“We want to go, but there are no options”: Exploring barriers and facilitators of transportation among diverse older adults

BACKGROUND Tele-exercise has emerged as a way for older adults to participate in group exercise during the COVID-19 pandemic. Yet, little is known about the technology support needs of older adults for accessing tele-exercise. OBJECTIVE Examine the interests and needs of older adults for transition to tele-exercise, 2) Identify barriers and facilitators of tele-exercise uptake and continued participation, and 3) Describe technology support challenges and successes encountered among older adults beginning tele-exercise. METHODS We used an exploratory sequential mixed method study design. Participants were older adults with symptomatic knee osteoarthritis (n=44) who started participating in remotely delivered Enhance Fitness. Prior to the start of classes, a subsample of participants (n=10) completed semi-structured phone interviews about technology support needs and barriers and facilitators for technology adoption. All participants completed surveys including the PROMIS-57, the Senior Technology Acceptance Model scale, and a technology needs assessment. The study team recorded technology challenges encountered when participants engaged in tele-exercise classes and attendance rates. RESULTS Four themes emerged from the interviews: Participants desire features in a tele-exercise program that foster accountability; importance of direct access to helpful people who can troubleshoot and provide guidance with technology; opportunities to participate in high value activities motivates willingness to persevere through technology concerns; and belief in the ability to learn new things supersedes technology-related anxiety. Among participants in the tele-exercise classes (mean age 74.0 years ± 6.3; 86.4% female; mean of 2.5 ± 0.9 chronic conditions), 70.5% had a computer with a webcam, but 40.9% had little or no experience with videoconferencing. Initial technology orientation sessions lasted, on average, 19.3 (±10.3) minutes and 23.9% required a follow-up assistance call. During the first two weeks of tele-exercise, 47.6% required technical assistance which decreased to 11.9% for weeks 3-16. Median attendance was 100% for the first six sessions and 93% for the subsequent 42 sessions. CONCLUSIONS With appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of stand-by technical assistance, particularly during the first two weeks of classes. Continued development of best practices in this area may allow previously hard-to reach populations of older adults to participate in health-enhancing, evidence-based exercise programs. CLINICALTRIAL NCT04099394

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Barriers and Facilitators for Screening Older Adults on Fall Risk in a Hospital Setting: Perspectives from Patients and Healthcare Professionals

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17051461 ◽

2020 ◽

Vol 17 (5) ◽

pp. 1461

Author(s):

Lotte M. Barmentloo ◽

Manon L. Dontje ◽

Moniek Y. Koopman ◽

Branko F. Olij ◽

Christian Oudshoorn ◽

...

Keyword(s):

Older Adults ◽

Healthcare Worker ◽

Acute Care ◽

Fall Risk ◽

Chronic Care ◽

Healthcare Professionals ◽

Assessment Instrument ◽

Barriers And Facilitators ◽

Worker Characteristics ◽

Program Characteristics

We aimed to gain insight into the barriers and facilitators to fall risk screening of older adults visiting the hospital as experienced by patients and healthcare professionals, and to examine the differences between chronic- and acute-care patients. We invited patients (≥ 70 years) attending the nephrology and emergency department to participate in the screening. Patients and their healthcare professionals were asked to complete a self-administered questionnaire based on the “Barriers and Facilitators Assessment Instrument”. Differences in barriers and facilitators between acute- and chronic-care patients were examined with chi-square tests. A total of 216 patients were screened, and 103 completed the questionnaire. They considered many factors as facilitators, and none as barriers. Acute-care patients were more positive than chronic-care patients about healthcare worker characteristics, such as knowledge and skills. After screening, patients were more open to receiving advice regarding fall prevention. The 36 healthcare professionals considered program characteristics to be facilitators and mainly factors regarding healthcare worker characteristics as barriers to implementation. For patients, the outpatient setting seemed to be a good place to be screened for fall risk. Healthcare professionals also suggested that program characteristics could enhance implementation. However, healthcare professionals’ mindsets and the changing of routines are barriers that have to be addressed first.

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Barriers and facilitators of engagement in psychological therapies among older adults with depression: A systematic review and thematic synthesis

Journal of Psychiatric and Mental Health Nursing ◽

10.1111/jpm.12697 ◽

2020 ◽

Author(s):

Yuan Liu ◽

Judith Gellatly

Keyword(s):

Systematic Review ◽

Older Adults ◽

Barriers And Facilitators ◽

Thematic Synthesis ◽

Psychological Therapies

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Low vision rehabilitation services: Perceived barriers and facilitators to access for older adults with visual impairment

British Journal of Occupational Therapy ◽

10.1177/0308022618821591 ◽

2019 ◽

Vol 82 (8) ◽

pp. 466-474 ◽

Cited By ~ 1

Author(s):

Jennifer Kaldenberg

Keyword(s):

Older Adults ◽

Visual Impairment ◽

Low Vision ◽

Public Awareness ◽

Perceived Barriers ◽

Barriers And Facilitators ◽

Rehabilitation Services ◽

Coordinated Care ◽

Low Vision Rehabilitation ◽

Vision Rehabilitation

Introduction The aim of this study is to describe the barriers and facilitators to accessing low vision rehabilitation services in Massachusetts, USA, and determine differences between communities with and without existing low vision rehabilitation services for older adults with visual impairment. Method A sample of older adults with visual impairment ( n = 64) from both communities participated in the study. Barriers and facilitators to accessing the services were explored through focus groups and prioritized during one-on-one interviews, which allowed for comparison between communities. Results Twelve themes were identified: (a) bureaucracy and funding (public policy); (b) public awareness and stigma (community); (c) services available, knowledge of providers, care coordination, transportation (organizational); (d) people and lack of awareness of family/friends (interpersonal); and (e) income, health status, knowledge, self-advocacy, and time (individual). Conclusion This study provides insights into the perceived barriers and facilitators of accessing low vision rehabilitation services for older adults with vision impairment living in Massachusetts, USA. Key findings indicate the need for improved awareness of these services at the provider and consumer level, coordinated care, increased education on the efficacy of occupational therapy low vision rehabilitation services, client-centered care provided when the client is ready to accept services, and service provision that addresses sociodemographic factors.

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Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis

BMC Family Practice ◽

10.1186/s12875-019-0983-y ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 5

Author(s):

Philine S. Harris ◽

Liz Payne ◽

Leanne Morrison ◽

Sue M. Green ◽

Daniela Ghio ◽

...

Keyword(s):

Older Adults ◽

Mixed Methods ◽

Barriers And Facilitators

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Barriers and facilitators to nutritional risk screening of older adults in primary care

Proceedings of The Nutrition Society ◽

10.1017/s0029665120004255 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Christine Mills

Keyword(s):

Older Adults ◽

Primary Care ◽

Grey Literature ◽

Community Dwelling ◽

Barriers And Facilitators ◽

Nutritional Risk ◽

Term Care ◽

Risk Screening ◽

Google Search ◽

Nutritional Risk Screening

AbstractIntroduction:Over one-third of these community-dwelling older adults in Canada are at increased nutritional risk. Worldwide, two-thirds of older adults are at increased nutritional risk, although this figure includes those who are hospitalized or in long term care. Nutritional risk can lead to malnutrition; this occurs when an individual's food intake has an imbalance of energy, protein, or other nutrients. Nutritional risk and malnutrition are associated with poor quality of life, increased hospitalization, and premature mortality. Since malnutrition starts in the community, primary care is the ideal location for nutritional risk screening. If nutritional risk is identified early, before it progresses to malnutrition, it can be more easily treated. It is therefore important to understand barriers and facilitators to nutritional risk screening in primary care.Materials and Methods:The peer-reviewed and grey literature were searched. The databases CINAHL, Embase, Medline, and Google Scholar were used to identify articles related to barriers and facilitators to nutritional risk screening of older adults in primary care. A Google search identified publications from the grey literature related to nutritional risk screening of older adults. Key informants consisting of health care professionals working in primary care were asked to identify additional barriers. The Theoretical Domains Framework (TDF) was used to classify the barriers and facilitators.Results:Nine barriers and nine facilitators relating to nutritional risk screening of older adults in primary care were identified. These barriers and facilitators were located within the following domains of the TDF: knowledge; skills; social/professional role and identity; beliefs about capabilities; beliefs about consequences; motivation and goals; memory, attention and decision processes; environmental context and resources; social influences; emotions; behavioural regulation; and nature of the behaviours.Discussion:The TDF can be used to examine the barriers and facilitators to nutritional risk screening of older adults in primary care. Identification and classification of these barriers and facilitators can aid in the development and implementation of interventions designed to improve rates of nutritional risk screening in primary care. Identifying older adults at nutritional risk can help to prevent malnutrition, by intervening early when poor dietary intake may still be relatively easy and inexpensive to address. Screening is the first step in this identification.

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