Care home residents spend most of their time sitting still, despite clear evidence that moving more improves their health and wellbeing. This project aims to change that by embedding physical activity into the daily routines of care homes, rather than relying on external therapists or special programmes that stop working once the experts leave. The problem is stark. People over 85 are the fastest-growing age group, and care home residents are among the frailest in the population, placing heavy demands on NHS services. Yet observational studies show they remain inactive for the majority of their day. Existing interventions often fail because they depend on outside resources and are not sustained. If this research succeeds, it will produce practical strategies—training materials, activity prompts, and implementation methods—that care home staff can use every day, without specialist help. The team will test these strategies in 12 care homes, measuring effects on physical function, mood, and quality of life. The ultimate goal is a large-scale trial that could shift how care homes approach daily activity, improving wellbeing for a neglected group without adding cost or complexity.
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AIMS To develop and preliminarily test strategies to enhance physical activity in the daily life routines of care home residents to improve their physical, psychological and social well-being. BACKGROUND Increase in life expectancy has led to a shift in demographics, with particular expansion in the age group 85 years and older. As many health conditions are age-related, there is a concurrent increase in the demand for long-term care. Residents of care homes are amongst the frailest in our population and place considerable burden on NHS primary and secondary services. Observational research has demonstrated that care home residents spend the majority of their time inactive, despite the known benefits of maintaining (or increasing) levels of physical activity and decreasing sedentary behaviour. We have updated the Cochrane review addressing rehabilitation in long-term care. This reported 67 studies and demonstrated that strategies to enhance physical activity can be implemented in care homes with reported benefits. However, many of the interventions evaluated were dependent on external resources (e.g. therapists) and gains were not sustained. We propose a research programme in which we will work with care home staff and residents to develop a range of methods to increase physical activity embedded in the daily routines of care homes that will be suitable for the majority of residents. We have undertaken development work in two care homes which included observations and interviews with residents and staff to inform our understanding of current levels of activity and what might work in practice. RESEARCH ENVIRONMENT The Academic Unit of Elderly Care and Rehabilitation has 20 years experience in the development and evaluation of complex interventions. It currently holds research funding of approximately £8 million from the MRC and NIHR. RESEARCH PLAN Five overlapping workstreams will be undertaken. Workstream 1 ~ we will undertake ethnographic work to test the understandings we have gained from the Programme Development Grant (PDG) within a wider range of care homes. Work will include observations and interviews to clarify our thinking on barriers, opportunities and factors that indicate that a care home (and their staff) are open to change. Workstream 2: Clarification of measures We aim to improve levels of physical activity and therefore require a valid and reliable measure of activity in a population of frail older people. In development work we have identified the Actigraph GTX-3 and GeneActiv accelerometers as possible measures and propose to test these with a larger population of residents and evaluate a newly developed physical activity questionnaire. Workstream 3 Using information obtained in the development work and previous workstreams we will use techniques of intervention mapping to develop practical mechanisms for increasing activity and appropriate methods of implementation (for example, training materials). Workstream 4 Working with action groups (which will include residents and staff) in four care homes we will refine the proposed mechanisms and methods to promote practical implementation in a range of care home settings. Workstream 5 Undertake a feasibility study in 12 care homes, with allocation by minimisation at the level of the care home, to test for feasibility and effect on physical function, mood and quality of life) and to gather data to inform a future large scale trial. OUTPUTS AND DISSEMINATION Our work will begin the staged process of developing a complex intervention embedded in the routine of care homes to promote physical activity tailored to the context and environment of individual care homes and thereby enhance quality of life for this neglected group. We will also develop manualised strategies for implementation of interventions in care homes which will be suitable for use in other behaviour change initiatives. Our work will be disseminated thr
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