Factors Influencing Mobility During the COVID-19 Pandemic in Community-Dwelling Older Adults.

OBJECTIVE: To describe and identify factors influencing mobility among older adults during the first 5 months of the COVID-19 pandemic. DESIGN: A cross-sectional telesurvey. SETTING: Community dwelling older adults, situated within the first 5 months of the COVID-19 pandemic, in Hamilton, Canada. PARTICIPANTS: A random sample of 2343 older adults were approached to be in the study, of which 247 completed the survey (N=247). Eligible participants were aged ≥65 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mobility was measured using global rating of change items and the Late Life Function Instrument (LLFI). Multivariate linear regression models were used to examine the association between mobility and related factors based on Webber's model. RESULTS: 247 older adults (29% male, mean age 78±7.3 years) completed surveys between May and August 2020. Respectively, 26%, 10%, and 9%, rated their ability to engage in physical activity, housework, and move around their home as worse compared with the start of the pandemic. The mean LLFI score was 60.9±13.4. In the model, walking volume (ß=0.03 95% confidence interval 0.013, 0.047), fall history (ß=-0.04, 95% confidence interval -0.08, -0.04), male sex (ß=0.06, 95% confidence interval 0.02, 0.09), unpleasant neighborhood (ß=-0.06, 95% confidence interval -0.11, -0.02), musculoskeletal pain (ß=-0.07, 95% confidence interval -0.11, -0.03), and self-reported health (ß=0.08, 95% confidence interval 0.03, 0.13) had the strongest associations with LLFI scores and explained 64% of the variance in the LLFI score. CONCLUSIONS: Physical and environmental factors may help explain poorer mobility during lockdowns. Future research should examine these associations longitudinally to see if factors remain consistent over time and could be targeted for rehabilitation.

People with COPD have greater participation restrictions than age-matched older adults without respiratory conditions assessed during the COVID-19 pandemic.

BACKGROUND: Participation restriction has detrimental effects for older adults but it is unknown how participation differs for people with chronic obstructive pulmonary disease (COPD) compared to older adults of the same age without respiratory conditions. We compared scores on the Late Life Disability Instrument (LLDI) between people with COPD (study group) and a random sample of older adults (control group). METHODS: Participants with COPD (study group) were recruited from two hospitals in Ontario and age- and sex-matched with a ratio of 1:2 with participants from a random sample of community-dwelling older adults who did not report having respiratory conditions (control group). The study group completed the LLDI prior to the COVID-19 pandemic and the control group completed the LLDI at the end of the first wave of the pandemic. LLDI frequency and limitation scores were compared between groups using Wilcoxon rank-sum tests. RESULTS: Forty-six study group participants (mean age 74.2 (SD 5.5) years) and 92 control group participants (mean age 74.4 (SD 5.4) years) were included. Fifty-four percent of the participants were female. The majority of the study group had severe COPD (median forced expiratory volume in one second of 34.5 (25th-75th percentile 27.0-56.0) % predicted). LLDI sores were lower for the study group compared to the control group for both the frequency (median difference -5.4 points, p<0.001) and limitation (median difference -7.6 points, p<0.001) domains. The personal subscale demonstrated the largest magnitude of difference between groups (median difference -13.4 points) and the social subscale demonstrated the smallest magnitude of difference (-5.2 points). CONCLUSION: People with COPD had greater participation restrictions than a random sample of older adults without ongoing respiratory conditions. The differences seen in participation between the two groups may have been reduced due to temporal confounding from the COVID-19 pandemic. While participation is relevant to all older adults, our results suggest that it is especially important that it be assessed in those with COPD.

The Impact of a Canadian Model of Aging in Place on Community Dwelling Older Adults’ Experience of Physical Distancing during the COVID-19 Pandemic

Naturally occurring retirement communities (NORCs) are unplanned communities with a high proportion of residents aged 65 years and older. Oasis is a Canadian aging in place model that combines health and supportive community services for adults aged 65 years and older within NORCs. The aims of this study were to explore how physical distancing restrictions during the COVID-19 pandemic impacted older adults living in a NORC (Oasis members) and to investigate whether Oasis served as a context for social connection and well-being during the COVID-19 pandemic. An interpretive description methodology guided this study. Semi-structured interviews were conducted with nine Oasis members (aged 66–77 years) and two Oasis site coordinators. The Oasis members also completed a social network mapping activity guided by the hierarchical mapping technique. Three overarching themes related to the impact of physical distancing on Oasis members during the COVID-19 pandemic were identified: (1) unintended consequences of physical distancing restrictions on participants’ wellbeing;(2) face-to-face interactions are important for social connection;and (3) family, friend, healthcare provider, and community support mitigated the impact of physical distancing restrictions during the COVID-19 pandemic. In addition, two of Oasis’ core pillars were found to support participants: strengthening social connectivity and connection to pre-existing community services. Findings illustrate that community programs like Oasis acted as a source of resilience during the COVID-19 pandemic and advance our understanding of the impact of aging in place models on community dwelling older adults’ experience of the COVID-19 pandemic.

Donuts et al;showcasing the ‘sweet’ side of online learning

AimsAt the height of the COVID-19 pandemic, traditional and widely-accepted teaching modalities did not meet social distancing requirements and, as a result, many events and educational sessions were cancelled or adjourned. Conventional journal clubs were destined to be one such casualty. Recognising the unique benefits of an active journal club in teaching fundamental critical appraisal skills, facilitating exchange of clinical insight and enabling social interaction, ‘Donuts et al.’ was established. Delivered over an online video platform, on a monthly basis, Donuts et al. is a regional journal club involving paediatric trainees and consultants from all paediatric units across Northern Ireland.MethodsDonuts et al. is delivered using ‘Zoom’ as the digital platform. At the initial and final session of the 2020- 2021 academic year, we utilised the embedded ‘poll’ feature to gather quantitative data, with the aim of mapping the impact of our journal club on our attendees. Collected poll information included: attendance at previous journal clubs, confidence with critical appraisal and the influence Donuts et al. had made on attendees critical appraisal skills and everyday clinical practice.ResultsDuring the initial poll, all paediatric trainees reported having attended a previous journal club, however, almost 50% of respondents did not feel confident in their critical appraisal ability. In comparison, a poll from the final session of the 2020-2021 academic year showed that 93.4% of trainees agreed or strongly agreed the regional journal club had increased their confidence critically appraising a paper and 80% agreed or strongly agreed it had influenced their clinical practice.ConclusionWithin the first year of its introduction, Donuts et al. has been incredibly popular amongst trainees and consultants alike. Junior and senior paediatricians from across the country have displayed an extremely high calibre of presentation and critical appraisal ability. We have witnessed a fantastic level of attendance and engaging clinical discussions between various members of the paediatric multidisciplinary team. As highlighted in the results section, there has been a significant increase in trainees confidence with critical appraisal following the introduction of this educational activity. Building upon our success to date, we have introduced a ‘Statistics topic of the month’ infographic that is presented at the start of each session, with the hopes of enhancing the academic learning potential from each session. More recently, our journal club has been featured in the education section of the Northern Ireland Paediatric Education, Audit and Research (NI PEAR) network website, showcasing the impressive reach and substantial impact we have achieved to date.

How Community-Based Teams Use the Stroke Recovery in Motion Implementation Planner: Longitudinal Qualitative Field Test Study.

BACKGROUND: The Stroke Recovery in Motion Implementation Planner guides teams through the process of planning for the implementation of community-based exercise programs for people with stroke, in alignment with implementation science frameworks. OBJECTIVE: The purpose of this study was to conduct a field test with end users to describe how teams used the Planner in real-world conditions; describe the effects of Planner use on participants' implementation-planning knowledge, attitudes, and activities; and identify factors influencing the use of the Planner. METHODS: This field test study used a longitudinal qualitative design. We recruited teams across Canada who intended to implement a community-based exercise program for people with stroke in the next 6 to 12 months and were willing to use the Planner to guide their work. We completed semistructured interviews at the time of enrollment, monitoring calls every 1 to 2 months, and at the end of the study to learn about implementation-planning work completed and Planner use. The interviews were analyzed using conventional content analysis. Completed Planner steps were plotted onto a timeline for comparison across teams. RESULTS: We enrolled 12 participants (program managers and coordinators, rehabilitation professionals, and fitness professionals) from 5 planning teams. The teams were enrolled in the study between 4 and 14 months, and we conducted 25 interviews. We observed that the teams worked through the planning process in diverse and nonlinear ways, adapted to their context. All teams provided examples of how using the Planner changed their implementation-planning knowledge (eg, knowing the steps), attitudes (eg, valuing community engagement), and activities (eg, hosting stakeholder meetings). We identified team, organizational, and broader contextual factors that hindered and facilitated uptake of the Planner. Participants shared valuable tips from the field to help future teams optimize use of the Planner. CONCLUSIONS: The Stroke Recovery in Motion Implementation Planner is an adaptable resource that may be used in diverse settings to plan community-based exercise programs for people with stroke. These findings may be informative to others who are developing resources to build the capacity of those working in community-based settings to implement new programs and practices. Future work is needed to monitor the use and understand the effect of using the Planner on exercise program implementation and sustainability.

‘Stepping up to Reg’ – a near peer regional teaching programme to support level 1 trainees’ transitioning to the middle-grade rota

BackgroundThe promotion from ‘SHO’ to ‘Registrar’ can be daunting. As a group of senior trainees, we were keen to support our more junior colleagues through this transition by providing a bespoke ‘Stepping up to Reg’ teaching programme, utilising our own recent experiences targeted with stakeholder feedback.ObjectivesTo identify perceived areas for development ahead of transitioning to a middle-grade rota from SHO, consultant and recently appointed registrar perspectives. To create and facilitate a teaching programme to meet these perceived learning needs.MethodsSupported by the Northern Ireland Medical and Dental Training Agency (NIMDTA) School of Paediatrics we assembled a faculty of senior trainees to create and deliver the teaching programme. A pre-course online questionnaire, completed by both SHOs and consultants, identified areas of perceived learning needs and was used to design the content of the programme. The SHO questionnaire included a 5-point Likert scale, to assess their perceived preparedness for certain aspects of the job;managing a resuscitation, phoning the consultant on-call, managing out-patients, safeguarding, prioritising workload and managing colleagues.The same questionnaire was completed 6 months later to assess the experience of their first registrar post and ask ‘in hindsight’ how prepared they actually were to transition for those certain aspects of the job. We then compared these responses to the same questions posed prior to the transition using the Man Whitney U-test.Faced with COVID-19 restrictions we adapted to virtual delivery creating an interactive half day online programme, with the use of breakout rooms, case presentations and question/answer sessions.ResultsThe SHO (n=15) and consultant (n=12) pre-course questionnaires identified some similar themes for development, including the management of paediatric and neonatal emergencies and team management/prioritisation. However, SHOs initially emphasised further specific clinical scenarios as areas of concern whilst consultants suggested a greater focus should be on managerial and career development aspects.On the follow up questionnaire (n=7), trainees identified ‘managing junior colleagues’ as the most challenging aspect of their first registrar post with less emphasis on the management of clinical scenarios.In hindsight, new registrars felt that they were actually better prepared than they had initially thought ‘in general’ (p<0.05) and specifically for ‘managing resuscitations’ and ‘safeguarding scenarios’ (p<0.05). Interestingly, they expressed being less well prepared for ‘managing colleagues’ than they had initially anticipated but this did not reach statistical significance.ConclusionsSHO anxiety during the transition to middle-grade relates to the responsibility of managing emergency situations, but following a 6-month period of ‘on the job’ experience they identified managerial aspects of the role as the biggest challenge, more in line with what consultants had already identified as an important area for development.Trainees responded positively to this near peer teaching programme with plans in place for this to be an annual event. Future iterations of the course need to be revised to continue to incorporate feedback from all stakeholders.

Frailty differences across population characteristics associated with health inequality: a cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVE: To evaluate the pattern of frailty across several of social stratifiers associated with health inequalities. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional baseline data on 51 338 community-living women and men aged 45-85 years from the population-based Canadian Longitudinal Study on Aging (collected from September 2011 to May 2015) were used in this study. PRIMARY OUTCOMES AND MEASURES: A Frailty Index (FI) was constructed using self-reported chronic conditions, psychological function and cognitive status and physical functioning variables. Social stratifiers were chosen based on the Pan-Canadian Health Inequalities Reporting Initiative, reflecting key health inequalities in Canada. Unadjusted and adjusted FIs and domain-specific FIs (based on chronic conditions, physical function, psychological/cognitive deficits) were examined across population strata. RESULTS: The overall mean FI was 0.13±0.08. It increased with age and was higher in women than men. Higher mean FIs were found among study participants with low income (0.20±0.10), who did not complete secondary education (0.17±0.09) or had low perceived social standing (0.18±0.10). Values did not differ by Canadian province of residence or urban/rural status. After simultaneously adjusting for population characteristics and other covariates, income explained the most heterogeneity in frailty, especially in younger age groups; similar patterns were found for men and women. The average frailty for people aged 45-54 in the lowest income group was greater than that for those aged 75-85 years. The heterogeneity in the FI among income groups was greatest for the psychological/cognitive domain. CONCLUSIONS: Our results suggest that especially in the younger age groups, psychological/cognitive deficits are most highly associated with both overall frailty levels and the gradient in frailty associated with income. If this is predictive of later increases in the other two domains (and overall frailty), it raises the question whether targeting mental health factors earlier in life might be an effective approach to mitigating frailty.

The Performance of Digital Monitoring Devices for Oxygen Saturation and Respiratory Rate in COPD: A Systematic Review.

Healthcare access and delivery for individuals with chronic obstructive pulmonary disease (COPD) who live in remote areas or who are susceptible to contracting communicable diseases, such as COVID-19, may be a challenge. Telehealth and remote monitoring devices can be used to overcome this issue. However, the accuracy of these devices must be ensured before forming healthcare decisions based on their outcomes. Therefore, a systematic review was performed to synthesize the evidence on the reliability, validity and responsiveness of digital devices used for tracking oxygen saturation (SpO2) and/or respiratory rate (RR) in individuals with COPD, in remote settings. Three electronic databases were searched: MEDLINE (1996 to October 8, 2020), EMBASE (1996 to October 8, 2020) and CINAHL (1998 to October 8, 2020). Studies were included if they aimed to evaluate one or more measurement properties of a digital device measuring SpO2 or RR in individuals with COPD. Six-hundred and twenty-five articles were identified and after screening, 7 studies matched the inclusion criteria; covering 11 devices measuring SpO2 and/or RR. Studies reported on the reliability (n = 1), convergent validity (n = 1), concurrent validity (n = 2) and predictive validity (n = 2) of SpO2 devices and on the convergent validity (n = 1), concurrent validity (n = 1) and predictive validity (n = 1) of RR devices. SpO2 and RR devices were valid when compared against other respiration monitoring devices but were not precise in predicting exacerbation events. More well-designed measurement studies are needed to make firm conclusions about the accuracy of such devices.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1945021 .