Reducing Sedentary Time among Older Adults in Assisted Living: Perceptions, Barriers, and Motivators

Abstract

Older adults accumulate more sedentary time (ST) than any other age group, especially those in assisted living residences (ALRs). Reducing prolonged ST could help maintain function among older adults. However, to develop effective intervention strategies, it is important to understand the factors that influence sedentary behavior. The purpose of this study was to explore perceptions of ST as well as barriers and motivators to reducing ST among older adults in assisted living, in the context of the Social Ecological Model (SEM). Using a qualitative description approach, we sought to learn about participants’ perceptions of sedentary time in their daily lives. Semi-structured focus groups were held at six ALRs with 31 participants (84% women, 83.5 ± 6.5 years). Data were transcribed and coded using an inductive thematic approach. Themes were categorized based on four levels of the SEM: individual, social, physical environment, and organization. Many reported barriers were at the individual level (e.g., lack of motivation, pain, fatigue) while others were associated with the organization or social environment (e.g., safety concerns, lack of activities outside of business hours, and social norms). These findings suggest that there are unique challenges and opportunities to consider when designing ST interventions for assisted living.

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

“…At the organizational level, residents described how the lack of sponsored activities outside of business hours leads to more sedentary behavior during evenings and weekends. Similar to our findings, participants also referenced how the living environment led to a decrease in daily household activities and engagement in more sedentary activities compared to living in their own home [ 36 ]. We provide additional context surrounding the interpersonal relationships between staff and residents and how staff attitudes and behaviors shape the facility culture and contribute to resident sedentary behavior.…”

“…Our work corroborates and expands on previous studies that have used the Social Ecological Model to frame determinants of sedentary behavior in older adults. Individual level factors such as health status, pain, fatigue, and motivation, as well as social level factors including the need or desire for support in reducing sedentary behavior have been expressed by both community-dwelling older adults [ 20 ] and assisted living residents [ 36 ]. While individual and social level factors are common between these populations, the residential living environment presents new influences on sedentary behavior that have not been fully explored.…”

“…While individual and social level factors are common between these populations, the residential living environment presents new influences on sedentary behavior that have not been fully explored. Recently, Voss et al published findings from focus groups with assisted living facility residents across six care homes in Canada [ 36 ]. They identified additional factors unique to the residential care environment that facilitate sedentary behavior in this population.…”

Stand When You Can: development and pilot testing of an intervention to reduce sedentary time in assisted living

“…After the review of literature, we conducted focus groups with older adults in assisted living to identify barriers and motivators to reducing sedentary time. Full details of the focus groups are presented elsewhere [32], but the key findings that informed our intervention are summarized here. In general, residents identified a negative connotation associated with the term "sedentary", and a perception that only passive or solo seated behaviours (e.g.…”

Detecting accelerometer non-wear periods using change in acceleration combined with rate-of-change in temperature

“…Accurate non-wear detection is critical for ensuring clinical utility of remote health assessment since misclassification of behaviors can have significant consequences for activity prescription and monitoring for treatment adherence and effectiveness. For example, recent evidence suggests that the pattern of sedentary behavior, in addition to volume, is linked to physical function, cardiorespiratory fitness [ 29 ], and metabolic outcomes [ 30 , 31 ], emphasizing the risk of misclassifying non-wear periods as sedentary behavior. In older adults and persons with NDD, increased sedentary time or motor symptoms such as akinesia or rigidity in Parkinson’s disease, or hemiplegia following stroke, can complicate accelerometry-derived behavior classification (non-wear, sedentary behavior, or manifestation of disease-specific symptoms).…”