FACILITATORS AND BARRIERS TO ENHANCING PHYSICAL ACTIVITY IN OLDER PATIENTS DURING ACUTE HOSPITAL STAY: A SYSTEMATIC REVIEW

G. Van Der Sluis¹, F. Dijkstra², H. Jager-Wittenaar³, L. Hempenius⁴, H. Hobbelen³, E. Finnema⁵

¹Nij Smellinghe Hospital, health innovation, Drachten, Netherlands, ²HAN University of Applied Sciences, Social Studies, Groningen, Netherlands, ³HAN University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, Netherlands, ⁴Medisch Centrum Leeuwarden, Geriatric Center, Leeuwarden, Netherlands, ⁵University Hospital Groningen, Health Science, Section of Nursing Research & Education, Groningen, Netherlands

Background: To improve older patients’ physical activity (PA) behavior, it is important to identify facilitators and barriers to enhancing PA in older patients (≥ 65 years) during hospitalization from the perspectives of patients, caregivers, and healthcare professionals (HCPs).

Purpose: The aim of this study was to systematically review the literature focusing on the identification of facilitators and barriers to enhance PA in older patients (≥ 65 y) during hospital admission from the perspectives of patients, informal caregivers, and HCPs (e.g., nurses, physiotherapists, medical doctors, dietitians) working in an acute care setting with older patients.

Methods: In this systematic review, a search of PubMed, CINAHL, PsycINFO, EMBASE, and Web of Science (January 2000–May 2021) was performed, and quantitative, qualitative, and mixed-methods studies were included. The methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Identified facilitators and barriers were categorized using the social ecological model at the intrapersonal, interpersonal, and institutional levels.

Results: The 48 included articles identified 230 facilitators and 342 barriers. The main facilitators at the intrapersonal level included: knowledge, awareness, and attitudes; interpersonal level: social support, including encouragement and interdisciplinary collaboration; and institutional level: stimulating physical environment, patient activities and schedules, and PA protocols. The main barriers at the intrapersonal level included: physical health status, having lines or drains, patients’ fear, and HCPs’ safety concerns; interpersonal level: patient-HCP relation and HCPs’ unclear roles; and institutional level: lack of space and resources, including time and equipment. Best evidence synthesis provided moderate level of evidence for three barriers: patients’ unwillingness or refusal to move, patients having symptoms, and patients having lines or drains. No moderate level of evidence was found for facilitators.

Conclusions: The PA behavior of older adults during hospitalization is multidimensional. Our overview highlights facilitators and barriers on multilevel scale (intrapersonal, interpersonal, and institutional levels) that guides patients, informal caregivers, HCPs, and researchers in future clinical practice, and intervention development and implementation.

Implications: Considering facilitators and barriers in a structured behavioral change framework might clarify potential strategies to enhance older patients’ PA behavior. We recommend that when enhancing PA in older hospitalized patients, attention should be paid to facilitators and barriers at the intrapersonal, interpersonal, and institutional levels, specifically targeting the health benefits of PA, patients’ health condition and willingness to move, healthcare team influences, resources, and hospital policies.

Funding acknowledgements: This work was supported by SIA SPRONG FAITH [grant number SPR.VG01.001].

Keywords:
physical activity
hospital
older adult

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Professional practice: other
Research methodology, knowledge translation & implementation science

Did this work require ethics approval? No

Reason: we conducted a systematic review and therefore ethics approval was not required