Personal and Environmental Contributors to Sedentary Behavior of Older Adults in Independent and Assisted Living Facilities

Differences in Quality of Care Interactions Across Care Tasks in Assisted Living

BACKGROUND

The quality of care interactions is crucial for the quality of life of assisted living residents. However, limited research has explored how interaction quality varies across different care tasks.

PURPOSE

This study aimed to assess whether the quality of care interactions differs by care task type in assisted living communities.

METHODS

This was a descriptive study done in 4 assisted living communities in Maryland. A total of 152 staff-resident care interactions were observed across various care tasks (eg, clinical care and dietary care) using an observation tool that categorizes the quality of the interaction as positive social, positive care, neutral, negative protective, or negative restrictive.

RESULTS

Most interactions were positive care (36%) and occurred during supportive/ambulatory care (34%). Care interactions during supportive/ambulatory care were significantly more negative than interactions during intimate personal care (P = .022).

CONCLUSION

Future research should focus on interventions aimed at improving the quality of care interactions during supportive/ambulatory care tasks.

Inactivity is isolation: insights from a sedentary time intervention in assisted living

BACKGROUND

As Canada's aging population continues to grow, a larger number of older adults will be residing in assisted living (residences with some on-site care and services). Research is needed to understand how to support active aging - defined as a combination of movement and social behaviours-in this unique living environment. In this study, we explored insights generated about active aging from older residents of assisted living who participated in an intervention designed to encourage standing breaks.

METHODS

This was a multi-method exploratory study. Residents of three assisted living facilities participated in a 12-week intervention called Stand When You Can. The Keele Assessment of Participation (KAP) was used to assess perceived levels of participation in various domains of assisted living at pre- and post-intervention. Focus group sessions were conducted to explore insights on active aging. Transcripts were thematically analyzed to generate themes and sub-themes.

RESULTS

A total of 18 residents (84.4 ± 6.8 years, 72% female), participated in the focus groups. KAP scores at pre-intervention were indicative of a high level of social participation within the residences. Five primary themes emerged from the focus group sessions: 1) intervention effectiveness, 2) physical and social engagement go hand in hand, 3) the congregate living environment can influence movement behaviour, 4) congregate living supports interpersonal relationships, and 5) personal preferences for solitary activity.

CONCLUSIONS

The natural communal setting of assisted living, along with supportive staff, presents a valuable opportunity to promote active aging, which is a complex interplay of social and movement behaviour. Our preliminary findings suggest that in addition to supporting individual behaviour change, a comprehensive approach that addresses the environment, social engagement, and staff engagement is needed in this setting. Future interventions should consider addressing each of these components to facilitate successful behaviour change related to active aging.

Multi-level factors associated with the sedentary behavior of adults with intellectual disabilities in community living arrangements

BACKGROUND

Sedentary Behavior (SB) is an independent risk factor for cardiometabolic diseases and mortality. Adults with intellectual disabilities (ID) that live in Community Living Arrangements (CLAs) participate in higher SB, however the factors associated with SB are unknown in this group.

OBJECTIVE

The cross-sectional study investigated the multi-level determinants related to SB among adults with ID in community living arrangements (CLAs).

METHODS

Adults with ID who lived in CLAs wore an activPAL device for seven days so that SB could be estimated. Prolonged SB and total SB duration served as the outcome variables. Electronic surveys assessed factors across the levels of the social-ecological model. Bivariate analyses estimated the association between each of the independent variables with each of the SB outcomes followed by a multivariable analysis using Least Absolute Shrinkage and Selection Operator (LASSO) regressions for both prolonged SB and total SB duration.

RESULTS

Study participants (n = 36) had a mean age of 44.1 years (SD = 15.01), were predominantly male (58.33 %) and White (83.33 %). Nearly half (n = 16; 47.22 %) exhibited prolonged SB, spending on average 7.46 h (SD = 2.23) in SB daily. The LASSO regression identified higher independence in activities of daily living (ADL) and low levels of staff conflict as being associated with lower total SB duration and less likelihood of prolonged SB.

CONCLUSION

Our findings underscore the influence of multi-level factors on SB in adults with ID. These data suggest that interventions to reduce SB should consider not just individual traits but also the broader social and environmental contexts.

A latent profile analysis of rest-activity behavior patterns among community-dwelling older adults and its relationship with intrinsic capacity

Rest-activity behavior clusters within individuals to form patterns are of significant importance to their intrinsic capacity (IC), yet they have rarely been studied. A total of 1253 community-dwelling older adults were recruited between July and December 2021 based on the baseline survey database of the Fujian Prospective Cohort Study on Aging. Latent profile analysis was used to identify profiles of participants based on rest-activity behaviors, whereas logistic regression analysis was carried out to investigate the relationship between profiles and IC. We identified three latent profiles including: (1) Profile 1-labeled "Gorillas": High physical activity (PA), moderate sedentary behaviors (SB), screen time (ST) and sleep (n = 154, 12%), (2) Profile 2-labeled as "Zebras": Moderate PA, low SB, ST and high sleep (n = 779, 62%), and (3) Profile 3-labeled as"Koalas": High SB, ST, low PA and sleep (n = 320, 26%). Logistic regression revealed a negative correlation between low IC and the "Gorillas" profile (β = - 0.945, P < 0.001) as well as the "Zebras" profile (β = - 0.693, P < 0.001) among community-dwelling older adults, with the "Koalas" profile showing the weakest IC compared to the other profiles. The demographic traits i.e., female, older age, living alone, and low educational level also correlated with low IC. Identifying trends of rest-activity behaviors may help in drawing focus on older adults at risk of decreasing IC, and develop personalized improvement plans for IC.

The Quiet Epidemic: An Overview of Emerging Qualitative Research Trends on Sedentary Behavior in Aging Populations

Sedentary behavior poses a significant health risk to older adults. The purpose of this scoping review is to summarize key findings from qualitative research (since 2012), with a focus on explaining prevailing research trends and patterns within the field. This review included 25 studies that met the strict inclusion criteria. Five key research themes have emerged: (1) defining and shaping perspectives of sedentary behavior, (2) understanding the dynamics of daily routines and contexts, (3) raising awareness of older adults' perceived advantages and disadvantages of sedentary behavior, (4) identifying its determinants and discouraging factors, and (5) exploring interventions to promote active behaviors and reduce sedentary behavior. These themes highlight the multifaceted nature of SB and underscore the importance of tailoring interventions to address individual, social, and environmental issues. A comprehensive understanding of SB is critical to developing effective strategies to promote active lifestyles and reduce SB in older adults. Further qualitative research is needed to deepen our understanding and develop targeted interventions and strategies.

Effectiveness of Interventions for Reducing Sedentary Behaviour in Older Adults Living in Long-Term Care Facilities: A Protocol for a Systematic Review

Background. Sedentary behaviour (SB) is an important risk factor for several health-related outcomes. The prevalence of SB is alarmingly high in older adults, who spend on average 9.4 h being sedentary each day, making them the most sedentary of all age groups. Objectives. The primary objective of this review is to assess the impact of interventions aimed at reducing SB in older adults (aged 60 years and older) living in long-term care facilities (LTCFs). The research question for this systematic review is as follows: in older people living in LTCFs, do interventions aimed at reducing SB, compared to usual care, result in a decrease in SB daily time or a reduction in the length of prolonged and uninterrupted sitting bouts? Data sources. Only peer-reviewed articles will be included in this systematic review, articles will be identified using the PICO method in seven different databases. Participants and interventions. Any primary intervention study (including randomized controlled trials, non-randomized controlled trials, and cohort studies) with the aim to reduce SB daily time or shorten the length of prolonged and uninterrupted sitting bouts in older adults living in LTCFs will be included. After searching databases, abstracts of the studies will be screened, and, after retrieving full text articles, data extraction will be conducted by two independent reviewers. Study appraisal and synthesis methods. The review will adhere to PRISMA reporting guidelines. Risk of bias (RoB) will be assessed using ROBINS-I or the RoB 2.0 tool and will be discussed with a third reviewer. The data will be grouped according to study design, with separate analysis for randomised and non-randomised designs. Results. The primary outcomes will be SB or time spent sedentary, assessed before and after the intervention. For the outcomes with the same measurement units, the pooled mean differences will be calculated. Standardised mean differences will be calculated for the outcomes with different measurement units. The data not suitable in numbers will be synthesised narratively. The strength of evidence of the outcomes will be assessed using GRADE assessment. If the data are suitable for quantitative analysis, we plan to use the Revman software to conduct a meta-analysis. Conclusions and implications of key findings. This protocol can serve as a valuable resource for other researchers interested in conducting similar systematic reviews or meta-analyses in the field of SB and older adult health.

Physical Activity Programming for Older Adults in Assisted Living: Residents' Perspectives

Decreasing sedentary behavior and increasing light physical activity could promote the maintenance of functional abilities for older adults in assisted living (AL). The purpose of this qualitative study was to gather residents' recommendations about a proposed self-efficacy enhancing intervention to replace sedentary behavior with light physical activity. We interviewed 20 residents (mean age 83.1; 60% women). Topics included their current activities and thoughts about physical activity. We presented the intervention and asked questions to inform its modification. Data were analyzed with content and thematic analysis. Specific recommendations included shorter one-hour sessions and framing the intervention as increasing light physical activity rather than decreasing sedentary behavior. The thematic analysis identified multiple factors that could influence intervention implementation, including motivation to be active, safety concerns, ageist attitudes about physical activity, varying abilities of residents, social influences, and limited opportunities for physical activity. These results will inform physical activity intervention implementation for AL residents.

Indoor Built Environment and Older Adults' Activity: A Systematic Review

Although the physical environment can influence people's activity, there are few knowledge syntheses for indoor environments and older adults' daily life routines. Therefore, we conducted a systematic review of peer-reviewed evidence to inform future research and practice. Inclusion criteria were studies with any research designs, across all years and languages focused on older adults 60 years of age or more, on physical activity/sedentary behaviour and the indoor environment. After searching five databases, two authors completed title/abstract and full-text screening. The last search was on December 19, 2020. We screened 1,367 citations, and included 23 studies situated in private or collective dwellings (e.g., assisted living). We identified physical activity-supportive indoor features across three domains: campus (e.g., amenities, pathways), building (e.g., area, floor level), and fixtures (e.g., elevators, hallways). Knowledge of indoor environmental factors for older adults' engagement in daily activities can guide future research and policy on housing design.

How Much Time in Sedentary Behavior Should Be Reduced to Decrease Fear of Falling and Falls in Community-Dwelling Older Adults?

Fear of falling and history of falls are frequent situations in older adults, which can be aggravated by sedentary behavior (SB). The objective was to establish SB cutoff values which discriminate falls and fear of falling in older adults and verify the association between these conditions. This was a cross-sectional study including 308 community-dwelling older adults. The SB was assessed by International Physical Activity Questionnaire. The outcomes were history of falling in the last 12 months and fear of falling (higher or equal than 23 points in Falls Efficacy Scale International-Brazil). The cutoff points found were >4.14 (area under curve = 0.60, 95% confidence intervals [CIs] [0.54, 0.65]) and >3.90 hr per day (area under curve = 0.59, 95% CI [0.53, 0.64]) for fear of falling and history of falls, respectively. Older adults with SB had 1.71 (95% CI [1.03, 2.84]) and 1.75 (95% CI [1.06, 2.89]) greater odds of having greater fear of falling and suffering falls, respectively.

On the Move clinic: A fall prevention nurse practitioner-driven model of care

Falls in older adults are common and interventions to reduce associated morbidity and mortality remain difficult to implement. This quality improvement project evaluated On the Move, a new clinic designed to provide tailored recommendations to reduce falls risk, based on an adaptation of CDC's STEADI: a falls risk screening, assessment and intervention guide. 89 participants were referred by primary care and emergency services. A nurse practitioner assessed modifiable physical, behavioral and environmental risk factors and utilized motivational interviewing and education to guide participants in developing an intervention plan. A physical therapist assessed gait/balance, the need for ongoing PT services and provided brief counseling. Participants received a 6-week phone call and 12-week follow up visit. Measurements, including 30-second chair stands, Timed Up and Go, 4-Item Dynamic Gait Index, and Activities-Specific Balance Confidence Scale all showed significant improvement. Participants made behavioral changes to reduce risk, and plans to continue exercise.