JMIR Publications

ABSTRACT

Background:

Walking is important for maintaining physical and mental wellbeing in aged residential care (ARC). Walking behaviours are not well characterised in ARC due to inconsistencies in assessment methods and metrics, and limited research regarding the impact of care environment, cognition or physical capacity on these behaviours. It is recommended that walking behaviours in ARC are assessed using validated digital methods which can capture low volumes of walking activity.

Objective:

This study aims to characterise and compare accelerometry-derived walking behaviours in ARC residents across different care levels, cognitive abilities, and physical capacities.

Methods:

306 ARC residents were recruited from the Staying Upright RCT from three care levels: rest home (n=164), hospital (n=117), and dementia care (n=25). Participants’ cognitive status was classified as mild (n=87), moderate (n=128) or severe impairment (n=61), and physical capacity as moderate (n=60), low (n=107) or very low (n=115) using the Montreal Cognitive Assessment and the Short Physical Performance Battery cut-off scores respectively. To assess walking, participants wore an accelerometer (Axivity AX3, York, UK; 23x32.5x7.6mm, 11g; sampling rate: 100Hz, range ± 8 g, memory: 512 M) on their lower back for seven days. Outcomes included volume (daily time spent walking, steps, bouts), pattern (mean walking bout duration, alpha) and variability (of bout length) of walking. Analysis of covariance was used to assess differences in walking behaviours between groups as categorised level of care, cognition, or physical capacity, while controlling for age and sex. Tukey HSD tests for multiple comparisons were used to determine where significant differences occurred. Effect size of group differences were calculated using Hedges’ G.

Results:

Dementia care residents showed greater volumes of walking (p<.01), with longer (p<.01), more variable bouts (p<.01) compared to other care levels, with moderate-large effect sizes. Residents with severe cognitive impairment took longer (p<.01), more variable (p<.01) bouts with moderate-large effect sizes compared to those with mild cognitive impairment and small-moderate effect sizes compared to moderate cognitive impairment. Residents with very low physical capacity had lower walking volumes compared to moderate capacity (p<.001) with moderate effect sizes.

Conclusions:

ARC residents across different levels of care, cognition and physical capacity demonstrate different walking behaviours. However, ARC residents often present with varying levels of both cognitive and physical abilities, reflecting their complex multi-morbid nature, which should be considered in further work. This work has demonstrated the importance of considering a nuanced framework of digital outcomes relating to volume, pattern and variability of walking behaviours in ARC. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12618001827224. Registered on 9 November 2018. Universal trial number U1111-1217-7148.