Effect of a sit-to-stand activity on mobility outcomes among Canadian continuing care residents with and without dementia

Year 2018, , 65 - 72, 01.09.2018

Susan E. Slaughter Carla Ickert C. Allyson Jones Jeffrey A. Bakal

https://doi.org/10.5505/jaltc.2018.52724

Abstract

The demand for continuing care facilities to support older adults in Canada is expected to increase. Currently, access to rehabilitation and recreation services is limited among this group of older adults. Identifying simple mobility interventions implemented by usual care staff may be a cost-effective way to maintain or improve mobility among older adults in continuing care. This study evaluated the effectiveness of mobility activity, the sit-to-stand activity, on mobility outcomes of long-term care and supportive living residents with and without dementia. Fifteen supportive living facilities and 8 long-term care facilities participated. Eligible residents were: aged ≥ 65 years, medically stable and able to stand up from a chair. Facility healthcare aide staff received training on the sit-to-stand activity by study educators and were asked to complete the activity with participating residents four times daily. Staff documented completion of the activity on flow sheets. Two mobility outcomes, time to complete first sit-to-stand and number of sit-to-stand repetitions completed in 30-seconds, were measured by research assistants at the beginning and end of the trial for all participants. Demographic information, including age, sex, and dementia diagnosis, was gathered from health records. Data were analyzed using receiver operating characteristic curves and logistic regression. Across all 296 residents, mean time to complete the first sit-to-stand at baseline was 5.58 seconds (SD = 4.20) and the final mean time was 4.63 (SD = 3.71) seconds (p<.001). Dementia did not show a significant effect in likelihood of losing repetitions (p =.12) or time (p =.12). Residents in supportive living facilities were approximately half as likely as their long-term care counterparts to gain two or more seconds on their time for the first sit-to-stand (adjusted odds ratio = 0.48; 95% CI: 0.26-0.88, p =.02). The sit-to-stand activity is a low-cost, simple mobility intervention that may improve the mobility of older adults in continuing care.

Key Practitioners Message

• Older adults in Canadian continuing settings have limited access to rehabilitation and recreation therapies.
• Usual care staff may be able to implement mobility activities to sustain resident mobility, which is essential for the quality of life and lowering care costs.
• A simple mobility intervention, the sit-to-stand activity, can be implemented by usual care staff and may help frail older adults maintain mobility.
• The mobility of both residents with and without dementia can benefit from the sit-to-stand activity.
  
  

Keywords

Sit-To-Stand Activity, Mobility Outcomes, Dementia, Long-Term Care, Continuing Care, Health Care Aides, Care Staff

References

• AHS (Alberta Health Services) (2010). Admission guidelines for publically funded continuing care living options. Retrieved from https://www.albertahealthservices.ca/assets/info/seniors/if-sen-living-optionguidelines.pdf
• Auyeung, T., Kwok T., Lee, J., Leung, P., Leung, J., & Woo, J. (2008). Functional decline in cognitive impairment: The relationship between physical and cognitive function. Neuroepidemiology, 31, 167- 173.
• Bauman, A., Merom, D., Bull, R., Buchner, D., & Singh, F. (2016). Updating the evidence for physical activity: Summative reviews of the epidemiological evidence, prevalence, and interventions to promote “Active Aging”. The Gerontologist, 56(S2), S268-S280.
• Bohannon R. (1995) Sit-to-stand test for measuring performance of lower extremity muscles. Perceptual and Motor Skills, 80,163-166.
• Carpenter, G. I., Hastie, C. L., Morris, J. N., Fries, B. E., & Ankri, J. (2006). Measuring change in activities of daily living in nursing home residents with moderate to severe cognitive impairment. BMC Geriatrics, 6, 7.
• CIHI (Canadian Institute of Health Information) (2017a). Seniors in transition: Exploring pathways across the care continuum. Ottawa, ON.
• CIHI (Canadian Institute of Health Information) (2017b). CCRS Profle of Residents in Continuing Care Facilities 2016-2017. Retrieved from https://www.cihi.ca/ en/quick-stats
• CIHI (Canadian Institute of Health Information) (2013). Residential Long-Term Care Financial Data Tables 2013. Retrieved from https://www.cihi.ca/en/quickstats
• Chou, C., Hwang, C., & Wu, Y. (2012). Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis. Archives of Physical Medicine and Rehabilitation, 93, 237-244.
• de Labra, C., Guimaraes-Pinheiro, C., Maseda, A., Lorenzo, T., & Millan-Calenti, J. (2015). Effects of physical exercise interventions in frail older adults: A systematic review of randomized controlled trials. BMC Geriatrics, 15, 154.
• Douglas, N. F., Campbell, W. N., & Hinckley, J. J. (2015). Implementation science: Buzzword or game changer? Journal of Speech, Language, and Hearing Research, 58, S1827-S1836.
• Estabrooks, C., Squires, J., Carleton, H., Cummings, G., & Norton, P. (2015). Who is looking after Mom and Dad? Unregulated workers in Canadian long-term care homes. Canadian Journal on Aging, 34(1), 47- 59.
• Fried, L., Tangen, C., Walston, J., Newman, A., Hirsch, C., Gottdiener, J., … McBurnie, M. A. (2001). Frailty in older adults: Evidence for a phenotype. Journal of Gerontology: Medical Sciences, 56A(3), M146-M156.
• Fries, B., Schneider, D., Foley, W., Gavazzi, M., Burke, R., & Cornelius, E. (1994). Refining a case-mix measure for nursing homes: Resource utilization groups (RUG-III). Medical Care, 32(7), 668-685.
• Jones, C. J., Rikli, R. E., & Beam, W. C. (1999). A 30s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly for Exercise and Sport, 70, 113-117.
• Kagwa, S., Bostrom, A-M., Ickert, C., & Slaughter, S. (2017). Optimizing mobility through the sit-to-stand activity for older people living in residential care facilities: A qualitative interview study of healthcare aide experiences. International Journal of Older People Nursing, 13, e12169.
• Levy, C. R., Zargoush, M., Williams, A. E., Williams, A. R., Giang, P., Wojtusiak, J., … Alemi, F. (2016). Sequence of functional loss and recovery in nursing homes. Gerontologist, 56(1), 52-61.
• Liu, C.-J., & Latham, N. (2011). Can progressive resistance strength training reduce physical disability in older adults? A meta-analysis study. Disability and Rehabilitation, 33(2), 87-97.
• McCarthy, E. K., Horvat, M. A., Holtsberg, P. A., & Wisenbaker, J. M. (2004). Repeated chair stands as a measure of lower limb strength in sexagenarian women. Journal of Gerontology: Medical Sciences, 59A, 1207-1212.
• Paterson, D. H., Jones, G. R., & Rice, C. L. (2007). Ageing and physical activity: Evidence to develop exercise recommendations for older adults. Canadian Journal of Public Health, 98(Suppl. 2), S69-S108.
• PHAC (Public Health Agency of Canada) (2012). Physical activity tips for older adults (65 years and older). Retrieved from https://www. canada.ca/en/public-health/services/health-promotion/healthy-living/physical-activity/physical-activity-tips-older-adults-65-years-older.html
• Roberts, C. E., Phillips, L. H., Cooper, C. L., Gray, S., & Allan, J. L. (2017). Effect of different types of physical activity on activities of daily living in older adults: Systematic review and meta-analysis. Journal of Aging and Physical Activity, 25, 653-670.
• Slaughter, S. E., Eliasziw, M., Morgan, D., & Drummond, N. (2010). Incidence and predictors of excess disability in walking among nursing home residents with middle-stage dementia: A prospective cohort study. International Psychogeriatrics, 23(1), 54-64.
• Slaughter, S. E., Estabrooks, C. A., Jones, C. A., Wagg, A. S., & Eliasziw, M. (2013). Sustaining Transfers through Affordable Research Translation (START): study protocol to assess knowledge translation interventions in continuing care settings. Trials, 14, 355.
• Slaughter, S. E., Wagg, A., Jones, A., Schopflocher, D., Ickert, C., Bampton, E., … Estabrooks, C. (2015). Mobility of Vulnerable Elders (MOVE) study: Effect of the sit-to-stand activity on mobility, function and quality of life. Journal of the American Medical Directors Association, 16(2), 138-143.
• Statistics Canada (2013). Population Projections for Canada (2013 to 2063), Provinces and Territories (2013) to 2038. Retrieved from http://www.statcan. gc.ca/pub/91-520-x/91-520-x2014001-eng.pdf
• Steib, S., Schoene, D., & Pfeifer, K. (2010). Dose-response relationship of resistance training in older adults: A meta-analysis. Medicine and Science in Sport and Exercise, 42(5), 902-914.
• Tworek, K., Ickert, C., Bakal, J., Eliasziw, M., Wagg, A. S., Jones, C. A., & Slaughter, S. (in press). Examining the impact of knowledge translation interventions on uptake of evidence-based practices by care aides in continuing care. Worldviews on Evidence-Based Nursing