Attitudes and needs of residents in long-term care facilities regarding physical activity-A systematic review and synthesis of qualitative studies

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.

Evaluation of an exercise program incorporating an international cycling competition: a multimodal intervention model for physical, psychological, and social wellbeing in residential aged care

BACKGROUND

The transition into residential aged care is frequently associated with a reduction in physical activity, social engagement, and emotional wellbeing. Our aim was to evaluate the impact of a 26-day international cycling competition (Road Worlds Competition for Seniors), incorporating elements of exercise, audiovisual cycling footage, social engagement, and gamification, on the physical, psychological, and social well-being of aged care residents. We aimed to use findings to inform the development of a multi-modal intervention model to maximise wellbeing for older adults.

METHODS

Residents (N = 32) participated in a mixed-methods single-group intervention pilot study that compared pre-and post-competition measures for the following wellbeing domains; physical, psychological, and social. In addition, interviews were conducted with residents (n = 27) and staff (n = 6) to explore their experiences.

RESULTS

Measures identified significant improvements across multiple wellbeing domains, including functional fitness, depression, self-efficacy, and social network sizes. Findings from the interview data indicated that the multimodal components involved in the program delivery were valued by staff and residents who enjoyed the gamification, audiovisual cycling footage, social engagement, opportunities for reminiscence, and camaraderie between peers, staff, and volunteers.

CONCLUSIONS

Findings highlight a constellation of benefits across physical, psychological, and social domains of wellbeing and inform a model for innovative multidimensional programs in residential aged care. The benefits for residents with varying physical and cognitive abilities support the use of creative strategies that maximise inclusion and engagement for residents.

Experiences of participants of a volunteer-supported walking intervention to improve physical function of nursing home residents - a mixed methods sub-study of the POWER-project

BACKGROUND

Regular physical activity improves physical health and mental well-being and reduces the risk of falling in older adults. The randomized controlled "Prevention by lay-assisted Outdoor-Walking in the Elderly at Risk" POWER-study investigates whether volunteer-supported outdoor-walking improves physical function and quality of life in older people living independently or in nursing homes. This sub-study explores the experiences of older participants and volunteers in relation to their physical and psychosocial well-being as well as the challenges faced by both groups. A further aim was to explore volunteers' experience with people living in nursing homes during the first pandemic lockdown (spring 2020).

METHODS

The sub-study was designed as mixed-methods approach consisting of 11 individual semi-structured guide-based interviews (nursing home residents), two focus group interviews (volunteers), and a cross-sectional questionnaire survey (volunteers). The interviews were audiotaped, transcribed verbatim, and analyzed by content analysis as described by Kuckartz. Topics addressed in the interviews were triangulated by means of a questionnaire. The quantitative data were analyzed using descriptive statistics.

RESULTS

Participants' evaluation of the intervention was generally positive. Nursing home residents appreciated the social interaction associated with the assisted walking, which motivated them to take part regularly, provided a sense of safety, and caused pleasure on both sides. The impact on physical health status of the nursing home residents of this sub-study varied to a large degree as reported in interviews: in some cases, an improvement in physical performance, a decrease in physical complaints, and an improvement in gait or independence was reported. If not, reference was made to previous or sudden illnesses and the advanced age of the participants. Despite the COVID-19-lockdown and the associated restrictions, about 60% of contacts were still possible and participants planned to continue the assisted walks after the lockdown.

CONCLUSION

Volunteers have a positive effect on the quality of life, mobility, and general health of nursing home residents. Even more than the improvement of physical performance, social interaction was seen as helpful. Despite their advanced age, the nursing home residents were curious and open to new contacts. When removing the identified barriers, it might be possible to integrate this program into the long-term everyday life of nursing homes.

TRIAL REGISTRATION

DRKS-ID: DRKS00015188, date of registration: 31.08.2018.

Challenges to Systems of Long-Term Care: Mapping of the Central Concepts from an Umbrella Review

The ageing of the population poses urgent challenges to the health and social protection sectors, including the need for greater adequacy and integration of health care services provided to older people. It is considered necessary and urgent to understand the state-of-the-art of community-based models of care for older people in institutional care and at home. This study aims to map the concepts that politicians and providers need to address through an umbrella review as a review method. Articles describing the structuring aspects of care models appropriate to the needs in long-term care and systematic reviews or meta-analyses targeting people aged 65 years or more were considered. A total of 350 studies met the inclusion criteria and were included in the review. The results identified the need to contribute to effective and more efficient integration and articulation of all the stakeholders, based essentially on professional care at the patient's homes, focused on their needs using the available technologies, empowering patients and families. Eight categories emerged that addressed factors and variables involved in care models for the long-term care needs of institutionalised and home-based older people as a guarantee of accessibility to healthcare and to enhance the well-being and quality of life of patients and family caregivers.

Development and Validation of New Exercises to Promote Physical Activity in Nursing Home Settings

Background: GAMotion is a giant physical activity board game intended to improve levels of physical activity and a broader array of physical and psychological outcomes among nursing home residents. Objective: The aim of the present study is to develop and validate new balance, flexibility, muscle strength, and walking exercises to be included in GAMotion. Methods: A two-step design combining the Focus group and Delphi method was conducted among healthcare professionals divided into two independent samples of experts. The first sample was asked to develop exercises during a focus group. The second sample participated in a two-round Ranking-type Delphi method. During the first round, the participants were asked to rate the exercises developed during the focus group on a four-point Likert scale (from 1: not adapted at all to 4: very adapted). The exercises that did not reach consensus were removed (consensus established: median ≥ 3 on the Likert scale and at least 75% of experts rating the exercises as « adapted » or « very adapted »). During the second round, it was asked to rank the exercises selected at the end of the first round from most suitable to least suitable. Results: The Focus group developed nine balance, twelve flexibility, twelve strength, and nine walking exercises. Following the first round of the Delphi method, two exercises in each category did not reach a consensus and were then removed. In the second round, the remaining seven balance, ten flexibility, ten strength, and seven walking exercises were ranked by the experts, and this classification allowed us to determine the four most suitable exercises from each category to be included in the GAMotion. Conclusion: A consensus-based approach among healthcare professionals allowed us to contribute to the development of new exercises to promote physical activity in nursing homes. These validated exercises can be included in the GAMotion board game.

Experience of physical activity in patients with COPD: A systematic review and qualitative meta-synthesis

OBJECTIVE

To systematically evaluate and integrate the qualitative research on physical activity (PA) experience of patients with chronic obstructive pulmonary disease (COPD).

METHODS

Web of Science, Cochrane Library, Embase, CINAHL and other databases were searched, and the qualitative research on PA experience of patients with COPD was collected. The systematic review was conducted in line with Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence.

RESULTS

12 studies were included and 3 themes were summarized, included: COPD patients experience more barriers while participating in physical activities than facilitators; COPD patients experience more positive effects post-physical activities than negative effects; Guaranteeing safety, goal setting, and establishing a professional support group improve compliance in COPD patients.

CONCLUSION

Health care professionals should help patients overcome the obstacles of PA, pay attention to the PA experience of patients, adopt diversified PA methods, improve PA participation and compliance, and make patients develop good PA habits.

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.

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

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

What matters to people aged 80 and over regarding ambulatory care? A systematic review and meta-synthesis of qualitative studies

The growing percentage of the population aged 80 and over is challenging for healthcare systems, as frailty and other complex health issues are common in this age group. In order to provide patient-centered ambulatory healthcare, their preferences and expectations need to be explored. Therefore, the aim of this study was to systematically search for and synthesize qualitative evidence on how people aged 80 and over believe ambulatory healthcare (medical and nursing care) should be delivered to them. Medline, PsycINFO, CINAHL, Web of Science Core Collection and Google Scholar were searched for full research reports of qualitative studies focusing on the preferences, wishes, needs, expectations and experiences of people aged 80 and over regarding ambulatory medical and nursing care. The results were screened by two independent reviewers using a two-step approach. The included studies were meta-synthesized using Thomas and Harden’s ‘thematic synthesis’ approach in order to gain a new, second-order interpretation of the findings of the primary studies. In the intermediate synthesis step, 14 aspects of healthcare structures and care relationships were identified as relevant. Based on these, three underlying wishes were found: feeling safe, feeling like a meaningful human being, and maintaining control and independence. The results of this review are in line with other research, such as reviews focusing on the preferences of the younger age group (65–80). However, the importance of aspects of care relationships as an integral part of favorable ambulatory healthcare and the wish to be strengthened as a meaningful human being are emphasized more strongly.

Self-identified motivators for physical activity: Perspectives of older residential care facility residents

OBJECTIVES

To inform strategies to increase physical activity amongst Older Residential Care Facility Residents (ORCFR), this research explored self-identified motivators for, benefits of and barriers to physical activity engagement.

METHODS

The research was framed within a salutogenic model of health, viewing health as a continuum shaped by one's health resources and life stressors. This exploratory qualitative research examined the physical activity experiences of seven ORCFR in Brisbane, Australia. Semi-structured interviews with open-ended questions assessed basic demographics, Physical Activity (PA) levels, perceived benefits of and barriers to PA. The resulting data underwent thematic analysis.

RESULTS

After seven interviews, data saturation was reached, revealing three major themes and seven subthemes. These were positive socialisation (inclusion) with subthemes of enjoying social contact and avoiding "zombieland" (loneliness). Negative socialisation (isolation) with subthemes of avoiding conflict and feeling awkward. Maintaining independence was the benefit, with subthemes of getting around to socialise, activities of daily living and preserving health to socialise.

CONCLUSION

Conventional physical activity programs emphasising medical and clinical benefits are disconnected from ORCFR motivators, as residents perceive benefits in terms of mobility and socialisation. This disconnect partially explains poor acceptability and uptake of ORCFR physical activity interventions over the last 25 years.

Innovations in Geroscience to enhance mobility in older adults

Aging is the primary risk factor for functional decline; thus, understanding and preventing disability among older adults has emerged as an important public health challenge of the 21st century. The science of gerontology - or geroscience - has the practical purpose of "adding life to the years." The overall goal of geroscience is to increase healthspan, which refers to extending the portion of the lifespan in which the individual experiences enjoyment, satisfaction, and wellness. An important facet of this goal is preserving mobility, defined as the ability to move independently. Despite this clear purpose, this has proven to be a challenging endeavor as mobility and function in later life are influenced by a complex interaction of factors across multiple domains. Moreover, findings over the past decade have highlighted the complexity of walking and how targeting multiple systems, including the brain and sensory organs, as well as the environment in which a person lives, can have a dramatic effect on an older person's mobility and function. For these reasons, behavioral interventions that incorporate complex walking tasks and other activities of daily living appear to be especially helpful for improving mobility function. Other pharmaceutical interventions, such as oxytocin, and complementary and alternative interventions, such as massage therapy, may enhance physical function both through direct effects on biological mechanisms related to mobility, as well as indirectly through modulation of cognitive and socioemotional processes. Thus, the purpose of the present review is to describe evolving interventional approaches to enhance mobility and maintain healthspan in the growing population of older adults in the United States and countries throughout the world. Such interventions are likely to be greatly assisted by technological advances and the widespread adoption of virtual communications during and after the COVID-19 era.

Physical performance trajectories and mortality among nursing home residents: results of the SENIOR cohort

BACKGROUND

Previous studies have shown that older people can experience a considerable change in their physical performance (PP) over time.

OBJECTIVES

To identify PP trajectories and their association with mortality among nursing home residents who were followed up for 3 years.

DESIGN

Three-year longitudinal observational study.

SETTING

Subjects of the SENIOR cohort.

SUBJECTS

Six hundred and four nursing home residents with a mean age of 82.9 ± 9.1 years.

METHODS

Baseline characteristics and the date of death were collected from the medical records. PP was assessed annually by the short physical performance battery (SPPB) test. Multiple imputations were performed to manage the missing data. PP trajectory groups were estimated using latent growth curve analysis. Cox proportional hazard regression models were applied to examine the risk of mortality according to the PP trajectory groups.

RESULTS

Three PP trajectory groups were identified: slow decline (N = 96), moderate decline (N = 234) and fast decline (N = 274). After adjustments for potential confounding variables and the baseline SPPB scores, the residents in the fast decline and moderate decline trajectory groups had an increased risk of mortality compared to those in the slow decline trajectory group, with hazard ratio values of 1.78 (95% confidence interval [CI] = 1.34-2.26) and 1.37 (95% CI = 1.10-1.66), respectively.

CONCLUSIONS

PP trajectories provide value-added information to baseline geriatric assessments and could be used for predicting 3-year mortality among nursing home residents. It may be important to regularly monitor the SPPB score and signal an alert when a fast decline in PP is detected in older people.

Motivational climate of group exercise sessions in nursing homes

Background

Motivational climate in exercise group environments would have an impact on adherence, effort and enjoyment. We examined the motivational climate among nursing home residents who were involved in group exercise sessions.

Methods

This cross-sectional study was conducted in 10 nursing homes of Liège area that offer group exercise sessions. Sociodemographic data (age, sex, body mass index), cognitive status (by the Mini Mental State Examination) and independence in activities of daily living (by the Katz Scale) were retrieved in the medical records. The “Abbreviated-Perceived Motivational Climate in Exercise Questionnaire” was translated into French and then administered face to face with a clinical researcher. This is composed of 6 ego-involving climate items (corresponding to rivalry, comparison and favoritism) and 6 task-involving climate items (corresponding to valorization, individual efforts, self-improvement and cooperation). Each item is ranged on a 5-point Likert scale ranging from 1 (not at all focused on ego or task) to 5 (totally focused on ego or task). Each subscale has a total score expressed as an average.

Results

A total of 102 subjects of exercise group sessions were included (84.3 ± 7.7 years and 83 (81.4%) women). The mean score of task-involving and ego-evolving motivational climate was respectively 3.57 (SD = 0.67) and 1.52 (SD = 0.49), suggesting that the motivational climate was more focused on the task-involving climate than on ego-involving climate. Some items results were of particular interest: 55.9% of the respondents found that the instructor doesn’t remark/reward when they try hard, 63.7% said that the instructor doesn’t encourage mutual aid and 38.2% found that instructor doesn’t encourage to do new exercises.

Conclusions

Participants tended to perceive motivational climate as more task-involving than ego-involving. The absence of individual positive feedback, new exercises and mutual aid were also highlighted.

Perceptions of older adults living in long-term care institutions regarding recreational physiotherapy: a qualitative study

Background: Long-term care institutions (LTCIs) present a limiting environment. Physiotherapy through recreational exercises can stimulate older adults.Objective: To explore LTCIs residents' perceptions regarding recreational physiotherapy.Method: This is a descriptive qualitative study. Participants included older adults living in two LTCIs, who took part in recreational physiotherapy and did not display severe communication problems or cognitive deficits. The activity was regularly offered in both LTCIs. Semi-structured interviews were audio-recorded to analyze the participants' perceptions of physiotherapy. We also observed video footage of the participants' behaviors during one session of the recreational activity. The audio recordings were transcribed, and content analysis was conducted with MAXQDA 12®.Results: Nine older adults participated, the majority women (n = 6), with a mean age of 83.8 ± 7.4 years. The interviews' average duration was about 30 minutes. The reports revealed three themes. In the "activity for myself" theme, participants discussed issues related to their own old age. In the "activity with others" theme, participants reported physiotherapy's value for providing sense of collectivity. In the "activity itself" theme, the components of physiotherapy and their benefits were evaluated. Observation of the video recording revealed that each resident engaged in the activity at their own pace and within their capabilities.Conclusions: The experience of older adults living in LTCIs showed that the regularly practicing physical exercises in recreational group, strengthens social bonds and provides physical and emotional well-being. When formulating and executing physiotherapy in the context of LTCIs, professionals should consider the residents' perceptions of the practice.