Active ageing the best is yet to come? Bob Laventure May 17 th 2016 - - PowerPoint PPT Presentation

Active ageing – the best is yet to come?

Bob Laventure May 17th 2016

Centenarians?

Life expectancy and demography

Increased life expectancy (78 and 82) is equivalent to an extra 5 hours a day

“What are you doing with yours”?

(Prof Tom Kirkwood WCAA 2012)

The best is yet to come?

• Active ageing – beginnings?
• Where are we now?
• If the best is yet to come – what would be

helpful? People, Places and Programmes

Active Ageing beginnings - 1

• Practice in the 80 and 90’s
• Voluntary sector (movement and dance)

Extend, KFA, WLHB, Women’s Institute

• Beth Johnson Foundation and Age Concern
• 50+ and All to Play For (Sports Council 1984)
• Health Walks (Eastbourne and Sonning

Common (1992)

• YMCA L3 Exercise for Healthy Older Adults

50+ (1992) NB Focus on HRE in schools and youth sport

Active ageing beginnings - 2

• Evidence and policy
• Moving on Symposium (1993)
• Active for Life (1995)

Moderate physical activity

• US Surgeon General Report and

Heidelberg Guidelines (WHO 1996)

• HEA Older people campaign (1996)

and 1st national conference (1997)

• ACSM Position Stand (1998)
• NSF for older people (2001)

(standards 6 Falls and 8 active lifestyles)

Trends and themes into the ooo’s

• What’s an older person ? (from 50 – 65) age

and functioning

• Recognition of impact of demographic

change but diversity of target populations

• Increased demands for evidence based/led

practice for commissioners

• Falls prevention - the growing “industry”
• Health, adult and social care and conditions

specific (multiple needs and outcomes)

• Evidence just gets stronger (King’s Fund

2016) Everyone’s interest, but no-one’s priority and never a physical activity priority

• 2. Where are we now?

Evidence and practice linked to the Public Health England Framework Everybody Active, Every Day NB There are other frameworks!

• 2. Where are we now?

Places People Programmes

Active environments

Moving professionals Moving at scale

(After PHE 2014)

Where are we now? – programmes

• We have evidence to inform
• Prof. G Morris (1954)
• Benefits of physical activity

(prevention, treatment and care)

(US Surgeon General 1996, DH 2005, 2011)

• Prevalence data (HSE 2011, Sport

England 2015)

• What helps and hinders older

people? Determinants, barriers and solutions

• How much is enough? (DH 2011)

Return on Investment and Cost Benefit Models (??????)

Where are we now? - programmes

We (are beginning to ) understand what works in practice?

• Systematic reviews eg, Cochrane 2013, NICE 2009
• Randomised controlled trials and “Gold standard”

landmark studies eg (CHAMPS Stewart et al 2001, Fame

Skelton 2005, Otago Campbell et al 2001, LIFE Clemson et al 2012)

• Consensus statements, expert opinion (DH 2011)
• Evaluation reports (eg, LEAP 2008, Football Foundation 2011,

Age UK 2015)

• Grey literature

Where are we now? – Programmes

There’s more to life than chair based exercise and moving to music!

• Recognition of multiple and diverse

– Target populations – Needs interests, motivation and expectations – Physical activity modes, walking, outdoor and green, adaptations to sport

• Differentiation, choice and access

Where are we now? – People

Multiple providers and services

• Prevention, treatment and care - condition

pathways (eg, Medical Charities and health services)

• Physical function, independence and daily living

(falls) (Adult and social care)

• Mental health, psychological functioning and

cognition

• Well-being and quality of later, later life

(Residential care services)

• Diminishing public and increasing private, SME and

voluntary sector

People, functional needs and services in Later Life

Actives Focus on maintaining and increasing physical activity levels Primary care, physical activity, leisure, recreation providers and services Those in transition Focus upon initiating and maintaining physical activity to improve health and maintain mobility and independence In contact with adult, social/care services, voluntary sector and housing services Frailer, older people Focus upon quality life and performance of activities

• f daily living

Some supported at home, many in residential care DH 2001, BHFNC 2008, PHE 2014

Where are we now – Places

Age appropriate, friendly, inclusive and active environments?

• Cities, communities, neighbourhoods eg

dementia friendly

• Natural, green and blue
• Social environment (networks and support

from significant others)

• “Physical activity places”?

• 3. So is the best is yet to come?
• Age Wave and the

Boomers - now 70

• Impact of technology
• Working life, retirement,

pensions, healthcare

• Increased life expectancy
• Family patterns and living

alone

• Ageing well or staying young?
• Inequalities are increasing

Places

People Programmes

• 3. So is the best is yet to come?
• Age Wave and the

Boomers - now 70

• Impact of technology
• Working life, retirement,

pensions, healthcare

• Increased life expectancy
• Family patterns and living

alone

• Ageing well or staying young?
• Inequalities are increasing

Places

People Programmes

And what might help?

Places – capitalising on our environment(s)

Age appropriate, friendly, inclusive and active?

• Built environments, cities, communities, neighbourhoods
• Reduction in Health Inequalities (Kendig and Phillipson

(2015)

• Perceptions of safety, crime and neighbourhood cohesion

(JAPA 2006)

• Physical environment – services (post office), absence of

rubbish, road crossings (JAPA 2006)

• Older people live their lives close to where they live (Davies

et al 2011)

Natural/green environments

Where we live – “somewhere good to go”

• Our footpaths and proximity to green spaces

amenities and services (incl. toilets and benches)

• Emotion state (in the moment)
• Verbal expression and stimulus
• Memory and attention
• Awareness, (multi-sensory) engagement
• Well-being and control

www.idgo.ac.uk

“Supported by their environment, most people aged 80+ living in the community, can expect to continue to go outdoors daily, engage in a range of activities and maintain quality of life into oldest age”.

)

Natural England 2012

Age friendly facilities

• Health clubs and gyms

Feeling comfortable and supported in the environment

• Somewhere to sit out or rest
• Music? Music? Music?
• Visual acuity- signage
• Personal attention (instructors, buddies, other older

people)

• Social activities (golf club as the model?)

Learning from mystery shoppers (ICAA 2008)

Age friendly equipment

• Minimal pre-programmed workouts
• Low starting speeds (0.5 mph)
• Low starting resistance and small (1lb?)

incremental increases in weight

• Display panels, easy to read and change
• Access to weight machines for those with

functional limitations

• Stable seating and support rails

Learning from the Inclusive Fitness Initiative (ICAA 2008)

Social environment (WHO 2015)

• Being connected (NEF

2000)

• Networks and relationships
• Integration and support
• Belonging eg, Family,

friends and peers

• Being engaged with others
• Physical activity and

social norms?

• Behaviour, support

from significant others

• Attractiveness of

group activity

• Media images and role

models (Someone like me)

Healthy settings (WHO 2008)

Residential care homes as environments (Health promoting schools)

3 key principles, 3 areas for improvement in each

You can access the resource at

http://www.careinspectorate.com/index.p hp?option=com_content&view=article&id =8429&Itemid=100214

Programmes (design) and moving at Scale

• 1. Translating evidence into practice

Principles of design and the use of guidance eg NICE 2008, PHE 2015

• 2. Moving at scale -Programme planning,

monitoring, evaluation, sustainability, transfer and scale up (PHE 2015)

Programmes 1.– design and skill set(s)

• Translating research into practice -

knowledge exchange, transfer – how?

• Key principles of programme design eg

– Engage (potential) participants – Behaviour change principles – Build skills and strengths (e.g. self efficacy and social relationships) – Supportive strategies and environments through change

• Or …………..
• Replication of and fidelity towards Gold

Standard interventions eg Otago Exercise Progamme

• Fit for purpose

The implementation challenge

70 35 15 7 20 40 60 80 100 awareness knowledge adoption partial use full use (as intended) % of intended users

What can we learn to improve adoption and implementation of effective adapted physical activity programmes?

(Hopman Rock M.R. 2009)

The implementation challenge

Programmes 2. – design and skill set(s)

• Planning
• Monitoring
• Evaluation
• Absence of planning

skills (PHE 2014)

• Lack of evaluation

(PHE 2014)

• Clarity on outcomes

required (BHFNC 2016)

Programmes 2 – design and skill set(s)

• Planning
• Monitoring
• Evaluation
• Sustainability
• Transfer and scale up
• Fidelity (RE-AIM Glasgow et

al 1999)

• Absence of planning

skills (PHE 2014)

• Lack of evaluation (2014)
• Clarity on outcomes

required (BHFNC 2016)

• Demand for innovation
• Short and changing

commissioning cycles

• Built in obsolescence

Why are the Guidelines important?

• Older adults - 1st time in UK
• Strong evidence base, basis of NHS

and partner work in the future

• Both professional and public

education message

“Our 5 a Day!” Design - how much physical activity is enough?

“Functional Fitness performance is having the physiological capacity to perform normal everyday activities safely and independently without undue fatigue”.

(Rikli @ Jones 1999)

How important is functional fitness?

“…… it is logical and possibly safer to suggest that older adults whose mobility is compromised start by increasing their strength and improving their balance before embarking on aerobic training”.

WHO World Report on Ageing and Health (Oct 2015)

(Sherrington et al 2008)

The missing ingredient?

Behaviour change

• Underpins planning

and built into programme design

– Adoption – Transition – Maintenance NICE (2009) (Michie et al 2009)

People – professional skills required to support older active lifestyles

• Moving professionals - multiple providers and

(non) physical activity workforce

Health, well-being, social care, exercise and movement, sport (incl. CSPs), voluntary/private sector, SMEs,

• Underpinning knowledge required on ageing and

physical activity

• To engage with and deliver effective, safe and

meaningful experiences

Underpinning knowledge and skills

• Workforces - what does a curriculum

look like and where is it? (BASES 2001)

– For those in physical activity, sport and exercise services – For those in health, social care and older people’s services

• Growth of knowledge and expectations
• Access

Safe and effective experiences

• Engagement skills
• Primary, social care, health, community,

lifestyle coaches, peer mentors, fire services

• Language and jargon (15 year dictionary)
• Communication skills
• Cognition, information processing speed

and learning

• Vision and hearing impairment
• Help with technology
• Learning styles and re-enforcement

Meaningful experiences

Personal attention

Residential care and exercise

• Do you know what your talking

about?

• You’re the expert, what

qualifications have you got?

• I’m putting my trust in you
• Make sure it’s right for me!
• Make it interesting and enjoyable

for me! (Stathi and Simey 2005)

“Our customers value the knowledge and advice on the shop floor” John Lewis Partnership

Some (very) tentative conclusions/challenges

In the context of an

• verwhelming volume of

research and need

• Knowledge translation to

multiple audiences

• Programme design including

behaviour change

• Impact of active environments
• Skilling the (non) physical

activity professional workforce

Active Ageing The best is yet to come?

Active Ageing – the best is yet to come?

Thank you for listening

bob.laventure@ntlworld.com