Participation in life activities after hematopoietic cell transplantation in older adults

This study aims to measure activity participation and describe barriers and goals for participation in older adults post-HCT.

In a convergent mixed methods design, we quantitatively assessed four domains of participation (instrumental, low demand leisure, high demand leisure, and social) using the modified Activity Card Sort (ACSm) and described cognitive, physical, and psychosocial function using validated measures. Semi-structured interviews were used to describe barriers and goals for participation.

Eighteen participants with the median age of 66 years (range 60-75 years) completed the ACSm and interview. Seventeen of the 18 participants were > 6 months post-HCT and 44% of the total participants were > 12 months out from transplant. Overall, participants returned to 80% of their total activities. Mean retention was the highest in low-demand leisure activities (89%), followed by instrumental (85%), social (77%), and high-demand leisure activities (59%). Fatigue and impaired physical function were barriers for all activity domains. Participants discussed cognitive function as a barrier for many instrumental and low-demand leisure activities. Side effects, complications (i.e., osteoporosis and GVHD) and immune suppression were barriers to high-demand leisure activities. Participants talked about the meaning and purpose behind activity participation, highlighting the centrality of returning to life activities despite ongoing symptoms. There were multiple goals discussed related to activity participation.

Older adults undergoing HCT have diminished functional reserve and need more time to recover from activities that require sustained energy. Physical activity promotion programs targeting activity limitations and participation restrictions in cancer survivors are particularly salient for older adults undergoing HCT.