Long-term care home residents' experiences with socially assistive technologies and the effectiveness of these technologies: a mixed methods systematic review.

OBJECTIVE: The objectives of this review were to determine the effectiveness of socially assistive technologies for improving depression, loneliness, and social interaction among residents of long-term care (LTC) homes, and to explore the experiences of residents of LTC homes with socially assistive technologies. INTRODUCTION: Globally, the number of older adults (≥ 65 years) and the demand for LTC services are expected to increase over the next 30 years. Individuals within this population are at increased risk of experiencing depression, loneliness, and social isolation. The exploration of the extent to which socially assistive technologies may aid in improving loneliness and depression while supporting social interactions is essential to supporting a sustainable LTC sector. INCLUSION CRITERIA: This mixed methods systematic review included studies on the experiences of older adults in LTC homes using socially assistive technologies, as well as studies on the effectiveness of these technologies for improving depression, loneliness, and social interaction. Older adults were defined as people 65 years of age and older. We considered studies examining socially assistive technologies, such as computers, smart phones, tablets, and associated applications. METHODS: A JBI mixed methods convergent, segregated approach was used. CINAHL (EBSCOhost), MEDLINE (Ovid), Embase, APA PsycINFO (EBSCOhost), and Scopus databases were searched on January 18, 2022, to identify published studies. The search for unpublished studies and gray literature included ProQuest Dissertations and Theses Global, Open Access Theses and Dissertations, Google, and the websites of professional organizations associated with LTC. No language or geographical restrictions were placed on the search. Titles, abstracts, and full texts of included studies were screened by 2 reviewers independently. Included studies underwent quality appraisal and data extraction. Quantitative and qualitative data findings were analyzed separately and then integrated. Where possible, quantitative data were synthesized using comparative meta-analyses with a fixed-effects model. RESULTS: From 12,536 records identified through the search, 14 studies were included. Quantitative (n=8), mixed methods (n=3), and qualitative (n=3) approaches were used in the included studies, with half (n=7) using quasi-experimental designs. All studies received moderate to high-quality appraisal scores. Comparative meta-analyses for depression and loneliness scores did not find any significant differences, and narrative findings were mixed. Qualitative meta-aggregation identified 1 synthesized finding (Matching technology functionality to user for enhanced well-being) derived from 2 categories (Enhanced sense of well-being, and Mismatch between technology and resident ability). CONCLUSIONS: Residents' experiences with socially assistive technologies, such as videoconferencing, encourage a sense of well-being, although quantitative findings related to depression and loneliness reported mixed impact. Residents experienced physical and cognitive challenges in learning to use the technology and required assistance. Future work should consider the unique needs of older adults and LTC home residents in the design and use of socially assistive technologies. REVIEW REGISTRATION: PROSPERO CRD42021279015.

Relationship of body mass index with frailty and all-cause mortality among middle-aged and older adults.

BACKGROUND: Parallel to growth of aging and obese populations, the prevalence of metabolic diseases is rising. How body mass index (BMI) relates to frailty and mortality across frailty levels is controversial. We examined the associations of high BMI with frailty and mortality and explored the effects of percent body fat on these associations. METHODS: We included 29,937 participants aged ≥50 years from the 2001-2006 National Health and Nutrition Examination Survey (NHANES) cohorts (N=6062; 53.7% females) and from wave 1 (2004) of Survey of Health, Ageing and Retirement in Europe (SHARE) (N=23,875; 54% females). BMI levels were categorized as: normal: 18.5-24.9 kg/m2, overweight: 25.0-29.9, obese grade 1: 30.0-34.9, and obese grade 2 or 3: >35.0. A frailty index (FI) was constructed excluding nutrition-related items: 36 items for NHANES and 57 items for SHARE. We categorized the FI using 0.1-point increments: FI ≤ 0.1 (non-frail), 0.1 < FI ≤ 0.2 (very mildly frail), 0.2 < FI ≤ 0.3 (mildly frail), and FI > 0.3 (moderately/severely frail). Percent body fat was measured using DXA for NHANES participants. All-cause mortality data were obtained until 2015 for NHANES and 2017 for SHARE to estimate 10-year mortality risk. All analyses were adjusted for age, sex, educational, marital, employment, and smoking statuses. RESULTS: Mean age of participants was 63.3±10.2 years for NHANES and 65.0±10.0 years for SHARE. In both cohorts, BMI levels ≥25 kg/m2 were associated with higher frailty, compared to normal BMI. In SHARE, having a BMI level greater than 35 kg/m2 increased mortality risk in participants with FI≤0.1 (HR 1.31, 95%CI 1.02-1.69). Overweight participants with FI scores >0.3 were at lower risk for mortality compared to normal BMI [NHANES (0.79, 0.64-0.96); SHARE (0.71, 0.63-0.80)]. Higher percent body fat was associated with higher frailty. Percent body fat significantly mediated the relationship between BMI levels and frailty but did not mediate the relationship between BMI levels and mortality risk. CONCLUSIONS: Being overweight or obese is associated with higher frailty levels. In this study, we found that being overweight is a protective factor of mortality in moderately/severely frail people and obesity grade 1 may be protective for mortality for people with at least a mild level of frailty. In contrast, obesity grades 2 and 3 may be associated with higher mortality risk in non-frail people. The relationship between BMI and frailty is partially explained by body fat.

Nursing Moral Distress and Intent to Leave Employment During the COVID-19 Pandemic.

BACKGROUND: Complexity in nursing practice creates an intense and stressful environment that may lead to moral distress (MD) and registered nurses (RNs) seeking other employment. LOCAL PROBLEM: In 2020, the RN turnover rate was 8%, with postpandemic turnover projected to reach 13%. METHODS: The Measure of Moral Distress for Health Care Professionals (MMD-HP) was used to measure the frequency and level of RNs' MD. RESULTS: t tests showed significant differences for 16 of 27 MMD-HP items in RN intent to leave. RNs had 2.9 times the odds of intent to leave (P = .019) due to perceived issues with patient quality and safety and 9.1 times the odds of intent to leave (P < .001) due to perceived issues with the work environment. Results explained 40.3% of outcome variance. CONCLUSIONS: MD related to work environment or patient quality and safety were significant factors in RN intent to leave their position.

Exploring the Association of a Total Physical Activity Energy Expenditure and Diabetes Mellitus in Adults: A Cross-Sectional Analysis of the Canadian Health Measures Survey.

Background: Physical activity (PA) guidelines for adults recommend participation in aerobic activities of moderate-to-vigorous intensity and a minimum of two sessions of resistance training (RT) weekly. These guidelines account for a small amount of the total PA energy expenditure and include no recommendation for low intensity activities (sleeping, sedentary behavior, and light intensity PA). Consequently, there is a need to investigate the benefits of total PA energy expenditure and diabetes mellitus (DM); to investigate the association between total PA energy expenditure and DM in adults aged 45 years or above. Methods: Data from the Canadian Health Measures Survey (CHMS; n = 5591) were used for the cross-sectional analysis. DM was measured using hemoglobin glycated (A1c) and questionnaires in adults aged 45 and above. PA and sedentary behavior were estimated using accelerometry. Sleep and RT were self-reported. Total PA energy expenditure was computed using the sum of metabolic equivalent of task-min/week. Results: The mean age of the sample was 58.0 ± 0.2 years old. No associations were observed between total PA energy expenditure and self-reported T2DM in all models (P > 0.05). For objectively measured DM, this association was significant when adjusted for age, sex, ethnicity, and smoking [OR: 0.45; 95% CI (0.25-0.80)]; however, the association was no longer significant once adjusted for waist circumference and further adjusted for meeting the International PA Guidelines [OR: 0.64; 95% CI (0.33-1.27)] (P > 0.05). Conclusion: Total PA energy expenditure performed weekly is not associated with DM when considering other known risk factors, including waist circumference and meeting the PA guidelines.

Potential functional benefits of a comprehensive evaluation of physical activity for aging adults: a CLSA cross-sectional analysis.

BACKGROUND: Physical activity recommendations for aging adults do not account for possible benefits of light-intensity physical activity on physical function. The purpose of this study was to assess if a sum of all physical activities (regardless of intensity) related to physical function for aging adults, independent of physical activity guidelines. METHODS: This cross-sectional study was conducted with baseline data of the Canadian Longitudinal Study on Aging (CLSA n = 25,072) including ages from 45 to 85. Physical activity was collected via the Physical Activity Scale for Elderly questionnaire. The sum of all activities, based on the Metabolic Equivalent of a Task (MET), was called Total Index. Physical function was derived from objective measures. Logistic regression was used for statistical analysis based on the specific age and sex median values of physical function. RESULTS: The Total Index was associated with being in the lowest median of physical function when adjusted for the physical activity guidelines and other potential confounders (OR = 1.02, 95% CI = 1.01-1.03, p < 0.05). CONCLUSION: This study suggests that components of physical activity not currently included in current guidelines may be associated with better physical function outcomes for aging adults.

Association between physical function and various patterns of physical activity in older adults: a cross-sectional analysis.

BACKGROUND: To improve physical function, physical activity (PA) guidelines for older adults recommend completing PA in bouts of 10 min or more. Spontaneous PA (< 10 min) can also benefit older adults. However, a paucity of research exists examining if shorter bouts of PA are associated with greater physical function. AIM: To determine the association between various patterns of PA and the likelihood of greater physical function in older adults. METHODS: Older adults from the 2003-2004 and 2005-2006 cycles of the National Health and Nutrition Examination Survey were included for analysis. PA lasting 1, 5, 10, 30, and 60 min was quantified using accelerometers. Physical function was assessed using a Likert scale reflecting the self-reported capability to complete 11 tasks. A single function score was then computed using factor analysis. Logistic regression analyses calculated the association between PA bout length and the likelihood of above average function. RESULTS: PA performed in 1-min (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.01-1.03), 5-min (OR 1.02; CI 1.01-1.03), or 10-min bouts (OR 1.02; CI 1.01-1.03) was associated with greater physical function following adjustment for confounders. When scaled to represent an accumulation of 10 min of MVPA, likelihoods increased for both 1-min ([OR] 1.25; 95% [CI] 1.11-1.39) and 5-min (OR 1.22; 95% CI 1.08-1.37) bouts. DISCUSSION/CONCLUSIONS: Our findings suggest bouts of PA lasting 10 min or shorter in duration are associated with greater physical function in older adults.

Association between Functional Movements Skills and Health Indicators in Children Aged between 9 and 12 Years Old.

Background: Children's health is a current concern and data suggests that poor fundamental movement skills (FMS) could be associated with poor health, which may or may not be mediated by low physical activity level. However, tools to assess FMS have not been standardized, and could consequently lead to different associations between FMS and health indicators. Objective: The primary objective of this study was to evaluate the associations between FMS and health indicators using two different FMS measurement tools often used in Canada. Methods: A total of 145 children between the ages of 9 to 12 were recruited from schools, after school programs, and summer camps in 2016. FMS were evaluated using the Passport for Life (bound, plank, run, kick, throw) and the PLAYbasic (run, hop, throw, kick, and balance). The association between each test and an average score for each tool were tests with health indicators including anthropometric measures, grip strength, cardiorespiratory fitness, and percent body fat. Results: Participants were composed of 54.2% boys aged 10.4 ± 1.2 years with an average body mass index of 18.8 ± 3.8 kg/m². The association between the average score of both tools was 0.77 (p < 0.01), body mass index was significantly associated with 67% of FMS elements using the Passport for Life (r ranging from -0.18 to -0.32; p < 0.05), and 60% of FMS using the PLAYbasic (r ranging from -0.15 to -0.30; p < 0.05). There were no significant differences between the associations of the health indicators with FMS and either FMS assessment tool (Passport for Life and PLAYbasic) (p = 0.05). Average score of FMS was significantly associated with all health indicators using both PLAYbasic and Passport for Life (all p < 0.05). Conclusions: Health indicators in children are associated with FMS regardless of whether the Passport for Life or the PLAYbasic was used as the assessment tool. It is worth investigating if interventions that improve FMS lead to improvements in these health indicators.

Resistance Training Contribute to the Aerobic Components of an Exercise Session in Adults but not as Much in Older Adults.

Previous research has indicated that active adults are able to achieve moderate intensity as measured via heart rate during a typical resistance training (RT) session. The main objective was to identify if overweight adults and older adults can reach aerobic moderate intensity at a rate comparable to adults displaying a recommended body mass index. Twenty participants in each group were asked to visit a fitness facility twice if they self-reported doing RT for a minimum two days per week. At the first session baseline characteristics and maximal lifting capacity for each RT exercise. At the second, intensity was monitored via heart rate monitor during a RT exercise program composed of 10 exercises targeting major muscle groups. Three sets of 10 repetitions at 70% of maximal load were completed for each exercise. Moderate intensity was defined as a minimum of 40% of heart rate reserve. The proportion of time spent at moderate to vigorous intensity between the comparison group and the overweight adult group was not significantly different, with a median (25th-75th) proportion time of 82.6% (69.2-94.6) versus 92.5% (73.3-99.1); p=.54 or an average time of 42 minutes versus 45 minutes. The older adults group, however, spent a lower proportion of time at moderate to vigorous intensity compared with the comparison group, 51.5% (22.0-86.6) or 24 minutes; p<.01 compared with the comparison group. This study suggests that a good proportion of time spent doing RT can contribute to an aerobic component of the international guidelines, and therefore reduce the weekly time commitment especially for men and women age below 60 years old.