Staff running chair-based exercise classeshave started to use sensors and tablets to assess the falls risk of clients and helpingthem tailor exercise programmes. Theprogramme has been used in care homes andis now being tested in community settings.
Keeping active later in life is essential for your physical health and for reducing the risk of falls. But activity levels decline as people get older.
In Hertfordshire, care home providers work together through the Hertfordshire Care Home Providers Association (HCPA). The organisation is commissioned by the county council and NHS to run chair-based exercise classes in some of the local care homes. The aim is to build up the strength of residents and reduce the risk of falls.
But to get information about falls risk or an individual’s capability to help properly tailor an exercise programmes requires a detailed assessment that can last well over 30 minutes.
Two years ago, HCPA, the council and local NHS started to look into way of using technology to improve the way these classes were organised.
The HCPA bought two devices – known as Quantitative Timed Up and Go (QTUG) – to help monitor the movement and strength of individuals and their risk of falls.
The devices are made up of a tablet which links wirelessly with two medical-grade sensors – about the size of iPod nanos.
These are strapped just below the knees during a walking assessment and are able to measure criteria such as gait and stride length.
With the sensors attached, the older person starts off in a seated position, stands up, walks three metres and turns around, walks back and sits back down again. The data is then compared to average data for someone of that height, age and weight to assess them for falls risk. A bespoke exercise programme can then be developed.
This technology was used in 19 care homes over six months in 2015 and then another 10 took part in 2016 when Fitbits were also used to monitor heart rate. Funding for the pilots was provided through the Better Care Fund and NHS England’s vanguard programme with the council and local NHS also providing some money.
In the first pilot the falls risk reduced in 15 of the 19 care homes for residents who took part in more than half of the classes. There was also an unexpected mental health benefit for residents. Their confidence and wellbeing levels, measured using self-reported scales, also increased with residents reporting feeling happier as a result of the classes and progress made.
Michelle Airey, HCPA integration programme manager, says: “I think the key is that the class tutors were able to spend more time focusing on the exercise classes and the residents doing them rather than carrying out a falls assessment.
“They can be incredibly time-consuming but just by using a good piece of technology the instructors were able to build it into the class and got immediate information on the individual’s capability and risk of falling.”
Ms Airey says the pilots have made them think about the best way to offer exercise classes in care homes.
“One of the problems you face running exercise classes in care homes for this cohort of people is that it is not always possible for them to make a regular class. They may be unwell or simply not able to make that set time.
“That is why we saw that a number of people were only able to make less than half the classes – and when that happened the benefits of the support declined.”
In response HCPA is looking to train care home staff to run the classes themselves.
“It would be good if they could put the classes on or provide some opportunities for exercise when it was appropriate for the residents and that is something we are thinking about now,” adds Ms Airey.
How is the approach being sustained?
This year saw HCPA take the technology out into the community with funding support provided by NHS England through the Harnessing Technology Fund.
This has been focused on the flexi-care housing sites that HCPA runs.
Residents at these sites live independently, with care built around their needs.
Classes using the QTUG technology started being run at these venues in April 2017 and will continue through to March. The hope is they will get over 100 people completing the 20-week programme.
Ms Airey says: “These people will be more active and we want to see what the benefits are when they are given this support. So far the signs are encouraging, but we will have to wait and see. Once we have finished we can look at what has worked best and where we can target the resources.
“But my advice to anyone thinking about using technology is don’t just put it in for the sake of it. You need to consider whether it is going to fix something or help develop something that cannot be done. There must be that added value.”