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Uniting Home and Community Care Central Sydney

Strong Steady Safe
Uniting Home and Community Care Central Sydney
, NSW

The Marion
Ronald Coleman Lodge
 

Home Care – Metropolitan, 80 + beds

Award descriptors:
Health and wellbeing, Enablement, Safety

About the program 

Falls are a major contributor of harm to older people in community and residential aged care facilities. Falls related injuries are a significant cost and burden on health and aged care services, frequently resulting in injury and hospitalisation which may lead to reduced length and quality of life. We continue to explore ways in which to improve the quality of life for older people.

Currently, we operate two Seniors Gyms, which have over 800 members aged over 60 years. A new initiative was designed to build on this success and pilot a strength training program in two residential aged care facilities. A 10-week strength training program was designed by our exercise physiology team and delivered to residents in two aged care facilities in Sydney. The main goal of the program was to improve the strength, power, balance and well-being of the participating residents whilst reducing their risk of falls. Participant feedback has been extremely positive with residents who completed the program requesting that it be continued. Due to the success of this pilot program, the Residential Operations Manager has decided to continue the program at both sites.

What we did
The design of the pilot program is largely based on the successful outcomes achieved by members of Seniors Gyms as well as a study conducted by a University on the Seniors Gyms in 2009. A summary of the outcomes is below.

Sydney University and the Seniors Gyms Project Report 2009: 

Over a three month period, University students conducted assessments on a relevant sample of the gym population to measure the difference that strength training exercise made.

Strength and functional outcomes demonstrated excellent improvements and these results were reflected in the positive responses from the member satisfaction survey with regards to areas of “improvement in health”.

The results clearly demonstrated why the gyms are successful at maintaining the independence and quality of life of people over 60 years of age. The training programs target specific needs of members with a variety of chronic diseases/conditions and the functional outcomes of the programs illustrate how members are able to maintain and improve their functional independence and quality of life.

Methodology
The program has been designed, developed and delivered by accredited exercise physiologists using an evidence-based approach. The assessment of participating residents included a record of previous exercise history, goal setting and assessment of functional capability prior to the design of the program. Outcome measures were recorded for each participant. The assessment was completed to develop a baseline of outcomes so that each participant’s progress or regression could be tracked.

  • The program was run for 10 weeks with the gym equipment being made available within the residential aged care facilities for a minimum of 2-3 x 2 hour blocks per week (Mon/ Wed/ Friday).
  • Participants were provided with individual exercise program cards designed by the Exercise Specialists/Physiologists and /or Exercise Science students.
  • Pictures of essential exercises were displayed around the wall for the participants to follow in a circuit routine. Only exercises prescribed on the exercise program card were to be completed.

Assessment process:
An individual assessment included a previous exercise history, goal setting, functional assessment and the development of an exercise program. This was completed to develop a base line of outcomes so progress or regression could be tracked for each participant.

An Accredited Exercise Physiologist completed the initial assessment.
A complete re-assessment was conducted by the Accredited Exercise Physiologist at the conclusion of the 10 week program

Exercise program:
Exercise Specialists/Physiologists developed an exercise program for each participant that included cardiovascular, strength, balance, functional and flexibility exercises, with numbers of sets, appropriate level of intensity and duration.

Outcome measures:
Outcome measures were recorded for each participant to ensure the program was outcome directed.
Outcomes focused on strength, balance, falls and pain levels.
Accredited Exercise Physiologist completed re-assessment at the end of 10 weeks.

Key functional assessments: 

  • Sit to stand (30 seconds)/ leg extension (repeats per 30 seconds)
  • Balance progression testing
  • Hand grip/bicep curl tests
  • Wellness survey
  • Satisfaction survey

Tracking Compliance/ Attendance:
Exercise Specialists/Physiologists staff monitored attendance.

Why we did it 
The concept for the program commenced with a request from a resident at one of our aged care facilities. Whilst some gym equipment was already available, the residents requested a specific strength training program be developed and supervised by exercise professionals. The Residential Operations Manager agreed and decided to also include the second residential aged care facility in the program. The program provided an innovative change from the regular exercise class approach to that of an individualised strength training program, as well as providing more variety to the residents existing leisure and lifestyle program. 

The program is focused on helping to improve the quality of life of older people living in residential aged care facilities. The program takes a proactive approach to preventing or reducing the risk of injury through falls by improving the strength, balance and mobility of the participants. This type of exercise program can also have a positive impact on the overall health and wellbeing of participants, with some reporting improved feelings of self-esteem and self-confidence. The participating residents were supported by their families and/or carers throughout the duration of the program.

Although the benefits of muscle strengthening exercises for older people are well understood, the prevalence of specific strength training exercise programs designed to improve the individual’s strength, balance, mobility and power is uncommon in residential aged care facilities. For over ten years, the organisation has been providing exercise services to older people in the community through its two Seniors Gyms located in Sydney, with impressive results.

Who worked with us:
Residents who were participating in the program were supported by their families/carers at the two residential aged care facilities. 

The Board, Executive Leaders, Residential and Health Care Services and Home and Community Care Services Management are committed to supporting residents/clients to achieve their optimal independence.

Home and Community Care Services-Senior Gyms: Commitment of management and staff to participate in the Program.

Residential and Health Care Services Central Sydney: Residential Operations Manager, Service Managers, Leisure and Lifestyle Coordinators, staff and volunteers.

The Australian Catholic University and University of NSW: The Universities provided permission for the Exercise Physiology students to go off site to residential care locations to assist in the assessment and supervision of the residents during the program.
Medical staff and General Practitioners: GPs and specialists had provided positive feedback regarding the Gym Program’s impact on the management of chronic illnesses such as: increased capacity to interact with grandchildren; opportunities for social engagement; mixing with like-minded people; maintaining capacity to participate in leisure pursuits; and positive impacts on emotional wellbeing.

The Senior Gyms: Already have effective established relationships with G/P’s, Geriatricians, Local Hospitals, Allied Health Services and Fitness Australia.

What we learned
Due to the success of the pilot, the Residential Operations Manager has decided to continue with the program at both sites. There is also the future potential for the program to be implemented in other residential care facilities, independent living and community sites. The final reports of the 10 week strength programs at the two facilities demonstrate the value and success of these programs to other services and service providers.  

The pilot program commenced in February 2016 and concluded in April 2016. In April 2016, the percentage of falls at both sites showed a marked decrease. This result is very encouraging but further analysis and longer term data will be required to assess the full impact of the program on the rate of falls.

Outcomes: Sites 1 & 2
Attendance:
Seven drop outs (2 residents due to cognitive impairment, 1 back pain, 4 not interested).
78.5% average attendance (excluding drop outs).
Total occasions of service = 193 (Site1.) 173 (Site 2.).
Average number of residents per session = 7 residents (across 2 x 1 hour sessions).

Falls:
Number of falls residents had experienced in 12 months prior to program: 9
Number of falls during the program: 2 (Site 1) 0 (Site 2)
Further analysis needed to look at impact of the program on falls.

Functional Outcomes:
12 residents completed the program and pre and post testing.
(3 regular attendees were unable to attend in the last week during post testing).
Excellent improvements in static balance, mobility and lower limb.

Large spread of results: 6 residents’ results completed pre and post measures. Small sample size: Sit to stand (lower limb strength) comparable results to Seniors Gym program. Small improvement in power (11.1%) (5 chair rise).

Wellbeing survey:
Wellbeing scored improved from 31.6 to 36.1
9 residents reported improved wellbeing.

Satisfaction survey: High levels of enjoyment (4/5); appropriate levels of duration and intensity of the exercises; all residents reported that the program helped with activities of daily living; all residents prepared to subsidise cost of future exercise programs.

Verbal feedback extremely positive: All residents that completed the program are requesting it to be continued. Examples of verbal feedback:

Resident #1 - Reduction in knee pain and use of pain medication. 

Resident #2 - Reported an improvement in his overall wellbeing and self-esteem. Resident #3 - Reported feeling improvements in balance and mobility.

Barriers:

  • Obtaining medical clearance - delay from facility staff/medical staff to complete medical histories of residents. This resulted in under prescribing intensity and types of exercises until clearance was obtained.
  • Cognition of residents – needed extra support from facility staff if residents with cognitive impairments are to participate in the program.
  • Communication between various RACF staff and AEP’s needs to be consistent and regular to ensure best-practice for residents.

Recommendations and Considerations:

  • The role of the Exercise Specialists/Physiologists: Qualified professionals to individually prescribe, monitor and implement exercise programs safely and effectively. AEPs experienced enough to progress exercise programs appropriately to elicit benefit.
  • Consider group versus individually prescribed programs. Dependant on: Equipment – availability of equipment, type and numbers. The residents – functional and cognitive ability of the residents. Staff to resident ratio – availability and cost of staffing.
  • Costs: Residents reported being prepared to pay for exercise sessions (satisfaction survey). Costs v benefit analysis required.

Inclusion criteria

  • Mobility – resident needs to be able to mobilise independently.
  • Cognitive function – resident needs to be able to follow instruction from staff.
  • Stable medical conditions – see medical clearance form for full list of contraindications.

Further statistical analysis of results may be needed. Only presented % change (i.e. are results statistically significant).

Continuation of programs:
The Accredited Exercise Physiologist will work closely with key facility staff to ensure the on-going monitoring and evaluation of the programs, which will continue to provide 2-3 sessions a week with a maximum of six residents per group. The functional capacity of residents will be assessed quarterly or if there is a change in health status. The wellbeing tool will be administered every six months. As the residents are assisted with the exercise program progression/regression will result in changes made on a session by session basis.

More information on this program:
Jacki Attridge, or phone (02) 9376 0474

Changed
Friday, 21 December 2018 - 7:08am