Daily activity patterns in older adults receiving initial support: the association between daily steps and sitting in bouts of at least 60 min.

BACKGROUND: Aging has a significant impact on health, underlining the importance of maintaining physical function and reducing time spent sitting among older adults. To understand how to reduce prolonged sitting or increase physical activity, factors related to the daily living and observed daily activity patterns should be explored. This study aimed to investigate the association between daily steps, self-rated health, physical activity, sedentary behavior, motivation to exercise and fear of falling among older adults receiving initial support. METHOD: Cross-sectional design with total population questionnaire data from adults aged ≥ 60 years (n = 917), living at home with initial support from municipal care in southern Sweden. The older adults were offered to participate in a follow-up study measuring daily activity patterns with accelerometers (n = 72). Linear regression was used to analyze associations between daily steps and possible predictors. RESULTS: The linear model ([Formula: see text]0.478) showed that sitting in unbroken bouts of > 60 min (ß = -0.313, p < 0.05), walking independently outdoors (ß = 0.301, p < 0.05), intending to increase physical activity (ß = -0.294, p < 0.05), sex (ß = 0.279, p < 0.05), relative autonomy index (ß = 0.258, p < 0.05), fear of falling (ß = -0.238, p < 0.05), and self-rated health (ß = 0.213, p < 0.05) predicted daily steps. CONCLUSION: The model of predictors brings new understanding regarding daily steps among community-dwelling older adults. The association between sitting in bouts of > 60 min and daily steps is interesting as 35% of participants had a number of sitting bouts that on average, showed 30% less steps taken. Minimizing long sitting bouts and maintaining physical functioning to promote independence when walking outdoors can be tools for clinical practitioners devising interventions to break prolonged sitting among community-dwelling older adults. Future research should prioritize studying older adults' outdoor walking independence, including its relation to walking with or without assistive devices and its impact on physical activity and sedentary behavior.

The meaning of sedentary behavior among older adults: a phenomenological hermeneutic study.

BACKGROUND: A sedentary lifestyle has implications for health and well-being. For healthy ageing, it is recommended to interrupt prolonged sitting; however, little is known about the meaning of sedentary behavior among older adults. The aim of this study was to understand the meaning of sedentary behavior among older adults with initial support from community care. METHODS: A phenomenological hermeneutics approach was used, and individual interviews were conducted with sixteen older adults aged 70 to 97 years, by phone and face to face. The older adults lived in ordinary housing in southern Sweden and received initial support from community care. RESULTS: The interviews yielded three key themes: Being sedentary is an unnatural part of life, having an ageing body means unwanted frailty, and having a sedentary lifestyle is based on conscious choices. CONCLUSION: Being sedentary means having a lack of physical activity and social interactions, resulting in wanting to be more physically active than sometimes possible. Clinical practitioners should bear in mind that becoming more sedentary is inevitable with an ageing body, but that older adults may have an innate desire to be as physically active as possible. A lifelong exposure to physical activity, the possibility of well-being found in sedentary activities and the impact of social networks should not be overlooked when creating clinical interventions to break unhealthy sedentary behavior among older adults. To increase the understanding of sedentary behavior among older adults, future research could focus on the impact of physical impairment on sedentary behavior and the relationship between sedentary behavior and physical activity throughout life.

Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study.

BACKGROUND: Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs. OBJECTIVE: This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home. METHODS: This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework. RESULTS: The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, "Breathing exercises" and "Picking up from the floor," revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested. CONCLUSIONS: This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support.

Embodied navigation: the influence of lived experience on physical activity and sedentary behavior among older adults.

PURPOSE: The impact of a sedentary lifestyle on health and well-being is well recognized. However, there is limited understanding of how a lifetime of physical activity and sedentary behaviour influences an active lifestyle in older adults. The aim of this study was to describe how lived experience of physical activity and sedentary behaviour impacts daily activities among older adults, from a life course perspective. METHODS: Qualitative content analysis was used; individual telephone interviews were conducted with fourteen older adults aged 71 to 92 years. The participants received initial support from community care and lived in ordinary housing in southern Sweden. RESULTS: The interviews yielded one theme, "Navigating with an embodied activity compass," and two sub-themes: "Being guided by the past" and "Unveiling pathways through body awareness." CONCLUSIONS: Our study highlights how older adults' lived experiences of physical activity, with their connections to body awareness and acceptance, impact daily physical activity. These findings offer new knowledge for clinical practitioners balancing recommendations of sedentary behaviour and physical activity, to promote healthy daily physical activity among older adults. Future research and policies should consider the lived experiences of older adults when addressing public health matters related to sedentary behaviour and physical activity.

Self-care management and experiences of using telemonitoring as support when living with hypertension or heart failure: A descriptive qualitative study.

Background: The need for support in self-care at home will increase with the growing older population with chronic illness. Many people have one or more chronic illnesses and struggle with self-care activities, often supported by informal carers at home. The rapid development of telemonitoring applications in primary care calls for increased knowledge about how people with chronic illness and their informal carers experience the use of telemonitoring applications at home. Objective: This study aims to describe experiences of self-care management at home when living with hypertension or heart failure, with support from primary care through telemonitoring. Design: A descriptive qualitative approach was applied using semi-structured interviews with patients and informal carers in a pilot project on telemonitoring of chronic illness in primary care from October 2019 to June 2021. Setting: Participants were recruited from three primary care settings and one medical department at one hospital in a region in southern Sweden. Participants: A purposive sample of patients (n = 20) with chronic illness living at home and their informal carers (n = 4) were recruited. Methods: Semi-structured telephone interviews were conducted, guided by open-ended questions targeting patients' and informal carers' experiences of self-care management at home and using telemonitoring applications as support. Transcribed interviews were analyzed through qualitative content analysis. Results: 'Developing the capability to perform self-care with technology as both an intruder and an invited guest' was the unifying theme that tied together the experiences of patients with chronic illness and their informal carers. Experiences of self-care management included acquiring necessary self-care skills, expertise in managing their chronic illness, and reciprocal relationships with healthcare professionals when using telemonitoring application as support in self-care monitoring of vital parameters. However, uncertainty regarding the interpretation of symptoms and a feeling of exclusion were seen. Conclusions: Telemonitoring applications offer potential support for patients with chronic illnesses and their informal carers, enabling them to establish new routines and enhance motivation for self-care activities at home. This study emphasizes the adaptability of telemonitoring applications in meeting the unique support requirements of patients and informal carers when managing self-care at home.

A comparative study of the 2D- and 3D-based skeleton avatar technology for assessing physical activity and functioning among healthy older adults.

Background: Maintaining physical activity (PA) and functioning (mobility, balance) is essential for older adults' well-being and quality of life. However, current methods (functional tests, self-reports) and available techniques (accelerometers, sensors, advanced movement analysis systems) for assessing physical activity and functioning have shown to be less reliable, time- and resource-consuming with limited routine usage in clinical practice. There is a need to simplify the assessment of physical activity and functioning among older adults both in health care and clinical studies. This work presents a study on using Skeleton Avatar Technology (SAT) for this assessment. SAT analyzes human movement videos using artificial intelligence (AI). The study compares handy SAT based on 2D camera technology (2D SAT) with previously studied 3D SAT for assessing physical activity and functioning in older adults. Objective: To explore whether 2D SAT yields accurate results in physical activity and functioning assessment in healthy older adults, statistically compared to the accuracy of 3D SAT. Method: The mobile pose estimation model provided by Tensorflow was used to extract 2D skeletons from the video recordings of functional test movements. Deep neural networks were used to predict the outcomes of functional tests (FT), expert-based movement quality assessment (EA), accelerometer-based assessments (AC), and self-assessments of PA (SA). To compare the accuracy with 3D SAT models, statistical analysis was used to test whether the difference in the predictions between 2D and 3D models is significant or not. Results: Overall, the accuracy of 2D SAT is lower than 3D SAT in predicting FTs and EA. 2D SAT was able to predict AC with 7% Mean Absolute Error (MAE), and self-assessed PA (SA) with 16% MAE. On average MAE was 4% higher for 2D than for 3D SAT. There was no significant difference found between the 2D and the 3D model for AC and for two FTs (30 seconds chair stand test, 30sCST and Timed up and go, TUG). A significant difference was found for the 2D- and 3D-model of another FT (4-stage balance test, 4SBT). Conclusion: Altogether, the results show that handy 2D SAT might be used for assessing physical activity in older adults without a significant loss of accuracy compared to time-consuming standard tests and to bulky 3D SAT-based assessments. However, the accuracy of 2D SAT in assessing physical functioning should be improved. Taken together, this study shows promising results to use 2D SAT for assessing physical activity in healthy older adults in future clinical studies and clinical practice.

'We just have to make it work': a qualitative study on assistant nurses' experiences of patient safety performance in home care services using forum play scenarios.

OBJECTIVE: Safety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients' functioning and health. The aim of this study is to explore assistant nurses' adaptive responses to everyday work to ensure safe care in the home care context. DESIGN: A qualitative approach using the drama-based learning and reflection technique forum play with subsequent group interviews. The audio-recorded interviews were transcribed and analysed with thematic analysis. SETTING: Home care services organisations providing care to older people in their private homes in two municipalities in southern Sweden. PARTICIPANTS: Purposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic. RESULTS: Home care workers' adaptive responses to provide safe home care were driven by an ambition to 'make it work in the best interests of the person' by adjusting to and accommodating care recipient needs and making autonomous decisions that expanded the room for manoeuvrability, while weighing risks of a trade-off between care standards and the benefits for the community-dwelling older people's independent living. Adaptations to ensure information transfer and knowledge acquisition across disciplines and borders required reciprocity. CONCLUSIONS: Safety performance in home care service is dependent on the staff closest to the older people, who deal with safety risks and ethical dilemmas on a day-to-day basis and their access to information, competence, and resources that fit the demands. A proactive leadership characterised by mutual trust and adequate support for decision making is suggested. Managers and decision-makers across healthcare and social care need to consider how they can develop interprofessional collaborations and adaptive routines supporting safety from a broader perspective.

Is that really my movement? - Students' experiences of a video-supported interactive learning model for movement awareness.

Healthcare staff and students have a great risk of developing musculoskeletal symptoms. One cause of this is heavy load related work activities such as manual handling, in which the quality of individual work technique may play a major role. Preventive interventions and well-defined educational strategies to support movement awareness and long-lasting movement changes need to be developed. The aim of the present study was to explore nursing students' experiences of a newly developed interactive learning model for movement awareness. The learning model, which is based on a life-world perspective with focus on interpersonal interaction, has been used with 11 undergraduate students from the second and final year. Each student participated in three individual video sessions with a facilitator. Two individual interviews were carried out with each student during the learning process and one interview 12-18 months after the last session. The interviews were audio-recorded and transcribed verbatim, and a phenomenological hermeneutic method inspired by Paul Ricoeur and described by Lindseth and Norberg was used to interpret the interviews and diary notes. The interpretation resulted in three key themes and nine subthemes. The key themes were; "Obtaining better preconditions for bodily awareness," "Experiencing changes in one's own movement," and "Experiencing challenges in the learning process." The interactive learning model entails a powerful and challenging experience that develops movement awareness. The experience of meaningfulness and usefulness emerges increasingly and alternates with a feeling of discomfort. The learning model may contribute to the body of knowledge of well-defined educational strategies in movement awareness and learning in, for example, preventive interventions and ergonomic education. It may also be valuable in other practical learning situations where movement awareness is required.

Impact of musculoskeletal symptoms on general physical activity during nursing education.

Nursing education should prepare students for a lifelong professional career including managing clinical physical demands. Musculoskeletal symptoms, such as bodily pain, have been reported among nurses and nursing students but less is known about the impact of symptoms in daily activities. The aim was to explore the prevalence of self-reported musculoskeletal symptoms and their impact on general physical activity among nursing students. This cross-sectional study was based on a questionnaire to all undergraduate nursing students at one university. The prevalence of symptoms and physical impact during past 3 and 12 months was calculated for each study year. Odds ratio was analysed with logistic regression. Of 348 students 224 responded, 84% women, mean age 24.6 years (range 20-46). Of those 143 (64%) reporting symptoms during the past 12 months, 91 (64%) reported impact on physical activities. Most commonly reported were everyday activities such as transportations and prolonged sitting. The odds ratio for reporting symptoms was 1.8 for year 2 (95% CI: 0.9-3.5), and 4.7 for year 3 (95% CI: 2.1-10.7). The prevalence of musculoskeletal symptoms was high among nursing students and higher the final study year and not only resulted in discomfort but had an impact on the students' general physical activities.