Residents in Edmonton General Continuing Care Center EGCCC In Edmonton Alberta Canada

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 staff’s 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 center’s 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 P.A. and lack of data for some variables like OR for physical activity and death rates among older people.

Another type of long-term care facility, Continued Care Senior Housing Community (CCSHC) in Southern California, was used as a sample for qualitative study in “Health Impacts Of The Stay-At-Home Order On Community-Dwelling Older Adults And How Technologies May Help: Focus Group Study.” The study aimed to investigate the impact of Covid 19 on older adults' mental and physical health when social isolation under the orders of stay-at-home increased (Daly et al., 2021). The longitudinal study with semi-structured interviews involved 112 participants from the long-term care facility that revealed four themes: effects of quarantine on mental and physical health, lack of physical activity, only reliance on technology to address social isolation, and ways of coping with effects of quarantine. The major strength of this study is careful steps taken for thematic analysis with digitally recorded group discussions and taking help from researchers for formulating manual codes. In contrast, the study's weakness is the inclusion of only those participants who had technological access to Zoom meetings and only educated respondents, belonging to high socio-economic status, Caucasian, and living in Southern California.

An ample narration of the risk and resilience tools and strategies for combating Covid 19 impacts the mental and physical health of the affected ones are described in the book “Covid 19: Systematic risk and resilience”. The purpose of the book is to publicize information to the stakeholders such as policymakers and even management of long-term care that manage the old age population, being the most susceptible ones to Covid, should use for maximizing socio-economic gains and increasing opportunities for public health recovery. The congregate living settings for older adults, such as retirement homes, assisted living, and supportive living as in nursing homes, should be the most active ones in terms of engaging the older population physically to reduce morbidity issues as well as psychological complexities in long term facilities (Linkov, Keenan & Trump, 2021, p. 147).

In the same way, another book, “Promoting the health of older adults: The Canadian experience” keeps a record of how the selected vulnerable groups specifically in Canada, such as old people in long term care, congregate living and community care systems, should be set as a high priority for in case of infectious disease transference. Centered on the Ottawa Charter for Health Promotion, the older population of Canada has been focused on formulating public policy, making supportive environments, consolidating community action, and evolving personal skills for health and social services. The authors are of the view that this population segment is on a high spectrum of vulnerability for getting affected the most due to reasons like low physical activity, low mobility, physical disability, frailty, and cognitive impairment in certain cases, etc. (Rootman et al., 2021, p. 521).

Since long-term care mainly revolves around the older population, the evidence from the Oxford Covid 19 Evidence Service Team, Center of Evidence-Based Medicine, provides some helpful resources for supporting this segment in social isolation during Covid 19. For reduction of sedentary behavior and increasing physical mobility for reducing muscle frailty, it is suggested in this evidence that exercise improves the rates of falls and functional ability of people aging over 70 years (Davies et al., 2020). The exercises that might be helpful include a low-intensity mixture of resistance exercises for strength-building in arms and legs, functional exercises, endurance exercises, and balance exercises. Also, the evidence suggests that exercises at home would be beneficial since a five times reduction in frailty was observed in older people who were physically engaged at home after one year. A major strength is the amalgamation of numerous studies for summarizing their useful findings for a specific target segment. At the same time, the weakness is no mention of where the studies were conducted.

An additional evidence-based standard procedure for taking care of the older population either at home or long term care (LTC) facilities from the World Health Organization suggests that older adults should stay as active as possible, even in daily activities, sanitize themselves regularly, and keep a social distance (World Health Organization, 2020). Drinking water and taking healthy meals along with constant engagement in hobbies and enjoyable activities is recommended. Based on a person’s self-assessment of physical power, the reliance on lighter tasks should be followed rather than exerting themselves much, avoiding stress and anxiety, and staying connected with friends and family through information technology.

Gaps in the Knowledge and Effects on Health Informatics Related to the Topic

One significant gap in the knowledge that exists for the related topic is the use of the availability of technology for helping the older people in long term care facilities through video calls to remain engaged in physical activities, even when the physical trainers are not allowed to come to the centers for training them in-person due to social distancing regulations. It could be the main facilitator in improving older adults' mental and physical health when trained through the infusion of technology. However, familiarity and overcoming fear for using technological devices remain barriers to routine practice for the selected segment in long-term care. Here, nurses and caretakers of LTC facilities can support making community-based connections, engaging in socialization, and enabling physical activity during critical times of pandemic like Covid 19.

References

Amini, H., Habibi, S., Islamoglu, A.H., Isanejad, E., Uz, C. & Daniyari, H. (2021). Covid-19 pandemic induced physical inactivity: The necessity of updating the Global Action Plan on Physical Activity 2018-2030. Environmental Health and Preventive Medicine, 26. https://doi.org/10.1186/s12199-021-00955-z

Aubertin-Leheudre, M., & Rolland, Y. (2020). The importance of physical activity to care for frail older adults during the COVID-19 pandemic. Journal of the American Medical Directors Association, 21(7), 973–976. https://doi.org/10.1016/j.jamda.2020.04.022

Daly, J.R., Depp, C., Graham, S.A., Jeste, D.V., Kim, H., Lee, E.E. & Nebeker, C. (2021). Health impacts of the stay-at-home order on community-dwelling older adults and how technologies may help: Focus group study. JMIR Aging, 4(1). https://doi.org/10.2196/25779

Davies, J.H.N., Frost, R., Bussey, J. & Park, S. (2020). Maximizing mobility in older people when isolated with Covid 19. The Center for Evidence-Based Medicine. https://www.cebm.net/covid-19/maximising-mobility-in-the-older-people-when-isolated-with-covid-19/

Frahsa, A., Altmeier, D., John, J.M., Gropper, H., Granz, H., Pomiersky, R., Haigis, D., Eschweiler, G.W., Nieb, A.M., Sudeck, G. & Thiel, A. (2020). “I trust in staff’s creativity”- The impact of COVID19 lockdown on physical activity promotion in nursing homes through the lenses of organizational sociology. Frontiers in Sports and Active Living, 2. https://doi.org/10.3389/fspor.2020.589214

Linkov, I., Keenan, J.M. & Trump, B.D. (2021). Covid 19: Systematic risk and resilience. Springer Nature.

Rootman, I., Edwards, P., Levasseur, M. & Grunberg, F. (2021). Promoting the health of older adults: The Canadian experience. Canadian Scholars’ Press.

Sallis, R., Young, D.R., Tartof, S.Y., Sallis, J.F., Sall, J., Li, Q., Smith, G.N. & Cohen, D.A. (2021). Physical inactivity is associated with a higher risk of severe Covid 19 outcomes: A study in 48 440 adult patients. British Journal of Sports Medicine, 55, 1099-1105. http://dx.doi.org/10.1136/bjsports-2021-104080

Thiel, A., Altmeier, D., Frahsa, A., Eschweiler, G.W., Nieb, A., & Sudeck, G. (2021). Saving lives through life-threatening measures? The Covid 19 paradox of infection prevention in long-term care facilities. European Review of Aging and Physical Activity, 18(11). https://doi.org/10.1186/s11556-021-00265-x

World Health Organization. (2020, July 23). 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. https://apps.who.int/iris/rest/bitstreams/1316982/retrieve

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Appendix

Table for Summarizing the Integrative Literature Review

Authors’ names

Study title

Purpose of the study

Study design

Sample size, age

Method use/ data collection

Findings of the study

Major strength

Major weakness

Amini et al., 2021

Covid-19 pandemic induced physical inactivity: The necessity of updating the Global Action Plan on Physical Activity 2018-2030.

To study the review of GAPPA and updated goals for physical activity plan designed by WHO in 2017 so that effects of lifestyle changes and physical activeness should be revised.

Not applicable (N.A.)

N.A.

N.A.

Older people should not be allowed outside their homes to go to centers for physical activities. Rather GAPPA has updates that mention suitably tailored programs for these people at home or community venues, including long-term care settings.

A detailed account of GAPPA and its update regarding the Covid 19 and similar pandemic until 2030.

There is a lack of a proper research study design, sample size, sample age, data collection process, methodology, etc. Still, it has secondary research.

Aubertin-Leheudre & Rolland, 2020

The importance of physical activity to care for frail older adults during the COVID-19 pandemic.

Narrating 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.

N.A.

N.A.

N.A.

In long-term hospitalization settings where 90% of the time that older adults sent was in sitting or lying down position, severely and adversely affected their muscle strength and mass, increasing their frailty.

Presentation of ways of how frail older adults could benefit from certain programs, activities, and exercises and the use of technology to increase their physical activity and pictures and web links.

There is a lack of a proper research study design, sample size, sample age, data collection process, methodology, etc. Still, it has secondary research.

Daly et al., 2021

Health impacts of the stay-at-home order on community-dwelling older adults and how technologies may help: Focus group study.

To investigate the impact of Covid 19 on the mental and physical health of older adults when social isolation under the orders of stay-at-home increased

Longitudinal study

112 participants from the long-term care facility.

Semi-structured interviews

Four themes were detected: effects of quarantine on mental and physical health, lack of physical activity, only reliance on technology in an attempt to address social isolation, and ways of coping with the effects of quarantine.

Careful steps were taken for thematic analysis with digitally recorded group discussions and taking help from researchers for formulating manual codes.

Inclusion of only those participants who had technological access to Zoom meetings, only educated respondents, belonging to high socio-economic status, Caucasian and living in Southern California.

Davies et al., 2020

Maximizing mobility in older people when isolated with Covid 19.

Providing helpful resources for supporting older population segment in social isolation during Covid 19.

The amalgamation of different studies and their methods

The amalgamation of different samples from those studies, mostly old age people

Different data collection methods from various studies

Exercise improves the rates of falls and functional ability of people aged over 70 years. The exercises that might be helpful include a low-intensity mixture of resistance exercises, functional exercise, endurance, and balance exercises. Also, exercises at home would be beneficial since a five times reduction in frailty was observed in older people who were physically engaged at home after one year.