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Best practice Community Health and Wellness for Older Australians

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This article originally appeared in Health Matters issue 88, published Summer 2018/2019

By Dr Tim Henwood

As we age, increasing sedentary behaviour and physical inactivity are the greatest drivers of later life disability. On the upside, you are never too old to benefit from exercise, as proven by the demand for Southern Cross Care's personal health and wellness programs for older Australians, which are going from strength to strength.

While it is reported older Australians are more active than their predecessor, they still report the lowest sports and recreational activity engagement of all Australian age brackets. This gap increases further with age, as does the gap between those reporting being active and those actually at or above the national recommended levels for physical activity. For older Australians, physical inactivity has significant health and financial burdens.

In recent work by Peeters G et al (2018) it was identified that the annual Medicare cost among inactive 73-78-year-old Australians was three times greater than their active counterparts, as was-their risk of hospitalisation. For older adults, the greatest driver of disability is physical inactivity which leads to muscle mass deconditioning, lost strength and reduced capacity to undertake activities of daily living independently. Current research reports that one in three older adults sit for greater than 10 hours per day, but reducing and/or breaking-up this sitting reduces the risk of declining muscle mass, a precursor to sarcopenia and frailty, by greater than 45%.

Exercise and physical activity are effective and recognised counter-measures to the deleterious impacts of sedentary behaviour, with progressive resistance combined with balance training currently accepted as the most powerful stimulus in the battle against later life's disability.

So strong is evidence that a plethora of research now shows you are never too old, too sick or too disabled to benefit from exercise. However, engaging older adults in exercise is only half the job. In addition, participants need to understand the value of exercising, have purpose in participation and be encouraged to adhere. Programs need to be individualised, perceived as value for money and easily accessed, and staff need to be experienced, passionate and engaging. When programs do not consider all these aspects, participants drop away and the service suffers.

Southern Cross Care SA & NT (SCC) have embraced this body of evidence to firmly embed Health Ageing into its mission. In 2014, Jo Boylan joined SCC and guided the organisation towards its current Health for All policy. As part of this mission SCC installed gyms in all residential aged care facilities (N=16) and implemented a robust early intervention rehabilitation program for residents at risk of declines and/or adverse events (e.g. falls). To compliment their work in the residential setting, SCC has modernised and now offers a unique Community Health and Wellness (CH&W) model to support its growing membership of community dwelling older South Australians. A 50 years-and-older service, the model offers customers the opportunity to better their physical, mental and social wellbeing. This includes CH&W centre that offers a range of exercise opportunities and state of the art equipment. Customers have programs written for them based in their individual needs with health outcomes targeted towards prevention, maintenance, rehabilitation and/or reablement. Centres accept people to group exercise and one-to-one (1:1) therapy through the usual referral and front door entry processes, and leverage all customer funding support pathways available. This ensures a reduced out-of-pocket cost and the offer of affordable activity opportunity for all.

For those still not ready to undertake exercise, there is the offer of social engagement and educational seminars. These programs provide a "back door" opportunity for new customers to familiarise themselves with the service and the staff, while supplying a purposeful activity where they meet others already participating in exercise. Equally important, for existing customers the program values an individual's desire more than exercise. It reinforces the benefit of adherence by linking their ability to go on the social outings to the benefits of participation.

An overview of the SCC CH&W customer's health journey may include a CHSP referral for allied health and therapy due to declining health and increasing disability. A preliminary health assessment with the new customer feeds into a multi-disciplinary case-conferencing exercise to identify the most suitable reablement pathway. As part of this process, the allied health and therapist team make internal referrals through a multi-disciplinary pathway breaking down the disciplinary silos of treatment and maximising the customer's health journey.

During case-conferencing, discussions also include information about alternative engagement opportunities, followed by the clinician discussing the importance of finding purpose, engaging socially and/or being informed via educational seminars. The primary goal, independent of where the customer starts their journey, is to achieve and maintain optimal social and physical health and wellbeing. In the presence of increasing disease (e.g. COPD), new incidents (e.g. Stroke) and/or changing situations (e.g. emergence of dementia), experienced and highly trained staff revisit the customer's management plan and refocus it to ensure that it continues to suit the customer's capacity (e.g. compromised mobility) and needs (e.g. improving lower body strength and balance).

With a growing acceptance of exercise being essential to the health pathway, community aged care service models need to change to support more than just a low-intensity, rudimentary offering. Evidence is strong that resistance training drives independence, that social engagement drives adherence, and that adherence drives prolonged health. Aligned to its Health for All policy, sec has developed what is believed to be a complete health and wellness model of care for its customers. A growth in membership and referrals, complemented by customer benefits, indicate the model is working.                                                                                             

 

Catholic Healthcare run a number of Health and Wellness programs including Feel Fit, an 8-week fitness program designed to maintain your independence and health. To find out more or place a booking, visit http://www.catholichealthcare.com.au/feelfit.