Long-term Care in Motion

Transcription

1 Long-term Care in Motion Klaus Hauer 1,2 Katrin Claßen 1, Carl-Philipp Jansen 1,2 & Hans-Werner Wahl 1, 1 Department of Psychological Ageing Research, Heidelberg University 2 Agaplesion Bethanien Hospital, Heidelberg & Heidelberg University European Forum on Social Innovations for Healthy and Active Life Expectancy , Riga

2 INNOVAGE and LTCiM [ ] develop and test as well as survey and catalogue, social innovations that will have a solid impact on improving the quality of life and well-being of older people. Improve healthy and active ageing in a vulnerable population at high risk of inactivity, decreased Quality of Life (QoL), isolation, and impaired healthy life expectancyby activity promotion WP 2 User-driven Housing for Older People WP 6 Knowledge exchange and transfer WP 3 ICT-based Social Support for Carers of Older People WP 1 Increasing Healthy Life Expectancy WP 4 Improving Obesity Related Outcomes in Old Age WP 7 Manageme nt WP 5 Long-term Care in Motion

3 Activity promotion in LTC Overwhelming evidence for positive effects of PA (Physical Activity) even at very old age. Positive effects relate to medical, cognitive, or psychological status und include social interactions and QuoL; PA mediator/means of effects LTC residents are at high risk of inactivity and respective negative consequences LTC residents may have the lowest likelihood to be addressed by social innovations (therapeutic pessimism; incarnation of negative ageing )

4 Activity promotion in LTC Recommendations do not include specific, highly institutionalized settings and frail, impaired target population. PA difficult to modify at any age/ behavioural feature with complex interactions and individual determinants. Nursing homes present with specific limitations but also with specific chances to support behavioural modifications. Determinants of and barriers for uptake and adherence of PA in this setting and the role of staff and management not well researched.

5 PA as a mediator and means Motor Status Emotional Status Physical Activity Cognitive Status Quality of Life, Autonomy, Participation

6 Research Gaps PA-promotion/ training literature mostly focuses on less impaired older adults living in the community (Motor) Performance primary study endpoint in previous LTC-studies. No systematic review on PA modifications as primary study goal available Assessment methodology limited Increased activity may influence risk of falling or other risks (risk reduction vs. risk exposition) Psychologically based social-ecological intervention or comprehensive setting approach for activity promotion in LTC settings lacking

7 LTCiM s Goals Goal 1: Collect knowledge on existing research in the domain of PA in LTC and collect knowledge of the specific site Systematic review on PA-interventions in long-term care Identify, document and rate specific situation in setting Goal 2: Develop comprehensive setting approach Implementation of tailored physical activity interventions targeting heterogeneous subgroups of residents Training of staff members in a psychologically based social-ecological intervention Goal 3:Evaluate feasibility and effectiveness of interventions Target specific set of assessments (pre-post mixed methods evaluation) advanced technology

8 Physical activity status/pa promotion Identify and document existing activities (externally vs. Individually driven) Rate group-based activities for goals/organisation/ methodsi/intensity/ frequency/adherence/ qualification of staff Identify activating groups Develop tailored promotion strategies for intervention phase Implement successful strategies in existing/new activities in follow-up for sustainability

9 Site specific Results Overall PA level substantially limited in most residents PA mostly restricted to indoor,ward, or even individual room activity (Life space) Most activities externally driven (Supervised group sessions) Groups not focused on activity promotion Limited knowledge of staff and trainers! Results accomplished by systematic review and long-term experience in interventional studies in target group Jansen et al, European Journal of Aging

10 Development of activities Supervised evidence-based training tailored for user needs. with focus behavioural activation (feasibility) Defining relevant classification and tailored methodology (Sub)group specific approach according to motor,psychological and cognitive status as well as individual preferences Dementia-specific approach (validation/patient centered)

11 Motor interventions/activities Supervised individual training Supervised group training 2 levels Supervised serious games

12 Advanced technical assessment systems Life Space Activity Analysis

13 Psycho-social Intervention Focus on staff members: information and training enabling staff members to motivate residents as optimally as possible to be physically active Theoretical Components Importance of PA in LTC residents Principles of behaviour change Facilitators and barriers Role of age stereotypes Attainable goals Communication strategies Communication skills Motivational Interviewing Practical Components Practical application of learned skills in role plays and bed-side training Feedback of practical experiences and development of specific solutions ( difficult cases ) Intervision groups to monitor implementation process Informal setting contacts substantially support training goals

14 Project Components and Project Flow Content Preparation of intervention setting and research update Time Line 1/13 2/13 3/13 4/13 1/14 2/14 3/14 4/14 1/15 2/15 3/15 4/15 Preparation of intervention program and assessment methodology Outcome assessment Intervention related training Implementation of intervention Implementation of follow-up assessments Data analysis and dissemination/ implementation of findings

15 LTCiM and social innovations

16 Social Innovations Behavioural goal: PA promotion in a very frail vulnerable population Methods to identify and document activity status and PA promotion in institutional setting Development of tailored interventions Advanced assessment methodology Comprehensive seeting approach including relevant setting actors (staff, trainers, management)

17 Thank you for your attention

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