Maximising independence in older people-4 Ways to Encourage Independence in Clients in Residential Care

Owing to increasing age, accidents or periods of illness, home care services are provided to community-dwelling older adults. Traditionally, these services focus on doing things for older adults rather than with them; though from a rehabilitative perspective, it is important to assist older adults to attain and maintain their highest level of functioning. Consequently, a re-orientation of home care services is required away from treating disease and creating dependency towards focusing on capabilities and opportunities and maximising independence. More specifically, home care professionals are expected to deliver goal-oriented, holistic and person-centred services focusing on supporting older adults to maintain, gain or restore their competences to engage in physical and daily activities so that they can manage their everyday life as independently as possible. Older adults who experience difficulties with personal care e.

Maximising independence in older people

While encouraging independent physical activity is important, it's imperative to make Maximising independence in older people that the activities you encourage will not cause Christina model f harm. As a consequence, it is important to ensure that team managers, policy makers and the board of directors have an understanding of the approach and are supportive of it. Both the programme model and core components and its potential relevance for Dutch home care services were discussed during an expert meeting with international researchers in the fields of reablement and Function Focused Maixmising. Anticipatory care planning encourages people indepensence make positive choices about what they should do themselves, and from whom they should seek support, in the event of a flare up or deterioration in their condition, or in the event of a carer crisis. Similarly the current availability of a specialist MS nurse to accompany a geriatrician to see a disabled patient in a remote location within 24 hours Maximisinf the ability of this team peopl make clear diagnostic plans Maximising independence in older people radiology or further investigations seems extremely unlikely7. Some people in residential care may need help getting to an area where they can interact with others.

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Ensuring that pain relief is adequate so that they can move about indeppendence helps them to maintain their muscular fitness. He challenges me every day about what I have done to improve health and care for the staff and individuals for whom I am responsible. With all the celebratory days, pressure Maximising independence in older people prevention day is one worthy of a calendar I am the chief operating officer at Belong Maxiimisinga not-for-profit organisation specialising in offering innovative settings and services to ensure a high quality of life for people living with dementia. What or who inspires you, and why? What would you like to read next Career advice My job Revalidation. Nursing Older People readers are invited to comment on research findings. What do you enjoy most about your job? What has given you most satisfaction? Comment Your views The swinging cross. He believes in living as full and active a life as his body will let him. An important task Maximising independence in older people the acute care nurse is to help and encourage the older patient to do as much for themselves as they are able. Information for staff Information for students Stories about the:.

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  • When older people become acutely ill or suffer an injury, and require surgical or medical admission to hospital, they may lose confidence in their own bodies and physical abilities.
  • I am the chief operating officer at Belong villages , a not-for-profit organisation specialising in offering innovative settings and services to ensure a high quality of life for people living with dementia.
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The dataset supporting the conclusions of this article are available from the authors. With population ageing, research is needed into new low-cost, scalable methods of effective promotion of health and wellbeing for older people.

We aimed to assess feasibility, reach and costs of implementing a new tailored computer-aided health and social risk appraisal system in primary care. Intervention: The Multi-dimensional Risk Appraisal for Older people MRA-O system includes: 1 Postal questionnaire including health, lifestyle, social and environmental domains; 2 Software system generating a personalised feedback report with advice on health and wellbeing; 3 Follow-up of people with new concerning or complex needs by GPs or practice nurses.

Evaluation: Feasibility of implementation; participant wellbeing, functional ability and quality of life; social needs, health risks, potential lifestyle changes; and costs of implementation. Compared to local UK Census data on older people, participants were younger, more were owner-occupiers and fewer were from ethnic minority groups than expected. Implementation costs were low.

A computer-aided risk appraisal system was feasible for General Practices to implement, yields useful information about health and social problems, and identifies individual needs. Participation rates were however low, particularly for the oldest old, the poorest, and ethnic minority groups, and this type of intervention may increase inequalities in access.

Widespread implementation of this approach would require work to address potential inequalities. With increasing life expectancy major challenges face governments internationally [ 1 ], and the care and support of older people are widely recognised as a public health imperative. Current policy emphasises the importance of personalised preventative approaches in community settings [ 2 — 4 ].

There is, however, a limited evidence base about the most appropriate approaches to meet these broad aims. Complex interventions designed to improve physical function and maintain independent living show potential to alter health behaviours, improve general health perception and self-efficacy, and promote independence in older people [ 5 ]. An ideal multi-faceted approach to promote healthy ageing in the general population of older people should be low cost, easy to implement using existing structures, and demonstrate effectiveness in improving wellbeing in later life.

In the UK the majority of older people are registered with a General Practitioner GP , and primary care is one of the few services that has the ability to reach the general population of older people.

This approach is potentially burdensome for primary care, particularly in the context of a rising older-old population. In this system older people are invited to complete a comprehensive survey on their health and wellbeing across different domains, and then receive an individualised report generated from their answers by a dedicated computer programme. If this report is also shared with primary care practitioners, those with more complex or concerning needs can be actively followed up for further face to face assessments.

This process can be automated, using editable software, and the report can include healthy ageing advice, signposting to local and national resources, and be tailored to individuals based on their responses. It can create opportunities for promoting self-care and wellbeing, and has the capacity to integrate social and health care information for older people. Aggregated data have the potential to contribute to the development of profiles of local populations and their needs, and so refine and inform commissioning of services [ 10 ].

The pilot and feasibility studies of the HRA-O system in primary care showed that the technology can be culturally adapted to the UK, is acceptable to older people and GPs, and can identify under-utilisation of preventive services [ 7 , 8 ].

A Randomised Controlled Trial RCT of HRA-O in the UK confirmed its acceptablity and had high response rates, but, without any local embedding of its use or reinforcement of its messages by active follow-up through primary care, its impact on changing health behaviour was limited [ 9 ]. In this study older people prioritised and developed a series of supplementary questions and feedback on housing, transport, income maximisation, safety, social isolation, care responsibilities, recent life events, access to services and environmental concerns, to add to standard Heath Risk Appraisal HRA.

This experience raised two questions: 1 Can a multi-faceted intervention with local embedding and re-enforcement of tailored recommendations be integrated into routine primary care? The locality working groups identified local agencies and individuals who could support older people in meeting individual needs identified using the MRA-O system. This information was incorporated into the MRA-O software. The locally adapted MRA-O system was tested by conducting assessments using postal questionnaires with a random sample of older people registered with participating General Practices.

Data were entered and automated personalised feedback was provided to individuals including details of local and national resources to support self-care and promote wellbeing. Those with complex or concerning needs had, with consent, additional follow-up from clinicians in primary care practice nurse, nurse practitioner or GP to encourage them to engage with actions to promote wellbeing. Practices were advised that the lead clinician should review the MRA-O report on arrival as with any clinical report they receive about patients, and decide on action needed with reference to the medical records, taking into account prior knowledge of the patient.

We conducted the study in two localities London Borough of Ealing, and the County of Hertfordshire, UK representing urban and semi-rural locations, with different proportions of black and minority ethnic BME populations and different socio-economic characteristics. Two General Practices participated in Hertfordshire, and three in Ealing. GPs wrote to all randomly selected eligible older people, inviting them to participate in the study. Those consenting to participate were sent a comprehensive page postal questionnaire survey.

One postal reminder was sent to non-responders. All materials were produced in large print versions. Translated versions of the study information sheet and consent forms were available for the main other languages at study sites. The main questionnaire was in English only, and participants were encouraged to seek support from friends or family in completion if needed.

A researcher assisted by telephone anyone who was unable to complete the written questionnaire due to, for example, sight, language or literacy problems. Data from the questionnaires were entered into the dedicated software programme by the research team. We collected data on uptake and compared the socio-demographic characteristics of those participating with UK Census data for that local area [ 13 ], where available. We recorded data on actions from practices following MRA-O assessments, including review of medical records, and consequent follow-up and referrals under-taken.

Questions from the SWISH study [ 12 ] included were on housing, transport, income maximisation, safety, social isolation, care responsibilities, recent life events, access to services, and environmental issues.

A supplementary questionnaire included measures of quality of life SF [ 17 ], well-being Warwick-Edinburgh Mental Well-being Scale item [ 18 ] and health, social care and voluntary sector service use.

Data were collected on work required from practices to complete the screening of practice lists, invite patients to participate and to perform patient assessments.

Unit costs were estimated for all activities using published unit costs of health and social care activity [ 19 ]. From this data we estimated the direct costs of the intervention. Other data were directly entered in SPSS. Data were double entered and discrepancies resolved. Data were cross-checked by tabulations and histograms identifying missing data and anomalies and cleaned with reference to the original questionnaires. Descriptive data analysis was undertaken only, as the primary purpose of this study was to determine the feasibility of implementing this process.

We approached 6 practices to participate and 5 agreed, 2 in Hertfordshire and 3 in Ealing, with an average list size of 8, range 4, — 10, registered patients. Of the 5 practices, 3 had not previously participated in any research. Two participants contacted us for support in completing the questionnaire, and for one person to our knowledge the questionnaire was translated by and completed with her son as the participant could not read English. Overall the median age of participants was Compared to local UK Census data, participants were younger, more were owner occupiers and fewer were from ethnic minority groups than expected.

In Hertfordshire, census data showed that Sensory deficits vision and hearing affected a quarter to a third of the sample. Just over a third of participants reported sedentary behaviour, defined as self-reported sitting for 4 or more hours daily not including sleep periods.

A quarter to a third of participants reported a change in walking half a mile or climbing stairs in the last year. There was a low prevalence of smoking at 5. A small proportion 6. The mean quality of life scores were This is slightly higher better health than normative population values reported for this age group in the UK [ 20 ]. The mean wellbeing score on the Warwick-Edinburgh Mental Well-being scale was Practices developed systems for dealing with new needs identified by the MRA-O questionnaire using the guidance described in Stage 2 of the intervention above.

The costs relate to central administrative tasks and costs for individual GP practices to deliver the intervention. This would need to be updated annually, however is likely to take less time in future years. The intervention costs of the study for individual GP practices comprised fixed and variable components. The fixed costs relate to the set-up of the intervention. This covered the cost of identifying patients, including manually reviewing lists generated from electronic searches of GP registers to remove people who were ineligible.

The variable costs related to the number of questionnaires sent, returned and requiring following up. These estimates include the costs of the postal questionnaire, data entry, report generation and checking, the time needed to review reports and carry out follow-up by nurse or GP. Data entry was estimated as min per questionnaire, which could be performed by a junior administrator, and could be undertaken centrally or within practices.

Costs are estimated in values. Unlike other approaches to risk assessment, the provision of computer generated personalised feedback and identification of solutions and services to address identified problems can facilitate self-management of the changes that occur with ageing. This is similar to previous research [ 22 ]. This self-selection bias is likely to underestimate the prevalence of health and social problems in the older population. On reviewing the reports generated, the practice clinician nurse or GP needed to review the notes for just under a third of participants, and initiated further follow-up generally a telephone call or appointment with the nurse or GP in around a quarter of participants.

This additional workload was feasible for practices to undertake as part of their usual care, without needing additional resources or support. A wide range of health and social problems was identified, a number of which were at similar levels to those expected, while others were more or less prevalent than in previous research.

Sedentary behaviour is associated with adverse physical and mental health outcomes [ 24 ], has deleterious health effects, even when physical activity recommendations are met [ 25 ], and sitting time is now recognised as a health risk factor independent of physical activity [ 26 ].

Older adults are most likely to be sedentary [ 27 , 28 ]. Almost one in four participants aged 65 and over expressed fear of falling, again similar to other studies in similar populations [ 29 ].

In some domains very high prevalence rates were reported. The most striking of these was pain, where more than a third of the sample reported pain limiting their activity or sleep, and more than half had experienced pain during the last week.

This is similar to the prevalence of pain identified using the same instrument in an earlier study [ 30 ]. This is significant given that the ageing process can be viewed as the cumulative effect of chronic health risks including hyperlipidemia, whilst among independently living older people low nutrient density of the diet and inadequate intakes of protein, vitamins, and minerals are the chief areas of nutritional concern [ 31 ].

A quarter to a third of respondents noted that their mobility had worsened in the last year. Self-reported preclinical disability as captured by the Fried questions predicts incident falls at 1-year follow-up, independent of other self-reported fall risk factors [ 32 ]. This is a group whose falls might be prevented, and whose disablement might be interrupted or delayed by intervention.

Self-rated impairments in vision and hearing were higher than prevalence rates reported in other studies [ 33 , 34 ], with nearly a third reporting hearing impairments and a quarter vision impairments. This study reports the feasibility of the implementation of computer-aided health and social risk appraisal for the general population of older people the MRA-O.

This is a novel system that produces a personalised report on both health and social concerns, integrated into routine primary care. The MRA-O itself was developed using co-design methods with significant input from older people, and has undergone extensive and iterative field testing. The implementation study was undertaken in five UK General Practices across two contrasting neighbourhoods in urban London and semi-rural Hertfordshire, chosen to maximise diversity in setting, and in type of practice including those that do not typically take part in research.

The findings may not, however, be generalizable to other settings or practices.

Related articles Older people's care in the East and West: What can we learn from other cultures? He believes in living as full and active a life as his body will let him. There are many ways that nurses can facilitate older patients' sense of independence while in hospital. Consider a career working with older people. What has given you most satisfaction?

Maximising independence in older people

Maximising independence in older people

Maximising independence in older people

Maximising independence in older people. Presbyterian Support NZ

There are many ways that nurses can facilitate older patients' sense of independence while in hospital. Ensuring that pain relief is adequate so that they can move about more helps them to maintain their muscular fitness. Giving them easy-to-understand information about their health conditions and treatments can also empower them to be in better control of their health. Skip to navigation Skip to content. Maximising Independence When older people become acutely ill or suffer an injury, and require surgical or medical admission to hospital, they may lose confidence in their own bodies and physical abilities.

Your progress:. I see this as a fantastic opportunity to use my skills, knowledge and competencies, and to learn and develop new skills. I bring considerable experience as a senior nurse leader and I look forward to learning more in my new role while being able to bring a fresh pair of eyes to Belong. I have a wonderful family who bring me great pleasure and pride. I live in the Yorkshire Dales, which is a beautiful part of the world.

Walking is a big part of my life. My year-old father. He believes in living as full and active a life as his body will let him. He challenges me every day about what I have done to improve health and care for the staff and individuals for whom I am responsible. When working with patients with dementia what qualities do you think a nurse should possess? Consider a career working with older people.

It is truly rewarding, and the scope of responsibility in the care sector is exciting, challenging and offers plenty of career development opportunities. What is likely to affect nurses working in dementia care over the next 12 months?

As life expectancy increases, more people will be diagnosed with dementia, so one of the challenges is to meet the needs of those people effectively and personally. Nurses have a crucial role to play, but they may need to review the way they have traditionally worked, and learn to think in a more innovative or collaborative way to meet the demands of the care sector. Find out more about Belong villages here. Sign in Register Subscribe. Comment Your views Reviews. Career advice My job Revalidation.

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Maximising Recovery, Promoting Independence: An Intermediate Care Framework for Scotland - fiddley.com

This site uses cookies to make the site simpler. Find out more about cookies. A well configured, integrated health and social care system which includes a range of Intermediate Care options can contribute significantly to the reshaping care agenda by:. The need for change is clear - the demographic changes facing Scotland are well documented:. This will involve a substantial shift in focus of care from institutional setting to care at home - because it is what people want and provides better value for money.

This projected growth in the older population will create significant additional demand on health, care and support services. There will be additional demands on other services. Reshaping our services for older people can change this. We have already made some progress in this area, but we need to do more. Intermediate Care has a key role to play in meeting the health and social care needs of people in Scotland.

Preventing unnecessary acute hospital admission or premature admission to long-term care. An important concern for older people is the increasing likelihood of unplanned or emergency hospital admission as they develop more long term conditions and complex needs. The probability that someone will be admitted to hospital increases with age Chart 1 as does the average time spent in hospital after admission Chart 2.

Many admissions are absolutely necessary. Some however can be avoided - if we take the right anticipatory action and if we ensure that effective alternatives are available in the community. A key outcome of reshaping care will be reducing the number of bed days used as result of emergency admissions to hospital by older people.

To avoid unnecessary admission to hospital alternative community services need to be in place to effectively respond to those in crisis. Providing a range of integrated intermediate interventions within community services will ensure timely support is available to those who need it, where they need it.

Intermediate Care is not just a health, or social care agenda. There is a role for all - health, social care, housing, the third and independent sectors - alongside families, carers, neighbours and the wider community. Unnecessary delays in discharge from hospital are not only costly to the NHS but are detrimental to the health and wellbeing of the individual. Unnecessary delays can lead to decreased independence and life skills, lack of confidence and a risk of further illness.

All of this can lead to an increased risk of premature admission to a care home, instead of a return home. The risk of becoming delayed in hospital increases when a patient is admitted as an emergency, and the longer the delay the greater the chance of dependency and a reduced chance of a return home. Therefore both the emergency admission and its outcome may be expensive - in financial and human terms.

In contrast, greater support upstream might have helped to prevent an avoidable admission, at lower cost. Our evidence demonstrates the need for public services to become outcome-focussed , integrated and collaborative. They must become transparent, community-driven and designed around users' needs.

They should focus on prevention and early intervention. There has been much progress in tackling delayed discharges. In October there were more than 2, patients delayed longer than 6 weeks. A target to reduce this to zero by April was achieved and the numbers delayed over 6 weeks generally remain below The group recognised the achievement over the last few years but felt that, from an outcomes perspective, a six-week delay in hospital discharge is too long in nearly all cases.

The group suggested that major cultural and behavioural change was needed to move to a position where discharges routinely take place in days and not weeks and that people are, wherever possible, discharged home or to where they were admitted from. It is clear that prolonged hospital stays are generally not good for a person's general wellbeing, especially their sense of control and independence.

To ensure that their potential for recovery is maximised, an individual should have the opportunity to recover at home or within a community setting supported, where required, by an appropriate package of Intermediate Care.

This recovery time could avoid premature admission to a care home - currently, too many older people are discharged directly from hospital to a care home at a time when their confidence is low following an acute illness. The development of Intermediate Care, such as Rapid Response Teams; community assessment and rehab teams, or hospital at home schemes, can help avoid admission to the acute sector, promote faster recovery from illness, and reduce delays to discharge from hospital.

Supporting anticipatory care planning and self management of long-term conditions. Around 2 million 8 people in Scotland have at least one long term condition, and one in four adults report some form of long term illness, health problem or disability. Long term conditions become more common with age. By the age of 75, nearly two-thirds of people will have developed a long term condition. The human costs of long term conditions and the economic consequences for health and social care are profound.

Approximately 71, people in Scotland have dementia, around 2, of whom are under The remainder is the contribution made by carers Most people who live with a long term condition manage their own condition or do so with help from family, unpaid carers or from community and voluntary sector partners. Supported self management encourages people to take decisions and make positive choices about their health, wellbeing and health-related behaviors.

It involves a holistic assessment of personal goals. A self management plan is a way of recording these personal goals and the supports people need to achieve them. It is designed to be held and used by the person at home. A recent study aimed at reducing unplanned hospital admissions highlighted that the use of Anticipatory Care Plans for those at high risk of a hospital admission was found to reduce the number of admissions and occupied bed days Anticipatory care planning encourages people to make positive choices about what they should do themselves, and from whom they should seek support, in the event of a flare up or deterioration in their condition, or in the event of a carer crisis.

This approach supports important outcomes:. Home Publications. Why do we need Intermediate Care? Supporting files Download. Accessibility: This document may not be fully accessible. Contents Close. Contents Choose section Foreword 1. Introduction 2. Purpose of the Framework 3. What is Intermediate Care? Key components of an effective Intermediate Care system 6. Specific Services and Functions 7. Service Design and Delivery 8. Policy Context 9. Links to the delivery framework for adult rehabilitation in Scotland References Footnotes.

A well configured, integrated health and social care system which includes a range of Intermediate Care options can contribute significantly to the reshaping care agenda by: Preventing unnecessary acute hospital admission or premature admission to long-term care; Supporting timely discharge from hospital; Promoting faster recovery from illness, and Supporting anticipatory care planning and the self management of long-term conditions. Preventing unnecessary acute hospital admission or premature admission to long-term care An important concern for older people is the increasing likelihood of unplanned or emergency hospital admission as they develop more long term conditions and complex needs.

Chart 1: Emergency admissions as a percentage of population in age band Chart 2: Average length of stay per emergency admission by age Supporting timely discharge from hospital Unnecessary delays in discharge from hospital are not only costly to the NHS but are detrimental to the health and wellbeing of the individual. Commission on the Future Delivery of Public Services There has been much progress in tackling delayed discharges.

New Delayed Discharge Target Partnerships will reduce to zero the number of delayed discharges: over 28 days by April , and over 14 days by April A target to reduce this to zero by April was achieved and the numbers delayed over 6 weeks generally remain below However, delayed discharges still account for nearly a quarter of a million bed days lost.

Promoting faster recovery from illness It is clear that prolonged hospital stays are generally not good for a person's general wellbeing, especially their sense of control and independence. Supporting anticipatory care planning and self management of long-term conditions "Introduce a systematic and integrated multi-agency approach across CHP s to provide better, local and faster access to services for people with long term conditions who require proactive and co-ordinated support. Most people who need long term residential care have complex needs from multiple long term conditions.

It is well known that elderly people with significant physical disease are at greater risk of co-existent psychiatric morbidity People with dementia are many times more likely to be admitted to hospital compared with older people who do not have dementia. This approach supports important outcomes: Person centred care, dignity, choice and control Effective co-ordination and communication between the individual, their family and the health and social care professionals involved Planning for the future at a stage when the person can make their preferences known, enabling them to be actively involved in planning their own future.

Care at home where appropriate, or care which is more local and closer to home. Key components of an effective Intermediate Care system. Was this helpful? Your feedback will help us improve this site Feedback type Yes No Yes, but. Please select a reason It wasn't detailed enough It's hard to understand It's incorrect It needs updating There's a broken link It wasn't what I was looking for Other Please select a reason It needs updating There's a spelling mistake It's hard to understand There's a broken link Other.

Maximising independence in older people