Rehabilitation Case Studies: BGS Autumn Meeting 2023

The CAPA Team are changing the culture of the delivery of rehabilitation in Nursing homes. The Programme was commenced within the Care About Physical Activity Improvement Programme within the Care Inspectorate in Scotland; looking to use an improvement approach to help care providers build physical activity and more movement into the daily lives of residents in Care Homes and beyond. The CAPA service in East Dunbartonshire have 3 main strands of work : 1.AHP Support to Care homes; providing Physiotherapy and Occupational Therapy, with Senior Healthcare Worker support to our 14 Nursing homes, to maximise opportunity for rehabilitation and reablement to residents.

2.Care About Physical Activity intervention, building on the work of the Care Inspectorate by embedding physical activity into each and every resident ensuring inclusion and access for all.

3. Prevention and Management of Falls and Fragility Fractures in Care homes. Offering support, care and treatment to residents and staff in line with the Scottish Care Inspectorate Tool on same. This can be in the form of training and assurance visits to Care Homes, as well as assessment, care and treatment of fallers.

Positive outcomes for older people from a united MDT approach to active participation and engagement in functional activities to maintain a sense of self and independence. Exploring the benefits of completing purposeful and meaningful group activities to retain wellbeing and positive mental health while in a restricted environment.

Dharitri Hombardi, Mid and South Essex NHS Foundation Trust

We will be talking about what the Intensive Rehabilitation service is, what it was set up to achieve and how we have succeeded in this, as well as how the service has supported the wider system within our working boroughs.

The Cancer Older Peoples Service, based at the Beatson - West of Scotland Cancer Centre joined forces with Maggie's to form the Living Well With Cancer In Older Age Class.

We all know the importance of getting older adults moving and of tackling loneliness. Older adults were less likely to engage with third sector support services and we were keen to address this. Only 40% of the over 65's visiting Maggie's Glasgow access wider services. After lockdown we noticed that many older adults attending our oncogeriatric clinic, as well as attending the Beatson had become deconditioned and socially isolated. We know that sarcopenia in older adults with cancer is common and results in poorer cancer outcomes. We were also faced with increasing challenges accessing AHP services e.g. the community rehabilitation team due to workforce challenges. We developed this class to address these issues.

The class was led by a Maggies exercise expert, the centre manager and a frailty nurse specialist from the Cancer Older Peoples Service. Clients at any point in their cancer journey, regardless of what treatment they were getting (even if best supportive care) could access the Class. Thus, it could be used to support prehabilitation or rehabilitation. Most of the referrals came from the Cancer Older Peoples Service - thus could compliment comprehensive geriatric assessment delivered in the oncogeriatric clinic or inpatient setting. However, clients could also self refer and other health professionals could refer patients in.

The course consisted of 4 x 2 hour classes;

• Week 1: introduction, discussion of functional movement, exercise session and initial fitness test.
• Week 2: functional movement session and discussion in eating for health.
• Week 3: functional movement session and discussion to managing stress, followed by relaxation session.
• Week 4: functional movement session, exercise test and discussion on further community support.

The first 2 classes only had 5 people each - due to social distancing still being in place at the time. Age range was from 68 to 72. All had significant improvements in fitness markers: sit to stand and step up and self reported improvements in fitness, nutrition and stress. All reported they felt they could live better with cancer, enjoyed the course and went on to participate in other Maggie's activities. 1 client was deemed fit enough for surgery after attendance at the oncogeriatric clinic, coupled with the class. Another client managed to get back to baking.

There are still barriers needing to be overcome: access to transport allowing people to attend; clients at times not taking up the opportunity to attend, this does seem to be improved if it is badged an exercise class; lack of other health professionals out with the cancer older peoples team referring into the class. However, despite this, classes have been running for over a year now - and clients still continue to show improvements and increasing engagement with Maggie's. So much so there are plans to roll out this project to all the Maggie's centres in Scotland.