Physical activity, neuropsychiatric symptoms, and physical function in nursing home residents: the HUNT 70+ study

As life expectancy increases, the incidence of age-related chronic health conditions and functional decline rises, increasing the need for institutional long-term care such as nursing homes. In Norway, 84% of nursing home residents have mild cognitive impairment or dementia. This population is characterized by a high burden of neuropsychiatric symptoms (NPS), which contribute to limited physical activity (PA) and a largely sedentary lifestyle. Regular PA is essential for maintaining physical function (PF) and independence, yet nursing home residents spend most of their time being sedentary. The present study aims to explore sensor-based measured PA patterns and investigate how PA is associated with NPS and PF in nursing home residents.

This cross-sectional study used data from the fourth wave of the population-based Trøndelag Health Study 70-years-and-older cohort (HUNT4 70+), including activity data from a total of 163 nursing home residents. PA was measured using two accelerometers placed on the lower back and thigh. PA patterns were described through the activity types walking, standing, sitting, and lying, activity bouts, and transitions. NPS was assessed using the Nursing Home Version of the Neuropsychiatric Inventory (NPI-NH), and PF using the Short Physical Performance Battery (SPPB). All outcome variables were grouped based on cognitive impairment and dementia severity, set by clinical experts using the DSM-5 diagnostic criteria and the Clinical Dementia Rating (CDR) scale.

Participants' mean age was 87.8 years, and 62% were female. With a daily average of 17.6 min walking, 1.1 h standing, 9.9 h sitting, and 12.7 h lying, our nursing home residents spent approximately 94% of the day being sedentary. Walking and standing appeared predominantly in bouts under 10 min across cognitive impairment and dementia severity. No association was found between time spent walking, standing, sitting, lying and transitions from sedentary behavior to activity with NPS. Time spent walking, standing, lying and transitions from sedentary behavior to activity was significantly associated with PF.

PA mainly occurred in bouts shorter than 10 min and sitting and lying accounted for most of the daily behavior. No association was detected between time spent in different activities and NPS. Although time spent walking and standing was limited in all groups, it showed an association with PF. This may suggest that even small amounts of PA play a significant role in maintaining or improving physical capabilities in nursing home residents.