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Elissa Burton,1,2 N Frances Horgan,3 Vanda Cummins,3,4 Austin Warters,5 Lauren Swan,6,7 Maria O’Sullivan,7 Dawn A Skelton,8,9 Bex Townley,9 Frank Doyle,10 Samira B Jabakhanji,11 Jan Sorensen,11 Debbie Rooney,6 Lisa Murphy,6 Rose Galvin12 1Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; 2enAble Institute, Curtin University, Perth, Western Australia, Australia; 3School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 4Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Dublin, Ireland; 5Older Person Services CHO9, Health Service Executive (HSE), Dublin, Ireland; 6North Dublin Home Care (NDHC), Dublin, Ireland; 7Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland; 8School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; 9Later Life Training Ltd, Killin, Scotland; 10Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 11Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland; 12School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick (UL), Limerick, IrelandCorrespondence: Elissa Burton, Curtin School of Allied Health, Curtin University, GPO Box U1987, Bentley, Western Australia, 6845, Australia, Tel +61 8 9266 4926, Fax +61 8 9266 3699, Email E.Burton@curtin.edu.auPurpose: Physical activity has been shown to improve older adults’ functional capacity, independence, and quality of life. In a feasibility study, we embedded a movement approach within older adults existing home care services through “Care to Move” (CTM). The aim of this qualitative study is to explore older adults’ experiences of CTM within their home care support services and to identify the strengths and barriers of engaging in CTM from the perspective of the older recipient.Materials and Methods: We conducted semi-structured telephone interviews with 13 older adults and one informal carer. Topics covered included participants’ overall experiences of CTM, changes to their overall activity and participation, aspects of CTM that they found valuable and issues that were challenging. Interview transcripts were coded and analyzed thematically to capture barriers and facilitators to the approach delivery.Results: Four themes were developed: i) “I have good days and bad days”, ii) “safety and security is the name of the game”, iii) “we’re a team as it stands’, iv) “it’s [COVID-19] depressing for everybody at the moment”. Older adults identified benefits of CTM engagement including improvements in physical and psychological wellbeing. However, subjective frailty and self-reported multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of delivering CTM and competing care staff interests. The broader role of care staff in supporting CTM was highlighted, as well as the emotional support that staff provided to older adults. Care staff continuity was identified as a barrier to ongoing engagement. The impact of COVID-19 on older adults physical and mental health negatively impacted the delivery of the approach.Conclusion: Our findings suggest that embedding CTM within home care services is feasible and that older adults enjoyed engaging in CTM. Addressing care staff continuity and adopting individual approaches to CTM delivery may enhance the implementation of services.Keywords: movement, older people, community care, motivation, barriers, home support

Lauren Swan,1,2 N Frances Horgan,3 Vanda Cummins,4 Elissa Burton,5 Rose Galvin,6 Dawn A Skelton,7,8 Bex Townley,8 Frank Doyle,9 Samira B Jabakhanji,10 Jan Sorensen,10 Debbie Rooney,2 Lisa Murphy,2 Austin Warters,11 Maria O’Sullivan1 1Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland; 2North Dublin Home Care (NDHC), Dublin, Ireland; 3School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 4Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Dublin, Ireland; 5Curtin School of Allied Health, Curtin University, Perth, Australia; 6School of Allied Health, Ageing Research Centre, University of Limerick (UL), Limerick, Ireland; 7School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; 8Later Life Training, Killin, UK; 9Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 10Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland; 11Older Person Services CHO9, Health Service Executive (HSE), Dublin, IrelandCorrespondence: Maria O’Sullivan, Email maria.osullivan@tcd.ieIntroduction: In Ireland, over 55,000 older adults are supported in their community by formal home support, amounting to an estimated 23 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the “Care to Move” (CTM) program through existing home support services. This qualitative study aimed to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in and delivered the CTM program.Methods: We conducted semi-structured telephone interviews with 22 HCAs [mean age 49.0 ± 10.7 years and female 21/22] involved in the delivery of the program with older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analyzed thematically to capture barriers and enablers to program delivery.Results: Barriers and enablers were identified under three themes i) the CTM approach ii) the home support setting, iii) older adults and physical activity, with iv) delivering care in a crisis and v) future directions further identified. Overall, there was a positive perception of the program’s focus on “movement prompts and motivators”, the “fit” within home support services, and the training provided. Practical challenges of limited time and the task-orientated nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the program for their clients. Though negative perceptions of older adults’ motivation or ability to engage with physical activity were noted. Risk, such as injury or pain, was identified but was not a dominant theme.Conclusion: Our findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional “task-oriented” care models to more personalised proactive approaches may facilitate this initiative and support aging in place.Keywords: aging, physical activity, integrated care, frailty, aging in place

Eva-Maria Elmenhorst,1,2 Daniel Rooney,1 Sibylle Benderoth,1 Martin Wittkowski,1 Juergen Wenzel,1 Daniel Aeschbach1,3,4 1Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, 51170, Germany; 2Institute for Occupational and Social Medicine, Medical Faculty, RWTH Aachen University, Aachen, 52074, Germany; 3Institute of Experimental Epileptology and Cognition Research, University of Bonn Medical Center, Bonn, 53127, Germany; 4Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USACorrespondence: Eva-Maria Elmenhorst, Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, 51170, Germany, Tel +49 2213 601 4735, Fax +49 2213 68323, Email eva-maria.elmenhorst@dlr.dePurpose: Recuperation during sleep on board of commercial long-haul flights is a safety issue of utmost importance for flight crews working extended duty periods. We intended to explore how sleep and blood oxygenation (in wake versus sleep) are affected by the conditions in an airliner at cruising altitude.Methods: Healthy participants’ sleep was compared between 4-h sleep opportunities in the sleep laboratory (n = 23; sleep lab, ie, 53 m above sea level) and in an altitude chamber (n = 20; flight level, ie, 753 hPa, corresponding to 2438 m above sea level). A subgroup of 12 participants underwent three additional conditions in the altitude chamber: 1) 4-h sleep at ground level, 2) 4-h sleep at flight level with oxygen partial pressure equivalent to ground level, 3) 4-h monitored wakefulness at flight level. Sleep structure and blood oxygenation were analysed with mixed ANOVAs.Results: Total sleep time at flight level compared to in the sleep laboratory was shorter (Δ mean ± standard error − 11.1 ± 4.2 min) and included less N3 sleep (Δ − 17.6 ± 5.4 min), while blood oxygenation was decreased. Participants spent 69.7% (± 8.3%) of the sleep period time but only 13.2% (± 3.0%) of monitored wakefulness in a hypoxic state (< 90% oxygen saturation). Oxygen enrichment of the chamber prevented oxygen desaturation.Conclusion: Sleep – but not wakefulness – under flight conditions induces hypobaric hypoxia which may contribute to impaired sleep. The results caution against the assumption of equivalent crew recovery in-flight and on the ground but hold promise for oxygen enrichment as a countermeasure. The present results have implications for flight safety and possible long-term consequences for health in crews.Keywords: polysomnography, oxygen saturation, EEG sleep power spectra, altitude, air travel, oxygen enrichment

Arthur R Brant,1 Suzann Pershing,1,2 Olivia Hess,1 David Rooney,1 Jeffrey Goldberg,1 Geoffrey Tabin,1,2 Sophia Y Wang1 1Byers Eye Institute, Stanford University, Stanford, CA, USA; 2VA Palo Alto Health Care System, Palo Alto, CA, USACorrespondence: Arthur R Brant Tel +1 330 651 7898Email abrant@Stanford.eduPurpose: To measure the COVID-19 pandemic impact on missed ophthalmology clinic visits and the influence of patient and eye disease characteristics on likelihood of missing clinic visits before and during the pandemic.Patients and Methods: A retrospective observational study analyzing eye clinic patients at a large tertiary care academic institution. We identified patients scheduled for eye care during pre-COVID-19 (January 1–February 29, 2020) and early COVID-19 (March 16–May 31, 2020) time periods. Missed appointment frequency and characteristics were evaluated during each time period. Multivariable logistic regression models were developed to examine adjusted odds of having at least one missed appointment during a given time period. Covariates included age, sex, race/ethnicity, marital status, preferred language (non-English vs English), insurance, distance from clinic, and diagnosis.Results: Overall, 82.0% (n = 11,998) of pre-COVID-19 patients completed all scheduled visits, compared to only 59.3% (n = 9020) during COVID-19. Missed visits increased dramatically in late March 2020, then improved week by week through the end of May 2020. General ophthalmology/cataract and strabismus clinics had the highest rates of missed clinic visits during the COVID-19 period; neuro-ophthalmology, retina, cornea, oculoplastics and glaucoma had the lowest. Females, Blacks, Hispanics, Asians, ages 50+, and married patients had higher adjusted odds of missing clinic visits, both pre-COVID-19 and during COVID-19. Asian, elderly, and cataract patients had the highest adjusted odds of missing clinic visits during COVID-19 and had significant increases in odds compared to pre-COVID-19. Non-married, diabetic macular edema, and wet age-related macular degeneration patients had the lowest adjusted odds of missed visits during COVID-19.Conclusion: Missed clinic visits increased dramatically during the COVID-19 pandemic, particularly among elderly and nonwhite patients. These findings reflect differences in eye care delivery during the pandemic, and they indicate opportunities to target barriers to care, even during non-pandemic eras.Keywords: COVID-19, healthcare utilization, disparities