Falls Prevention and Improving Well-being
What: Free interactive Talks – Falls Prevention and Improving Well-being
Where: Scouts Hall Kilcock. As part of Open Door group – but all are welcome.
When: 12 noon Friday 25th April – Session 1 Falls + Falls Prevention
12 noon Friday 2nd May – Session 2 Falls Prevention + Physical Activity
Who: The sessions are aimed at the over 60 age group but anyone is welcome, especially if you have had a fall or are at risk of falling and would like some more information.
By: Fionnuala Corcoran. P.TH M.I.A.P.T (Kilcock Therapy)
May – August 2014 – Create awareness, Needs Assessment and planning
August 2014 – Special Falls Assessment Month
September 2014 – Physical Activity Programme (yet to be determined, but likely to be twice weekly classes based on evidence based interventions such as the Otago programme (2003))
Full text of Plan
Some of the physical problems affecting the 60+ age group include a reduction in aerobic capacity, flexibility, strength and development of urinary incontinence all of which are implicated in gradual loss of independence and higher risk of falls. Approximately 19% of men, 25% of women and 30% of individuals aged 75 and over have fallen in the last year. Almost 10% of the over 50s population have had an injurious fall (i.e., requiring medical treatment) in the last year. (TILDA 2014)
Urinary incontinence (UI) is a common problem that can seriously affect an individual’s quality of life, can be embarrassing and consequently go unreported. (NICE, 2013).
Studies have shown that the prevalence of any UI tends to increase up to middle age, then levels off, rising to 35% in 85 year olds. (EPINCONT survey as cited in NICE 2013).
The NICE guideline for management of urinary incontinence in women recommends supervised pelvic floor muscle training (PFMT) as a primary intervention for women with stress or mixed UI. PFMT leads to improvement or cure in two-thirds of patients and there are no adverse effects. Despite this only 20% of those affected seek help for the problem. (EPINCONT survey as cited in (Sjöström et al., 2013).
Physical activity has been shown to be the best intervention for addressing flexibility, strength and falls prevention (Hughes et al., 2009) and it also has the added benefit of having a positive impact on emotional and social well-being.
This proposal is for the development of a programme aimed at the over 60 age group, to initially raise awareness, assess needs and if appropriate progress to delivering a physical activity programme. The programme will incorporate screening and assessment and evidenced based physical activity.(GetIrelandActive n.d.). It will be implemented in a way that enables building capacity and increasing participants control over their health and well-being in accordance with principles of the Ottawa charter(World Health Organization, 1986). It will incorporate a PFMT programme and will be undertaken in a fun and sociable environment. A recent study (Pelaez et al., 2014) shows that incorporation of PFMT into a physical activity programme can prevent UI.
The planning model used for this proposal is from Scriven (2010).
Identify needs, assets and priorities
A normative need has been identified in relation to urinary incontinence prevalence (NICE, 2013)(Lucas et al., 2012)(Buckley and Lapitan, 2009). McCarthy et al (n.d.) report the prevalence of urinary incontinence in Ireland at 33%. General Practitioners in local medical centre have mentioned a need for pelvic floor muscle training. Kildare Baseline Study (n.d) identifies the prevalence of exercise drops sharply once respondents reach their eighties. The Kildare Baseline study (n.d) also notes that the over eighties seem generally more satisfied with facilities and services than the fifty to eighty age group, although they are also generally less involved in activities. The study shows a strong motivation among the over eighties for maintaining independence. There may be a requirement for creating awareness of the importance of physical activity, the required type of physical activity and its correlation to maintaining independence. Use of behaviour change models like stages of change (Prochaska and Velicer, 1997) and techniques such as reframing (“Main Section | Community Tool Box,” n.d.) may be used to assist in creating this awareness. Further needs assessment will include gathering the views from other health professionals and the target group. Group work, buzz groups (Scriven, 2010) and other participatory methods (Dempsey et al, 2012) will be used to facilitate participants in identifying individual and group needs, setting priorities, decision making, planning and implementing the programme, thereby empowering them through ownership and control of their own endeavours. (World Health Organization, 1986). Discussion items can include the need for the programme, timing of programme, facilities, transport, access, structure of programme, communication of programme, sustainability, equipment, environment etc.
Aims and Objectives
The project aims are to raise awareness of the importance of physical activity (including PFMT) in the older adult population and to involve them in determining and delivering an optimum physical activity programme that would meet their needs.
Participants will be able to describe the importance and relevance of physical activity for the older adult.
Participants will be able to identify their own current levels of function and performance in basic functional assessments and how these relate to activities of daily living.
Participants will be able to perform physical activity skills for strength, endurance, flexibility, coordination, balance.
Participants will be able to apply physical activity skills learned, to improve functional daily activities at home.
Participants with UI may experience an improvement in their condition and in their quality of life.
(Hughes et al., 2009)(American College of Sports Medicine, n.d.) shows that the above objectives are realistic and achievable. The measurement outcomes are mainly functional tests which participants will become familiar with and will easily understand.
Types of validated measurement outcomes that will be used include:
- Self-efﬁcacy for exercise (Lorig et al.)
- Outcome expectations for exercise: using a 17-item scale developed by Seymour (2006).
- Exercise adherence self-efﬁcacy: McAuley (1992) barriers scale to assess self-efﬁcacy for exercise adherence in the face of barriers.
- Lower-extremity muscle strength: a timed sit–stand test to assess lower extremity muscle strength (Rikli et al 2001).
- Upper-body strength: arm curl test to assess upper-body strength (Różańska-Kirschke et al, 2006 as cited in Hughes et al, 2009).
- Upper-body ﬂexibility: back scratch test to assess upper-body ﬂexibility (Rikli, 2001)
- Aerobic Fitness: Six-minute distance walk (Rikli, 2001) or the 2 minute step in place test (Jones and Rikli, 2002).
- Urinary Incontinence and Quality of Life Measures: ICIQ-UI SF, ICIQ-LUTSQoL(“ICIQ International Consultation on Incontinence Modular Questionnaire,” n.d.)
The target population is older men and women who need and would like to increase their physical activity in a scientific, evidence based, fun and sociable group setting. Research shows that older people can be very good attendees at group exercise programmes (Manchester Metropolitan University, et al., 2005).
Stakeholders include the participants, participants’ families, local medical centre, participants GP’s, other health care professionals and the practice/practitioner developing the programme.
Addressing inequities, ethical aspects and other considerations
This proposal is to provide a service that currently is not available.(“GetIrelandActive ” n.d.) Participants should have informed choice, the aim is not for compliance. (Scriven, 2010).
Hughes et al (2009) demonstrate that this type of physical activity programme is successful even for participants that are overweight or obese, and have co-morbidities.
Kildare Baseline Study (n.d.) reported that cost is not perceived locally as a barrier to availing of services, and the area is not one of social deprivation (Burtenshaw Kenny Associates, 2012) however the costs will be kept to a minimum to ensure that poverty is not an exclusion factor, and where cost is a barrier for an individual this will be handled discretely to allow participation.
The setting for this proposal (Kilcock Co. Kildare) is a village serving a rural hinterland. Many older adults (68%), have difficulties making their own way to appointments (Kildare Baseline Study, n.d.). This issue will need to be addressed with the participants and resolved if the programme is to be successful.
Integration of ethnic minorities is an increasing issue within the area (Burtenshaw Kenny Associates, 2012) although this is more relevant in the younger population it will be considered in developing and communicating the programme.
Assets and Resources
In the Kilcock area there is a lack of basic recreational amenities, but there are plans to develop a multi-purpose community facility (Burtenshaw Kenny Associates, 2012) which could be a good location for the planned programme. In the meantime there are other facilities in the Kilcock area which could be used. Local knowledge and being personally known to many in the area is an advantage.
The planned programme fits well into the national age friendly counties programme; whose overarching goal is that “every county in Ireland will be a great place in which to grow old”.(“National Age Friendly Counties Programme Ireland,” n.d.). Contacts will be established to see what resources may be available.
The practice currently collaborates with GP’s in the local medical centre. It is hoped that the medical centre will recommend the programme to patients.
Finance: The financial outlay for the programme will be low, the main investment being in equipment.
Financial Budgeting and planning Skills: Practitioner has extensive financial experience and training.
Marketing: Some limited marketing experience and training.
Equipment requirements: (therabands, balls, chairs, forms to record measures etc.). All of these will need to be researched and procured.
Competence in teaching and delivery of programme: Practitioner has extensive experience and training in teaching and learning.
Knowledge and Research: Practitioner has knowledge and training (IPTAS Level 8 and IPTAS level 7).
Personnel Assistance: Assistance will be required for the initial session.
Achieving the Aims – Methods and Strategies
Research demonstrates that the aims and objectives are best achieved by a group based physical activity programme (Hughes et al., 2009) (Manchester Metropolitan University, et al., 2005), however methods will depend on the needs expressed at needs assessment, views of stakeholders and available resources.
An initial health educational session will be held to raise awareness and assess needs. This will include a talk, question and answer session, facilitated group work (using group work principles – Ch. 13 (Scriven, 2010)).
Initial ideas for the programme based on a study by Manchester Metropolitan University, et al.(2005) are as follows:
- A structured group programme of two or three sessions per week.
- Multiple components including educational elements, warm-up, aerobic exercise, strengthening, co-ordination, balance and flexibility.
- Individual progression, provision of regular feedback on fitness/strength improvement.
- Provision of ‘exit routes’ to other opportunities should the programme close.
- Led by a professional able to communicate respectfully, be supportive and who creates an enjoyable, welcoming and social atmosphere.
- Regular individual attention in order to reassure, build confidence, and make participants feel ‘wanted’.
- Paying close attention to participants perceptions and needs.
- Developing a sense of duty and programme ownership among participants by involvement in design of programme elements, their own progression and recruitment of new members.
- Takes place in an accessible facility, in well-lit, welcoming surroundings with appropriate music.
Literature for the programme needs to be developed using principles of health literacy, “40% have inadequate or problematic health literacy” (“Health Literacy,” n.d.)
The practitioner will keep abreast of research and initiatives that can inform the programme.
Communicate / Market Action
A range of communication skills (Dempsey et al, 2012) will be utilised in developing, marketing and delivering the needs assessment and the programme.
Kildare Baseline Study (n.d.) reports that television (97%), newspapers (87%) and national radio (81%) remain the most popular sources of news and information among Kildare’s older people and that only 10% rely on the internet. This suggests that it may be challenging to reach the over 80’s using lower cost marketing and communication methods. Most of this population however will have family and friends who access social media and internet. The practice can make use of its database of previous patients, collaboration with the medical centre and will consider other methods (e.g parish newsletter, post office, ICA and other older adult groups, local newspaper etc.).
Evaluation of Process and Outcomes
A feedback questionnaire can be used to assess participant’s awareness. Group discussions, rounds, safe revelations (Scriven, 2010) or questionnaire could be used to assess the participants’ views of the impact of the session, and the process of the needs assessment work. Feedback should also be sought from facilitators involved in the group work session.
The physical activity programme can be evaluated for effectiveness using the outcome measures previously described. The overall process should be evaluated by questionnaire and/or group discussion, capturing elements such as the overall enjoyment of the programme, facilities, environment, timing etc.
Efficiency of the resource usage needs to be evaluated including all costs, time and donations.
All measures will be recorded, analysed, reported to stakeholders, used to inform the development of the programme, may result in resources being made available and can be shared with other health professionals.
The action plan details each task identifying completion date and responsibility. It includes steps for reviewing aims and priorities, networking and reporting and includes milestones to measure progress. Change control process and management of communications are included in the action plan. A draft of the plan is in appendix 1.
American College of Sports Medicine, Exercise and the Older Adult. Available at: http://www.acsm.org/docs/current-comments/exerciseandtheolderadult.pdf.
Anon, Kildare Baseline Study, Amarach Research, Ageing Well Network. Available at: http://agefriendlycounties.com/images/uploads/downloads/Kildare_AFC_Final_Baseline_Report.pdf
Buckley, B.S. & Lapitan, M.C.M., 2009. Prevalence of urinary and faecal incontinence and nocturnal enuresis and attitudes to treatment and help-seeking amongst a community-based representative sample of adults in the United Kingdom. International Journal of Clinical Practice, 63(4), pp.568–573. Available at: http://doi.wiley.com/10.1111/j.1742-1241.2008.01974.x [Accessed March 4, 2014]
Burtenshaw Kenny Associates, 2012. Integrated Services Programme Kilcock. Phase I Area Research & Plan 2012-2016 , Available at: http://www.kildare.ie/kilcockceltic/images/ISP%20Kilcock%202012%20to%202016.pdf.
Community Tool Box. Available at: http://ctb.ku.edu/en/table-of-contents/advocacy/encouragement-education/reframe-the-debate/main [Accessed March 5, 2014].
Dempsey, C., Battel-Kirk B., Barry M.M. and the CompHP Project Partners (2011), The CompHP Core Competencies Framework for Health Promotion. IUHPE, Paris
GetIrelandActive. Available at: http://www.getirelandactive.ie/get-info/brochures/ [Accessed March 5, 2014].
Ghoniem, G., E. Stanford, K. Kenton, C. Achtari, R. Goldberg, T. Mascarenhas, M. Parekh, et al., 2008. Evaluation and Outcome Measures in the Treatment of Female Urinary Stress Incontinence: International Urogynecological Association (IUGA) Guidelines for Research and Clinical Practice. International Urogynecology Journal and Pelvic Floor Dysfunction 19, no. 1: 5–33. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2096636/ [Accessed February 27,2014].
Health Literacy. Available at: http://healthliteracy.ie/ [Accessed March 5, 2014].
Hughes, Susan L., Rachel B. Seymour, Richard T. Campbell, Nancy Whitelaw, and Terry Bazzarre., 2009. Best-Practice Physical Activity Programs for Older Adults: Findings From the National Impact Study. American Journal of Public Health 99, no. 2 362–368. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622796/ [Accessed March 5, 2014].
ICIQ International Consultation on Incontinence Modular Questionnaire. ICIQ. Available at: http://www.iciq.net/structure.html [Accessed February 27, 2014].
Lorig KR, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efﬁcacy in people with arthritis. Arthritis Rheum. 1989;32:37–44.
Lucas, M. G., JLHR Bosch, F. R. Cruz, and European Association of Urology. 2012. Guidelines on Urinary Incontinence. European Association of Urology Guidelines. Available at http://www.uroweb.org/gls/pockets/english/16%20Urinary%20Incontinence_LR.pdf.[Accessed February 27, 2014].
Manchester Metropolitan University,, UK (Project Co-ordinators) University of Pavia, Italy, Free University of Brussels, Belgium , University of Burgundy-Dijon, France , King’s College, London University, UK , University of Milan, Italy , and University of Bristol, UK ., 2005. Guidelines for Exercise Programming for the Frail Elderly The Results of the European Commission Framework V Better Ageing Project. Available at http://www.laterlifetraining.co.uk/guidelines-for-exercise-programming-for-the-frail-elderly-better-ageing-project-2005/
McAuley E, Lox C, Duncan TE. Long-term maintenance of exercise, self-efﬁcacy, and physiological change in older adults. J Gerontol B Psychol Sci Soc Sci. 1993;48:218–224.
McCarthy, G. et al., Pulling the plug on containment, Available at http://www.euronuk.com/uploads/Resource-Handbook.pdf [Accessed March 6, 2014)
National Age Friendly Counties Programme Ireland. Available at: http://www.ageingwellnetwork.com/AWN-joint-initiatives/age-friendly-counties [Accessed March 5, 2014]
NICE, Urinary incontinence in women. NICE. Available at: http://www.nice.org.uk/ [Accessed February 13, 2014]
Okamura, K. et al., 2002. “Quality of life” assessment of urination in elderly Japanese men and women with some medical problems using International Prostate Symptom Score and King’s Health Questionnaire. European urology, 41(4), pp.411–419. Available at: http://www.sciencedirect.com/science/article/pii/S0302283802000611 [Accessed February 23, 2014].
Pelaez, Mireia, Silvia Gonzalez-Cerron, Rocío Montejo, and Rubén Barakat. 2014. Pelvic Floor Muscle Training Included in a Pregnancy Exercise Program Is Effective in Primary Prevention of Urinary Incontinence: A Randomized Controlled Trial. Neurourology and Urodynamics 33, no. 1 : 67–71. Available at: http://onlinelibrary.wiley.com/doi/10.1002/nau.22381/abstract [Accessed February 6, 2014].
Parry, S. W., N. Steen, S. R. Galloway, R. A. Kenny, and J. Bond., 2001. Falls and Confidence Related Quality of Life Outcome Measures in an Older British Cohort. Postgraduate Medical Journal 77, no. 904: 103–108. Available at: http://pmj.bmj.com/content/77/904/103 [Accessed February 27, 2014].
Prochaska, J.O. & Velicer, W.F., 1997. The transtheoretical model of health behavior change. American journal of health promotion: AJHP, 12(1), pp.38–48.
Rikli RE, Jones CJ. Senior Fitness Test Manual. Champaign, IL: Human Kinetics; 2001.
Seymour RB. Scale development for self-efﬁcacy for exercise among older adults. DissAbstrIntB.2006;66:6560.
Scriven, A., 2010. Promoting Health: A Practical Guide. Sixth Edition.ed. Balliere Tindall Elsevier, UK.
Sjöström, Malin, Göran Umefjord, Hans Stenlund, Per Carlbring, Gerhard Andersson, and Eva Samuelsson. Internet-based Treatment of Stress Urinary Incontinence: a Randomised Controlled Study with Focus on Pelvic Floor Muscle Training. BJU International 112, no. 3 (2013): 362–372. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11713.x/abstract [Accessed February 6, 2014].
World Health Organization, 1986. WHO | The Ottawa Charter for Health Promotion. The Ottawa Charter for Health Promotion. Available at: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ [Accessed September 21, 2013]