Nursing: The Impact of Physical Inactivity in Long-Term Care Settings during Covid- Pandemic- Case Study of Residents in Edmonton General Continuing Care Center (EGCCC), In Edmonton, Alberta Canada

Integrative Literature Review

Engaging in physical activity is good for both physical wellbeing but also mental health. It supports the prevention of both physical and psychological problems and brings an improvement in the overall quality of life for a person. This paper aims to provide an integrative literature review to investigate the impact of physical inactivity in long-term settings during the Covid-19 pandemic based on the case study of residents in Edmonton, Alberta, Canada. The residents target population and the sample are based on Edmonton General Continuing Care Center (EGCCC), a long-term facility located in the vicinity.

For the current integrative literature review, ten sources, including scholarly articles, books, and evidence-based papers, were used to produce a comprehensive overview of the past studies related to the topic. The inclusion criteria used for research for the literature review encompassed:

Articles extracted from CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Google.

Articles should be from the last five years of publishing

The articles should be based on long-term care settings, physical inactivity, and pandemic like Covid 19. If they include previous similar articles in the Canadian context, they would be of additional value.

The exclusion criteria comprised of following details:

The articles were not more than five years old.

No other database or search engine was used to conduct this research.

Furthermore, the research was conducted by listing out some of the keywords for entering into the database. It was done to extract the most relevant articles that were considered pertinent to the selected topic. The keywords used for this reason were: impact of physical inactivity, the impact of physical activity, the effect of physical activity, effects of physical inactivity, effects of physical inactivity in long-term care settings, effects of physical inactivity in long term care settings during the pandemic, and impact of physical inactivity in long term care settings during Covid 19 pandemic.

Impact of Physical Inactivity Worldwide Due To Covid 19

An article published in the name of Saving Lives Through Life-Threatening Measures? The Covid, 19 Paradox Of Infection Prevention In Long-Term Care Facilities, is a mere description of the situation that has posed a contrasting situation for the older population who are highly vulnerable to Covid and have to be confined within homes while at the same time, reducing their physical activity, creating a greater risk to their mental and physical health for long term care (Thiel et al., 2021). A major strength of the article is the recommendations posted by the authors for long-term care facilities so that an increase in physical activities for the older population could be ensured. In contrast, a major weakness is the absence of study design, methodology, sample selection, and method usage for actual research.

An article, Covid-19 Pandemic-Induced Physical Activity: The Necessity Of Updating The Global Action Plan On Physical Activity 2018-2030, was recently published stating the descriptive facts that the World Health Organization (WHO) updated its global plan named as Global Action Plan on Physical Activity 2018-2030 (GAPPA) in the year 2017 (Amini et al., 2021). The findings revealed that since older people are at high risk of being infected with Covid 19, they should not be allowed outside homes to go to centers for physical activities. Rather GAPPA has updates that mention suitably tailored programs for these people at home or in the community venues, including long-term care settings. A major strength is a detailed account of GAPPA and its update regarding the Covid 19 and similar pandemic till the year 2030. Major weaknesses include lack of a proper research study design, sample size, sample age, data collection process, methodology, etc. Still, it has used useful secondary sources that lead it to be considered secondary research.

Impact of Physical Inactivity on Older Adults

An article, The importance of the physical activity to care for frail older adults during the Covid 19 pandemic, was written that shows key findings related to the physical inactivity for the said community (Aubertin-Leheudre & Rolland, 2020). It is merely a descriptive article that narrates some of the observations regarding how Covid 19 impacted the physical activity of frail older adults in long-term care settings and their physical functioning. When the government imposed social distancing and the complete lockdown, the number of walking steps, specifically by older adults, reduced immensely. Similar observations were made in long-term hospitalization settings where 90% of the time that older adults sent was in sitting or lying down, which severely and adversely affects their muscle strength and mass, increasing their frailty. The major strength of the article is the presentation of ways of how frail older adults could benefit from certain programs, activities, and exercises along with the use of technology to increase their physical activity. The article has pictures and a list of programs accompanied with web links that offer them. Major weakness could be the absence of study design, sample size, and data collection method for the research; however, it could be considered secondary research as it has made use of internet articles and web sources within its reference list.

Impact of Physical Activity in Various Types of Long Term Care Settings amidst Covid 19

As nursing homes are long-term care facilities for the older population and during Covid 19, the elderly people were confined within the walls of these nursing homes, I trust in staffs creativity- The impact of Covid 19 lockdowns on physical activity promotion in nursing homes through the lenses of organizational sociology talks about German nursing homes that collected data with the help of semi-structured interviews and open-ended surveys for documenting the daily activities regarding taking care of elderly people in eight nursing homes in the Federal state of Baden-Wurttemberg during lockdown (Frahsa et al., 2020). The results from the thematic analysis revealed that due to social distancing restrictions, physical therapists for older people were not allowed within the centers walls and nurses had to step in for patient-centered care and mobilization so that physical isolation and inactivity do not pose mental or physical challenges on their outdoor time spending while keeping in line with the infection management regulations. A major strength of this article was the use of actual study methods and thematic analysis. In contrast, the weakness was not a comprehensive inclusion of nursing homes within the targeted German state. Hence, the results could not be considered wide-ranging.

A study was conducted using electronic health records (EHR) at Kaiser Permanente Southern California that has more than 4.7 million residents of old age people belonging to diverse racial backgrounds, household incomes, and educational levels. Physical Inactivity Is Associated With A Higher Risk For Severe Covid 19 Outcomes: A Study In 48 440 Adult Patients includes an adult sample from an integrated healthcare system in Southern California that were infected with Covid 19, including ages 18 years and above for a cohort study (Sallis et al., 2021). The ICU admission rates, hospitalization for long-term care, and death rates were analyzed along with the effect of physical activity (P.A.) on their survival. The results from the X2 test revealed that Covid patients who were constantly physically inactive had a higher risk of hospitalization and being subjected to death during their stay at the facility compared to those who were physically active. A major strength is the large inclusion of patients for research. At the same time, weakness includes the self-reported data for...…where the studies were conducted.

Frahsa et al., 2020

I trust in staffs creativity- The impact of COVID19 lockdown on physical activity promotion in nursing homes through the lenses of organizational sociology.

Assessing the impact of P.A. on older adults during the lockdown in Covid 19, specifically nursing homes.

Exploratory study

Eight nursing homes Federal state of Baden-Wurttemberg during lockdown

Semi-structured interviews and open-ended surveys

Thematic analysis revealed that due to social distancing restrictions, physical therapists for older people were not allowed within the centers walls and nurses had to step in for patient-centered care and mobilization so that physical isolation and inactivity do not pose mental or physical challenges to their outdoor time spending while keeping in line with the infection management regulations.

Use of actual study methods and thematic analysis.

Not a comprehensive inclusion of nursing homes within the targeted German state. Hence, the results could not be considered wide-ranging.

Linkov, Keenan, & Trump, 2021

Covid 19: Systematic risk and resilience.

Description of risk and resilience tools and strategies for combating Covid 19 impacts the mental and physical health of the affected ones.

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The congregate living settings for older adults should be the most active in terms of physically engaging the older population to reduce morbidity issues and psychological complexities in long-term facilities. The information is beneficial for all the stakeholders involved.

Application of tools and strategies for checking their effectiveness in a wholesome manner in each new chapter.

None that could be applied substantially.

Rootman et al., 2021

Promoting the health of older adults: The Canadian experience.

The edited collection describes the action framework in Ottawa Charter for Health Promotion for investigation factors and issues related to the health of older adults, specifically in Covid 19.

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Five action areas are identified for health promotion actions and interventions that would be useful in contemporary times.

An up-to-date profile description of the Canadian adults and current trends with the elixir of technological benefits.

None that could be applied substantially.

Sallis et al., 2021

Physical inactivity is associated with a higher risk of severe Covid 19 outcomes: A study in 48 440 adult patients.

Cohort study

48 440 adult samples from an integrated healthcare system in Southern California that were infected with Covid 19, including ages 18 years and above

X2 test

Covid patients who were constantly physically inactive had a higher risk of hospitalization and being subjected to death during their stay at the facility than those who were physically active.

Large inclusion of patients for research.

Self-reported data for P.A. and lack of data for variables like OR for physical activity and death rates among older people.

Thiel et al., 2021

Saving lives through life-threatening measures? The Covid 19 paradox of infection prevention in long-term care facilities.

Description of the situation that has posed a conflicting situation for the older population who are highly vulnerable to Covid and have to be confined within homes while at the same time reducing their physical activity, creating a greater threat to their physical and mental health for long term care.

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The targeted population's physical and mental strain goes through so that protective measures could be taken against it.

The authors post recommendations for long-term care facilities to increase physical activities for the older population.

Absence of study design, methodology, sample selection, and method usage for actual research.

World Health Organization, 2020

Guidance on Covid 19 for the care of older people and people living in long-term care facilities, other non-acute care facilities, and home care.

Providing an evidence-based standard procedure for taking care of older population either at home or at long term care (LTC) facilities.

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Older adults shoud stay as active as possible, even in daily activities, sanitize themselves regularly, and keep a social distance. Drinking water and taking healthy meals along with constant engagement in hobbies and enjoyable activities is recommended.

Widely researched statistics related to deaths and physical weaknesses of the older population at home and LTC facilities related to their religious and ethnic…