Social Work-Supported Physiotherapy and Psychosocial Outcomes in Third Age University and Nursing Home Residents

The aging process is a multidimensional life stage that leads to significant changes not only in individuals' physical functioning but also in their psychosocial well-being, social participation, and social roles. The World Health Organization defines healthy aging as the ability of individuals to maintain functional capacity and lead a meaningful life in later stages of life, emphasizing that this process is shaped by the interaction of biological, psychological, and social components. This perspective highlights that interventions targeting older adults should not be limited to disease and physical decline, but should instead adopt a holistic approach encompassing daily life, social relationships, and social participation.

The International Classification of Functioning, Disability and Health, developed by the World Health Organization, provides a comprehensive framework that conceptualizes health not only in terms of diagnoses and impairments, but also through body functions and structures, activities, participation, and environmental factors. The ICF facilitates a better understanding of the relationships between physical functioning, social participation, life satisfaction, and psychosocial well-being, particularly among older adults, and offers a common conceptual language for rehabilitation and social work fields. The ICF enables an interdisciplinary evaluation of health and functioning.

The literature indicates that physical activity and rehabilitation-based interventions improve balance, mobility, and functional capacity in older adults, while also being associated with reductions in depressive symptoms, enhanced psychological well-being, and improved quality of life. The physical activity is a key protective factor not only for physiological health but also for psychological and social well-being. Similarly, participation in regular physical activity has been shown to positively influence self-efficacy, emotional well-being, and social interaction among older adults.

However, recent studies suggest that the sustainability of gains in physical functioning is strongly influenced by social support, motivation, and environmental opportunities. The social support and psychosocial factors play a central role in older adults' participation in physical activity. In this context, social work emerges as a complementary profession that facilitates access to environmental resources, strengthens social relationships, and supports psychosocial well-being.

The social context in which older individuals live has a decisive impact on their psychosocial well-being and social health. Older adults living in nursing homes often represent a more vulnerable group due to social isolation, role loss, and the constraints of institutional living. In contrast, Third Age Universities, which emphasize lifelong learning and social participation, provide protective environments that support active aging. The literature clearly demonstrates that different living arrangements lead to significant differences in mental health and life satisfaction among older adults.

The WHO's Integrated Care for Older People (ICOPE) approach also emphasizes that services for older adults should be structured in a person-centered, interdisciplinary, and function-oriented manner. ICOPE recommends addressing physical capacity alongside psychological and social dimensions simultaneously, demonstrating strong conceptual alignment with the ICF model. Within this framework, social work-supported physiotherapy interventions are considered to offer a holistic approach that can contribute not only to physical functioning but also to psychosocial well-being and social health among older individuals.

This study has the potential to provide an original and interdisciplinary contribution to holistic health approaches in the field of aging within the Turkish context. Despite international policy documents emphasizing the importance of supporting not only physical functioning but also psychosocial well-being and social health in older adults, comparative intervention studies integrating social work and physiotherapy within an ICF-based framework remain limited. This study addresses this gap by examining both community-based active aging models, such as Third Age Universities, and institutional care settings, such as nursing homes, thereby revealing how older individuals respond to interventions across different social contexts. It is expected that the findings will generate evidence on the effectiveness of interdisciplinary intervention models and provide a scientific basis for developing policies and practices in Turkey that holistically address functionality, participation, and psychosocial support in services for older adults. Furthermore, the results are anticipated to contribute to the integration of the ICF framework into social work practice and to inform the development of innovative, applicable, and sustainable intervention models in the field of elderly welfare.

The aim of this study is to comparatively examine the effects of a social work-supported physiotherapy intervention on functionality levels, psychosocial well-being, and social health-within the framework of the International Classification of Functioning, Disability and Health (ICF)-among students enrolled in the 60+ Refresher University (Third Age University model) and older adults living in nursing homes in Turkey. Accordingly, the study seeks to compare the psychosocial and social outcomes of physiotherapy interventions centered on physical functioning when integrated with social work interventions across different institutional and social contexts, namely a lifelong learning-based Third Age University model and an institutional care setting.

Research Hypotheses Hypothesis 1: ICF-Based Functionality H0₁ (Null Hypothesis): There is no significant change in participants' ICF-based functionality levels after the social work-supported physiotherapy intervention compared to pre-intervention levels.

H1₁ (Alternative Hypothesis): There is a significant improvement in participants' ICF-based functionality levels after the social work-supported physiotherapy intervention compared to pre-intervention levels.

Hypothesis 2: Psychosocial Well-Being H0₂ (Null Hypothesis): There is no significant change in participants' psychosocial well-being levels after the intervention compared to pre-test measurements.

H1₂ (Alternative Hypothesis): There is a significant increase in participants' psychosocial well-being levels after the intervention compared to pre-test measurements.

Hypothesis 3: Social Health H0₃ (Null Hypothesis): There is no significant change in participants' social health levels after the intervention compared to pre-test measurements.

H1₃ (Alternative Hypothesis): There is a significant increase in participants' social health levels after the intervention compared to pre-test measurements.

Hypothesis 4: Between-Group Comparison H0₄ (Null Hypothesis): There is no significant difference between Third Age University students and nursing home residents in terms of the effects of the intervention on functionality, psychosocial well-being, and social health.

H1₄ (Alternative Hypothesis): There is a significant difference between Third Age University students and nursing home residents in terms of the effects of the intervention on functionality, psychosocial well-being, and social health.