the MEDLINE database were also indexed in PubMED (Figure 1).

Figure 1
Flowchart of article selection. Maringá, Paraná, 2018.

After reading the full texts of the 21 pre-selected articles, 18 studies were excluded: ten for including participants under 60 years of age, six for describing future or ongoing research protocols and two which did not fully address the objectives of the review (Table 1). In the end, three studies met the eligibility criteria and comprised the results of this review (Chart 2) years.

Chart 1
Description of pre-selected articles subsequently excluded from the review. Maringá, Paraná, 2018.
Chart 2
Description of articles selected and included in the review. Maringá, Paraná, 2018.

Chart 2 describes the articles selected and included in the review. The selected articles were published in years 2016 (n=1) and 2017 (n=2). The countries in which the surveys were conducted were: the Netherlands, South Korea, and the USA. The average age of the older adults ranged from 64.7 to 80.9 years. The studies were developed as randomized controlled trials, with the presence of intervention and control groups. The number of participants ranged from 90 to 18,107. The t and Chi-square tests were mainly used for statistical analysis.

Of the three articles selected, two applied face to face coaching77 Park YH, Moon SH, Ha JY, Lee MH. The long-term effects of the health coaching self-management program for nursing-homeresidents. Clin Interv Aging 2017;11:1079-88.,2727 Zimmerman RK, Brown AE, Pavlik VN, Moehling KK, Raviotta JM, Lin CJ, et al. Using the 4 Pillars Practice Transformation Program to Increase Pneumococcal Immunizations for Older Adults: a Cluster-Randomized Trial. J Am Geriatr Soc. 2017;65(1):114-22., one of which combined face to face coaching with telephone coaching2727 Zimmerman RK, Brown AE, Pavlik VN, Moehling KK, Raviotta JM, Lin CJ, et al. Using the 4 Pillars Practice Transformation Program to Increase Pneumococcal Immunizations for Older Adults: a Cluster-Randomized Trial. J Am Geriatr Soc. 2017;65(1):114-22., and one article applied only online coaching66 Broekhuizen K, de Gelder J, Wijsman CA, Wijsman LW, Westendorp RG, Verhagen E, et al. An Internet based physical acivity intervention to improve quality of life of inactive older adults: a randomized controlled trial. J Med Internet Res [Internet]. 2016 [acesso em 06 jul. 2018];18(4):e74 [16p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917725/
https://www.ncbi.nlm.nih.gov/pmc/article...
. The intervention period ranged from two to 24 months. In terms of objectives, the studies sought to evaluate coaching tools for lifestyle changes and health risk reduction.

The results achieved in the studies were positive, with a significant improvement in quality of life (mental and physical)66 Broekhuizen K, de Gelder J, Wijsman CA, Wijsman LW, Westendorp RG, Verhagen E, et al. An Internet based physical acivity intervention to improve quality of life of inactive older adults: a randomized controlled trial. J Med Internet Res [Internet]. 2016 [acesso em 06 jul. 2018];18(4):e74 [16p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917725/
https://www.ncbi.nlm.nih.gov/pmc/article...
,77 Park YH, Moon SH, Ha JY, Lee MH. The long-term effects of the health coaching self-management program for nursing-homeresidents. Clin Interv Aging 2017;11:1079-88.; health status77 Park YH, Moon SH, Ha JY, Lee MH. The long-term effects of the health coaching self-management program for nursing-homeresidents. Clin Interv Aging 2017;11:1079-88.; achieving goals77 Park YH, Moon SH, Ha JY, Lee MH. The long-term effects of the health coaching self-management program for nursing-homeresidents. Clin Interv Aging 2017;11:1079-88.; self-efficacy77 Park YH, Moon SH, Ha JY, Lee MH. The long-term effects of the health coaching self-management program for nursing-homeresidents. Clin Interv Aging 2017;11:1079-88. and increased immunization2727 Zimmerman RK, Brown AE, Pavlik VN, Moehling KK, Raviotta JM, Lin CJ, et al. Using the 4 Pillars Practice Transformation Program to Increase Pneumococcal Immunizations for Older Adults: a Cluster-Randomized Trial. J Am Geriatr Soc. 2017;65(1):114-22. of the elderly persons evaluated.

DISCUSSION

There are few articles that evaluate the effect of coaching on health promotion, hampering a robust analysis of the effect of coaching on health promotion among the elderly. Most studies analyzed in their entirety (n=21) at the eligibility stage were excluded (n=10) as they included older and middle-aged individuals in the groups evaluated (intervention and control), which may mean the results are unreliable, as the elderly have their own characteristics resulting from the aging process. In addition, six studies were from future or ongoing study protocols.

It was also observed that although the studies reported the use of coaching for health promotion, there is great difficulty on the part of the authors when it comes to understanding the term “health coaching”. In general, the understanding of coaching observed was focused on the action of a health professional who combines information and health education to encourage the individual to initiate and maintain behavioral changes associated with health. This procedure, however, relates to the application of mentoring rather than coaching. The former involves the transmission of instructions from an individual who has knowledge of a specific domain to a less experienced individual, and does not require mentor coaching skills2828 Grant AM. Towards a psychology of coaching: The impact of coaching on metacognition, mental health and goal attainment [Doctoral thesis]. Australia: Macquarie University, Departament of Psychology; 2001.. Coaching, on the other hand, is a process in which the coach (the one who leads the process) facilitates the learning of an individual without, however, having knowledge of the area of learning of such individual, that is, the coach only needs to have experience in the process of learning facilitation and performance enhancement2929 Oliveira-Silva LC, Werneck-Leite CDS, Carvalho PSF, Anjos AC, Brandão HIM. Desvendando o Coaching: uma Revisão sob a Ótica da Psicologia. Psicol Ciênc Prof. 2018;38(2):363-77.. Coaching is a process of human development that involves the use of structured, focused interactions and strategies, as well as appropriate tools and techniques to bring about desirable change for the benefit of the individual.3030 Cox E, Bachkirova T, Clutterbuck D. The complete handbook of coaching. London: Sage; 2014.

The lack of understanding and inadequate use of these techniques may be related to the scarcity in literature of information about the specifications needed for coach training. There are some basic requirements for working in this area, such as: obtaining a coaching development training certificate; have gone through a specific coaching process; have carried out work on one’s own; provide adequate vocational training; remain under constant supervision in one’s activities as a coach2929 Oliveira-Silva LC, Werneck-Leite CDS, Carvalho PSF, Anjos AC, Brandão HIM. Desvendando o Coaching: uma Revisão sob a Ótica da Psicologia. Psicol Ciênc Prof. 2018;38(2):363-77.. Other limitations of health coaching studies are associated with the lack of clarification about the characteristics of health coaching (strategies, practices, delivery methods); what is the exact role of the coach (educator, facilitator, navigator, partner); what training is required to act as a coach and what type of training would enable such professionals to perform competently in the health coaching process3131 Wolever RQ. Health & Wellness Coaching: evidence, challenges and opportunities. London: Vanderbilt University Medical Center; 2016..

The difficulty in defining the coach’s duties, as well as their academic training or the training methodology verified in the studies, made selection difficult and restricted the results to a few articles. It was a challenging task, given the variety of concepts used, the diversity of approaches, as well as the scarcity of studies focused on the theme.

The evidence of the selected articles66 Broekhuizen K, de Gelder J, Wijsman CA, Wijsman LW, Westendorp RG, Verhagen E, et al. An Internet based physical acivity intervention to improve quality of life of inactive older adults: a randomized controlled trial. J Med Internet Res [Internet]. 2016 [acesso em 06 jul. 2018];18(4):e74 [16p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917725/
https://www.ncbi.nlm.nih.gov/pmc/article...
,77 Park YH, Moon SH, Ha JY, Lee MH. The long-term effects of the health coaching self-management program for nursing-homeresidents. Clin Interv Aging 2017;11:1079-88.,2727 Zimmerman RK, Brown AE, Pavlik VN, Moehling KK, Raviotta JM, Lin CJ, et al. Using the 4 Pillars Practice Transformation Program to Increase Pneumococcal Immunizations for Older Adults: a Cluster-Randomized Trial. J Am Geriatr Soc. 2017;65(1):114-22. in the present review that met the eligibility criteria suggests that coaching is a viable strategy for improving health, self-management, adherence to health promotion activities and, consequently, to improving the quality of life of the elderly. Programs that enable the elderly to self-manage their symptoms and treatments based on lifestyle changes are essential for a healthy life3232 Richard AA, Shea K. Delineation of self-care and associated concepts. J Nurs Scholarsh. 2011;43(3):255-64.. Self-management improves problem solving, the maintenance of exercise, medication use, and communication skills.3333 Jordan JE, Briggs AM, Brand CA, Osborne RH. Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach. Med J Aust. 2008;189(10 Suppl):9-13.

The coaching methodology presents beneficial results that lead to behavioral and lifestyle changes, such as increased physical activity, improved nutrition and self-esteem3434 Mendes FP, Garin NC, Timm EZ, Ribeiro J L. Aplicação da metodologia coaching para o tratamento da obesidade: uma visão multidisciplinar. Ciênc Mov. 2017;19(39):61-9.

35 Magalhães T, Neves L, Poínhos R. A metodologia de coaching aplicada às ciências da nutrição: usos, potencialidades e controvérsias em Portugal. Acta Port Nut. 2018;12:26-31.
-3636 Meya-Molina A, Giménez-Sánchez J. Coaching nutricional como herramienta para la adquisición de hábitos alimentarios preventivos del cáncer. Rev Esp Nutr Hum Diet. 2014;18(1):35-44., reinforcing that this technique can be used as a strategy for health promotion, aimed at such promotion and an improved quality of life.

Thus, research evaluating the effects of coaching on health promotion in the elderly needs to be further explored, as the world’s older population is expanding rapidly. This is a challenge for the health care needs of these individuals, as aging is a multifactorial process that promotes anatomical and functional changes in the body. Such changes usually result in the onset of chronic diseases; functional disability; the need for care; reduced mobility; depression; isolation and loneliness, which can negatively influence the quality of life of the older adult3737 Ory MD, Cox DM. Forging ahead: Linking health and behavior to improve quality of life in older people. In: Romney DM, Brown RI, Fry PS, editors. Improving the Quality of Life. Dordrecht: Springer Publishing Company; 1994..

Under chronic conditions, the commitment to self-care and the ability to adhere to long-term recommendations is of utmost importance. In this sense, health coaching motivates individuals to initiate and maintain change, and to recognize factors that contribute to achieving their goals44 Wolever RQ, Dreusicke M, Fikkan J, Hawkins TV, Yeung S, Wakefield J, et al. Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial. Diabetes Educ. 2010;36(4):629-39.. Health coaching is an effective strategy for older people to prevent a disease from getting worse and for improving their lifestyle3838 Huffman M. Health coaching: a new and exciting technique to enhance patient self-management and improve outcomes. Home Healthc Nurse. 2007;25(4):271-4..

Limitations of the present study include its design, as the eligibility criterion meant that only free full text studies in the searched databases were evaluated, the sample size obtained (three articles) and the individualistic approach, as observed in one of the selected studies, in which the participation of the older adults was voluntary, which may have contributed to the representation of participants who were highly motivated towards lifestyle-related changes. Similarly, the restricted selection of internet-enabled elderly persons led to a sample with a relatively high educational level; as a consequence, the application of the results of this study to the general elderly population is limited66 Broekhuizen K, de Gelder J, Wijsman CA, Wijsman LW, Westendorp RG, Verhagen E, et al. An Internet based physical acivity intervention to improve quality of life of inactive older adults: a randomized controlled trial. J Med Internet Res [Internet]. 2016 [acesso em 06 jul. 2018];18(4):e74 [16p.]. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917725/
https://www.ncbi.nlm.nih.gov/pmc/article...
.

CONCLUSION

Although the studies produced promising results, suggesting that health coaching brings about changes in the disease management and lifestyle of the elderly, the application of the methodology in health promotion for older individuals is still incipient. The sense of partnership between patients and health professionals promoted through the coaching methodology, either face to face, online or by phone, can be a tool used to promote the health of the elderly.

The importance of further studies that evaluate the coaching methodology in the health promotion of elderly persons in the areas involved, such as those related to physical, mental and social aspects, is emphasized. Such studies are important for the planning of strategies that aim to implement actions for the promotion of the health of the elderly, contributing to geriatric and gerontological research and practice.

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  • No funding was provided for this study.

Publication Dates

  • Publication in this collection
    04 Nov 2019
  • Date of issue
    2019

History

  • Received
    29 Mar 2019
  • Accepted
    09 Sept 2019
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