Perceived barriers, facilitators and patterns of physical activity of older old adults living in assisted retirement accommodation

Abstract

There is little data on the physical activity and perceived barriers and facilitators of physical activity of the older old living in assisted care. Physical activity is known to play a key role in healthy ageing and people aged 85 years and older are the largest growing proportion of the population. This study aims to: Identify perceived barriers and facilitators to participating in physical activity for the older old living in assisted care accommodation compared to independent living; assess the relationship of place of residence (assisted care versus independent living) to self-reported and objectively measured physical activity levels and functional indicators (strength and balance); and to assess the value of self-reported physical activity measures in this population, specifically the convergent validity between self-reported and objectively measured physical activity and association with functional indicators. A cross sectional study was undertaken using qualitative and quantitative methods. Focus groups, physical activity and functional indicator measures were conducted with a convenience sample (n=40) of non-demented residents currently living in assisted care (mean age=89.2years) and independent living (mean age =78.9 years) in a southern metropolitan Sydney retirement village. Barrier and facilitator themes were derived from thematic analysis of focus groups' transcripts. Physical activity measures included average steps per day, moderate to vigorous physical activity (MVPA), light intensity physical activity (LIPA) and sitting behaviour measured by Sense Wear accelerometry and self-reported physical activity measured by the International Physical Activity Questionnaire (short-form; IPAQ). Health concerns, fear of injury and motivation were overarching themes of barriers to participation; however, the frequency of these themes differed by place of residence. People living independently more often identified fear of injury and lack of motivation as barriers to physical activity. People living in assisted care more often identified health concerns as barriers to participating in physical activity. The social and physical environments were found to be key facilitators of physical activity. Social support as a facilitator was important for both genders. Staff involvement was identified as a key facilitator of physical activity for people living in assisted care. Whereas people living independently identified other residents or companions as important in facilitating physical activity. Aspects of the physical environment that were reported to increase participation in physical activity for independent living participants were short walking distances to facilities such as the gym, shops and parks. For the assisted living group, aspects of the physical environment that were reported to increase participation in physical activity accessibility of paths and the strategic placement of seats (seating situated with short distances between them). Both groups identified pleasant scenery as an important facilitator of physical activity. This pilot investigation suggests that to keep older old adults physically active, social support and staff involvement are important facilitators for physical activity participation. Attention should be directed to making the physical environment safe and conducive to physical activity participation. This may involve having level paths for walking and strategically placed seating to allow for rest periods. In the older old it appears that increased hours of sitting are related to functional limitations. Therefore, attention should be directed to encouraging older old adults to sit for fewer hours during the day and participate in some form of physical activity. Significant differences in age-adjusted balance and strength capacity were noted between people living in assisted care and independent living accommodation. People living independently had greater leg strength and better balance than people living in assisted care. By contrast, the only differences in age-adjusted physical activity patterns were greater average steps per day for the independent living group. The agreement between MVPA, steps per day and functional indicators (strength and balance) was low. No associations were found between steps per day or MVPA and measures of functional indicators. Sitting behaviour was inversely associated with functional indicators. That is, more hours spent sitting was correlated with decreased measures of strength and balance. Comparison between IPAQ (self-report) and SenseWear (objective) measures indicated a clear pattern of error in overestimating moderate to vigorous physical activity (MVPA) with the IPAQ. The assisted living group overestimated physical activity levels on the IPAQ to a greater degree than the independently living group. There was, however, greater agreement between the IPAQ and SenseWear when measuring sitting behaviour. The participants were able to recall more accurately the amount of time they spent sitting compared to the objective sitting measures. In this study, self ""reported data of physical activity should be taken with great caution in the older old population, especially in assisted care, as they overestimated physical activity levels using the IPAQ a greater degree than those living independently. This study found poor convergent validity between self-reported physical activity measures (IPAQ) and objectively measured (SenseWear) physical activity levels. Functional indicators appear unrelated to measures of physical activity such as MVPA and steps per day highlighting the inability of these aerobic dimensions to influence strength and balance. Strength and balance have been found to be key factors in healthy ageing and preventing falls, hence, it is important to include in questionnaires for older adults, specific questions on strength and balance activities in this population.

Date of Award	2016
Original language	English