Healthy Ageing Framework - Research into Practice
- 1. The Healthy AgeingFramework Research into Practice Jo Boylan Student DPH Northern Region Residential Services Manager
- 2. Why Healthy The four key Our purpose How do we Target Ageing? components achieve a Outcomes to progress whole of healthy ageing system paradigm shift? 2
- 3. What is HealthyAgeing o Healthy ageing encompasses principles of healthy lifestyles to achieve positive ageing, active ageing and health promotion outcomes o 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; an easy choice 3
- 4. How health promoting is residential aged care in Australia? 4
- 5. Current State • Viewedas …….accommodation for older people with diseases demanding medical intervention (Kane & Kane, 2005) • Reality……..often traditional services that focus on comfort care • ……... This approach is by its nature, costly 5
- 6. How older peoplefunction and how they die… Sudden Death Terminal Illness High High Cancer Function Function 7% 22% Death Death Low Low Time Time Organ Failure Frailty Dementia Lung Strokes High Heart High Arthritis Liver Parkinson’s Hip Fracture Function Function 47% 16% Death Death Low Low Time Time Lunney, JR, Lynn J, Hogan, C. Profiles of Older Medicare Decedents. JAGS 50:1108-1112, 2002
- 7. Steep decline inhealth, 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 Healthy ageing an easy ). 7
- 8. Aged Care Reform ProductivityCommission Report Aged Care Standards mostly financial draft standards aim reform to promote person centered approach / more health promoting
- 9. Next step? Exercise Prescription? Early intervention & Rehabilitation?
- 10. Will this levelof thinking penetrate the Residential Aged Care door?
- 11. Frequently all levelsof the aged care workforce inadvertently reinforce decline ‘through a mindset for inevitable decline’. This fixed mindset is not always challenged by our tertiary and vocational teaching systems..... A Mindset for Healthy Ageing is not embedded
- 13. Our purpose isto create health promoting environments where........ Healthy Ageing is an easy choice
- 14. Therefore optimal health can be Health is achieved when created within healthy choices are the contexts of enabled by: where people The physical live, love, play environment and work Social environment
- 15. • Expands responsibility for health beyond the individual to the community and environment. • Calls for Aged Care leadership to move towards integrating a whole system health promotion approach to progress healthy ageing across the lifespan.
- 16. Healthy Ageing Framework Science of wellbeing Life course model Five for wellbeing Standards for Health Positive Promotion Psychology A systems based strategy Build staff capacity Healthy Settings & mindset for healthy ageing approach Shapes the health and wellbeing of the individual, staff and Healthy ageing, an easy wider community choice 16
- 17. The enablers for healthy ageing Five Standards for Health Promotion To guide our responsibilities for health Healthy Workforce Health Promotion Environment Staff ‘systems approach’ Integrated at every level Partners in Positive Ageing – life course model for health Older people and wellbeing Healthy ageing an easy choice 17
- 19. Five Standards forHealth Promotion A framework for reorienting our service and building a healthy community 19
- 20. 5 standards forHealth 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. The policy is aimed at residents, staff and relatives/families. Standard 2: describes the organisations obligation to ensure the assessment of residents needs for health promotion, disease prevention and rehabilitation. Standard 3: states the organisation must provide residents with information relating to their health conditions and establish health promotion interventions in their care planning. Standard 4: gives management the responsibility to establish conditions for the development of ACH group homes as a healthy workplace. Standard 5: deals with continuity and cooperation, demanding a planned approach to collaboration with other health care service sectors and institutions. 20
- 21. Science of Healthy ageing Wellbeing Framework Life course model for wellbeing Five Standards For Health Positive Promotion Psychology A systems based strategy Build staff capacity Settings Approach & mindset for healthy ageing Environment shapes the health and wellbeing of the individual, staff and Healthy ageing, an easy choice wider community 21
- 22. Say yes to Say yes to Say yes to being active savouring Speaking up Say yes to Say yes to Say yes to positive learning connecting emotion
- 23. Pathway to optimalhuman 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.
- 24. The enablers for healthy ageing The setting enables healthy choices by making Environment Staff them safe and accessible Older people Healthy ageing an easy choice 24
- 25. -Incorporate health promotionat all levels and in every system - Implement the Five standards for health Promotion - guides responsibilities for health outcomes -Implement the model of wellbeing and activities to achieve a good life -Adapt the physical environment to promote activity in every day life -Incorporate Early Intervention Staff Programs for restoration and rehabilitation; to bounce back from adversity -Monitor and measure progress Older people Healthy ageing an easy choice 25
- 26. The enablers for healthy ageing Staff actively promote positive ageing through focus on making healthy life Environment Staff choices the easy choices Older people Healthy ageing an easy choice 26
- 27. Educate & trainstaff to promote ‘activity in every day life’ - Incorporate positive psychology principles and techniques; such as bringing strengths to work, building resilience and positive emotion, coaching and encouraging strengths and opportunities for older people Environment -apply the 6 key understandings to achieve a good life across the life course - Monitor and measure effect Older people Healthy ageing an easy 27 choice
- 28. Environment Staff Healthy ageing becomes an The older person is committed easy choice to healthy choices and is motivated to seek and demand a better quality of life 28
- 29. In a nutshell o Staff promote healthy ageing o Systems promote healthy ageing o Health promotion education promotes healthy lifestyles/ healthy choices o Procedures/policies and ultimately practises promote healthy ageing o The organisation and wider community promote healthy ageing How these interact is ultimately the ‘ecological approach’
- 30. 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’
- 31. More than 85%of staff indicated value and interest in training sessions in 2011 that addressed health literacy, early interventions, positive psychology, workplace wellbeing and health promotions/healthy ageing.
- 32. So do healthpromoting interventions cost more? No…..Our sites are using the ACFI tool which is an appropriate instrument for the promotion of healthy ageing….why? How? Pain based – 90% of residents have pain – bring into play allied health in a greater way Use the complex health component… initially, rehabilitate the resident and then continue with same funding to maintain them… Some resource costs associated with developing a gym/equipment The cost is in training staff in ‘a mindset for healthy ageing’
- 33. Where to fromhere? Our goal is to extend healthy life expectancy – by focusing on physical and psychosocial wellbeing • We do this by directing 80% of attention into early intervention strategies (prevention) using our care workers to implement this approach, monitored by the EN’s. • This enables RNs, Physio, OT’s to focus on more acute needs with the aim of restoring /recovering residents (physical & social) and avoiding events that may lead to hospitalisation.
- 34. 90% of residentsat Highercombe and Milpara ‘walk until they die’ Healthy ageing an easy 34
- 35. Parting questions toprepare for Healthy Ageing in the future o Are health promoting interventions/services/strategies embedded into your organisations culture? o Is recovery or restoration or rehabilitation easily accessible in order to bounce older people back from adversity? o Do you invest in early interventions to prevent or reduce inevitable decline? o Do you have robust health promoting systems / models in place that promote healthy ageing across the life course? for residents and staff? o Do you train and develop in your staff … a ‘mindset for healthy ageing?’
Editor's Notes
- #2 Today I am going to share with you an operational model for healthy ageing. This model incorporates a synthesis of current literature in relation to healthy ageing , ecological health promotion, healthy setting’s approach, positive psychology, science of wellbeing and mindsets for healthy ageing. This model could easily be translated into community care packages and retirement villages.
- #6 ……..and indicated to be shared by an ever-decreasing proportion of our society…and this implies a significant deterioration in economic prosperity for future generations
- #7 On the bottom right side shows the trajectory of high level needs residents……slow and long deterioration. What we are experiencing now two years into the model is more episodes of sudden deaths. We have had a significant decline in palliative care. This is not a bad things as we are now able to compress disability and extend healthy life expectancy right through to the end of their lives.
- #8 Physical inactivity is a major determinant of ill health, and therefore this has been our major focus. Our goal is to work on the fitness gap and keep our residents above the disability line. We have been able to do this by encouraging and coaching residents to engage in at least 3 exercise activities per week and participate in other social activities. Our gym runs 9-5pm each day, run by personal trainers and complimented with golf sessions, tai chi, balance classes, easy move and walking groups. All activity programs are monitored for participation. Residents who are not consistently participating in social or physical activities are flagged through a data base and this is followed up for further problem solving by the early intervention working party. There may be disengagement related to ill health or emotional issues . Where an adverse situation is occurring a resident may go onto a recovery program. This additional support is highly successful in bouncing residents back to their normal state, and recovery or rehabilitation usually takes one to two months.
- #9 Reform is on the way…however….do we really need the government to legislate healthy ageing before we embrace it…..
- #10 There are a number of pilot programs in the community that are integrating restorative models into their care packages…however this has not yet been adopted by the community aged care sector
- #11 I am concerned in Residential aged care we shape ill-being in our homes, create dependency limit access to regular and sustained health promoting activities accept avoidable decline as a part of ageing and label residents palliative….even though they are not symptomatic of a dying person. Limited mobility does not equal palliative care.
- #12 Since 1986 (Ottawa Charter) we have been asked to reorient our services to be more health promoting………. despite this, there is little evidence to demonstrate a ‘whole system’ Health Promotion approach to promote and enable the health and wellbeing of people living and working in aged care homes
- #13 A mindset for healthy ageing builds capacity within aged care organisations to move from ‘fixed ideas’ about what aged care looks like, should be, has been.. to a position of healthy ageing that is the entitlement of every person no matter how old or frail. Marry this growth mindset with knowledge, skills and attitudes arising from education around health promotion, positive psychology and the science of wellbeing... and a powerful mindset for healthy ageing emerges as the key enabler for healthy ageing in aged care.
- #14 Researchers, Harris and Grootjans believe that…..…by situating aged living and care within an ecological settings framework could synthesize the efforts within the sector into a unified approach to achieve the common goal of improved health and wellbeing for older people……… This focus also considers the ecological footprint of aged communities (Bradley, 2004)
- #15 We are a health setting. This means that health is created in and around and because of this setting. Health of residents and staff is directly impacted because of the setting.All we need to understand is how health promotion works.
- #16 Health promotion in the twenty first century should be embedded within the operation of the organisations, such as is happening in schools and other local community places.
- #18 When all of these factors are provided by the environment and selected by the individual, an increase in quality of life is generally evident.
- #19 This is an example of the Health ageing framework for my two facilities. It follows a logical process, using health promotion standards and positive psychology to deliver on 6 key understandings for a good life. The key understandings were developed by reviewing the literature for what makes for a good and even flourishing life. The framework has very clear KPI’s attached to it. This enables you to evaluate your progress and your systems and to enable readjustment of your goals.
- #20 Recognising the need for standards for health promotion in health care settings, the WHO established 5 core standards. The standards outlined are related to individuals care and define the responsibilities and activities concerning health promotion as an integral part of all health care services.
- #21 The healthy ageing framework draws on the WHOs 5 standards for health promotion and other health related research and practice to reorient our resident aged care homes toward prevention of illness and aged related disability. Policies and procedures guide the transformation of facilities into health promoting settings
- #24 The goals of the PiPA model are to;reduce burden of diseaseIncrease wellbeing and quality of lifeThe key principles underpinning the model support older people to:live full and active lives have the right and the responsibility to be (or become) as healthy and involved in life as they possibly can partner with staff to create a lifestyle that supports wellbeing