Promotion of physical activity in older adults

a couple out for a walk.

Introductory points

This article presents:

Relevance to Australian context

The study was undertaken in a Norwegian setting. However, the contextual factors are applicable to the Australian aged care service environment.

Key concepts

Physical activity is“…any bodily movement produced by skeletal muscles that requires energy expenditure”.

Therefore, physical activity is not limited to exercise programmes, but includes everyday activities in the home and community.

Strategies that promote physical activity need to:

Participant level

FacilitatorsBarriers
Participants goals

Clear and meaningful goals.

Participants found it difficult to set specific goals.
Motivation

Client “self-effort”, particularly when reablement period has finished.

Having a positive history of P physical activity experiences and daily habits

Understanding how PA habits influence function

Engaging in PA was more likely through meaningful activities the person had recently participated in.
“The longer a person has been passive, the more difficult it may be to get them going again”
Health and functional status

Maintaining/promoting health, including meeting nutrition and hydration needs.
Significant medical conditions, hospitalisations, falls, pain, cognitive impairment

Anxiety and fear of falling à inactivity, passivity, weakness, fragility.
Social and physical environment

Supportive, enabling social networks that encourage reablement participation.

Environments that encourage movement
Social networks that constrained participation and independence. E.g., Family who want to “help” by taking over tasks.

Physical environment – “easy living” environments can promote sedentary behaviours. Overly challenging environments can be dangerous and/or discouraging.

Professional level

FacilitatorsBarriers
Strategies for promoting physical activity

Incorporating different strategies for promoting PA – physical exercises and daily activities.

Standardised exercise programmes with a strong evidence base

Exercises that were easy to understand and follow.

Physical activity was most successfully encouraged through daily and familiar activities.
Sometimes standardised exercises were not sufficiently targeted to the individual’s needs.
 
Clients often didn’t continue exercises after the reablement period.
Interdisciplinary collaboration and reablement philosophy
 
Team members with different competencies and perspectives
 
Effective communication between the team re: progression/adaptation of activities to meet client needs
Lack of shared reablement philosophy in the team
 
Sometimes there were different perspectives on how PA should be integrated into reablement
Support worker competencies and motivation.
 
Knowledge of the client, especially when able to identify changes.

Workers who had additional training in reablement or rehabilitation
 
Significant experience in reablement
 
Having had previous successful experiences in promoting physical activity.
Lack of competency in reablement (limited training) for home care staff.
 
Some staff found reablement boring.

Organisational level

FacilitatorsBarriers
Client recruitment strategies
 
Having reablement as an integrated part of broader home care services à improved general knowledge of reablement and ability to identify candidates.
 
Connecting with people with early signs of functional decline (e.g., just started receiving domestic assistance) or recently reduced activity levels.
 
Clear conceptualisation of reablement (in the organisation) and well-defined eligibility criteria.
Having an independent reablement team was a potential barrier to identifying suitable candidates, as they had to rely on other parties for referral.
 
Insufficient knowledge of reablement in other health care services (impacting on referral).
 
Perception that reablement was only an exercise programme – lack of appreciation of broader approach.
Staff resources
 
Staff stability enables development of reablement competencies
High staff turnover – loss of competency in the team
 
Time available for reablement interventions (appointment times)
Collaboration structure

Regular interdisciplinary meetings where team members could learn from each other and discuss approach to clients.
Limited opportunities to get the team together.
 
Team members with no knowledge of the client
 
Difficulty communicating progress amongst multiple team members

System level

FacilitatorsBarriers
Shared enabling philosophy in the community.
 
The home care provider has a shared enabling philosophy with wider health and community services.
 
Having support in the wider community for clients to be physically active
 
Varied and accessible activities, meeting the needs and desires of clients are available in the community.
 
Community-based activities needed to be introduced during or immediately after the reablement period to support confidence.  
Enabling philosophies not sufficiently implemented in the community (i.e., societal barriers)
 
Lack of support/follow up after reablement period.
 
Lack of access to desirable and meaningful activities in the community.

Reflective questions

The following series of questions is prompted by the research. They can help identify both achievements and opportunities for improvement in wellness and reablement practice. Using these questions to inform work practices and policies can demonstrate evidence-based practice and supports compliance with aged care quality standards.

There is a lot to consider from this research. Don’t try to tackle it all at once! Use the question bank as a checklist, ticking the items your organisation is doing well and noting the items that represent opportunities for improvement.

You could discuss/review selected questions to:

  • Does our assessment process explore the client’s previous activity history (including self-care, work, housework, volunteering, leisure, community and social participation)?
     
    Do we explore what activities will enhance a client’s quality of life?
     
    Do we share evidence-based ageing science with clients? This can promote understanding of how physical activity impacts independence and wellbeing, improving motivation.
     
    Are our team skilled at developing meaningful SMART goals in collaboration with our clients? Consider a documentation audit.
     
    Do we effectively identify and explore (including making referrals) the functional impact of medical conditions, falls, pain and cognitive impairment?
     
    Do we have strategies to identify if anxiety/fear of falling is a barrier to physical activity?”
    Note: A sensitive approach is important to avoid escalation of anxiety and fear.
    Do we engage family and support networks in promotion of reablement, including sharing ageing science?
     
    Do we look for “just right challenges” in the client’s home? (not eliminating all physical challenges, but still promoting accessibility)
     

  • Does every member of our team have strong knowledge of reablement principles?
     
    Do we promote physical activity through exercises and daily activities?
     
    Do we deliver evidence-based exercise programmes?
     
    Do we have evidence that we customise exercise programmes sufficiently for individual needs?
     
    Are clients provided with easy-to-follow exercise instructions, accommodating sensory (e.g., visual) and cognitive needs?
     
    Are we good at communicating client progress and changes with all members of the team?
     
    Does our team have a clearly identified and uniting reablement philosophy?
     
    How do we identify staff who need additional training in reablement?
     
    What reablement training opportunities are available to our team?
     
    How do we help staff (aged care support workers) have successful experiences in promoting reablement through physical activity? (e.g., mentoring, shadowing an allied health professional, etc)

  • Does our organisation have a clear vision for what reablement means and looks like?
     
    How do we promote reablement referral for people with early signs of functional decline (e.g., needing help for shopping or housework)?
     
    Is reablement integrated at all levels of support at home (not just CHSP)? Are reablement principles promoted to all staff?
     
    What strategies can we implement to develop reablement competencies? What resources are available to us?
     
    Have we identified the most effective communication strategies for our team? (including in-person, written, verbal, electronic, etc)
     
    Thinkign about the LifeCurve stages should this be help with shopping/heavy housework 

  • Do we identify opportunities for clients to continue being physically active in the community post-reablement? This does not just mean exercises; it includes any meaningful activity that promotes physical activity.
     
    Do we introduce community-based activities before (preferably) or immediately after the reablement period?
     
    Do we promote reablement principles in the wider community (e.g., with GPs and other health service providers)?

Here are some ideas that may help your organisation address some of the identified issues:

Staff development opportunities – Reablement

Understanding and sharing ageing science to motivate staff and clients

Promoting the importance of everyday activities in reablement

Evidence-based exercise programmes and falls prevention

Identifying opportunities in the community for continuing physical activity after reablement