“Long-term Care in Motion“

Katrin Claßen1, Hans-Werner Wahl1, Carl-Philipp Jansen1,2 & Klaus Hauer1,2

1Department of Psychological Ageing Research, Heidelberg University 2Agaplesion Bethanien Hospital, Heidelberg & Heidelberg University

European Forum on Social Innovations for Healthy and Active Life Expectancy

25. 09. 2013, Lund

Overview

• “Long-term Care in Motion” (LTCiM) as part of INNOVAGE

• Healthy and active ageing in LTC residents

• Physical activity (PA) as fundament of LTCiM

• Overall ambition of LTCiM

• Social innovative component of LTCiM

• Current state and interim findings

INNOVAGE and LTCiM

Overall goal of INNOVAGE:

WP 1

Increasing Healthy

Life Expectancy

WP 4

Improving Obesity

Related Outcomes

in Old Age

WP 5

Long-term Care in Motion

WP 2

User-driven

Housing for Older

People

WP 3

ICT-based Social

Support for Carers of Older People

WP 6 Knowledge

exchange and transfer

WP 7

Management

“[…] develop and test

as well as survey and

catalogue, social

innovations that will

have a solid impact on

improving the quality of

life and well-being of

older people.”

Background of LTCiM

Goal: Improve healthy and active ageing in a vulnerable population at

high risk of inactivity, decreased Quality of Life (QoL), isolation, and

impaired healthy life expectancy

Project Background

• Despite the positive effects of PA even in very old age, LTC residents are at

high risk of inactivity and respective negative consequences

• LTC residents may have the lowest likelihood to be addressed by social

innovations (therapeutic pessimism; incarnation of “negative ageing”)

• Novel approach based on combined PA training and psychosocial

intervention and latest motion tracking technologies

• Use of cutting-edge tracking technology as a means for assessing user

needs in the LTC setting

What does healthy and active

ageing mean …

…for the specific group of LTC residents?

- Maintaining mental capacity and mental well-being at the highest level

possible

- Maintaining physical functioning at the highest level possible

- Maximizing autonomy, participation, quality of life and well-being

…but how to reach this?

PA as fundament

Physical

Activity

Motor

Status

Emotional

Status

Cognitive

Status

Quality of Life, Autonomy, Participation

PA as fundament

• PA training literature mostly focuses on “normally ageing” older adults

living in the community and thus focuses on those being still rather well in

physical and cognitive functioning

• (Motor) Performance is primary study endpoint in previous LTC-studies. No

systematic review available, assessment methodology limited

• It remains unclear how increased activity (risk reduction vs. risk exposition)

will influence risk of falling

• Psychologically based social-ecological intervention components have so

far not been widely established in RCTs using physical training/activity

promotion in LTC settings

Research Gaps

Research on PA promotion in LTC limited and in need

of innovative future directions

Ambitions of LTCiM

Goal 1: Reviewing existing research in the domain of PA in LTC

• Systematic review(s) on PA-interventions as well as psychosocial

interventions in long-term care

Goal 2: Establish a “natural lab” to learn more about motor behaviour

LCT settings

• State of the art measurement of activity behaviour and life-space with

high-end sensor technology in one specific nursing home as “natural

lab”

• State of the art measurement of psychosocial constructs (e.g.

personality, quality of life)

Ambitions of LTCiM

Goals 3: To get the whole LTC facility in motion with particularly increasing

LTC residents’ PA. Evaluate effects based on an innovative combination of

outcome methodology

• Implement various strategies of end-user tailored physical activity

interventions targeting heterogeneous subgroups of residents living in a

large long-term care setting

• Involvement of staff members (and relatives) in a psychologically based

social-ecological intervention

• Enrich environment to create activity motives (Serious Games)

Accounting for residents’ wishes and needs (pre test)

Evaluate feasibility and effectiveness of interventions with a unique set of

assessments (pre-post mixed methods evaluation)

LTCiM and social innovativeness?

Answers from LTCiM…

• Documentation and exact mapping of PA in LTC as well as

residents’ life space Quantitative data on PA in LTC; barriers

and facilitators for PA

• Objective assessment of residents’ psychosocial constructs

Quantitative data allowing for more extensive analysis on PA in

LTC

LTCiM and social innovativeness?

• Supervised evidence-based training groups aiming at the

activation and increase in motor and cognitive performances

which are most relevant of mobility and motor security

Realization in LTC setting

(Sub)group specific approach

according to motor and cognitive status

as well as individual preferences

LTCiM and social innovativeness?

• Implementation of Serious Games Component Motivation

of persons not addressed by established groups programs;

possibility for trial and error; giving back autonomy to

residents

LTCiM and social innovativeness?

• Setting approach Behaviour changes at multiple levels

Residents

Organi-

sation

Relatives

Staff Environ-

ment

Staff as interactive partners

Significant

Others

Common agenda for staff and

relatives; joint groups Creation of

activity motives

Inclusion of further

stakeholders

Process orientation

Possibility of feedback-loops

LTCiM and social innovativeness?

Current state and interim findings

• Systematic review(s) considering existing research on interventions in

long-term care with impact on physical activity (PA) as well as psychosocial

interventions

• Exchange and cooperation with experts in the field of implementation

research (e.g. Prof. Schäufele, Prof. Kempen, Prof. Becker, Dr. Notthoff)

• Cooperation with Farseeing

• Preparation of Research Setting (e.g. planning discussions with nursing

home director and other responsible persons, on-site visits and participation

in residents group offers)

• Preparation of intervention programme (PA promotion and psychosocial

component) and compilation of self- and proxy structured questionnaire

• Selection of motion/tracking sensors, implementation

Project Components and Project Flow

Content Time Line

1/13 2/13 3/13 4/13 1/14 2/14 3/14 4/14 1/15 2/15 3/15 4/15

Preparation of intervention setting and research update

Preparation of intervention program and assessment methodology

Establishing outcome assessment

Intervention related training

Implementation of intervention

Implementation of follow-up assessments

Data analysis and dissemination/ implementation of findings

Thank you for your attention