Self-management processes, sedentary behavior, physical activity and dietary self-management behaviors: impact on muscle outcomes in continuing care retirement community residents

Background Despite the known benefits of non-sedentary behavior, physical activity, and protein and caloric intake to health and muscle mass, strength, and function, many older adults do not meet physical activity and dietary recommendations. A better understanding of the factors associated with sedentary behavior, physical activity and dietary self-management behaviors, and muscle outcomes (muscle mass, strength, and function) is needed, particularly among continuing care retirement community residents. The objective of this study was to examine the factors associated with sedentary behavior, physical activity and dietary self-management behaviors, and muscle outcomes among continuing care retirement community residents. It also aimed to determine whether sedentary behavior and physical activity and dietary self-management behaviors mediate the relationships between self-efficacy, goal congruence, aging expectations, social support, and muscle outcomes. Methods A sample of 105 continuing care retirement community residents (age > 70 years) participated in this correlational, cross-sectional study. Questionnaires on pain, self-efficacy, goal congruence, aging expectation, social support, and daily protein and caloric intake were administered. Physical activity and sedentary behavior (ActiGraph wGT3X-BT), muscle mass (ImpediMed SFB7), muscle strength (Jamar Smart Digital Hand Dynamometer), and muscle function (Short Physical Performance Battery) were measured. Multiple regression, logistic regression, and mediation analyses were performed. Results Low goal congruence predicted engagement in sedentary behavior and light physical activity. Higher levels of self-efficacy and social support were associated with increased likelihoods of achieving greater moderate physical activity and meeting daily recommendations for caloric intake, respectively. Self-efficacy and goal congruence predicted muscle function and strength. Moreover, sedentary behavior and achieving greater moderate physical activity were found to partially but significantly mediate the relationship between self-efficacy and muscle function. Conclusion Future research should evaluate whether attempts to reduce sedentary behavior and promote physical activity and dietary self-management behaviors and muscle outcomes are more successful when modifications to the self-management process factors are also targeted.

Preparing for the New Normal: Chronicling the Impact of COVID-19 on Older Adults and Providers

COVID-19 and social distancing heralded an unprecedented change in the way older adults and health care providers live, work, socialize and manage their health. Early “calls-to-action” included the call for researchers to chronicle the impact of the COVID-19 pandemic on care of older adults to inform models of care and best practices in the new normal. This symposium explores the impact of COVID-19 on the health of older adults across the care continuum and healthcare delivery augmented by technology. The perspectives of older adults living in the community and providers who care for this population are highlighted. Additionally, there is a focus on the most vulnerable, those living in skilled care facilities and continuing care retirement communities. Fisher analyzes the key themes in 37 COVID-19 video communiques over 11 months at a continuing care retirement community. Sefcik explores coping strategies including outdoor activities among community-dwelling older adults. DiMaria-Ghalili examined patterns of physical and mental health, technology usage and loneliness in older adults, including those living in the community and a continuing care retirement community. Using longitudinal data and COVID-19 supplemental survey data from the National Health and Aging Trends Study, Huh-Yoo discusses disparities in online patient-provider communication and implications for the Post-COVID era. Coates discusses the facilitators and barriers perceived by interdisciplinary providers deploying telehealth during the COVID-19 pandemic and implications for healthcare delivery in older adults. The symposium will conclude with a discussion by Dr. Sefcik on the implications for research, practice and policy in the post COVID-19 era.

Continuing care retirement community senior housing in Shanghai: an analysis of the development barriers

Purpose Shanghai is currently faced with a rapid increase in the ageing population and demand for elderly homes. Continuing care retirement community (CCRC) has been emerging as a high-end alternative to offer specialised accommodation to the elderly in major cities. Since the first development in 2008, the industry is now still at the infancy stage. This study aims to examine the investment barriers hindering the supply and demand of CCRCs with an aim to recommend practical and senior housing policy measures to facilitate CCRC developments. Design/methodology/approach Multiple-case study method was used to confirm whether the literature findings on investment barriers apply to the context of Shanghai. Four representative CCRC development cases in Shanghai were examined, in which qualitative data were collected from interviews with experienced CCRC development managers and quantitative data from a questionnaire survey of the CCRC residents. Findings Operation management experience, financial risks and government support policy were found to be the main supply barriers. Chinese traditional family-oriented culture and affordability were not the main demand barriers of CCRCs in Shanghai. Poor quality of services and living environment were identified as the main barriers suppressing the demand for CCRC. Research limitations/implications Although common trends and views can be drawn from the representative cases in Shanghai to provide valid results, further research should be conducted on other major cities in China so that the results can be widely applied. Practical implications Successful CCRC investment strategy should focus on partnering with experienced professional eldercare management companies, provisions of high-quality medical professionals and trained care personnel and delivery of flexible care service, along with intensive capital flows for land, construction and operating costs. Social implications Additional senior housing policy support should be established to promote the CCRC supply to address the ageing needs, particularly granting lands for CCRC developments at Tiers 1 and 2 major cities where the land cost is high. Originality/value This research’s practical and policy measures can be applied to enable and promote CCRC developments in Shanghai, thus benefitting both housing investors and the government. The findings also form a baseline for CCRC developments in other major cities.

Stronger Impact of Interpersonal Aspects of Satisfaction Versus Tangible Aspects on Sustainable Level of Resident Loyalty in Continuing Care Retirement Community: A Case Study

The objectives of the study were to examine the impact of interpersonal and tangible aspects of resident satisfaction on word-of-mouth (WOM) intention in community-embedded third places with long-duration service experiences and to investigate the mediating effect of interpersonal aspects on the relationship between tangible resident satisfaction and WOM intention. Paper-based survey questionnaires and postage-paid envelopes were mailed to 293 continuing care retirement community (CCRC) residents. Reliability and validity of the multidimensional construct of resident satisfaction were ensured through confirmatory factor analysis. Hierarchical regression analysis and MANOVA were used to test the hypotheses. A total of 157 completed surveys were received. Analysis showed that two categories of resident satisfaction were statistically distinct. Interpersonal aspects of resident satisfaction (resident involvement, social interaction, and staff care) positively impacted WOM intention more than the tangible aspects (room, home, and meals service). The relationship between tangible resident satisfaction and WOM intention was mediated by interpersonal aspects of resident satisfaction. This study contributes to the literature by (1) examining the mediating effect of interpersonal resident satisfaction between tangible satisfaction and WOM intention in community embedded third places and by (2) exploring the role of non-traditional third places, (i.e., third places nested within residential community settings) as opposed to conventional types (i.e., individual commercial settings). Thus, it addresses the call for research on permanent residents with long-duration service experiences and the effect of one location nested within another.