Josephine Boylan, ACH Group - Putting Theory Into Practice: an Operational Framework for Healthy Ageing

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Josephine Boylan, Northern Region Residential Services
Manager, ACH Group delivered the presentation at the Transition Care: Improving Outcomes for Older People Conference 2013.

The Transition Care: Improving Outcomes for Older People Conference explores a combination of residential and community transition care programs. It also features industry professionals' experiences in transitional aged care, including the challenges and successes of their work.

For more information about the event, please visit: http://www.communitycareconferences.com.au/transitioncareconference13

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Josephine Boylan, ACH Group - Putting Theory Into Practice: an Operational Framework for Healthy Ageing

  1. 1. What drives your practice? What drives your thinking? How does that thinking translate into practice? Healthy ageing; an easy choice 1
  2. 2. More positive views of ageing Healthy Ageing - addresses the lifestyle factors that influence healthy ageing Active Ageing - optimize opportunities for health, participation and security - intentional Positive Ageing - emphasises the need to remain actively engaged in society in order to adapt successfully to older age
  3. 3. What is Healthy Ageing Theory? Healthy Ageing is the ability to continue to function mentally, physically, socially, and emotionally as the body slows down its processes (Hansen-Kyle, 2005, p46) Healthy ageing encompasses principles of healthy lifestyles to achieve positive ageing, active ageing and health promotion outcomes Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. Health promotion embraces actions directed at strengthening the skills and capabilities of individuals but also actions directed towards changing social, environmental, political and economic conditions to alleviate their impact on populations and individual health. Healthy ageing; an easy choice 3
  4. 4. 2 Case Studies Highercombe -126 bed home Brand new home New staff New Residents New model Milpara - 92 bed home Renovated home Existing Staff Existing Residents Traditional model
  5. 5. So why did we change? We wanted to shape a more positive future for older people
  6. 6. The answers to what we needed to ‘know and do’ was in the research
  7. 7. What did the research tell us? 7 The research was very clear….decline as we know it ……even for our frail elderly is…………. avoidable - Studies highlighted that the sedentary life of the elderly person in residential homes was the largest contributor to decline. - Studies conducted in 2002 showed an average of 12 minutes a day of constructive activity was occurring in residential homes - That aged care is viewed as……accommodation for older people with diseases demanding medical intervention…..and is costly
  8. 8. What did the research tell us? 8 -There is inattention to health promoting interventions for all residents. - That current service designs lack a theoretical and empirical base - That older Australians fear a move into residential care, preferring instead an early death Avoidable decline
  9. 9. Australia
  10. 10. Oxidative Stress & Aptosis Protein Oxidation Reactions Stem Cell Ageing Genetic Transcription Telomere and Telomerase Immune Functions Cellular Biochemistry Glycation Mitochondrial Processes CURRENT TRENDS OF Aged RELATED DISEASES Cardiovascular Disease Diabetes Arthritis Osteoporosis Cerebral vascular Disease Alzheimer's Disease Chronic Respiratory Disease Cancers Depression & ANXIETY 80%ofnoncommunicable diseasesarepreventable
  11. 11. We wanted a sustainable model for healthy ageing that focuses on active living across the lifespan.
  12. 12. Where healthy ageing for our residents would be about ‘being in the living room’, not ‘the waiting room’.
  13. 13. and....health promotion for our staff would be about living and working in ways to guard our long term health and wellbeing
  14. 14. We now know that ‘Getting older is unavoidable, but falling apart is not’ The magic pill of physical activity is powerful, with effects demonstrated on numerous health outcomes, including positive mental health. We believe the ‘feel good’ factor associated with exercise is not the privilege of the young or the middle aged.
  15. 15. Healthy ageing an easy 16 Healthy ageing does not happen by chance. We planned a structured approach steeped in research from Health Promotion (World Health Organisation), Science of wellbeing and Positive Psychology to embed strategies and thinking that enable and promote the health and wellbeing of residents and staff....Health for All
  16. 16. Our purpose was to create a health promoting environment with ...integrated systems and interventions to promote and enable healthy ageing; easy access and easy choices
  17. 17. More action is required to transfer knowledge into practice
  18. 18. Bridging the know–do gap - the greatest opportunity for strengthening health systems and ultimately achieving equity in global health. Knowledge translation - a paradigm to learn and act towards closing the gap. Knowledge translation strategies can harness the power of scientific evidence and leadership to inform and transform policy and practice.
  19. 19. Closing the Gap Staff Older people Environment 20 We reviewed the physical and social enablers for healthy ageing: the environment (building/infrastructure/ systems) and the staff (their confidence, capability and competence)......and developed a Plan
  20. 20. Knowledge Transfer: prepare and embed the paradigm shift Review literature - come from evidence base Develop leadership group Develop Healthy Ageing Vision – Active living being core to policies, procedures & practices Develop communication strategy - admission process to include new thinking – families/residents – gather feedback Set targets/KPI to measure progress Prepare validated data gathering tools – evaluate along the way Review budget for new equipment (gym/training) Determine Teaching program – focus on Leaders course first - 3 day training program Provide ‘time off & resources’ for Project Management (2-5 day) Train Care staff – 2 days Review for role Personal trainers Set up Early intervention working party (interdisciplinary) and systems Partner with Universities / TAFE Develop health promotion awareness tools /documentation Develop Healthy Ageing competency tool to embed new thinking - mindset Review recruitment /appraisal process to include healthy ageing as core KPI Develop education / healthy literacy tools Develop Well being Plans
  21. 21. Healthy Ageing Approach Life course model for wellbeing A systems based strategy Shapes the health and wellbeing of the individual, staff and wider community Build staff capacity & mindset for healthy ageing Five Standards for Health Promotion Science of wellbeing Positive Psychology Healthy Settings approach Healthy ageing, an easy choice 22
  22. 22. Healthy Ageing Approach Life course model for wellbeing A systems based strategy Environment shapes the health and wellbeing of the individual, staff and wider community Build staff capacity & mindset for healthy ageing Five Standards For Health Promotion Science of Wellbeing Positive Psychology Settings Approach Healthy ageing, an easy choice 24
  23. 23. Expands responsibility for health beyond the individual to the community and environment. ‘Calls for Aged Care leaders to move towards a health settings approach to advance healthy ageing across the lifespan’.
  24. 24. Healthy Ageing Approach Life course model for wellbeing A systems based strategy Environment shapes the health and wellbeing of the individual, staff and wider community Build staff capacity & mindset for healthy ageing Five Standards For Health Promotion Science of Wellbeing Positive Psychology Settings Approach Healthy ageing, an easy choice 26
  25. 25. Say yes to learning Say yes to connecting Say yes to savouring Say yes to Speaking up Say yes to positive emotion Say yes to being active
  26. 26. Our aim is to increase healthy life expectancy and compress the stage of disability.
  27. 27. Pathway to optimal human functioning across the life course..we teach the model to staff so that they can apply it to their own lives and families... 6 ingredients for positive ageing Staff enable and promote residents engagement in the model through coaching and monitoring participation The Partners in Positive Ageing model (PiPA) is a structured approach (partnership) to share responsibility (between staff and residents) for the health outcomes of older people in our facilities.
  28. 28. Healthy ageing an easy 30 Steep decline in health, due to factors such as inactivity, can be reversed at any age. Our aim is to address the fitness gap of older people (see  below) by encouraging and supporting them to participate in exercise based activity.   Exercise based activity can assist older people to remain above the disability threshold (see  ).
  29. 29. Healthy Ageing – Highercombe Exercise Activity EXERCISE WHO/WHERE /WHEN OUTCOME Easy moves & Balance Class Staff, Volunteers – group program 4x per week, on site at Highercombe Flexibility, Strength, Balance, Social Gym Personal trainers – group/individual Residents attend 2-3x per week Cardio, strength, balance, mobility, , social Walking (walk around Australia) Staff, Volunteers, Family, Outdoors/indoors, Daily Mobility, social, outdoors, fresh air, goal orientated Electric Pedals Staff, gym, room visits, 2-3x per week Mobility, Circulation , cardio Aquatics Staff, local community centre Monday each week Therapeutic, gentle movement, buoyancy Golf Staff/Volunteers, Highercombe Golf Club, Thursday each week Walking, fresh air, social, Golfers previously Carpet Bowls Staff/Volunteers, Activity room, 2x per week + Milpara sister site visits Social, mobility Room exercise Staff, volunteers, Student placements 2 – 3x per week Strength, flexibility, mobility Tai Chi Instructor, weekly Flexibility, Balance,
  30. 30. Healthy Ageing Approach Life course model for wellbeing A systems based strategy Environment shapes the health and wellbeing of the individual, staff and wider community Build staff capacity & mindset for healthy ageing Five Standards For Health Promotion Science of Wellbeing Positive Psychology Settings Approach Healthy ageing, an easy choice 32
  31. 31. 5 standards for Health Promotion Standard 1: The organisation has a written policy for health promotion – This policy is implemented as an overall quality system and is aiming to improve health outcomes for residents, staff and relatives/families. (pg 21) Standard 2: describes the organisations obligation to ensure the assessment of residents needs for health promotion, disease prevention and rehabilitation. (pg 22) Standard 3: states the organisation must provide residents with information relating to their health conditions and establish health promotion interventions in their care planning. (pg 22) Standard 4: gives management the responsibility to establish conditions for the development of ACH group homes as a healthy workplace. (pg 24) Standard 5: deals with continuity and cooperation, demanding a planned approach to collaboration with other health care service sectors and institutions. (pg 33
  32. 32. Pathway to optimal human functioning across the life course..we teach the model to staff so that they can apply it to their own lives and families... 6 ingredients for positive ageing Staff enable and promote residents engagement in the model through coaching and monitoring participation The Partners in Positive Ageing model (PiPA) is a structured approach (partnership) to share responsibility (between staff and residents) for the health outcomes of older people in our facilities.
  33. 33. Early Intervention program The inter-disciplinary Early intervention working party meets monthly reviewing; adverse events – mostly related to falls, increased in behaviours Physical and Social participation in activities / fitness, Residents at risk and requiring support and education Residents requiring tailored recovery programs to re-engage in physical and social activities
  34. 34. Healthy Ageing Approach Life course model for wellbeing A systems based strategy Environment shapes the health and wellbeing of the individual, staff and wider community Build staff capacity & mindset for healthy ageing Five Standards For Health Promotion Science of Wellbeing Positive Psychology Settings Approach Healthy ageing, an easy choice 36
  35. 35. A mindset for healthy ageing Older people Environment 37 Healthy ageing - an easy choice Building capacity of older people for healthy ageing cannot be achieved without building capacity of staff staff
  36. 36. Staff Healthy ageing becomes an easy choice Environment 39
  37. 37. How older people function and how they die… 7% 22% 16% 47% Lunney, JR, Lynn J, Hogan, C. Profiles of Older Medicare Decedents. JAGS 50:1108-1112, 2002 7 7% High Low Function Time Death Sudden Death 22% High Low Function Time Death Terminal Illness 47% High Low Function Time Death Frailty 16% High Low Function Time Death Organ Failure Lung Heart Liver Dementia Strokes Arthritis Parkinson’s Hip Fracture Cancer
  38. 38. How older people at Milpara function and how they died in 2012 7% 47% Lunney, JR, Lynn J, Hogan, C. Profiles of Older Medicare Decedents. JAGS 50:1108-1112, 2002 7 38% High Low Function Time Death Sudden Death 31%High Low Function Time Death Frailty Lung Heart Dementia Strokes Arthritis Parkinson’s Hip Fracture Cancer 90% of residents walked until they die
  39. 39. Active Living for Healthy ageing Our results include: Participants: n=70 - 73% of Residents who participated in the WHOQOL BREF survey from their admission in 2009/10 until 2011 indicated improved quality of life -Nearly 20% of this sample group indicated improved ‘health’ -In 2013 – 15 residents who participated in the WHOQOL BREF indicated 83% improved quality of life.
  40. 40. 95% of residents at Highercombe ‘walk until they die’
  41. 41. Active Living for Healthy ageing gives more years to life and more life to years

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