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.
……..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
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.
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.
Reform is on the way…however….do we really need the government to legislate healthy ageing before we embrace it…..
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
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.
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
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.
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)
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.
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.
When all of these factors are provided by the environment and selected by the individual, an increase in quality of life is generally evident.
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.
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.
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
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
Healthy Ageing Framework - Research into Practice
The Healthy Ageing Framework Research into Practice Jo Boylan Student DPHNorthern Region Residential Services Manager
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
What is Healthy Ageingo Healthy ageing encompasses principles of healthy lifestyles to achieve positive ageing, active ageing and health promotion outcomeso 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
How health promoting is residential aged care in Australia? 4
Current State• Viewed as …….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
How older people function and how they die… Sudden Death Terminal Illness High High CancerFunction 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
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 assistolder people to remain above thedisability threshold (see Healthy ageing an easy ). 7
Aged Care ReformProductivity Commission Report Aged Care Standardsmostly financial draft standards aim reform to promote person centered approach / more health promoting
Next step?Exercise Prescription? Early intervention & Rehabilitation?
Will this level ofthinking penetrate theResidential Aged Caredoor?
Frequently all levels of the aged care workforceinadvertently reinforce decline ‘through a mindsetfor inevitable decline’. This fixed mindset is notalways challenged by our tertiary and vocationalteaching systems.....A Mindset for Healthy Ageing is not embedded
Our purpose is to create health promoting environments where........Healthy Ageing is an easy choice
Therefore optimal health can be Health is achieved whencreated within healthy choices arethe contexts of enabled by: where people The physicallive, love, play environment and work Social environment
• 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.
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 andHealthy ageing, an easy wider communitychoice 16
The enablers for healthy ageing Five Standards for Health Promotion To guide our responsibilities for health Healthy WorkforceHealth Promotion Environment Staff‘systems approach’Integrated at everylevel Partners in Positive Ageing – life course model for health Older people and wellbeing Healthy ageing an easy choice 17
Five Standards for Health PromotionA framework for reorienting our service and building a healthy community 19
5 standards for Health PromotionStandard 1: The organisation has a written policy for health promotion– This policy is implemented as an overall quality system and is aimingto improve health outcomes. The policy is aimed at residents, staff andrelatives/families.Standard 2: describes the organisations obligation to ensure theassessment of residents needs for health promotion, diseaseprevention and rehabilitation.Standard 3: states the organisation must provide residents withinformation relating to their health conditions and establish healthpromotion interventions in their care planning.Standard 4: gives management the responsibility to establishconditions for the development of ACH group homes as a healthyworkplace.Standard 5: deals with continuity and cooperation, demanding aplanned approach to collaboration with other health care servicesectors and institutions. 20
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 andHealthy ageing, an easy choice wider community 21
Say yes to Say yes to Say yes tobeing active savouring Speaking up Say yes to Say yes to Say yes to positive learning connecting emotion
Pathway to optimal human functioningacross the life course..we teach the modelto staff so that they can apply it to theirown lives and families...6 ingredients for positive ageingStaff enable and promote residentsengagement in the model throughcoaching and monitoring participationThe Partners in Positive Ageing model(PiPA) is a structured approach(partnership) to share responsibility(between staff and residents) for thehealth outcomes of older people inour facilities.
The enablers for healthy ageing The setting enables healthychoices by making Environment Staff them safe and accessible Older peopleHealthy ageing an easychoice 24
-Incorporate health promotion at alllevels and in every system- Implement the Five standards forhealth Promotion - guidesresponsibilities for health outcomes-Implement the model of wellbeingand activities to achieve a good life-Adapt the physical environment topromote activity in every day life-Incorporate Early Intervention StaffPrograms for restoration andrehabilitation; to bounce back fromadversity-Monitor and measure progress Older peopleHealthy ageing aneasy choice 25
The enablers for healthy ageing Staff actively promote positive ageing through focus on making healthy life Environment Staff choices the easy choices Older peopleHealthy ageing an easychoice 26
Educate & train staff 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 peopleHealthy ageing an easy 27choice
Environment Staff Healthy ageing becomes anThe older person is committed easy choice to healthy choices and ismotivated to seek and demand a better quality of life 28
In a nut shello Staff promote healthy ageingo Systems promote healthy ageingo Health promotion education promotes healthy lifestyles/ healthy choiceso Procedures/policies and ultimately practises promote healthy ageingo The organisation and wider community promote healthy ageing How these interact is ultimately the ‘ecological approach’
Our results include:Participants: n=70- 73% of Residents who participated in theWHOQOL BREF survey from their admissionin 2009/10 until 2011 indicated improvedquality of life-Nearly 20% of this sample group indicatedimproved ‘health’
More than 85% of staff indicated valueand interest in training sessions in 2011that addressed health literacy, earlyinterventions, positive psychology,workplace wellbeing and healthpromotions/healthy ageing.
So do health promoting 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’
Where to from here? 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.
90% of residents at Highercombe and Milpara ‘walk until they die’Healthy ageing an easy 34
Parting questions to prepare for Healthy Ageing in the futureo 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?’