Sedentary behaviour and physical activity in hospitalised older people

Abstract

Reducing sedentary behaviour of hospitalised older people has gained increased interest because of the adverse consequences of immobility in hospital and the benefits of physical activity, vital for recovery from illness and avoiding functional decline post-hospitalisation. This PhD focuses on reducing sedentary behaviour whilst increasing physical activity amongst older people in hospital. It includes 1) a narrative review of the qualitative literature relating to the perspectives about physical activity in hospitalised older patients among older patients, carers and clinicians; and 2) a scoping review exploring the prevalence and assessment of sedentary behaviour, as well as interventions (including perspectives of the interventions) to reduce sedentary behaviour among hospitalised older people. The reviews revealed that qualitative studies have predominantly focused on ambulation or mobility as a domain of physical activity rather than broader physical activity or other domains such as physical function and self-care. Additionally, there is a dearth of qualitative or intervention studies about sedentary behaviour in older inpatients. The views of carers of older patients regarding sedentary behaviour and physical activity are lacking but should be considered as this will better inform the development of interventions. To address identified gaps in the literature, research conducted as part of this PhD included: a) non-directional interviews with (i) older patients, (ii) carers and (iii) clinicians; and b) a focus group study with clinicians on experiences of hospitalised older patients as well as strategies for reducing sedentary behaviour and increasing physical activity in older inpatients. Findings from this thesis have identified solutions from (i) older patients, (ii) carers and iii) clinicians to reduce sedentary behaviour and increase physical activity in hospital. These include integrating and coordinating physical activity into routine clinical care, empowering patients and their carers to initiate and sustain physical activity through education and communication, making the hospital environment activity-friendly and improving collaboration between clinicians regarding reducing sedentariness and increasing physical activity. Importantly, older patients, carers and clinicians identified several psychological consequences of sedentary behaviour on older patients, including loss of motivation and confidence, depression, anger and anxiety. These findings have important clinical implications for reducing prolonged sitting and lying periods and increasing physical activity during hospitalisation. This thesis provides two key messages for clinicians and policymakers. Firstly, despite the dynamic nature of clinical care, older people can be more active if physical activity is integrated into routine care and personalised according to patient’ ability, clinicians collaborate effectively, and carers are involved in supporting patients to be active. Secondly, sedentary behaviour has negative consequences on the psychological health of older patients, emphasising the need to encourage physical activity in this cohort.