Physical Activity and Healthy Ageing: The Psychosocial Impact of Digital Music and Movement for Care Home Residents, and the Role of Care Home Staff Wellbeing

Abstract

Promoting healthy ageing has become a priority in the health sector considering the decline in health and wellbeing associated with ageing, particularly among residents in care homes who are at higher risk of poor psychosocial wellbeing. In improving older adults’ wellbeing, physical activity (PA) has been proven to have a positive multidimensional impact, thus, the primary focus of this thesis was to explore the effectiveness of digital music and movement intervention on the psychosocial wellbeing of older adults/residents and evaluate the feasibility of the intervention in care homes. Also, this thesis assessed the wellbeing of care home staff and how it relates to digital music and movement intervention implementation capacity in care homes. Firstly, a systematic review and meta-analysis of eight randomised controlled trials and five non-randomised controlled trials were carried out to investigate the benefits of PA and the role of its dimensions on anxiety in older adults (65+ years). Results from the systematic review showed significant effects of PA (SMD = -0.41; 95% CI = -0.58, -0.24; p <.00001) on anxiety symptoms. Further analysis revealed significant effects for all PA dimensions but with differences in magnitude of effects. Secondly, a realist evaluation was used to explore the feasibility of implementing digital music and movement intervention across ten care homes. Out of the 49 older adults recruited, 18 residents completed the baseline and post-intervention surveys on psychosocial wellbeing and a 12-week music and movement intervention of four prescribed sessions. Post-intervention interviews with a sub-sample of residents and focus groups with activity coordinators (ACs) were carried out. Digital music and movement intervention in care homes was found to be feasible but with 60% adherence rate and delivery challenges. Significant changes were reported for anxiety, depression and loneliness but not in fear of falling or quality of life. Qualitative findings emphasised improved mood, physical health and social support for residents and job satisfaction for ACs. To further evaluate the effectiveness of digital music and movement interventions on the psychosocial wellbeing of residents, a pilot mixed methods study with 34 older adults across four care homes were recruited into intervention and waitlist control groups. The intervention lasted for 12 weeks with three sessions prescribed weekly, but the waitlist control condition was not adhered to during the study. Surveys on multidimensional health markers were conducted at baseline and post-intervention with process evaluation and monitoring throughout the study. A sub-sample of residents and ACs were interviewed after the intervention. Results showed significant improvements in anxiety, fear of falling and loneliness. Qualitative findings highlighted the benefits and challenges of the intervention and supported findings from the process evaluation monitoring. Finally, a secondary data analysis of care home staff wellbeing survey that recruited 198 staff was conducted. Staff were grouped according to roles and questioned on psychosocial and physical wellbeing aspects as these were deemed to be linked to digital music and movement intervention implementation capacity in care homes. Results showed staff that provide direct care to residents have poorer wellbeing when compared to staff that do not provide direct care to residents. Poorer wellbeing may be attributed to working conditions and aspects of the role which previous studies indicate can impact delivery of digital muic and movement interventions. Qualitative findings from the survey revealed themes such as work-life balance, job satisfaction and impact of work and made recommendations for improving wellbeing. Collectively, this thesis supports the importance of music and movement on the psychosocial wellbeing of older adults especially among residents in care homes. Optimising the effects of music and movement on psychosocial wellbeing of residents is dependent on the dose of the intervention, the successful facilitation and implementation of digital music and movement in care homes, and the improvement of care home conditions for staff.