Features

Self-sufficiency at any age

06 June 2017

The number of over-85s in Britain is set to soar in the next few decades. With the right support and care, they can stay healthy and independent. Vivien Hollis of the Active Ageing Service in Bath demonstrates how.

Self sufficiency at any age: iStock

Office for National Statistics (ONS) figures suggest that over the next 20 years the number of people over 85 years old will rise by 3.5 million across the UK (ONS, 2011). The Bath & North East Somerset (B&NES) Council supports these figures when it says that by 2021, there will be 20% more people aged over 75 and 40% more over 90 (B&NES, 2014). This is not bad news. It is something to celebrate for the families and communities we serve.

However, many will need a lot of support to remain healthy and independent. To complicate matters, the gap in life expectancy between our richest and poorest areas is growing (Bennett, 2016).

The public health agenda in B&NES has highlighted five priorities for this age group:

  • Food
  • Fitness
  • Relationships
  • Resilience
  • Social isolation.

These areas represent the most significant challenges to the health and wellbeing of the older residents in the B&NES area. In response, Sirona Care & Health in Bath was commissioned to develop and deliver a new health visiting service for older people, particularly the 80- to 84-year-olds, called the Active Ageing Service. This service was introduced in 2014 and is now run by Virgin Care, and is part of the B&NES Council community health and care services.

The Active Ageing Service aims to:

  • Improve health and wellbeing outcomes for older people, which includes their social and emotional needs as well as their physical health
  • Reduce health inequalities
  • Improve access to services
  • Work in partnership with others
  • Celebrate and build community resilience.

The team is made up of health visitors, specialist community public health nurses and health visitor support workers (NVQ Level 2/3 in Health and Social Care). The team covers B&NES and works within the community adult multidisciplinary team model. Our work will always remain a public health role and has the central aim of preventing hospital admissions and helping people to enjoy their lives and re-evaluate what is important to them.

The 80 to 84 age group was chosen after discussions with local hospitals, GPs, community nursing, and social care services, as it was identified that older people in our area were regularly being admitted into hospital around the age of 83 as they became more frail. By offering a service three years before this, we hope to prevent ill health and accidents, while supporting people who already have long-term conditions to live well.

For example, from 2012-14 the number of hip fractures in B&NES was higher than the national average (PHE, 2016). The cost of falls to the whole NHS is estimated at more than £2.3bn a year (NICE, 2013). While society values the reactive health services that support us to recover when we are unwell, it is equally important that health and care services work together to upgrade the prevention and public health services that keep people well.

The Active Ageing Service model is based on the National Health Visitor Plan, which remarks on the growing evidence for the benefits of early intervention and prevention. A Care Quality Commission (CQC) report of 2016 said the Active Ageing Service was caring, quick to recognise people in vulnerable circumstances and innovative. They also described the service as ‘working in partnership for patient’s wellbeing – both in terms of their physical and emotional needs’ (CQC, 2017).

Our core objectives that reflect this are to:

  • Reduce the number of falls, and prevent accidents
  • Create conversation around dietary changes, improve older adults’ nutritional status, promote good health through nutrition
  • Support people who have been bereaved
  • Support carers and families
  • Support people with long-term conditions, and help them to live more comfortably with existing ones
  • Offer advice and support for families and people with memory loss and cognitive decline.

To do this, we offer three levels of service:

1. Building community capacity

Here we gain an understanding of our communities’ assets in order to work in partnership and to strengthen clients’ aims and wishes, identifying specific needs, and helping communities and individuals to help themselves. We work closely with organisations like British Red Cross, Age UK, Alzheimer’s UK, Dial-a-Ride community transport, St Monica Trust charity, local action groups and befriending groups, sports groups, memory cafés, and community health and care services in B&NES, such as the Healthy Lifestyle Service, as well as council and public health groups. Building community capacity fits well within our role and has been identified as an integral aspect of the health visitor, specialist community public health nurse role (NICE, 2016; Kenyon, 2015; Department of Health, 2013; 2011).

Case studies

  • While at a sheltered housing complex, an Active Ageing health visitor noticed people were eating pre-packed meals alone in their flats. The large sitting/dining room was hardly used. Working with the Healthy Lifestyle Service and warden, she set up a six-week ‘Come cook and dine’ group for residents. Each week they would meet to prepare food, take turns to cook, and share the meal together. They all said they enjoyed sitting around a table to eat and chat, and all agreed it had helped them regain their interest in food.
  • Another Active Ageing health visitor approached a local gym to start an exercise group for older adults to improve their mobility and balance. Three years later, it is still running.

2. Universal service

The Active Ageing Service differs from other health visiting/nursing services for older people, which normally only take referrals. Instead, our team contacts every 80- to 84-year-old. This way we can support healthy ageing and actively promote the health of older people, helping them to be independent, to enjoy life, and to live well with illness, dementia and fragility. During the home visit, we include an holistic assessment, exploring topics such as social support, mobility, home safety, falls, medications management, daily activities, mood and memory. We have referred over 1500 people to the Avon Fire and Rescue Service for a home safety visit. In our conversations with older people, we look at whether the person has something to do, something to look forward to, and someone or something – a pet, perhaps – to love. Exploring these themes makes us a holistic service, as opposed to a medical one.

Case studies

  • An Active Ageing support worker helped one man to change his diet, enabling him to reduce, and eventually stop, taking laxatives. The worker explained food labels to him, along with fluid and fibre intake. He also cut down on caffeine and now sleeps better. He says he feels more alert and no longer suffers severe constipation.
  • Another support worker visited a woman who lived on her own and had bought a computer tablet so she could Skype her 90-year-old sister, who lived far away and who she had not seen since 1945. However, she found the technology difficult to master and with huge disappointment abandoned the idea. The support worker worked out how to use the tablet, and helped the woman set up Skype so she could see and talk to her sister.
  • A support worker met a couple who were concerned about their fading memories. They loved to go out each day, but would often forget their lunchtime medication. They had dosette boxes but these were too big to take out with them. The support worker found them a smaller portable tablet container that ‘buzzed’ at tablet time. The couple were delighted and have regained their confidence when out and about.
  • An Active Ageing health visitor used motivational interviewing techniques to help a man cut his alcohol intake – he reduced his glass size and learned how to work out the calorie-count per drink. He lost weight and said he felt better.

The people most likely to visit A&E for alcohol-related falls are not the young but the elderly. This is probably because elderly people don’t realise their alcohol tolerance levels reduce as they get older. Some drink because they are lonely. Sometimes, a simple conversation is all that is needed to help people review and understand their drinking habits.


3. Universal plus service

This is a service for clients above and within the 80 to 84 years age group, who have additional needs highlighted through their history or a universal visit. Individuals are referred by a GP and the service is provided by a health visitor, enables a more in-depth assessment, and can offer additional assessments around memory, depression and falls.

In response to the information that 10% of older people in the UK live with chronic loneliness (Victor, 2011), the Active Ageing Service also provides short-term support for people who have low mood, are bereaved or socially isolated. All are offered an annual review.

Case studies

  • A health visitor referred an isolated man to the Library at Home, and to befriending and community transport services – he is now more independent and in touch with his community.
  • The team has also helped a lonely but able older man to become a volunteer for Contact the Elderly.
  • A man needed new shoes, but since losing his wife he had not been shopping on his own. The Red Cross was asked to go with him to help build his confidence, so he could do it by himself in the future.
  • A woman with impaired hearing was given information about amplified hearing aids, Deaf Plus and the local social-care hearing and vision team. She can now make phone calls and manage her finances.

What’s next?

At the end of 2016, the University of the West of England agreed that our service could support a student nurse on second-year placement. The student reported: ‘What made the Active Ageing Service such a good learning environment was the opportunity I had to hone and develop my holistic assessment skills, gain a better understanding of the importance of public health and observe how health visitors worked in partnership with clients, connecting them to the many different local and national agencies.’

Sharing our knowledge and skills is important to us. So is the belief that public health is everybody’s responsibility. Being a force for change and becoming more visible in adult nursing has allowed us to encourage all our hospital and community teams to value the preventative, public health services that work to keep us all well.

  • Vivien Hollis is the clinical lead and a health visitor. Information for this article was also provided by health visitor Jenny Rudge and specialist community public health nurse Kate Sharp.

References

Bennett JE, Li G, Foreman K, Best N, Kontis V, Pearson C, Hambly P, Ezzati M. (2015) The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting. The Lancet 386(9989): 163-70.

Bath and North East Someset Council. (2014) Report of the director of public health 2013-14: the good, the bad and the ugly. See: bit.ly/2qZrmLM (accessed 24 May 2017).

Care Quality Commission. (2017) Sirona Care & Health CIC quality report. See: cqc.org.uk/sites/default/files/new_reports/AAAG0267.pdf (accessed 24 May 2017).

Department of Health. (2011) Health visitor implementation plan 2011-15. See: bit.ly/1Lu9kTE (accessed 24 May 2017).

Department of Health. (2013) Improving outcomes and supporting transparency: a public health outcomes framework for England, 2013-2016. See: bit.ly/1E31iwF (accessed 24 May 2017).

Kenyon L. (2015) Building community capacity: an introductory toolkit for health visitors. See: ihv.org.uk/wp-content/uploads/2015/10/iHV_BCC-Toolkit.pdf (accessed 24 May 2017).

NICE. (2013) Falls in older people: assessing risk and prevention. See: nice.org.uk/guidance/cg161 (accessed 24 May 2017).

NICE. (2016) Community engagement: improving health and wellbeing and reducing health inequalities. See: nice.org.uk/guidance/NG44 (accessed 24 May 2017).

Office for National Statistics. (2011) UK population projected to hit 70m by 2027. See: ons.gov.uk/ons/dcp29904_240697.pdf (accessed 24 May 2017).

Public Health England. (2016) Bath and North East Somerset health profile 2016. See: bit.ly/2qZm9Sp (accessed 24 May 2017).

Victor C. (2011) Loneliness in old age: the UK perspective. Safeguarding the Convoy: a call to action from the Campaign to End Loneliness. Age UK: Oxfordshire.

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