Did you know....

2.  Aimee France, Senior Lecturer in
Physiotherapy
 Julie Walters, Senior Lecturer in Occupational
Therapy

3.  Work with a partner and ask them the
following questions
 What is your routine like at the weekends?
 What sort of things do you enjoy doing?
 What motivates you to get out of bed in the
morning?

4.  Take a moment to imagine yourself as an
older person.
 Yourself at say 86 years old.
 Work with the same partner and ask them
this...
 How might your daily routine and your
pattern of activity change when you are older?

5. at the end of this workshop we will ask you to
consider these questions...
 In the light of the evidence of this workshop
and your own reflections how are you
intending to age well?
 Has anything we have covered here made you
think differently about working with older
people?

8. Why do we use them? Benefits
 safety
 increase base of
support
 balance
 to facilitate discharge
 increase confidence
 increase independence
 increase community
mobility
 reduce pain
 "Mobility aids can
increase older adults’
confidence and
feelings of safety,
which, in turn, can
raise their levels of
activity and
independence".

10.  https://www.youtube.com/watch?v=7NZ6C6
wGpAE
 Johanna Quaas (b 1925) – the oldest active
Gymnast in the world

11.  altered posture
 altered length/tension of muscles
 reduce range of movement at joints
 alter proprioceptive feedback
 over-reliance on vision
 affects cognitive processing
 trip hazard
 affects physiological demands
 fixation of upper limbs
 reduced ability to refine movement
= altered postural control and inefficient balance
mechanisms

12.  Large evidence base suggests that walking aids can
overcome some physical and psychological barriers to
mobilising
 However, emerging evidence suggests long term use
can have adverse effects on a person's internal
mechanisms for balance
 Walking aids can also increase risk of falling if used
incorrectly
 Walking aids should only be prescribed by a relevant
health care professional after a full assessment of
need
 Walking aids should be used in conjunction with
balance training to reduce the reliance on such aids
and support from people

13.  Group exercise programmes
 hydrotherapy
 sports- bowls, darts
 Thai chi
 Home exercise programmes

14.  Bateni, H and Maki B.E (2005) Assistive devices for
balance and mobility: Benefits, demands, and adverse
consequences. Archives of Physical Medicine and
Rehabilitation. Volume 86, Issue 1, 134–145
 M.P. Foley, B. Prax, R. Crowell, T. Boone (1996) Effects
of assistive devices on cardiorespiratory demands in
older adults. Phys Ther, 76, pp. 1313–1319
 B.E. Maki, W.E. McIlroy, G.R. Fernie (2003) Change-in-
support reactions for balance recovery: control
mechanisms, age-related changes and implications
for fall prevention. IEEE Eng Med Biol Mag, 22, pp.
20–26
 M. Woollacott, A. Shumway-Cook (2002) Attention
and the control of posture and gait: a review of an
emerging area of research. Gait Posture, 16, pp. 1–14

15. • W.C. Mann, C. Granger, D. Hurren, M. Tomita, B. Charvat
(1995)
An analysis of problems with canes encountered by
elderly persons. Phys Occup Ther Geriatr, 13, pp. 25–49
• W.C. Mann, C. Granger, D. Hurren, M. Tomita, B. Charvat
(1995) An analysis of problems with walkers
encountered by elderly persons Phys Occup Ther
Geriatr, 13, pp. 1–23
• L.L. Brooks, J.J. Wertsch, H.E. Duthie (1994) Use of
devices for mobility by the elderly. Wis Med J, 93, pp.
16–20
• B.E. Maki, P.J. Holliday, A.K. Topper (1994) A prospective
study of postural balance and risk of falling in an
ambulatory and independent elderly population. J
Gerontol, 49, pp. M72–M84

17.  moves the joints through a greater range of
movement, stimulates synovial fluid
 stretches connective tissue
 encourages weight bearing through upper
limbs
 challenges trunk control and balance
 requires maximal muscle activity to stand and
uses major muscle groups

18.  Sarcopenia- age related changes to muscle mass
and function
 People who are physically inactive can lose as
much as 3% to 5% of their muscle mass per
decade after age 30
 Sarcopenia typically accelerates around age 75
 may be caused by altered function of nerves,
hormones and protein synthesis
 Research has shown that a program of
progressive resistance training exercises can
increase protein synthesis rates in older adults in
as little as two weeks

19.  Move more!
 Change your position
 Make activity dynamic
 Make it purposeful and fun
 Consider activities to maintain to muscles and
joints, alongside your cardiovascular fitness
 Exercise prescription guidelines for
strengthening- start at a low intensity and build
gradually to moderate intensity (5/6), 10-15
repetitions of an exercise at least 2 times a week
(increasing to a program of 8 exercises).

20.  Household chores, gardening
 Swimming, hydrotherapy
 Tailored gym program
 Group exercise programmes
 Sporting activities
 Home exercise programmes
 Bed exercises
 Use your body weight, resistance, weights
 Stair climbing

21.  Morley et al (2011) Sarcopenia With Limited Mobility: An
International Consensus Journal of the American Medical
Directors Association
Volume 12, Issue 6, Pages 403–409
 http://onlinelibrary.wiley.com/doi/10.1046/j.1532-
5415.2002.50216.x/full
 http://europepmc.org/abstract/med/11041074
 Nelson, Miriam E., et al. "Physical activity and public health
in older adults: recommendation from the American
College of Sports Medicine and the American Heart
Association." Circulation 116.9 (2007): 1094.
 Latham, Nancy K., et al. "Systematic review of progressive
resistance strength training in older adults." The Journals
of Gerontology Series A: Biological Sciences and Medical
Sciences 59.1 (2004): M48-M61.

23. Important qualitative value related to health and
wellbeing
Perruzza and Kinsella (2010) Lit review of the
therapeutic use of creative arts occupations
Outcomes:
 Enhanced perceived control
 Building a sense of self
 Expression
 Transforming the illness experience
 Gaining a sense of purpose and
 Building social support

24.  Perruzza, N and Kinsella, E (2010). Creative
Arts Occupations in Therapeutic Practice: A
Review of the Literature. British Journal of
Occupational Therapy June 2010 vol. 73 no.
6 261-268
 Walters, J.H. Sherwood, W and Mason, H
(2014) Creative Activities. Chapter 17 in
Creek’s Occupational Therapy and Mental
Health. Eds Bryant, W; Fieldhouse, J and
Bannigan, K London Elsevier

25.  https://www.youtube.com/watch?v=2i4-x6-
6vws
 Dingle et al (2013) IPA study
 Themes
◦ personal impact (positive emotions, emotional
regulation, spiritual experience, self-perception,
finding a voice);
◦ social impact (connectedness within the choir,
connection with audience, social functioning); and
◦ functional outcomes (health benefits, and routine)

26.  Dingle, G; Brander, C; Ballantyne, J and Baker,
F. (2013) ‘To be heard’: The social and
mental health benefits of choir singing for
disadvantaged adults. Psychology of
Music July 2013 vol. 41no. 4 405-421

27.  Developed following a systematic review of
the main non-pharma therapies for dementia
 Evaluated using a multi centre RCT in 23
residential homes and day centres –
published in 2003

28.  Typically a 14 session programme of twice
weekly meetings
 https://www.youtube.com/watch?v=g0FiSird
wA8
 Findings from the 2003 RCT suggest that CST
improves both cognitive function and quality
of life for people with mild to moderate
dementia
 Groups are popular with participants and
don’t need specialist training to run

29.  Spector A, Orrell M, Davies S and Woods B (2001).
Can reality orientation be rehabilitated?
Development and piloting of an evidence-based
programme of cognition-based therapies for
people with dementia. Neuropsychological
Rehabilitation, 11(3/4): 193-196.
 Spector A, Thorgrimsen L, Woods B, Royan L,
Davies S, Butterworth M and Orrell M (2003).
Efficacy of an evidence-based cognitive
stimulation therapy programme for people with
dementia: Randomised Controlled Trial. British
Journal of Psychiatry, 183: 248-254

30. College of occupational therapy key facts:
 Increasing physical activity can improve physical and
mental health and increase life expectancy. Current
guidelines from across the UK recommend that older
adults participate in regular physical activity to:
◦ • Reduce the risk of depression and dementia
◦ • Maintain functional ability
◦ • Contribute to the prevention of numerous chronic
conditions
◦ • Reduce the likelihood of falling
◦ • Maintain independence and social engagement
(Chief Medical Officers of England, Scotland Wales and
Northern Ireland, 2011)

31.  https://www.youtube.com/watch?v=ggswWV
Z8zKA
 This clip from BGT shows a group of older
men exploiting our stereotype of aging and
having a lot of fun in the process

32.  The promotion of good health for older
people reduces their need for more costly
medical interventions and improves quality of
life. Occupational therapy interventions have
been identified as key to promoting mental
health and well being in the NICE Public
Health Guidance (2008).

33.  Older people can obtain tangible benefits
from a health-promoting, occupation-
focused intervention. Health-promoting
services involving older people need to be
embedded into communities (Mountain et al,
2008).

34.  randomized controlled trial in independent-living
older adults (the Well-Elderly Study) found significant
health, functional and quality of life benefits
attributable to a 9-month preventative occupational
therapy programme. The study aimed to evaluate the
cost-effectiveness of this preventative programme. It
was found that post-intervention healthcare costs for
the occupational therapy intervention groups were
reduced by 50% compared to the control group. The
research concluded that preventative occupational
therapy for this client group demonstrated cost-
effectiveness and a trend towards decreased medical
expenditures. (Hay J et al, 2002)

35.  Chief Medical Officers of England, Scotland, Wales and Northern
Ireland (2011)Start active, stay active: a report on physical
activity from the four home countries’ Chief Medical Officers.
London: Department of Health, Physical Activity, Health
Improvement and Protection.
 Hay J, LaBree L, Luo R, Clark F, Carlson M, Mandel D, Zemke R,
Jackson J, Azen SP (2002) Cost-effectiveness of preventive
occupational therapy for independent-living older adults. Journal
of the American Geriatrics Society 50(8) 1381–1388
 Mountain G et al (2008) Occupational therapy led health
promotion for older people: feasibility of the Lifestyle Matters
programme British Journal of Occupational Therapy 71(10) 406-
413
 National Institute for Health and Clinical Excellence (2008)
Occupational therapy interventions and physical activity
interventions to promote the mental wellbeing of older people in
primary care and residential care London: NICE

36. The questions...
 In the light of the evidence of this workshop
and your own reflections how are you
intending to age well?
 Has anything we have covered here made you
think differently about working with older
people?