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Professional practice

I have been your age but you have not been mine

Karin Tancock talks about the Falls and Fragility networking event held by COT.

The College’s networking event on falls and fragility in June centred around recent NICE Quality Standards, the College’s Practice Guideline and a report on frailty by UCL Partners, National Voices and Age UK.

The day was structured with short presentations followed by 45 minute discussions. As anticipated much of the discussion focused on how to measure occupational therapy interventions within multidisciplinary working and the tension between balancing independence and risk. However, for me what came out most strongly is the importance of any intervention having meaning to the person. No matter how sound the recommendation and advice if it does not feel relevant to the person or support them with the occupations that are important to them in their day to day life they will not adopt any changes. With many occupational therapists limited to assessment and making recommendations…how do we communicate this to ensure maximum chance of uptake?

Laura Stuart (Frailty Programme Manager from UCL Partners) found from interviews with 74 older people aged over 75 independence was key. Independence was described as doing “what I want, when I want”. For interviewees it is not about self-care activities but activities that had meaning to them and opportunities to have new experiences. Activities were seen as the vehicle for experiencing choice and control and maintaining identity. Kate Robertson (Consultant Occupational Therapist and Honorary Assistant Professor at the School of Medicine, Nottingham) quoted her father “I have been your age but you have not been mine.” This summed up the clinicians dilemma – we know what is recommended to improve safety and minimise risk but do we fully understand the lived experience of older people.

Some of the challenges delegates reported includes limited capacity to follow up on assessments, services restricted to only address self-care , and fear of falling not sufficiently addressed.

So from the day’s discussions I drew out the following actions occupational therapists may consider

  1. Focus on the positive – what the person can do and not just on the hazards and difficulties. This is core to our approach but many standardised or generic assessments are risk and problem focused.
  2. Assess for fear of falling and how this restricts the person’s choice of occupations.
  3. Formulate recommendations so that they support the continuation of activities that have meaning to the person.
  4. Ensure the person is supported to make informed decisions and signpost them to possible services/ support they may wish to consider at a later stage (for example on leaving hospital).
  5. Finally not forgetting that daily life is more than self-care and although many services are not commissioned to think beyond this, signposting the older person to services that can offer wider support, particularly the third sector, is important.
  6. Apply to do strength and balance training so that people can be shown how to incorporate such activity within their daily routine and occupations. If strength and balance training is seen as the role of physiotherapy, work together so that the person can assimilate the exercises into their daily life.
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