Personal and Environmental Contributors to Sedentary Behavior of Older Adults in Independent and Assisted Living Facilities

Abstract

Sedentary behavior is associated with negative health outcomes and unhealthy aging. Older adults are the most sedentary age group, and decreasing sitting time represents an intervention target for improving health. Determinants of sedentary behavior have been examined in older adults living in their own homes, yet less is known about sedentary behavior of older adults in residential care facilities. The purpose of this study was to explore factors contributing to sedentary behavior among residents of independent and assisted living facilities. We conducted eight focus groups with residents (n = 44) and semi-structured interviews with staff (n = 6) across four living facilities. Audio recordings were transcribed and analyzed using an iterative, inductive approach. Three salient themes were identified. Residents and staff both viewed sedentary behavior negatively unless it was in the context of social engagement. Additionally, fear of falling was discussed as a significant contributor to sedentary behavior. Finally, residents felt the community living environment contributed to their sedentary behavior while staff did not. Our findings provide valuable insight for designing targeted interventions for older adults in residential facilities and suggest thinking beyond the individual and considering environmental influences on sedentary behavior in the residential care setting.

Physical Activity Programming for Older Adults in Assisted Living: Residents’ Perspectives

“…Social engagement, such as through group physical activities, may motivate residents to reduce their sedentary behavior (Voss et al, 2020a). Walking companions or walking groups may provide social support (Kotlarczyk et al, 2020), although residents in our study did not favor larger walking groups. Receiving encouragement from family or AL staff can motivate residents to reduce sedentary time and take walks (Phillips & Flesner, 2013;Voss et al, 2020a).…”

“…Attitudes and beliefs about physical activity identified in the thematic analysis were consistent with previous research. Other studies have reported that AL residents are aware that too much sedentary behavior or not enough physical activity can negatively affect physical and mental health (Kotlarczyk et al, 2020; Phillips & Flesner, 2013; Vos et al, 2019; Voss et al, 2020a) and that lack of motivation (Phillips & Flesner, 2013; Voss et al, 2020a), self-efficacy (Chen et al, 2015), and safety concerns are important (Kotlarczyk et al, 2020; Voss et al, 2020a).…”

“…Residents reinforced the fact that structural factors have a major impact, specifically environmental and policy factors. Space available for being active, such as walking areas and dedicated exercise space and equipment, influences the physical activity of AL residents and requirements for physician permission or supervision are a barrier to residents using exercise space (Kotlarczyk et al, 2020; Phillips & Flesner, 2013). Services provided in AL for activities of daily living and household activities give them fewer reasons to move (Kotlarczyk et al, 2020; Voss et al, 2020a).…”

“…Space available for being active, such as walking areas and dedicated exercise space and equipment, influences the physical activity of AL residents and requirements for physician permission or supervision are a barrier to residents using exercise space (Kotlarczyk et al, 2020; Phillips & Flesner, 2013). Services provided in AL for activities of daily living and household activities give them fewer reasons to move (Kotlarczyk et al, 2020; Voss et al, 2020a). Residents’ dissatisfaction with chair exercise classes and desire for more challenging programs are not surprising given that activities in AL are usually planned according to the “lowest common denominator” of physical and cognitive abilities (Morgan et al, 2014).…”

Indoor Built Environment and Older Adults’ Activity: A Systematic Review

“…We observed several illustrations of the connection between the older adult and their environment. Different settings could potentially support specific types of physical activity: Older adults in collective dwellings often do not engage in as many ADLs because they receive services from the facility (e.g., prepared meals reduce the need to cook) (Kotlarczyk et al, 2020). Similarly, older adults can influence their environments.…”