Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report

FRAILSURVEY-an mHealth App for Self-Assessment of Frailty Based on the Portuguese Version of the Groningen Frailty Indicator: Validation and Reliability Study

BACKGROUND

Portugal is facing the challenge of population ageing, with a notable increase in the proportion of older individuals. This has positioned the country among those in Europe with a high prevalence of frailty. Frailty, a geriatric syndrome characterized by diminished physiological reserve and heightened vulnerability to stressors, imposes a substantial burden on public health.

OBJECTIVE

This study seeks to address two primary objectives: (1) translation and psychometric evaluation of the European Portuguese version of the Groningen Frailty Indicator (GFI); and (2) development and evaluation of the FRAILSURVEY app, a novel assessment tool for frailty based on the GFI. By achieving these objectives, the study aims to enhance the accuracy and reliability of frailty assessment in the Portuguese context, ultimately contributing to improved health care outcomes for older individuals in the region.

METHODS

To accomplish the objectives of the study, a comprehensive research methodology was used. The study comprised 2 major phases: the initial translation and validation of the GFI into European Portuguese and the development of the FRAILSURVEY app. Following this, an extensive examination of the app's validity and reliability was conducted compared with the conventional paper version of the GFI. A randomized repeated crossover design was used to ensure rigorous evaluation of both assessment methods, using both the paper form of the GFI and the smartphone-based app FRAILSURVEY.

RESULTS

The findings of the study revealed promising outcomes in line with the research objectives. The meticulous translation process yielded a final version of the GFI with robust psychometric properties, ensuring clarity and comprehensibility for participants. The study included 522 participants, predominantly women (367/522, 70.3%), with a mean age of 73.7 (SD 6.7) years. Psychometric evaluation of the European Portuguese GFI in paper form demonstrates good reliability (internal consistency: Cronbach a value of 0.759; temporal stability: intraclass correlation coefficient=0.974) and construct validity (revealing a 4D structure explaining 56% of variance). Evaluation of the app-based European Portuguese GFI indicates good reliability (interinstrument reliability: Cohen k=0.790; temporal stability: intraclass correlation coefficient=0.800) and concurrent validity (r=0.694; P<.001).

CONCLUSIONS

Both the smartphone-based app and the paper version of the GFI were feasible and acceptable for use. The findings supported that FRAILSURVEY exhibited comparable validity and reliability to its paper counterpart. FRAILSURVEY uses a standardized and validated assessment tool, offering objective and consistent measurements while eliminating subjective biases, enhancing accuracy, and ensuring reliability. This app holds promising potential for aiding health care professionals in identifying frailty in older individuals, enabling early intervention, and improving the management of adverse health outcomes associated with this syndrome. Its integration with electronic health records and other data may lead to personalized interventions, improving frailty management and health outcomes for at-risk individuals.

Group exercise in long-term care facilities, alignment with World Health Organization recommendations: a cross-sectional survey

BACKGROUND

Maintaining functional status in institutionalized older people is a challenge for long-term care (LTC) institutions. In this regard, exercise may have positive effects. The World Health Organization (WHO) has issued guidelines which include recommendations of exercise for each population group. Nonetheless, the literature shows that the levels of exercise among institutionalized population are still low.

AIMS

This study sought to determine: (1) the characteristics of exercise programs for older people performed by health professionals in LTC facilities, (2) the knowledge and use of the WHO recommendations and guidelines for exercising among older people in LTC facilities; (3) the limitations identified by health professionals regarding the application of the WHO guidelines.

MATERIALS AND METHODS

A cross-sectional national survey following STROBE guideline was performed.

SAMPLE

professionals developing exercise programs for institutionalized older people. A Delphi study was conducted to create the survey which included sociodemographic data, exercise characteristics, knowledge about WHO recommendations and limitations regarding their application. Descriptive statistics were used on the data, such as Pearson's χ2 and independent t- test.

RESULTS

Many professionals do not know (27,5%) or do not follow (52%) the guidelines proposed by the WHO. There is a low weekly frequency for strength exercises (30%) and aerobic exercise (51%). The professional contract influences the weekly frequency of exercise. Most identified limitations for using the WHO recommendations were the lack of time and large groups.

DISCUSSION AND CONCLUSIONS

Recommendations of WHO guidelines are familiar to many professionals, however, some are difficult to implement in exercise programs in LTC facilities.

Prevention and Mitigation of Frailty Syndrome in Institutionalised Older Adults Through Physical Activity: A Systematic Review

Background/Objectives: Frailty syndrome significantly impacts the health and quality of life of institutionalised older adults, increasing the risk of adverse outcomes such as disability and mortality. This systematic review aimed to evaluate the effectiveness of physical activity interventions in preventing and mitigating frailty syndrome among institutionalised older adults and to identify key intervention characteristics influencing their effectiveness. Methods: A systematic search following PRISMA guidelines was conducted in the Web of Science, PubMed, and Cochrane databases to identify randomised controlled trials published from 2001 to June 2024. Studies involving institutionalised adults aged 60 or older, assessing the impact of physical activity interventions on frailty using validated measures, were included. A narrative synthesis approach was employed to analyse the findings due to the heterogeneity of interventions and settings. Results: Twelve randomised controlled trials comprising 1223 participants were included. Multicomponent exercise programmes-combining resistance exercises, balance, and aerobic training-consistently improved frailty indicators, including muscle strength, gait speed, and balance, among others parameters. Frailty reversal occurred in 36% of participants, with interventions showing a reduction in frailty criteria and improved functional autonomy. Programmes integrating physical activity with cognitive or nutritional components demonstrated high efficacy. The control groups showed minimal improvement, highlighting the unique impact of tailored interventions. Despite variability in intervention design, frailty was consistently shown to be reversible in pre-frail and frail individuals, where the benefits were evident including for individuals over 85 years old. Conclusions: Physical activity interventions, particularly multicomponent exercise programmes, are effective in reducing frailty and improving health outcomes in institutionalised older adults. Future research should focus on optimising intervention characteristics and exploring the long-term sustainability of benefits in diverse populations. These findings reinforce the importance of exercise as a cornerstone in frailty management.

Leisure-Time Physical Activity and Life Satisfaction in Older Adults: The Moderating Effect of Dementia Diagnosis

This study investigated the relationship between different intensities of leisure-time physical activity (LTPA) (i.e., vigorous LTPA vs. leisure walking) and life satisfaction, and the moderating effect of dementia diagnosis on this association in a representative sample of U.S. older adults derived from the 2022 National Health Interview Survey (n = 8,779). Multivariable regression analysis revealed significant associations between both LTPA intensity and life satisfaction. Moderation analysis revealed that dementia diagnosis significantly influenced the relationship between vigorous LTPA and life satisfaction in older adults, while no significant dementia diagnosis moderating effect was found to affect the relationship between leisure walking and life satisfaction. These findings suggest that vigorous LTPA was particularly beneficial for enhancing the life satisfaction of people living with dementia (PLWD), while leisure walking universally enhances life satisfaction in older adults regardless of their dementia status. Practical suggestions and implications are provided for designing LTPA programs tailored to the specific needs of PLWD.

Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases and ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes. Physical activity and exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance physical function, and reduce the burden of non-communicable chronic diseases including cardiometabolic disease, cancer, musculoskeletal and neurological conditions, and chronic respiratory diseases as well as premature mortality. Physical activity influences the cellular and molecular drivers of biological aging, slowing aging rates-a foundational aspect of geroscience. Thus, PA serves both as preventive medicine and therapeutic agent in pathological states. Sub-optimal PA levels correlate with increased disease prevalence in aging populations. Structured exercise prescriptions should therefore be customized and monitored like any other medical treatment, considering the dose-response relationships and specific adaptations necessary for intended outcomes. Current guidelines recommend a multifaceted exercise regimen that includes aerobic, resistance, balance, and flexibility training through structured and incidental (integrated lifestyle) activities. Tailored exercise programs have proven effective in helping older adults maintain their functional capacities, extending their health span, and enhancing their quality of life. Particularly important are anabolic exercises, such as Progressive resistance training (PRT), which are indispensable for maintaining or improving functional capacity in older adults, particularly those with frailty, sarcopenia or osteoporosis, or those hospitalized or in residential aged care. Multicomponent exercise interventions that include cognitive tasks significantly enhance the hallmarks of frailty (low body mass, strength, mobility, PA level, and energy) and cognitive function, thus preventing falls and optimizing functional capacity during aging. Importantly, PA/exercise displays dose-response characteristics and varies between individuals, necessitating personalized modalities tailored to specific medical conditions. Precision in exercise prescriptions remains a significant area of further research, given the global impact of aging and broad effects of PA. Economic analyses underscore the cost benefits of exercise programs, justifying broader integration into health care for older adults. However, despite these benefits, exercise is far from fully integrated into medical practice for older people. Many healthcare professionals, including geriatricians, need more training to incorporate exercise directly into patient care, whether in settings including hospitals, outpatient clinics, or residential care. Education about the use of exercise as isolated or adjunctive treatment for geriatric syndromes and chronic diseases would do much to ease the problems of polypharmacy and widespread prescription of potentially inappropriate medications. This intersection of prescriptive practices and PA/exercise offers a promising approach to enhance the well-being of older adults. An integrated strategy that combines exercise prescriptions with pharmacotherapy would optimize the vitality and functional independence of older people whilst minimizing adverse drug reactions. This consensus provides the rationale for the integration of PA into health promotion, disease prevention, and management strategies for older adults. Guidelines are included for specific modalities and dosages of exercise with proven efficacy in randomized controlled trials. Descriptions of the beneficial physiological changes, attenuation of aging phenotypes, and role of exercise in chronic disease and disability management in older adults are provided. The use of exercise in cardiometabolic disease, cancer, musculoskeletal conditions, frailty, sarcopenia, and neuropsychological health is emphasized. Recommendations to bridge existing knowledge and implementation gaps and fully integrate PA into the mainstream of geriatric care are provided. Particular attention is paid to the need for personalized medicine as it applies to exercise and geroscience, given the inter-individual variability in adaptation to exercise demonstrated in older adult cohorts. Overall, this consensus provides a foundation for applying and extending the current knowledge base of exercise as medicine for an aging population to optimize health span and quality of life.

Prevalence of physical inactivity and its determinants among older adults living in nursing homes: A cross-sectional study based on COM-B model

AIMS

To investigate the prevalence of physical inactivity in older adults living in nursing homes and explore the determinants of physical inactivity by using the Capability, Opportunity, Motivation-Behaviour model.

DESIGN

A multisite, cross-sectional study was performed by convenience sampling and questionnaire survey.

METHODS

A total of 390 nursing home residents were recruited from three nursing homes in Southern China from May 2022 to April 2023. The participants completed a self-designed general information questionnaire, Physical Activity Scale for the Elderly, Self-Efficacy for Exercise Scale, Exercise Benefits Scale, Patient Health Questionnaire-9 and the Short Physical Performance Battery test. Descriptive statistics, univariate analysis, Spearman correlation analysis, and ordinal logistic regression were applied for data analysis.

RESULTS

The prevalence of physical inactivity among the nursing home residents reached 88.46%. Ordinal logistic regression results showed that exercise self-efficacy, perceived exercise benefits, physical function, availability of physical activity instruction, having depression, number of chronic diseases and living with spouse were the main influencing determinants of physical inactivity and explained 63.7% of the variance.

CONCLUSIONS

Physical inactivity was considerable in nursing home residents in China and influenced by complex factors. Tailored measures should be designed and implemented based on these factors to enhance physical activity while considering the uniqueness of Chinese culture.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Healthcare professionals should enhance physical activity of residents by increasing benefits understanding, boosting self-efficacy, improving physical function, alleviating depression and integrating personalized physical activity guidance into routine care services. And more attention should be paid to the residents who had more chronic diseases or did not live with spouse.

IMPACT

Physical inactivity is a significant problem in nursing home residents. Understanding physical inactivity and its determinants enables the development of tailored interventions to enhance their physical activity level.

REPORTING METHOD

This study was reported conforming to the STROBE statement.

PATIENTS OR PUBLIC CONTRIBUTION

Nursing home residents who met the inclusion criteria were recruited.

Sarcopenia interventions in long-term care facilities targeting sedentary behaviour and physical inactivity: A systematic review

BACKGROUND

Sedentary behaviour and physical inactivity are independent risk factors for sarcopenia for long-term care facility residents. Understanding the components, mechanisms and context of interventions that target change in these risk factors can help optimize sarcopenia management approaches. This study aimed to identify, appraise and synthesize the interventions targeting sedentary behaviour and physical inactivity, construct a Theory of Change logic model, inform complex sarcopenia intervention development and identify areas for improvement.

METHODS

Eight electronic databases, including Embase and Web of Science, were searched for eligible interventional studies from inception until February 2024. Narrative synthesis was used. The Theory of Change was applied to develop a logic model presenting the synthesized results. A Cochrane risk of bias assessment tool was used for quality appraisal.

RESULTS

The study included 21 articles involving 1014 participants, with mean ages ranging from 72.5 to 90.4 years. The proportion of female participants ranged from 8.0% to 100.0%. The applied sarcopenia diagnosis criteria varied, including those of the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People. The overall risk of bias in the included studies was moderate. Interventions primarily targeted physical inactivity, with resistance training being the most common intervention type. The reporting of intervention adherence was insufficient (only 11 out of 21 included studies provided adherence reports), and adherence overall and by intervention type was not possible to discern due to inconsistent criteria for high adherence across these studies. Four categories of intervention input were identified: educational resources; exercise equipment and accessories; monitoring and tailoring tools; and motivational strategies. Intervention activities fell into five categories: determining the intervention plan; educating; tailoring; organizing, supervising, assisting and motivating; and monitoring. While sarcopenia-related indicators were commonly used as desired outcomes, intermediate outcomes (i.e., sedentary time and physical activity level) and other long-term outcomes (i.e., economic outcomes) were less considered. Contextual factors affecting intervention use included participant characteristics (i.e., medical condition and education level) and intervention provider characteristics (i.e., trustworthiness).

CONCLUSIONS

The findings led to the development of a novel logic model detailing essential components for interventions aimed at managing sarcopenia in long-term care facilities, with a focus on addressing sedentary behaviour and physical inactivity. Future sarcopenia interventions in long-term care facilities should fully attend to sedentary behaviour, enhance adherence to interventions through improved education, monitoring, tailoring and motivation and establish an agreed standard set of outcome measures.

'Can do' versus 'Do do' in nursing home residents: identification of contextual factors discriminating groups with aligned or misaligned physical activity and physical capacity

BACKGROUND

Physical activity (PA) is fundamental to nursing home residents' health. Likewise, physical capacity (PC) is essential to carry out activities of daily living. Although PC and PA are associated, misalignment has been reported in specific subgroups. Increased PC is oftentimes not linked to high PA (i.e., Can do - don't do) and vice versa (i.e., Can't do - do do). Therefore, identifying other contextual factors influencing PA in misaligned groups is important. This study aimed to identify contextual factors in nursing home residents with aligned or misaligned PA and PC.

METHODS

In total, 180 nursing home residents (≥ 65 years, 79.4% females) were divided into four quadrants (Q1: Can do - do do; Q2: Can do - don't do; Q3: Can't do - do do; Q4: Can't do - don't do) based on thresholds for PA (≥ or < 2,500 steps/day) and PC (≤ or > 0.5 m/s gait speed). Kruskal-Wallis H test and effect sizes (ES) were applied to analyze quadrants' differences regarding PA (steps per day), objective motor capacity, life-space mobility, activities of daily living (ADL), psychosocial well-being, cognition, subjective mobility-related concerns, and spatial orientation.

RESULTS

Specific contextual factors differed significantly between the groups. Compared to Q1, Q2 presents a significantly lower life-space mobility (ES: 0.35) and objective motor capacity (ES: 0-36-0.49); Q3 has a lower objective motor capacity (ES: 0.55-1.10); Q4 shows lower independence in ADL (ES: 0.57), life-space mobility (ES: 0.48), subjective mobility-related concerns (ES: 0.38) and objective motor capacity (ES: 0.99-1.08). No significant group differences were found for psychosocial well-being, cognition, and spatial orientation.

CONCLUSIONS

This study provides new insights into PA behavior of nursing home residents. Key variables linked to PA are objective motor capacity, life-space mobility, ADL, and subjective mobility-related concerns. Surprisingly, some potentially impactful variables such as cognition, orientation, and psychosocial well-being did not differ between the groups. This may suggest that these variables may not represent key targets for interventions aiming to improve PA. This study builds the foundation for further research into the underlying mechanisms behind PA behaviors and supports future efforts to plan specific, targeted interventions for nursing home residents.

TRIAL REGISTRATION

The trial was prospectively registered at DRKS.de with registration number DRKS00021423 on April 16, 2020.

Maintaining daily living activities in older adults: The impact of a functional exercise program in long-term nursing homes. A single-group pre-post intervention

OBJECTIVE

To evaluate the impact of a function-focused multicomponent exercise program on long-term nursing home (LTNH) residents' ability to maintain activities of daily living (ADL), physical performance, cognitive function, quality of life, and frailty.

METHODS

This multicenter single-group pre-post quasi-experimental study involved 148 participants from 16 LTNHs in Gipuzkoa, Spain. Participants underwent a twice-weekly, 6-month function-focused multicomponent exercise program and were assessed both before and after the intervention.

RESULTS

Following the intervention, participants significantly maintained ADL ability, improved physical performance and quality of life, and reduced frailty (all p < 0.05). Cognitive function showed a positive trend. Subgroup analysis showed consistent improvements across demographics and health variables.

CONCLUSIONS

The exercise program effectively maintained or improved ability to perform ADL, cognitive function, physical performance, and quality of life while reducing frailty in LTNH residents, irrespective of individual characteristics. This highlights the importance of exercise interventions to preserve overall function and wellbeing in this population.

TRIAL REGISTRATION

NCT04221724.

Outdoor stays-A basic human need except for older adults in residential care facilities? Researcher-practitioner interaction crosses zones and shows the way out

The aim of this discussion paper is to show the way to the outdoors by shedding light on conditions in the physical environment enabling outdoor stays for older adults living in residential care facilities (RCFs). The origin was that outdoor stays is a basic human need and applies to everyone. However, despite extensive research on the health-promoting values of contact with the outdoors, it seems that for older adults in RCFs this is not met because they often have difficulty getting outdoors on their own. Therefore, the access to and the conditions of outdoor environments are discussed and exemplified through two cases based on evidence-based approaches, namely the principal model of four zones of contact with the outdoors, and the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). An interdisciplinary team, including both researchers and practitioners highlights future directions by showing the way to the outdoors on a national level with six suggested points. As a reader, you will gain increased knowledge about environmental qualities that support outdoor stays as well as initiatives that are needed to achieve equal conditions related to outdoor stays in RCFs.

Person-focused interventions for fall risk assessment, fall prevention and fall injury prevention in long-term care facilities: a scoping review

OBJECTIVE

Falls are a significant concern in long-term care facilities (LTCFs) as fall-related injuries can result in functional impairment, disability and death. Older adults living in LTCFs are at greater risk for falls than those in the community. Using scoping review methodology, we aimed to synthesise evidence examining intervention effects of person-focused interventions for risk assessment and prevention in LTCFs in order to identify evidence-based practices in LTCFs.

METHODS

We included three databases (Ovid-Medline, CINAHL and EMBASE) to identify original research from 2007 to 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline. From the initial search, we identified 988 articles. Following the removal of duplicates, title and abstract screening, and full-text review against inclusion/exclusion criteria, 20 studies remained for analysis. Then, we conducted a narrative synthesis to summarise the included studies.

RESULTS

Identified evidence-based interventions for fall prevention include (1) exercise programmes (eg, high-intensity functional exercise, aerobic exercise, short stick exercises, etc); (2) multifactorial programmes; and (3) other interventions (eg, lavender olfactory stimulation). Outcomes of included studies included the number of falls, fall rate, risk of falls and fear of falls before and after interventions.

CONCLUSION

Overall, most studies reported significant effects of person-focused interventions in LTCFs. Available evidence supports that well-designed person-focused interventions can reduce falls and fear of falls for individuals in LTCFs.

Physical Activity, Sedentary Behavior, and Their Predictors Among Nursing Home Residents-Cross-Sectional Results of the BaSAlt Study

Little is known about physical activity (PA) and sedentary behavior (SB) among nursing home residents although PA is known as a health promoter. This study examined PA, SB, and their predictors among nursing home residents (n = 63). Dependent variables were accelerometry-based PA and SB. Predictor variables included in a path analysis were age, sex, body mass index, Barthel Index, cognitive status (Mini-Mental State Examination), physical performance (hand grip strength and habitual walking speed), and well-being (World Health Organization-5 well-being index). PA was very low (M steps per day = 2,433) and SB was high (M percentage of sedentary time = 89.4%). PA was significantly predicted by age (β = -0.27, p = .008), body mass index (β = -0.29, p = .002), Barthel Index (β = 0.24, p = .040), and hand grip strength (β = 0.30, p = .048). SB was significantly predicted by body mass index (β = 0.27, p = .008) and Barthel Index (β = -0.30, p = .012). Results might be helpful for everyday practice to identify individuals at high risk for low PA and high SB.

Assessing virtual reality acceptance in long-term care facilities: a quantitative study with older adults

PURPOSE

Our study aimed to investigate the factors associated with the acceptance of virtual reality (VR) games among older adults living in LTC, with a particular emphasis on identifying social and individual factors that have been overlooked in existing technology acceptance models.

MATERIALS AND METHODS

We conducted VR gaming sessions, followed by a composite questionnaire to explore the factors associated with the acceptance of VR games among residents of LTC with a focus on technology acceptance models (TAM) and social factors derived from Selective Optimization with Compensation (SOC) theory and Socioemotional Selectivity Theory (SST).

RESULTS

We studied 20 older adults aged 65 and older. Participants were moderately sedentary, with the majority of them having prior gaming experience. Participants with prior gaming experience had higher mean scores in most SOC theory and SST subscales, except for elective selection. Participants perceived the technology as useful and easy to use, with no heightened gaming-related anxiety. Significant correlations were found between perceived ease of use and selection strategies, and between attitudes towards gaming and elective selection strategies. No significant score differences were observed between male and female participants.

CONCLUSIONS

The positive correlation between VR acceptance and using SOC strategies suggests a positive response to straightforward experiences. Our study highlights VR exergaming's potential benefits for encouraging LTC residents' engagement in valued activities and pursuing goals. Moreover, social theories of aging can inform technology acceptance and guide the design and marketing of VR exergames to better suit older adults' needs and preferences in LTC.IMPLICATIONS FOR REHABILITATIONThe findings of this study have important implications for rehabilitation programs aimed at enhancing physical activity (PA) and engagement among older adults living in long-term care (LTC) facilities. The use of virtual reality (VR) games can be an important tool to promote PA and improve the overall well-being of LTC residents. Based on the results, the following implications can be drawn:Integrating VR exergaming in rehabilitation:The positive perception of VR technology's usefulness and ease of use among older adults in LTC suggests that VR exergaming can be effectively integrated into rehabilitation programs. Healthcare professionals and rehabilitation specialists in LTC facilities can consider incorporating VR-based exercise routines and gaming sessions to motivate and engage residents in physical activities. By doing so, they can create enjoyable and interactive rehabilitation experiences that may lead to improved adherence to exercise regimens.Addressing social factors for VR acceptance:Our study highlights the significance of social factors derived from theories of aging, such as Selective Optimization with Compensation (SOC) and Socioemotional Selectivity Theory (SST), in influencing VR acceptance among LTC residents. Rehabilitation programs should take into account these social aspects and create a supportive and encouraging environment for older adults to engage with VR exergames. Encouraging social interactions and providing opportunities for residents to share their experiences with VR gaming may enhance acceptance and overall engagement.Tailoring VR exergames for older adults:The correlation between VR acceptance and the use of SOC strategies indicates that customized experiences may be well-received by LTC residents. Game developers and rehabilitation specialists should consider designing VR exergames that align with the specific preferences and needs of older adults. This could involve providing choices and options for users to optimize their gaming experiences based on their individual abilities and interests.Recognizing gaming experience:Our study highlights that prior gaming experience positively influenced participants' attitudes towards VR gaming. Rehabilitation professionals should acknowledge and leverage this prior experience when introducing VR exergaming to older adults in LTC. By incorporating elements familiar to older adults or providing guidance for those new to gaming, rehabilitation programs can foster a more seamless and enjoyable transition to VR exergames.Promoting goal pursuit and valued activities:Our study suggests that VR exergaming has the potential to encourage LTC residents' engagement in valued activities and goal pursuit. Rehabilitation programs can utilize VR exergaming as a means to help residents achieve specific rehabilitation goals and engage in activities that are meaningful to them. This approach can contribute to a sense of purpose and satisfaction in the rehabilitation process.Overall, the integration of VR exergaming in rehabilitation for older adults in LTC facilities has promising implications for improving physical activity levels, enhancing engagement, and addressing the holistic well-being of residents. By considering the social factors influencing VR acceptance and tailoring experiences to individual preferences, rehabilitation professionals can optimize the potential benefits of VR technology in LTC settings.

Handgrip Strength and Dehydroepiandrosterone Sulfate in a Frailty Unit: A Retrospective Study

INTRODUCTION

Frailty is characterized by vulnerability and decline in physical, mental, and social activity, significantly contributing to adverse health outcomes. Frailty encompasses nutritional status, muscle strength, inflammation, and hormones. Dehydroepiandrosterone sulfate (DHEAS) is one of the hormones hypothesized to play a role in frailty. Handgrip strength (HGS) correlates with overall muscle strength. The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale can be used to readily screen frailty. Identifying markers associated with frailty can facilitate its early diagnosis, risk stratification, and target interventions to prevent or mitigate its negative consequences. This study sought to evaluate the associations between frailty, HGS, and DHEAS in a Portuguese frailty unit (FU).

METHODS

We developed an observational retrospective study in an FU. Patients admitted to the FU underwent a rehabilitation program. We assessed frailty with the FRAIL scale. We assayed DHEAS upon admission to the FU. We measured HGS at admission (i-HGS) and discharge (f-HGS). We also considered HGS variation (∆ HGS) and length of stay.

RESULTS

Out of 119 subjects, 97 fulfilled the eligibility criteria (mean age 78.35 ± 9.58 years; 44.33% men). Overall, 88 (90.72%) patients had a FRAIL scale score of 3 or more. DHEAS values were not significantly different in either the categories of the FRAIL scale or frailty status. DHEAS values were also not significantly correlated with either i-HGS, f-HGS, ∆ HGS, age, or FU length of stay. Frail patients had a significantly lower i-HGS (p = 0.002) and f-HGS (p = 0.001) and a significantly higher length of stay (p = 0.006). Also, the i-HGS and f-HGS significantly decreased with the increase of the FRAIL scale score (p < 0.0001 for both). The cut-off values of the i-HGS and the f-HGS for detecting frail patients in our study were 13.3 kg and 19.1 kg, respectively (p < 0.0001 for both). The i-HGS was significantly and independently associated with the frailty status of frail (p = 0.001), with a 15% probability reduction of a patient being frail for every kilogram increase in the i-HGS.

CONCLUSION

Frail patients assessed with the FRAIL scale had a significantly lower i-HGS and f-HGS and a higher length of stay. In this study, we found frailty and DHEAS to be not associated and DHEAS values to be not correlated with i-HGS or f-HGS. In our opinion, the creation of an FU with an initial FRAIL scale screening and HGS measurement might have a significant impact on identifying frail people and ensuring the implementation of a multimodal multidisciplinary approach.

Longitudinal Analysis of Functional Capacity in Nursing Home Residents During the COVID-19 Pandemic

BACKGROUND AND PURPOSE

The COVID-19 pandemic has raised concerns about nursing home (NH) residents' well-being, with recent studies indicating a significant increase in functional decline rate during this critical period. However, a comprehensive exploration of functional capacity trajectories in NH residents during the pandemic remains unexplored. This study aims to address this research gap by conducting an in-depth analysis of the impact of the COVID-19 pandemic on NH residents' functional capacity.

METHODS

A 24-month multicenter prospective study involving 123 NH residents from Spain, with data collected at 6-month intervals over 5 waves, starting just before the pandemic's onset. Functional capacity was assessed using the Modified Barthel Index, and data were analyzed employing the actuarial method, log-rank test, and Cox's regression.

RESULTS AND DISCUSSION

The likelihood of maintaining functional capacity was unfavorable, with only a 19.3% chance of preservation for a 1-point decline (FD-1) in Barthel scores and a 50.5% probability for a 10-point decline (FD-10). Personal hygiene, eating, and toilet use were identified as the most affected activities of daily living. Urinary continence decline emerged as a risk factor for FD-1, while fecal continence decline was associated with FD-10. The probability of maintaining functional capacity in the initial 6 months of a pandemic was comparable to a 2-year non-pandemic follow-up. Pandemic-induced isolation strategies significantly impacted toileting and personal hygiene. Urinary decline was associated with minor functional decline (FD-1), while fecal decline correlated with major functional decline (FD-10). Notably, the number of days spent in room confinement did not significantly contribute to the observed decline.

CONCLUSIONS

A substantial increase in the risk of FD among NH residents during the COVID-19 pandemic compared to the pre-pandemic period was found. It is crucial to implement urgent, targeted interventions that prioritize promoting physical activity and the implementation of mobility and toileting programs. These measures are pivotal for mitigating functional decline and enhancing the overall health and well-being of NH residents in a pandemic context.

Behavior change techniques to increase physical activity among older adults living in long-term care facilities: A systematic review

Despite the health benefits of physical activity, many older adults living in long-term care facilities lead sedentary lifestyles and do not meet minimum physical activity recommendations. Determining the behavior change techniques (BCTs) used in physical activity interventions can help us understand the underlying mechanisms by which behavioral change is achieved. The purpose of this systematic review was to identify and evaluate BCTs in physical activity interventions for the elderly residents. Six electronic databases were searched and 15 eligible studies were retained. Nine promising BCTs associated with physical activity promotion among elderly residents were identified: credible source, social support (unspecified), goal setting (outcome), goal setting (behavior), demonstration of the behavior, instruction on how to perform a behavior, self-monitoring of behavior, self-monitoring of outcome(s) of behavior, and adding objects to the environment. Future research is encouraged to select and tailor these BCTs to the specific needs and preferences of the target population.

Acceptance of physical activity virtual reality games by residents of long-term care facilities: A qualitative study

BACKGROUND

Little is known about the experience and the social and contextual factors influencing the acceptance of virtual reality (VR) physical activity games among long-term care (LTC) residents. Our study aims to address this research gap by investigating the unique experience of older adults with VR games. The findings will provide valuable insights into the factors influencing VR acceptance among LTC residents and help design inclusive VR technology that meets their needs and improves physical activity (PA) and well-being.

OBJECTIVE

We aimed to: (1) investigate how participants experience VR exergames and the meaning they associate with their participation; and (2) examine the factors that influence the participant's experience in VR exergames and explore how these factors affect the overall experience.

METHODS

We used a qualitative approach that follows the principles of the Interpretive Description methodology. Selective Optimization and Compensation (SOC) theory, Socioemotional Selectivity theory (SST) and technology acceptance models underpinned the theoretical foundations of this study. We conducted semi-structured interviews with participants. 19 Participants of a LTC were interviewed: five residents and ten tenants, aged 65 to 93 years (8 female and 7 male) and four staff members. Interviews ranged from 15 to 30 minutes and were transcribed verbatim and were analyzed using thematic analysis.

RESULTS

We identified four themes based on older adults' responses that reflected their unique VR gaming experience, including (1) enjoyment, excitement, and the novel environment; (2) PA and motivation to exercise; (3) social connection and support; and (4) individual preferences and challenges. Three themes were developed based on the staff members' data to capture their perspective on the factors that influence the acceptance of VR among LTC resident including (1) relevance and personalization of the games; (2) training and guidance; and (3) organizational and individual barriers.

CONCLUSIONS

VR gaming experiences are enjoyable exciting, and novel for LTC residents and tenants and can provide physical, cognitive, social, and motivational benefits for them. Proper guidance and personalized programs can increase understanding and familiarity with VR, leading to a higher level of acceptance and engagement. Our findings emphasize the significance of social connection and support in promoting acceptance and enjoyment of VR gaming among older adults. Incorporating social theories of aging helps to gain a better understanding of how aging-related changes influence technology acceptance among older adults. This approach can inform the development of technology that better meets their needs and preferences.

Characteristics and Effectiveness of Physical Therapist-Supervised Exercise Interventions for Nursing Home Residents With Dementia: A Systematic Review

Background and Objectives

Although physical therapy, in particular exercise therapy, is widely used in nursing home residents with dementia, the literature on this topic is relatively scarce. This systematic review aimed to summarize the literature on the characteristics and effectiveness of exercise interventions supervised by physical therapists in nursing home residents with dementia.

Research Design and Methods

Six electronic databases were systematically searched for relevant studies up to August 17, 2022. Randomized controlled trials (RCTs) comparing exercise interventions supervised by a physical therapist to any other form of intervention or usual care in nursing home residents with dementia were selected. Data were narratively analyzed and forest plots visualizing exercise effects were created.

Results

From the 1 377 records retrieved and screened, 6 RCTs, reported in 11 papers, met the selection criteria. Included studies used multimodal or aerobic exercise interventions, with the frequency, duration and intensity varying across studies. Three of the 6 studies were at high risk of bias. Due to inconsistency in the findings and variety in outcome measures, results on the effectiveness of the interventions are inconclusive.

Discussion and Implications

Our review emphasizes the need for more robust studies to offer understanding of the efficacy of exercise interventions supervised by physical therapists for nursing home residents with dementia.

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.

Virtual reality exergames for improving physical function, cognition and depression among older nursing home residents: A systematic review and meta-analysis

OBJECTIVE

To explore the effectiveness of virtual reality (VR) exergames on physical function, cognition and depression among older nursing home residents.

METHODS

A systematic review and meta-analysis were conducted. The PubMed, Ovid, Embase, Cochrane, CINAHL, and Web of Science databases were searched for relevant studies from inception until June 1, 2023. The reviewers independently completed the study selection, data extraction and quality assessment. Subgroup analyses were conducted to explore the sources of between-study heterogeneity and to determine whether participant or intervention characteristics influenced effect sizes.

RESULTS

Eighteen studies met the inclusion criteria and were selected for qualitative and quantitative synthesis. The overall methodological quality was relatively high, and the overall evidence grade was moderate. VR exergames had a large effect on physical function, including mobility [SMD=-0.66, P < 0.001], balance [SMD=0.95, P < 0.001], and lower limb strength [SMD=0.53, P = 0.0009]; and a moderate effect on cognition [SMD=0.48, P = 0.02] and depression [SMD=-0.72, P = 0.03]. Subgroup analyses revealed that a training frequency of 2 sessions per week and coordinating with physiotherapists yielded greater improvements in mobility (P = 0.009; P = 0.0001). VR exergames had especially beneficial effects on balance for physically fit participants (P = 0.03) and on cognition for participants with cognitive impairment (P = 0.01). Additionally, regarding the improvement of depression, commercial VR exergames were superior to self-made systems (P = 0.03).

CONCLUSION

VR exergames can provide a positive impact on physical function, cognition and depression among older nursing home residents. The study also demonstrated the different benefits of exergames between participants who were physically fit and those with cognitive impairment, which is considered as an innovative, cost-efficient and sustainable approach. Specifically, commercial VR exergame programs with a frequency of 2 sessions per week and coordinating with physiotherapists may be the most appropriate and effective option.

Impact of Pain and Neuropsychiatric Symptoms on Activities in Nursing Home Residents (COSMOS Trial)

OBJECTIVE

This study aims to identify whether pain and dementia-related behavior are associated with different types of activities in nursing home residents, controlled for dementia severity.

DESIGN

Cross-sectional baseline data from the multicomponent cluster randomized controlled COSMOS trial (acronym for Communication, Systematic pain treatment, Medication review, Organization of activities, and Safety).

SETTING AND PARTICIPANTS

A total of 723 patients from 33 Norwegian nursing homes with 67 units (clusters). Participants aged ≥65 years, with a life expectancy of >6 months, and with valid data on activity were eligible for inclusion.

METHODS

Activity was operationalized in time (hours per week) and type (cognitive, social, physical, and no activity). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), pain with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and behavior with the Neuropsychiatric Inventory Nursing Home version (NPI-NH). Analyses were performed using linear and logistic regression. Sensitivity analyses for dementia severity were performed to account for effect modification.

RESULTS

A total of 289 participants were included (mean age 86.2 [SD 7.6]; 74% female). A higher pain score was associated with less time spent on activity in participants with severe dementia (estimate 0.897, P = .043). A higher score for the NPI-NH mood cluster (depression and anxiety) was associated with a higher likelihood of participation in cognitive activities (odds ratio [OR], 1.073; P = .039). Apathy (OR, 0.884; P = .041) and lack of inhibition (OR, 0.904; P = .042) were associated with a lower likelihood of participation in social activities as well as no engagement in activities (apathy OR, 0.880; P = .042; lack of inhibition OR, 0.894; P = .034).

CONCLUSION AND IMPLICATIONS

Pain and dementia-related behavior may influence the participation in activities in the nursing home. There is an urgent need to investigate what type of activity stimulates people in different stages of dementia.

The bidirectional relationship between activities of daily living and frailty during short-and long-term follow-up period among the middle-aged and older population: findings from the Chinese nationwide cohort study

Objective

Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals.

Methods

The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs.

Results

In cross-sectional analysis, BADL [OR = 6.660 (4.519-9.815)], IADL [OR = 5.950 (4.490-7.866)], and ADL [OR = 5.658 (4.278-7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574-9.933)], IADL [OR = 6.042 (4.555-8.016)] and ADL [OR = 5.735 (4.333-7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150-3.379), ADL: HR = 1.920 (1.146-3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085-3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126-2.939)] and IADL [HR = 1.724 (1.103-2.694)].

Conclusion

In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.

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.

Implementation of exergaming for people with dementia: facilitators, barriers, and recommendations

OBJECTIVES

To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs).

METHODS

Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context.

RESULTS

Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually.

CONCLUSION

Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD.

Doll therapy for improving behavior, psychology and cognition among older nursing home residents with dementia: A systematic review and meta-analysis

OBJECTIVE

To explore the effectiveness of doll therapy (DT) on behavior, psychology and cognition among older nursing home residents with dementia.

METHODS

A systematic review and meta-analysis was conducted. Subgroup analyses were performed to determine whether the intervention characteristics influenced effect sizes.

RESULTS

Ten studies met the inclusion criteria and were selected for qualitative and quantitative synthesis. The overall methodological quality was relatively high. DT significantly improved all behaviors [SMD=-0.42, P=0.01], including agitation [SMD=-0.94, P<0.001], apathy, irritability and wandering, and psychological states (i.e., pleasure, anxiety and depression). However, there was no significant difference in the improvement of cognition. Subgroup analyses revealed that the DT process employing empathy dolls and coordinating with caregivers was more beneficial for improving all behaviors (P=0.01; P=0.02).

CONCLUSION

DT significantly reduced behavioral and psychological disturbances among older nursing home residents with dementia. Specifically, administering empathy dolls and coordinating with caregivers may be the most appropriate and effective option.

The association between sedentary behaviour and sarcopenia in older adults: a systematic review and meta-analysis

BACKGROUND

Sedentary behaviour is considered to contribute to sarcopenia when combined with physical inactivity. Whether sedentary behaviour is independently associated with sarcopenia remains controversial. The aim of this study is to explore the association between sedentary behaviour and sarcopenia in older adults in community and long-term care facility settings.

METHODS

Eight electronic databases including MEDLINE, PsycINFO, Wanfang were searched from inception until August 2023. The review included cross-sectional and longitudinal studies concerning the association between sedentary behaviour and sarcopenia among participants over 60 years old. Evidence was pooled by both random-effects meta-analysis and narrative synthesis. Subgroup analyses explored variation according to adjustment of physical activity, settings, and measurements of sedentary behaviour and sarcopenia. Quality assessment for individual studies was performed with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.

RESULTS

Seventeen articles (16 cross-sectional studies and 1 longitudinal study) of 25,788 participants from community or long-term care facility settings were included. The overall quality of the included studies was rated high. Meta-analysis of 14 cross-sectional studies showed that sedentary behaviour was independently positively associated with sarcopenia: pooled odd ratio 1.36 (95% confidence interval, 1.18-1.58). The independent positive association remained in subgroup analyses by adjustment of physical activity, settings, and measurements of sedentary behaviour and sarcopenia. The narrative analysis corroborated the findings of the meta-analysis and provided additional evidence suggesting that interruptions in sedentary periods were linked to a decreased likelihood of developing sarcopenia.

CONCLUSIONS

The findings support the hypothesis that sedentary behaviour is independently positively associated with sarcopenia in older adults, providing vital indications for the development of strategies to prevent sarcopenia.

SYSTEMATIC REVIEW REGISTRATION

The systematic review protocol has been registered with the PROSPERO database (CRD42022311399).

Older persons' expressed perceptions on exercise programs in long-term care institutions: Influence of professionals and institutions

OBJECTIVE

To explore the perceptions of institutionalised older people about the professionals and institutions regarding exercise programs in long-term care institutions DESIGN, SETTING, AND PARTICIPANTS: A qualitative study was carried out using focus group discussions. Forty-seven institutionalised participants (≥ 65 years old) with a score of > 23 in the Mini-Mental State Examination (MMSE) were recruited.

RESULTS

Most participants believed that the frequency of the exercise sessions could be increased by enhancing the number of staff assisting them and by adapting the facilities to their needs. They also suggested using outdoor spaces and avoiding childish activities and treatment. Participants' beliefs were grouped into three major themes (i) Perceptions about the health professionals delivering the exercise programs (ii) Perceptions about the institution or centre regarding exercise programs; (iii) Perceptions about the exercise programs.

CONCLUSION

Participants proposed certain changes that could take place in the institutions to promote engagement with exercise programs: tailored exercise programs, avoiding puerile treatment, increasing the number of staff members, and the creation of well-equipped spaces to perform the exercise.

PRACTICAL IMPLICATIONS

Professionals should spend time designing tailored exercise programs and avoid puerile treatment. Institutions must review the need for spaces and the personnel assigned.

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).

Effectiveness of Combined Exercise and Nutrition Interventions in Preventing and Improving Sarcopenia in Frail or Healthy Older Adults: A Systematic Review

The current systematic review compared whether combined exercise and nutrition interventions are effective in preventing or improving sarcopenia in frail older adults and healthy older adults. Medline, Embase, Cochrane Library, and CINAHL were searched for randomized controlled trials. Of the 1,596 citations, 22 trials (N = 1,767) were included in the final sample. In frail older adults, significant improvement after combined exercise and nutrition interventions was observed in seven indicators: skeletal muscle index, 0.16 kg/m2; handgrip, 1.41 kg; knee extension strength, 0.24 Nm; five-repetition chair-stand test, -1.89 sec; gait speed, 0.06 m/s; Short Physical Performance Battery, 0.43; and Timed Up and Go test, -0.56 sec. In healthy older adults, two indicators improved and showed statistically significant differences: handgrip, 2.15 kg; and 6-Minute Walking Test, 9.71 m. Combined exercise and nutritional interventions can improve skeletal muscle quality, strength, and physical performance in frail and healthy older adults. [Research in Gerontological Nursing, 16(6), 312-320.].

Feasibility and Efficacy of Low-to-Moderate Intensity Aerobic Exercise Training in Reducing Resting Blood Pressure in Sedentary Older Saudis with Hypertension Living in Social Home Care: A Pilot Randomized Controlled Trial

Background and Objectives: The effect of non-pharmacological aerobic exercise training on blood pressure in sedentary older individuals receiving social home care in Saudi Arabia has not been investigated. This study aimed to examine the effects of aerobic exercise on blood pressure in sedentary older Saudis with hypertension residing in these settings. Materials and Methods: A pilot randomized control trial was conducted with 27 sedentary individuals, aged 60-85, diagnosed with hypertension, and living in social home care in Makkah, Saudi Arabia. Recruitment took place between November 2020 and January 2021, and participants were randomly assigned to either the experimental or control group. The experimental group engaged in three 45 min sessions of low-to-moderate intensity aerobic activity per week for eight weeks. This trail was registered with the ISRCTN registry (ISRCTN50726324). Results: Following eight weeks of mild to moderate aerobic exercise training, the primary outcome of resting blood pressure showed a significant reduction in the experimental group (systolic blood pressure: mean difference [MD] = 2.91 mmHg, 95% confidence interval [CI] = 1.61, 4.21, p = 0.001; and diastolic blood pressure: MD = 1.33 mmHg, 95% CI = 1.16, 1.50, p = 0.001) compared to the control group. Within the experimental group, there was also a significant decrease in systolic blood pressure (MD = -2.75 mmHg, 95% CI = -7.73, 2.22, p = 0.005) and diastolic blood pressure (MD = -0.83 mmHg, 95% CI = -5.81, 4.14, p = 0.02). Conclusions: This trial demonstrates the feasibility and potential benefits of low-to-moderate intensity aerobic exercise training in reducing resting blood pressure among sedentary older Saudis with hypertension residing in this aged care setting.

Effects of physical exercise on physical function in older adults in residential care: a systematic review and network meta-analysis of randomised controlled trials

BACKGROUND

Physical exercise is effective at attenuating ageing-related physical decline in general, but evidence of its benefits for older adults in residential care, who often have functional dependency, multimorbidity, and polypharmacy, is inconclusive. We aimed to establish the effects of exercise interventions on the physical function of this population.

METHODS

For this systematic review and network meta-analysis, we searched PubMed, Web of Science, Cochrane Library, Rehabilitation & Sports Medicine Source, and SPORTDiscus to identify randomised controlled trials assessing the effects of exercise interventions (vs usual care) on physical function (ie, functional independence, physical performance, and other related measures, such as muscle strength, balance, or flexibility) in adults aged 60 years or older living in residential care. Relevant studies published in English or Spanish up to Jan 12, 2023, were included in the systematic review. The quality of studies was assessed using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX) score. A network meta-analysis was performed for physical function-related outcomes reported in at least ten studies, with subanalyses for specific intervention (ie, exercise type, training volume, and study duration) and participant (eg, having cognitive impairment or dementia, pre-frail or frail status, and being functionally dependent) characteristics. The study protocol was registered on PROSPERO (CRD42021247809).

FINDINGS

147 studies (11 609 participants, with mean ages ranging from 67 years [SD 9] to 92 years [2]) were included in the systematic review, and were rated as having overall good quality (median TESTEX score 9 [range 3-14]). In the meta-analysis (including 105 studies, n=7759 participants), exercise interventions were associated with significantly improved overall physical function, with a standardised mean difference [SMD] of 0·13 (95% credible interval [CrI] 0·04-0·21), which was confirmed in all analysed subpopulations. The strongest association was observed with 110-225 min per week of exercise, and the greatest improvements were observed with 170 min per week (SMD 0·36 [95% CrI 0·20-0·52]). No significant differences were found between exercise types. Subanalyses showed significant improvements for almost all analysed physical function-related outcomes (Barthel index, five-times sit-to-stand test, 30-s sit-to-stand test, knee extension, hand grip strength, bicep curl strength, Short Physical Performance Battery, 6-min walking test, walking speed, Berg balance scale, and sit-and-reach test). Large heterogeneity was found between and within studies in terms of population and intervention characteristics.

INTERPRETATION

Exercise interventions are associated with improved physical function in older adults in residential care, and should, therefore, be routinely promoted in long-term care facilities.

FUNDING

None.

TRANSLATION

For the Spanish translation of the abstract see Supplementary Materials section.

A realist evaluation of the feasibility of a randomised controlled trial of a digital music and movement intervention for older people living in care homes

BACKGROUND

Low physical activity in care home residents brings about negative mental health consequences, such as higher levels of depression and loneliness. With advancements in communication technology, particularly during the COVID-19 pandemic, the feasibility and effectiveness of a randomised controlled trial (RCT) of a digital Physical Activity (PA) resource in care homes deserve more research attention. A realist evaluation was used to uncover influencing factors of a feasibility study implementation to inform how a digital music and movement programme would work and under what circumstances this would be most effective.

METHODS

Participants were 49 older adults (aged 65 years +) recruited across ten care homes in Scotland. Surveys were administered at baseline and post-intervention comprising psychometric questionnaires on multidimensional health markers validated in older adults with possible cognitive impairment. The intervention comprised 12 weeks of four prescribed digitally delivered movement (n = 3) and music-only (n = 1) sessions per week. An activity coordinator delivered these online resources in the care home. Post-intervention focus groups with staff and interviews with a sub-sample of participants were conducted to gain qualitative data on the acceptability of the intervention.

RESULTS

Thirty three care home residents started the intervention, but only 18 residents (84% female) completed both pre- and post-intervention assessments. Activity coordinators (AC) offered 57% of the prescribed sessions, with an average residents' adherence of 60%. Delivery of the intervention did not go as planned due to Covid restrictions in care homes and delivery challenges, including (1) motivation and engagement, (2) changes in cognitive impairment and disabilities of the participants, (3) death or hospitalisation of the participants and (4) limited staffing and technology resources to deliver the programme as intended. Despite this, group participation and encouragement of residents supported the delivery and acceptance of the intervention, with ACs and residents reporting improved mood, physical health, job satisfaction and social support. Improvements with large effect sizes were found for anxiety, depression, loneliness, perceived stress and sleep satisfaction, but no changes in fear of falling, domains of general health or appetite.

CONCLUSION

This realist evaluation suggested that this digitally delivered movement and music intervention is feasible. From the findings, the initial programme theory was refined for future implementation of an RCT in other care homes but future research exploring how to tailor the intervention to those with cognitive impairment and/or lacking capacity to consent is needed.

TRIAL REGISTRATION

Retrospectively registered at ClinicalTrials.gov NCT05559203.

Exercise Guidelines to Counteract Physical Deconditioning in Long-Term Care Facilities: What to Do and How to Do It?

With age, older adults experience a decrease in muscle function and changes in body composition, which raise the risk of functional incapacity and loss of autonomy. These declines are more pronounced in older adults living in long-term care (LTC) facilities than those living in the community (ie, sarcopenia prevalence: ∼41% vs ∼10%; obesity prevalence: 30% vs17%). The main cause of these declines is chronic diseases, which are a driver of higher rates of sedentary behavior (85% of time in LTC). Exercise, however, is recognized to help counteract age-related decline, yet it is not integrated into clinical practice.

Effectiveness of a Supervised Group-Based Otago Exercise Program on Functional Performance in Frail Institutionalized Older Adults: A Multicenter Randomized Controlled Trial

BACKGROUND AND PURPOSE

Because of its high prevalence and association with negative health-related outcomes, frailty is considered one of the most important issues associated with human aging and its mitigation is among the essential public health goals for the 21st century. However, very few studies have focused on institutionalized older adults, despite the knowledge that frailty can be reversible when identified and treated from its earliest stages. Therefore, the objective of this study was to evaluate the effects of a supervised group-based multicomponent exercise program intervention with or without oral nutritional supplementation on functional performance in frail institutionalized older adults.

METHODS

This was a multicenter randomized controlled trial study with a 6-month intervention period. A total of 111 frail institutionalized older adults (75 years or older) who met at least 3 of the 5 Fried frailty criteria were randomly allocated to the control group (CG; n = 34, mean age = 87.3 ± 5.3 years), a supervised group-based multicomponent Otago Exercise Program group (OEP; n = 39, mean age = 86 ± 5.9 years), or a supervised group-based multicomponent exercise program intervention with oral nutritional supplementation (OEP+N; n = 38, mean age = 84.9 ± 6 years). Measurements included the Timed Up and Go test (TUG), Berg Balance Scale (BBS), Short Physical Performance Battery, repeated chair stand test (STS-5), handgrip strength (HGS), 10-m walking test, and 6-minute walking test, both at baseline and after the 6-month intervention period.

RESULTS AND DISCUSSION

The between-group analysis by 2-way analysis of covariance showed significant improvement in the TUG [{OEP vs CG: -8.2 seconds, 95% CI [-13.3 to -2.9]; P < .001}; {OEP vs OEP+N: -7.3 seconds, 95% CI [-12.4 to -2.2]; P = .002}], BBS [{OEP vs CG; 8.2 points, 95% CI [5.2 to 11.2]; P < .001}; [{OEP+N vs CG: 4.6 points, 95% CI [1.6 to 7.6]; P < .001}; {OEP vs OEP+N: 3.5 points, 95% CI [0.6 to 6.5]; P = .011}], and HGS [{OEP vs CG: 3.4 kg, 95% CI [1.5 to 5.3]; P < .001}; {OEP+N vs CG: 3.6 kg, 95% CI [1.7 to 5.5]; P < .001}]. Additionally, the within-group analysis showed a significant improvement in the TUG (-6.9 seconds, 95% CI [-9.8 to -4.0]; P < .001) and BBS (4.3 points, 95% CI [2.6 to 5.9]; P < .001) in the OEP group. A significant decrease in the BBS and HGS was shown in the CG.

CONCLUSIONS

A 6-month supervised group-based multicomponent exercise intervention improved the levels of mobility, functional balance, and HGS in frail institutionalized older adults. Further research will be required to evaluate the nutritional supplementation effects on functional performance to better determine its clinical applicability for tackling frailty.

The effectiveness of a group-based Otago exercise program on physical function, frailty and health status in older nursing home residents: A systematic review and meta-analysis

OBJECTIVES

To explore the effects of a group-based Otago exercise program (OEP) on physical function (mobility, balance, lower limb strength), frailty and health status in older nursing home residents to determine the optimal scheme and format.

METHODS

This systematic review and meta-analysis was conducted to estimate group-based OEP effects. Subgroup analysis was performed to identify the influences of the participant and intervention characteristics on the effects.

RESULTS

Twelve studies met the eligibility criteria and were included in this meta-analysis, and the overall quality was relatively high. The results showed that the group-based OEP significantly improved physical function, including mobility [SMD=-0.64, 95% CI (-0.83,-0.45), Z=6.55, p<0.001], balance [MD=4.72, 95% CI (3.54, 5.90), Z=7.84, p<0.001], lower limb strength [SMD=-1.09, 95% CI (-1.40, -0.79), Z=7.01, p<0.001]; frailty [SMD=-0.73, 95% CI (-1.01, -0.45), Z=5.13, p<0.001] and health status [SMD=0.47, 95% CI (0.20, 0.74), Z=3.44, p=0.0006]. Subgroup analysis revealed that 30-minute sessions were more beneficial for improving balance than >30-minute sessions (p=0.0004). The training was coordinated with physiotherapists, who were more skilled at improving mobility than providing health training education (p=0.04).

CONCLUSIONS

Group-based OEP is helpful for improving physical function, frailty and health status in older nursing home residents. Specifically, 30-minute sessions and coordinating with physiotherapists may be the most appropriate and effective options.

Effects of a 12-week Vivifrail exercise program on intrinsic capacity among frail cognitively impaired community-dwelling older adults: secondary analysis of a multicentre randomised clinical trial

INTRODUCTION

The World Health Organisation recently defined the construct of intrinsic capacity (IC), a function-based marker of older adult's health encompassing all mental and physical capacities of the individual. Multicomponent physical exercise (MCE) is a potential intervention capable to maintain/increase IC at older age; however, evidence is scarce on the effects of MCE on IC in cognitively impaired pre-frail/frail older adults.

METHODS

Secondary analyses of a randomised clinical trial. One hundred and eighty-eight older outpatients (age = 84.06 ± 4.77, 70.2% women) presenting with pre-frailty/frailty (according to Fried Criteria) and mild cognitive impairment (MCI)/mild dementia were recruited in the Geriatric clinics of three tertiary hospitals in Spain. Subjects were randomised to participate in the 12-week home-based individualised Vivifrail MCE or usual care. An IC index was created based on the z-score of the locomotion (Short Physical Performance Battery), cognitive (Montreal Cognitive Assessment), psychology (15-item Geriatric Depression Scale Yesavage) and vitality (handgrip strength) domains.

RESULTS

After the 3-month intervention, linear mixed models showed significant between-group differences in the evolution of the IC composite score (β=0.48; 95% confidence interval [CI] = 0.24, 0.74; P < 0.001), IC Locomotion (β = 0.42; 95% CI = 0.10, 0.74; P < 0.001), IC Cognition (β = 0.45; 95% CI = 0.03, 0.87; P < 0.05) and IC Vitality domains (β = 0.50; 95% CI = 0.25, 0.74 at 3-month) favouring the MCE group.

CONCLUSIONS

The 12-week Vivifrail multicomponent exercise program is an effective strategy to enhance IC, especially in terms of locomotion, cognition and vitality IC domains in community-dwelling older adults with pre-frailty/frailty and MCI/mild dementia, compared to usual care.

Multicomponent or Resistance Training for Nursing Home Residents: A Systematic Review With Meta-Analysis

OBJECTIVES

To perform a systematic review with meta-analysis to verify the effects of multicomponent and resistance training on the physical performance in older adult residents in long-term care, as well as to compare these modalities.

DESIGN

Systematic review with meta-analysis of randomized controlled trials.

SETTING AND PARTICIPANTS

Older adults age over 60 years who are nursing home residents in long-term care.

METHODS

Seven electronic databases (PubMed, Embase, Central, Web of Science, SportDiscus, LILACS, and SCIELO) were searched from their inception until May 1, 2022. The methodological quality was assessed using PEDro scale. Mean difference and 95% confidence interval were pooled using a random-effects model. The significance level established was P value of ≤.05 for all analyses.

RESULTS

A total of 30 studies were included in the qualitative review (n = 1887, mean age 82.68 years and 70% female). Multicomponent training appeared in 19 studies and resistance training in 12 studies. Out of these, 17 studies were incorporated into the meta-analysis. Multicomponent training and resistance training showed statistically significant difference (P ≤ .05) in the physical performance of institutionalized older adults compared with the control groups (usual care); this was evaluated with the Short Physical Performance Battery (+1.2 points; +2 points), 30-second chair-stand (approximately +3 repetitions; both), and Timed Up and Go (-4 seconds on mean; both) tests. Comparisons between multicomponent and resistance training did not show statistically significant differences in any of the physical outcomes evaluated.

CONCLUSIONS AND IMPLICATIONS

The studies provide evidence that both multicomponent training and resistance training may be effective in improving the physical performance of institutionalized older adults. Further studies with more representative sample numbers, an improvement in methodological quality, and a more specified prescription of the training used are necessary.

Efficacy of therapeutic exercise on activities of daily living and cognitive function among older residents in long-term care facilities: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

This study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities.

DATA SOURCES

PubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018.

STUDY SELECTION

Databases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes.

DATA EXTRACTION

Two independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer.

DATA SYNTHESIS

A total of 11 RCTs with 1,280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD] = 0. 22, 95% confidence interval [CI]: 0.02, 0.42, p = 0.03)]. Subgroup analyses indicated that interventions were conducted ≥ 3 days per week [SMD = 0.42, 95% CI 0.02, 0.82, p = 0.04]. For cognitive function, group exercise and ≥ 3 days/week of intervention had a significant benefit (group exercise: mean difference [MD] = 3.36, 95% CI 0.91, 5.80, p = 0.007; ≥ 3 days/week of intervention: MD = 2.28, 95% CI 0.07, 4.49, p = 0.04).

CONCLUSIONS

Therapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.

Effectiveness of Elastic Band Exercises on the Functional Fitness of Older Adults in Long-Term Care Facilities

BACKGROUND

Population aging has caused a rise in the institutionalization, disability, and mortality rates of older adults worldwide. Older adults are able to engage in muscle training. Elastic band exercises can safely and effectively improve the upper and lower muscle strength and balance of older adults.

PURPOSE

This study was developed to examine the effects of a 3-month elastic band exercise program on the activities of daily living (ADLs), hand muscle strength, balance, and lower limb muscle strength of older adults living in institutional settings.

METHODS

This was a randomized controlled trial. Sixty-one participants were randomly sampled from two long-term care facilities (LTCFs) in northern Taiwan (31 participants in the experimental group and 30 participants in the control group). Both groups underwent pretesting concurrently. The experimental group participated in 3 months of elastic band exercises, whereas the control group participated in the routine exercise program in their LTCFs. All of the participants were tested 1 and 3 months after the intervention.

RESULTS

The average ADL, hand muscle strength, balance, and lower limb muscle strength scores of participants in the experimental group had improved significantly more than those of the control group at posttest (all p s < .05).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Elastic band exercises positively affect ADLs, hand muscle strength, balance, and lower limb muscle strength in older adults living in LTCFs. Moreover, the high benefit-to-cost ratio of these exercises helps lower the threshold of health promotion. We recommend including elastic band exercises in routine activities and designing different elastic band exercises for older adults at different proficiency levels. Furthermore, an elastic band exercise network should be established to improve the policy and implementation aspects of elastic band activities, raise awareness among community-dwelling and institutionalized older adults, and promote elastic band exercises to LTCFs nationwide.

Exploring the effectiveness of a fitness-app prototype for home care service users in Austria and Italy

An infinite number of fitness apps are available on various app stores. However, hardly any of them are fitted to the needs and requirements of care-dependent people. This paper investigates the effectiveness of a customised fitness-app prototype for increasing physical activity in home care service users. Home care service users from Austria and Italy were randomly assigned to two groups. In total, 216 participants were involved in the field trial, 104 received a tablet with the fitness app and an activity tracker (treatment group), 112 did not (control group). Regularity of physical activity, frequency of fitness exercises and walking behaviour were self-reported by participants at baseline, after 4 months and after 8 months. In addition, the frequency of using the prototype was assessed based on the fitness app's logged usage data. We estimated multilevel mixed-effects ordered logistic models to examine the effects of the intervention. After 4 months, the intervention increased the home care users' probability of agreeing strongly with being physically active on a regular basis by 28 percentage points (p < 0.001; 95% CI: 0.20, 0.36) and their probability of reporting to exercise more than once a week by 45 percentage points (p < 0.001; 95% CI: 0.32, 0.57). Walking behaviour was not affected on group-level but improved for frequent users of the activity tracker. Frequent and regular users of the fitness app benefited most and effects persisted until the end of the 8 months controlled trial. Tailoring a fitness-app prototype to the needs of care-dependent people has the potential to support people with functional limitations to engage in a more active lifestyle. Future research is encouraged to seek further insights into how new technologies can support physical activities in people with long-term care needs.

Therapy-based allied health delivery in residential aged care, trends, factors, and outcomes: a systematic review

Background

Allied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF; specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality.

Methods

Empirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist.

Results

Twenty-eight unique studies were included in this review; 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians (n = 9), allied health assistants (n = 9), and social workers (n = 6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies.

Conclusion

Evidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03386-9.

Improving the Identification of Frailty in Long-Term Care Residents: A Cross-Sectional Study

PURPOSE

To compare the capacity of blood myostatin concentration and physical, cognitive, and affective function tests to predict frailty among long-term care (LTC) residents.

METHODS

This cross-sectional analysis used baseline data from three randomized controlled trials involving 260 older adults in 14 LTC centers. Serum myostatin levels were analyzed by enzyme-linked immunosorbent assay. Frailty, physical fitness, cognitive and affective functions were assessed using validated tests and scales.

RESULTS

The Timed Up and Go, gait speed, 6-minute walk, and Berg Balance Scale had excellent capabilities in identifying frail individuals in accordance with Fried's Frailty Phenotype (FFP). The best tests for identifying frailty in accordance with the Clinical Frailty Scale (CFS) were Timed Up and Go and Berg Balance Scale. For the Tilburg Frailty Indicator (TFI), the best tests were Quality of Life in Alzheimer's Disease (QoL-AD) and Goldberg Anxiety. Myostatin, along with physical, cognitive, and affective function tests, improved the capability of the hand grip, arm-curl, Montreal Cognitive Assessment, Goldberg Anxiety, Goldberg Depression, and QoL-AD to identify frailty according to FFP, while myostatin improved CFS-defined frailty identification by the hand grip, arm-curl, 6-minute walk test, Berg Balance Scale, 30-second chair-stand, gait speed, Montreal Cognitive Assessment, Goldberg Anxiety, and De Jong-Gierveld Loneliness Scale.

CONCLUSION

Among LTC residents, serum myostatin was associated with being frail according to FFP and CFS. However, this measure was less discriminating of frailty than physical fitness tests (for FFP and CFS) and affective function parameters (for TFI). However, evaluated concurrently with physical, cognitive, and affective parameters, myostatin improved the capabilities of these measures to predict CFS-defined frailty.

Factors Associated with Handgrip Strength Among Older Adults in Malaysia

Purpose

Handgrip strength (HGS) is indicative of overall physical health among older adults. A decrease in HGS may be associated with an increased risk of disease. The aim of this study is to determine the factors associated with HGS among older adults in Malaysia.

Patients and Methods

One thousand two hundred four (1204) participants from urban and rural areas in Selangor state, Malaysia, were recruited. Sociodemographic and health-related conditions were gathered through a comprehensive face-to-face interview, followed by HGS assessments by a handgrip dynamometer. Subsequently, multiple linear regression was used to test the main association with the HGS.

Results

A total of 691 participants (57.4%) were male, and 513 (42.6%) were female. Males had a mean HGS of 30.0 (SD 7.53) kg, and females had a mean HGS of 19.4 (SD 5.28) kg. Males' handgrip strength was significantly reduced with increasing age, physically inactive, and diabetes (all at the level p<0.001) after adjusting for social-demographic characteristics and health-related variables. Meanwhile, for females, the HGS was significantly decreased with age (p<0.001), physically inactive (p<0.001) and hypertension (p=0.03). However, female HGS was positively related to BMI (p<0.001).

Conclusion

The study contributed to a better understanding of factors associated with HGS, and thus, the HGS is recommended as a section in the health evaluation among high-risk older adults as the strategy of disease control and prevention.

Phyx.io: Expert-Based Decision Making for the Selection of At-Home Rehabilitation Solutions for Active and Healthy Aging

While the importance of physical activity in older adults is beyond doubt, there are significant barriers limiting the access of older adults to physical exercise. Existing technologies to support physical activity in older adults show that, despite their positive impacts on health and well-being, there is in general a lack of engagement due to the existing reluctance to the use of technology. Usefulness and usability are two major factors for user acceptance along with others, such as cost, privacy, equipment and maintenance requirements, support, etc. Nevertheless, the extent to which each factor impacts user acceptance remains unclear. Furthermore, other stakeholders, besides the end users, should be considered in the decision-making process to develop such technologies, including caregivers, therapists and technology providers. In this paper, and in the context of physical rehabilitation and exercise at home, four different alternatives with incremental characteristics have been defined and considered: a software-based platform for physical rehabilitation and exercise (Alternative 1), the same software platform with a conventional RGB camera and no exercise supervision (Alternative 2), the same software platform with a convention RGB camera and exercise supervision (Alternative 3) and finally, the same software platform with a depth camera and exercise supervision (Alternative 4). A multiple attribute decision-making methodology, based on the ordinal priority approach (OPA) method, is then applied using a group of experts, including end users, therapists and developers to rank the best alternative. The attributes considered in this method have been usefulness, cost, ease of use, ease of technical development, ease of maintenance and privacy, concluding that Alternative 3 has been ranked as the most appropriate.

The Effect of a Resistance Training, Detraining and Retraining Cycle on Postural Stability and Estimated Fall Risk in Institutionalized Older Persons: A 40-Week Intervention

Physical inactivity and low levels of muscle strength can lead to the early development of sarcopenia and dynapenia, which may increase the number and risk of falls in the elderly population. Meanwhile, exercise programs can stop or even revert the loss of muscle mass, strength, power, and functional capacity and consequently decrease the risk of falls in older adults. However, there is a lack of studies investigating the effect of strengthening programs in octogenarians. The present study investigates the effects of 40 weeks of a training-detraining-retraining cycle of muscle strength exercise program on postural stability and estimated fall risk in octogenarians. Twenty-seven institutionalized participants were allocated into two groups: the muscular strength exercise group (MSEG, n = 14) and control group (CG, n = 13). After the first training period, the MSEG improved postural stability and decreased the estimated fall risk by 7.9% compared to baseline. In comparison, CG worsened their stability and increased their risk of falling by more than 17%. No significant changes were found between groups in the detraining and the retraining period. This study demonstrated that strength exercise effectively improved postural control and reduced fall risk scores. In addition, the interventions were able to reduce the forward speed of postural control deterioration in octogenarians, with great increments in the first months of exercise.

How physiotherapists promote physical activity at long-term care facilities for older adults

BACKGROUND

Physical activity is important for residents of long-term care facilities (LTCFs) for older adults. Still, many spend most of their time in sedentary activities. How physiotherapists, with competence in physical activity, promote physical activity for residents has previously not been studied from a wide perspective.

PURPOSE

The purpose of this study was to describe how physiotherapists at LTCFs for older adults, promote physical activity for the individual resident and how they work to support the facility to promote the residents' physical activity.

METHOD

A cross-sectional mixed methods study was performed by convenience sampling, using a digital survey sent via professional networks, to reach physiotherapists at LTCFs in Sweden. Qualitative data were analyzed through manifest inductive content analysis. Quantitative data were summarized descriptively.

RESULTS

Ninety-seven survey responses were analyzed from physiotherapists at LTCFs in Sweden. Five categories emerged from the qualitative analysis: 1) Knowledge for active daily living; 2) Adapt to present circumstances and priorities; 3) Methods for exercise and to stay active in daily living; 4) Acts and adjustments for the resident; and 5) Communication to promote activity. The quantitative result shows that work priorities were similar, while the work context varied.

CONCLUSION

Physiotherapists at LTCFs for older adults used a range of methods to promote physical activity for residents, and to support the facility in promoting physical activity.

Effects of an individualized and progressive multicomponent exercise program on blood pressure, cardiorespiratory fitness, and body composition in long-term care residents: Randomized controlled trial

This study analyzed the effects of an individualized and progressive multicomponent exercise program on blood pressure, cardiorespiratory fitness, and body composition in long-term care residents. This was a single-blind, multicenter, randomized controlled trial performed in 10 long-term care settings and involved 112 participants. Participants were randomly assigned to a control group or an intervention group. The control group participated in routine activities; the intervention group participated in a six-month individualized and progressive multicomponent exercise program focused on strength, balance, and walking recommendations. The intervention group maintained peak VO₂, oxygen saturation, and resting heart rate, while the control group showed a significant decrease in peak VO₂ and oxygen saturation and an increase in resting heart rate throughout the six-month period. Individualized and progressive multicomponent exercise programs comprising strength, balance, and walking recommendations appear to be effective in preventing cardiorespiratory fitness decline in older adults living in long-term care settings.