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Did you know.....

Aimee France, Senior Lecturer in Physiotherapy

Julie Walters, Senior Lecturer in Occupational Therapy

Introduction

Work with a partner and ask them the following questions

What is your routine like at the weekends? What sort of things do you enjoy doing? What motivates you to get out of bed in the

morning?

Activity for you

Take a moment to imagine yourself as an older person.

Yourself at say 86 years old.

Work with the same partner and ask them this...

How might your daily routine and your pattern of activity change when you are older?

Activity for you

at the end of this workshop we will ask you to consider these questions...

In the light of the evidence of this workshop and your own reflections how are you intending to age well?

Has anything we have covered here made you think differently about working with older people?

Activity for you

Did you know.....

.... that walking aids can actually impair balance

Walking aids

Why do we use them? Benefits

safety increase base of

support balance to facilitate discharge increase confidence increase independence increase community

mobility reduce pain

"Mobility aids can increase older adults’ confidence and feelings of safety, which, in turn, can raise their levels of activity and independence".

What is balance?

What is balance? https://

www.youtube.com/watch?v=7NZ6C6wGpAE

Johanna Quaas (b 1925) – the oldest active Gymnast in the world

altered posture altered length/tension of muscles reduce range of movement at joints alter proprioceptive feedback over-reliance on vision affects cognitive processing trip hazard affects physiological demands fixation of upper limbs reduced ability to refine movement= altered postural control and inefficient balance mechanisms

How can walking aids affect balance?

Large evidence base suggests that walking aids can overcome some physical and psychological barriers to mobilising

However, emerging evidence suggests long term use can have adverse effects on a person's internal mechanisms for balance

Walking aids can also increase risk of falling if used incorrectly

Walking aids should only be prescribed by a relevant health care professional after a full assessment of need

Walking aids should be used in conjunction with balance training to reduce the reliance on such aids and support from people

Ageing actively principles

Group exercise programmes hydrotherapy sports- bowls, darts Thai chi Home exercise programmes

Balance activities

Bateni, H and Maki B.E (2005) Assistive devices for balance and mobility: Benefits, demands, and adverse consequences. Archives of Physical Medicine and Rehabilitation. Volume 86, Issue 1, 134–145

M.P. Foley, B. Prax, R. Crowell, T. Boone (1996) Effects of assistive devices on cardiorespiratory demands in older adults. Phys Ther, 76, pp. 1313–1319

B.E. Maki, W.E. McIlroy, G.R. Fernie (2003) Change-in-support reactions for balance recovery: control mechanisms, age-related changes and implications for fall prevention. IEEE Eng Med Biol Mag, 22, pp. 20–26

M. Woollacott, A. Shumway-Cook (2002) Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture, 16, pp. 1–14

Evidence base

• W.C. Mann, C. Granger, D. Hurren, M. Tomita, B. Charvat (1995)

An analysis of problems with canes encountered by elderly persons. Phys Occup Ther Geriatr, 13, pp. 25–49• W.C. Mann, C. Granger, D. Hurren, M. Tomita, B. Charvat

(1995) An analysis of problems with walkers encountered by elderly persons Phys Occup Ther Geriatr, 13, pp. 1–23

• L.L. Brooks, J.J. Wertsch, H.E. Duthie (1994) Use of devices for mobility by the elderly. Wis Med J, 93, pp. 16–20

• B.E. Maki, P.J. Holliday, A.K. Topper (1994) A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol, 49, pp. M72–M84

Evidence base

....that getting out of bed can be a more effective exercise than walking

moves the joints through a greater range of movement, stimulates synovial fluid

stretches connective tissue encourages weight bearing through upper

limbs challenges trunk control and balance requires maximal muscle activity to stand

and uses major muscle groups

Why is getting out of bed useful?

Sarcopenia- age related changes to muscle mass and function

People who are physically inactive can lose as much as 3% to 5% of their muscle mass per decade after age 30

Sarcopenia typically accelerates around age 75 may be caused by altered function of nerves,

hormones and protein synthesis Research has shown that a program of

progressive resistance training exercises can increase protein synthesis rates in older adults in as little as two weeks

Muscle changes and strengthening principles

Move more! Change your position Make activity dynamic Make it purposeful and fun Consider activities to maintain to muscles and

joints, alongside your cardiovascular fitness Exercise prescription guidelines for

strengthening- start at a low intensity and build gradually to moderate intensity (5/6), 10-15 repetitions of an exercise at least 2 times a week (increasing to a program of 8 exercises).

Ageing actively principles

Household chores, gardening Swimming, hydrotherapy Tailored gym program Group exercise programmes Sporting activities Home exercise programmes Bed exercises Use your body weight, resistance, weights Stair climbing

Strengthening and movement activities

Morley et al (2011) Sarcopenia With Limited Mobility: An International Consensus Journal of the American Medical Directors Association

Volume 12, Issue 6, Pages 403–409 http://

onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2002.50216.x/full

http://europepmc.org/abstract/med/11041074 Nelson, Miriam E., et al. "Physical activity and public health in

older adults: recommendation from the American College of Sports Medicine and the American Heart Association." Circulation 116.9 (2007): 1094.

Latham, Nancy K., et al. "Systematic review of progressive resistance strength training in older adults." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 59.1 (2004): M48-M61.

Evidence base

Creative activities

Important qualitative value related to health and wellbeingPerruzza and Kinsella (2010) Lit review of the therapeutic use of creative arts occupationsOutcomes: Enhanced perceived control Building a sense of self Expression Transforming the illness experience Gaining a sense of purpose and Building social support

Creative activities

Perruzza, N and Kinsella, E (2010). Creative Arts Occupations in Therapeutic Practice: A Review of the Literature. British Journal of Occupational Therapy June 2010 vol. 73 no. 6 261-268

Walters, J.H. Sherwood, W and Mason, H (2014) Creative Activities. Chapter 17 in Creek’s Occupational Therapy and Mental Health. Eds Bryant, W; Fieldhouse, J and Bannigan, K London Elsevier

Creative activities evidence

https://www.youtube.com/watch?v=2i4-x6-6vws

Dingle et al (2013) IPA study Themes

◦ personal impact (positive emotions, emotional regulation, spiritual experience, self-perception, finding a voice);

◦ social impact (connectedness within the choir, connection with audience, social functioning); and

◦ functional outcomes (health benefits, and routine)

Singing

Dingle, G; Brander, C; Ballantyne, J and Baker, F. (2013) ‘To be heard’: The social and mental health benefits of choir singing for disadvantaged adults. Psychology of Music July 2013 vol. 41no. 4 405-421

Singing evidence

Developed following a systematic review of the main non-pharma therapies for dementia

Evaluated using a multi centre RCT in 23 residential homes and day centres – published in 2003

Cognitive stimulation therapy

Typically a 14 session programme of twice weekly meetings

https://www.youtube.com/watch?v=g0FiSirdwA8

Findings from the 2003 RCT suggest that CST improves both cognitive function and quality of life for people with mild to moderate dementia

Groups are popular with participants and don’t need specialist training to run

Cognitive stimulation therapy

Spector A, Orrell M, Davies S and Woods B (2001). Can reality orientation be rehabilitated? Development and piloting of an evidence-based programme of cognition-based therapies for people with dementia. Neuropsychological Rehabilitation, 11(3/4): 193-196.

Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M and Orrell M (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: Randomised Controlled Trial. British Journal of Psychiatry, 183: 248-254

Cognitive stimulation therapy evidence

College of occupational therapy key facts: Increasing physical activity can improve physical and

mental health and increase life expectancy. Current guidelines from across the UK recommend that older adults participate in regular physical activity to: ◦ • Reduce the risk of depression and dementia ◦ • Maintain functional ability ◦ • Contribute to the prevention of numerous chronic conditions ◦ • Reduce the likelihood of falling ◦ • Maintain independence and social engagement

(Chief Medical Officers of England, Scotland Wales and Northern Ireland, 2011)

Promotion of general health and wellbeing for older people

https://www.youtube.com/watch?v=ggswWVZ8zKA

This clip from BGT shows a group of older men exploiting our stereotype of aging and having a lot of fun in the process

The promotion of good health for older people reduces their need for more costly medical interventions and improves quality of life. Occupational therapy interventions have been identified as key to promoting mental health and well being in the NICE Public Health Guidance (2008).

Older people can obtain tangible benefits from a health-promoting, occupation-focused intervention. Health-promoting services involving older people need to be embedded into communities (Mountain et al, 2008).

randomized controlled trial in independent-living older adults (the Well-Elderly Study) found significant health, functional and quality of life benefits attributable to a 9-month preventative occupational therapy programme. The study aimed to evaluate the cost-effectiveness of this preventative programme. It was found that post-intervention healthcare costs for the occupational therapy intervention groups were reduced by 50% compared to the control group. The research concluded that preventative occupational therapy for this client group demonstrated cost-effectiveness and a trend towards decreased medical expenditures. (Hay J et al, 2002)

Chief Medical Officers of England, Scotland, Wales and Northern Ireland (2011)Start active, stay active: a report on physical activity from the four home countries’ Chief Medical Officers. London: Department of Health, Physical Activity, Health Improvement and Protection.

Hay J, LaBree L, Luo R, Clark F, Carlson M, Mandel D, Zemke R, Jackson J, Azen SP (2002) Cost-effectiveness of preventive occupational therapy for independent-living older adults. Journal of the American Geriatrics Society 50(8) 1381–1388

Mountain G et al (2008) Occupational therapy led health promotion for older people: feasibility of the Lifestyle Matters programme British Journal of Occupational Therapy 71(10) 406-413

National Institute for Health and Clinical Excellence (2008) Occupational therapy interventions and physical activity interventions to promote the mental wellbeing of older people in primary care and residential care London: NICE

Health promotion References

The questions...

In the light of the evidence of this workshop and your own reflections how are you intending to age well?

Has anything we have covered here made you think differently about working with older people?

Activity for you