Critical Analysis of Mindfulness-Based Activities in Older Adults

Cognitive decline is considered one of the most significant consequences of ageing (Mallya & Fiocco, 2015). This impairment in cognitive performance has been linked to higher levels of depression, anxiety, and neuroticism and subsequent brain pathology such as dementia and Alzheimer’s disease (Luchetti et al., 2016; Marchant et al., 2020).  However, engaging in meditation training has shown to alleviate these conditions and the linked cognitive decline (Goyal et al., 2014; Mallya & Fiocco, 2015; Luders et al., 2016; Klimecki et al., 2019). This research plan investigates the influence of mindfulness-based interventions (MBIs) such as mindfulness-based stress reduction (MBSR) and meditation on wellbeing and quality of life in people over 65 years old. Using an explanatory, qualitative, cross-sectional research design this study aims to determine whether people aged over 65 years who consistently practice mindfulness-based interventions (MBIs) and/or meditation report a higher quality of life and whether there is a correlation between frequency of practice and reported quality of life. The data will be collected using the Quality of Life Scale (QOLS) (Dasanayaka et al., 2022; Burckhardt & Anderson, 2003; Flanagan, 1978) and an adapted version of the Five Facet Mindfulness Questionnaire (FFMQ) which includes questions inquiring the length of time spent practicing mindfulness and/or meditation consistently (length in months and amount of practice weekly) (Dasanayaka et al., 2022, Chowdhury, 2019).

It is hypothesised that people aged over 65 years old who practice MBIs and/or meditation will report higher on a quality-of-life scale (QOLS) (Dasanayaka et al., 2022; Burckhardt & Anderson, 2003; Flanagan, 1978). By comparing the results of older adults, it is predicted that the longer (in months) and more consistent (in frequency over time) practice of MBIs and/or meditation will have a direct and positive correlation between these two components of the research study and subsequently, people who practice less both in frequency and over time are likely to have lower quality of life scores. This research plan will present a background and rationale on the subject of MBIs on wellbeing followed by the proposed limitations of this research. It will outline the discussion on the proposed research along with potential implications. Finally, this paper will conclude with a clinical analysis of the ethical, social justice and legal considerations.

Background

Ageing people, even in the absence of brain pathology, will experience a decline at some level in cognitive function. That may include reasoning, memory, attention, or executive processing (Requier et al., 2023). Since cognitive decline is considered one of the most significant consequences of ageing, it is an important and necessary sociological pursuit to conduct studies which aim to reduce the depression and anxiety associated with cognitive decline and promote wellbeing and quality of life (Mallya & Fiocco, 2015; Lomas et al., 2016). A multiplicity of studies have investigated this topic with reference to MBIs and meditation, most specifically how mindful activities ameliorate the more problematic consequences of age relate cognitive decline (Soysa & Wilcomb, 2015; Geiger et al., 2015; Mallya & Fiocco, 2015; Luders et al., 2016; Klimecki et al., 2019; Marchant et al., 2020; Whitfield et al., 2021; Dasanayaka et al., 2022).

Mindfulness can be described as moment-to-moment awareness. It is cultivated by purposefully bringing attention to the present moment without judgement (Kabat-Zin, 1990). The positive effects of mindfulness-based programs on executive function in older adults (>60 years) was explored through a recent meta-analysis (Whitfield et al., 2021) and the concluding remarks suggested that mindfulness-based programs enhance self-regulation in attention, emotion, perspectives of the self, and interoception as well as cognitive function. This supported earlier research (Geiger et al., 2015; Klimecki et al., 2019; Casedas et al., 2020) exploring the positive influence of meditation on brain function and structures relevant to cognition. Enhancing positive emotions through MBIs and meditation also support the function of downregulating age-related mental health deterioration. This can be presented by brain scans of meditators compared to non-meditators showing higher levels of attention and executive function, and a younger brain age (Klimecki et al., 2019). It is worth noting the study by Lao et al. (2016) which found meditation to have no effect on attention, limited evidence on executive function improvement and only preliminary evidence on improvement to working memory. However, this study draws from a small sample of 18 studies and is dated between 2000 and 2015 compared to the newer studies finding more positive results.

Rationale

The topic for this particular research draws on the information collated from earlier research and meta-analysis data and finds a gap in the research worth investigating. As is presented, research is limited in the area which explores associations between trait mindfulness, higher quality of life and lower levels of self-reported stress and depressive symptoms. This research framework is metabolised from the stance that MBIs could be beneficial for optimal ageing in late life through ameliorating age-related cognitive decline and significant findings of differences in meaning of life scores comparing meditation and non-meditation groups (Purandara, 2014; Geiger et al., 2015; Fiocco & Mallya, 2015; Lomas et al., 2016; Fiocco et al., 2018). Expanding on this research will provide beneficial data to assist with improving the wellbeing of older adults in care facilities and those living in the community. People working in aged care facilities, aged care lifestyle assistance, and any other activity-based relationship with people over 65 years old can also utilise the information presented in this research as evidence to support the efficacy of meditation as a long term and consistent practice which improves personal wellbeing and quality of life (Soysa & Wilcomb, 2015; Geiger et al., 2015). Understanding the connection between long-term practice of MBIs and meditation and overall sense of wellbeing using two quantitative questionnaires will further improve the body of research which works to understand the effects of implementing a consistent routine of MBIs. Furthermore, results which determine that overall quality of life and wellbeing is higher in people who practice mindfulness and/or meditation would benefit vulnerable people from a variety of population groups. For example, these practices could also be recommended for people with anger management issues, children in schools to assist with concentration, and people presenting with mental health problems such as anxiety and depression as an alternative to prescription medication. It is for these reasons mentioned that understanding the influence of mindfulness-based activities on the overall quality of life and wellbeing of people is a necessary pursuit of research.

Limitations

There are some limitations identified with the current study design. The two quantitative questionnaires are limited by their set of questions and seek only to understand the person’s answers to the specific questions. Though conclusions can be drawn from these results, they are general in nature and further research should always be conducted to continually support this body of evidence. Cross-sectional research such as a meta-analysis comparing other similar studies will also be beneficial to support future research. Quantitative data only represents a person’s perceived evaluation of a particular subject and does not articulate the actual lived experience of each participant.

Where permitted, posters will be displayed in libraries, aged care facilities, medical centres and public notice boards asking people over 65 years of age to email a specified email address. This results in a random selection of participants. Participants are those who email the researchers. Each participant will be emailed information about the research study and a consent form. Those who respond consenting to participate will be asked to complete the QOLS questionnaire. This will measure the quality of life across the participant group distinct from health status or other causal indicators of quality of life (Burckhardt & Anderson, 2003). Only participants who complete the initial QOLS Questionnaire will be emailed a week later with the FFMQ. This questionnaire measures the five aspects of mindfulness: observation, description, aware actions, non-judgemental inner experience, and non-reactivity (Chowdhury, 2019). It is noted participants could over- or under-exaggerated personal data on one or both of the questionnaires and there may have been a high degree of scepticism surrounding the practice of mindfulness due to lack of knowledge or openness to experience. We are limited in the participant sample to people who have access to the internet, are over the age of 65 and are computer literate. This assumption may skew the results given this specific demographic did not grow up using computers or internet.

People who meditate more may not have seen these fliers because they do not attend the places that they were advertised, the same can be said for people who do not mediate but have an overall positive sense of wellbeing and health. Furthermore, the participants were people who willingly chose to be a part of the study and are only from a particular area where the fliers and posters were advertised. Therefore, it may be likely that the results are biased in that this population group are all from a particular location and may not represent the world population as a whole.

Discussion

This research plan is comparing frequency of mindful and meditation practice in a cohort of individuals, the study is aware of labelling terms such as ‘meditator’ and ‘non-meditator’ and will not specifically indicate participants into such groups as this may influence a person’s self-analysis through positive or negative connotation. As a qualitative study using questionnaires, there may be some discrepancies in the understanding of what is meant by ‘mindfulness’, ‘mindfulness-based activities’, and ‘meditation’. A thorough explanation of these terms would be required prior to presenting the questionnaires. Similarly, having clear questions outlining the frequency of practice and what is meant by ‘frequency’ and consistency’ so the results align with the perspective of the research design (Klimecki et al., 2019). Advertisement of this study limited the participants to people who attended these locations and people who had access to a computer. An alternative method of participant collection may produce differing results as well as using hard copy questionnaires. This is considering the population group is for people over 65, a population group which have not had as much exposure to computers as younger populations. Furthermore, the results are only valid as much as the results present from these questionnaires and secondary research using a qualitative and/or longitudinal study design should be conducted to complement this study. Bowles et al (2022) found the benefits of meditation to accrue over time in a non-linear manner and vary based on practice context so conducting analysis outside of a standardised program timeframe would prove to benefit these results. It would also be beneficial for the study to be conducted using a control group to compare the results using terms such as ‘meditator’ and ‘non-meditator’ to understand whether this influences the results. Requier et al. (2023) found that even without formal meditation practice, ‘dispositional mindfulness’ that is, engaging in receptive attention to and awareness of current experiences with non-judgement and acceptance can still act as a protective factor for cognitive ageing and would be a factor worth considering in overall outcomes. Thus, another aspect of this study would be to compare the influence of other interventions such as exercising, socialising, and personally meaningful activities on quality of life. Comparing people who regularly meditate and those who regularly commit to other activities to determine whether meditation is more, less, or the same at providing a positive influence on wellbeing may also produce significant results.

Implications

As mentioned in the rationale, it is anticipated that the results of this study will benefit people who work with older adults such as in aged care facilities, or private lifestyle assistance by providing knowledge and insight about mindfulness and meditation practices and the positive influence on ageing and wellbeing. Data which affirms the ability of MBIs and meditation to reduce the implications of cognitive decline will also inform policy in ways such as introducing group practices in activity groups for older adults. Research which finds a positive correlation between frequency of practice and quality of life will support any person wishing to create mindfulness-based curriculum. Finally, the contribution to this area could also assist with supporting further research proposals aiming to utilise mindfulness and meditation with patient’s experiencing pathological cognitive decline in late life such as dementia, though more specific research investigating brain pathology would be required (Klimecki et al., 2019).

Ethics, Social Justice, and Legal Considerations

This research plan has been revied to ensure alignment with the National Statement on Ethical Conduct in Human Research (2008). Specifically for this research, the statement identifies guidelines when working with people who have a cognitive impairment or a mental illness. Though this research does not specifically ask for people from those cohort, there may be some participants who have identified with such. The risks of including people with the above specificities are mitigated through the following indications. Integrity is maintained through continuous alignment with ethical principles in this scope of practice. As this is a social study involving participants from the community, a number of ethical, social justice, and legal implications have been considered to promote the best interest of the participants and reduce the risk of harm in any way. Participants are under no obligation to respond to the advertisement to uphold voluntary participation. Those who do choose to participate will remain anonymous, where the only necessary personal details are their age and responses to the questions. These participants are provided clear details about the nature of informed consent including the right to withdraw. Informed consent of this specific research would involve detailed information about the nature of the study, the proposed research method and the potential ways the data may be utilised. As such, participants understand the consequences of participating, including any potential risks. Their signed confirmation of willingness to participate indicates their understanding of the above, though they are able to withdraw from the study until the point where data is being collated and extrapolated. Participants will have no face-to-face contact with researchers thus confidentiality is preserved. All data being stored on a password protected computer that is only accessible to the researchers of this specific study and will be held only for the necessary amount of time.

Previous literature clearly articulates the benefits of research exploring practices which improve quality of life and promote wellbeing (Lomas et al., 2016). A risk-benefit analysis based on this literature suggests that deepening the research surrounding the potential positive influence of mindfulness-based activities and meditation on wellbeing and overall quality of life would assist society in a variety of ways for older adults especially those over 65 years. (Mallya & Fiocco, 2015; Whitfield et al., 2021). Aged-care facilities, hospitals and other locations which are frequented by older adults would benefit from introducing MBIs as a means to improve overall wellbeing and self-reflection and to mitigate negative affect such as depression and anxiety (Requier et al., 2023). With some prior research suggesting younger brain ages and higher levels of attention and executive function in meditators compared to non-meditators (Luders et al., 2016; Klimecki et al., 2019) this quantitative data supports the introduction of activities which improve the emotional, social and mental wellbeing of older adults.

Conclusion

Regular mindfulness-based interventions influence negative affect and improve self-regulation, cognitive function, and overall sense of wellbeing in older adults (Geiger et al., 2015; Whitfield et al., 2021). Even a form of dispositional non-judgement mindfulness can still act as a protective factor for cognitive ageing through practices which involve inquiries into the nature of thought, perception, and self-reflection (Requier et al.,2023) as the effects of cognitive declines are somewhat mitigated by the act of self-inquiry and introspection (Soysa & Wilcomb, 2015; Klimecki et al., 2019; Casedas et al., 2020 Requier et al., 2023). Further research to investigate the correlation between mindfulness and quality of life will enhance the current body of evidence which supports the implementation of MBIs and meditation in spaces frequented by older adults. The two questionnaires will be analysed with the results displayed as a scatter graph depicting people’s overall quality of life and mindfulness and it is proposed that this research will produce outcomes which show that frequent and consistent mindfulness practice is beneficial for optimal ageing by reducing cognitive decline. It is hoped that this research can be used for future research on this topic and as evidence-based literature to support the implementation of meditation and MBIs in the community.

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