Use of wearable technology to assess activity in cognitively impaired populations: Inside care homes and the community: Dementia care research: Dementia care ‐ evaluation

Background Preservation of mobility is a key mediator for maintaining functional abilities, preventing falls, and slowing cognitive decline in older adults with cognitive impairments, such as dementia. Community-dwellers with dementia are less active than cognitively-intact older adults, spending less time walking and taking less varied walking activities [Mc Ardle et al., 2019]. Care homes might further increase barriers to mobility for cognitively-impaired residents due to organizational and environmental constraints [Benjamin et al., 2014]. However, there are limited objective studies characterising activity in care home residents with cognitive impairment. This study aims to investigate activity in care home residents compared to community-dwellers with cognitive impairment. Method Data from the Staying UpRight study (University of Auckland, NZ) provided information about 37 care home residents with predominately mild-moderate cognitive impairment, while the GaitDem study (University of Newcastle, UK) illustrated activity in 51 community-dwellers with dementia. Both studies placed a tri-axial accelerometer (Axivity, AX3) on participants’ lower backs, which continuously monitored their activity for 7 days on average. Activity measures included volume (time spent walking, steps and ambulatory bouts per day), pattern (mean bout length, proportion of short to long walking bouts) and variability (of bout length). Independent t-tests compared activity measures between care home residents and community dwellers. Result Controlling for age and sex, care home residents (Age: 85±8, MOCA: 14±7, 74%female) spent less minutes walking (p<.001), took less steps (p<.001) and fewer ambulatory bouts (p<.001) compared to community-dwellers with dementia (Age: 77±6, sMMSE: 22±4, 29%female). Their ambulatory bout lengths were also shorter (p=.032), and they spent proportionally more time in short bouts (p=.012). Conclusion This study provides initial evidence that care home residents with cognitive impairment are objectively less active compared to community-dwellers. Improving mobility in care homes is an important target for maintaining functional abilities, lowering falls risk and enhancing longevity. Future work should identify modifiable factors for activity preservation when residing in care homes. This analysis was limited by the synthesis of two discrete datasets with culturally-diverse populations at different stages of cognitive impairment. This highlights the need for a comprehensive study to investigate the complexities of activity loss in care homes.