Embed Size (px)
Citation preview
National Dementia Conference Adelaide 2017
Re-enabling health services: Prescribing exercise for people living with cognitive decline in residential
facilities
Gaynor Parfitt1 and Alison Penington2 1Alliance for Research in Exercise, Nutrition and Physical Activity (ARENA), Sansom Institute for Health
Research.
2 Helping Hand, Adelaide, SA
Exercise Physiology
• Allied Health Professional
• Chronic Disease, injury and disability
• Lifestyle/behaviour modification
• Group based + individual exercise
• Self management support
• Exercise advice
The Exercise Physiology Journey
Exercise Physiologist (EP) in Aged Care Project:
“Improving cognitive and functional capacity in older people in residential aged care through an exercise prescription approach” A four stage project:
Design pathways
for integrating EP
interventions
Develop a model
for sustainability
and up-scaling of
these practices
within aged
Care. Promote
the model
to the
Aged Care
sector.
Explore the
impact of
targeted,
specific EP
interventions.
Exercise Physiology: Where do they fit in Aged Care?
‘There is no longer an evidence gap,
rather there is an implementation gap’1
1. Deloitte Access Economics. Value of accredited exercise physiologists in Australia. 2015 [cited 2016 21 October]; Available from: https://www.essa.org.au/wp-content/uploads/2015/10/Deloitte-Report-2015_Value-of-AEPs-in-Australia.pdf.
Development of Targeted Programs:
Who?
- HHAC Residents
- Residents living with Cognitive Decline or Dementia
- Related functional Decline
How?
- Staff recommendations/referrals
- Family referrals
- Residents EOI
- Consent
Level of cognition-
ACE
Functional ability-
TUG, 5 Rep sit to
stand, Hand Grip,
POMA & 2MWT
Well-being- QOL AD
Development of Targeted Programs:
Program Evaluation - CDPC Activity 29: Evaluation of an
Implementation project – improving cognitive and functional capacity of older people with dementia in residential aged care through an exercise prescription approach.
CDPC Project Evaluate impact on: Resident Family Staff
Design pathways
for integrating EP
interventions
Develop a model
for sustainability
and up-scaling of
these practices
within aged
Care. Promote
the model
to the
Aged Care
sector.
Explore the
impact of
targeted,
specific EP
interventions.
Pre-control
measurements
Post-intervention
measurements
Post-control
(pre-intervention) measurements
12 weeks 12 weeks
CONTROL PERIOD INTERVENTION PERIOD
Level of cognition
Functional ability
Well-being
Activity – 5 day
EP Project
GENEActiv device
• Worn on the wrist
• Accepted by residents
• Measures activity for 24 hour blocks
Objective measurement of activity
MVPA
Light
Sedentary
Sleep
• Survey
• Interviews
Perceptions and acceptability of
program from staff and family
members
https://pixabay.com/en/photos/interview/
Awareness of exercise benefits
20%
73.7%
6.3%
aware that thereis scientificevidence
assume thatthere arebenefits
not aware of thebenefit ofexercise
50% 50%
0, % 0, %
aware that there isscientific evidence
assume that thereare benefits
Family members Care staff
Exercise benefits for residents with functional decline
• 93.4% of family members, and 92.9% of care staff either agreed or strongly agreed that ambulatory residents would benefit from exercise.
• In contrast, only 66.7% of family members, and 78.6% of care staff either agreed or strongly agreed that residents in princess chairs would benefit from exercise.
Exercise benefits for residents with cognitive decline
• 100% of family members and care staff either agreed or strongly agreed that residents with no cognitive decline would benefit from exercise.
• In contrast, only 46.6% of family members and 57.1% of care staff either agreed or strongly agreed that residents with severe cognitive decline would benefit from exercise.
• At baseline, family members and staff believe that
residents with high functional capacity, or high cognitive
capacity, are more likely to benefit from exercise than
residents with low functional capacity, or low cognitive
capacity.
So…….?
Perceptions of areas of possible improvement – Family members (% response)
0
10
20
30
40
50
60
70
80
90
Social involvement Cognitiveawareness
Physical strength Mobility andFlexibility
Pain expressed
Family members - no change
Family members - small to moderateimprovement
Family members - big change
Perceptions of areas of possible improvement – Care staff (% response)
0
10
20
30
40
50
60
70
80
Social involvement Cognitiveawareness
Physical strength Mobility andFlexibility
Pain expressed
Care staff - no change
Care staff - small to moderate change
Care staff - big change
Barriers to support exercise delivery: care staff (% response)
0
10
20
30
40
50
60
70
80
90
Lack confidence I don't have time I don't have theequipment I need
I need to besupervised
Not comfortableasking allied healthstaff for assistance
Not part of my job There are no barriers
Agree/Strongly agree Disagree/Strongly disagree
Would EPs be of value in the Aged care setting?
100% Agree
Outcomes: Care Staff
“There was one resident that was doing it (the exercise) with her legs
and her arms, and we can stand transfer her, and she’s meant be a
stand transfer.... (She was)…using her legs and everything else. I
mean, after this program, I’ve seen this woman get up out of her chair
and walk, and I’m like what is she doing (laughs)….” Care worker
“Someone like [the EP] who’s got the right personality, has got these
people engaged beautifully, they’re laughing, they’re enjoying, and
it’s just fabulous.” Senior Care worker
“[the program]…should be in every single aged care facility.” Care worker
Outcomes: Family members
“Valuable exercise, as it helped Mum to regain strength & posture
from medical setback.” (Family member)
“I felt gratitude, reassurance and support seeing an improvement to his
mobility and overall well-being- instead of an uninterrupted path of
decline.” (Wife of resident)
“Thrilled that mum is involved in the program.” (Family member)
Summary: Where are we?
• Completed one unit at first site. • Second unit to be completed by end of March. • Second site pre control. • Qualitative interviews have begun. • Quantitative data collection ongoing. • Developing sustainability strategies and future
recommendations
Acknowledgements
Funders: Department of Health (Australian Government) Cognitive Decline Partnership Centre (University of Sydney) Team: Megan Corlis (Director, Research and Development, Helping Hand) Dannielle Post (Project Assistant, UniSA) Jan Van Emden (Business Manager, Research and Development, Helping Hand). Georgia Perkins (Accredited Exercise Physiologist, Helping Hand) Sandy Jensen (Administrative Assistant, Helping Hand) A/Prof Tracey Comans (Health Economist, Griffith University) Dr Kim Nguyens (Research Fellow, Griffith University) Dr Kade Davison (Director Clinical Exercise Physiology, UniSA) Dr Ashleigh Smith (NHMRC-ARC Dementia Development Fellowship, UniSA)
