Physical, social, and symbolic environment related to physical activity of older individuals in long-term care: A mixed-method systematic review

Background: Being active in old age is vital for health and well-being. Inactivity decreases functional ability, mo-bility, and increases care dependence and risk of falling. Worryingly, older individuals in long-term care settings spend most of their waking day sitting or lying down. The environment should be of special interest considering active life in long-term care. This review aimed to synthesize evidence and provide a comprehensive understand-ing of the environmental aspects related to the physical activity of older individuals in long-term care settings.Methods: A mixed-method systematic review, registered in PROSPERO (CRD42021251899; May 30th, 2021) was conducted using four international scientific databases (CINAHL, PubMed, Cochrane, PsychInfo). The searches were conducted from the earliest possible date till Dec 31st, 2020. All empirical peer-reviewed studies published in the English language in scientific journals were included if they had investigated environmental aspects (phys-ical, social, and/or symbolic) in relation to the physical activity of older individuals in long-term care facilities pro-viding full-time care. Critical appraisal was conducted using Joanna Briggs Institute's Critical Appraisal tools, and the Mixed Method Appraisal Tool. Abductive thematic analysis and a conceptual map were used to synthesize the evidence.Results: Altogether 838 original articles were assessed for eligibility, resulting in 30 included studies. No studies were excluded based on quality. The mean age of residents was over 75 when reported. Their cognitive and phys-ical functioning varied. The most frequent setting was nursing home. Three themes and corresponding descrip-tive themes were formulated, including 1) Physical environment: accessible and safe living environment, activating physical environment, 2) Social environment: supportive professionals, the role of other people, ade-quate activities to socialize and be active, and 3) Symbolic environment: policy at multiple levels, values of orga-nizations and professionals. Different environmental aspects within and between the dimensions of the physical, social, and symbolic environment were related to each other.Conclusions: A comprehensive synthesis of current evidence was provided and may be used for the assessment and development of long-term care settings. However, some aspects may have been missed because they have been addressed with terminology not identified with the word environment or similar concepts. As increasing activity may require actions in multiple dimensions, experimental research should be conducted to develop and test the effects of widescale modifications to existing environments from the needs of residents and fitting for each context. The evidence should be used for the design of new facilities. Tweetable abstract: Environmental aspects at multiple levels should be addressed to increase the activity of older long-term care residents.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).