Physical activity interventions to improve the quality of life of older adults living in residential care facilities: a systematic review

Characterizing Walking Behaviors in Aged Residential Care Using Accelerometry, With Comparison Across Care Levels, Cognitive Status, and Physical Function: Cross-Sectional Study

Background

Walking is important for maintaining physical and mental well-being in aged residential care (ARC). Walking behaviors are not well characterized in ARC due to inconsistencies in assessment methods and metrics as well as limited research regarding the impact of care environment, cognition, or physical function on these behaviors. It is recommended that walking behaviors in ARC are assessed using validated digital methods that can capture low volumes of walking activity.

Objective

This study aims to characterize and compare accelerometry-derived walking behaviors in ARC residents across different care levels, cognitive abilities, and physical capacities.

Methods

A total of 306 ARC residents were recruited from the Staying UpRight randomized controlled trial from 3 care levels: rest home (n=164), hospital (n=117), and dementia care (n=25). Participants' cognitive status was classified as mild (n=87), moderate (n=128), or severe impairment (n=61); physical function was classified as high-moderate (n=74) and low-very low (n=222) using the Montreal Cognitive Assessment and the Short Physical Performance Battery cutoff scores, respectively. To assess walking, participants wore an accelerometer (Axivity AX3; dimensions: 23×32.5×7.6 mm; weight: 11 g; sampling rate: 100 Hz; range: ±8 g; and memory: 512 MB) on their lower back for 7 days. Outcomes included volume (ie, daily time spent walking, steps, and bouts), pattern (ie, mean walking bout duration and alpha), and variability (of bout length) of walking. Analysis of covariance was used to assess differences in walking behaviors between groups categorized by level of care, cognition, or physical function while controlling for age and sex. Tukey honest significant difference tests for multiple comparisons were used to determine where significant differences occurred. The effect sizes of group differences were calculated using Hedges g (0.2-0.4: small, 0.5-0.7: medium, and 0.8: large).

Results

Dementia care residents showed greater volumes of walking (P<.001; Hedges g=1.0-2.0), with longer (P<.001; Hedges g=0.7-0.8), more variable (P=.008 vs hospital; P<.001 vs rest home; Hedges g=0.6-0.9) bouts compared to other care levels with a lower alpha score (vs hospital: P<.001; Hedges g=0.9, vs rest home: P=.004; Hedges g=0.8). Residents with severe cognitive impairment took longer (P<.001; Hedges g=0.5-0.6), more variable (P<.001; Hedges g=0.4-0.6) bouts, compared to those with mild and moderate cognitive impairment. Residents with low-very low physical function had lower walking volumes (total walk time and bouts per day: P<.001; steps per day: P=.005; Hedges g=0.4-0.5) and higher variability (P=.04; Hedges g=0.2) compared to those with high-moderate capacity.

Conclusions

ARC residents across different levels of care, cognition, and physical function demonstrate different walking behaviors. However, ARC residents often present with varying levels of both cognitive and physical abilities, reflecting their complex multimorbid nature, which should be considered in further work. This work has demonstrated the importance of considering a nuanced framework of digital outcomes relating to volume, pattern, and variability of walking behaviors among ARC residents.

Effect of self-regulating fatigue on health-related quality of life of middle-aged and elderly patients with recurrent stroke: a moderated sequential mediation model

Although the association between self-regulation of fatigue and health-related quality of life (HRQoL) has been confirmed, the potential mechanism remains unclear. This study aimed to explore the role of health literacy, health behavior, and exercise frequency in the relationship among middle-aged and elderly patients with recurrent stroke. A cross-sectional survey was conducted. A total of 176 patients completed the survey, in which self-regulation of fatigue, HRQoL, health literacy and health behavior were measured by questionnaires. Based on Bootstrap analyses, a moderating sequential mediation model using PROCESS software was constructed with health literacy and health behavior as mediators and exercise frequency as the moderator. Of the participants, the mean age was 65.44 ± 12.43 years. Self-regulation of fatigue was found to affect HRQoL indirectly through two significant mediation pathways: (1) health literacy (β=-0.11, 95%CI = -0.20, -0.03), which accounted for 28.79% of the total effect, and (2) health literacy and health behavior (β=-0.02, 95%CI = -0.05, -0.00), which accounted for 4.80% of the total effect. Exercise frequency moderated the relationship between self-regulating fatigue and HRQoL. Specifically, the interaction term between self-regulating fatigue and exercise frequency significantly predicted HRQoL (β = 0. 25, t = 2.55, p < 0.05). These findings highlight the role of health literacy and health behavior as sequential mediators of the relationship between self-regulating fatigue and HRQoL. Moreover, exercise frequency moderated the relationship between self-regulating fatigue and HRQoL. Encouraging patients with recurrent stroke to increase exercise frequency appropriately might improve HRQoL for patients with poor health literacy and health behavior.

A Mixed Methods Feasibility Study of Machine-Based Resistance Training With Prefrail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial II

Physical activity is an effective, proactive intervention to reduce or reverse frailty and functional decline. However, uncertainty exists about the feasibility and impact of resistance training on multidimensional health in prefrail older adults in residential care. This mixed methods feasibility study assessed practicability with limited efficacy testing on health and functional outcomes. Eleven prefrail older adults participated in a 6-week progressive resistance training protocol three times per week. The intervention and measures were found to be appropriate and acceptable by those who completed the trial, with participants self-reporting improved well-being, mood, and function. Analysis identified several barriers to recruitment, including prior commitments, seasonal impact, and session timing, and offered potential solutions with further recommendations for program refinement prior to a definitive randomized controlled trial. These findings add to our understanding of prefrail older adults' preferences regarding participation in physical activity research and the perceived benefits of resistance training. This trial was registered with ClinicalTrials.gov: NCT03141879.

Effectiveness of a multicomponent activity and horticultural intervention for the hospitalized older adults: A randomized controlled trial: Effectiveness of Intervention for the Hospitalized Older Adults

This study evaluated the effectiveness of different intervention programs in improving function among hospitalized older individuals using the Comprehensive Geriatric Assessment (CGA). A randomized controlled trial consisted of three groups: routine care, horticulture, and multicomponent activities (n = 32 each). Horticultural and multicomponent activity interventions showed beneficial effects on the CGA in hospitalized older individuals, particularly regarding cognitive function and quality-of-life. Additionally, horticultural activities significantly contributed to the perception of older adults' health status. We recommend to select older patients in geriatric wards with long-term hospitalization and adjust the frequency of activities or choose a single intervention program to provide long-term and effective intervention effects.

Promoting activity and mobility in long-term care environments: A photo-elicitation study with older adults and nurses

AIM(S)

The aim of this research study is to collaboratively generate insights in the current institutional long-term care environment for activity and mobility of older adults, and of solutions that could be used to increase the activity and improve the mobility of the older adults.

DESIGN

This research constitutes a qualitative study with a critical approach.

METHODS

Data were collected using photo-elicitation in four long-term care units in Finland during the spring of 2022. Older adults participated in individual data collection sessions which combined photographing and discussion. Staff members individually took photographs and later participated in a group discussion based on the photographs. Reflexive thematic analysis was used to analyse all data together.

RESULTS

Ten older adults and 12 staff members participated in the research study. Four themes were identified: (1) facilities should be designed and equipped for their users, (2) moving in the institutional environment, (3) passivity as a norm, and (4) nurses should act differently and have the resources to do so.

CONCLUSION

To increase the activity and improve the mobility of older adults, improvements are needed in terms of the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Increased attention to the support of activity and mobility could benefit older adults in institutional long-term care. Physical activity promotion should be incorporated as an integral part of nursing practice.

PATIENT OR PUBLIC CONTRIBUTION

Directors of units were consulted when planning the study. Older adults and nurses contributed to the data collection and interpretation of data.

IMPACT

(ADDRESSING): What problem did the study address? ○Older adults have recurrently been reported as living inactive lives in institutional long-term care. ○There is evidence of the relationship between the environment and the activity and mobility of older adults, but there seems to be a research-practice gap in terms of implementing activity- and mobility-promoting environments. ○Older adults and staff members are important in developing practice and change-oriented knowledge that can be used to increase the activity and improve the mobility of older adults in institutional long-term care. What were the main findings? ○Various environmental improvements are recommended to increase the activity and improve the mobility of older adults in institutional long-term care settings. ○Improvements for the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources for activity support would benefit older adults' activity and mobility. Where and on whom will the research have an impact? ○Increasing the activity of older adults requires better activity promotion and mobility support by nurses in institutional care. Sufficient education and resources should be organized for activity promotion, in addition to a care and organizational culture that values activity. ○Environmental aspects to promote activity and mobility need to be considered already at the planning, building and renovating phases of facilities. ○Policymakers and care organizers should consider evidence of the harms and benefits of different institutional living environments when making decisions on organizing care.

REPORTING METHOD

The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Willingness-to-pay in physical activity: how much older adults value the community-wide initiatives programs?

Background

Previous studies have shown insufficient physical activity (PA) as a significant global health concern and a major risk factor for non-communicable diseases (NCDs). Community-wide initiatives in physical activity (CWIPA) is considered as a best-buy for Community-wide initiatives in physical activity (CWIPA) is considered as a best-buy for NCDs prevention. However, assessment regarding resource allocation and cost-effectiveness of existing programs is lacking. This study investigated local residents' willingness-to-pay (WTP) for community PA programs in Southern Thailand.

Methods

The contingent valuation method (CVM) using the payment card approach was employed to elicit the WTP of 472 residents aged 45 years and over in selected provinces in which community PA programs had been implemented. Respondents were asked to indicate their WTP for the continuous offering of free CWIPA by choosing how much they were willing to pay from eight bid-value options, payable through their monthly electricity bill.

Results

The mean WTP of Thai older adults was found to be 72 baht/month ($2/month) or 868 baht/year ($25/year). This indicated the maximum amount an older person was willing to pay for any community-based PA program. More than half the sample (54.2%) chose zero as their answer, while there was a fairly large variation in other levels of WTP. The WTP was lower among older respondents and those who resided in rural areas but was higher among those with a history of participation in an organized PA program.

Conclusion

The level of WTP can be interpreted as an indicator of community satisfaction with CWIPA. That finding can be used as evidence for the government and policy makers in allocating resources and designing future CWIPA. A variety of organized PA programs should be offered to all community members to ensure inclusivity and also to provide equal access for senior citizens.

Relationship between anxiety and quality of life among older adults with self-reported polypharmacy in long-term care: A cross-sectional study

AIMS

To investigate the relationship between anxiety and quality of life among older adults with self-reported polypharmacy living in the long-term care setting.

DESIGN

A cross-sectional design was used.

METHODS

Between July 2021 and August 2022, 92 older adults living in long-term care completed an anonymous one-time questionnaire packet. Polypharmacy was measured as self-reported five or more medications daily. Anxiety was measured using the Geriatric Anxiety Scale-Long Term Care tool. Quality of life was measured as health-related quality of life using two global questions from the RAND-36 and as medication-related quality of life using the Medication-Related Quality of Life Scale.

RESULTS

The prevalence of polypharmacy was 89%. Among participants with polypharmacy, average age was 80.1 ± 7.9 years. The majority were female (70%) and white (85%). There was a moderate-to-strong correlation between anxiety and quality of life. Specifically, anxiety was negatively related to current health-related quality of life, perceived change in health-related quality of life and medication-related quality of life. Overall, anxiety explained 27-31% of the variance in both health-related and medication-related quality of life.

CONCLUSION

The results of this study indicate that as anxiety increases, health-related and medication-related quality of life decreases in older adults living in long-term care who report consuming five or more medications daily. Advanced practice nurses can use these findings to guide practice, tailor interventions and improve care for these long-term care residents.

IMPLICATIONS

Multiple medications are increasingly prescribed to treat multiple comorbidities in older adults. As a result, the prevalence of polypharmacy (≥5 medications per day) is rising and problematic. The main findings of this study highlight the negative relationship between anxiety and quality of life in this population and the need for adequate assessment of anxiety by advanced practice nurses in order to personalize care.

REPORTING METHOD

In preparing the manuscript, the authors have adhered to relevant EQUATOR guidelines and the STROBE checklist for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution outside of participation in the actual study for purposes of data collection.

Physical function mediates the effects of sensory impairment on quality of life in older adults: Cross-sectional study using propensity-score weighting

AIMS

To investigate the effect of sensory impairment on quality of life in older adults and to assess the role of physical function as a mediator of the effect of the sensory impairment on quality of life.

DESIGN

A cross-sectional study.

METHODS

Older adults aged ≥65 years (N = 600) were recruited from January 2019 to May 2020. Hearing and visual function were measured with pure-tone audiometry and Snellen visual acuity tests, respectively. Quality of life (World Health Organization Quality of Life Scale Brief Version), physical function (Multidimensional Functional Assessment Questionnaire) and sociodemographic characteristics were reported by participants using interviewer-administered questionnaires. Propensity score weighting analysis was conducted based on generalized propensity scores via multinominal logistic regression for age, gender, education, income, and comorbidities. The difference in the quality of life was tested by applying a one-way analysis of variance. Multiple mediation analysis was conducted to explore the direct, indirect, and total effects of sensory impairment on quality of life through physical function.

RESULTS

After propensity score weighting adjustment, when compared with participants with no sensory impairment, participants with dual sensory impairment had the worst quality of life, followed by visual impairment and then hearing impairment. Physical function statistically significantly mediated the effect of hearing impairment, visual impairment and dual sensory impairment on quality of life in older adults.

CONCLUSION

Our findings demonstrated that the negative effect of the sensory impairment on quality of life in older adults was mediated through physical function.

IMPACT

The convergence of an increasing ageing population and the prevalence of sensory impairment presents a significant global health burden. This study demonstrated that physical function was a mediator of quality of life in older adults. Designing appropriate physical activity interventions for older adults with sensory impairment could serve to enhance physio-psychological health and improve quality of life.

Association between sarcopenia and quality of life among adults aged ≥ 65 years from low- and middle-income countries

BACKGROUND

Sarcopenia has been associated with a lower quality of life (QoL). However, studies on this association from low- and middle-income countries (LMICs) are scarce.

AIMS

To examine the association between sarcopenia and QoL, in a large nationally representative sample of older adults from six LMICs.

METHODS

Cross-sectional, community-based data from the WHO study on global ageing and adult health (SAGE) were analysed. Non-severe sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength but no slow gait speed, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression analysis was conducted.

RESULTS

Data on 14,585 people aged ≥ 65 years were analyzed [mean (SD) age 72.6 (11.5) years; 55.0% female]. After adjustment for potential confounders, compared to no sarcopenia, severe sarcopenia was associated with a significant - 3.37 points [95% CI - 5.56, - 1.18] lower QoL score. Non-severe sarcopenia was not significantly associated with lower QoL.

DISCUSSION

The association between sarcopenia and QoL observed in our study may be explained by factors such as functional impairment and disability related with sarcopenia.

CONCLUSIONS

In this large representative sample of older adults from multiple LMICs, compared to no sarcopenia, only severe sarcopenia was associated with a significantly lower QoL score. Interventions to prevent or manage sarcopenia among older adults in LMICs may contribute to better QoL in this population.

The Effectiveness of Multicomponent Intervention on Daily Functioning among the Community-Dwelling Elderly: A Systematic Review

The deterioration of physical and cognitive functioning in the elderly is an impairment to their independent self-management and to improving their ability to perform daily functions. Nurses should support the elderly to experience a healthy and a successful aging process by preventing dependence on daily functioning and understanding the care assistance that such persons need. This study aimed to gain insight into the evidence on the effectiveness of multicomponent intervention on the activities of daily living (ADL) and instrumental activities of daily living (IADL) among the community-dwelling elderly without cognitive impairment. The design is a systematic review of a randomized controlled trial. The language of the published literature was English, and the search period was from January 2000 to December 2020. Articles were included under the PICO (population, intervention, comparison, and outcome) framework for: (a) community-dwelling elderly without cognitive impairment; (b) multicomponent intervention; (c) comparison group who did not receive the intervention; and (d) measurement of the effect of ADL and IADL. A total of 4413 references were found, 6 studies were included. Most studies (n = 5) reported that the multicomponent intervention exerted a beneficial effect on ADL and IADL. Only one study showed the highest methodology and reporting quality in the Cochrane review. Common components of the programs included: occupational therapy, physical therapy, exercise, memory training, cognitive–behavioral therapy, interdisciplinary intervention, and cognitive training. Multicomponent intervention may be a beneficial way to improve dependence on ADL and IADL as an important area of functional evaluation in the elderly. Considering the physical condition of the elderly, multicomponent interventions, including physical activity, exercise, occupational therapy, and especially individually customized coaching related to ADL and IADL training, may be useful.

Factors Associated with Health-Related Quality of Life among Older Adults in Rural South Korea Based on Ecological Model

As the portion of older adults in the population in rural areas of South Korea exceeds 20%, the importance of health-related quality of life is increasing. The aim of the study was to examine the health-related quality of life through the ecological model and its basic determining factors for older adults. The study was conducted on 184 respondents aged 65 and over living in rural areas of South Korea. The measurements were health-related quality of life, health care service needs, sleep quality, social support, and personal characteristics. The collected data were tested using descriptive, t-test, ANOVA, and hierarchical multiple regression. The results showed that older adults in rural areas experienced a low quality of life. Religion, having a helper, and social support were significantly related to health-related quality of life in older adults. This directly shows that the government should make efforts to build a social support system to improve the gap between urban and rural areas. To improve the health-related quality of life of older adults in rural areas, it would be helpful to increase physical activity and to form a community, leading to a social network.

Effects of Chronic Physical Exercise or Multicomponent Exercise Programs on the Mental Health and Cognition of Older Adults Living in a Nursing Home: A Systematic Review of Studies From the Past 10 Years

Some nursing homes for the elderly provide holistic care that integrates several interventions, including physical exercise. The aim of this systematic review is to summarize the effects of physical exercise or multicomponent exercise programs on the mental health (wellbeing, anxiety and depression) and cognitive functions of older adults with/without dementia who live in a nursing home and do/do not require wheelchair assistance. To this end, PubMed, PsycInfo and Web of Science are using to identify clinical trials and randomized controlled studies conducted during the period January 2011 to December 2021 to examine the progression of research in this field over the past ten years. In total, 2597 articles are identifying and 21 are including in the systematic review. After selecting articles according to the PRISMA standards, the data extraction and methodological quality assessment of the eligible studies are performing individually by two reviewers and then pooled together. The synthesis of the studies shows that physical exercise or multicomponent exercise programs have a beneficial effect on mental health and cognitive functions. However, this effect is more common among older adults without dementia, compared to their counterparts who have dementia or use wheelchairs. The explanatory mechanisms, lack of benefits from physical exercise and the need to standardize methods are discussing in this regard. Finally, future studies must examine the effects of an innovative and adaptive physical activity program on the mental health and cognitive functions of older adults living in nursing homes.

Wishes and perceptions about exercise programs in exercising institutionalized older adults living in long-term care institutions: A qualitative study

The level of exercise among older adults is low, particularly among those living in health-care institutions. To gain insight into the perceptions of institutionalized older adults towards the exercise programs developed in long-term care institutions and to identify their wishes and needs regarding these programs, we conducted a qualitative study using focus group discussions. Thirty-six institutionalized participants (≥ 65 years) were recruited. Six common themes emerged: participants' attitudes and motivations towards the exercise programs, self-perceived health, knowledge of the concept of physical exercise, perceived effects of the exercise programs, and wishes or expectations for the exercise programs. The main wishes were to increase frequency of exercise sessions, to exercise outdoor and to increase walking times. The results suggest the need for changes in the development of exercise programs, including changes in the frequency, performance environment and types of exercises performed.

The Importance of Age-Friendly City on Older People's Continuity and Life Satisfaction

According to continuity theory, successful aging is promoted when older people are able to continue familiar activities as a way to maintain self-identity. The purpose of this study was to examine the importance of both external resources provided by Taipei city and older adults’ internal resources in internal and external continuity and life satisfaction. The data were from the 2019 Taipei City Senior Citizen Condition Survey acquired through face-to-face interviews. Only the community-based sample without disability was included in the analysis (n = 1494). Structural equation modeling was used for the analysis. Both internal and external resources significantly promoted internal continuity (physical activity, Internet use, and lifelong learning) and external continuity (work, social connectedness, and social participation), and the effects of personal resources were larger. External continuity was positively related to life satisfaction. The effects of external resources on continuity and life satisfaction were stronger in older women than in older men. Age-friendly cities may provide support for activity continuity and promote well-being for older people. Policy suggestions are discussed.