Exploring physical activity changes and experiences of older adults living in retirement villages during a pandemic

Objective: To explore physical activity changes and participation among physically active older adults living in retirement villages during the coronavirus (COVID-19) pandemic. Methods: Semi-structured interviews were conducted over the telephone. The interviews were recorded and transcribed verbatim. Reflexive thematic analysis was conducted. Results: Seventeen older adults were interviewed, and they engaged in many types of physical activity before the COVID-19 lockdown. During the COVID-19 lockdown, the most common physical activity that older adults participated in was walking. Mental well-being and socialisation were affected during the lockdown, with older adults employing several strategies to help them cope. Conclusions: During the COVID-19 pandemic, physically active residents of retirement villages maintained their physical activity, but with reduced intensity and variety. In some cases, this impacted their mental and physical health. Physical activity resources aimed at facilitating diverse and sufficiently intense physical activity may benefit this group, and others.</p

sj-docx-1-cre-10.1177_02692155221129832 - Supplemental material for Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis

Supplemental material, sj-docx-1-cre-10.1177_02692155221129832 for Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis by Jane Hopkins, Keith Hill, Angela Jacques and Elissa Burton in Clinical Rehabilitation</p

Effectiveness of Outdoor Exercise Parks on Health Outcomes in Older Adults—A Mixed-Methods Systematic Review and Meta-Analysis

The objective of this systematic review was to examine the effectiveness of outdoor exercise park equipment on physical activity levels, physical function, psychosocial outcomes, and quality of life of older adults living in the community and to evaluate the evidence of older adults’ use of outdoor exercise park equipment. A search strategy was conducted from seven databases. Nine articles met the inclusion criteria. The study quality results were varied. Meta-analyses were undertaken for two physical performance tests: 30-s chair stand test and single-leg stance. The meta-analysis results were not statistically significant. It was not possible to conclude whether exercise parks were effective at improving levels of physical activity. The review shows that older adults value the benefits of health and social interaction from the use of exercise parks. Findings should be interpreted with caution due to the small sample sizes and the limited number of studies.</p

Effectiveness of outdoor exercise equipment in older people: A systematic review and meta-analysis

Introduction and Aims: Participation rates in physical activity are low amongst older people and declines with increasing age.  Outdoor exercise equipment (OEE) installed strategically in parks can enhance older people’s access to physical activity options. To date, no systematic review has investigated the usage of OEE and health outcomes associated with their use by older people. This systematic review aims to review the effectiveness of OEE on health outcomes, and their usage by older people.  Methods: Seven databases were searched (to January 2020). Eligibility criteria included: People aged ≥60 years (≥50% of the sample  population); interventions delivered using OEE to increase physical function; comparison groups for randomised and non-randomised controlled trials; outcome: qualitative and quantitative evaluation of OEE. The titles and abstracts were scanned by the first reviewer and full article screening was completed independently by two reviewers. Results of all articles were summarised and randomised controlled trials (RCTs) were analysed by meta-analysis. Results: Nine studies met the inclusion criteria. The meta-analysis results were not statistically significant for the 30 second chair stand test (MD [95% CI]=1.05 [-0.42 to 2.53]) and single-leg stance (MD [95% CI]=8.52 [-8.88 to 25.93]). The single leg stance test results need to be interpreted with caution due to the high heterogeneity. Common cited benefits by older people for using OEE were improvements to health and social interaction. Conclusion: Older adults use OEE while performing other activities at the park. Future research should include larger sample sizes, similar OEE and outcome measures evaluating intensity levels of physical activity. </p

Reliability and Validity of a Modified Version of the Community Balance and Mobility Scale (CBMS-Home) for Use in Home Assessment

Objective: The Community Balance and Mobility Scale (CBMS) has been shown to be a valid and reliable outcome measure for evaluating balance and mobility among older adults; however, some items cannot be conducted in all home environments, limiting its use in home-based assessments. The purpose of this study was to evaluate the accuracy and selected measurement properties of a modified 12-item CBMS-Home (8 original items and 4 modified items of the CBMS) feasible for use within the constraints of home assessments for older adults. Methods: Fifty-five people (mean [SD] age = 77.2 [6.0] years) were recruited for this validation study. Participants completed the full original CBMS, CBMS-Home (the modified items of the CBMS), the Functional Reach Test, and Step Test. Principal components analysis, internal consistency, test-retest and intermethod reliability, agreements within and between methods, and criterion validity were calculated. Results: Principal components analysis of CBMS and CBMS-Home both revealed 3 similar components and loadings. Bland-Altman and weighted κ analyses revealed that the CBMS-Home demonstrated moderate to almost perfect agreement (weighted κ = 0.45–0.84) with CBMS. The distribution of scores of CBMS-Home were satisfactory, and other results showed excellent test-retest (intraclass correlation coefficient [ICC]  = 0.95) and intermethod reliability (ICC = 0.94) and internal consistency (Cronbach α = 0.94). There were no ceiling effects (0%) or floor (1.8%) effects. CBMS-Home demonstrated a low (Spearman ρ = 0.39) and moderate positive (Spearman ρ = 0.63) relationship with the Functional Reach Test and Step Test, respectively. Conclusions: The CBMS-Home has good psychometric properties and provides a useful multidimensional assessment tool. Impact: A modified version of the CBMS (CBMS-Home) can be confidently used to assess older adults—within their own home—who might have mild balance impairments.</p

Physical activity programs for older people in the community receiving home care services: systematic review and meta-analysis

The proportion of older adults is increasing around the world and most wish to live in their home until they die. To achieve this, many will require services in the home to remain living independently. To maintain function (ie, strength, balance, and endurance), physical activity needs to be undertaken on a regular basis, and is essential as a person ages. Unfortunately, as people age there is a tendency to reduce activity levels, which often leads to loss of function and frailty, and the need for home care services. This updated systematic review includes a mix of study methodologies and meta-analysis, and investigated the effectiveness of physical activity/exercise interventions for older adults receiving home care services. Eighteen studies including ten randomized controlled trials meeting the selection criteria were identified. Many of the studies were multi-factorial interventions with the majority reporting aims beyond solely trying to improve the physical function of home care clients. The meta-analysis showed limited evidence for effectiveness of physical activity for older adults receiving home care services. Future exercise/physical activity studies working with home care populations should consider focusing solely on physical improvements, and need to include a process evaluation of the intervention to gain a better understanding of the association between adherence to the exercise program and other factors influencing effectiveness

Physical activity programs for older people in the community receiving home care services:systematic review and meta-analysis

The proportion of older adults is increasing around the world and most wish to live in their home until they die. To achieve this, many will require services in the home to remain living independently. To maintain function (ie, strength, balance, and endurance), physical activity needs to be undertaken on a regular basis, and is essential as a person ages. Unfortunately, as people age there is a tendency to reduce activity levels, which often leads to loss of function and frailty, and the need for home care services. This updated systematic review includes a mix of study methodologies and meta-analysis, and investigated the effectiveness of physical activity/exercise interventions for older adults receiving home care services. Eighteen studies including ten randomized controlled trials meeting the selection criteria were identified. Many of the studies were multi-factorial interventions with the majority reporting aims beyond solely trying to improve the physical function of home care clients. The meta-analysis showed limited evidence for effectiveness of physical activity for older adults receiving home care services. Future exercise/physical activity studies working with home care populations should consider focusing solely on physical improvements, and need to include a process evaluation of the intervention to gain a better understanding of the association between adherence to the exercise program and other factors influencing effectiveness

Examining gait aid use and user safety by older people with dementia: Perspectives of informal carers to inform practice

To determine gait aid use and decision-making related to usage in people with dementia, and examine factors influencing (1) gait aid use or not; and (2) falls in past year. A survey of informal carers of older people with dementia in the community. Closed questions on gait aid use, falls, timing and sources of gait aid acquisition, and advice received to support use were used. Chi-squared tests (Fisher’s Exact) compared: (1) gait aid users vs non-users and carers’ report of (i) unsteadiness in walking/turning, (ii) dementia severity, (iii) falls in past year, and (2) fallers vs non-fallers and (i) timing of gait aid commencement relative to dementia diagnosis, (ii) whether health professional advice was received regarding use, and iii) regularity of use. Forty-seven completed surveys, 63.8% of care recipients used a gait aid; 56.9% had ≥2 falls in past year; 66.7% commenced use after dementia diagnosis; 25% acquired their aids from non-health professionals; and 37% did not receive advice regarding use. Gait aid users and non-users differed on carer ratings of unsteadiness in walking/turning (p = 0.02). Carers reported important aspects regarding gait aid acquisition, safe gait aid use and benefits which warrant further investigation.IMPLICATIONS FOR REHABILITATIONIn our small sample, use of gait aids by people with dementia was related to the level of unsteadiness in walking and/or turning, and not associated with falling in the past year.People with dementia do not routinely receive professional advice about how to use gait aids, highlighting the potential value of maximizing health professional involvement in gait aid prescription and training.Deterioration in the ability of gait aid use after the diagnosis of dementia indicates a need for re-assessment or re-training of gait aid use over time.Clinical guidelines to facilitate decision-making regarding under what conditions gait aids are beneficial, what duration and aspects require instruction to ensure effective use by people with dementia are needed. In our small sample, use of gait aids by people with dementia was related to the level of unsteadiness in walking and/or turning, and not associated with falling in the past year. People with dementia do not routinely receive professional advice about how to use gait aids, highlighting the potential value of maximizing health professional involvement in gait aid prescription and training. Deterioration in the ability of gait aid use after the diagnosis of dementia indicates a need for re-assessment or re-training of gait aid use over time. Clinical guidelines to facilitate decision-making regarding under what conditions gait aids are beneficial, what duration and aspects require instruction to ensure effective use by people with dementia are needed.</p

Enhancing existing formal home care to improve and maintain functional status in older adults: protocol for a feasibility study on the implementation of the Care to Move (CTM) programme in an Irish healthcare setting

An increasing ageing population leads to greater demand for care services to help maintain people in their own homes. Physical activity programmes have been shown to improve older adults’ functional capacity, enabling the older adult to live independently and maintain functional status. There has been a lack of quality research conducted around physical activity within the landscape of home care services. We describe a feasibility study of implementing the Care to Move (CTM) programme in older adults receiving low-level home care. A Phase 1 mixed-methods feasibility study design will explore the recruitment, attrition, retention, costs to deliver and data loss. It will also explore the acceptability and impact of the CTM programme on older adults and thematic analysis of data collected from older people, home care workers and relevant stakeholders through use of semi-structured interviews and focus groups. We will measure functional status and fall outcomes in older adults receiving low levels of home care, facilitating this population to continue living independently at home and providing data currently not known around this group

A qualitative study of older adults’ experiences of embedding physical activity within their home care services in Ireland

Purpose: Physical activity has been shown to improve older adults’ functional capacity, independence, and quality of life. Ina feasibility study, we embedded a movement approach within older adults existing home care services through “Care to Move”(CTM). The aim of this qualitative study is to explore older adults’ experiences of CTM within their home care support services and to identify the strengths and barriers of engaging in CTM from the perspective of the older recipient. Materials and Methods: We conducted semi-structured telephone interviews with 13 older adults and one informal carer. Topics covered included participants’ overall experiences of CTM, changes to their overall activity and participation, aspects of CTM that they found valuable and issues that were challenging. Interview transcripts were coded and analyzed thematically to capture barriers and facilitators to the approach delivery. Results: Four themes were developed: i) “I have good days and bad days”, ii) “safety and security is the name of the game”, iii) “we’re a team as it stands’, iv) “it’s [COVID-19] depressing for everybody at the moment”. Older adults identified benefits of CTM engagement including improvements in physical and psychological wellbeing. However, subjective frailty and self-reported multi?morbidity influenced overall engagement. Participants expressed concerns around the logistics of delivering CTM and competing care staff interests. The broader role of care staff in supporting CTM was highlighted, as well as the emotional support that staff provided to older adults. Care staff continuity was identified as a barrier to ongoing engagement. The impact of COVID-19 on older adults physical and mental health negatively impacted the delivery of the approach. Conclusion: Our findings suggest that embedding CTM within home care services is feasible and that older adults enjoyed engaging in CTM. Addressing care staff continuity and adopting individual approaches to CTM delivery may enhance the implementation of services </p