1 Recommendations

This document constitutes NICE's formal guidance on occupational therapy interventions and physical activity interventions to promote the mental wellbeing of older people.

The evidence statements that underpin the recommendations are listed in appendix C.

The evidence reviews, supporting evidence statements and economic analysis are available online.

The definition of 'mental wellbeing' used in this guidance follows that developed by NHS Health Scotland as part of their national programme of work on mental health improvement. This definition includes areas such as life satisfaction, optimism, self-esteem, mastery and feeling in control, having a purpose in life, and a sense of belonging and support (NHS Health Scotland 2006).

Occupational therapy aims to enable people who have physical, mental and/or social needs, either from birth or as a result of accident, illness or ageing, to achieve as much as they can to get the most out of life (College of Occupational Therapists 2008).

If need exceeds the resources available, there should be a focus on the most disadvantaged older people, for example, those with physical or learning disabilities, those on very low incomes or living in social or rural isolation, including older people from minority ethnic groups.

In this guidance 'older people' are people aged 65 years and over.

Occupational therapy interventions

Recommendation 1

Who is the target population?

Older people and their carers.

Who should take action?

Occupational therapists or other professionals who provide support and care services for older people in community or residential settings and who have been trained to apply the principles and methods of occupational therapy.

What action should they take?
  • Offer regular group and/or individual sessions to encourage older people to identify, construct, rehearse and carry out daily routines and activities that help to maintain or improve their health and wellbeing. Sessions should:

    • involve older people as experts and partners in maintaining or improving their quality of life

    • pay particular attention to communication, physical access, length of session and informality to encourage the exchange of ideas and foster peer support

    • take place in a setting and style that best meet the needs of the older person or group

    • provide practical solutions to problem areas.

  • Increase older people's knowledge and awareness of where to get reliable information and advice on a broad range of topics, by providing information directly, inviting local advisers to give informal talks, or arranging trips and social activities. Topics covered should include:

    • meeting or maintaining healthcare needs (for example, eye, hearing and foot care)

    • nutrition (for example, healthy eating on a budget)

    • personal care (for example, shopping, laundry, keeping warm)

    • staying active and increasing daily mobility

    • getting information on accessing services and benefits

    • home and community safety

    • using local transport schemes.

  • Invite regular feedback from participants and use it to inform the content of the sessions and to gauge levels of motivation.

Physical activity

Recommendation 2

Who is the target population?

Older people and their carers.

Who should take action?

Physiotherapists, registered exercise professionals and fitness instructors and other health, social care, leisure services and voluntary sector staff who have the qualifications, skills and experience to deliver exercise programmes appropriate for older people.

What action should they take?
  • In collaboration with older people and their carers, offer tailored exercise and physical activity programmes in the community, focusing on:

    • a range of mixed exercise programmes of moderate intensity (for example, dancing, walking, swimming)

    • strength and resistance exercise, especially for frail older people

    • toning and stretching exercise.

  • Ensure that exercise programmes reflect the preferences of older people.

  • Encourage older people to attend sessions at least once or twice a week by explaining the benefits of regular physical activity.

  • Advise older people and their carers how to exercise safely for 30 minutes a day (which can be broken down into 10-minute bursts) on 5 days each week or more. Provide useful examples of activities in daily life that would help achieve this (for example, shopping, housework, gardening, cycling).

  • Invite regular feedback from participants and use it to inform the content of the service and to gauge levels of motivation.

Walking schemes

Recommendation 3

Who is the target population?

Older people and their carers.

Who should take action?

GPs, community nurses, public health and health promotion specialists, 'Walking the way to health initiative' walk leaders, local authorities, leisure services, voluntary sector organisations, community development groups working with older people, carers and older people themselves.

What action should they take?
  • In collaboration with older people and their carers, offer a range of walking schemes of low to moderate intensity with a choice of local routes to suit different abilities.

  • Promote regular participation in local walking schemes as a way to improve mental wellbeing for older people and provide health advice and information on the benefits of walking.

  • Encourage and support older people to participate fully according to health and mobility needs, and personal preference.

  • Ensure that walking schemes:

    • are organised and led by trained workers or 'Walking the way to health initiative' volunteer walk leaders from the local community who have been trained in first aid and in creating suitable walking routes

    • incorporate a group meeting at the outset of a walking scheme that introduces the walk leader and participants

    • offer opportunities for local walks at least three times a week, with timing and location to be agreed with participants

    • last about 1 hour and include at least 30–40 minutes of walking plus stretching and warm-up/cool-down exercises (depending on older people's mobility and capacity)

    • invite regular feedback from participants and use it to inform the content of the service and to gauge levels of motivation.

Training

Recommendation 4

Who is the target population?

Health and social care professionals, domiciliary care staff, residential care home managers and staff, and support workers, including the voluntary sector.

Who should take action?
  • Professional bodies, skills councils and other organisations responsible for developing training programmes and setting competencies, standards and continuing professional development schemes.

  • NHS and local authority senior managers, human resources and training providers and employers of residential and domiciliary care staff in the private and voluntary sector.

What action should they take?
  • Involve occupational therapists in the design and development of locally relevant training schemes for those working with older people. Training schemes should include:

    • essential knowledge of (and application of) the principles and methods of occupational therapy and health and wellbeing promotion

    • effective communication skills to engage with older people and their carers (including group facilitation skills or a person-centred approach)

    • information on how to monitor and make the best use of service feedback to evaluate or redesign services to meet the needs of older people.

  • Ensure practitioners have the skills to:

    • communicate effectively with older people to encourage an exchange of ideas and foster peer support

    • encourage older people to identify, construct, rehearse and carry out daily routines and promote activities that help to maintain or improve health and wellbeing

    • improve, maintain and support older people's ability to carry out daily routines and promote independence

    • collect and use regular feedback from participants.