Active ageing – the best is yet to come? Bob Laventure May 17 th 2016
Centenarians?
Life expectancy and demography Increased life expectancy (78 and 82) is equivalent to an extra 5 hours a day “What are you doing with yours”? (Prof Tom Kirkwood WCAA 2012)
The best is yet to come? • Active ageing – beginnings? • Where are we now? • If the best is yet to come – what would be helpful? People, Places and Programmes
Active Ageing beginnings - 1 • Practice in the 80 and 90’s • Voluntary sector (movement and dance) Extend, KFA, WLHB, Women’s Institute • Beth Johnson Foundation and Age Concern • 50+ and All to Play For (Sports Council 1984) • Health Walks (Eastbourne and Sonning Common (1992) • YMCA L3 Exercise for Healthy Older Adults 50+ (1992) NB Focus on HRE in schools and youth sport
Active ageing beginnings - 2 • Evidence and policy • Moving on Symposium (1993) • Active for Life (1995) Moderate physical activity • US Surgeon General Report and Heidelberg Guidelines (WHO 1996) • HEA Older people campaign (1996) and 1 st national conference (1997) • ACSM Position Stand (1998) • NSF for older people (2001) (standards 6 Falls and 8 active lifestyles)
Trends and themes into the ooo’s • What’s an older person ? (from 50 – 65) age and functioning • Recognition of impact of demographic change but diversity of target populations • Increased demands for evidence based/led practice for commissioners • Falls prevention - the growing “industry” • Health, adult and social care and conditions specific (multiple needs and outcomes) • Evidence just gets stronger (King’s Fund 2016) Everyone’s interest, but no- one’s priority and never a physical activity priority
2. Where are we now? Evidence and practice linked to the Public Health England Framework Everybody Active, Every Day NB There are other frameworks!
2. Where are we now? Active environments Moving Places professionals People Programmes Moving at (After PHE 2014) scale
Where are we now? – programmes • We have evidence to inform • Prof. G Morris (1954) • Benefits of physical activity (prevention, treatment and care) (US Surgeon General 1996, DH 2005, 2011) • Prevalence data (HSE 2011, Sport England 2015) • What helps and hinders older people? Determinants, barriers and solutions • How much is enough? (DH 2011) Return on Investment and Cost Benefit Models (??????)
Where are we now? - programmes We ( are beginning to ) understand what works in practice? • Systematic reviews eg, Cochrane 2013, NICE 2009 • Randomised controlled trials and “Gold standard” landmark studies eg (CHAMPS Stewart et al 2001, Fame Skelton 2005, Otago Campbell et al 2001, LIFE Clemson et al 2012) • Consensus statements, expert opinion (DH 2011) • Evaluation reports (eg, LEAP 2008, Football Foundation 2011, Age UK 2015) • Grey literature
Where are we now? – Programmes T here’s more to life than chair based exercise and moving to music! • Recognition of multiple and diverse – Target populations – Needs interests, motivation and expectations – Physical activity modes, walking, outdoor and green, adaptations to sport • Differentiation, choice and access
Where are we now? – People Multiple providers and services • Prevention, treatment and care - condition pathways (eg, Medical Charities and health services) • Physical function, independence and daily living (falls) (Adult and social care) • Mental health, psychological functioning and cognition • Well-being and quality of later, later life (Residential care services) • Diminishing public and increasing private, SME and voluntary sector
People, functional needs and services in Later Life Actives Focus on maintaining and Primary care, physical increasing physical activity activity, leisure, recreation levels providers and services Those in transition Focus upon initiating and In contact with adult, maintaining physical social/care services, activity to improve health voluntary sector and and maintain mobility and housing services independence Frailer, older people Focus upon quality life and Some supported at home, performance of activities many in residential care of daily living DH 2001, BHFNC 2008, PHE 2014
Where are we now – Places Age appropriate, friendly, inclusive and active environments? • Cities, communities, neighbourhoods eg dementia friendly • Natural, green and blue • Social environment (networks and support from significant others) • “Physical activity places”?
3. So is the best is yet to come? • Age Wave and the Boomers - now 70 Places • Impact of technology • Working life, retirement, pensions, healthcare People Programmes • Increased life expectancy • Family patterns and living alone • Ageing well or staying young? • Inequalities are increasing
3. So is the best is yet to come? • Age Wave and the Boomers - now 70 Places • Impact of technology • Working life, retirement, pensions, healthcare People Programmes • Increased life expectancy • Family patterns and living alone • Ageing well or staying young? And what • Inequalities are increasing might help?
Places – capitalising on our environment(s) Age appropriate, friendly, inclusive and active? • Built environments, cities, communities, neighbourhoods • Reduction in Health Inequalities (Kendig and Phillipson (2015) • Perceptions of safety, crime and neighbourhood cohesion (JAPA 2006) • Physical environment – services (post office), absence of rubbish, road crossings (JAPA 2006) • Older people live their lives close to where they live (Davies et al 2011)
Natural/green environments Where we live – “somewhere good to go” • Our footpaths and proximity to green spaces amenities and services (incl. toilets and benches) • Emotion state (in the moment) • Verbal expression and stimulus • Memory and attention • Awareness, (multi-sensory) engagement • Well-being and control “ Supported by their environment , most people aged 80+ living in the community, can expect to continue to go outdoors daily, engage in a range of activities and maintain quality of life into oldest age”. ) Natural England 2012 www.idgo.ac.uk
Age friendly facilities • Health clubs and gyms Feeling comfortable and supported in the environment • Somewhere to sit out or rest • Music? Music? Music? • Visual acuity- signage • Personal attention (instructors, buddies, other older people) • Social activities (golf club as the model?) Learning from mystery shoppers (ICAA 2008)
Age friendly equipment • Minimal pre-programmed workouts • Low starting speeds (0.5 mph) • Low starting resistance and small (1lb?) incremental increases in weight • Display panels, easy to read and change • Access to weight machines for those with functional limitations • Stable seating and support rails Learning from the Inclusive Fitness Initiative (ICAA 2008)
Social environment (WHO 2015) • Physical activity and • Being connected (NEF social norms? 2000) • Behaviour, support • Networks and relationships from significant others • Integration and support • Attractiveness of group activity • Belonging eg, Family, • Media images and role friends and peers models (Someone like • Being engaged with others me)
Healthy settings (WHO 2008) Residential care homes as environments (Health promoting schools) 3 key principles, 3 areas for improvement in each You can access the resource at http://www.careinspectorate.com/index.p hp?option=com_content&view=article&id =8429&Itemid=100214
Programmes (design) and moving at Scale 1. Translating evidence into practice Principles of design and the use of guidance eg NICE 2008, PHE 2015 2. Moving at scale - Programme planning, monitoring, evaluation, sustainability, transfer and scale up (PHE 2015)
Programmes 1. – design and skill set(s) • Translating research into practice - knowledge exchange, transfer – how? • Key principles of programme design eg – Engage (potential) participants – Behaviour change principles – Build skills and strengths (e.g. self efficacy and social relationships) – Supportive strategies and environments through change • Or ………….. • Replication of and fidelity towards Gold Standard interventions eg Otago Exercise Progamme • Fit for purpose
The implementation challenge The implementation challenge 100 % of intended users 80 What can we learn to improve 70 adoption and implementation of effective adapted physical activity 60 programmes? 35 40 15 20 7 0 awareness adoption partial use full use (as knowledge intended) (Hopman Rock M.R. 2009)
Programmes 2. – design and skill set(s) • Planning • Absence of planning skills (PHE 2014) • Monitoring • Lack of evaluation • Evaluation (PHE 2014) • Clarity on outcomes required (BHFNC 2016)
Programmes 2 – design and skill set(s) • Planning • Absence of planning skills (PHE 2014) • Monitoring • Lack of evaluation (2014) • Evaluation • Clarity on outcomes required (BHFNC 2016) • Sustainability • Demand for innovation • Transfer and scale up • Short and changing • Fidelity (RE-AIM Glasgow et commissioning cycles • Built in obsolescence al 1999)
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