Community participation of community dwelling older adults: a cross-sectional study

The Impact of Social Participation on Frailty among Older Adults: The Mediating Role of Loneliness and Sleep Quality

BACKGROUND

Frailty has become a common health issue among older adults, imposing a burden on both society and individuals. The relationship between social participation and frailty has received widespread attention, but the mechanism remains to be explored. The aim of this study is to explore the impact of social participation on frailty among older adults and to analyze the mediating role of loneliness and sleep quality, providing suggestions to alleviate frailty.

METHODS

Data related to social participation, loneliness, sleep quality, and frailty from 7779 older adults were collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2018). The chain mediation model was conducted to explore the relationship between variables, and the Bootstrap method was used to examine the path coefficients.

RESULTS

Social participation negatively affected frailty (β = -0.00391049, 95% CI = [-0.042296, -0.035465]); the indirect effect of social participation on frailty mediated by loneliness was -0.0019505 (95% CI = [-0.002551, -0.001371]); the indirect effect of social participation on frailty mediated by sleep quality was -0.0011104 (95%CI = [-0.001692, -0.000557]); the effect mediated by both loneliness and sleep quality was -0.0004263 (95% CI = [-0.000593, -0.000304]).

CONCLUSIONS

Social participation negatively affected frailty. Loneliness and sleep quality not only mediated independently, but also played a chain mediating role. This suggested that encouraging older adults to engage in more social participation, reducing loneliness, and improving sleep quality are feasible measures to improve frailty.

User interfaces for older adults to support social interaction through digital technology: a systematic review update

PURPOSE

This systematic review aims to update the results related to user interfaces and digital technologies that support the social interactions of older adults. Multiple innovative technological forms in existing research were evaluated to obtain evidence that digital technologies improve older adults' quality of life and social well-being.

MATERIALS AND METHODS

A search for relevant studies published in the last five years was conducted using the databases of Google Scholar, IEEE Xplore, PubMed, Scopus, Springer Link and Web of Science.

RESULTS

Of the 4959 records identified, a total of 29 studies met the inclusion criteria. The findings were reviewed in three areas: social interaction of older adults supported by user interface, the digital technologies used in the user interface, and the effects of user interfaces on the social interactions of older adults.

CONCLUSIONS

Future research should develop digital technologies and service models to enhance the quality of life of older adults. Long-term solutions to promote social interaction in older adults require more user interface support. Community connection-based user interfaces can support existing social relationships and develop new social circles for older adults.

Accelerometer-based and self-reported physical activity and sedentary time and their relationships with the P300 in a Go/No-Go task in older adults

Older adults who experience cognitive decline are more likely to have a reduced quality of life. Identifying lifestyle factors that may influence cognitive processing and in turn improve quality of life during older adulthood is an important area of interest. Cognitive function, as measured by the P300 event-related potential (ERP), has been noted to be modified by physical activity; however, no study to date has examined relationships between this neurophysiological measure and physical activity and sedentary time in older adults. Furthermore, there is a gap in understanding as to whether physical activity and sedentary time assessed using self-reported and accelerometer-based methods similarly relate to the P300. This study aimed to assess the P300 during a Go/No-Go task in relation to self-reported and accelerometer-based physical activity and sedentary time in a community sample of 75 older adults. Results indicated that participants engaging in more moderate-to-vigorous physical activity had larger P300 amplitudes across self-reported and accelerometer-based measurements; however, no relationships between sedentary time and P300 amplitude were observed. Notably, accelerometer-based moderate-to-vigorous physical activity explained P300 amplitudes over and above self-reported moderate-to-vigorous physical activity-an effect that remained significant even after accounting for age. Although these results highlight the importance of moderate-to-vigorous physical activity in relation to cognitive function, as measured via the P300 in older adults, a secondary analysis indicated that engaging in lifestyle activity may have similar effects on the P300 as moderate-to-vigorous physical activity. In sum, the present study highlights the role of habitual engagement in physical activity as a possible means for supporting cognitive function during the aging process.

Social Participation and Loneliness in Older Adults in a Rural Australian Context: Individual and Organizational Perspectives

A rise in aging populations globally calls attention to factors that influence the well-being and health of older adults, including social participation. In Australia, rural older adults face cultural, social, and physical challenges that place them at risk for isolation. Thus, research surrounding social participation and healthy aging is increasingly relevant, especially in rural areas. This qualitative study in a remote town in Western Australia explores barriers and facilitators to older adults' social participation. To investigate multiple perspectives, 23 adults aged 50+ and 19 organizations from a rural town were interviewed. A stakeholder reference group was engaged to refine the research design and validate the findings. Feedback from early interviews was used to refine the data collection process, thus enhancing the validity of the findings. Thematic analysis showed that health and mobility issues, inadequate infrastructure, poor sustainability, and cultural tensions commonly impacted social participation. Themes of rural town culture, cultural power dynamics, and rural stoicism were identified as cultural aspects that inhibited participation. Based on results of this study and the supporting literature, recommendations for inclusive activities include supporting community-designed programs, utilizing culturally sensitive language and personnel, expanding services using existing community resources, and diversifying older adults' roles in existing groups.

Association between residential environment and emotional wellbeing among older adults in China: the mediating effect of health lifestyle

Introduction

The association between the residential environment and emotional wellbeing (EWB) in older adults has received extensive attention from gerontologists, especially during the COVID-19 pandemic; however, the mediating mechanism of how residential environment affects emotional wellbeing has not been fully explored. This study examined the effects of the residential environment on EWB and the mediating role of health lifestyle.

Methods

This study analyzed the survey data of 493 rural and 515 urban older adults from 2021 Chinese General Social Survey. General linear regression and structural equation models were used to examine the effects of residential environment and health lifestyle.

Results

Urban participants exhibited clear advantages in EWB, residential environment, and physical activity. Residential environment significantly affected the EWB of older adults, and health lifestyle played a mediating role in this relationship. The residential environment and health lifestyle did not significantly affect EWB in rural participants.

Discussion

This study revealed differences in the effects of health lifestyles and residential environments on EWB among older adults in rural and urban settings in China. This study provided empirical evidence of mental health disparities between older rural and urban Chinese residents.

The Way I See It: Older Adults with Mental Illness Share Their Views of Community Life Using Photovoice

The importance of community involvement for both older adults and individuals coping with mental illness is well documented. Yet, barriers to community integration for adults with mental illness such as social stigma, discrimination, and economic marginalization are often exacerbated by increased health and mobility challenges among older adults. Using photovoice, nine older adults with mental illness represented their views of community in photographs and group discussions over a six-week period. Participant themes of community life included physical spaces, valued social roles, and access to resources in the community. Themes were anchored by older adults' perceptions of historical and cultural time comparisons between 'how things used to be' and 'how things are now.' Barriers to community integration were often related to factors such as age, mobility, and resources rather than to mental health status. Program evaluation results suggest photovoice can promote self-reflection, learning, and collaboration among older adults with mental illness.

Association of life-space with light-intensity and moderate to vigorous-intensity physical activity in older adults using daycare rehabilitation facilities

BACKGROUND

The use of assistive devices and the presence of caregivers in the living space of older people using daycare rehabilitation facilities may increase their physical activity. However, the exact relationship between these factors and physical activity has not been well established.

OBJECTIVE

We aimed to examine whether assistive devices and caregivers were life-space factors associated with light-intensity physical activity (LPA) and moderate to vigorous-intensity physical activity (MVPA) among daycare rehabilitation facility users.

METHODS

Forty-seven daycare rehabilitation facility users were recruited (mean age: 76.5 ± 8.6 years; men: 16; women: 31). LPA and MVPA were measured using accelerometers and averaged over 7 days. Life-space assessment (LSA) and the Geriatric Depression Scale score were assessed. The LSA includes composite life-space, maximal life-space (LS-M), life-space using equipment (LS-E), and independent life-space. Grip strength and maximum gait speed were measured two times, and the best results were used.

RESULTS

Multiple regression analysis showed that LPA was significantly associated with sex (β = 0.773), grip strength (β = 0.434), and LS-M (β = 0.325), whereas MVPA was significantly associated with age (β = -0.421) and LS-E (β = 0.455).

CONCLUSION

A close association was found between LS-M and LS-E and the intensity of physical activity in older people who used daycare rehabilitation facilities.

Systematic review of best practices for GPS data usage, processing, and linkage in health, exposure science and environmental context research

Global Positioning System (GPS) technology is increasingly used in health research to capture individual mobility and contextual and environmental exposures. However, the tools, techniques and decisions for using GPS data vary from study to study, making comparisons and reproducibility challenging.

OBJECTIVES

The objectives of this systematic review were to (1) identify best practices for GPS data collection and processing; (2) quantify reporting of best practices in published studies; and (3) discuss examples found in reviewed manuscripts that future researchers may employ for reporting GPS data usage, processing and linkage of GPS data in health studies.

DESIGN

A systematic review.

DATA SOURCES

Electronic databases searched (24 October 2023) were PubMed, Scopus and Web of Science (PROSPERO ID: CRD42022322166).

ELIGIBILITY CRITERIA

Included peer-reviewed studies published in English met at least one of the criteria: (1) protocols involving GPS for exposure/context and human health research purposes and containing empirical data; (2) linkage of GPS data to other data intended for research on contextual influences on health; (3) associations between GPS-measured mobility or exposures and health; (4) derived variable methods using GPS data in health research; or (5) comparison of GPS tracking with other methods (eg, travel diary).

DATA EXTRACTION AND SYNTHESIS

We examined 157 manuscripts for reporting of best practices including wear time, sampling frequency, data validity, noise/signal loss and data linkage to assess risk of bias.

RESULTS

We found that 6% of the studies did not disclose the GPS device model used, only 12.1% reported the per cent of GPS data lost by signal loss, only 15.7% reported the per cent of GPS data considered to be noise and only 68.2% reported the inclusion criteria for their data.

CONCLUSIONS

Our recommendations for reporting on GPS usage, processing and linkage may be transferrable to other geospatial devices, with the hope of promoting transparency and reproducibility in this research.

PROSPERO REGISTRATION NUMBER

CRD42022322166.

Geographic intelligence to investigate community participation: a scoping review

PURPOSE

To understand the applicability and unique contributions of global positioning system (GPS) and geographic information system (GIS) technologies to investigate individuals' participation in the community.

METHODS

A scoping review was conducted to summarize studies that employed GPS and/or GIS to assess community participation. Systematic literature searches were performed using nine electronic databases, up to April 2022. Two independent reviewers screened studies for eligibility and extracted data from the selected studies.

RESULTS

The searches retrieved 628 articles, of which 36 met the inclusion criteria. In 31 studies, a GPS unit or GPS-enabled device monitored the community mobility of individuals with different health conditions. Tracking periods varied from five hours to 30 consecutive days. The spatiotemporal parameters obtained from satellite-based data provided information about individuals' presence in the community. Most studies combined GPS with other measuring tools (self-report diaries/questionnaires, qualitative interviews) to capture a broader description of community participation.

CONCLUSIONS

GPS and GIS are viable approaches for advancing research as they provide unique information about community participation not easily captured by other methods. The combination of available methods comprehensively address the physical and social dimensions of this construct.IMPLICATIONS FOR REHABILITATIONGlobal positioning system (GPS) and geographic information system (GIS) technology allows direct and real-time quantification of patterns of individuals' community mobility.The geographic area where individuals participate in daily living activities complements information from self-report diaries/questionnaires.Combining GPS technology with self-report diaries/questionnaires allows a broader description of individuals' community participation, addressing respectively both its physical and social dimensions.Knowledge of individuals' access to and involvement in community locations/situations may help therapists design interventions to improve community participation.

A randomized trial of a theory-driven model of health coaching for older adults: short-term and sustained outcomes

BACKGROUND

Healthy Lifetime, a theoretically driven, personalized health coaching program delivered electronically, including face-to-face videoconferencing, was developed to intervene in early aging to stave off functional decline and minimize the onset/exacerbation of chronic conditions.

OBJECTIVE

To determine the efficacy of a theoretically driven, personalized health coaching program in participants 50 years and older with one or more chronic conditions using a randomized, controlled, pragmatic clinical trial methodology.

METHODS

Participants were randomly assigned to the HL (n = 59) or a usual care (n = 63) group. The HL group received health coaching from a trained nurse over eight weeks. Outcomes were measured at baseline, eight weeks, and 20 weeks (after the 12-week no-treatment phase). Regression modeling with fixed-effect repeated measures was used to account for the longitudinal data collection.

RESULTS

For the HL group, health habits increased at 8 weeks (3.1 units; SE = 1.0; p = .0005; effect size = .15). This difference was sustained at 20 weeks (2.4 units, SE = 0.2; p = .0005). Independent self-care agency improved at 8 weeks in individuals with high blood pressure (13.5 units; SE = 4.37; p = .0023; effect size = .3). However, that difference was not sustained at 20 weeks (p = .47). No significant improvements were shown in the usual care group at 8 weeks or 20 weeks.

CONCLUSIONS

HL participants significantly improved their health habits at 8 weeks and sustained this improvement at week 20 (after a 12-week no-treatment phase) vs. the usual care group. Changing health habits alone has been shown to reduce all-cause morbidity and mortality in chronic disease. The high-functioning, community-dwelling older adults with chronic diseases we studied is an important target population for primary care practices to intervene early in aging to stave off the complications of chronic disease and functional decline.

TRIAL REGISTRATION

ClinicalTrials.gov (record NCT05070923, 07/10/2021).

Characteristics of programmes designed to link community-dwelling older adults in high-income countries from community to clinical sectors: a scoping review protocol

INTRODUCTION

Research on effectively navigating older adults into primary care is urgently needed. Community-clinic linkage models (CCLMs) aim to improve population health by linking the health and community sectors in order to improve patients' access to healthcare and, ultimately, population health. However, research on community-based points of entry linking adults with untreated medical needs into the healthcare sector is nascent. CCLMs implemented for the general adult population are not necessarily accessible to older adults. Given the recency of the CCLM literature and the seeming rarity of CCLM interventions designed for older adults, it is appropriate to employ scoping review methodology in order to generate a comprehensive review of the available information on this topic. This protocol will inform a scoping review that reviews characteristics of community-based programmes that link older adults with the healthcare sector.

METHODS AND ANALYSIS

The present protocol was developed as per JBI Evidence Synthesis best practice guidance and reporting items for the development of scoping review protocols. The proposed scoping review will follow Levac and colleagues' update to Arksey and O'Malley's scoping review methodology. Healthcare access at the system and individual levels will be operationalised in data extraction and analysis in accordance with Levesque and colleagues' Conceptual Framework of Access to Health. The protocol complies with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Beginning in August 2023 or later, citation databases (AgeLine (Ebsco); CINAHL Complete; MEDLINE (PubMed); Scopus Advanced (Elsevier); Social Services Abstracts (ProQuest); Web of Science Core Collection (Clarivate)) and grey literature (Google; American Public Health Association Annual Meeting Conference Proceedings; SIREN Evidence & Resource Library) will be searched.

ETHICS AND DISSEMINATION

The authors plan to disseminate their findings in conference proceedings and publication in a peer-reviewed journal and deposit extracted data in the Figshare depository. The study does not require Institutional Review Board approval.

REGISTRATION DETAILS

Protocol registered in Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/2EF9D).

Effects of a Physical Therapist Intervention on GPS Indicators of Community Mobility in Older Adults: A Secondary Analysis of a Randomized Controlled Trial

OBJECTIVE

The authors compared the effects of a standard strength and endurance intervention with a standard plus timing and coordination training intervention on community mobility measured using global positioning systems (GPS) among community-dwelling older adults in this secondary analysis of a randomized controlled trial.

METHODS

Participants were randomized to a standard or a standard plus timing and coordination training program. Community mobility was measured using the Life Space Assessment (LSA) and GPS indicators of community mobility at baseline, as well as at 12 (immediately after the intervention), 24, and 36 weeks. Linear mixed models were used for analysis.

RESULTS

There were 166 participants with GPS data at baseline, including 81 in the standard plus group and 85 in the standard group. The groups did not differ in participant characteristics or GPS measures at baseline. There were no significant within-group changes in GPS indicators of community mobility or LSA score over time, nor between-group differences of the same.

CONCLUSION

There were no significant changes in community mobility with either intervention or between-intervention differences. These findings suggest that interventions targeting physical function alone may not be sufficient to improve community mobility or participation in older adults. Future research should focus on the development of multifaceted interventions targeted to improve real-world participation.

IMPACT

The studied interventions did not significantly change community mobility measured using GPS-derived community mobility measures or self-report measures in older adults, suggesting that more comprehensive interventions may be needed to target improvements in community mobility.

Staff Successes and Challenges with Telecommunications-Facilitated Patient Care in Hybrid Hospital-at-Home during the COVID-19 Pandemic

Technology-enhanced hospital-at-home (H@H), commonly referred to as hybrid H@H, became more widely adopted during the COVID-19 pandemic. We conducted focus group interviews with Mayo Clinic staff members (n = 14) delivering hybrid H@H in three separate locations-a rural community health system (Northwest Wisconsin), the nation's largest city by area (Jacksonville, FL), and a desert metropolitan area (Scottsdale, AZ)-to understand staff experiences with implementing a new care delivery model and using new technology to monitor patients at home during the pandemic. Using a grounded theory lens, transcripts were analyzed to identify themes. Staff reported that hybrid H@H is a complex care coordination and communication initiative, that hybrid H@H faces site-specific challenges modulated by population density and state policies, and that many patients are receiving uniquely high-quality care through hybrid H@H, partly enabled by advances in technology. Participant responses amplify the need for additional qualitative research with hybrid H@H staff to identify areas for improvement in the deployment of new models of care enabled by modern technology.

Older adults' community participation, physical activity, and social interactions during and following COVID-19 restrictions in Australia: a mixed methods approach

BACKGROUND

With the increasing age of the global population, key components of healthy ageing including community, physical, and social participation continue to gain traction. However, management of the COVID-19 pandemic aimed to protect older adults and reduce the spread of the virus, this restricted community participation and reduced the opportunities for social interaction.

METHODS

This mixed methods study investigates community dwelling older adults' community participation; physical activity and social interaction prior to, during, and following the COVID-19 lockdown in Adelaide, Australia. Twenty-six community dwelling older adults were monitored over three time-points between November 2018 and October 2020, with Global Positioning Systems, accelerometry and self-reported diaries. In addition, nineteen participants completed semi-structured interviews.

RESULTS

Community participation varied across the three time points, with significant reduction in the number of trips taken out-of-home (p = 0.021), social interactions (p = 0.001) and sleep quality (p = 0.008) during restrictions. Five themes were identified to explain personal experiences of community participation during restrictions: (1) Reframing of meaning, (2) Redefining to maintain activities, (3) Revision of risk, (4) Reflection and renewal and (5) Future planning.

CONCLUSION

During COVID-19 the physical and social activities of community dwelling older adults changed. Services that support older adults to adapt their activities   , considering their capacities and preferences, to facilitate community participation are required.

Effects of the CarFreeMe Traumatic Injuries, a Community Mobility Group Intervention, to Increase Community Participation for People With Traumatic Injuries: A Randomized Controlled Trial With Crossover

Introduction

After traumatic injuries community participation is a common goal, promoting wellbeing and independence. Community mobility and transportation influence an individual's independence in community participation. With the ability to drive safely often compromised after traumatic injuries, the adverse consequences of driving cessation include a loss of identity and reduced participation in chosen activities. In rehabilitation, individualized community mobility intervention is not routinely provided. The primary aim of this trial was to evaluate whether a group-based intervention, the CarFreeMe TI program was more effective than standard intervention, an information sheet of alternative transport, in improving community mobility for people following traumatic injuries. The secondary aim of this study was to evaluate the effect: types of transport used, transport satisfaction, community mobility self-efficacy, quality of life, goal satisfaction and performance, for people following traumatic injuries; and to undertake a preliminary assessment of the potential resource use associated with the intervention, and lessons for implementation.

Design

Prospective, pilot, randomized, blind observer, controlled trial with crossover.

Participants

Twenty individuals with traumatic injuries.

Intervention

Six-week group-based support and education program, the CarFreeMe TI delivered in community settings (intervention) and standard information related to transport options available (control).

Primary Outcome Measures

Community participation using a Global Positioning System device to record the location and number of outings from home.

Secondary Outcome Measures

CarFreeMe TI Transport Questionnaire, Community Mobility Self-efficacy Scale, quality of life measures, Modified Canadian Occupational Performance Measure for goals (importance and satisfaction), participant satisfaction survey results and researcher logs.

Results

Those who received the intervention were more likely to use public transport and transport services and had an improved quality of life, when compared to the control group. The intervention group also reported high levels of improvement in goal performance and satisfaction. Global Positioning System data collection was incomplete, with geolocation data unusable. There was no significant change in number/type of visits away from home.

Conclusions

A group-based community mobility education program promoted modes of active independent transport but did not impact on outings from home. Future research could include passive collection methods using a smartphone to record community participation.

Clinical Trial Registration

https://www.anzctr.org.au/, identifier: ACTRN12616001254482.

Community services for older people: a cross-sectional study to explore awareness and the degree of need for long-term care resources

Background: Dementia can lead to family, medical, and social burdens. Long-term care issues of older adults in Taiwan and the burdens of caregivers are beginning to be taken seriously by the government. Relevant resources for older adults have gradually increased; however, older adults and caregivers are often not likely to seek resources and might not know what resources are available.Aims: In this study, we screened for cognitive impairment among community-dwelling older adults, and investigated knowledge of dementia among older adults, awareness of long-term care resources, and the degree of need from caregivers' perspectives.Design: A cross-sectional research design with purposive sampling was used.Methods: This study was carried out in a city in northern Taiwan. In total, 137 older adults completed the surveys with the following inclusion criteria: (1) being 65 years or older and (2) living at home. Additionally, 128 caregivers were also interviewed. Face-to-face interviews were conducted and self-administered questionnaires were delivered to all enrolled participants including: (1) a questionnaire of knowledge of dementia, (2) the Ascertain Dementia (AD)-8 questionnaire; and (3) awareness of community-based long-term care resources and needs questionnaire.Results: Results showed that 16.8% of older adults required a further definite diagnosis of dementia and had relatively low knowledge regarding dementia. Caregivers reported a low level of awareness regarding available long-term care resources despite needing and/or using those resources.Conclusions: Policymakers and practitioners should proactively promote supportive services for older adults and caregivers in the community. Future research should explore strategies for enhancing resource utilization and accessing tailored support to meet the needs of older adults with dementia.