It’s time for exercise to be normalised for aged care residents, write Louise Czosnek, Dr Tim Henwood and Martin Bending.
For older adults, exercise can ameliorate the physical declines associated with ageing and facilitate functional improvements that allow people to remain independent for longer.
For those with aged care needs, these benefits may present through the person being able to dress independently, complete household chores and reduce their caregiver needs.
Further to the individual benefits of exercise, the aged care sector more broadly can realise the value of exercise through reduced hospitalisations, decreased costs of care and improvements in service quality.
The evidence is there, so why isn’t exercise a normal part of aged care?
Translating the undeniable evidence for exercise into an aged care best practice model of care has proven notoriously difficult.
More broadly, research shows that as little as 14 per cent of positive evidence is implemented into healthcare practice. This translation of evidence to support best practice healthcare must also overcome many key barriers traditionally found within the aged care sector.
Workforce
The aged care workforce is under significant strain, with staffing shortages predicted over the coming decades. For university-trained individuals with the required chronic disease management and exercise prescription knowledge, such as accredited exercise physiologists (AEPs), the lure of the aged care industry is not well-supported by the provider or the government.
For those who do engage in the sector, there is no end to the positive stories of client change and the associated professional satisfaction of facilitating this change.
To support better engagement of exercise expertise within the aged care workforce, we must ensure that:
- student practicum opportunities for exercise expertise disciplines are readily available
- appropriate staffing of the aged care workforce with these exercise expertise disciplines is supported, as this will work to improve the understanding of the value of exercise within the sector.
While many aged care providers may feel they already supply exercise to clients, if physical declines of clients continue and falls remain common in their facilities, despite these current exercise programs, a review of the capabilities and effectiveness of staff delivering these programs should be undertaken to help identify improved healthcare solutions.
Funding barriers
Regular exercise, and in particular, evidence-based progressive resistance plus balance training, is the most powerful intervention in disability reversals and falls prevention among older people.
In the community environment, exercise delivered by an AEP is becoming increasingly utilised as a model of care with measurable consumer health and wellbeing benefits.
For example, in the presence of consumer-directed care designed to give consumers more choice and control and with providers looking to offer effective well-rounded services, the employment of these exercise knowledgeable professionals is becoming more common.
However, similar acceptance has not occurred in the residential care environment, with uptake hindered by the exclusion of AEP as a recognised allied health profession in the sector’s funding tool.
While future change is possible, given the suggested inclusion of AEPs and improved exercise provision as a physical therapy in the latest Rosewarne report to the government, these changes may be months away meaning older Australians in residential care will continue to be disadvantaged in relation to exercise-derived physical health benefits.
Yet, for residents, the power of exercise is four-fold over their community-dwelling counterparts as a health, wellbeing and quality of life enhancer. For the handful of providers nationally putting gym and exercise knowledgeable professionals into their residential services, the benefits are undeniably positive, however to supply this evidenced-based service provision, they must do so out of the organisations’ own pockets.
Considering the context
Implementing any new intervention requires a focus on the context upon which the intervention is to be embedded. The implementation of exercise into aged care, requires concerted thought, planning and deliberation given the foreignness of evidence-based, beneficial exercise in this sector.
To ensure benefit, feasibility and sustainability, effective context planning must consider organisational characteristics, delivery environment, general and delivery staff knowledge, and intervention efficacy. For example, it is vital to ask questions such as:
- do we have the right resources to support the introduction of exercise in our facility?
- do we have the right exercise knowledgeable staff, such as AEPs?
- what is the value of increasing the program and benefit knowledge of our general staff?
- to what level as an organisation are we willing to invest?
- how ready are our clients to receive exercise in their model of care?
Learning from other organisations that have already adopted exercise as part of normal care is a good place to start. Positive examples are Southern Cross Care (SA & NT), which has embedded exercise delivered by AEPs within its residential facilities as core business.
Burnie Brae in Queensland is another example of an organisation offering a range of home and community-based exercise programs, as well as train-the-trainer models to upskill existing staff.
To support successful healthy ageing among our complex care needs clients, regular exercise must be a core element within the model of care.
The evidence is undeniable. To drive this forward we need to move from “exercise works” to “exercise works, what is the most effective implementation for my organisation?” If we don’t progress this conversation, we risk failing our duty to realise better ageing for our clients.
Let’s stop the talking and start the moving; embrace the evidence and implement exercise as medicine.
Louise Czosnek is an exercise physiologist and policy advisor for Exercise & Sports Science Australia; Dr Tim Henwood is the group manager, connected living, community wellness and lifestyle at Southern Cross Care SA & NT; and Martin Bending is an exercise physiologist and the NSW service delivery manager for Remedy Healthcare, a subsidiary of Australian Unity.
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Well said and an issue that was comprehensively demonstrated at the NZ Otago Convention 2011 which claimed a 35% pushback on early hospital admissions
Its also true to say that blanket provision is theoretically a good approach but in practice there will be a cohort of fitness focussed members who will do their own exercise anyway.
What needs to be done is to identify the non practitioners and get them into a routine.
Needless to say, technology can play a part now where it couldn’t a couple of years ago.
I agree with John that part of embedding exercise in people living at home is to support the non-practitioner who in turn can support the older person.
Another complementary service that could deliver somewhat positive outcomes for community-dwelling older adults is counseling. It has unrecognized potential to improve wellbeing and enhance quality of life. I’m hoping that one day we can look at a range of interventions that benefit people to remain at home rather than have to push for recognition such as counseling.
At ACHGroup we have a long history of Healthy Aging for both residential and community clients .There are many benefits for clients in residential services being active .The use of physical and chemical restraint is reduced markedly .Exercise is used to promote movement ,independence ,improved feelings of achievement and gives hope along the journey .Frailty should not be accepted as the norm as people age ,everybody deserves an opportunity to maximise their independence no matter what their situation .
Great article and very required discussion.
Along with the obvious need for support within the aged care sector to make AEP’s accessible allied professionals, the critical factor of readiness and acceptance of the resident, I feel is dependent on a cultural shift around structured exercise that needs to take place. This shift, in the attitudes of our aging population needs to take place before people end up in care. The shift I speak of is the simple understanding that the older we get the more we need to include structured or formal exercise or activities – opposite to what it is. A popular modern health focus has been on creating active kids in retaliation to the amount of digital ‘screens’ in their lives. Though the biggest void I feel is in mobilizing the aging. I think all age related health warnings should be accompanied by warnings of inactivity and the consequences of loosing strength. Ironically if we were better in this realm across the board, we’d have less people entering aged care in the twilight of their life.
As the daughter of two parents who have dementia and entered a residential facility 7 months ago I can say that no importance is put on providing purposeful exercise programs to residents As a family we have requested both parents have appropriate exercise programs as part of their care plans to maintain their mobility but this does not happen. They have had a least 5 falls between them and we watch their mobility decline daily whereas 7 months ago they were both walking daily independently I feel not providing exercise is a form of restraint as it eventually results in immobility
I have worked in community agedcare for many years and our aim was to improve mobility and encourage independence which I feel is not happening in residential care
If the residents aren’t mobile they’re actually a captive audience