Aged Care Insite Issue 110 Dec-Jan 2019 | Page 23

practical living resilient and adaptable to the stresses placed on it. Also, ensure that the more comorbidities you have, the more you engage with an appropriate health professional, like a physiotherapist, to grade that exercise up. the more comorbidities someone has, the more they should be referred to a physiotherapist. Why is there ageism associated with seniors and exercise? That’s a big question. Most of my work at present is across residential care, but also a lot of work in home care in the community. So I’ll speak to residential care first. Almost all aged care facilities will have a physiotherapist on site, at least doing some assessment and care planning. A part of that care planning practice should be engaging with staff – and that can be care staff, recreational activity officers and so on; it depends on the individual facility and what resources they have. I’m at a residential care facility this morning, and we have some volunteer-run group programs here. We worked with them when we first came into the facility to look at what they were doing, how we could keep it fun, and how we could weave some of the evidence base in there for some challenging balance exercises too, because we know that for falls prevention, balance exercises need to be challenging – they can’t be simple. Also, we looked at what sort of resistance exercises, strength exercises, we could do in that environment. So we’ve got volunteer- led groups and some individual one-on-one work. This facility’s lucky to have a physio aide, so the aide does that work as well. It depends on the resources of the facility, but to keep it simple, engage with the physiotherapist onsite and ask those questions. What are we doing to attack falls? What are we doing to look at managing osteoporosis and osteoarthritis with strength and resistance exercises? With home care it’s a little easier, mainly because the funding there is not a friction point between what we do in terms of care and how we’re funded. So it’s easier to engage a health professional to come out, and whether they work with that person weekly or fortnightly or monthly or whatever their need, or depending on the resource of, say, their home care package, they might have care staff funded with that. So we’re doing some things where we can leave paper-based programs that care staff or family can follow. We certainly have some family working with their loved ones at home, and there are some fantastic exercise-based apps now that care staff can use. The physiotherapist can put those exercises in the hands of the care staff, and they can feel confident looking at a quick video of how to do that exercise and help their person with it. So the takeaway from that question is, when in doubt, ask: What are we doing to improve the exercise outcomes of older adults in residential care and in the community? And make sure you’ve got a policy and procedure on how you’re achieving that. I think there’s ageism against lots of populations, not just older adults. Sometimes we see it towards younger people. Although most of my practice is with older adults, we certainly get members of the community asking: What sort of exercises are safe for younger people? Are heavy weights not suitable for adolescents? So, there’s a lot of confusion out there about which exercises are safe for which groups of people. I think a lot of it comes from some health professionals not keeping up with the evidence base. There’s a lot of literature out there that says certain health professionals are 20–30 years behind the evidence base. So, you have poor education coming from certain health professionals, and you have articles like this Reader’s Digest one that propagate that message. Certainly, in residential care, it can get more complex, but I think I can speak for physiotherapists when I say that we know where the evidence base is for exercises that are safe, meaningful and appropriate for older adults in residential care. However, at the moment, we have a funding tool that somewhat restricts how we can put that evidence in to practice. So you could almost say that the funding tool at the moment is ageist against exercises for older adults in residential care. How important is it to base physical activity on need rather than age? We’ve touched on this a little bit, and always with these conversations it’s a broad bird’s-eye view that we’re taking of things. So I guess I can empathise with Reader’s Digest – they were trying to put out some information and they’ve got someone writing there who took a little bit of information from one or two health professionals. Maybe what the Reader’s Digest could’ve done a bit better was engage with the peak body in their country of origin. So APA would’ve been a good body in Australia to talk to, and they could’ve got someone doing research on exercise and osteoarthritis, like Christian Barton, who would have been able to talk to that subject a little bit better. But when thinking about exercise, you’re looking at those broad topics of physical activities. The Australian government has a fantastic online resource on that – just search for “physical activity Australian government guidelines”. This is a nice resource you can use to talk to consumers, members of the public, or even use yourself. Exercise is medicine, we all know that. Whatever health conditions people are dealing with, and often older adults have multiple comorbidities, there are many things to understand – for example, polypharmacy and drug interactions. So, the more comorbidities going on, the more you want to engage with a health professional so they can tailor things to suit that. For example, someone with osteoporosis comes in to see a physiotherapist, versus someone that comes in with osteoarthritis, and let’s just keep it simple: they don’t have comorbidities. There are going to be key choices relative to the evidence base that the physio is going to recommend in terms of which exercises they should start to look at. So the key message for the general public and health professionals would be to look at that resource if you don’t know what those physical activity guidelines are, and How can aged care or nursing staff encourage clients and patients to exercise? What final message do you want to tell people reading this? For older adults over 50, exercises and challenging strength exercises are safe. Your body is resilient, robust and will adapt to the demands you place on it. If you want to get stronger, do certain resistance exercises that are challenging. These sorts of challenging strength exercises, and also cardiovascular exercises, are in the best interests of your health outcomes as you age. You will live longer and you will have better mood. The interactivity between physical activity and mental health is well documented. For osteoporosis, it’s going to strengthen your bones. For osteoarthritis, it’s going to help you with the pain. It goes on and on, and no matter what health condition or conditions you’re living with as you age, exercise needs to be your first medicine, and everything else is secondary in our mind. ■ agedcareinsite.com.au 21