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Ageing & DementiaJudy Stevenson & Jill Dentith
Judy Stevenson Public Health Hub Lead
Principal Lecturer, Academy of Sport and Physical Activity
[email protected] 225 3982
Jill DentithHead of Health
Sheffield City Trust [email protected]
0114 22 33 811
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Discussion
• Please share your ideas and contributions• Share successful practice• What would be helpful to you for your future
practice/work?• Can you see possibilities for future
collaboration/research/service re-design/CPD/events
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Introduction & Ice breaker
• How old is old?• What words do we
think of when we think of 'old'?
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Aims of the workshop
• Context for Ageing nationally • Context for Ageing locally• Dementia and Physical activity - where's the
evidence?• Dementia pilot project• Discussion
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National Drivers
• WHO and Alzheimer's International, Dementia: a public health priority (2012)
• NICE Quality standard (QS30): Supporting people to live well with dementia (2013)
• PHE & Alzheimer's Society: Dementia Friendly Societies (2014)• PHE Dementia Action Alliance- Dementia Friends (2013)• NICE guidelines [PH16] : Occupational therapy and physical activity
interventions to promote the mental wellbeing of older people in primary care and residential care (2008) + evidence update (2015)
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Local Drivers
• Sheffield City Council, South Yorkshire Housing Association: Fulfilling Lives, Ageing Better- Big Lottery Fund (2014)
• Sheffield Dementia Action Alliance (2013)• Sheffield Hallam University http://ed.ted.com/on/wQqgWSdl• National Centre for Sport & Exercise Medicine
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Sheffield
What is the NCSEM?
• 3 national partners - London, East Midlands & Sheffield• Linked to Olympic legacy cabinet committee• £30 million capital investment nationally• £10 million capital in Sheffield • Opportunity to have national and international impact• Sheffield NCSEM project managed and led by SHU with a range of
key partners including SCC, NHS Sheffield CCG, 3 x NHS Foundation Trusts, 2x Universities, Sheffield City Trust and voluntary sector
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5 Core themes
Physical Activity in Disease PreventionPromote physical activity and healthy lifestyles as a preventative therapy for long term conditions. Chronic Disease TreatmentDevelop the prescription of physical activity in the treatment of chronic disease. Musculoskeletal HealthDevelop models for the use of physical activity in diagnosis and management of musculoskeletal disorders, and public cost savings through reductionin work absenteeism.
Mental Health and WellbeingImprove staff wellbeing, reduce absenteeism and enhance productivity, through physical activity.
Promote physical activity in the treatment of mental illness and deliver research, education and training in the identification of eating disorders in sport. Performance Health Research elite athlete performance to further understand how to optimise health for this population and make it applicable to benefit other groups, such as the ageing population.
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Objectives: NCSEM
• Co-locate expertise• Develop and implement physical activity care pathways that
establish the business case for physical activity as medicine• Provide opportunity for physical activity research that
improves clinical care• Stimulate advances in tele-health and tele-medicine and
translate innovations into clinical practice• Develop and implement programmes for disease prevention
through the city-wide Move More programme. • Evidence the benefits
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NCSEM-Sheffield Vision
To create a culture of physical activity that results in Sheffield becoming the most active city in the UK by
2020
NCSEM-Sheffield Mission
Make it easier for everyone in Sheffield to be active as part of everyday life.
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Capital infrastructure
NCSEM capital investment establish an innovative model to;
• co-locate patients, clinicians, researchers, sport and exercise medicine specialists and public health professionals across the City
• create community facilities to extend the reach of Sport and Exercise Medicine that include; research, recreation, rehabilitation and education.
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NCSEM Hub - Graves
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NCSEM Spoke - North Active
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NCSEM Spoke - Concord
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NCSEM Spoke - Concord
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Clinic Rooms
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Task
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How physically active are you?
• What are the physical activity recommendations for
• Adults?• Older adults?
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Adults• Adults should aim to be active daily. Over a week, activity should add up
to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week.
• Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous intensity activity.
• Adults should also undertake physical activity to improve muscle strength on at least two days a week.
• All adults should minimise the amount of time spent being sedentary
(sitting) for extended periods. Start Active , Stay Active (2011) Chief Medical Officers Report
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Older Adults• Older adults should aim to be active daily. Over a
week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week.
• For those who are already regularly active at moderate intensity, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous activity.
• Older adults should also undertake physical activity to improve muscle strength on at least two days a week.
• Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week.
• All older adults should minimise the amount of time spent being sedentary (sitting) for extended periods.Start Active , Stay Active
(2011) Chief Medical Officers Report
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Percentage of Adults achieving 150 minutes per week Physical Activity
Core City <30 mins 30-89 mins 90-149 mins 150+ mins
National 28.5% 8.1% 7.3% 56.0%
Sheffield 30.4% 8.8% 6.2% 54.6%
Birmingham 34.3% 9.9% 8.9% 46.9%
Bristol 28.4% 8.4% 7.8% 55.4%
Leeds 26.9% 6.4% 5.5% 61.3%
Liverpool 31.6% 6.8% 9.6% 52.0%
Manchester 40.2% 5.4% 2.8% 51.6%
Newcastle upon Tyne 25.6% 9.1% 7.6% 57.6%
Nottingham 33.2% 7.9% 7.0% 51.9%25
Physical Activity and older adults
78% of men and 86% of women living in care homes in Great Britain were classified as inactive. This is twice as many as those who live in private households
41% of adults in Great Britain over the age of 70 years take a 20 minute walk (for transport purposes) less than once a year
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National travel survey 2009. Department of Transport 2010.
Physical inactivity
Physical inactivity is described as;“doing no or very little physical activity at work, at home, for transport or during discretionary time … notreaching physical activity guidelines deemed necessary to benefit public health”
(Bull et al. in Lopez, Rodgers and Murray (eds) 2004)
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Sedentary behaviour
Sedentary behaviour refers to a group of behaviours that occur whilst sitting or lying down and that typically require very low energy expenditure
The low energy requirements distinguish sedentary behaviours from other behaviours that also occur whilst seated, e.g. chair based exercise, but which require greater effort and energy expenditure.
Sedentary behaviour is not defined simply as a lack of physical activity; it is a separate behaviour in its own right.(Pate, O'Neill and Lobelo 2008)
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Dementia
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Dementia
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Physical Activity & Dementia
The Cochrane collaboration Review (2013) 'Exercise programmes for people with dementia'; included 16 trials with a total of 937 participants. Most participants were older people with Alzheimer’s disease (AD). The exercise programs varied greatly; the length of time that they ran ranged from two weeks to 12 months, and activities varied (e.g. hand movements, sitting, walking, and upper and lower limb exercises) The review suggests that exercise programs may have a significant impact on improving cognitive functioning and the ability to perform ADLs in people with dementia.
31(Laventure 2014)
Physical Activity & Dementia
• Blankevoort et al. (2010) assessed the effects of exercise on physical function and activities of daily living in older people with dementia. 10 RCT’s with a total of 492 participants.
• Littbrand et al. (2011) assessed the effects of exercise on physical function, cognitive function and ADLs in people with dementia. This review included only RCTS and included a total of 10 studies with 622 participants.
• Martinez (2014) - a summary of 20 studies to improve cognition, neuropsychiatric symptoms and physical function in people with Mild Cognitive Impairment (MCI), dementia and AD. Involving over 1,400 participants.
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Physical Activity & Dementia
Furthermore, the findings reveal that the burden experienced by informal caregivers providing care in the home may be reduced if they supervise their family member with dementia during participation in an exercise programme.
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Sheffield City Trust
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What is Sheffield City Trust?• Sheffield City Trust (SCT) is an independent
registered charity• Sheffield International Venues Ltd. (SIV) is a wholly
owned subsidiary of SCT – all profits reinvested• SIV manages and operate a number of sports and
leisure facilities in Sheffield on behalf of SCT• SIV hosts a range of events from local community
activities to world class sporting and entertainment events
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SCT Charitable Objects
The objects of SCT are:
“To provide facilities for recreation for the benefit of residents of Sheffield; to promote the physical health of Sheffield residents; the development and promotion of the arts and the promotion of social welfare in the City.”
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SCT Sport and Leisure Centres• Concord Sports Centre• English Institute of Sport• Heeley Pool and Gym• Hillsborough Leisure Centre• iceSheffield• Ponds Forge International Sports Centre• Springs Leisure Centre• Westfield Sports Centre
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SCT Golf Courses and Entertainment Venues
• Beauchief Golf Course• Birley Wood Golf Course• Tinsley Park Golf Course• Motorpoint Arena• Sheffield City Hall
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How can SCT help increase physical activity?SCT have facilities and staff across the city to support people to be more physically active whatever their age or ability:
– Start well e.g. aqua-natal, swimming lessons and athletots
– Developing well e.g. team sports, athletics and gymnastics
– Living and working well e.g. gym membership and exercise classes
– Ageing well e.g. exercise referral, silver circuits and tea dances
– Specific programmes for people through cardiac and pulmonary rehab, Parkinson’s, stroke etc.
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*Plus one scheme
*Let me take you there
*Dementia and physical activity
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SCT: a dementia friendly organisation• Signed the SDAA charter• Life-size cut outs to promote “Dementia Friends”• Staff training and support• Sheffield Dementia Friendly City of Culture• Supporting people into main stream services• Physical activity interventions for those with
dementia and their carers
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Pilot Project
• A taster day of activity took place in March 2015 at Concord Sport Centre which included swimming, badminton, use of the gym and sensory room.
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Question Feedback
What activity have you enjoyed today?
Gym (6)Badminton (5)Table Tennis (4)Treadmill (2) Sensory Room (2)
What did you enjoy about the activities?
Being activeGetting together with other people Being part of a group of friendsVariety of activitiesA qualified instructor explaining what to doBeing reminded that a gym might help me Being competitive Doing activities with people in similar positions
What are the things that have helped you to take part today?
Having friendly and welcoming people around (4)Having a support worker with me (3) The Alzheimer's Society identifying my needs (2)Staff taking each activity at the individuals pace Not being rushed Encouragement from everyone
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"Being part of a group where everyone is in the same boat"
"It was fun being with other people"
"Being part of a group and getting out. Everything was gentle and friendly"
"Staff very friendly and inclusive"
Is there anything that would have helped to make this a better experience?
Would have liked the opportunity to swim (2) Would have liked the squash to be included (2) A different venue due to this being a long distance for some to travel Should have been told to bring trainers
Are there other activities you would like to try in the future?
Indoor bowls (7) Dance (3) Walking football (2) Meditation/yoga/Pilates (2) Exercise classes (2)Swimming (2)Trampoline
Do you take part in any sport or exercise, if so what?
Walking (4)Swimming (3) Gym (2)Dancing Ten pin bowling Table tennis Golf driving range Cycling Keep fit
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"People challenged to try new things"
"Revived memories"
"There was an element of being serious, but it was also light-hearted and fun" "Being able to do the activities that have been part of my life for so long without feeling rushed, and being understood by the instructor"
"We feel like we belonged and were made welcome" "Norma became overwhelmed and said 'they understand our ways'" (Support Worker)
"Encouragement from others and not feeling self-conscious" "No, it was a good positive experience"
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Next StepsProposalTo develop a funding bid - Big Lottery - Awards for All England - to deliver a 'programme' of activity for participants with Dementia. Evaluation will be undertaken by Sheffield Hallam University after consultation with participants.
PartnersSheffield City Trust (SCT) / Sheffield International Venues (SIV)Sheffield Dementia Alliance Group including Sheffield Alzheimer’s Society and Public Health at Sheffield City CouncilThe Public Health Hub - Sheffield Hallam UniversitySheffield Health and Social Care NHS Foundation Trust Ideas8 week programme of activity at an SIV facility for those with early onset dementia and their carersTaster day at SIV golf rangeGroup Ten pin bowling activitySporting Memories session
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Outcome Measures• We will work with the clients and carers to establish 'what they would like
to measure'. This may include;
• Cognitive functioning• Mobility and other physical function measures, and reduces decline in the
ability to perform ADLs.• Improved, confidence, self esteem, positiveness - no evidence suggested
in BL paper,
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Furthermore, considering the PA recommendations we will consider the feasibility of including some of these measures •Reducing sedentary behaviour •Aim to be active every day•Accumulating 150 minutes of moderate- to vigorous-intensity aerobic exercise per week, in bouts of 10 minutes or more •Muscle strengthening activities using major muscle groups, at least two times per week •Balance and co-ordination activities are recommended for those older adults at risk of falls.
Outcome Measures
Questions
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Discussion
• Please share your ideas and contributions• Share successful practice• What would be helpful to you for your future
practice/work?• Can you see possibilities for future
collaboration/research/service re-design/CPD/events
52
ReferencesBlankevoort , C. G., van Heuvelen, M. J. G., Boersma. F., Luning, H., de Jong, J. and Scherder. E. J. A. Review of Effects of Physical Activity on Strength, Balance, Mobility and ADL Performance in Elderly Subjects with Dementia. Dementia and Geriatric and Cognitive Disorders 2010;30:392-402https://www.karger.com/Journal/Issue/254680 Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S. (2013) Exercise programs for people with dementia. Cochrane Database of Systematic Reviews 2013, Issue 12. The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006489.pub3/pdf Laventure, B. Draft Briefing Paper; People living with dementia, physical activity and exercise. Summary of current research – findings and implications for practice (2014)Littbrand, H., Stenvall, M., and Rosendahl, E. Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: A systematic review. American Journal of Physical Medicine and Rehabilitation 2011;90:495-518 Martinez J.T. (2014) Dementia and Alzheimer’s Disease in Physical Activity and Mental Health (Clow A. and Edmunds S. Eds.) Human Kinetics Champaign, Illinois.
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