Feature ArticleThe development of the MIBBO: A measure of resident preferences for physical activity in long term care settings
Introduction
In numerous studies, it has been established that physical activity, even with low intensity, has beneficial effects on both physical and mental functioning in older people aged 65 years and over.1, 2, 3 Despite these benefits, it has also been shown that many people in this age group are insufficiently active to achieve these positive effects. They hardly meet the required 30 min of moderate physical activity a day, as recommended by several international guidelines.4, 5, 6 A specific sub group within this target population is formed of residents of long-term care facilities (e.g. nursing homes). They are, on average, (even) less active than their peers living at home and, in addition, due to cognitive and communicative impairments, they are often difficult to stimulate to become more physically active.7, 8
The American College of Sports Medicine defines physical activity as ‘body movement that is produced by the contraction of skeletal muscles and that increases energy expenditure’.2 According to this definition, all sorts of routine activities in daily life have a ‘natural’ activity component. For example, activities such as setting the table for a meal and watering plants involve walking, reaching, grasping, and carrying. Daily activities residents prefer to do could be integrated in their daily routines, increasing their physical activity level and contributing to person-centered care. However, according to a recent study, only a minority of residents (18%) seem to participate in these kinds of routine everyday activities.9 In these types of activities, informal and professional caregivers can be involved to supervise residents, but at least partly the residents may perform them independently. This increases the physical activity opportunities for residents as they are not merely dependent on the caregivers' availability or a specific location (e.g. gym).
Many long-term care facilities organize exercise activities for their residents, such as gymnastics, walking programs or recreational activities (e.g. woodwork) that may have a physical component. Residents are invited to participate in these activities but often caregivers have limited insight into which kind of activities residents prefer. The activity program is often based on what the institute has to offer, not on what the residents would like to do.
Including residents' preferences in selecting activities can improve interest and compliance.10 According to the recommendations of the American College of Sports Medicine and the American Heart Association every older adult (aged 65+ years) should have a physical plan based on individual abilities and preferences.6 The same is true in the Netherlands. The Dutch Inspectorate for Health Care has defined seven modules for physical activities in elderly care that must be taken into account when developing personalized activity plans. According to one of these, health care facilities need to incorporate the wishes and preferences of elderly people when planning, performing, and evaluating policy with regard to physical activity.11 However, it remains unclear how the perspective of this communication vulnerable group of residents in long-term care facilities can be investigated.
A variety of generic and standardized assessments and tools to investigate abilities of older adults on different levels (e.g. cognition or mobility) are available for care professionals. With the increase in client-centered care, more individualized tools and measures to explore a person's needs, preferences, and aims have been developed. The existing tools are, however, related to goal setting within rehabilitation or to a certain medical treatment.12, 13
A measure to identify preferences with regard to physical activities tailored to the situation of residential long-term care facilities has therefore been developed. The measure is named “MIBBO” which is a Dutch acronym for “Measure to Identify Meaningful Physical Activities in the Elderly”. The aim of this study was to investigate:
- 1)
The feasibility of the MIBBO in residents of long-term care facilities
- 2)
Which activities residents of long-term care facilities prefer
- 3)
How consistent preferences of residents are over a short period of time (1 week).
Section snippets
Design
This study was a descriptive study in two phases testing preliminary use of the MIBBO. First, feasibility was assessed in a small sample. Subsequently, the MIBBO was used with a larger sample to identify the activities that residents chose most often. In this second phase, a test-retest procedure was embedded using a subsample to research how consistent the preferences of residents were.
Sample
The population of residents in long-term care facilities is heterogeneous in terms of physical,
Results
The results of the study are presented according to the three research questions.
Discussion
In this study, a measure to identify preferred physical activities of residents in long-term care facilities, the MIBBO, was developed and evaluated. The MIBBO was considered to be feasible for use with most of the participating residents based on the following results. First, in general, the residents understood the procedure of the MIBBO and wished to participate in the interview. Second, care professionals needed 30 min on average to conduct the MIBBO. Although this is a relatively long time
Conclusion
The MIBBO seems a promising measure to help health care professionals identify residents' preferred activities and tailor physical activity plans. These activities can be embedded in daily routines. Future research investigating the relation between the residents' abilities and characteristics, and the support needed to perform the preferred activities is warranted, as well as research assessing the benefits of performing the preferred activities for the residents' functioning.
Acknowledgments
We would like to thank Fenna Graff, Kirsten Pieters, Monique Kokkelmans, Marloes van de Molen, Katharina Burgholz, Michaela Spiertz, Arantxa Vos, Milou Janssen, Naomi Pelser, Daisy Erens, Kristin Blanckers, and Michel Bleijlevens for the input and effort in the development of the MIBBO and the pilot testing. We would also like to thank Monique Lexis for her valuable comments on a concept version of this article.
Funding: This study is financially supported by Innovation Alliance Foundation
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