None listed
Conditions
Brief summary
There is clear evidence from the recent Royal Commission in Aged Care Quality and Safety that (a) older people living in residential aged care and in the community need allied health services to optimise their health and well-being, (b) older people living in residential aged care and in the community are not getting the services they need, and (c) the ways in which allied health services are accessed in the aged care system is not working. The proposed intervention draws on a strong evidence base that reablement principles can improve outcomes for older people in living at home and in residential aged care. Reablement “involves time-limited interventions that are targeted towards a person’s specific goal or desired outcome to adapt to some functional loss or regain confidence and capacity to resume activities”. Some key points about programs that use reablement are they: • Focus on the skills, abilities and social situation a person has to help themselves, rather than doing things for the person; • Are focused, time-limited and goal focused; • Can focus on modifying tasks or the environment to address a loss of function and/or training a new skill and using existing social supports. There is evidence that allied health using reablement principles improve outcomes for older people including physical function, falls prevention, communication, nutrition, personal care and social function. However, the translation of this evidence into practice has not been systematically applied and reported in Australia. To address some of the issues around frailty, falls and social isolation identified in residential aged care and in the community, we will implement and evaluate a multidisciplinary allied health service consisting of physiotherapy, exercise physiology, occupational therapy and speech pathology. Importantly, this service will be based on evidence-based, reablement principles.
Interventions
The intervention will involve multiple allied health intervention with a client focussed approach. The client focussed approach means that the duration and dose will vary depending on the needs of the participant, guided by Discipline specific assessments. Participants could receive occupational therapy and/or physiotherapy and/or exercise physiology and/or speech pathology. A brief description of each Discipline's assessment and interventions are:
Occupational Therapy:
1. Assessments: Canadian
The intervention will involve multiple allied health intervention with a client focussed approach. The client focussed approach means that the duration and dose will vary depending on the needs of the participant, guided by Discipline specific assessments. Participants could receive occupational therapy and/or physiotherapy and/or exercise physiology and/or speech pathology. A brief description of each Discipline's assessment and interventions are: Occupational Therapy: 1. Assessments: Canadian Occupational Performance Measure. 2. Interventions: The COPM allows each participant to choose areas of everyday living that are important to them and they would like to perform better at. Some expected interventions for occupational therapy will include: a. Self-care training: Some participants may have decreased ability to do activities of daily living such as dressing or showering. The occupational therapist will address this. b. Leisure: We expect many participants will have leisure interests that can't be met for a number of reasons (access, resources, transport) that could be addressed by an occupational therapist. If participants identify a leisure based goal through the COPM the occupational therapist and/or the allied health assistant will address this. c. Productivity: Older people want to continue to be productive members of their community such as through volunteering and informal care of friends and family members. 3. Format and duration of intervention: We will offer each participant occupational therapy for 1-2 hours, 3 times/per week for 6 weeks either individually or in groups. The maximum group size is 6 for occupational therapy. Speech Pathology In addition to the usual assessments and interventions dealing with swallowing, eating and drinking, the Speech Pathologist will target communication and social engagement. 1. Assessment: RISE 2. Interventions: This will include changing the environment to promote communication and use of alternative communication methods such as memory books and graphic cues. In many cases, the Speech Pathologist will work with the Occupational Therapist in group or individual sessions. 3. Format and duration of intervention: We will offer each participant speech pathology for 1-2 hours, 2 times/per week for 6 weeks either individually or in groups. The maximum group size is 6 for speech pathology. Physiotherapy and Exercise Physiology A falls and balance intervention will target leg strength, standing balance exercises (reaching in standing, stepping) Everyday living interventions include practice of everyday activities such as squats to reach downwards, stairs, negotiating obstacles and turning. Format and Dose: Physiotherapy or exercise physiology sessions weekly for 6 weeks. Participants will receive a combination of 1-1 and group sessions based on their individual needs. 1-1 sessions will be twice weekly for 30 minutes. Sessions to include exercises that are tailored to the resident’s mobility and physical ability. Group intervention: Classes led by a physiotherapist or exercise physiologist and stratified by participants’ mobility level (grouping people of similar abilities wherever possible) 2 x 50 min classes per week for 6 weeks Group size: 6-8 people per class
Sponsors
University of Canberra
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
55 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Any new or existing (permanent) resident (nursing home or independent living) of Estia Bexley and Estia Blakehurst is eligible. Any relative, family member, Power or Attorney or Guardian of the resident is eligible for face to face interviews. Any staff member involved in the care of the resident participant is eligible for face to face interviews.
Exclusion criteria
In some case people with severe cognitive impairment will not be able to engage in the allied health program. For example, people who have severe expressive and receptive communication impairment and who are immobile due to dementia are unlikely to be able to meaningfully engage in the program. Anyone who is not a relative, family member, Power or Attorney or Guardian of the resident is not eligible for face to face interviews. Staff members who have not been involved in the care of the resident participant are not eligible for face to face interviews.
Outcome results
None listed