Strategies for working with the ageing population

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Strategies for working with the ageing population

• Bob Laventure
• BHF National Centre for
  Physical Activity and Health, Loughborough
  University and Later Life Training Ltd.

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Presentation summary

• ageing, inactivity and independence - what do we
  know ?
• who should we target and why ?
• what does this mean strategically ?
• what does this mean practically ?

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Key focus

• disability or independence ?
• language matters
• a positive view of active ageing

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Ageing, inactivity and independence
- what do we know ?

• activity declines with age
• function declines with age
• the consequences are life limiting
• there are significant individual differences
• increased importance among ethnic minority elders

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Men aged 50 participation in activity 5 x week
at an intensity likely to produce a health benefit
100
³5 kcal/min including brisk/fast walks ³2 miles
80
³4 kcal/min including all walks ³2 miles
60
³4 kcal/min plus all walks ³1 mile
Frequently active ()
40
20
0
55-59
50-54
60-64
65-69
70-74
75-79
80
Age
(Skelton. Young et al 1999)
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Levels of sedentary behaviour among women aged
50, England
How active are older people?

• participationis less than once a week

(Skelton, Young et al, 1999)
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Inactivity in care and residential settings

• 86 of women and 78 of men in care homes are
  classed as sedentary
• inactivity levels in care homes are double those
  in private households (65 and over)
• half of all people in residential homes never or
  very occasionally take trips outside the home
  (DOH 2002)
• residents in nursing homes in the USA spend over
  80 of their time seated or lying down
• 80 of older people would rather die than enter a
  nursing home (Salkeld 1999)

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Isometric knee extension strength in men and
women aged 50-74
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Maximal oxygen consumption (VO max) in men and
women aged 50-74
2
Maximal oxygen uptake (ml/kg/min)
VO2 max to walk comfortably at 3 mph
Age (years)
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women aged 70 able to walk for different periods
of time and lengths of walk, without discomfort
100
1/4 of a mile or more
80
30 min
60
15,5,40
20
0
70-74
75-79
80
80
70-74
75-79
Age
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independence, daily living and
physical tasks

• walking 200 metres
• climbing 12 stairs
• picking up items from the floor
• getting in and out of a chair
• getting in and out of bed
• dressing and undressing
• (Kings College 2006)
• (in private households and care homes)

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The good news ! - Improvements in fitness and
functional capacity

• balance - Static (8 weeks) , dynamic (8 weeks)
• muscle strength - (8 - 12 weeks)
• gait - (8 weeks)
• muscle power - (12 weeks)
• postural hypotension - (24 weeks)
• transfer - (24 weeks)
• endurance - (26 weeks)
• bone strength - 1 year for femur and lumbar spine
• (Skelton 1999)

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The good news it works !
- reviews of evidence

• Physical Activity Interventions Targeting
  Older Adults a Critical Review and
  Recommendations (1998) American Journal of
  Preventative Medicine)
• Health Development Agency (2005) Review of
  Physical Activity Interventions
• CHAMPS Programme (Stewart et al (1997)
• (Community Healthy Activities Model Programme
  for Seniors
• we can help older people change their behaviour
  and remain active
• - but they need help and support

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who should we target ?

• entering old age - (activity choices)
• (To promote and extend healthy and active life
  and to compress morbidity)
• transitional phase (increasing the circle of
  life)
• (To identify emerging problems ahead of crisis
  and ensure effective responses which will prevent
  crisis and reduce long term dependency)
• frail older people (moving more often)
• (Anticipate and respond to problems and
  recognise.. Interaction of physical, mental and
  social care factors)
• (The National Service Framework for Older People
  (DOH 2001)

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the opportunity to make activity choices

• entering old age
• previous experiences may be very positive
• make demands upon service providers
• avoiding stereotypes
• adventure and challenge
• exercise and fitness as a growth area
• growing old (dis)gracefully ?)

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Increasing the Circle of Life

• the transitional stage
• those coming into contact with a variety of
  services
• spiral of inactivity and decline
• over caring ? services
• a captured but not captive audience
• skills of front line staff critical

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Moving More Often

• Frail, older people
• increasing frailty and disease
• specific needs e.g dementia, stroke, Parkinsons
• different models of restorative, occupational and
  therapeutic care
• intervention dependent upon professional and
  health care staff

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differentiation in targeting

• older people are not a homogeneous group
• age can be (very) unhelpful
• within categories look at potential
  - partners (e.g. social services,
  3rd age sector)
  - settings (e.g. home,
  leisure centre, day care, residential settings)
  -
  activities (e.g. swimming, dance, chair-based
  exercise)
  - needs (e.g. physical
  function, reducing isolation, falls prevention)

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what does this mean strategically ?

• deciding on priorities
• engaging with and listening to older people
• matching partners and their priorities
• building workforce skills (marketing, delivery
  and support)
• offering quality experiences
• (which is what IFI has been doing)
  so whats the difference ?

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priority income generation ? - GOTYs (Getting
Older Thinking Younger)

• Prime of Life Survey
• 60 is the new 40
• 80 of the countrys wealth
• 19 would try online dating
• 10 would try plastic surgery
• 60 enjoy a good sex life
• 80 own their own homes 50 have no mortgage
• (OMD UK 2005)

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priority - income generation ? SWELLS
(Sixty, Well Off and Enjoying Later Life)

• enjoying disposable time and income - but we are
  competing - with new roles
• grand parenting (or second families) and caring
• internet and lifelong learning
• 2nd or 3rd careers, part time and voluntary work
• Saga travel lifestyles
• (Age Concern 2004)

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priorities and economic trends wealthier -
healthier generations ?

• 50 is a society of two halves
  the health/wealth
  gap is widening
• 50 spend 240 B per annum 40 of total
  consumer spending
• personal disposable income of 205 per week.
• 50 65s spend 2,761 per annum on leisure, under
  30s - 1,679
• But - 31 of those retired survive on less than
  10 K a year.
• (Family Expenditure Survey 1999 2000)

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the priority for targeting - Transitional phase

• physical function , independence and well-being
  as the focus
• evidence of need and outcome
• match to Government priorities e.g. independence
  and wellbeing
• But
• many barriers and competing priorities
• NB reference POPPS programmes, philosophy and
  practice

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Whats the difference ?matching partners and
priorities

• social and care services (Care Trusts)
• 3rd age sector e.g. Ageing Well, University of
  3rd Age, Bramley Elderly Action, sheltered and
  supported living agencies)
• faith and other community groups
• building capacity to deliver and evaluate

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whats the difference ?

• workforce skills
  marketing and reaching the older person
• Whats the message ?
  staying younger or enjoying active ageing
  ? - positive images of active ageing
  - ask older people about what they want
• Have a clear concept of what you want to
  communicate and offer tangible benefits
• (ICAA 2003)

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a different spin on fitness

• strength to lift household objects, open a jar
  and get in and out of the bath
• flexibility to wash hair, tie shoes
• balance and agility to climb stairs
• co-ordination and dexterity to open a door with a
  key
• speed to cross the road whilst the lights are
  green
• endurance to walk to the shops, play with the
  grandchildren

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what does this mean - practically ?

• targeting physical function
• using evidence of what works ?
• workforce training and support

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priorities and preventing disability
- what activities does this mean ?

• specific targeting of function
• strength and flexibility are the missing
  components
• importance increases with age
• key to independence and activities of daily living

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sit to stand the key to independence
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evidence of what works

• planning our programmes
• authoritative health education
• involve older people
• recognise and deal with the barriers they face
  (fears, transport, supportive environment)
• access and choice
• educational component
• support to make the change (BHF
  NC 2003, HDA 2005,)

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workforce training and support

• we have strong evidence !
• maintain and support behaviour change
• prevent relapse
• maintain contact and communication
• high quality customer care
• helps us to achieve our aims/objectives including
  evaluation
• ..and Its what people want !

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last words offering a positive view of aging ?

• active ageing ?
• enjoying ageing ?
• individual differences ?
• making a contribution to society ?
• independence ?
• living in their own home ? able to make a choice
  ?

• disability and disease ?
• staying young ?
• labelling all older people as being the same ?
• drain on health services ?
• at risk ?
• institutionalised ?
• exercise is dangerous ?

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Thank you for listening !bob.laventure_at_ntlworld.c
om

• www.bhfactive.org.uk
• www.laterlifetraining.co.uk