Better Bones Better Balance _ Keeping Older People Well through Exercise in the Community

Description

aile Mhuire are a voluntary organistaion charity providing services for older people since 1988. Baile Mhuire Day Care Centre is a company limited by guarantee and has a total of nine members on the Board’ of Management. Baile Mhuire Ltd is a registered Charity, CHY 15602, CRO Number 350235, CRA No 20054267.
The Service operates a Day Service for Older Persons, Stroke Day Service, Meals On Wheels, Memory Technology Resource Room, Currently developing a Neuro Functional Zone
and run a Better Balance Better Bones Programe which this application focues on

In Ireland, it is estimated that 126,300 older adults live alone with 36,000 of those individuals experiencing a functional disability which impacts their activities of daily living (ADL) (Kenny, 2020). Physical activity is widely acknowledged as being crucial for the maintenance of positive health. WHO have reported that physical inactivity is one of the main determinants of poor health and risk of mortality worldwide? It is widely reported that physical activity levels decrease with age particularly among those aged 65.
Falls and falls related injuries are common among older adults and have a devastating effect both for the faller and a significant economic consequence for health services

There is strong evidence to support the positive affect that exercise can have on the effects of ageing including maintaining bone mass and balance, improved sleep, cognitive function and mood all of which can reduce the older person’s risk of falling. Barriers to exercise for the older population can include the lack of opportunity and specifically age appropriate opportunities to exercise safely in their communities. The fear of falling associated with reduced balance and as a result of having experienced a fall can further reduce the person’s willingness to engage in exercise. Hence the older person can become deconditioned and experience muscle and bone loss both of which increase the risk of falling and the likelihood of a fracture from the fall. As recommended by the National Falls and Bone Health strategy community based programmes aimed at the well elderly are an important component of the aims of the strategy.
In 2019. Baile Mhuire Services for Older Persons submitted a funding proposal to the HSE to establish a community based exercise programme for older adults. The Better Balance Better Bones programme is an evidence-based programme targeting strength and balance for low risk community dwelling older people, it aims to maintain strength and balance and hence reduce the risk of falling
The programme is being provided by trained exercise professionals employed through Baile Mhuire Services providing a cost effective model for service delivery. This evidence based strength and balance programme has been designed by the Primary Care Physiotherapy services in Cork
The eight weeks exercise programme is provided throughout the county in community settings with high attendance at the programmes with up to 350 older adults exercising on a weekly basis

Aim of Initiative

The aim of the BBBB to support older adults to live well and to live independently for as long as possible. Both in Ireland and internationally people are living longer and there is an increasing proportion of older adults in the population. As such, the maintenance of health and physical function for older adults is of critical importance. Physical activity is widely acknowledged as being crucial for the maintenance of positive health, particularly for older adults. Research has suggested that physical activity programmes are an effective means of engaging older adults in physical activity for the promotion of positive health.
A number of physical activity programmes have been developed and implemented worldwide for the purpose of engaging older adults in physical activity. The the Better Balance, Better Bones (BBBB) programme. aims to facilitate increased levels of physical activity for older adults in order to promote positive health outcomes for this demographic. The programme is delivered in community settings consisting of an 8‐week physical activity programme, repeated several times each year, to incrementally improve strength, balance, and general aerobic fitness in older adults. The programme consists of an aerobic warm up including endurance exercises, walking and range of movement stretches. The programme predominantly features exercises to improve balance, joint and muscle flexibility, and strength. In addition, exercises to practice at home, in the form of an ‘exercise of the week.

Who is it aimed at

The aim of the BBBB to support older adults to live well and to live independently for as long as possible. Both in Ireland and internationally people are living longer and there is an increasing proportion of older adults in the population. As such, the maintenance of health and physical function for older adults is of critical importance. Physical activity is widely acknowledged as being crucial for the maintenance of positive health, particularly for older adults. Research has suggested that physical activity programmes are an effective means of engaging older adults in physical activity for the promotion of positive health.
A number of physical activity programmes have been developed and implemented worldwide for the purpose of engaging older adults in physical activity. The the Better Balance, Better Bones (BBBB) programme. aims to facilitate increased levels of physical activity for older adults in order to promote positive health outcomes for this demographic. The programme is delivered in community settings consisting of an 8‐week physical activity programme, repeated several times each year, to incrementally improve strength, balance, and general aerobic fitness in older adults. The programme consists of an aerobic warm up including endurance exercises, walking and range of movement stretches. The programme predominantly features exercises to improve balance, joint and muscle flexibility, and strength. In addition, exercises to practice at home, in the form of an ‘exercise of the week.

3 Steps critical to success

1. Collaborative approach-/ Community Based
   The BBBB provides classes throughout the county thus facilitating those without transport which can be common in rural parts of the county. The use of local community venues often entices participants and the socialisation with neighbours/friends again assists with a high attendance rate at each class. Community based services mean that older adults can access the service easily and have an increased adherence to the programmes.
   The success of both BBBB relied on the collaborative approach and successful working relationship between the HSE and Baile Mhuire. It is community focused and governed by a well established organistaion who are providing services for older people since 1988
   Baile Mhuire are aligned it to other key services such as the dementia specific day centre, the HSE ICPOP team etc. . Its proximity to these key services yet distance from the busy acute services made it the ideal location for the service
2. Evaluation The Munster Technological University were a key partner in developing the project and evaluation was built in to the roll out of the project
   An evaluation was carried out by Health & Leisure Master Research Student which focused on ther Exercise Intervention Programme _ Better Balance Better Bones .
   The evaluation found that ‘Participants reported to experiencing both physical and psychological improvements attributed to programme participation as well as educational benefits related to the development of home-based exercise skills. Furthermore, the social benefit of the programme was highlighted as a key feature, with all participants noting the social support which was received throughout the programme as being instrumental to their enjoyment of the programme. From these outcomes it is clear that the programme was effective for many participants at eliciting the intended effect of improving physical and psychosocial health for participants as well as increasing participant knowledge of physical activity. Programme experience was reported as being extremely positive with organisational aspects of the programme leading to participants enjoyment
3. The BBBB provides classes throughout the county thus facilitating those without transport which can be common in rural parts of the county. The use of local community venues often entices participants and the socialisation with neighbours/friends again assists with a high attendance rate at each class.

3 Challenges in Planning / Delivery

1. COVID ; COVID posed a significant challenge however the programme transitioned very succesfully to Zoom, BBBB programmes are still operating some programmes via Zoom. In addition to online BBBB classes via Zoom , the Exercise Facilitators provided short exercise chair based exercises every day through out lockdown through Baile Mhuire Face Book Page . This had huge hits through the FB page.
   In the process of completing the first cycle of the research in March 2020, the Covid-19 pandemic escalated to the level where a countrywide lockdown was implemented. This lockdown had a profound impact on the research project due to restrictions placed on movement, social distance requirements, facilities closing, and exercise classes being cancelled. The pandemic was especially impactful on the present study due to the participants of the study being considered to be at high risk due to the age profile of participants (aged 65+). When the lockdown occurred, the researcher had just implemented the evaluation protocol which had been developed as per the aim of the study. Due to these restrictions the researcher was unable to continue working towards that initial aim and instead a change of methodology was required.
   The new methodology proposed involved conducting telephone interviews with programme participants in order to perform an evaluation of the programme. This evaluation would relate to perceived programme outcomes, programme experience, and barriers and facilitators to physical activity. As a considerable amount of work had already been completed from Phase 1 of the research, including the development of an evaluation protocol, the researcher felt it unwise to abandon this information.
2. Venues ; Venues in some rural areas posed a challenge to get a hall with a large hall , however through collaboration with HSE Community Work Dept and collaboration with other stakeholders , these obstacles were overcome.
3. ADmission / discharge .People are slow to leave programme , we liiase with physio and oIt can can be challenging to ensure the correct people are accepted onto the course this is when the collaboration with Physio comes into play as individuals can be assessed by Physiotherapy and they can signpost people to appropriate programmmes
   Another challenge is that people participating in the programme really enjoy the and it be challenging to discharge people off the programme however we have worked with other providers in signposting people to other programmes such as walking clubs , social prescriber etc. People are encouraged to continue with the programme however we encourage breaks also due to large weight lists /demands
   ther stake holders referring them on to other initiatives.

3 Outcomes / Benefits

1. The evaluation found that ‘Participants reported to experiencing both physical and psychological improvements attributed to programme participation as well as educational benefits related to the development of home-based exercise skills. Furthermore, the social benefit of the programme was highlighted as a key feature, with all participants noting the social support which was received throughout the programme as being instrumental to their enjoyment of the programme. From these outcomes it is clear that the programme was effective for many participants at eliciting the intended effect of improving physical and psychosocial health for participants as well as increasing participant knowledge of physical activity. Programme experience was reported as being extremely positive with organisational aspects of the programme leading to participants enjoyment
2. Feedback from participants and large waiting lists
   The following quotes demonstrates the functional benefits the participants are achieving following the completion of programme• “I can put on my clothes on without leaning against the wall”
   • “I can now reach up to open the window”
   • “I find it easier to play with my grandchildren”
   • “I can bend down to take items out of the bottom press without sitting on a stool”

   Success has provided an easy platform for the establishment for a further more specialised Falls ex programme- Ex professionals have been trained to become Postural Stability instructors and can now in addition to the BBBB programme provide falls groups for older adults at higher risk of falls. The upskilling of the ex professionals facilitates specialised programmes to be provided in the community.

3. Success has provided an easy platform for the establishment for a further more specialised Falls ex programme- Ex professionals have been trained to become Postural Stability instructors and can now in addition to the BBBB programme provide falls groups for older adults at higher risk of falls. The upskilling of the ex professionals facilitates specialised programmes to be provided in the community.