Digwyddiad Rhannu Ymarfer Da MonAnglesey Learning Exchange

KTP

“Y Stori Hyd Yma” - “The Story so Far”

Gareth S Parry

Rheolwr Prosiect KTP Project Manager

Bulkely Hotel, Biwmares – 08/07/2010

KTP - PTG

“Enhance the design and provision of older people’s wellbeing programmes on Anglesey to increase participation and effectiveness; and establish a valid evaluation strategy”.

“Gwella cynllunio a darpariaeth o rhaglenni pobl hyn sy’n cynnyddu cyfranogiad ac effeithiolrwydd; a sefydlu strategaeth gwerthuso dilys”.

6 Project Stages - 6 Rhan y Prosiect

1 Current Provision AuditArchwilio’r Ddarpariaeth Bresennol

2 In-depth Review of Current Literature including valid measurement toolsAstudio’r holl Erthyglau sydd ar gael a chan gynnwys dulliau dilys i fesur

3 Interventions with Current ParticipantsGwaith Ymyrryd a’r Cyfranogwyr Presennol

4 Interventions to Encourage Non ParticipantsYmyrryd er mwyn Cynnig Anogaeth i Rai sydd ddim yn Cyfranogi

5 Training of Service Providers Hyfforddiant i Ddarparwyr Gwasanaeth

6 Dissemination and embedding of project outcomesRhannu deilliannau’r prosiect a’u hymgorffori mewn gweithgareddau

1. Audit - Archwiliad• Over 50’s Clubs

Cylbiau Dros 50• Leisure Centres

Canolfannau Hamdden• Town Councils

Cynghorau Tref• Private Companies

Cwmniau Preifat• Community Centres

Canolfannau cymunedol• Recreational Clubs

Clybiau adloniant/hamdden

Policies – Polisiau

• NSF Older People – Pobl Hyn• Strategy For Older People

Strategaeth Pobl Hyn• Climbing Higher – Dringo’n Uwch• Health Social Care and Well-being Strategy

Strategaeth Iechyd, Gofal Cymdeithasol a Lles• NICE Guidelines – Canllawiau NICE• At Least 5 a Week – O Leia 5 yr Wythnos

Referral Pathway – Llwybr CyfeirioFormal

Coastal Path

Informal

NERS:

Falls:PSI

Physio Rehab

AgeWell Village Hall’s

WW2H

Leisure Centre

Sports Clubs

Wheel Walks

Free Swim

Cycle Paths

Trim Trail

Allotments

National Trust

WI – Merchaid y Wawr

Community Champions

Over 50’s

Churches / Chapels

Community Fit Club

Communities 1st

Green Gym

Cycling

Outdoor Activities

Phase 3 Cardiac

Mental Health

CHCPSI / COPD

Cardiac

* Already established* Established but not aware of initiatives* Need to start work in these areas website

Literature Review – Astudiad Erthyglau

• Scientific evidence increasingly indicates that health benefits ( e.g. the prevention of cardiovascular disease, type 2 diabetes and obesity) extend into the later years. Physical activity and well-being interventions can also extend years of independent living, reduce disability and improve the quality of life for older people. (ACSM 1998, WHO 2002, DOH 2005, Young and Dinan 2006)

• More recently, public policy has highlighted the importance of promoting well-being, physical function, independence and mobility in the later years, enabling the older person to continue enjoying activities of daily living and maintain their social networks.

(Active 4 Later Life Toolkit - BHF)

Barriers - Rhwystrau

Cost - Cost

No friends –Dim ffrindiau

Instructors -Hyfforddwyr

Transport - Cludiant

Safety - Diogelwch

Facility - CyfleusterauEducation - Addysg

Time - Amser

Environment -Amgylched

Opportunities -Cyfleuon

Ageism –Rhagfarn ar Sail Oed

(Anglesey audit, Rai + Finch, 1997)

What Works – Beth Sy’n Gweithio?• Group Based Activities

Gweithgareddau Grwp• Encouragement from Health Care Professionals

Cefnogaeth Gweithwyr Proffesiynol• Enjoyable / Fun Sessions

Sesiynau Hwylus• Continuous Professional Support

Cefnogaeth Parhaus• Social Support

Cefnogaeth Cymdeithasol

The Challenge – Y Sialens• Provide interventions that / Darparu ymyriadau sy’n:-

– Overcome the barriers identifiedGoresgyn y rhwystrau

– Promote adherence and maintenanceHybu cynhaliaeth

– Realistic / Realaidd– Replicable / Ail-adrodd– Sustainable / Cynaladwy– Fit within the Council’s remit

Disgyn o fewn gorchwyl y Cyngor– Attract external funding / Cyllid allanol

Interventions - Ymyriadau

1. Community Based National Exercise Referral Scheme (NERS)Cynllun Ymarfer Drwy Wahoddiad yn y Gymuned

2. AgeWellHeneiddio’n Dda

3. Falls PreventionAtal Codymu

4. Wii Fit Sheltered HousingWii Fit Cartrefi Gwarchod

• London Road Community CentreCanolfan Cymunedol Ffordd Llundain– Private / Preifat– Cafe / Caffi– Other Activities / Gweithgareddau

• 20 Week Pilot – Peilot 20 Wythnos• 12 Participants – 12 Cyfranogwr• Funding from Health Alliance

Cyllid Y Gyngrhair Iechyd

Community Based National Exercise Referral Scheme (NERS)Cynllun Ymarfer Drwy Wahoddiad yn y Gymuned

Methodology - Methodoleg• Referred by GP – Cyfeirio gan Feddyg• Attendance Record – Cofnod presenoldeb• Semi-Structured Focus Group

Grwp Manylu• Transcript, Moderator

Adysgrif, Cymedrolwr• Inductive Content Analysis

Dadansoddiad anwythol

Results - Canlyniadau

NERS Leisure Centre 2007/2008

London Road

Drop Out % 62% 8.3%Participants 407 12

•Participants Mean Age was 60 years old

•Average “less” distance they travelled compared to Leisure Centre was 0.7 miles

• 116 Quotes – 116 Dyfyniad

Benefits for well-being

Group size

Motivation to continue positive

enjoyment

negative

Positive

Suggestions/recommendations

Motivation to Continue negative

Socialising with others

intimidation

positive

negative

Instructor

transport

Positive motivation

Negative Motivation Interpersonal

Social support

London RoadLeisure Centre

Internal Factors

External factors

Environmental/Service Providers

Facility

Main Findings – Prif Ddarganfyddiadau• Looked forward to sessions – Edrych ymlaen• Felt rejuvenated – Teimlo’n well• Motivated to continue – Eisiau parhau• Less intimidating than LC – Llai bygythiol• Smaller group size (personal) – Grwp llai• Conducive environment – Amgylchedd ffafriol• Social opportunities – Cyfleuon cymdeithasu• Easier access – Mynediad haws• Empathic instructor – Addysgwr empathetig

Age Well – Heneiddio’n Dda• One Stop Shop for Older People

Siop un Stop i Fobl Hyn• Big Lottery Fund “People & Places”

Cronfa Loteri Fawr• Age Concern Gwynedd a Mon• KTP Management Structure

Strwythyr Rheoli KTP• £495,384 over 3-years / dros 3 mlynedd

• 2 Full time and 3 Part time posts2 Swydd llawn amser a 3 Rhan amser

• Range of ActivitiesAmryw o weithgareddau

• Exit route to all servicesLlwybr allan o wasanaethau

• Satellite centres – Canolfannau lloeren• Sustainability through constituted groups

Cynaladwyedd - grwpiau gyda chyfansoddiad

Age Well – Heneiddio’n Dda

Formal

Coastal Path

Informal

NERS:

Falls:PSI

Physio Rehab

AgeWell

Village Hall’s

WW2H

Leisure Centre

Sports Clubs

Wheel Walks

Free Swim

Cycle Paths

Trim Trail

Allotments

National Trust

WI – Merchaid y Wawr

Community Champions

Over 50’s

Churches / Chapels

Community Fit Club

Communities 1st

Green Gym

Cycling

Outdoor Activities

Phase 3 Cardiac

Mental Health

CHCPSI / COPD

Cardiac

* Already established* Established but not aware of initiatives* Need to start work in these areas

Health Services / Voluntary Sector

Monitoring + Evaluating Monitro a Gwerthuso

• 3 Year Big Lottery targetsTargedau Loteri Fawr

• 3-month action plansCynlluniau gwaith 3-mis

• Yearly report / Team building dayAdroddiad blynyddol / Diwrnod Tim

• Further fundingCyllid ychwanegol

Directory of MeasuresCyfeiriadur Mesuriadau

• Excel Spreadsheet• Lubben Social Network Scale – 6 • SF-12• Leisure Time Exercise Questionnaire (LTEQ)• Rosenborg Self Esteem Scale• Physical Function Tests• Case Studies (DVD)• Focus Groups

Marketing - Marchnata• Need for better marketing

Angen marchnata yn well• Links with Bangor University

Cyswllt gyda Prifysgol Bangor• 50-65’s still in work – dal i weithio• 65+ retired in the community

Ymddeol yny y gymuned• Agencies to refer to AgeWell

Asiantaethau i gyfeirio i Heneiddio’n Dda

Falls Prevention – Atal Codymu

• Falls a major public health concernCodymu yn achos sylweddoli iechyd cyhoeddus

• Preventable – Gall cael ei hatal• Multifactorial approach to assessment and intervention

Dynesiad amlffactoraidd i ymyriad ac asesu• Sufficient duration – Cyfnod digonol• Cost effective community based serivce

Gwasanaeth cost-effeithiol yn y gymuned

Methodology - Methodoleg

FRAT Questionnaire

People over 65 living in the community

•G.P’s•Health Care Professionals•Social care professionals•Leisure service Professionals•Ambulance Service•Self referral

Entered onto data base.Referred to Falls prevention service (MRA Team)

+ve risk of falls

Physio Database

Patient contacted and invited for a Multi

factorial Risk Assessment (MRA)

Designated PSI instructors (Leisure Service) & Physio Joint working to

deliver MRA clinic in community venue

G.P. for medication

review

Optometrist

Care and repair

PSI intervention

Home Safety Check

Social Services

Other services

General Community based ActivitiesTai ChiNERSWalking Clubs etc

Referrals

based

on

assessment

findings

• Participants– 7 males and 28 females (mean age = 77

years + 6.87) who, on average attended 32 of the 40 weeks (80.28%).

• Assessments– 4 Physical Function Tests– SF-12, FES-I– Focus Group– Generic Programme Evaluation

• Analysis– Manova, Anova, Tukey’s Post Hoc– Inductive Content Analysis

Results - Canlyniadau

Figure 2 - Physical Function Tests 1 and 4

10152025

Week 0 Week 10 Week 20 Week 30 Week 40

Time

Seco

nds Sit to Stand

Timed Up and Go

Sts – 0-20 TUG – 0-20

Figure 3 - Physical Function Tests 2 + 3

22.5

33.5

44.5

55.5

Week 0 Week10

Week20

Week30

Week40

Time

No.

of S

teps

/ Le

vel

180 Degree Turn

4 Point Balance Scale

180 – 0-20 4PB – 0-30

Figure 4 - FES-I + SF12 (PCS)

25

30

35

40

45

Week 0 Week 20 Week 40

Time

Scor

es FES-I

PCS

FES-I – 0-20 PCS – 0-40

Focus Group – Grwp Manylu• Quote from an 83 year-old female participant

“I never thought this class would make such a change in my well being, but I do feel ‘younger’! The greatest benefit has been to the muscles in my arms. I can now get out of the bath easily and can now mow my own lawn. I try to do a daily walk up the headlands at Llaneilian. This was hard work and not very enjoyable. Now I can walk quickly, don’t get back ache and am not out of breath. I can garden for longer without a rest. When I was Blackberry picking this autumn I found I could keep my balance much better and did not need a stick. I really look forward every week to coming to the class; everyone is so friendly and encouraging”

• “It’s been great having it here because we’ve come into contact with other activities and groups that go ahead”

• “I can leap out of the bath now, I couldn’t before. Now I can have a bath whereas before I had to use the shower. I can also mow the lawn”

• “When we went blackberry picking we both commented on it. We could turn around and stretch out to pick berries without being afraid of falling and walk for longer.”

• “I know how to get myself up off the floor now. I didn’t like to do things before in case I fell and was stuck. Now I will attempt a lot more gardening as i know I’ll be able to get off the floor.”

• “Right back at the beginning of the 40 weeks you know nothing about the people coming here. You know nothing about them. Slowly as time goes on you hear a little more and understand a bit more and you respect all the processes they’re going through and that they’ve got problems just as hard as what you’ve got. And it’s amazing to see how well they all do and I think it gives you mental support”

Liz at week 0

Liz at week 40 !!

Ethel at week 0

Ethel at week 40

Maggie at week 0

Maggie at week 40

Ted at week 0

Ted at week 40

Conclusion – Casgliad• Positive results for physical function up to 20

weeks• Balance up to 30 weeks• Reduced fear of falling up to week 20• Improvement in Physical well-being throughout• Importance of informal community setting, social

opportunities, and an empathetic/knowledgeable instructor lead to greater adherence rates and continuation.

Formal

Coastal Path

Informal

NERS:

Falls:PSI

Physio Rehab

AgeWell

Village Hall’s

WW2H

Leisure Centre

Sports Clubs

Wheel Walks

Free Swim

Cycle Paths

Trim Trail

Allotments

National Trust

WI – Merchaid y Wawr

Community Champions

Over 50’s

Churches / Chapels

Community Fit Club

Communities 1st

Green Gym

Cycling

Outdoor Activities

Phase 3 Cardiac

Mental Health

CHCPSI / COPD

Cardiac

* Already established* Established but not aware of initiatives* Need to start work in these areas

Health Services / Voluntary Sector

Promotion - Hyrwyddo•International Society Behavioural Nutrition Physical Activity (ISBNPA)

•9-12th June, 2010 – Minneaplois, USA

•NERS National Meeting

•Llandrindod Wells, Powys, Wales

•CHC Funding

Wii Fit

• Sheltered Housing ConferenceCynhadledd Tai Gwarchod

• Low-cost, fun activity in the homeGweithgaredd rhad yn y cartref

• Existing research has shown increases in functional skills are attainable through regular use of the WiiYmchwil presennol yn dangos gall Wii Fit wella sgiliau swyddogaethol

• It is unknown as to the benefits for the elderly population of Wii Fit training in improving their functional skills and perceived quality of life, and whether they would adhere to using it.Nad ydym yn gwybod os yw Wii Fit yn gweithio i fobl hyn

Stones et al. (1989), Deutsch et al. (2008

Methodology - MethodolegParticipants Test Control

(n = 7) (n = 3) P

Age (yrs) 71.9  ± 10.1 75.3 ± 13.3 0.66

Height (m) 1.58 ± 0.06 1.57 ± 0.70 0.76

Body mass (kg) 79.7 ± 21.5 72.3 ± 5.8 0.14

Questionnaires: A SSHES medical history questionnaire; SF12 health survey, Falls efficacy scaleExercise attitudes questionnaire.

Physical function tests:

Strength - 30-s bicep curl and sit to stand tests. Balance – Wii Balance test, Four point turn test and 180 degree turn. Agility/Balance - The Get up and Go Wii Fit age gave an overall physical fitness age.

Results - Canlyniadau

• Adherence levels of the participants increased from month 1 to 2 then dropped considerably in the 3rd month (total time: 1st mo = 269 min, 2nd mo = 347 min, 3rd mo = 50 min). However, throughout the intervention the usage was low working out at 38, 50 and 7 minutes/person/month over the 3 months.

• There was no differences observed in either group over the 3 month intervention period in either physical functional performance (balance, strength or agility) or in quality of life.

Discussion - Trafodaeth• Strength may have showed no improvement due to the fact that the Wii Fit involves

no resistance training which is key in strength training• No significant decrease in Get up and Go test scores indicate that the Wii Fit is

ineffective at increasing agility and balance whilst walking. Wii Fit activities do not involve balance activities at different gaits and research shows that balance strategies during gait are task specific

• The lack of significant increase in static balance is surprising as improvementsthrough activities such as yoga have been seen in existing research. This is anactivity area on the Wii Fit.

• The lack of significant results across all tests could be explained by the lowadherence levels of test participants; increased frequency of sessions should yieldbetter results.

• Reasons for low adherence may include the season in which the intervention tookplace. Poor weather is often a barrier to participation in exercise interventions.

• The main obstacle to acquiring valid, reliable and significant results appears to beparticipant involvement; therefore future research should focus on maximizing this.

Training of Service Providers Hyfforddi Darparwyr Gwasanaeth

• Nordic Walking – Cerdded Nordig• Residential Care Homes, Cartrefi Preswyl• Low Intensity Functional Training (LIFT)• ROSPA – Home Injury Prevention, Atal

Damweiniau yn y Cartref• Directory of Measures

Cyfeirlyfr Mesuriadau• Motivate Me

Motivate Me – Ysgogi fy Hyn

• Motivating older people and helping them to become active – what do I need to know?

• Understanding motivation, understanding older people and understanding physical activity

• Recognising individual differences, needs, barriers and motivation

• Practical opportunities and strategies for professional intervention

• Participant review and planningThe course has been developed by the British Heart Foundation National Centre for Physical Activity and Health and Age Concern England, delivered by Later Life Training.

Dissemination and embedding Rhannu deilliannau ac Ymgorffi

• Projects mentioned – Prosiectau uchod• Physical Activity / Older People / AgeWell Website

Gwefan Gweithgaredd Corfforol / Pobl Hyn / Heneiddio’n Dda

• BHF National Conference• ISBNPA – Minneaplois• Excellence Wales Award – Gwobr Rhagoriaeth Cymru• AVON Network – Rhwydwaith AVON• WLGA Laerning Exchange – Cynhadledd CLILC• Today’s Conference – Cynhadledd Heddiw• Journal Publications – Cyhoeddiad Cyfnodolyn

Other Work – Gwaith Ychwanegol

P Ac Action Plan Cynllun Gweithredu GC2008 Calendar Calendr 2008PCV Test Bws MiniCommunity Chest Cist CymunedolConservation Officer Swyddog CadwraethWales in Bloom Cymru yn ei BlodauTosan Research Ymchwil TosanInterreg Bid Bid Interreg

University Benefits – Buddiant y Brifysgol

• Applied experience for students – Chin Wei, Emily, Becky, Lorretta, Byron, Heather, Julia, Fiona –Profiad cymwysiedig

• Healthy Ageing Module participants – Cyfranogwyr i Fodiwl Heneiddio’n Dda

• Promoting the School at Conferences – BHF, ISBNPA – Hyrwyddo’r Ysgol

• Potential for journal publicationsPotensial i Gyhoeddiad Cyfnodolyn

Associate Benefits – Buddion i’r Cydymwr

• Nordic Walking Instructor• Applied experience – project management, interviewing,

supervision, monitoring, presenting, chairing etc• Microsoft Project• MSc Research Skills• Motivational Interviewing• NVQ4 Management• PCV Licence• IOSH Managing Safety• First Aid at Work• Prince 2 Foundation + Practitioner• ISBNPA Conference, Minneapolis, USA• Chartered Management Status• MPhil

Thank You – Diolch

Gareth S Parry

KTP Project Manager – Rheolwr Prosiect KTP

01407 721943

gspss@anglesey.gov.uk