Improving Later Life

Blog from our newest AHP National Consultants, Jenny ACKLAND and Yolanda STRACHAN.

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It’s harvest time already! Jenny and I joined Age Scotland six months ago in February, when actually the weather wasn’t that bad and you could see some green shoots starting to come through.

It has been a great summer and an even greater six months since being in post and we are delighted to have this opportunity to tell you a little more about our role and some of the work we have been harvesting.

Partnership Working

Ours is the fourth of the Allied Health Professional (AHP) Consultant posts to be created within the third sector. For those who are uncertain, third sector comprises not-for-profit organisations and is sometimes also known as the voluntary sector. We also have AHP colleagues working with the Care Inspectorate, Alzheimer Scotland and the Alliance Scotland.

Our posts were created by the Chief Health Professions Office at Scottish Government. Those of you who know your Reshaping Care for Older People will recognise the context for these posts; of ’building partnerships with third sector organisations in order to develop new community driven models of care which help older people maintain their independence’ (and a better quality of life) wherever possible.

Our passion is older people and it might surprise you to know that here at Age Scotland ‘older’ encompasses everyone from the age of 50 years upwards. I love this definition of ‘older’ because it widens the scope of our role and the kind of projects we can look at to increase the awareness of our AHPs and the contribution they make to the health and wellbeing of older people especially in the areas of public health information and prevention.

Raising awareness is a significant part of our work and it can take many forms.  Everything from contributing the AHP perspective to responses to consultations emanating from Scottish Government to helping with broad enquiries coming through Silver Line Scotland, Age Scotland’s Information, Friendship and Advice Helpline for Older people.

An equally important part of our role is to provide our AHPs with information about the support and resources that Age Scotland provide for older people. Having that knowledge base about the kind of supports available in their areas and nationally from third sector organisations is vitally important for helping AHPs meet the aspirations of their patients for life as they would have it and to petition for service change on that basis. Age Scotland has over 900 member groups. These are organisations big and small who are out there working to ensure that older people enjoy a better later life. Have a look at Age Scotland’s website and the resources available and then please do come back to myself or Jenny if you would like to know more.

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One of my favourite questions when I meet other colleagues and professionals is ‘What is keeping you busy today?’ It can often be too much to explain an entire work plan but asking people to tell you where their energies lie on a particular day can be really satisfying for them and you. This is the question I used when I first joined Age Scotland to try and understand the many different roles of the people working here. Jenny and I ‘sit’ with the Policy and Communications Team This is a very lively group of very talented professionals whose role is to campaign on behalf of older people.  I use the word ‘sit’ loosely because one of the flags Jenny has been flying very strongly for us since arriving here is the work on Understanding Sedentary Patterns and how these contribute to ill health. We are soon to take delivery of a prototype of a standing desk, currently being built by one of our Men’s Sheds. If you haven’t heard about Men’s Sheds you might want to take a look here.

We also work closely with the Information and Advice Team, again who represent an incredibly diverse skill and knowledge base, contributing to health information projects where we can and recruiting in the expertise of AHP colleagues as needed. You may get a call from us!

badgeSo…  What has been keeping me busy today? …… I have been meeting with my colleague and health information writer to discuss her findings from a scoping exercise on older people and mental health. I’ll be using this information to represent Age Scotland and our AHPs on a short life working group at Scottish Government looking at psychological services for older people. There are many reasons why our older people have poor access to and uptake of these services so it would be really wonderful to make progress on this issue.

I have been following up with some of our AHPs on articles they have written for Age Scotland Advantage magazine. One of the things that has pleasantly surprised us since being in post is the discovery that people are genuinely very interested in who the Allied Professions are and this is a great way to highlight the very practical help and advice that AHPs can offer.

I have been continuing in dialogue with some of our NES career fellows on questions they have raised regarding co-production and achieving consensus following a visit here to Age Scotland.

Finally I have been scoping for future work streams. One of the things I find most enjoyable about my new role in third sector is the sheer diversity of the work being carried out to ensure that older people can love later life. This is an aspiration we all share as AHPs working with older people.

And what has been keeping Jenny busy today? There have been a few bits of work in progress that I can tell you about.

The former Scottish Pre-retirement Council and the former Tayside Pre-Retirement Council joined forces with Age Scotland in July this year and we have been asked to provide a health and well being input to their training days. Jenny participated in one of these training events herself last March prior to her own voluntary early retirement and she can hardly believe that she will be on the delivering end of this training come September.  Keeping well and active is very dear to our hearts and we are planning an interactive session that we hope will be interesting and of value for the participants approaching a new and exciting chapter in their lives

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An element of our workplan is to develop and evaluate practice placements for student AHPs. Our AHP Consultant colleagues in Alzheimer Scotland and the Care Inspectorate have developed contemporary placements for students in care homes and in the third sector in conjunction with NES.  We would like to learn from the experience of our colleagues and currently Jenny is arranging a meeting to debate and agree a way forward for some innovative AHP student placements in the third sector.

Jenny is representing Age Scotland on the dissemination advisory group associated with the Seniors Understanding Sedentary Patterns (USP) study being led by Professor Dawn Skelton at Glasgow Caledonian University. Part of our role on this group is to share information about the study and the

 health risks associated with sedentary behaviours – or prolonged sitting within our member groups and with our own staff. Dawn has organised a free webinar on 27th August to share information and you can register for this and other free informative seminars via the Seniors USP website

An interesting and very pragmatic consequence from this work has been the recognition that we ourselves in Age Scotland are very sedentary indeed … we are sitting a lot at our desks working on computers all day. We have been chatting a lot about how we can change this pattern and if we can possibly work differently and be a bit more active in our workplace. There is also a view that we need to be ’walking the talk’ in terms of being less sedentary if we are really trying to encourage and empower our older people to do the same.

UnknownThere is a real energy and enthusiasm to try and change how we work and every team in our office and wider has put forward a representative to be part of a group that will debate ideas to be more active and practically workable for their particular team. I mentioned earlier about the Mens Sheds initiative and we are so excited about the delivery of our very own custom made standing desk. Our CEO at Age Scotland Brian Sloan has very kindly championed and taken this forward for us with one our Mens Shed groups.  Mens Sheds have a core purpose of engaging and utilising the crafting skills of our older people and this group has designed and is actually producing a piece of furniture for our office that has the potential to improve the health outcomes for our staff – WOW!

For us this is co-production in its essence and it just can’t get any better than that!

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Finally, Jenny has been planning for – and what turned out to be a really fabulous day in the middle of August at the Scottish Parliament. Age Scotland had been invited to work in partnership with podiatry colleagues from the Society of Chiropodists and Podiatrists to share information about our work with politicians and visitors in the garden lobby. We had the opportunity with the help of our policy officers to engage and network with a wide range of people and it was a real joy to talk about the issues that are important to older people and the benefits of good footcare – and the real difference this can make to peoples independence, mobility and quality of life.

Serious….for a reason

 

Serious for a reason – The importance and consequences of red flags – by Mick McMenemy Physiotherapy Clinician and Annie Glover – Founder & Chair of Cauda Equina Syndrome UK

Cauda Equina Syndrome is a relatively rare occurrence but has such potentially serious consequences that it should be screened for in every patient presenting with low back pain. Increasingly patients have direct access to Allied Health Professionals [AHPs] so it is imperative that we have a good understanding of this condition, know how to screen for it and crucially, know what action to take if CES is suspected.

This is of major importance to physiotherapists who typically will be recognised as the health professional of choice to assess and manage the patient with low back pain.

 

UnknownThe physiotherapist will routinely be presented with the patient who has either self-referred without seeking advice from their GP or who has been advised by their GP to self- refer for treatment but without a medical examination being carried out.

We therefore have to actively assume that there is a possibility that the patient being assessed may have some kind of undiagnosed serious pathology (until we have checked) and that we must immediately screen for these before actively assessing and treating the patient.

Recently, there has been a growing criticism of the current use of lists of red flags. Lists of red flags ( signs and symptoms of serious pathology) often contain flags with little evidence of predictive value and mix together flags of different serious pathologies which is unhelpful and confusing to the health professional, particularly the non-expert in that specific serious pathology. For example, flags for Osteoporotic fracture, infection and CES are often included in one list; these conditions are quite different and have very different signs and symptoms. Confusing lists create the risk that clinicians will miss a specific condition or refer patients to specialists unnecessarily.

UnknownMartin Underwood (2014) has called for a move towards using ‘clusters ‘of red flags for a specific pathology. For example, if screening a patient for CES the following might be asked: since developing your back pain have you had any new symptoms such as

  • Loss [or change] of control of your bladder i.e. incontinence or lack of control such as incomplete voiding or retention.
  • Loss [or change] control of your bowel i.e. incontinence, constipation
  • Saddle anaesthesia (numbness around the perineal area)
  • Gait disturbance; tripping or unsteady on your feet]

 

If screening for undiagnosed cancer the key red flags are:

  • Past Medical History of cancer
  • Elderly (over 55 with increasing risk with increasing age)
  • Unexplained recent weight loss

You can see the two different conditions are naturally screened for quite differently and if present require quite different management; suspected CES is an immediate transfer to Accident and Emergency for medical assessment, undiagnosed cancer is referred urgently to the patients GP for their assessment.

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National audits in Scotland showed marked variation as to whether screening for serious pathology was even recorded never mind which flags were screened for. Current practice continues to see a wide variation in practice on which flags are screened for and whether this is recorded. This is surely not desirable?   [click here for most recent work around this]

Shifting to a new paradigm of using and recording the screening of specific serious pathologies by implementing the use of ‘clusters’ of flags for each relevant specific condition would be a significant step for AHPs to systematically demonstrate that patient safety is central to our care. The development and utilisation of a standard screening tool would be very helpful for health professionals who are trying to help their patients and not harm them. Most importantly and fitting with the National policy on patient-centred care, routine screening will minimise the risk that patients are harmed due to a serious pathology being missed at the earliest opportunity.

Annie Glover in her blog below describes the personal catastrophic effects that result from suffering CES. Tragically, despite the long- existence of clear guidelines on how to screen for CES (CSAG on back pain 1994), this condition is often still not diagnosed quickly enough to avoid serious medical, physical and emotional consequences to the patient.

Continue reading

Let’s get bothered about self management!

Let’s get bothered about self management! louise.gibson@alliance-scotland.org.uk from Health and Social Care Alliance Scotland (the ALLIANCE)

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With Scotland’s aging population comes the challenge of living with multiple conditions. People living with multiple conditions are more likely to be admitted to hospital, more likely to be prescribed drugs and have a poorer quality of life. Self management is key to improving outcomes for individuals with multiple conditions – allowing people to live their lives better by being more informed, prepared for everyday challenges and better supported when they need it.

What is self management?

Self management is based on a ‘strengths’ or ‘assets’ based approach. It means working collaboratively with people’s strengths so that together you find the best outcomes and the way to move forwards.

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How can Allied Health Practitioners engage in self management?

Allied Health Practitioners (AHPs) can take a shared approach to setting goals and problem solving and can take account of peoples inherent ability for self-healing whilst recognising people with long term conditions as experts in their own life circumstances. Through meaningful conversations, AHPs can encourage self confidence and support people to have more control of their conditions and lives.

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Self management makes a difference

Research shows that supporting self management improves:

  • self care behaviours
  • quality of life
  • clinical outcomes
  • patterns of healthcare use

When people are supported to look after themselves:

  • they feel better
  • enjoy life more
  • have less need to visit their doctor or hospital.

By practising self management, AHPs can relieve some of the pressure placed on health providers and help relieve the 70% expenditure which long term conditions are estimated to consume from health and social care resources.  

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The figure above shows the journey of a person living their life with a long term condition. The green line depicts the fluctuations associated with managing a long term condition, while the red stripes indicate the episodic consultations from health and social care practitioners. While people themselves are the principle contributors to their health and wellbeing, there are opportunities for AHPs to positively assist with this journey.

 

What supports self management

  • Gaun Yersel: The Self Management Strategy for Long Term Conditions in Scotland (2008)
  • Mental Health Strategy for Scotland 2012-1015
  • A Route Map to the 2020 Vision for Health and Social Care (2013)
  • House of care:

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When to endorse self management.

Now, Now, Now! Supporting self management is essential to the sustainability of delivering quality healthcare services across Scotland. A national acknowledgement of the importance of the individual being at the centre of their health and social care makes it an essential time to embrace an asset based, self management approach.

My Condition, My Terms, My Life

The Health and Social Care Alliance Scotland (the ALLIANCE) has launched the My Condition, My Terms, My Life campaign to share the message that living with a long term condition does not stop you being in charge of your own life. The campaign aims to:

  • help improve public understanding of what self management means for people living with long term conditions, and
  • encourage people living with long term conditions, and the people who support them to adopt a self management approach

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The ALLIANCE would welcome collaborating with any AHPs promoting self-management who are looking for advice, support, guidance and materials in their work.

All enquires to louise.gibson@alliance-scotland.org.uk or call 0141 404 0231.

 

For Allied Health Professional information related to Long Term Conditions please contact heather.hall@alliance-scotland.org.uk.

Should OTs be taking a tablet?

Should OTs be taking a tablet? Use of touch screen apps in early dev. By Melanie Ross Specialist OT, Keycomm AAC service, Edinburgh

Adapted from original in OT news with permission and thanks -Paediatric OT and portable touch screens in early development – Should OTs be taking a tablet? 

One of the common goals for Lothian’s Communication Technology service (Keycomm), and the Paediatric OT service at the Sick Children’s hospital in Edinburgh is to provide support for young children with complex disabilities to learn and develop through play. In Keycomm, I work predominantly with the under fives, or those at a very early developmental level, using technology and adapted or switch accessible toys to support access to play. I am increasingly aware how many children have regular access to touch screen devices.

ipad mum and toddler

At home they may relax with youtube clips on Mum’s ipad; While waiting for an appointment, they watch or listen to music on Dad’s iphone; and almost every nursery/school has access to touch screen tablets, ipads or smart boards. Apple sold 3 million ipads in 3 days in 2012 and sales have continued to soar. There are a vast array of apps tailored for children, both with and without disabilities and many specifically geared to the interests and learning styles of children with conditions such as Autism Spectrum Disorders and Down Syndrome.

There is an ongoing debate at many levels about the impact of “screen time” on the youngest learners. In October 2013, the American Academy of Paediatrics’ position statement, based on analysis of existing research, re-asserted that television and similar entertainment media should be avoided for children under 2. Key researchers like D Christakis (2009) support this with convincing arguments, concerned about the way in which television in particular is experienced as a passive, isolated activity for so many children. However, there is also support for the argument that video, television and touch screens (in particular) have potential for learning. There is admittedly little robust research in this area, but some studies have concluded that because the interaction required from the user of a touch screen device may enhance the potential for learning and may counteract at least some of the concerns around passive viewing e.g with a standard television. Stephenson and Limbrick (2013) have published a meta-analysis of studies with (mostly older) individuals with learning disabilities which may be of interest to readers.

ipad toddler tongue out

There is little or no substitute for interpersonal play. However, we must accept that touch screens are part of everyday experience for even the youngest children. In my experience, considered use, facilitated by an adult play partner and requiring response and interaction from the child, has little potential for harm, and strong possibility for good. Certainly, OT’s in our paediatric service and no doubt many others are embracing it, as we always do, with our analytic and pragmatic, solution focus.

Asking the question “how can this tool help to achieve our goals?”

For learners at early developmental stages, touch screen “Apps” have advantages. The high contrast, movement rich, audio-visual mix seems to promote attention and concentration in children who are otherwise hard to engage. Apps certainly suit visual learners, including those with Autistic Spectrum disorder and the huge variety of free or almost free apps increases the chances of finding something that really captures the special interests of the child. Apps can reward simply making a sound (e.g. apps like “furry friend”, sock puppets, Speak up*). For those who, perhaps with postural support, can control a reach or touch with even 2-3 fingers together on the screen there are visual and auditory rewards (apps like Electra*, imeba*, play piano and magic piano) and for children with the motor control to touch a target area, repeat a touch, swipe and drag a whole world of possibilities for learning and play are available. This seems particularly pertinent for those children whose access to a wider world of experience is restricted by illness or physical fragility.

There are of course drawbacks – touching over a larger surface area or “swiping” can unintentionally close the app or activate unwanted functions. However, guided access and other accessibility settings on ipads and iphones can help reduce these problems. An array of robust cases and screen protectors are now available too, thus avoiding very expensive accidents! The conclusion I have reached is that when the right apps are offered to any child they provide immediate and consistent feedback in a variety of forms (sound, colour, visual movement, etc), and are often very motivating, because, as one parent put it “they are just built to be great fun.”

(*from Sensory App House),

Through discussion with many parents, educators, speech therapists and other OTs. I have compiled a list of apps for developing early interaction and touch screen skills. This is available on Keycomm’s website at www.keycomm.weebly.com and is very much an evolving document with hyperlinks to (as far as possible) free apps. To promote goal centred use of apps, they are arranged in an approximately developmental sequence, starting with those that seem most effective at developing attention, then those for children who show desire to interact with the screen by making a sound or touching. Later apps encourage more precise touch, repeated touch, swiping and dragging. Currently the list also includes apps which develop skills for early writing/hand control and some fine motor skill apps for more advanced learners, but these may be re-located in their own advice sheets soon.

With such a multitude of apps available, including supporting daily living, social and behaviour skills, personal organisation, communication, etc, finding the right one for individual learning needs and preferences can seem a daunting task. Many apps seem to be marketed for a target audience, e.g. “for children with autism” but may be inappropriate for the age and stage of a particular child with that condition. It can be hard to find quality sources of unbiased, professionally qualified, pragmatic advice. I and colleagues have found Ian Bean to be an excellent UK authority on applying apps for early learners in special education. His website http://www.ianbean.co.uk/ has links to his facebook and twitter accounts which are very regularly updated with new ideas for apps, as well as lots of other ideas for using ICT with children with additional needs. In the US, Kate Ahern manages a very active blog at www.teachinglearnerswithmultipleneeds.blogspot.com/ ‎. This has links to so many other useful sources I feel obliged to give the warning to only open it when you have at least an hour to spare!!

Touch screen technologies are here (and there and everywhere!) to stay. I would love to inspire interest and an ongoing discussion about how we as a profession access and harness their potential across our diverse areas of practice.

REFERENCES

Christakis, D (2009) The effects of infant media usage: what do we know and what should we learn? Acta PaediatricaVolume 98, Issue 1, pages 8–16, January

American Academy of Pediatrics (2013) “Media and children”

Apple Press Info. (2012). Apple sells three million iPads in three days. http://www.apple.com/pr/library/2012/11/05Apple-Sells-Three-Million-iPads-in-Three-Days.html. Accessed 14 February 2014.

Stephenson J • Limbrick L (2013) A Review of the Use of Touch-Screen Mobile Devices by People with Developmental Disabilities J Autism Dev Disord, July 2013

2nd Chance to View: AHP leadership in the fight against obesity

ahpscot:

With the consultation period for the “Scientific consultation: draft SACN Carbohydrates and Health report – June 2014″ now open (http://bit.ly/1lYw4BC) and the launch of Public Health England’s discussion paper “Sugar reduction: responding to the challenge.” we thought we’d give a little more food for thought by giving you a second chance to view a blog from earlier this year. Please feel free to comment and join the discussion.

Originally posted on AHPScot Blog --->AHPs Sharing Information:

AHP leadership in the fight against obesity 

Linda Hindle, Chair of DOM UK [Dietitians in Obesity Management]

@hindlelinda

The obesity epidemic is a societal problem which will only be solved by simultaneous action at many levels and by a wide range of partners.  AHPs are rising to this challenge but we need to do more and faster if we are to tackle this ‘ever-growing’ problem.  Not surprisingly, dietitians, with their focus on food, are at the forefront of the fight against the nation’s obesity epidemic.   DOM UK is a specialist group of the British Dietetic Association dedicated to supporting health professionals to prevent and treat obesity.  Members of DOM UK are leading multi-agency strategies to tackle adult and childhood obesity, providing expert specialist input to bariatric surgery teams, informing national guidance and policies, supporting the provision of clear evidence based information to the public plus a range of local innovative…

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2nd Chance to View – Celebrating the launch of the ‘Personal Footcare Guidance and Resources – A Video Blog

Launch of the Personal Footcare Guidance and Resources

The Personal Footcare Guidance and resources were launched in September 2013.  Delegates were asked two questions about the guidance

  1. What is the best thing about the guidance
  2. What is your take home message from the launch

Here is what they had to say……

http://youtu.be/WSbjwVls72g

With thanks to

  • Jenny Ackland, National AHP Lead for Personal Footcare 
  • John McConway, Podiatry Manager, NHS Ayrshire & Arran
  • Karen Utting from the Society of Podiatrists and Chiropodists
  • Tracy MacInnes, AHP Officer, Scottish Government
  • Allister Kelly, Podiatry Manager, NHS Dumfries & Galloway
  • Pauline Johnston, Practice Development Podiatrist, NHS Greater Glasgow & Clyde
  •  Jacqui Lunday-Johnstone, Chief Health Professions Officer, Scottish Government
*[You can contact Jenny via email @ jenny.ackland@ggc.scot.nhs.uk]

Fully detailed information and resources to share and use can be found on the new footcare guidance web site http://www.lookafteryourfeet.info Click here to be redirected to it. 

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