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Vanda Cummins, Health Service Executive


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Strong, Steady and Straight - Raising the bar on keeping older people active

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Vanda Cummins, Health Service Executive

  1. 1. Strong, Steady and Straight Raising the bar on keeping older people active in their communities Vanda Cummins HSE Primary Care Physiotherapist Oct 22nd 2019
  2. 2. Job: HSE Primary Care Physiotherapist in Ballymun. Locations: Health Centre, Clients house or exercise groups. Referrals: Majority older clients with loss of mobility and poor function/pain. Most from GPs, hospitals or Primary Care Team colleagues. (also accept self referrals) Interventions: Assessments, falls and frailty risk, rehabilitation of mobility and function, support, education & training. HRB Applied Partnership Research Grant: Since April 2019, Part-time clinical researcher with RCSI looking at feasibility of enhancing existing state funded carer support for older adults using ‘Care to Move Approaches’
  3. 3. Screening & Assessment 1:1 Interventions or Group Rehabilitation Monitoring Education Role of physiotherapist in the integrated care of falls prevention & bone health Acute Care Primary Care Community & Social Care Risk detection Education Multidisciplinary, Multi-agency, Multi-level approach National Strategy 2008 •Targeted, specific home based or group based exercise programmes to suit needs and preferences •Exit strategies to self directed active lifestyles
  4. 4.  Discuss evidence for strength and balance training for independence & reduced risk of falls & injuries.  Highlight importance of working partnerships to improve the quality and effectiveness of exercise pathways for older people ‘consistent messages across agencies’  Look at currently practice in Ireland and the UK and discuss ways to try build on this. “Right Care, Right exercises, Right Professionals, Right time”
  5. 5.  Low muscle strength linked to a decline in ability to carry out activities of daily living such as bathing, dressing and going out.   Muscle weakness and poor balance- Two most common modifiable risks for falls.  In UK for those aged 65+ only 13% of men and 10% of women met the recommended PA guidelines which included strength, balance and co-ordination exercises x 2 weekly.
  6. 6. “Strong older people fall and get back up. Weak older people fall and stay down. Falling isn’t the problem, deconditioning is” Prof Dawn Skelton Webinar on ROI on Otago and FaME programmes 2018
  7. 7. So what if I’m inactive?
  8. 8. Over cautious/fearful
  9. 9. Increasing the fracture risk? No standing activity leads to active loss of bone and muscle 1 wk bed rest  strength by ~ 20% 1 wk bed rest  spine BMD by ~1% Nursing home residents spend 80-90% of their time seated or lying down CTM Copyright Later Life Training Ltd 2016
  10. 10. Sedentary Behaviours Increases risk of: •Stiffness, pain •Muscle weakness •Falls & fractures •Frailty •Dependence •Decreased quality of life •Decreased social engagement Consistent messages from all health care providers to help prevent the risks
  11. 11. Moving Moving More Often Moving regularly and frequently Sedentary Meeting physical Activity guidelines Increased physical activity Increased benefits
  12. 12. Skelton, Mavroeidi (2018) How do muscle and bone strengthening and balance activities (MBSBA) vary across the life course and are there particular ages where MBSBA are important? Journal of Frailty, Sarcopenia and Falls
  13. 13. EVERYONE No Matter what your age, size or fitness level, its never too late to start. Exercise follows dose response curve. The lower the baseline level the greater the health benefits associated with increased activity. Research nursing home residents age 90+ Increasing exercise levels shown rejuvenation of muscle strength of 10-20 years in only 12 weeks (Fiatarone 1990) Who should we target?
  14. 14. Top tip if you wish to change sitting patterns Start small & achievable Have a plan for what you want to do when breaking sitting time Build the routine, then you can make the break times more challenging Don’t be too hard on yourself it’s not easy to change
  15. 15. Skelton D, Mavroeidi (2018) Which S&B activities are safe and efficacious for individuals with specific challenges (Osteoporosis, vertebral fractures, frailty, dementia?) A Narrative Review Journal of Frailty, Sarcopenia and falls
  16. 16. Foster C, Armstrong M (2018) What type of physical activities are effective in developing muscle and bone strength and balance? Journal of frailty, Sarcopenia and Falls
  17. 17. Key components of Strength and balance exercise programmes researched and evidence based for falls prevention  At least three times weekly (group and/or home based)  Include an assessment by appropriately qualified health professional/instructor before commencing  Fidelity – i.e individually tailored with clear progressions  Comprise of 50 hours or more over at least 6 months  Involve challenging and progressive balance and resistance training and exercise in a standing position.  Monitored by appropriately trained professional
  18. 18. We need a multi dimensional, multi- disciplinary quality service across agencies for our vulnerable older adults Consequences after a fractured hip with examples of a positive and a not so positive pathway
  19. 19. Need to build on good work already being done One size does not fit all- Tailored to suit needs and preferences
  20. 20. Free fitness testing (NCT) event as part of Positive Ageing Week 2016 Poppintree Community Centre Event included strength, balance, flexibility and BMI testing, exercise and dietetic advice free exercise and Tai Chi ‘taster’ sessions and refreshments Sustainability ideas – functional fitness testing
  21. 21. Falls prevention taskforce (Wales)
  22. 22. 1. Raise awareness 2. Encourage uptake 3. Exercise referral pathways that work 4. Stick to the evidence 5. Monitor for outcomes and improvements
  23. 23.  Understand S&B programmes are cost effective and achieve good outcomes  Design and support services than enable EB approaches  Include funding for S&B education and awareness raising campaigns  Include funding for assessment time and conversations around behaviour change/motivators  Develop collaborative pathway with a supporting decision making tool  Embed QA and evaluation into all programmes
  24. 24.  Identify training to suit your target audience with ongoing CPD and opportunities.  Facilitate instructor meetings for shared learning and standardised delivery  Embed S&B messages across all classes  Foster good communication pathways between referrers and professions  Allow time for pre and ongoing assessments  QA sessions to support fidelity  Ensure health and safety including emergency plans.
  25. 25. Later life training UK: Accredited, quality assured :Blend of online learning, assignments, MCQ’s & face to face training Teaching manuals, safety checks, behaviour change strategies, assessments, written feedback. Ongoing networks & learning, social media (twitter and facebook), study days, conferences Cascade trainers: 5 days ( including OEP leader training and assessment) OEP Leaders: 3 days for Fitness Instructors -2 day training + 1 day practical exams 2 days for Physiotherapists - 1 day training + 1 day practical exams
  26. 26. Back knee strengthening: helps with stair climbing, getting in/out of chairs/cars and getting up and down from the floor Toe raises: helps with stepping backwards and on/off pavements Heel toe walking: improves balance and walking in narrow spaces, stepping sideways to avoid objects or when on uneven surfaces. Blend of Home programme x 2 weekly and Group x 1 weekly
  27. 27. Cross Agency Memorandum of understanding Developed by Catherine Devaney, HSE Physiotherapy Manager Dublin North Central
  28. 28. Client feedback: I feel a lot steadier….I took the bus into town for the 1st time in 2 years. The pace of this group suits me…… I feel listened to….. I like the small numbers Otago Instructor feedback: ‘I love this because it’s got evidence and I feel supported by the physios’ The training was a lot more work than I thought, but I like the structure and progressions It’s great to see the group motivate each other along I’m surprised how much they like it..It definitely seems to be working
  29. 29. Falls prevention websites: NHS information on falls section check your risk of falls & create personalised plan programme/take-the-balance-challenge.aspx training for health and exercise professionals healthy-you-age Physical activity: websites training for health professionals. adults/ Royal Society of Osteoporosis UK Living Longer Living Stronger Strength and Balance Programmes for Older Adults Apps and games: Otago exercises app- Video and audio of leg strength and balance exercises designed to reduce falls in older adults who are at risk of falls. Clock yourself app. consists of progressively challenging cognitive and balance tasks to improve balance reaction
  30. 30. ‘Exercise is a journey not a destination. We do not stop exercising because we grow old, we grow old because we stop exercising’ Kenneth H Cooper