- – Are many OTs working in roles where they offer specific interventions around resilience or wellbeing? Are OTs supporting colleagues / workplace resilience and wellbeing?
- -Why do we struggle with these terms- are there better ways to describe this work?
- -Do OTs feel they should be doing more in this area / what is stopping them?
- -What creative examples of practice are emerging?
This week chat will be hosted by the Rotal College of Occupatinal Therapists Specialist Section, Older People @RCOT_OP
General deconditioning in older adults with frailty is a serious and all-too-common problem. According to the British Geriatrics Society, deconditioning includes reduced muscle strength, reduced mobility, increased falls, confusion and demotivation. Immobility can effect continence and constipation, appetite and digestion. As Occupational Therapists, the primary impact of deconditioning can be seen in reduced well-being and cognitive and physical function; in turn this impacts a person’s ability to engage in meaningful activities.
The recent #RightToRehab Twitter campaign brought to light prevalent attitudes of ageism and discrimination towards frail older people in the acute hospital setting and in the community. In the current climate of the Covid-19 pandemic, isolation and immobility has raised further discussion
around deconditioning and the right to rehab in older adults.
As a Specialist Section for Older People we’d love to continue this discussion with an Occupational perspective, and to share ideas and Top Tips for addressing this issue in hospitals and the communities where we work.
The questions for discussion in our #OTalk conversation:
1) What are people’s experiences of seeing the impact of deconditioning on levels of occupational performance in older adults?
2) How can Occupational Therapists support older adults to avoid deconditioning?
3) What intervention approaches are used, and what considerations taken into account, when assessing rehab potential in older people?
4) How is ageism a risk when considering rehab potential for deconditioned older adults?
5) In what ways do Occupational Therapy theory and practice challenge these attitudes?
This weeks chat will be hosted by Sally Scott-Roberts @sallyroberts.
Antonovsky’s (1996) salutogenic orientation (a focus on the origins of health) was proposed as a shift in the way we think about health. It was not intended to replace the more traditional pathogenic (medical) paradigm, that focuses on risk factor reduction, but to compliment it. Antonovsky suggests that people are viewed as being on a health/dis-ease continuum rather than being viewed as healthy or not. Therefore, rather than focusing on the management of a condition and/or the characteristics of a disability, the factors that keep someone nearer the ‘health’ end of the continuum should be explored and where possible engaged. Simply, he proposed a process that focused on the whole of the person, engaging both the person’s and their communities’ resources to further both their individual and collective health and wellbeing.
Antonovsky’s (1996) proposition of being asset focused was directed at the field of Health Promotion but it can so easily be seen to align with Occupational Therapy. It affiliates well with the underpinning humanistic philosophy of Occupational Therapy; valuing the uniqueness of each person, whilst supporting them to be active agents in unlocking their occupational potential (Stein & Cutler, 1998). Our occupational therapy operational models promote the exploration of the person in context and identify strengths as well as barriers to participation. In doing so it is possible to establish ‘what has worked well and how,’ when someone requests support because they have moved or wish to avoid moving towards ‘dis-ease.’
From practice experience, working mainly with people who consider themselves to be neurodivergent, many have become experts in managing their health, often only entering services at a point of ‘crisis.’ At this point in time, they may have lost sight of, or may not recognise, the assets that help to keep them well. In reframing my focus, I have endeavoured to work with people appreciatively, to identify, develop and then mobilise their personal and community assets, with the aim of empowering them to continue to self-manage their health and well-being. This is particularly important, as this group of people, as adults, often remain hidden from traditional health and care services.
I was hoping that this topic may be of interest to those Occupational Therapists, working with people who live with life-long conditions or chronic disability but also those working to promote well-being in the wider community. I look forward to the chat.
Questions to reflect upon for the chat:
- Is an asset based way of working new or does it just describe the way in which we already work?
- Are there interventions we already utilise that have a basis in salutogenesis e.g. Recovery Through Activity?
- When might you choose to use asset based interventions and with whom?
- What might be the barriers to working in this way?
- What skill set do Occupational Therapists need to draw upon to work in this way?
This week the Royal College of Occupational Therapists Specialist Section Neurological Practice – Stroke Clinical Forum are hosting the chat.
In the UK, Occupational therapists, as well as Neuropsychologists use the MoCA widely in stroke care to screen for cognitive impairment. From September 2020, the Montreal Cognitive Assessment (MoCA) requires those carrying out the screen to have undertaken certificated training to obtain a licence for continued use. Training fees/licence can be purchased for an individual or a service and is available ere: https://www.mocatest.org/. This change has come about through an increase in litigation in the United States where the scores of the MoCA had been used for diagnostic purposes.
In light of this current change, services are having to review their use of cognitive screens, consider alternatives and undertake the certificated training if they wish to continue using the MoCA. In this OTalk, the RCOT SSNP Stroke Clinical Forum, alongside colleagues from Neuropsychology will discuss current use of cognitive screens, issues around interpretation and training needs.
We look forward to a busy #OTalk, with relevance to wider areas of practice and other screening tools.
Q1. What cognitive screens due you currently use in your service?
Q2. At what point post-stroke do you use a cognitive screen and how do you use it ? (from a patient perspective, treatment planning, research)
Q3. What issues are there in relation to administration and interpretation of cognitive screens (not MOCA specific) (thinking OT, assistants, interface between OT and Neuropsychology)
Q4. What have your services done to date in response to the new requirements around the MoCA?
Q5. The stroke forum and BPS are hoping to collaborate to create a guidance / competency framework around tool selection, administration and interpretation to use across stroke teams. What specific guidance about cognitive screens would you find useful?