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Its too bloody late for me Physical activity and older people

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BHF National Centre for Physical Activity and Health. Loughborough University ... CMO 2005, BHF NC 2007, AHA & ACSM 2007. Different for obesity and weight loss ... – PowerPoint PPT presentation

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Title: Its too bloody late for me Physical activity and older people


1
Its too bloody late for me ! Physical activity
and older people
  • Bob Laventure
  • BHF National Centre for Physical Activity and
    Health
  • Loughborough University
  • Bassetlaw Partnership for Health
  • November 2007

2
Overview
  • Update on evidence
  • PSA Targets and themes
  • Targeting and priorities
  • Activity recommendations
  • The BHF National Centre at Loughborough
    University
  • No, its not too by late for me !

3
New evidence
  • Diabetes
  • Cancers
  • Obesity
  • Cognitive functioning
  • Prevention of dementia
  • Falls prevention
  • All linked to lifestyle
  • Just how much more do we need ?
  • www.bhfactive.org.uk

4
Older evidence mental health have we
forgotten ?
The benefits of physical activity for older people
  • Reduction in stress, anxiety and depression
  • Improvement in overall psychological well-being
  • Improvements in cognitive function
  • Improvements in self-esteem and self-worth
  • Increased contact with friends, community and
    reduction in isolation and loneliness
  • Increased prevalence and most frequently reported
    by participants across the age range
  • (UK Enquiry into Mental Health of Older People
    (NIMH and Age Concern 2006)

5
Evidence of effectiveness
  • Brief interventions (NICE 2006/7)
  • Public health interventions (BHF NC 2007, NICE
    2007)
  • Multi level interventions ecological health
    promotion

6
Evidence of effectiveness
Can we help to change matters?
  • From a critical review of 29 physical activity
    interventions
  • Increased activity levels over a longer period of
    time 18 months (75)
  • Group/class-based and home-based activity were
    effective
  • Tailored to individual needs
  • Cognitive-behavioural strategies and goal-setting
  • Telephone support and continued contact
  • More likely than young adults
  • (King et al, 1998)

7
Policy drivers, PSA Targets and themes
  • PSA 17 Tackle poverty and promote greater
    independence and well being in Later Life
  • PSA 18 Promote better health and well-being for
    all
  • PSA 19 Ensure better care for all
  • PSA 21 Build more cohesive, empowered and active
    communities
  • PSA 23 Make communities safer

8
PSA 17 - Independence and well being in later life
  • Indicators 1 2 - employment and pensions
  • Indicator 3 - healthy life expectancy at age 65
  • Indicator 4 - Satisfaction with home and
    neighbourhood
  • Indicator 5 - Support to live independently at
    home

9
PSA 18 - Better health and well-being for all
  • Indicator 1 - All age all cause mortality rate
  • Indicator 2 AAACM (spearhead areas)
  • Indicator 4 people to supported to live
    independently

10
PSA 18 - Better health and well-being for all
  • All age all cause mortality indicators/measures
  • reducing the mortality rate by 2010 for cancer by
    at least 20 per cent in people under 75, with a
    reduction in the inequalities gap by at least 6
    per cent
  • reducing the mortality rate by 2010 for heart
    disease, stroke and related diseases by at least
    40 per cent in people under 75, with a reduction
    in the inequalities gap by at least 40 per cent
  • National stroke strategy

11
PSA 19 - Ensure better
care for all
  • Patient services and waiting times
  • Indicator 5 - Long term conditions
  • (preventative care and self care self management)

12
PSA 21 - More cohesive active communities
  • Indicator 5 Thriving communities strong
    emphasis on 3rd sector and volunteering
  • Indicator 6 - participation in culture or sport
    (beware of measures !)

13
PSA 23 - Make communities safer
  • A pre-requisite for older peoples mobility,
    independence, confidence to travel, get out and
    about and participate in their community

14
PSA targets
  • Distinguish between
  • Those with direct association with Physical
    activity
  • Those by inference/contribution e.g. stronger
    communities
  • Support from other frameworks e.g. NSFs

15
LIFE STAGES IN ACTIVITY all older people but a
change in focus
  • Entering Old Age
  • disease prevention
  • recreation and social activity
  • Transitional Phase
  • reduce disability
  • maintain mobility and independence
  • Activity in the later years
  • occupational activities
  • maintain autonomy and dignity

Promote and extend healthy active life Compress
morbidity
Identify emerging problems ahead of crisis Reduce
long-term dependency
Recognise complex interaction of physical, mental
and social care factors compromising independence
and quality of life
16
Priority groups and conditions
  • Who should we be targeting ?
  • Boomers
  • Older men
  • The transitional phase between independence and
    frailty and especially people isolated at home
  • People over 85
  • People with dementia

17
Boomers
  • Prevention - Evidence on impact of an active
    lifestyle is increasing
  • New generation, new ideas, new challenges
  • Busier than ever, we are competing for their
    time, counter-attractions
  • We need to be innovative and provide high quality
    experiences

Hope I die before I get old My generation -
The Who 1966
18
Older men
  • Inequality in health
  • Men die younger
  • Different disease patterns
  • Do not use health services
  • Are services designed or appropriate for men ?

19
People isolated at home
  • Poor mental health, significant isolation and
    loneliness
  • Downward spiral of functional decline and loss of
    independence
  • Circle of Life (contact with friends, neighbours
    and community) diminishes
  • Inactivity is life limiting

20
People over the age of 85
  • The new generation
  • Small proportion in nursing and care.
  • Most at home
  • Increased prevalence of disease and frailty
  • We have low expectations of them
  • Fear and skills factor

21
People with dementia
  • Prevalence set to increase (Im by 2025)
  • Not all in advanced years and 2/3 live at home
  • D is accompanied by depression, anxiety and
    increased risk of falls
  • Impact on carers
  • National Dementia strategy next year
  • New skills and ways of working required

22
People with dementia
  • Costs of care CHD, Stroke and cancers together
    in UK (17b)
  • IN USA someone under 65 develops D every 79
    seconds
  • By 2030 costs in USA will total medicare budget
  • The New Cancer ? Fear and ignorance
  • Prevalence is increasing, cure not in sight,
    delayed onset by 5 years would halve deaths

23
New guidelines
  • BHF National Centre for Physical Activity and
    Health
  • How much is physical activity is enough and how
    do we communicate this ?
  • What works in practice ?
  • www.bhfactive.org.uk

24
Effective health promotion for older people and
physical activity
  • What works ?
  • Ecological models that recognise multilevel
    components e.g.
  • Population wide interventions
  • Community interventions and programmes
  • 1 to 1 interventions
  • (Whitehead 1999, Sallis et al 1999, CDC 2000)

25
New activity
  • Active for Later Life resource updated and now
    available online as website
  • BHF Campaign 30 Mins. a Day, Any
    Way,
  • Policy calls for the 50 65 population
  • Fit for Life Plan - (motivating the older person)

26
Activity recommendations
  • 30 mins moderate intensity on 5 or more days a
    week
  • Strength, flexibility, balance and coordination
    are vital (2 x per week)
  • CMO 2005, BHF NC 2007, AHA ACSM 2007
  • Different for obesity and weight loss
  • Different for falls prevention and management

27
Activity recommendations
  • Distinguishing between
  • Authoritative Guidelines
  • Professional understanding (PA and non
    specialist)
  • Public education (clear and accurate messages)

28
Its too by late for me !
  • Fiatarone et al (1990) strength training among
    nono-generians
  • Campbell et al 75 (fallers)
  • Prevalence of depression and anxiety amongst
    oldest old
  • Older people respond to training in the same way
    as young people
  • So detrained that gains are greater
  • Quick wins

29
The good news ! - Improvements in fitness and
functional capacity
  • Balance - Static 8 weeks , dynamic 8 weeks
  • Muscle strength (8 - 12 weeks)
  • Gait (8 weeks)
  • Muscle power (12 weeks)
  • Postural Hypotension (24 weeks)
  • Transfer (24 weeks)
  • Endurance (26 weeks)
  • Bone strength 1 year for femur and lumbar spine
  • (Skelton 1999)

30
Thank you for listening ! bob.laventure_at_ntlworld.c
om
  • www.bhfactive.org.uk
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