Physical Inactivity in Long-Term Care During COVID-19: A Mixed-Methods Study

Introduction and Purpose Statement

The COVID-19 pandemic has undoubtedly imposed unwanted restrictions on people's lives worldwide, a reality corroborated by a growing body of research. People of all ages — from children to elderly adults — have been massively affected. Older adults in particular, who are already physically vulnerable, have faced profound limitations, often confined to rest with little opportunity for movement. Social distancing and isolation have led to decreased physical activity, contributing to mental health disturbances such as stress, depression, and anxiety (Cunningham & O'Sullivan, 2020).

A previously developed research question asked: "Whether there is any relationship between physical declines in elderly people residing in EGCCC and the pandemic restrictions imposed during COVID-19?" This paper aims to provide the study's purpose statement and to outline the research methodology for the selected project.

The purpose statement is to investigate a relationship between physical inactivity — potentially forced by COVID-19 pandemic restrictions imposed by the government — and physiological decline among elderly residents. Although it is clearly understood that restrictions on social distancing and mobility were established for public safety against the virus, these measures have nonetheless affected the support networks for older people residing in long-term care facilities. Therefore, the purpose statement is to explore whether there is a connection between physiological health declines and the sedentary behavior of elderly residents at the Edmonton General Continuing Care Center (EGCCC) resulting from government-imposed limitations during the COVID-19 pandemic.

The population under study consists of elderly residents at the Edmonton General Continuing Care Center who are 65 years of age or older. The facility is located in Edmonton, Alberta, Canada. These are senior citizens who require special physical and psychological care and are therefore particularly sensitive to changes related to inactivity. Many are at risk of developing chronic diseases if they remain inactive for extended periods. Decisions regarding their care and support must be carefully considered, even during a global pandemic such as COVID-19.

Mixed-Methods Methodology

A mixed-methods (MM) methodology will be used in this research, incorporating both qualitative and quantitative research designs. However, the qualitative research design will remain the dominant strand, as the opinions and self-reported views of EGCCC's older residents will be obtained to determine whether an actual relationship exists between their physical health and inactivity resulting from COVID-19 restrictions.

Patient-related outcomes (PROs) are considered key elements when collecting qualitative data, since health outcomes must be self-reported by the participants themselves (Regnault, Willgoss & Barbic, 2018). Combining qualitative and quantitative research methods helps clarify patient priorities related to their health while also providing scientific rigor for improved recommendations. The MM research paradigm suggests that a clearly formulated research question can be answered by applying both qualitative and quantitative methods; the articulation of both methods should be pre-specified within the study design. Responses to research questions should emerge from the results of both types of research within the MM framework (Regnault, Willgoss & Barbic, 2018).

Several studies have noted that quality of life (QoL) in the late stages of palliative care is linked to chronic diseases that negatively affect patients both physically and psychologically (Frazer & Mobley, 2017). During late-life stages, social and emotional stress are elevated. Patients' social, spiritual, and psychological needs demand attention, arising primarily from physical conditions and QoL. MM methodology allows these dimensions to be examined together. Interviews capture patients' self-reported beliefs about their personal QoL, while quantified results provide authentication for those beliefs. For this reason, the current study employs MM methodology.

The amalgamation of close-ended quantitative questions and open-ended qualitative questions within MM methodology helps expand the research horizon of the current study. The deep insight gained from the narratives of study participants — including their personal opinions about physical activity and COVID-19 restrictions in long-term care — supports generalization of findings from a small sample to a larger population of older adults in long-term care (Dawadi, Shrestha & Giri, 2021).

Rationale for Selecting Mixed Methods

MM methodology is deemed most suitable for this study because it captures both the attitudes and opinions of elderly residents who have experienced the effects of COVID-19 restrictions on their health, while also providing quantification of actual research results. The use of one research method complements the other, since the strengths of one approach offset the limitations of the other (Regnault, Willgoss & Barbic, 2018). In studies aimed at identifying health outcomes that require participants' viewpoints — as in the current study — it is preferable to use mixed methods, allowing the quantitative strand to serve as a secondary check on the accuracy of self-reported measures collected through the qualitative design. The quantification of results helps verify qualitative findings, offering a patient-centered and innovative approach to addressing complex health research questions.

An additional reason for selecting MM methodology is that it allows the researcher to approach research questions from multiple perspectives (Regnault, Willgoss & Barbic, 2018). The strengths and limitations of the quantitative and qualitative approaches balance each other well, adding weight and credibility to the research findings.

The flexibility and inductive potential that MM methodology offers — especially in exploring health research outcomes — is substantial. Even when data are obtained from a small sample, the method provides the depth and flexibility needed to inform everyday emerging PROs in the health industry (Dawadi, Shrestha & Giri, 2021). At-risk and underserved populations, including older adults in palliative care, are especially well-suited to investigation through this methodology (Regnault, Willgoss & Barbic, 2018). For these reasons, MM methodology has been selected for collecting data from older adults at EGCCC, in order to deeply scrutinize the relationship posed in the research question.

Since the qualitative design is the dominant strand in this MM approach, it is worth noting that mixed-methods research is particularly strong in capturing people's actual "lived" experiences (Regnault, Willgoss & Barbic, 2018). First-hand patient perspectives are gathered so that verification through the quantitative design can be achieved. Incorporating MM methodology therefore ensures that the research remains focused on patients' needs, feelings, and priorities — specifically regarding the effects that COVID-19 restrictions have had on their physical activity and overall health.