#OTalk 1st Dec 2015 – Growing Older and Frailer…. With HIV

Final month of the year and we only have three #OTalks left. Once again a huge thanks to our extra team for supporting us. This week @Nnikki_Duffy will be supporting  @Esthermmc who will be tweeting from @rehabHIV.


Thanks for inviting me back to present another #OTalk. I’ve just read through the transcript from last year’s Tweetchat and am amazed at how many things we touched on, although briefly. You can refresh your memory here https://otalk.co.uk/2014/07/21/otalk-22nd-july-2014-hiv-and-occupational-therapy/.


This year I thought we would focus on HIV, Ageing and Frailty, which is a growing issue within HIV care.


But going back to basics first, HIV was first diagnosed in the early 80’s, with first treatments available in the early-to-mid 1990s. These anti-retroviral drugs are often referred to as ARVs, ART, or HAART (highly active anti-retroviral therapy), and are different types of drugs that interrupt different stages of the replication process. People take a combination of the drugs to stop the virus in as many ways as possible. Prior to the introduction of these, a person diagnosed with HIV would develop various complications of an impaired immune system, leading to eventual death (thought to be about ten years after infection).


Since the introduction of more and more effective drug therapy, people are living longer with HIV, and someone diagnosed today at an early stage of infection could expect a normal lifespan with good adherence to treatment. Early infection is indicated by a high CD4 count (immune system marker) and low viral load (copies of the virus in the blood). 40% of new diagnoses in 2014 were ‘late’ with a CD4 less than 350, previously the cut off point for starting treatment. There is a ten-fold increased risk of death within in one year when diagnosed late.


We are however now seeing the long term effects of living with HIV. Research shows that HIV causes the immune system to age faster, so conditions of ageing are seen in younger populations of positive people. ‘Older’ adults are considered those over the age of 50 in HIV care! There is also thought to be a link between some of the ARVs and these comorbidities. Some of the common co-morbidities include bone health, cardiovascular problems, and cancer.


People living with HIV (PLH) over the age of 50 fall into two categories – those who have been living for many years with HIV, so are sometimes referred to as long-term survivors (often from pre-ARV times), and those who are newly diagnosed as an older adult. In 2014 30% of new diagnoses of HIV were in those over 45, compared to 16% in 2005, and 1 in 4 PLH in the UK is now aged over 50.


And thinking about frailty (taking into account this year’s research that older people don’t like the term frailty – see the ‘I’m still me’ link found here http://www.uclpartners.com/our-work/academic-health-science-network/integrated-co-morbidities/what-matters-most) how do we define it and how does it relate to PLH?


So, why does this matter for occupational therapists?

  • You’re more likely to see someone who has HIV as a co-morbidity in your service
  • Services are sometimes still ‘ageist’ – making it difficult to access required rehabilitation because PLH aren’t old enough, even if they have all the co-morbidities expected in someone much older


In this Tweetchat I’d like to explore some of these issues – why the premature ageing, which co-morbidities, and how to approach the occupational therapy process when working with someone living with HIV.

People seen for HIV care by age group over time; 2005-2014 – PHE 2015







#OTalk 24th Nov 15 – Enhancing Learning on practice placements

Please join @LisaForrestOT for tonight’s #OTalk
In Occupational Therapy, practice education is a key and essential element of the Occupational Therapy curriculum (Kirke et al, 2007). Whilst on placement students develop the required practice skills, professional behavior and competencies required for clinical practice (Rodger et al, 2011). It is therefore essential that the placement experience is of a high quality that optimizes and facilitates learning which supports development which is individualised to meet the needs of the each student (Kirke et al, 2007).


It is therefore essential that we explore and ascertain the main factors that enhance the learning experience of our Occupational Therapy students whilst on a range of placement experiences. The focus of the discussion should therefore include the role of the Higher Education Institution, the placement provider/practice educator and the student and how each individually and collectively we can ensure and promote a positive learning environment and experience.


Occupational Therapy practice placements can and should be a positive and enlightening learning experience for both students and practice educators.


Questions for discussion


1. What makes good practice placements?

2. What is being done well in relation to enhancing the student learning experience on placements?

3. What makes a good practice educator?

4. What makes for good university/practice educator partnerships?

5. What do we feel is required in order to enhance the learning experience of occupational therapy students on placement?

a. What would the ideal look like?

b. What opportunities could be facilitated?

c. What support mechanisms would be required?

6. How do we sustain and maintain positive learning experiences on placement?




Kirke, P., Layton, N., Sim, J. (2007) Informing fieldwork design: Key elements to quality in fieldwork education for undergraduate occupational therapy students. Australian Occupational Therapy Journal, 54, S13-S22.


Rodger, S., Fitzgerald, C., Davila, W., Millar, F., Allison, H. (2011) What makes a quality occupational therapy practice placement? Students and practice educators perspectives. Australian Occupational Therapy Journal, 58, P195-202.


Post Chat:

The Numbers

14Avg Tweets/Hour
8Avg Tweets/Participant

#OTalk Participants

Post Chat Transcript


An Inspector Calls – What to expect from a CQC visit. Tuesday 17th November 2015

This Tuesday 17th November the OT Show (@theOTshow) are hosting #OTalk and have invited one of this year’s OT show speakers Mary Booth – FCOT (@MaryBoothOT) – Your @OTalk_ support with be Rachel @OT_rach

The Care Quality Commission (CQC) is the independent regulator for Adult Health and Social Care in England. The Care Quality Commission regulates and inspects all hospitals, community health services, GPs, dentists and care homes both NHS and private. Let’s share our understanding of the CQC and its role, the new inspection process and the five key areas of inspection, the new rating system and how they apply generally and to occupational therapy, gaining an improved understanding of the CQC inspection process, how to prepare for it and gain an understanding of what happens when the inspector comes ‘knocking on your door’. Outside of the formal inspection process, Occupational Therapists will be able to use the five key areas of inspection to look with fresh eyes and improve their own services and how to ensure they meet service users’ needs for safety, responsiveness, caring, effectiveness and leadership.

The OT Show takes place at the NEC on 25th and 26th November 2015, it’s dedicated to OTs. You can access over 100 focussed lectures, seminars and practical workshops, gain over 60 hours of CPD and learn from world renowned speakers. It has something to offer all practice areas and has over 300 trade exhibitors and suppliers attending. Here is the link to find out more about the OT show http://www.theotshow.com/

Mary Booth will be speaking at the OT show on embracing CPD and also about the CQC inspection process and what it means for Occupational Therapists. Mary is a recently (mostly) retired OT and AHP lead with over 35 years of experience, in 2013 she was made fellow of the College of Occupational Therapy. Mary currently works as a CQC specialist advisor.

The first park of this week’s OTalk will ask what you know and think constitutes the detail of the five key areas the CQC inspects. The CQC summarises these as follows



By safe, we mean that people are protected from abuse and avoidable harm.


By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.


By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.


By responsive, we mean that services are organised so that they meet people’s needs.


By well-led, we mean that the leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture

To learn more about the 5 key areas visit http://www.cqc.org.uk/ . Perhaps take a look at some recent completed inspection reports to get an idea of what constitutes good in the five domains above.

This will be followed by time for a question and answer session with Mary and will finish with a chance to find out a bit more about the OT Show.


  1. How do you think OTs can help their organisations meet the key area of being safe.
  2. What in practice are effective services
  3. How do you define caring, how you show your service is caring.
  4. Is your service responsive to people’s needs?
  5. How can we show we are well lead?

Hope to see you all on Tuesday night 8pm.

Thanks to all those who joined the chat here is the transcript for your CPD. 

1,201,078 Impressions
452 Tweets
46 Participants
19 Avg Tweets/Hour
10 Avg Tweets/Participant

17th Nov Transcript

#OTalk – 10th November 2015 – Maintaining Occupational Balance after the Transition from Student to Practitioner

Thanks to Emma Carter for this weeks chat and Nikki Duffy for supporting.

Maintaining Occupational Balance after the Transition from Student to Practitioner.

The OTalk on 25 August highlighted some interesting themes around the challenges faced by new graduates as they start out in their qualified roles, as well as some useful strategies to manage these. Now, as the majority of new grads are a few months in, the day to day demands of roles may be more familiar but the pressure to perform and achieve may be ever increasing. Clouston (2014) identified that the current UK healthcare climate of doing more with ever decreasing resources, often creates a state of occupational imbalance for occupational therapists whereby work-life is regularly prioritised over other important personal and leisure occupations. As new grads begin to acclimatise to their new settings, what strategies can be used to ensure that occupational balance, and overall wellbeing, is maintained.


1. As OTs, do you find that work pressures impact your occupational balance?

2. If so, what is the cause of these pressures? Are they environmental, cultural or personal?

3. What strategies have you used / considered using to manage these pressures?

4. What would be your top tips for new grads to prevent occupational imbalance?

5. How, as OTs in practice, could we work to lessen the demands placed on us whilst still demonstrating our value in healthcare settings?

Reference Clouston, T.J., 2014. Whose occupational balance is it anyway? The challenge of neoliberal capitalism and work–life imbalance. British Journal of Occupational Therapy 77 (10), 507–515.

#OTalk 3rd Nov – OT Week and Promoting OT

Tonight @DebbiiHarrison will be hosting the chat. For those that still have an hour’s energy left in you after the OT24vx we’d love you to join in and talk about how to promote OT during and outside of OT Week.

Here’s the questions to guide the chat

What have you done to promote OT this week?

Have you accessed any COT resources or suggestions? https://www.cot.co.uk/OTWeek2015

What is the most unusual thing anyone has done to promote OT?

What feedback do you get from the public about OT?

What makes you proud about OT?