Linked Lives: Exploring Gender and Sedentary Behaviors in Older Adult Couples

Objectives: We explored associations between co-habiting partners for sedentary behavior (type and time, via accelerometry and self-report), gender, and a surrogate health measure (inflammatory biomarker: C-reactive protein, CRP). Methods: Participants completed activity questionnaires and the Timed Up and Go (mobility), wore an accelerometer for 7 days, and provided samples for high-sensitivity (hs) CRP. We used multilevel modeling (partners within couples) to investigate associations between independent variables and (a) sedentary behavior and (b) hsCRP. Results: 112 couples (50% women) provided sedentary data and hsCRP. Sedentary behavior was significantly correlated (r = .440, p men). Gender, moderate to vigorous physical activity (MVPA), and mobility estimated 37% of the modeled variance in sedentary time, while body mass index (BMI) and MVPA estimated 10% of the modeled variance in hsCRP. Discussion: Despite differences in how activity was accumulated, there were no significant differences between women’s and men’s health biomarker.Canadian Institutes of Health Research https://doi.org/10.13039/501100000024michael smith foundation for health research https://doi.org/10.13039/501100000245social sciences and humanities research council of canada https://doi.org/10.13039/501100000155university of british columbia https://doi.org/10.13039/501100005247Peer Reviewe

Walk the Talk : the association between older adult mobility and the built environment

Mobility is vital to healthy aging. The built environment is central to mobility as it is the setting where mobility occurs. Older adults of low socioeconomic status (SES) may be especially reliant on built environments that support non-motorized mobility. Despite this, older adults of low SES are underrepresented in research. Therefore, this dissertation applies quantitative methods to describe the mobility (capacity and enacted function) and investigate the association between the built environment and non-motorized mobility (walking for transportation and physical activity) of older adults of low income. The studies within this dissertation are set in Metro Vancouver; the last three utilize data from a cross-sectional study of 161 older adults of low income. The first study investigates the reliability of a novel approach (virtual audits) for measuring the built environment. I found that virtual audits reliably measure macroscale (neighbourhood-level) built environment features that promote older adult walking, but may be inappropriate for measuring fine-grain details of the microscale (street-level) built environment. The second study provides an in-depth description of the mobility of older adults living on low income. I noted that participants generally had the capacity to be mobile and made a high proportion of walking trips, although these did not together serve to meet physical activity guidelines for most. The third study analyzes travel diary data to identify destinations that older adults most commonly visit in a week (i.e., grocery stores, malls, restaurants/cafes); I also found that each 10-point increase in Street Smart Walk Score (measure of the built environment) was associated with a 20% increase in walking for transportation (IRR = 1.20, 95% CI = 1.12, 1.29). The fourth study analyzes accelerometry and self-report data to investigate associations between the built environment and physical activity and walking for transportation. Odds of any walking for transportation were 1.45 (95% CI = 1.18, 1.78) times greater for each 10-point increase in Street Smart Walk Score. There were no other built environment-mobility associations. Taken collectively, these studies fill methodological gaps in the literature and provide data on an understudied population that may be especially reliant on built environments that support walking.Medicine, Faculty ofGraduat

Neighborhood walkability, physical activity, and walking for transportation: A cross-sectional study of older adults living on low income

Background: Walking, and in particular, outdoor walking, is the most common form of physical activity for older adults. To date, no study investigated the association between the neighborhood built environment and physical activity habits of older adults of low SES. Thus, our overarching aim was to examine the association between the neighborhood built environment and the spectrum of physical activity and walking for transportation in older adults of low socioeconomic status. Methods: Cross-sectional data were from the Walk the Talk Study, collected in 2012. Participants (n = 161, mean age = 74 years) were in receipt of a rental subsidy for low income individuals and resided in neighbourhoods across Metro Vancouver, Canada. We used the Street Smart Walk Score to objectively characterize the built environment main effect (walkability), accelerometry for objective physical activity, and the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to measure walking for transportation. We used regression analyses to examine associations of objectively measured physical activity [total volume, light intensity and moderate intensity physical activity (MVPA)] and self-reported walking for transportation (any, frequency, duration) with walkability. We adjusted analyses for person- and environment-level factors associated with older adult physical activity. Results: Neighbourhood walkability was not associated with physical activity volume or intensity and self-reported walking for transportation, with one exception. Each 10-point increase in Street Smart Walk Score was associated with a 45% greater odds of any walking for transportation (compared with none; OR = 1.45, 95% confidence interval = 1.18, 1.78). Sociodemographic, physical function and attitudinal factors were significant predictors of physical activity across our models. Conclusions: The lack of associations between most of the explored outcomes may be due to the complexity of the relation between the person and environment. Given that this is the first study to explore these associations specifically in older adults living on low income, this study should be replicated in other settings.Medicine, Faculty ofOther UBCNon UBCFamily Practice, Department ofReviewedFacult

Are we missing the sitting? Agreement between accelerometer non-wear time validation methods used with older adults’ data

We used Bland Altman plots to compare agreement between a self-report diary and five different non-wear time algorithms [an algorithm that uses ≥60 min of consecutive zeroes (Troiano) and four variations of an algorithm that uses ≥90 min of consecutive zeroes to define a non-wear period] for estimating community-dwelling older adults’ (n = 106) sedentary behaviour and wear time (min/day) as measured by accelerometry. We found that the Troiano algorithm may overestimate sedentary behaviour and wear time by ≥30 min/day. Algorithms that use ≥90 min of continuous zeroes more closely approximate participants’ sedentary behaviour and wear time. Across the self-report diary vs. ≥90 min algorithm comparisons, mean differences ranged between −4.4 to 8.1 min/day for estimates of sedentary behaviour and between −10.8 to 1.0 min/day for estimates of wear time; all 95% confidence intervals for mean differences crossed zero. We also found that 95% limits of agreement were wide for all comparisons, highlighting the large variation in estimates of sedentary behaviour and wear time. Given the importance of reducing sedentary behaviour and encouraging physical activity for older adult health, we conclude that it is critical to establish accurate approaches for measurement

Future directions for patient engagement in research: a participatory workshop with Canadian patient partners and academic researchers

Abstract Background Patient engagement in research (also commonly referred to as patient or patient and public involvement in research) strives to transform health research wherein patients (including caregivers and the public) are regularly and actively engaged as multidisciplinary research team members (i.e. patient partners) working jointly towards improved health outcomes and an enhanced healthcare system. To support its mindful evolution into a staple of health research, this participatory study aimed to identify future directions for Canadian patient engagement in research and discusses its findings in the context of the international literature. Methods The study met its aim through a multi-meeting pan-Canadian virtual workshop. Participants (n = 30) included Strategy for Patient-Oriented Research-funded academic researchers and patient partners identified through a publicly available database, personal and professional networks and social media. All spoke English, could access the workshop virtually, and provided written informed consent. The workshop was composed of four, 1.5–3-h virtual meetings wherein participants discussed the current and preferred future states of Canadian patient engagement in research. Workshop discussions (i.e. data) were video and audio recorded. Themes were generated through an iterative process of inductive thematic analysis that occurred concurrently with the multi-week workshop. Results Our participatory and iterative process identified 10 targetable areas of focus for the future of Canadian patient engagement in research. Five were categorized as system-level (systemic integration; academic culture; engagement networks; funding models; compensation models), one as researcher-level (engagement processes), and four crossed both levels (awareness; diversity and recruitment; training, tools and education; evaluation and impact). System level targetable areas called for reshaping the patient engagement ecosystem to create a legitimized and supportive space for patient engagement to be a staple component of a learning health system. Researcher level targetable areas called for academic researchers and patient partners to collaboratively generate evidence and apply knowledge to inform values and behaviours necessary to foster and sustain supportive health research spaces that are accessible to all. Conclusions Future directions for Canadian patient engagement in research span 10 interconnected targetable areas that require strong leadership and joint action between patient partners, academic researchers, and health and research institutions if patient engagement is to become a ubiquitous component of a learning health system

Models and frameworks of patient engagement in health services research: a scoping review protocol

Plain English summary Patient engagement in research is an emerging approach that involves active and meaningful collaboration between researchers and patients throughout all phases of a project, including planning, data collection and analysis, and sharing of findings. To better understand the core features (elements) that underlie patient engagement, it is useful to have a look at models and frameworks that guide its conduct. Therefore, this manuscript aims to present a protocol for a scoping review of models and frameworks of patient engagement in health services research. Methods: Our protocol design is based on an established framework for conducting scoping reviews. We will identify relevant models and frameworks through systematic searches of electronic databases, websites, reference lists of included articles, and correspondence with colleagues and experts. We will include published and unpublished articles that present models and frameworks of patient engagement in health services research and exclude those not in English or unavailable as full texts. Two reviewers will independently review abstracts and full texts of identified articles for inclusion and extract relevant data; a third reviewer will resolve discrepancies. Our primary objective is to count and describe elements of patient engagement that overlap (present in 2 or more) and diverge among included models and frameworks. Discussion: We hope this review will raise awareness of existing models and frameworks of patient engagement in health services research. Further, by identifying elements that overlap and diverge between models and frameworks, this review will contribute to a clearer understanding of what patient engagement in research is and/or could be. Abstract Background: Patients can bring an expert voice to healthcare research through their lived experience of receiving healthcare services. Patient engagement in research is an emerging approach that challenges researchers to acknowledge and utilize this expertise through meaningful and active collaboration with patients throughout the research process. In order to facilitate a clearer understanding of the core elements that underlie patient engagement, it is useful to examine existing models and frameworks that guide its conduct. Therefore, the aim of this manuscript is to present a protocol for a scoping review of models and frameworks of patient engagement in health services research. Methods: Drawing on Arksey and O’Malley’s and Levac et al.’s framework for scoping reviews, we designed our protocol to identify relevant a) published articles through systematic searches of 7 electronic databases and snowball sampling and b) unpublished articles through systematic searches of databases and websites and snowball sampling. We will include published and unpublished models and frameworks of patient engagement in health services research and exclude those not in English or unavailable as full texts. Two reviewers will independently screen the abstracts and full texts of identified articles for inclusion and extract relevant data; a third reviewer will resolve disagreements. We will conduct a descriptive analysis of the characteristics (i.e., elements underlying patient engagement and those related to the study authors, publication, and model/framework) of included articles and a narrative analysis of the data concerning elements of the model or framework. Our primary objective is to count and describe elements of patient engagement that overlap (present in ≥ 2) and diverge (present in < 2) among identified models and frameworks. Discussion: Through identification of elements that overlap and diverge between existing models and frameworks, this review will provide a starting point for the critical reflection on our collective understanding of what patient engagement in health services research is and/or could be. Ultimately, we hope that the findings of this review raise awareness of existing models and frameworks and shed light on some of the complexity of conducting patient engaged research through identification of key elements that shape this approach

Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study

BackgroundDespite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. ObjectiveThe aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. MethodsEngagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. ResultsThe advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. ConclusionsPatient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users

Use of a mobile health application by adult non-congenital cardiac surgery patients: A feasibility study.

Mobile Health (mHealth) technologies are becoming integral to our healthcare system. This study evaluated the feasibility (compliance, usability and user satisfaction) of a mHealth application (app) for delivering Enhanced Recovery Protocols (ERPs) information to Cardiac Surgery (CS) patients peri-operatively. This single centre, prospective cohort study involved patients undergoing CS. Patients received a mHealth app developed for the study at consent and for 6-8 weeks post-surgery. Patients completed system usability, patient satisfaction and quality of life surveys pre- and post-surgery. A total of 65 patients participated in the study (mean age of 64 years). The app achieved an overall utilization rate of 75% (68% vs 81% for 65 and <65 years respectively) in the post-surgery survey. MHealth technology is feasible for peri-operative CS patient education, including older adult patients. The majority of patients were satisfied with the app and would recommend using it over the use of printed materials