A Novel Approach to Reduce Sedentary Behaviour in Care Home Residents: The GET READY Study Utilising Service-Learning and Co-Creation

The key values and factors identified by older adults to promote physical activity and reduce sedentary behaviour using co-production approaches: a scoping review

BACKGROUND

Inactivity and sedentary behaviour in older adults adversely impacts physical function, reduces social networks, and could contribute to population healthcare costs. To encourage and support the planning and uptake of physical activity by older adults, it is important to understand what physical activity means to older adults. Therefore, the aim of this scoping review was to collate what older adults have self-identified as the key factors for sustaining and increasing their physical activities.

METHODS

Arksey and O'Malley's Scoping Review framework was used to guide the review process. SCOPUS, ASSIA, PsychINFO and MEDLINE databases were searched. Studies were eligible for inclusion if they were peer-reviewed, the target population were older adults (aged 55 and above), co-production related research approaches were explicitly stated in the methods and there was a focus on design of physical activity interventions or products to support or enhance physical activity. Assets and values important for physical activity were first extracted from included studies and were subsequently thematically analysed. Themes are presented to provide an overview of the literature synthesis.

RESULTS

Sixteen papers were included in the analysis. Data from these papers were gathered via designing interventions or services (n = 8), products (n = 2), 'exergames' (n = 2) or mobile applications (n = 4). Outcomes were varied but common themes emerged across papers. Overarching themes identified by older adults were associated with a desire to increase activity when it was accessible, motivational, and safe. In addition, older adults want to enjoy their activities, want independence and representation, want to stay connected with families and friends, be outdoors, familiarity, activities to be tailored and resulting in measurable/observed progress.

CONCLUSIONS

Population demographics, personal attributes, and life experiences all affect preferences for physical activity. However, the key factors identified by older adults for increasing physical activity were common-even in separate co-production contexts. To promote physical activities in older adults, activities must fundamentally feel safe, provide a sense of social connectedness, be enjoyable and be accessible in terms of cost and ability.

The Impact of Service Learning on Academic, Professional and Physical Wellbeing Competences of EFL Teacher Education Students

In response to the challenges of the 21st century, the European Higher Education Area (EHEA) has been committed to the development of a training model that focuses on the acquisition of cognitive, physical, and social competences, among others, rather than the mere acquisition of knowledge. This approach has gained momentum in recent years, where the learners are the protagonists of their own learning process. This change of approach requires a change in methodology and involves a renewal of the methodological approach in Spanish universities. Service learning (S-L) is an active methodology that is gaining ground across universities due to its experiential, community-based and reflective characteristics. The present study aimed to provide an overview of the impact of S-L by active programs (physical activities, movement games, active tasks, etc.) on the acquisition of professional, linguistic, pedagogical or intercultural competencies, as well as physical wellbeing skills, on English as a foreign language (EFL) teacher education students. Fourteen Spanish EFL university students carried out an S-L active intervention with a migrant group from the Migrant Temporary Stay Centre in the autonomous city of Melilla (Spain). A qualitative study was designed to evaluate the achievement of these competencies. The results show that even though S-L is a challenging methodology, it favours the development of academic, professional, and physical wellbeing competences to succeed in a competitive and changing world, as well as the improvement of the participant students.

Long-term care residents' acceptance of a standing intervention: A qualitative intrinsic case study

Older adults in long-term care are sedentary. Standing is recommended to reduce sedentary time, but there is limited research on long-term care residents' acceptability of standing interventions. The acceptability of the Stand If You Can (SIYC) randomized clinical trial among long-term care residents was explored using a single intrinsic qualitative case study design. The five month intervention consisted of supervised 100 min standing sessions per week. Participants completed post-intervention interviews, which were analyzed using the Thematic Framework Analysis through the lens of an acceptability framework. The 10 participants (7 female), age 73 to 102 years, stood a median of 53% of the intervention offered time (range 20%-94%). The participants reported acceptability in many aspects of the Theoretical Framework of Acceptability. Standing is a simple intervention to decrease sedentary time and seems to be accepted among long-term care residents when burden is not perceived as too high.

Approaches to co-production of research in care homes: a scoping review

BACKGROUND

Using the technique of co-production to develop research is considered good practice. Co-production involves the public, practitioners and academics working together as equals throughout a research project. Co-production may help develop alternative ways of delivering care for older adults that are acceptable to those who live and work in care homes. However, guidance about applying co-production approaches in this context is lacking. This scoping review aims to map co-production approaches used in care homes for older adults in previous research to support the inclusion of residents and care staff as equal collaborators in future studies.

METHODS

A scoping review was conducted using the Joanna Briggs Institute scoping review methodology. Seven electronic databases were searched for peer-reviewed primary studies using co-production approaches in care home settings for older adults. Studies were independently screened against eligibility criteria by two reviewers. Citation searching was completed. Data relating to study characteristics, co-production approaches used, including any barriers and facilitators, was charted by one reviewer and checked by another. Data was summarised using tables and diagrams with an accompanying narrative description. A collaborator group of care home and health service representatives were involved in the interpretation of the findings from their perspectives.

RESULTS

19 studies were selected for inclusion. A diverse range of approaches to co-production and engaging key stakeholders in care home settings were identified. 11 studies reported barriers and 13 reported facilitators affecting the co-production process. Barriers and facilitators to building relationships and achieving inclusive, equitable and reciprocal co-production were identified in alignment with the five NIHR principles. Practical considerations were also identified as potential barriers and facilitators.

CONCLUSION

The components of co-production approaches, barriers and facilitators identified should inform the design of future research using co-production approaches in care homes. Future studies should be explicit in reporting what is meant by co-production, the methods used to support co-production, and steps taken to enact the principles of co-production. Sharing of key learning is required to support this field to develop. Evaluation of co-production approaches, including participants' experiences of taking part in co-production processes, are areas for future research in care home settings.

The use of co-design in developing physical activity interventions for older adults: a scoping review

BACKGROUND

Promoting physical activity (PA) participation in older adults is important for preserving quality of life and functional independence. Co-design has been shown to increase engagement of end-users in health-related policies and interventions. This scoping review aimed to examine how co-design has been used to develop PA interventions for older adults.

METHODS

We searched MEDLINE, EMBASE, AMED, and CINAHL. Peer-reviewed primary research studies that met the following criteria were included: had at least one participant aged ≥60 years involved in the co-design process and the intervention was delivered to individuals whose mean age was ≥60, used co-design methodologies, and any form of PA. After duplicate removal, two or more independent reviewers completed title and abstract and full text screening. Data were extracted from the included studies according to study aims.

RESULTS

Of the 29 included studies, 12 different terms were used to describe co-design with variable operational definitions that we consolidated into five proposed components. Fifteen studies engaged users in a consultative way, 13 studies using collaboration, and one study engaged end-users in consumer-control. No studies involved end-users in the dissemination phase. Further, no studies directly measured the effectiveness of the co-design process. Five categories of barriers and facilitators to co-design were identified including frameworks and methodologies, logistics, relationships, participation, and generalizability.

CONCLUSIONS

There is a large degree of variability in how co-design is used to develop PA interventions for older adults. Our findings can be used by researchers to improve rigor and standardization in this emerging field.

TRIAL REGISTRATION

osf.io/vsw2m.

Older residents' perceptions of loneliness in long-term care facilities: A qualitative study

Loneliness is a negative emotional feeling often experienced by older residents in long-term care facilities (LTCFs). Previous studies have shown that loneliness is related to depression, inferior quality of life, cardiovascular disease, and suicidal thoughts. Thus, it is important to understand older residents' viewpoints about loneliness to provide better care in the long-term care context. This study aimed to explore residents' perceptions of loneliness in LTCFs. For this qualitative research, data were collected from two LTCFs in northern Taiwan, and purposive sampling was used. In-depth interviews with 16 older residents were conducted using a semi-structured interview guide. Content analysis was performed to analyse the data. Four themes with nine subthemes were generated. The themes were: being cut off from continually meaningful relationships, experiencing tears of pain, feeling alone, and lacking a sense of belonging. The findings of this study can provide information for health care professionals to better understand older residents' views on loneliness and remind them to re-examine care protocols for psychological health care. Thus, this study found that in order to prevent or alleviate older residents' feelings of loneliness, the LTCFs should maintain continually meaningful relationships, accompany them, and give them a sense of belonging. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used to report this study.

Effectiveness of a reablement training program for homecare staff on older adults' sedentary behavior: A cluster randomized controlled trial

BACKGROUND/OBJECTIVES

Homecare staff often take over activities instead of "doing activities with" clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the "Stay Active at Home" (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior.

DESIGN

Cluster randomized controlled trial (c-RCT).

SETTING

Dutch homecare (10 nursing teams comprising a total of 313 staff members).

PARTICIPANTS

264 clients (aged ≥65 years).

INTERVENTION

SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual.

MEASUREMENTS

Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed.

RESULTS

We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] -22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI -1.5, 2.6], p = 0.589) or for most secondary outcomes.

CONCLUSION

Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.

Patterns of Sedentary Behavior among Older Adults in Care Facilities: A Scoping Review

Understanding the sedentary patterns can guide the design of strategies to engage older adults in physical activity. This scoping review aimed to synthesize available evidence on sedentary behaviors in care facilities. We searched PubMed/MEDLINE and Web of Science for studies published from inception through October 2020. Eighteen studies were included and reviewed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Data obtained were analyzed based on levels of care provided. Overall, daily sedentary time was higher among residents in high level care facilities (e.g., nursing homes) (11.6 h/day) than intermediate/mixed level care facilities (e.g., assisted living) (9.5 h/day). In intermediate/mixed level care facilities, television (TV) viewing was the most common sedentary activity (2.5-2.9 h/day; 26% of daily sedentary time), while napping was the most favorite sedentary activity (4.7 h/day; 36% of waking hours) in high level care facilities. Sex differences in daily patterns of sedentary behavior (sedentary time, uninterrupted bouts, and bout durations) were commonly observed in intermediate/mixed level care facilities, as exemplified by men being more sedentary by 0.7-1.1 h/day. In summary, this study highlights distinctive sedentary patterns among older adults residing in different levels of care facilities, addressing a pressing need for customized interventions to engage care facility residents in physical activity.

A Pilot Randomised Clinical Trial of a Novel Approach to Reduce Sedentary Behaviour in Care Home Residents: Feasibility and Preliminary Effects of the GET READY Study

Care-home residents are among the most sedentary and least active of the population. We aimed to assess the feasibility, acceptability, safety, and preliminary effects of an intervention to reduce sedentary behaviour (SB) co-created with care home residents, staff, family members, and policymakers within a pilot two-armed pragmatic cluster randomized clinical trial (RCT). Four care homes from two European countries participated, and were randomly assigned to control (usual care, CG) or the Get Ready intervention (GR), delivered by a staff champion one-to-one with the care home resident and a family member. A total of thirty-one residents participated (51.6% female, 82.9 (13.6) years old). GR involves six face to face sessions over a 12-week period with goal-oriented prompts for movement throughout. The feasibility and acceptability of the intervention were assessed and adverse events (AEs) were collected. The preliminary effects of the GR on SB, quality of life, fear of falling, and physical function were assessed. Means and standard deviations are presented, with the mean change from baseline to post-intervention calculated along with 95% confidence intervals. The CG smoked more, sat more, and had more functional movement difficulties than the GR at baseline. The GR intervention was feasible and acceptable to residents and staff. No AEs occurred during the intervention. GR participants showed a decrease in daily hours spent sitting/lying (Cohen’s d = 0.36) and an increase in daily hours stepping, and improvements in health-related quality of life, fear of falling, and habitual gait speed compared to usual care, but these effects need confirmation in a definitive RCT. The co-created GR was shown to be feasible and acceptable, with no AEs.

Mission (im)possible: Engaging care homes, staff and residents in research studies

OBJECTIVES

With increasing age the risk of institutionalization increases. To address the problem of underrepresentation of care homes and their residents in future research studies, we aimed to explore care home staff members' thoughts on barriers, challenges, facilitators and key aspects of engaging in research studies.

METHODS

Five staff members from four care homes in Glasgow and Barcelona were interviewed. Transcription of the interviews was completed verbatim and an inductive thematic analysis was conducted to understand the difficulties and challenges they perceive for engaging in research studies.

RESULTS

Three themes emerged that encapsulated the staff members' perspectives. 'Too much to deal with' included two subthemes; 'interested but with support' encapsulated four subthemes; and 'on the residents' terms' highlighted three subthemes. Staff members showed interest in engaging in research studies if a clear management support accompanied by a whole team approach was evident. The involvement of the resident's relatives was seen as essential if residents were to be supported to be engaged.

CONCLUSIONS

Despite the small sample size, the perspectives of staff members, irrespective of country, provided valuable insights for informing researchers on best approaches to maximize care home and resident engagement in research.

Reducing Sedentary Time among Older Adults in Assisted Living: Perceptions, Barriers, and Motivators

Older adults accumulate more sedentary time (ST) than any other age group, especially those in assisted living residences (ALRs). Reducing prolonged ST could help maintain function among older adults. However, to develop effective intervention strategies, it is important to understand the factors that influence sedentary behavior. The purpose of this study was to explore perceptions of ST as well as barriers and motivators to reducing ST among older adults in assisted living, in the context of the Social Ecological Model (SEM). Using a qualitative description approach, we sought to learn about participants’ perceptions of sedentary time in their daily lives. Semi-structured focus groups were held at six ALRs with 31 participants (84% women, 83.5 ± 6.5 years). Data were transcribed and coded using an inductive thematic approach. Themes were categorized based on four levels of the SEM: individual, social, physical environment, and organization. Many reported barriers were at the individual level (e.g., lack of motivation, pain, fatigue) while others were associated with the organization or social environment (e.g., safety concerns, lack of activities outside of business hours, and social norms). These findings suggest that there are unique challenges and opportunities to consider when designing ST interventions for assisted living.

Service-Learning with College Students toward Health-Care of Older Adults: A Systematic Review

Service-Learning (SL) has become a teaching methodology that promotes social and personal skills while helping groups in need and at risk of social exclusion. This paper is a systematic review of the literature on SL experiences and research on college subjects in the area of health-care promotion in settings for older adults. After an exhaustive search, 43 peer-reviewed publications were classified according to frequency and geographical distribution, sample and duration of the programs, research methodologies, data collection instruments used, and main outcomes investigated. The results indicate that the research methodologies used tended to be qualitative and mixed, while the variety of samples and duration of interventions was very broad. The instruments used were mainly interviews and questionnaires, and the programs were developed specially in the United States of America. The groups receiving most SL were healthy older adults and older adult populations with aging disabilities and illnesses. The articles in the present review highlight that SL can have a positive effect on older adults' health promotion and can enhance their community participation.