Implementing programmes to encourage active healthy lifestyles in older people - the role of the OT

Dr Dawn Skelton PhD Reader in Ageing and Health, HealthQWest, Glasgow Caledonian University Co-ordinator of Prevention of Falls Network Europe Chair, Organising Committee, World Congress on Active Ageing 2012 Implementing programmes to encourage active healthy lifestyles in older people - the role of the OT

Why active ageing? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Nice 16: 2008; Allen 2008; UK Inquiry into Mental Health and Well-being in Later Life 2006

3 Dimensions of Human Frailty TIME DISEASE DISUSE HUMAN FRAILTY Spirduso, 1995

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ageing affects us all, and earlier than you think! Sedentary behaviour accelerates the loss of performance...

A Vicious cycle of Inactivity Physical deterioration - Heart disease - High blood pressure - Aches and pains - Osteoporosis Further decrease in physical activity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Increasing age Less exercise Decreased physical abilities - Increased body fat - Sagging muscles - Decreased energy

Sedentary Behaviour = Active bone and strength loss ,[object Object],[object Object],[object Object],[object Object],[object Object],(Krolner 1983; Tinetti 1988; Skelton 2001; Beyer 2002)

70 yr old woman, active, strength-trained 70 yr old woman, sedentary (Adapted from Sipilä & Suominen Muscle Nerve 1993;16:294 ) Size difference is equivalent to a 30 year old (L) and an 70 year old (R)

National Service Framework For Older People 2001 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Active Lifestyles ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ACSM 2007; CDC 1996,2002; Sesso et al 2000; Nicholl 1994, WHO 1997, NIA 1998.

Benefits of Exercise ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

It’s never too late ,[object Object],[object Object],[object Object]

What’s the difference? ,[object Object],[object Object],[object Object],[object Object],[object Object],Gardening DIY Housework Bowling Walking Cycling Exercise class Sports

How much is enough? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Wide range of abilities and needs

Training Standards in provision Physiotherapist Postural Stability Instructor Seniors Exercise Instructor Chair Based Exercise Leader Physical Activity Leader Senior Peer Activity Motivator Self Led Activity / Exercise Otago Exercise Instructor

Chair Based Exercise ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Gardner 2000; Skelton & Dinan 1999; Skelton & Todd, 2005; NICE 2004 Exercise could help fallers in a number of ways

Sherrington et al., JAGS 2008 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],But not all exercise helps reduce falls

Highly challenging Balance Training ,[object Object],[object Object],[object Object],[object Object],24% RR 0.76 (95%CI =0.62 to 0.93) Sherrington et al., JAGS 2008

High Dose ,[object Object],[object Object],[object Object],20% RR 0.80 (95%CI =0.65 to 0.99) Sherrington et al., JAGS 2008

No reduction: RR 0.95 (0.78 to 1.16) No reduction: RR 0.96 (0.80 to 1.16) No reduction: RR 0.91 (0.79 to 1.05) Increased risk: RR 1.20 (1.00 to 1.44) High balance Low dose Walking Low balance Low dose Walking Low balance Low dose No walking Low balance High dose Walking Sherrington et al., JAGS 2008

[object Object],[object Object],[object Object],[object Object],[object Object],Sherrington et al., JAGS 2008 So what do we need to know?

Commonly found in the UK ,[object Object],[object Object],[object Object],[object Object],[object Object],(Campbell 1997; Robertson 2001; Campbell 2005; Liu_Ambrose 2008; Skelton 2005, 2008;) Falls Injuries Cost effective >80s Cost neutral >65s Cognitive Function Falls Quality of Life Bone Mineral Density Change of residence Coping strategies Long lies

OEP Strengthening Exercises ,[object Object]

OEP Balance Exercises ,[object Object]

Teaching transfer skills Regaining Floor Coping Skills FaME – Postural Stability Instructor: Avoid long-lies - Crawling, rolling, getting to help, keep moving to avoid complications…. Get back up again….play with grandchildren 

Motivators Barriers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Reducing barriers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Recommendations for Promoting the Engagement of Older People in Falls Prevention Exercise Yardley L, 2007 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What can the OT do? ….with thanks to…. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

NICE 16: OT & PA interventions to promote mental wellbeing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What actions should OT’s take? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Nice 16: 2008

OT interventions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],What actions should OT’s take? Nice 16: 2008

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Physical Activity Recommendations Nice 16: 2008

Walking Schemes ,[object Object],[object Object],[object Object],[object Object],Nice 16: 2008

Training ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Nice 16: 2008

Confounding factors? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Active Ageing Weeks… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ideas for AA Weeks ,[object Object],[object Object],[object Object],[object Object],[object Object]

Issues in activity provision in Nursing homes… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Olympage Games – Sheffield 2009 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Key Messages ,[object Object],[object Object],[object Object]

“ Man does not cease to play because he grows old. Man grows old because he ceases to play” George Bernard Shaw [email_address] Any Questions? Come and join the fun – Glasgow SECC Aug 13-17 th 2012 www.wcaa2012.com

Other useful sites ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Implementing programmes to encourage active healthy lifestyles in older people - the role of the OT

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Implementing programmes to encourage active healthy lifestyles in older people - the role of the OT

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