Physical Activity and Function in Assisted Living Residents

The effect of corrective exercises on musculoskeletal disorders among the older adults residing in a nursing home in Rasht, Guilan, Iran

BACKGROUND

Ageing causes changes in the function of musculoskeletal systems and disability, and injury among older adults. This study aimed to determine the effect of corrective exercises on musculoskeletal disorders among older adults residing in a nursing home in Iran.

METHOD

This controlled clinical trial study was conducted on 58 older adults (29 samples in each group). The intervention group performed corrective exercises for 8 weeks and three sessions per week and each session lasted for one hour. The pre-test was performed one week before intervention and the post-test one week after the 8-week intervention. The research instruments included Nordic Musculoskeletal Questionnaire (NMQ), and the pain visual analog scale (VAS). Descriptive and inferential (Chi-square, Mann-Whitney, Wilcoxon, and McNemar test) statistics were used to analyze the data using SPSS software version 19.

RESULTS

the majority of the participants were males (67.2%) and in the age range of 60-74 years (82.8%). The mean age of samples in intervention and control groups was 68.45 (SD = 5.38) and 69.17 (SD = 5.86), respectively. The results showed that the prevalence of musculoskeletal disorders (MSDs) was decreased in the intervention group after the intervention (%Δ = -34.68, p < .05). The results also showed a statistically significant decrease in pain intensity of musculoskeletal in the intervention group, after the intervention (%Δ = -68.34, p < .001).

CONCLUSIONS

Corrective exercises reduce the prevalence of MSDs and the pain intensity among older adults. It is recommended to pay attention to these exercises to improve physical health and reduce the prevalence of MSDs among older adults.

Physical Activity and Sedentary Behavior of Residents in Assisted Living: A Preliminary Study

Low physical activity (PA) and high sedentary behavior (SB) place residents in assisted living at risk for physical decline, but little is known about factors that influence PA/SB in this setting. In the current cross-sectional study, we described objectively measured PA/SB (activPAL™) and examined the relationships between PA/SB and use of an assistive walking device, depression, sleep disturbance, pain, fatigue, social isolation, and the tendency to make social comparisons. Fifty-four residents from eight assisted living facilities participated. Mean time spent in PA was 252.9 (SD = 134.3) minutes/day. Mean time spent in SB was 660.8 (SD = 181.4) minutes/day. Depression predicted PA (R2 = 0.16). Residents using an assistive device spent significantly more time in SB (p = 0.02). Fatigue correlated with time in longer bouts of SB (r = 0.19, p = 0.04). The tendency to make social comparisons correlated with SB (r = 0.22, p = 0.04). Findings show residents in assisted living are inactive and further research is needed to fully understand factors that influence PA/SB. [Research in Gerontological Nursing, xx(x), xx-xx.].

Factors Associated With the Quality of Staff-Resident Interactions in Assisted Living

BACKGROUND

Care interactions are verbal or nonverbal interactions between staff and residents during social or physical care activities. The quality of care interactions could be positive, negative, or neutral.

PURPOSE

The purpose of this study was to examine the resident- and facility-level factors associated with the care interactions in assisted living (AL).

METHODS

Regression analysis was performed using a stepwise method utilizing baseline data of 379 residents from 59 AL facilities recruited in a randomized trial.

RESULTS

Accounting for 8.2% of variance, increased resident agitation was associated with negative or neutral quality interactions while for-profit ownership was associated with positive quality interactions.

CONCLUSIONS

To promote positive care interactions, findings suggest the need to educate staff about strategies to minimize resident agitation (eg, calm posture and respectful listening) and work toward optimizing care interactions in nonprofit settings. Future research could further explore the influence of staff-level factors on care interactions.

Replication of Implementing a Sit-to-Stand Exercise Program in an Assisted Living Facility

The current quality improvement project aimed at replicating the implementation of a sit-to-stand exercise program in a small 20-bed assisted living facility (ALF) in rural North Carolina. The primary outcome was for residents to maintain or improve function in performance of activities of daily living (ADLs). Even with the challenges of the coronavirus disease 2019 pandemic, ALF staff and residents found a way to continue the exercise program with a high level of participation and thus prevent avoidable decline in residents' independence with ADLs. [Journal of Gerontological Nursing, 48(3), 30-36.].

Physical Activity in Hospitalized Persons With Dementia: Feasibility and Validity of the MotionWatch 8

Persons with dementia are at high risk for hospital-acquired disability, associated with low physical activity during hospitalizations. To determine the effectiveness of efforts to increase physical activity, a valid and reliable measurement approach is required. Data from an ongoing cluster randomized clinical trial examined the feasibility and validity of the MotionWatch 8 (MW8) triaxial actigraphy device. The sample included 321 participants of which 259 (81%) were willing to wear the MW8 for 24 hr. Regression analysis revealed that time in low activity, β = 0.17, t(255) = 2.9, p = .004, and time in moderate activity, β = 0.14, t(255) = 2.4, p = .017, measured by the MW8, were associated with participants' physical function. Engagement in moderate physical activity was associated with return to baseline function at discharge (Wald χ2 = 4.10, df = 1, p = .043). The study provides preliminary support for the feasibility and validity of the MW8 in hospitalized persons with dementia.

Quantifying Reliable Walking Activity with a Wearable Device in Aged Residential Care: How Many Days Are Enough?

Strong associations exist between quality of life and physical activity for those living in aged residential care (ARC). Suitable and reliable tools are required to quantify physical activity for descriptive and evaluative purposes. We calculated the number of days required for reliable walking outcomes indicative of physical activity in an ARC population using a trunk-worn device. ARC participants (n = 257) wore the device for up to 7 days. Reasons for data loss were also recorded. The volume, pattern, and variability of walking was calculated. For 197 participants who wore the device for at least 3 days, linear mixed models determined the impact of week structure and number of days required to achieve reliable outcomes, collectively and then stratified by care level. The average days recorded by the wearable device was 5.2 days. Day of the week did not impact walking activity. Depending on the outcome and level of care, 2–5 days was sufficient for reliable estimates. This study provides informative evidence for future studies aiming to use a wearable device located on the trunk to quantify physical activity walking out in the ARC population.

Stand When You Can: development and pilot testing of an intervention to reduce sedentary time in assisted living

Background

Prolonged daily sedentary time is associated with increased risk of cardiometabolic diseases, impaired physical function, and mortality. Older adults are more sedentary than any other age group and those in assisted living residences accumulate more sedentary time as they often have little need to engage in light-intensity or standing activities such as cleaning or meal preparation. This “low movement” environment can hasten functional decline. Thus, the purpose of this study was to develop a multi-level intervention to reduce and interrupt sedentary time within assisted living residences and conduct a pilot study to determine if the intervention is feasible and if further testing is warranted.

Methods

“Stand When You Can” (SWYC) was developed using a Social Ecological framework based on a review of literature and consultation with residents and staff at assisted living residences. After development, a six-week pilot study was conducted in two different residences with 10 older adults (82.2 ± 8.7 years). Before and after the 6 weeks, ActivPAL™ inclinometers were used to measure daily movement behaviours and self-report questionnaires assessed time spent in different sedentary behaviours and quality of life. Physical function was assessed using the Short Physical Performance Battery. Paired sample t-tests examined pre-post differences for pooled data and individual sites. At the end of the pilot study, feedback on the intervention was gathered from both residents and staff to examine feasibility.

Results

There was a trend towards a decrease in self-reported sitting time (142 min/day; p = 0.09), although device-measured sedentary time did not change significantly. Participants with lower physical function at baseline showed clinically meaningful improvements in physical function after the 6 weeks (p = 0.04, Cohen’s d = 0.89). There was no change in quality of life. Residents and staff reported that the intervention strategies were acceptable and practical.

Conclusion

This study suggests that a multi-level intervention for reducing prolonged sedentary time is feasible for implementation at assisted living residences. The intervention could potentially help delay functional decline among older adults when they transition to a supportive living environment. Longer and larger trials to test the efficacy of SWYC are necessary.

Trial registration

Name of Clinical Trial Registry: clinicaltrials.gov

Trial Registration number: NCT04458896.

Date of registration: July 8, 2020. (Retrospectively registered).

Gender Differences in Function, Physical Activity, Falls, Medication Use, and Life Satisfaction Among Residents in Assisted Living Settings

The purpose of the current study was to test for gender differences among residents living in assisted living settings. This was a secondary data analysis using data from the first 64 facilities participating in the ongoing Function Focused Care for Assisted Living study using the Evidence Integration Triangle (FFC-AL-EIT). A total of 593 residents were recruited. Differences by gender with regard to function, physical activity, falls, total number of medications, and satisfaction with assisted living were tested using multivariate analysis of variance. There were 166 (28%) men and 427 (72%) women with a mean age of 88 (SD = 7.5 years). Participants had five (SD = 2) comorbidities and took on average 6.88 medications (SD = 3.47). Participants had moderate functional impairment with a mean of 64.13 (SD = 19.09) on the Barthel Index and engaged in 43.8 (SD = 76.12) minutes daily of moderate level physical activity. Women reported higher satisfaction with activities (4.32 [SD = 1.14]) than men (3.85 [SD = 1.51]), and women received more medications than men (7.09 [SD = 3.51] vs. 6.34 [SD = 3.31]). Current study findings suggest that deprescribing may be particularly important for women versus men and focusing on expanding activity options to include those preferred by men should be considered in assisted living settings. [Research in Gerontological Nursing, 13(1), 31-40.].

Path analysis from physical activity to quality of life among dementia patients: A dual-path mediating model

AIMS

To clarify the specific impact paths among physical activity, activity of daily living, depression and quality of life among dementia patients.

DESIGN

A descriptive, cross-sectional design.

METHODS

Dementia patients and their caregivers from five tertiary general hospitals and one dementia patients' club were recruited. A total of 216 valid questionnaires were collected from November 2018 - March 2019. Path analysis was performed by Mplus 7.0 to test the casual relationship among physical activity, activity of daily living, depression and quality of life.

RESULTS

Most patients with dementia presented a low level of physical activity and suffered from impaired quality of life. The modified model presented a good model fit and revealed that physical activity had indirect positive effects on quality of life mediated by activity of daily living and depression.

CONCLUSION

The results showed that physical activity was a promising non-pharmacological method to improve the performance of activity of daily living and reduce depressive symptoms and then enhance the quality of life among dementia patients.

IMPACT

The findings were beneficial to elevate the awareness of physical activity among patients and professionals. This study was helpful to understand how physical activity exerted effects on life quality of dementia patients. This study provided a new perspective for researchers to elucidate the causal relationship of variables among dementia patients.

Testing of the Function Focused Environment Assessment and the Function Focused Policy Assessment in Assisted Living

This study tested two new instruments, the Function Focused Environment Assessment (FF-EA) and the Function Focused Policy Assessment (FF-PA). The measures were developed for clinical evaluation of AL settings to help optimize function and physical activity among residents. A total of 106 AL settings and 242 residents were included. There was evidence of item reliability (0.92) and interrater reliability (kappa=0.40, p=.015; percent agreement 85%) of FF-EA and item reliability (0.89) and interrater reliability (kappa=0.48, p=.001, percent agreement 82%) of the FF-PA, and support for validity of both measures based on INFIT and OUTFIT statistics and hypothesis testing.