Members Network Event 6th March, 2019 Older People Support - - PowerPoint PPT Presentation

Members Network Event 6th March, 2019

AGENDA

Older People Support Services*

• Draft Exercise standards
• Active Ageing
• Exercise and Education
• Best Practice Falls Pathways
• Malnutrition and Dehydration
• Enablement and Postural Support

Exercise Standards

Current guidelines from NICE 1.1.5 Exercise in extended care settings 1.1.5.1 Multifactorial interventions with an exercise component are recommended for older people in extended care settings who are at risk of falling. [2004]

National Institute for Health and Care Excellence. (2013). Falls in older people: assessing risk and prevention. NICE.

1- What are you currently offering within your service? 2- What areas would you like more support and guidance? 3- Any other feedback on the standards?

HCPA Offer

• Chair Based Exercise level 2
• Developing a Level 3 Balance course
• Physio Support Facilitator

Long term (10 month) Exercise group 6 sites – Care home CBE 4 Sites – Care Homes Dementia 10 Sites Flexi / Supported living 5 Intergenerational exercise groups

HCPA Offer

• Chair Based Exercise level 2
• Developing a Level 3 Balance course
• Physio Support Facilitator

Long term (10 month) Exercise group 5 Learning Disability services

Falls Pathways

• Falls Risk Identification
• Management of person who has

fallen - Care Home and Domiciliary

FRAT

Falls Checklist

Alison Smith Prescribing Support Consultant Dietitian Herts Valleys Clinical Commissioning Group

Malnutrition and Dehydration – Care Homes and Homecare

Hydration

Dehydration in older people is common too Also affects most body systems Unlike malnutrition, there is no validated

screening tool

What does CQC say?

 A variety of nutritious, appetising food should be available to meet people's needs

and be served at an appropriate temperature. When the person lacks capacity, they must have prompts, encouragement and help to eat as appropriate.

 Where a person is assessed as needing a specific diet, this must be provided in line

with that assessment

 Staff must follow the most up-to-date nutrition and hydration assessment for each

person and take appropriate action if people are not eating and drinking in line with their assessed needs

 Staff should know how to determine whether specialist nutritional advice is

required and how to access and follow it

What do the CCGs (NHS) advise in Herts?

Raise awareness about malnutrition Identify malnutrition before you start to treat it Follow Herts guidance when treating

malnutrition

New – Herts Malnutrition management pathway for care homes

Nutrition policies

What does yours say? Potential for Herts wide care home nutrition

policy

Treating malnutrition – Hospital vs community

 Many patients receive sip feeds during a hospital admission

 In hospital, sip feeds are likely to be the most cost effective way of preventing and

treating malnutrition

 Sip feeds are often included on discharge summaries, but usually they are not needed

following discharge because:

• When in hospital most patients are:
• acutely unwell, which increases

nutritional requirements but decreases nutritional intake

• in an unfamiliar environment,
• ffered unfamiliar food which

they may not find appetising, at times which may not suit them

• On discharge home most patients:
• are no longer as acutely unwell
• have an improved appetite and

can choose familiar and preferred meals/ snacks at times and in an environment that suit them

• can implement a food first

approach (especially true for those resident in a care home)

Treating malnutrition – ONS vs homemade supplements

 1 bottle of Ensure Plus provides 330kcal + 13.8g protein;

cost to the NHS = £1.11

 1 over the counter Complan provides 387kcal + 15.6g protein;

cost to the patient/Home = £0.95

 1 Homemade fortified milkshake provides 305kcal + 17g protein;

cost to the patient/Home = £0.35

 Nutritionally, all 3 products are virtually identical

Treating malnutrition – Food first

 Should provide more than just calories (it’s not just about adding butter and

cream…)

Any questions?

 Alison Smith

Prescribing Support Consultant Dietitian alison.smith47@nhs.net

 Chair of  CQC Specialist Adviser

 Chair of ACBS

Enablement and Postural Support –

Top Tips for your staff

SUZY WHITE ENLIGHT PHYSIOTHERAPY

Postural Management and Benefits

• Posture is any position that the body is in, in lying, sitting or standing
• Good posture is where everything is aligned in a balanced way without too

much tension

• Good posture is important for being able to:
• Move
• Function
• Breathe
• Eat
• Be free of pain

P .E.A.K.

Used to check sitting posture:

• P - pelvis in a neutral position
• E - equal weight on both buttocks
• A - 90° angles at hips, knees and ankles
• K - knees facing forwards

Posture Practical

Consequences of poor posture

• Pain
• Difficulty eating
• Pressure sores
• Muscle shortening/contractures
• Reduced ability to move functionally, e.g. lifting arm, sit to stand
• Breathing problems
• Chest infections
• Death
• Safeguardings

Solutions

• Get people moving
• Practise positive risk taking
• Use enabling language – believe people can improve
• Make appropriate referrals to specialist services and using

the right language for these

• Provide training for staff (e.g. PSF via HCPA)

Any questions?

Summary