Showing posts with label Healthy Ageing. Show all posts
Showing posts with label Healthy Ageing. Show all posts

Friday, 30 June 2023

One size fits none, watch your language, and keep pondering...

Insights from the Integrated Community Care to Promote Healthy Ageing event

Posted by Hamdi Hamzah, Research and Evaluation Coordinator with NECS Research & Evidence

It was my first time attending an event that saw people (some of us dressed in red) from across different professions – academics, healthcare professionals, voluntary, community and social enterprises (VCSE) professionals and members of the public – come together to share common interests and explore future opportunities or collaborations.

Being new to the health and social care sector and a career changer with experience working with large corporations through strategic human resource roles, the Integrated Community Care to Promote Healthy Ageing event co-hosted by Fuse introduced something that I felt was closer to what was happening on the ground, especially when research and practice interweave. From this event, I have identified seven insights that I felt were worth sharing.


But first... what exactly is Integrated Care? The NHS England website describes Integrated Care Systems as: “…partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area.” They also provide a helpful video explainer.

So, on to my magnificent seven:

1. There is no “one-size fits all” approach to care


Throughout the event, this was a common theme from both presenters and attendees, who continued to stress the importance of putting individual needs at the forefront in providing care. To echo Dr Bethany Bareham (pictured right), Fuse Associate and NIHR fellow at Newcastle University through her talk on providing support to older adults with co-occurring alcohol and mental health problems, support for one individual may not be needed for someone else.

2. Similarly, there is no one way to answer a research question

The event brought together different questions, methods and groups of people to enhance our understanding of promoting healthy ageing. For example, a video presentation by Dr Vanessa Davey, a Research Associate at Newcastle University, on the feasibility of developing a data set in care homes to assist in care delivery and commissioning decisions was eye-opening. You might think that digital GP records could readily be used in one form or another to build this data set, but it is clearly not that straightforward as data from other systems, namely social care, could (and should) provide additional insights into this dataset. Most importantly, while we might take different approaches and target different populations, we are all aiming towards achieving the same goal.

3. Language can have an important effect on how we approach a question


Simply put, are we talking about the same thing? We might think that the terminologies that we are using are similar but they could mean different things to different people. For example, Dr Dan Cowie (pictured right), clinical lead with the North East and North Cumbria (NENC) Ageing Well Network (who also spoke about the Frailty iCARE platform) posed the question: are "personalised care," "personhood" and "person-centred" the same thing for the groups of people that researchers are interested in studying? How we phrase the topic we are researching could also help or hinder what we get out of our work.

4. Co-production of research through VSCE organisations

Local communities should be involved in every activity within the research lifecycle, such as research planning, analysis and dissemination, and not just during the delivery stage of the study – an opinion shared by Greta Brunskill from Voluntary Organisations' Network North East (VONNE) in one of the workshops. Patient and public involvement (PPI) is a useful platform to involve members of the public and co-produce research, but there is the risk of “professionalising” these platforms, which may lead to voices from certain communities not being heard.

5. But what about before we reach a specific age?

There was interest from the audience in exploring personal and environmental factors before someone even reaches a specific age. The idea of testing the impact of, for instance, universal basic income among young people on healthy ageing was food for thought and suggests that a lot of where we are now or – perhaps will be in the future – could depend on factors in the present such as lifestyle, socioeconomic status and access to relevant services.

6. Addressing health inequalities remains challenging

Expanding on points 4 and 5 above, health inequalities remain a hot topic in this field of work. Access to care, health literacy (a person’s ability to understand and use information to make decisions about their health), personal qualifications and involvement of underserved communities were mentioned by attendees either during the talks or workshops as challenging areas. Introducing care or support may not work if barriers to accessing care remain.

7. Keep pondering

The entire event not only provided the opportunity to know what research is being conducted but showed the tremendous volume of research questions left to be explored! One of the themes that came out of Tania Jones' workshop on maximising the use of pharmacy services was the bigger role that they may play in primary care, especially in 2026 once pharmacy graduates enter the job market with prescribing qualifications. This could in turn lead to more questions, for example, is there an inclination for pharmacists to prescribe pharmaceutical over non-pharmaceutical treatments?

While the possibilities are endless, identifying questions that are crucial and impactful may be the first step to starting a research journey and finding the right collaborators. Regardless, we should continue to think about things that we are working on, as Lesley Bainbridge (pictured right), clinical lead in the NENC Ageing Well Network, quite aptly put it, "Some of the best research questions come from what we ponder."


Images: provided with thanks to NHS NECS Research & Evidence Team

Saturday, 12 October 2019

Research journey for hospice evaluating its innovative dementia care

Posted by Nicola Kendall, Namaste Lead, St Cuthbert’s Hospice and Dr Sonia Dalkin, Senior Lecturer in Public Health and Wellbeing and Lead of the Fuse Healthy Ageing Research Programme

To celebrate World Hospice and Palliative Care Day, we wanted to share part of St. Cuthbert’s Hospice’s research journey, in collaboration with Northumbria University. Specifically, we wanted to share some of the innovative activity that has been taking place in practice surrounding ‘Namaste Care’ and the evaluation of it with Fuse funding.

What is Namaste Care?

As dementia progresses, family carers describe a changing relationship and sense of loss, which can cause significant distress. Finding new ways of communicating is important to help the family carer and person with dementia to maintain a good quality of life. ‘The End-Of-Life Namaste Care Program for People with Dementia’ (Namaste Care) challenges the perception that people with advanced dementia are a ‘shell’, a ‘living death’; it provides a holistic approach based on the five senses. Early evidence suggest that it can improve communication and the relationships families and friends have with the person with dementia.

How has St. Cuthbert’s Hospice used it?

St Cuthbert’s Hospice in Durham has started to provide Namaste Care in the person’s own home, as opposed to its more traditional use in care homes. We train volunteers who are then matched with a person with dementia, in terms of personality, abilities and interests, for example. Volunteers visit the person, usually weekly for two hours and try to build a bond with the person living with dementia and the family.

Why did we want an evaluation?

Evaluating Namaste Care has proved challenging for many organisations. It is straightforward to measure reduced number of falls, less infections and reduced agitation, but teasing out the nuances of why the approach works requires more detailed study. Also, we were aware that our use of Namaste was somewhat novel, with only one other hospice in the UK implementing Namaste Care in people’s own homes. A team at Northumbria University, led by Dr Sonia Dalkin applied to the Fuse Pump Prime fund and was successful in attaining a small pot of funding to do some preliminary evaluation of our use of Namaste Care.

What did the evaluation find?

The preliminary research found that when used in people’s own homes Namaste Care has positive outcomes, such as increasing engagement and social interaction. Previously, social interaction had potentially been overlooked in the literature as an important outcome of Namaste Care. This was particularly important for carers who felt that their loved ones with dementia often didn’t have any interaction with others, beyond those living with them. The importance of matched volunteers was also highlighted, and special relationships were built between volunteers and the person with dementia. Family members would often use the time when the volunteer was present as respite as opposed to taking part in the session, and this highlighted interesting perspectives on their involvement in Namaste. The evidence suggested that those who care for a person with dementia at home provide continuous care and have little input from other services, therefore provision of two hours contact with a trained Namaste Care volunteer allowed them to concentrate on other things, knowing that the their loved one was in safe hands. This is in contrast to the usual delivery of Namaste Care in care homes, where family members may feel more able to get involved as they do not provide continuous care.

What next? 

Book for organisations and carers
interested in using the approach
  • Delivery of Namaste Care in various settings
  • The ethos of the Namaste Care approach has proved transferable into various care settings at St Cuthbert’s hospice. We now run a Namaste inspired ‘Potting Shed’ Men’s Group and we deliver Namaste Care at the bedside in an acute hospital. We are also in the early stages of discussions about taking Namaste Care into prisons, either via staff training or training prisoner buddies. We are very proud to say that due to this and other work we have been shortlisted as finalists for ‘Best Team Award’ in the 10th National Dementia Care Awards 2019.
  • Research
  • Nicola has just attended the Namaste Care International Conference and continues to take Namaste Care from strength to strength at St Cuthbert’s Hospice. We are now planning to further evaluate our work, building on the findings of the preliminary evaluation and the guide book… Watch this space!

Friday, 6 September 2019

Health inequalities in rural and coastal areas

Last November we, a team of Fuse academics, were successful in winning competitive funding from Public Health England (PHE) and given just four months to complete a rapid evidence review investigating health inequalities in older populations in coastal and rural areas. The team from Northumbria University and led by myself, consisted of Professor Katie Brittain a Social Gerontologist and Dr Sonia Dalkin Co-lead of the Fuse Healthy Ageing Research Programme (HARP). Read a case study about the review on the HARP pages of the Fuse Website.

The short timescale and vast quantity of literature made this a challenging project from the outset but the evidence was urgently needed to provide recommendations for taking an asset-based approach to reducing inequalities and promoting productive healthy ageing in rural and coastal areas. We worked closely, consulting and collaborating, with stakeholders including PHE Centre leads, Knowledge and Libraries Service, the Health Inequalities Team and Director of Public Health representatives from rural and coastal authorities. Key partners were approached from the start to recommend grey literature and case studies.

One hundred and eleven studies later the report is finally published and launched by our colleagues at Public Health England with this great blog showing how we age is strongly influenced by our environment, including where we live.

Katie Haighton, Associate Professor in Public Health, Northumbria University



How we age is strongly influenced by our environment, including where we live


Helen Brock - Programme Manager for Adults & Older Adults at Public Health England
Dr Rashmi Shukla - Director, Midlands and East of England at Public Health England

The impact of where we live

The long-term trend in life expectancy in the UK has been upwards; however, our experience of getting older varies across the nation. Some people have good physical and mental health well into old age, whereas others become frail or ill.

How we age is strongly influenced by our environment, including where we live. For both men and women, there is a 19-year difference in healthy life expectancy between those living in the most and the least deprived areas of the country.

Whether or not we live in an urban setting can also make a difference. While many of our country’s rural and coastal areas are picturesque, they can present significant challenges to protecting the health of the local population.

Our new evidence review builds on the existing evidence and suggests that older people living in rural or coastal areas may experience specific inequalities in their physical and mental health.

With almost 10 million of us living in rural areas, and older people making up a growing number of this group, it is important to understand why these health inequalities exist so that we can help to tackle them.

The evidence review aims to provide a synthesis of the evidence to support leaders in local areas in their efforts to reduce health inequalities.

Why are there public health inequalities in rural and coastal areas?

There are several drivers of health inequalities in rural and coastal areas.

One significant factor is social exclusion and isolation. Research suggests that loneliness can increase the risk of premature death by 30%.

Rural and coastal areas can face infrastructure challenges, with many villages and small towns lacking frequent and reliable public transport and high-speed internet. Having sufficient numbers of healthcare workers and carers in certain areas is an additional problem.

However, living in a rural or coastal area also has benefits. Rural places often have a strong sense of community, easier access to green space and lower crime rates than urban areas. ONS figures indicate that a higher proportion of people living in rural areas feel a sense of belonging and safety in their neighbourhood compared to people living in urban areas. Coastal environments may also provide benefits, through increased opportunities for physical activity as well as the restorative and stress-reducing impact of blue space (water).

What can we do to reduce these inequalities?

Local government and NHS partners, alongside the voluntary and community sectors, play a key role in taking action to improve the health and wellbeing of their populations.

PHE and NICE recognise that local interventions which bring communities together are some of the most valuable in addressing rural public health challenges.

Good social relationships and engagement in community life are necessary for good mental health and can help people become more resilient. By providing and maintaining community areas, green spaces and promoting public and community transport, councils can help to create a positive local environment and tackle social isolation.

Creating communities

Community activities such as lunch clubs can encourage older people to socialise and participate in community life. Bringing groups together in a village hall or other community space also provides the opportunity to reach older people with services, helping them to look after their wellbeing.

It is important to encourage social connections and contact for those in marginalised groups, who may be particularly affected by social exclusion. Involving older men who often find it harder than women to make friends later in life and may be reluctant to engage in community activities or social groups can also be a challenge.

Men’s Sheds is a programme that provides a place for older men in rural communities to participate in physical activities and projects such as gardening, woodwork and model-building. The initiative helps older men to meet, socialise and learn new skills, alleviating social isolation and creating a sense of purpose. With over 480 Sheds open in the UK, and more than 100 in development, it’s estimated that over 11,000 ‘Shedders’ are benefitting from Men’s Sheds across the country.

Promoting physical activity and making use of natural assets

There is potential for coastal and rural areas to use their natural assets to promote physical activity and reduce social isolation, for example, through volunteer-led walking groups or outdoor activities.

‘Stepping into Nature’ is a project led by Dorset Area of Outstanding Natural Beauty using Dorset’s natural and cultural landscape to provide activities and sensory-rich places for older people, including those with dementia and their carers. It seeks to increase physical and mental wellbeing, to reduce social isolation and loneliness, and to increase confidence and motivation for people to access the countryside.

Promoting and normalising physical activity as part of the experience of daily living for older people living in sheltered housing or residential care settings can result in further benefits.

In rural Norfolk, Active Norfolk – a partnership of organisations working to encourage people to participate in sport and physical activity – trialled Mobile Me, a physical activity programme for older people funded through Sport England.

For ten weeks, Mobile Me visited 65 sheltered housing and residential care homes to encourage them to get moving through games such as bowls and table tennis. The programme helped to reduce older peoples’ sedentary behaviour and fear of falling as well as increasing overall wellbeing.

Harnessing technology

Technology can be useful for providing care services to older people in the country’s most remote areas.

NHS Highland recently trialled video conferencing in remote care homes to allow doctors to speak to dementia patients in a familiar setting without the need for extensive travel.

The technology enabled care home residents to be assessed and reviewed more quickly and monitored more regularly. Video conferencing also helped care home staff to access specialist knowledge and advice more easily, helping them to feel more confident and actively involved in their residents’ care.

However, it’s important to find a balance between remote and direct face-to-face contact that many older people value.

Supporting local areas

With advances in healthcare and a greater understanding of how healthy lifestyles, supportive communities and environments can help us to live longer, enabling older people to lead fulfilling lives for as long as possible is more important than ever.

Recognising the health inequalities faced by people in different areas of the country, including rural and coastal places, is a crucial step to ensuring that all older people have the opportunities and care relevant to their needs, no matter where they live.

PHE’s evidence review seeks to share what is known about these issues, so that through Locality Plans, local Health and Wellbeing Strategies and other mechanisms, local authorities and the NHS locally are supported to prioritise work to address the health inequalities that exist within and between coastal and rural areas.

To find out more you can read the full report: An evidence summary of health inequalities in older populations in coastal and rural areas. You can also read our rural health report produced with the Local Government Association: Health and wellbeing in rural areas, and our recent health inequalities report: Place-based approaches for reducing health inequalities.


Reproduced with thanks to Public Health England and Exposure: 
https://publichealthengland.exposure.co/health-inequalities-in-rural-and-coastal-areas


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