long-term care in motion - innovage
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“Long-term Care in Motion“
Katrin Claßen1, Hans-Werner Wahl1, Carl-Philipp Jansen1,2 & Klaus Hauer1,2
1Department of Psychological Ageing Research, Heidelberg University 2Agaplesion Bethanien Hospital, Heidelberg & Heidelberg University
European Forum on Social Innovations for Healthy and Active Life Expectancy
25. 09. 2013, Lund
Overview
• “Long-term Care in Motion” (LTCiM) as part of INNOVAGE
• Healthy and active ageing in LTC residents
• Physical activity (PA) as fundament of LTCiM
• Overall ambition of LTCiM
• Social innovative component of LTCiM
• Current state and interim findings
INNOVAGE and LTCiM
Overall goal of INNOVAGE:
WP 1
Increasing Healthy
Life Expectancy
WP 4
Improving Obesity
Related Outcomes
in Old Age
WP 5
Long-term Care in Motion
WP 2
User-driven
Housing for Older
People
WP 3
ICT-based Social
Support for Carers of Older People
WP 6 Knowledge
exchange and transfer
WP 7
Management
“[…] develop and test
as well as survey and
catalogue, social
innovations that will
have a solid impact on
improving the quality of
life and well-being of
older people.”
Background of LTCiM
Goal: Improve healthy and active ageing in a vulnerable population at
high risk of inactivity, decreased Quality of Life (QoL), isolation, and
impaired healthy life expectancy
Project Background
• Despite the positive effects of PA even in very old age, LTC residents are at
high risk of inactivity and respective negative consequences
• LTC residents may have the lowest likelihood to be addressed by social
innovations (therapeutic pessimism; incarnation of “negative ageing”)
• Novel approach based on combined PA training and psychosocial
intervention and latest motion tracking technologies
• Use of cutting-edge tracking technology as a means for assessing user
needs in the LTC setting
What does healthy and active
ageing mean …
…for the specific group of LTC residents?
- Maintaining mental capacity and mental well-being at the highest level
possible
- Maintaining physical functioning at the highest level possible
- Maximizing autonomy, participation, quality of life and well-being
…but how to reach this?
PA as fundament
Physical
Activity
Motor
Status
Emotional
Status
Cognitive
Status
Quality of Life, Autonomy, Participation
PA as fundament
• PA training literature mostly focuses on “normally ageing” older adults
living in the community and thus focuses on those being still rather well in
physical and cognitive functioning
• (Motor) Performance is primary study endpoint in previous LTC-studies. No
systematic review available, assessment methodology limited
• It remains unclear how increased activity (risk reduction vs. risk exposition)
will influence risk of falling
• Psychologically based social-ecological intervention components have so
far not been widely established in RCTs using physical training/activity
promotion in LTC settings
Research Gaps
Research on PA promotion in LTC limited and in need
of innovative future directions
Ambitions of LTCiM
Goal 1: Reviewing existing research in the domain of PA in LTC
• Systematic review(s) on PA-interventions as well as psychosocial
interventions in long-term care
Goal 2: Establish a “natural lab” to learn more about motor behaviour
LCT settings
• State of the art measurement of activity behaviour and life-space with
high-end sensor technology in one specific nursing home as “natural
lab”
• State of the art measurement of psychosocial constructs (e.g.
personality, quality of life)
Ambitions of LTCiM
Goals 3: To get the whole LTC facility in motion with particularly increasing
LTC residents’ PA. Evaluate effects based on an innovative combination of
outcome methodology
• Implement various strategies of end-user tailored physical activity
interventions targeting heterogeneous subgroups of residents living in a
large long-term care setting
• Involvement of staff members (and relatives) in a psychologically based
social-ecological intervention
• Enrich environment to create activity motives (Serious Games)
Accounting for residents’ wishes and needs (pre test)
Evaluate feasibility and effectiveness of interventions with a unique set of
assessments (pre-post mixed methods evaluation)
LTCiM and social innovativeness?
Answers from LTCiM…
• Documentation and exact mapping of PA in LTC as well as
residents’ life space Quantitative data on PA in LTC; barriers
and facilitators for PA
• Objective assessment of residents’ psychosocial constructs
Quantitative data allowing for more extensive analysis on PA in
LTC
LTCiM and social innovativeness?
• Supervised evidence-based training groups aiming at the
activation and increase in motor and cognitive performances
which are most relevant of mobility and motor security
Realization in LTC setting
(Sub)group specific approach
according to motor and cognitive status
as well as individual preferences
LTCiM and social innovativeness?
• Implementation of Serious Games Component Motivation
of persons not addressed by established groups programs;
possibility for trial and error; giving back autonomy to
residents
LTCiM and social innovativeness?
• Setting approach Behaviour changes at multiple levels
Residents
Organi-
sation
Relatives
Staff Environ-
ment
Staff as interactive partners
Significant
Others
Common agenda for staff and
relatives; joint groups Creation of
activity motives
Inclusion of further
stakeholders
Process orientation
Possibility of feedback-loops
LTCiM and social innovativeness?
Current state and interim findings
• Systematic review(s) considering existing research on interventions in
long-term care with impact on physical activity (PA) as well as psychosocial
interventions
• Exchange and cooperation with experts in the field of implementation
research (e.g. Prof. Schäufele, Prof. Kempen, Prof. Becker, Dr. Notthoff)
• Cooperation with Farseeing
• Preparation of Research Setting (e.g. planning discussions with nursing
home director and other responsible persons, on-site visits and participation
in residents group offers)
• Preparation of intervention programme (PA promotion and psychosocial
component) and compilation of self- and proxy structured questionnaire
• Selection of motion/tracking sensors, implementation
Project Components and Project Flow
Content Time Line
1/13 2/13 3/13 4/13 1/14 2/14 3/14 4/14 1/15 2/15 3/15 4/15
Preparation of intervention setting and research update
Preparation of intervention program and assessment methodology
Establishing outcome assessment
Intervention related training
Implementation of intervention
Implementation of follow-up assessments
Data analysis and dissemination/ implementation of findings
Thank you for your attention
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