Presentation delivered to the National Lutheran Aged Care Conference May 3rd 2012, by Jo Boylan - ACH Group Northern Region Residential Services Manager
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Healthy Ageing Framework - Research into Practice
1. The Healthy Ageing Framework
Research into Practice
Jo Boylan Student DPH
Northern Region Residential Services Manager
2. Why Healthy The four key Our purpose How do we Target
Ageing? components achieve a Outcomes
to progress whole of
healthy ageing system
paradigm shift?
2
3. What is Healthy Ageing
o Healthy ageing encompasses principles of healthy lifestyles to
achieve positive ageing, active ageing and health promotion
outcomes
o Healthy Ageing is the ability to continue to function mentally,
physically, socially, and emotionally as the body slows down
its processes (Hansen-Kyle, 2005, p46)
Healthy ageing; an easy choice
3
5. Current State
• Viewed as …….accommodation for older people
with diseases demanding medical intervention
(Kane & Kane, 2005)
• Reality……..often traditional services that focus
on comfort care
• ……... This approach is by its nature, costly
5
6. How older people function and how they die…
Sudden Death Terminal Illness
High High
Cancer
Function Function
7% 22%
Death
Death
Low Low
Time
Time
Organ Failure Frailty
Dementia
Lung Strokes
High Heart High
Arthritis
Liver Parkinson’s
Hip Fracture
Function Function 47%
16% Death
Death
Low
Low
Time
Time
Lunney, JR, Lynn J, Hogan, C. Profiles of Older Medicare Decedents. JAGS 50:1108-1112, 2002
7. Steep decline in health, due to factors such as inactivity, can
be reversed at any age. Our aim is to address the fitness gap
of older people (see below) by encouraging and supporting
them to participate in exercise based activity.
Exercise based activity can assist
older people to remain above the
disability threshold (see Healthy ageing an easy
). 7
8. Aged Care Reform
Productivity Commission Report Aged Care Standards
mostly financial draft standards aim
reform to promote person
centered approach
/ more health
promoting
10. Will this level of
thinking penetrate the
Residential Aged Care
door?
11. Frequently all levels of the aged care workforce
inadvertently reinforce decline ‘through a mindset
for inevitable decline’. This fixed mindset is not
always challenged by our tertiary and vocational
teaching systems.....
A Mindset for Healthy Ageing is not embedded
12.
13. Our purpose is to create health promoting
environments where........
Healthy Ageing is an
easy choice
14. Therefore optimal
health can be
Health is achieved when
created within healthy choices are
the contexts of enabled by:
where people The physical
live, love, play environment
and work Social
environment
15. • Expands responsibility for health beyond
the individual to the community and
environment.
• Calls for Aged Care leadership to move
towards integrating a whole system
health promotion approach to progress
healthy ageing across the lifespan.
16. Healthy Ageing Framework Science of
wellbeing
Life course model
Five for wellbeing
Standards
for Health
Positive Promotion
Psychology
A systems based strategy
Build staff capacity Healthy Settings
& mindset for healthy ageing
approach
Shapes the health and wellbeing of
the individual, staff and
Healthy ageing, an easy wider community
choice 16
17. The enablers for
healthy ageing
Five Standards for Health Promotion
To guide our responsibilities for health
Healthy
Workforce
Health Promotion Environment Staff
‘systems approach’
Integrated at every
level
Partners in Positive
Ageing – life course
model for health
Older people
and wellbeing
Healthy ageing an easy
choice 17
18.
19. Five Standards for Health
Promotion
A framework for reorienting our
service and building a healthy
community
19
20. 5 standards for Health Promotion
Standard 1: The organisation has a written policy for health promotion
– This policy is implemented as an overall quality system and is aiming
to improve health outcomes. The policy is aimed at residents, staff and
relatives/families.
Standard 2: describes the organisations obligation to ensure the
assessment of residents needs for health promotion, disease
prevention and rehabilitation.
Standard 3: states the organisation must provide residents with
information relating to their health conditions and establish health
promotion interventions in their care planning.
Standard 4: gives management the responsibility to establish
conditions for the development of ACH group homes as a healthy
workplace.
Standard 5: deals with continuity and cooperation, demanding a
planned approach to collaboration with other health care service
sectors and institutions.
20
21. Science of
Healthy ageing Wellbeing
Framework
Life course model
for wellbeing
Five Standards
For Health
Positive
Promotion
Psychology
A systems based strategy
Build staff capacity Settings Approach
& mindset for healthy ageing
Environment shapes the health and wellbeing
of the individual, staff and
Healthy ageing, an easy choice wider community
21
22. Say yes to Say yes to Say yes to
being active savouring Speaking up
Say yes to Say yes to Say yes to positive
learning connecting emotion
23. Pathway to optimal human functioning
across the life course..we teach the model
to staff so that they can apply it to their
own lives and families...
6 ingredients for positive ageing
Staff enable and promote residents
engagement in the model through
coaching and monitoring participation
The Partners in Positive Ageing model
(PiPA) is a structured approach
(partnership) to share responsibility
(between staff and residents) for the
health outcomes of older people in
our facilities.
24. The enablers for
healthy ageing
The setting
enables healthy
choices by making Environment Staff
them safe and
accessible
Older people
Healthy ageing an easy
choice 24
25. -Incorporate health promotion at all
levels and in every system
- Implement the Five standards for
health Promotion - guides
responsibilities for health outcomes
-Implement the model of wellbeing
and activities to achieve a good life
-Adapt the physical environment to
promote activity in every day life
-Incorporate Early Intervention Staff
Programs for restoration and
rehabilitation; to bounce back from
adversity
-Monitor and measure progress
Older people
Healthy ageing an
easy choice 25
26. The enablers for
healthy ageing Staff actively
promote positive
ageing through
focus on making
healthy life
Environment Staff choices the easy
choices
Older people
Healthy ageing an easy
choice 26
27. Educate & train staff to promote
‘activity in every day life’
- Incorporate positive psychology
principles and techniques; such as
bringing strengths to work, building
resilience and positive emotion,
coaching and encouraging
strengths and opportunities for
older people
Environment -apply the 6 key understandings to
achieve a good life across the life
course
- Monitor and measure effect
Older people
Healthy ageing an easy 27
choice
28. Environment Staff
Healthy ageing
becomes an
The older person is committed easy choice
to healthy choices and is
motivated to seek and demand
a better quality of life
28
29. In a nut shell
o Staff promote healthy ageing
o Systems promote healthy
ageing
o Health promotion education
promotes healthy lifestyles/
healthy choices
o Procedures/policies and
ultimately practises promote
healthy ageing
o The organisation and wider
community promote healthy
ageing
How these interact is ultimately
the ‘ecological approach’
30. Our results include:
Participants: n=70
- 73% of Residents who participated in the
WHOQOL BREF survey from their admission
in 2009/10 until 2011 indicated improved
quality of life
-Nearly 20% of this sample group indicated
improved ‘health’
31. More than 85% of staff indicated value
and interest in training sessions in 2011
that addressed health literacy, early
interventions, positive psychology,
workplace wellbeing and health
promotions/healthy ageing.
32. So do health promoting
interventions
cost more?
No…..Our sites are using the ACFI tool
which is an appropriate instrument for
the promotion of healthy ageing….why?
How?
Pain based – 90% of residents have
pain – bring into play allied health in
a greater way
Use the complex health
component… initially, rehabilitate the
resident and then continue with
same funding to maintain them…
Some resource costs associated
with developing a gym/equipment
The cost is in training staff in ‘a
mindset for healthy ageing’
33. Where to from here?
Our goal is to extend healthy life expectancy –
by focusing on physical and psychosocial
wellbeing
• We do this by directing 80% of attention into
early intervention strategies (prevention) using
our care workers to implement this approach,
monitored by the EN’s.
• This enables RNs, Physio, OT’s to focus on
more acute needs with the aim of restoring
/recovering residents (physical & social) and
avoiding events that may lead to hospitalisation.
34. 90% of residents at
Highercombe and
Milpara ‘walk until they
die’
Healthy ageing an easy 34
35. Parting questions to prepare for Healthy
Ageing in the future
o Are health promoting interventions/services/strategies
embedded into your organisations culture?
o Is recovery or restoration or rehabilitation easily accessible in
order to bounce older people back from adversity?
o Do you invest in early interventions to prevent or reduce
inevitable decline?
o Do you have robust health promoting systems / models in
place that promote healthy ageing across the life course? for
residents and staff?
o Do you train and develop in your staff … a ‘mindset for
healthy ageing?’
Notas do Editor
Today I am going to share with you an operational model for healthy ageing. This model incorporates a synthesis of current literature in relation to healthy ageing , ecological health promotion, healthy setting’s approach, positive psychology, science of wellbeing and mindsets for healthy ageing. This model could easily be translated into community care packages and retirement villages.
……..and indicated to be shared by an ever-decreasing proportion of our society…and this implies a significant deterioration in economic prosperity for future generations
On the bottom right side shows the trajectory of high level needs residents……slow and long deterioration. What we are experiencing now two years into the model is more episodes of sudden deaths. We have had a significant decline in palliative care. This is not a bad things as we are now able to compress disability and extend healthy life expectancy right through to the end of their lives.
Physical inactivity is a major determinant of ill health, and therefore this has been our major focus. Our goal is to work on the fitness gap and keep our residents above the disability line. We have been able to do this by encouraging and coaching residents to engage in at least 3 exercise activities per week and participate in other social activities. Our gym runs 9-5pm each day, run by personal trainers and complimented with golf sessions, tai chi, balance classes, easy move and walking groups. All activity programs are monitored for participation. Residents who are not consistently participating in social or physical activities are flagged through a data base and this is followed up for further problem solving by the early intervention working party. There may be disengagement related to ill health or emotional issues . Where an adverse situation is occurring a resident may go onto a recovery program. This additional support is highly successful in bouncing residents back to their normal state, and recovery or rehabilitation usually takes one to two months.
Reform is on the way…however….do we really need the government to legislate healthy ageing before we embrace it…..
There are a number of pilot programs in the community that are integrating restorative models into their care packages…however this has not yet been adopted by the community aged care sector
I am concerned in Residential aged care we shape ill-being in our homes, create dependency limit access to regular and sustained health promoting activities accept avoidable decline as a part of ageing and label residents palliative….even though they are not symptomatic of a dying person. Limited mobility does not equal palliative care.
Since 1986 (Ottawa Charter) we have been asked to reorient our services to be more health promoting………. despite this, there is little evidence to demonstrate a ‘whole system’ Health Promotion approach to promote and enable the health and wellbeing of people living and working in aged care homes
A mindset for healthy ageing builds capacity within aged care organisations to move from ‘fixed ideas’ about what aged care looks like, should be, has been.. to a position of healthy ageing that is the entitlement of every person no matter how old or frail. Marry this growth mindset with knowledge, skills and attitudes arising from education around health promotion, positive psychology and the science of wellbeing... and a powerful mindset for healthy ageing emerges as the key enabler for healthy ageing in aged care.
Researchers, Harris and Grootjans believe that…..…by situating aged living and care within an ecological settings framework could synthesize the efforts within the sector into a unified approach to achieve the common goal of improved health and wellbeing for older people……… This focus also considers the ecological footprint of aged communities (Bradley, 2004)
We are a health setting. This means that health is created in and around and because of this setting. Health of residents and staff is directly impacted because of the setting.All we need to understand is how health promotion works.
Health promotion in the twenty first century should be embedded within the operation of the organisations, such as is happening in schools and other local community places.
When all of these factors are provided by the environment and selected by the individual, an increase in quality of life is generally evident.
This is an example of the Health ageing framework for my two facilities. It follows a logical process, using health promotion standards and positive psychology to deliver on 6 key understandings for a good life. The key understandings were developed by reviewing the literature for what makes for a good and even flourishing life. The framework has very clear KPI’s attached to it. This enables you to evaluate your progress and your systems and to enable readjustment of your goals.
Recognising the need for standards for health promotion in health care settings, the WHO established 5 core standards. The standards outlined are related to individuals care and define the responsibilities and activities concerning health promotion as an integral part of all health care services.
The healthy ageing framework draws on the WHOs 5 standards for health promotion and other health related research and practice to reorient our resident aged care homes toward prevention of illness and aged related disability. Policies and procedures guide the transformation of facilities into health promoting settings
The goals of the PiPA model are to;reduce burden of diseaseIncrease wellbeing and quality of lifeThe key principles underpinning the model support older people to:live full and active lives have the right and the responsibility to be (or become) as healthy and involved in life as they possibly can partner with staff to create a lifestyle that supports wellbeing