Real Time Fatigue And Physical Activity Of Older Adults In Assisted Living

PURPOSE: Fatigue is associated with decreased physical activity (PA) among older adults in assisted living (AL), but the direction of the relationship is unclear and may differ by mobility status. Because PA studies often exclude older adults with mobility disabilities, our understanding of their PA behaviors and associated factors is limited. Further research is needed for equitable health promotion. In AL residents with differing levels of mobility, this study 1) assessed the feasibility and acceptability of measuring real-time fatigue and PA using ecological momentary assessment methods and 2) described and compared the temporal, dynamic relationship between real-time fatigue and PA (mean 1-minute PA counts 30, 60, and 120 minutes before and after fatigue scores) using generalized estimating equations. METHODS: Older adults in AL (n = 34; mean age 75.6) wore a PA monitor for 7 days and recorded their fatigue 5 times/day. We reported recruitment, completion, and satisfaction metrics. We used generalized estimating equations to examine the temporal relationships between real-time fatigue and each of 6 PA time intervals (PA counts/minute averaged over 30, 60, and 120-minute intervals before and after fatigue scores). We examined 2 sub-groups: those who primarily ambulated and those who primarily used a wheelchair/scooter. RESULTS: The protocol was feasible and acceptable. Eighty percent of residents screened were eligible and enrolled. Ninety-four percent of participants wore the monitor for at least four valid days and they completed 76% of fatigue ratings. Most participants said the monitor was comfortable and had no difficulty entering fatigue scores. There were no significant associations between real-time fatigue and PA for the overall sample or the ambulatory sub-group. In those who used a wheelchair or scooter, there were significant positive associations between real-time fatigue and mean PA 30, 60, and 90 minutes before fatigue scores (B = 0.004-0.009; p-values 0.002-0.015). CONCLUSIONS: These data suggest that increased PA drives subsequent higher fatigue in the non-ambulatory group. Those with greater mobility disability may need support to manage fatigue following PA participation. Supported by: Sigma Theta Tau Alpha Chapter Research Grant, Midwest Nursing Research Society Seed Research Grant, NIH NINR (grant number T32NR018407), and a Center for Enhancing Quality of Life in Chronic Illness at Indiana University School of Nursing fellowship.