Forskningsartikler

Sammendrag

Hensikt: Beboere på langtidsopphold på sykehjem har omfattende helsebehov og krever tverrfaglig oppfølging. Til tross for krav om at fysioterapi-tjenester skal være tilgjengelige, er kunnskap om faktisk bruk begrenset. Hensikten med studien er å kartlegge organisering, tidsbruk og omfang av fysioterapitjenester under langtidsopphold på sykehjem.

Design: Tverrsnittstudie

Metode og materiale: Digital undersøkelse med spørsmål om tidsbruk, omfang og organisering av fysioterapiressurser under langtidsopphold på sykehjem ble sendt til leder for kommunale fysioterapeuter i alle kommuner i Norge.

Resultat: Totalt 262 av 357 kommuner besvarte undersøkelsen. De fleste kommunene (n=214, 82 %) hadde ikke avsatt fysioterapistilling(er) til beboere på langtidsopphold på sykehjem. Median tidsbruk for alle kommunene var 2,9 (0-50) minutter fysioterapi pr. langtidsplass pr. uke og 0,3 (0-2,1) henvisninger pr. langtidsplass pr. år. Kommuner med avsatt stilling til langtidsplasser (n=48) og mindre kommuner leverte mer fysioterapi til langtidsopphold på sykehjem enn kommuner uten avsatt stilling og større befolkning. Den vanligste henvisningsårsaken var brudd og andre skader etter fall, og funksjonsfall etter sykdom eller sykehusinnleggelse.

Konklusjon: Fysioterapi under langtidsopphold organiseres som regel via henvisning til kommunal fysioterapitjeneste. Det er betydelige variasjoner i antall henvisninger og tidsbruk mellom kommunene, men både antall henvisninger og tidsbruk fremstår som lavt, gitt beboernes funksjonsnivå og behov for tiltak som opptrening, mobilisering og veiledning av pleiepersonell.

Elisabeth Wiken Telenius, Kristine Bjorheim Bøe, Nina Skjæret-Maroni, Kristin Taraldsen, Gro Gujord Tangen, Karen Sverdrup

Abstract: 

Background: Immersive technologies such as virtual reality (VR) that has been developed the recent years, are now increasingly accessible and offers new opportunities for VR environments combined with games that may enhance physical activity. However, these games may require adaptation and further customization for use among older users. In this pilot study, we investigate the experiences of older adults using a head-mounted VR exercise game that was developed in close collaboration with end users.

Methods: We included ten community-dwelling older adults aged 65 years and older who undertook six VR exercise sessions across a two-week period, each session lasting 15 min. Descriptive information included age, gender, mobility (Timed Up and Go test, TUG), and gait speed (10 m walk test), and daily steps from ankle-worn accelerometers. Semi-structured individual interviews were conducted, transcribed verbatim and analyzed by use of reflexive thematic analysis.

Results: We included four men and six women, age range from 66 to 77 years, with an average gait speed of 1.4 m/sec and an average TUG-time of 7.6 s. Their average activity levels were close to 4200 steps per day. After the trial period, participants’ experiences were that VR is a new and exciting development. They found VR to be more of a game than exercise, and they suggested integrating more challenging activities, physical movement and social engagement to enhance the exercise part of the game. They did not feel that the game facilitated any more physical activity in their daily lives.

Discussion/conclusion: VR is a promising tool that older adults in this trial enjoyed, but the game was not physically demanding enough for the participants. Future adaptations should include more challenges. Game development should focus on tasks that keep players interested and engaged over longer times, without jeopardizing safety.

Bård Bogen, Martin Moum Hellevik, Gro Gujord Tangen, Lars Peder Bovim, Nina Øye, Kristin Taraldsen

Abstarct:

Background: Knowledge about how older adults walk is crucial for the effective prevention and treatment of various mobility issues as well as treatment evaluation, but it is currently largely limited to laboratory-based measurements. Although laboratory-based data provide relevant information about what older adults can do under standardized conditions, they do not provide insight into how they actually walk in their daily life, a gap that needs to be addressed urgently.

Objective: The objective of this study was to describe how older adults walk in daily life, in relation to age, sex, and level of physical function, using wearable sensor data from a large sample of older adults with a wide range of age and function from the HUNT4 Trondheim 70+ study.

Methods: The current study is based on 1-week accelerometer data (Axivity AX3) from 1289 older adults (mean age 77.41, SD 6.06 years; age range 70-105 years; n=705, 54.7% women). Physical function was assessed using the Short Physical Performance Battery (SPPB). To investigate the effect of age and SPPB score on gait metrics (daily number of steps, 95th percentile speed, mode speed, 95th percentile cadence, mode cadence, and maximum walking bout [WB] distance) for women and men, univariate gamma regression models with log link were used for each outcome measure, with age and SPPB score in separate models. Sex differences were investigated using Mann-Whitney U tests.

Results: Older adults showed a large variation in how and how much they walked in daily life across age, sex, and physical function, particularly younger participants and those with better physical function. Most gait metrics decreased at an increasing rate with higher age, with men maintaining their levels up to higher ages than women. Poorer physical function led to an exponential or close-to-linear decrease in all gait metrics apart from habitual cadence, which remained stable up to a high age. Women had a lower daily number of steps, gait speed, and maximum distance but higher cadence than men (P<.001 for all). On average, 63% of all WBs lasted <10 seconds, corresponding to a median accumulated time of 99 (IQR 66-128) minutes. For WBs lasting 10 to 30 seconds, 30 to 60 seconds, and >60 seconds, the median accumulated time was 105 (IQR 65-154) minutes, 31 (IQR 18-47) minutes, and 113 (IQR 37-219) minutes, respectively.

Conclusions: Daily-life walking performance was affected more by functional ability than by age itself, except for the highest ages, and differed significantly between sexes. Although most WBs were very short, the total accumulated walking time in WBs shorter than 30 seconds was longer than that in longer WBs. Future research can build upon our findings by considering both the impact of short WBs and relevant group and sex differences when implementing daily-life mobility assessment in both clinical studies and patient follow-up.

Karoline Blix Grønvik, Anisoara Paraschiv-Ionescu, Gro Gujord Tangen, Øyvind Salvesen, Jorunn Lægdheim Helbostad, Nina Skjæret-Maroni & Beatrix Vereijken

Abstarct:

Background: As life expectancy increases, the incidence of age-related chronic health conditions and functional decline rises, increasing the need for institutional long-term care such as nursing homes. In Norway, 84% of nursing home residents have mild cognitive impairment or dementia. This population is characterized by a high burden of neuropsychiatric symptoms (NPS), which contribute to limited physical activity (PA) and a largely sedentary lifestyle. Regular PA is essential for maintaining physical function (PF) and independence, yet nursing home residents spend most of their time being sedentary. The present study aims to explore sensor-based measured PA patterns and investigate how PA is associated with NPS and PF in nursing home residents.

Methods: This cross-sectional study used data from the fourth wave of the population-based Trøndelag Health Study 70-years-and-older cohort (HUNT4 70+), including activity data from a total of 163 nursing home residents. PA was measured using two accelerometers placed on the lower back and thigh. PA patterns were described through the activity types walking, standing, sitting, and lying, activity bouts, and transitions. NPS was assessed using the Nursing Home Version of the Neuropsychiatric Inventory (NPI-NH), and PF using the Short Physical Performance Battery (SPPB). All outcome variables were grouped based on cognitive impairment and dementia severity, set by clinical experts using the DSM-5 diagnostic criteria and the Clinical Dementia Rating (CDR) scale.

Results: Participants’ mean age was 87.8 years, and 62% were female. With a daily average of 17.6 min walking, 1.1 h standing, 9.9 h sitting, and 12.7 h lying, our nursing home residents spent approximately 94% of the day being sedentary. Walking and standing appeared predominantly in bouts under 10 min across cognitive impairment and dementia severity. No association was found between time spent walking, standing, sitting, lying and transitions from sedentary behavior to activity with NPS. Time spent walking, standing, lying and transitions from sedentary behavior to activity was significantly associated with PF.

Conclusions: PA mainly occurred in bouts shorter than 10 min and sitting and lying accounted for most of the daily behavior. No association was detected between time spent in different activities and NPS. Although time spent walking and standing was limited in all groups, it showed an association with PF. This may suggest that even small amounts of PA play a significant role in maintaining or improving physical capabilities in nursing home residents.

Stine Øverengen Trollebø, Karen Sverdrup, Atle Skjelbred, Kristin Taraldsen, Ellen Marie Bardal, Nina Skjæret-Maroni