The meaning of walking and gait training in nursing facilities in Germany

Abstract

Background: Physical activities are beneficial for health – even in nursing facilities (NF). We consider walking and movement as important determinants of social interaction. Only NF-residents “who move†can actively seek contact persons. Immobile residents wait for visits. Therefore, gait and movement training should be prioritized in NFs. Methods: Residents of German NFs participating in the “Berlin Project†underwent a comprehensive, standardized assessment RAI 2.0 (www.interrai.org) once a year. We used data from 2014 (N14=2,034) and 2015 (N15=1,841). Exclusion: residents <65years, coma, and end of life. Average age=83.7 years (SD=24.47), female: 71.3%. Findings: 54.5% of NF-residents like walking. This preference is positively associated with uncomplicated interaction, accepting of visits, self-determination (own plans, participation in the community and its programs), etc. Locomotion training is rare: Only 26.1% have gait, 32.4% transfer training. Of those residents, the majority is trained daily. The lower clients’ ADL performance in walking, the more walking training they receive (e.g., ADL walking between rooms and training: b = .62, SE = .07, p < .001).Whether trainings are provided frequently depends on the goodwill of staff. “Troublemakers†who have conflict with staff or other residents, and exhibit adjustment deficits are overrepresented among residents without training, and underrepresented among those trained daily. Discussion: Walking training is seemingly not provided for preventive purpose, since impaired walking performance qualifies residents for walking training rather than some remaining performance in this activity. Not surprisingly, after one year, neither overall functional status, nor cognition, mood, or ADLs are influenced by the trainings.