What drives your

practice?

What drives your

thinking?

How does that thinking translate

into practice?

Healthy ageing; an easy choice 1

More positive views of ageing

Healthy Ageing -

addresses the lifestyle

factors that influence healthy

ageing

Active Ageing - optimize

opportunities for health,

participation and security -

intentional

Positive Ageing -

emphasises the need to

remain actively engaged in

society in order to adapt

successfully to older age

What is Healthy Ageing Theory?

Healthy Ageing

is the ability to continue to function mentally, physically, socially, and

emotionally as the body slows down its processes (Hansen-Kyle,

2005, p46)

Healthy ageing

encompasses principles of healthy lifestyles to achieve positive

ageing, active ageing and health promotion outcomes

Health promotion

is the process of enabling people to increase control over the

determinants of health and thereby improve their health.

Health promotion

embraces actions directed at strengthening the skills and capabilities

of individuals but also actions directed towards changing social,

environmental, political and economic conditions to alleviate their

impact on populations and individual health.

Healthy ageing; an easy choice 3

2 Case Studies

Highercombe -126 bed home

Brand new home

New staff

New Residents

New model

Milpara - 92 bed home

Renovated home

Existing Staff

Existing Residents

Traditional model

So why did we change?

We wanted to shape a more positive future for older people

The answers to what we needed to ‘know and do’

was in the research

What did the research tell us?

7

The research was very clear….decline as we

know it ……even for our frail elderly is………….

avoidable

- Studies highlighted that the sedentary life of the

elderly person in residential homes was the largest

contributor to decline.

- Studies conducted in 2002 showed an average

of 12 minutes a day of constructive activity was

occurring in residential homes

- That aged care is viewed as……accommodation

for older people with diseases demanding medical

intervention…..and is costly

What did the research tell us?

8

-There is inattention to health promoting

interventions for all residents.

- That current service designs lack a theoretical

and empirical base

- That older Australians fear a move into

residential care, preferring instead an early death

Avoidable decline

Australia

Oxidative Stress

& Aptosis

Protein Oxidation

Reactions

Stem Cell

Ageing

Genetic

Transcription

Telomere and

Telomerase

Immune

Functions

Cellular

Biochemistry

Glycation

Mitochondrial

Processes

CURRENT TRENDS OF Aged RELATED

DISEASES

Cardiovascular Disease

Diabetes

Arthritis

Osteoporosis

Cerebral vascular Disease

Alzheimer's Disease

Chronic Respiratory Disease

Cancers

Depression & ANXIETY

80

% o

f no

n co

mm

un

icable

d

isease

s are p

reven

table

We wanted a

sustainable model

for healthy ageing

that focuses on

active living

across the

lifespan.

Where healthy

ageing for our

residents would

be about ‘being

in the living

room’, not ‘the

waiting

room’.

and....health promotion for our staff would be about living and working in ways to guard our long term health and wellbeing

We now

know that

‘Getting

older is

unavoidable,

but falling

apart is not’

The magic pill of physical activity is powerful, with effects

demonstrated on numerous health outcomes, including

positive mental health.

We believe the ‘feel good’ factor associated with exercise is

not the privilege of the young or the middle aged.

Healthy ageing an easy choice

16

Healthy ageing does not happen by chance.

We planned a structured

approach steeped in research from Health Promotion (World Health Organisation), Science of wellbeing and Positive Psychology to embed strategies and thinking that enable and promote the health and wellbeing of residents and staff....Health for All

Our purpose was to create

a health promoting environment with

...integrated systems and interventions to promote and enable healthy ageing; easy

access and easy choices

More action is required to transfer knowledge into practice

Bridging the know–do gap - the greatest opportunity for strengthening health systems and ultimately achieving equity in global health.

Knowledge translation - a paradigm to learn and act towards closing the gap. Knowledge translation strategies can harness the power of scientific evidence and leadership to inform and transform policy and practice.

Closing the Gap

Staff

Older people

Environment

20

We reviewed the physical and social enablers for healthy ageing: the environment (building/infrastructure/ systems) and the staff (their confidence, capability and competence)......and developed a Plan

Knowledge Transfer: prepare and embed the

paradigm shift

Review literature - come from evidence base

Develop leadership group

Develop Healthy Ageing Vision – Active living being core to policies, procedures & practices

Develop communication strategy -admission process to include new thinking – families/residents – gather feedback

Set targets/KPI to measure progress

Prepare validated data gathering tools – evaluate along the way

Review budget for new equipment (gym/training)

Determine Teaching program – focus on Leaders course first - 3 day training program

Provide ‘time off & resources’ for Project Management (2-5 day)

Train Care staff – 2 days

Review for role Personal trainers

Set up Early intervention working party (interdisciplinary) and systems

Partner with Universities / TAFE

Develop health promotion awareness tools /documentation

Develop Healthy Ageing competency tool to embed new thinking - mindset

Review recruitment /appraisal process to include healthy ageing as core KPI

Develop education / healthy literacy tools

Develop Well being Plans

Healthy Ageing

Approach Life course model for wellbeing

A systems based strategy

Shapes the health and wellbeing of

the individual, staff and wider community

Build staff capacity & mindset for healthy ageing

Five Standards for Health Promotion

Science of wellbeing

Positive Psychology

Healthy Settings approach

Healthy ageing, an easy

choice 22

Healthy Ageing

Approach Life course model

for wellbeing

A systems based strategy

Environment shapes the health and wellbeing

of the individual, staff and wider community

Build staff capacity & mindset for healthy ageing

Five Standards

For Health

Promotion

Science of Wellbeing

Positive Psychology

Settings Approach

Healthy ageing, an easy choice

24

Expands responsibility for health beyond the individual to the community and environment.

‘Calls for Aged Care leaders to move towards a health settings approach to advance healthy ageing across the lifespan’.

Healthy Ageing

Approach Life course model

for wellbeing

A systems based strategy

Environment shapes the health and wellbeing

of the individual, staff and wider community

Build staff capacity & mindset for healthy ageing

Five Standards

For Health

Promotion

Science of Wellbeing

Positive Psychology

Settings Approach

Healthy ageing, an easy choice

26

Say yes to learning

Say yes to connecting

Say yes to savouring

Say yes to Speaking up

Say yes to positive emotion

Say yes to being active

Our aim is to increase healthy life expectancy and compress

the stage of disability.

Pathway to optimal human functioning across the life course..we teach the model to staff so that they can apply it to their own lives and families... 6 ingredients for positive ageing Staff enable and promote residents engagement in the model through coaching and monitoring participation

The Partners in Positive Ageing model (PiPA) is a structured approach (partnership) to share responsibility (between staff and residents) for the health outcomes of older people in our facilities.

Healthy ageing an easy choice

30

Steep decline in health, due to factors such as inactivity, can

be reversed at any age. Our aim is to address the fitness gap

of older people (see below) by encouraging and supporting

them to participate in exercise based activity.

Exercise based activity can assist

older people to remain above the

disability threshold (see ).

Healthy Ageing – Highercombe Exercise Activity

EXERCISE WHO/WHERE /WHEN OUTCOME

Easy moves & Balance Class

Staff, Volunteers – group program 4x per week, on site at Highercombe

Flexibility, Strength, Balance, Social

Gym Personal trainers – group/individual Residents attend 2-3x per week

Cardio, strength, balance, mobility, , social

Walking (walk around Australia)

Staff, Volunteers, Family, Outdoors/indoors, Daily

Mobility, social, outdoors, fresh air, goal orientated

Electric Pedals Staff, gym, room visits, 2-3x per week Mobility, Circulation , cardio

Aquatics Staff, local community centre Monday each week

Therapeutic, gentle movement, buoyancy

Golf Staff/Volunteers, Highercombe Golf Club, Thursday each week

Walking, fresh air, social, Golfers previously

Carpet Bowls Staff/Volunteers, Activity room, 2x per week + Milpara sister site visits

Social, mobility

Room exercise Staff, volunteers, Student placements 2 – 3x per week

Strength, flexibility, mobility

Tai Chi Instructor, weekly Flexibility, Balance,

Healthy Ageing

Approach Life course model

for wellbeing

A systems based strategy

Environment shapes the health and wellbeing

of the individual, staff and wider community

Build staff capacity & mindset for healthy ageing

Five Standards

For Health

Promotion

Science of Wellbeing

Positive Psychology

Settings Approach

Healthy ageing, an easy choice

32

5 standards for Health Promotion

Standard 1: The organisation has a written policy for health promotion – This policy is implemented as an overall quality system and is aiming to improve health outcomes for residents, staff and relatives/families. (pg 21) Standard 2: describes the organisations obligation to ensure the assessment of residents needs for health promotion, disease prevention and rehabilitation. (pg 22) Standard 3: states the organisation must provide residents with information relating to their health conditions and establish health promotion interventions in their care planning. (pg 22) Standard 4: gives management the responsibility to establish conditions for the development of ACH group homes as a healthy workplace. (pg 24) Standard 5: deals with continuity and cooperation, demanding a planned approach to collaboration with other health care service sectors and institutions. (pg

33

Pathway to optimal human functioning across the life course..we teach the model to staff so that they can apply it to their own lives and families... 6 ingredients for positive ageing Staff enable and promote residents engagement in the model through coaching and monitoring participation

The Partners in Positive Ageing model (PiPA) is a structured approach (partnership) to share responsibility (between staff and residents) for the health outcomes of older people in our facilities.

Early Intervention program

The inter-disciplinary Early

intervention working party meets

monthly reviewing; adverse events – mostly related to

falls, increased in behaviours

Physical and Social participation in

activities / fitness,

Residents at risk and requiring

support and education

Residents requiring tailored

recovery programs to re-engage

in physical and social activities

Healthy Ageing

Approach Life course model

for wellbeing

A systems based strategy

Environment shapes the health and wellbeing

of the individual, staff and wider community

Build staff capacity & mindset for healthy ageing

Five Standards

For Health

Promotion

Science of Wellbeing

Positive Psychology

Settings Approach

Healthy ageing, an easy choice

36

A mindset for healthy ageing

Older people

Environment

37 Healthy ageing - an easy choice

Building capacity of older people for healthy ageing cannot be achieved without building capacity of staff

staff

Staff

Healthy ageing becomes an easy choice

Environment

39

How older people function and

how they die…

7% 22%

16%

47%

Lunney, JR, Lynn J, Hogan, C. Profiles of Older Medicare Decedents. JAGS 50:1108-1112, 2002

7 7%

High

Low

Function

Time

Death

Sudden Death

22% High

Low

Function

Time

Death

Terminal Illness

47% High

Low

Function

Time

Death

Frailty

16% High

Low

Function

Time

Death

Organ Failure

Lung Heart Liver

Dementia Strokes Arthritis

Parkinson’s Hip Fracture

Cancer

How older people at Milpara function and

how they died in 2012

7%

47%

Lunney, JR, Lynn J, Hogan, C. Profiles of Older Medicare Decedents. JAGS 50:1108-1112, 2002

7 38%

High

Low

Function

Time

Death

Sudden Death

31% High

Low

Function

Time

Death

Frailty

Lung Heart

Dementia Strokes Arthritis

Parkinson’s Hip Fracture

Cancer

90% of residents walked until they

die

Active Living for Healthy ageing

Our results include:

Participants: n=70

- 73% of Residents who participated in the

WHOQOL BREF survey from their admission

in 2009/10 until 2011 indicated improved

quality of life

-Nearly 20% of this sample group indicated

improved ‘health’

-In 2013 – 15 residents who participated in the

WHOQOL BREF indicated 83% improved

quality of life.

95% of residents at Highercombe

‘walk until they die’

Active Living for

Healthy ageing gives

more years to life and

more life to years