Psychological and Physical Practices for Older Adults: What the Science Says

Sleep Disorders

Research has demonstrated beneficial results of cognitive behavioral therapy for insomnia (CBT-I) for people with chronic insomnia disorder. There is also some evidence suggesting that relaxation therapy may be useful for this condition. There is limited evidence that other complementary health approaches such as yoga may be helpful for people with sleep problems.

Current clinical practice guidelines from the American Academy of Sleep Medicine (2021) recommend psychological and behavioral interventions in the treatment of chronic insomnia disorder in adults. 

• The American Academy of Sleep Medicine guidelines state: “We recommend that clinicians use multicomponent cognitive behavioral therapy for insomnia (CBT-I) for the treatment of chronic insomnia disorder in adults (strong recommendation). We suggest that clinicians use relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults (conditional recommendation).” The authors of the guidelines also noted that there were fewer than three studies meeting their inclusion criteria for the use of cognitive therapy, paradoxical intention, mindfulness, biofeedback, and intensive sleep retraining; as a result, no recommendations were made about these treatments.

What Does the Research Show?

• Cognitive behavioral therapy for insomnia (CBT-I). Clinical practice guidelines issued by the American Academy of Sleep Medicine in 2021 recommend psychological and behavioral interventions for the treatment of chronic insomnia disorder in adults. The guidelines state: “We recommend that clinicians use multicomponent cognitive behavioral therapy for insomnia (CBT-I) for the treatment of chronic insomnia disorder in adults (strong recommendation).”
• Relaxation techniques. There is a small amount of low-quality evidence that relaxation techniques by themselves can help with chronic insomnia.  Relaxation techniques may be recommended in certain situations, depending on individual preferences, health provider qualifications, and treatment availability. Current clinical practice guidelines from the American Academy of Sleep Medicine (2021) conditionally recommend relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults.
• Yoga. Yoga has been shown to be helpful for sleep in several studies of cancer patients, women with sleep problems, and older adults and in individual studies of other population groups, including people with arthritis and women with menopause symptoms. However, a 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was insufficient evidence to recommend for or against yoga for treating insomnia.
• Tai chi. Results of several studies, using objective and subjective measures, have shown that tai chi may be helpful for people with sleep problems. However, a 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was insufficient evidence to recommend for or against using tai chi to treat insomnia.
• Mindfulness meditation. A 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was not enough evidence to know whether mindfulness meditation is helpful for people with insomnia, and a 2021 clinical practice guideline from the American Academy of Sleep Medicine said there was not enough evidence to make recommendations on using mindfulness by itself for insomnia.
• Music-based interventions. A 2022 review of 13 studies with 1,007 adult participants found that listening to music may lead to improved sleep quality among people with insomnia. However, there was not enough good-quality evidence to determine the effect of listening to music on the severity of insomnia or the number of times a person wakes up.
• Acupuncture. A 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was not enough evidence to recommend for or against using acupuncture for insomnia, except for a weak recommendation for auricular acupuncture, which involves specific points on the outer ear. Results from some studies suggest that auricular acupuncture may help improve insomnia; however, many of the studies conducted on acupuncture for sleep disorders are small and are of low quality.

Safety

• CBT-I and relaxation therapies for insomnia are considered safe.
• Tai chi appears to be safe. A 2019 meta-analysis of 24 studies (1,794 participants) found that the frequency of adverse events was similar for people doing tai chi, another active intervention, or no intervention. 
• In general, research studies of music-based interventions do not show any negative effects. However, listening to music at too high a volume can contribute to noise-induced hearing loss. In addition, because music can be associated with strong memories or emotional reactions, some people may be distressed by exposure to specific pieces or types of music.
• Relatively few complications from using acupuncture have been reported. However, complications have resulted from use of nonsterile needles and improper delivery of treatments.  When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, and injury to the central nervous system. 

• Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor. However, as with other forms of physical activity, injuries can occur. Pregnant women, older adults, and people with health conditions should talk with their health care providers and the yoga instructor about their individual needs. They may need to avoid or modify some yoga poses and practices. 
• Meditation is considered to be safe for healthy people. There have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched. People with physical limitations may not be able to participate in certain meditative practices involving physical movement. Individuals with existing mental or physical health conditions should speak with their health care providers prior to starting a meditative practice and make their meditation instructor aware of their condition.

Menopausal Symptoms

Overall, research suggests that some psychological and physical approaches, such as yoga, tai chi, and meditation-based programs may provide some benefit in reducing common menopausal symptoms.

What Does the Research Show?

• A 2019 systematic review and meta-analysis of 12 randomized controlled trials involving a total of 1,016 women found that psychological interventions, including cognitive behavioral therapy, mindfulness-based therapy, and behavioral therapy reduced hot flashes in the short and medium-term and other menopausal symptoms in the short-term.
• A 2018 systematic review and meta-analysis of 13 randomized controlled trials involving a total of 1,306 women found that yoga appears to be at least as effective as other types of exercise in relieving menopause symptoms such as hot flashes, and psychological symptoms, such as anxiety or depression.
• A 2010 review of 21 papers assessed mind and body therapies for menopausal symptoms. The researchers found that yoga, tai chi, and meditation-based programs may be helpful in reducing common menopausal symptoms including the frequency and intensity of hot flashes, sleep and mood disturbances, stress, and muscle and joint pain.
• A 2013 Cochrane review of 16 randomized controlled trials involving 1,155 women found that when acupuncture was compared with sham acupuncture, there was no evidence of difference in their effect on hot flashes. However, when acupuncture was compared with no treatment, there appeared to be some benefit from acupuncture. Acupuncture was less effective than hormone therapy. The low quality of evidence and lack of control with sham acupuncture for some of the studies led the reviewers to conclude that there is insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms.

Safety

• Meditation is considered to be safe for healthy people. There have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched. People with physical limitations may not be able to participate in certain meditative practices involving physical movement. Individuals with existing mental or physical health conditions should speak with their health care providers prior to starting a meditative practice and make their meditation instructor aware of their condition.
• Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor. However, as with other forms of physical activity, injuries can occur. Pregnant women, older adults, and people with health conditions should talk with their health care providers and the yoga instructor about their individual needs. They may need to avoid or modify some yoga poses and practices.
• Tai chi is considered to be a safe practice. Complaints of musculoskeletal pain after starting tai chi may occur but have been found to improve with continued practice.

• Relatively few complications from using acupuncture have been reported. However, complications have resulted from use of nonsterile needles and improper delivery of treatments.  When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, and injury to the central nervous system.

Poor Balance/Risk of Fall

There is evidence that tai chi may reduce the risk of falling in older adults. There is also some evidence that tai chi and qigong may improve balance and stability with normal aging and in people with neurodegenerative conditions, including mild-to-moderate Parkinson’s disease and stroke.

What Does the Research Show?

• A 2019 Cochrane review of 108 randomized controlled trials involving 23,407 community-living participants aged 60 years and older found that exercise programs reduce the rate of falls and the number of people experiencing falls in older people living in community settings. The review also found that tai chi may reduce the rate of falls by 19 percent (low-certainty evidence) and may reduce the number of people who experience falls by 20 percent (high-certainty evidence).
• The number of qigong studies that have included older adults is limited. Two 2019 reviews looked at the effects of qigong on the physical and psychological health of older adults. Some of the results were positive, suggesting a potential benefit of qigong for older adults. A 2019 survey of reviews found sufficient evidence to support qigong for balance training and fall prevention. When compared to more traditional interventions, qigong was found to have similar and sometimes better effects.

Safety

• Tai chi and qigong are considered to be safe practices. Complaints of musculoskeletal pain after starting tai chi may occur but have been found to improve with continued practice.

Cognitive Function

There is some evidence that suggests psychological and physical exercise programs such as tai chi and yoga may have the potential to provide modest enhancements of cognitive function in older adults without cognitive impairment.

What Does the Research Show?

• A 2018 systematic review and meta-analysis of 19 randomized controlled trials involving a total of 2,539 older adults found that compared to a control group, mind-and-body exercise (such as tai chi and yoga) showed significant benefits on cognitive performance, global cognition, executive functions, learning and memory, and language. All of these programs involved actions and breathing techniques associated with mind-and-body exercise (e.g., stretching and abdominal breathing). However, more high-quality studies are needed before definitive conclusions can be drawn.
• A 2023 systematic review and meta-analysis of 17 randomized studies found that tai chi and qigong have beneficial effects on physical and cognitive functions in older adults. 

Safety

• Tai chi and qigong are considered to be safe practices. Complaints of musculoskeletal pain after starting tai chi and qigong may occur but have been found to improve with continued practice.

References