Shared learning database

 
Organisation:
Older Adult CMHT
Published date:
September 2009

The Positive Ageing group is facilitated by occupational therapy staff from older adult community mental health teams based in the Glenkirk Centre, Drumchapel, Glasgow. It is aimed primarily at service users aged 65 and over with a functional diagnosis, usually but not exclusively anxiety and/or depression who may be referred by GP's, or medical and nursing staff in the community mental health teams. Referrals may also be accepted from service users with mild cognitive impairment if they are able to take on board new information.

Does the example relate to a general implementation of all NICE guidance?
No
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Yes

Example

Aims and objectives

The Positive Ageing Group aims to promote a positive attitude to ageing and the changes which it brings to all areas of life. By so doing the group seeks to promote mental well-being among the target group of older adults with mental health problems.

1. To provide an opportunity for sharing experiences and expectations related to ageing, and by so doing to increase confidence and self esteem.
2. To provide information using local advisors on a range of topics including; health and well-being, nutrition, staying active, home and community safety
3. To encourage the use of community resources including local transport schemes.

Reasons for implementing your project

Occupational therapy staff recognised a gap in the service provision for older adults experiencing symptoms of anxiety and/or depression. The majority of these service users were being treated with appropriate medication, but despite this they were becoming increasingly socially isolated and lacked motivation for change. Based on previous group experience it was felt by occupational therapy staff that these needs would best be met through the context of a community based group.

When deciding what format the group should have research was carried out using the internet, relevant published literature, the content of previous groups, (including one also carrying the title Positive Ageing Group), local resources and local knowledge.

The U.K. inquiry into mental health and well-being in later life in its first report 'Promoting Mental Health and Well-being in Later Life' 2006, listed five main areas that influence mental health and well-being in later life;
1. Discrimination
2. Participation in meaningful activity
3. Relationships
4. Physical health
5. Poverty

The group aims to begin to address these five areas through its comprehensive programme.
Assessment for the group is carried out using a local assessment tool for group work. Service users also complete a questionnaire which covers their previous experience of groups, their perceived needs and their expectations for the group.

The group has a twelve week programme which is dynamic and changes in response to the feedback from participants as to what they perceive as relevant for them. Since its inception the group has been held in the dayroom of a local sheltered housing complex, which provides a local community venue where participants feel comfortable. The venue is accessible for some participants by foot or by local transport schemes. Some participants require to be transported by staff due to mobility issues.

How did you implement the project

1. To provide opportunity for sharing experiences and expectations related to ageing and by so doing to increase confidence and self esteem; The group provided a safe environment where participants got to know and trust each other. Over the 12 weeks relationships developed and experiences and expectations were shared. Growth in confidence and self esteem was observed. One session of the group focussed on goal setting using SMART (specific, measurable, attainable, realistic and timely) goals as a model. Participants were encouraged to set personal goals for themselves. This was revisited on several occasions throughout the programme. Where participants had achieved their goals this also led to increased confidence and self esteem. Where goals had not been achieved they were encouraged to look at the reasons and what could be done differently.

2. To provide information using local advisors on a range of topics; Local advisors who came into lead sessions included the nutritionist from a local Community Older Persons Team, who led a session on nutrition and healthy eating; the Community Safety Police Officer from the local police station spoke about safety both in the home and community; an outing to the local leisure centre included a tour and a talk by the Exercise Consultant on the benefits of exercise as you age and specific resources available for older adults; a session was held on falls prevention and how to cope in the event of a fall. It is hoped that this session will be led by an occupational therapist from the falls team in future; other sessions included good mental health and hobbies and interests.

3. To encourage the use of community resources including local transport schemes; Outings were organised to different community venues including the leisure centre, garden centres and a local country park. Each participant was provided with a file of local resources including the Dial a Bus service.

Key findings

Participants were monitored each week in terms of communication, interaction with staff and other clients, interest in topic, concentration/attention span and tolerance of others. This was done using a scale from 1-5; with 1 being poor and 5 being very good. Factors which may have influenced the results in any particular week were noted at the end of the form. Results generally showed increasing participation in group activities and discussion. At the end of the programme participants had the opportunity to evaluate the programme using a questionnaire. This invited comments about whether their expectations had been met, the venue, the length of each session. They also had the opportunity to rate each individual session and to suggest other topics which they would like covered. Comments from participants included;
'I felt we all fitted in with each other'
'Enjoyed having company, I will keep in touch with I L (another participant)'
'It made me realise I was not alone in needing help'
'I found I was not the only one feeling this way'
'Everybody had something to say and sometimes you associated with it yourself'
'I enjoyed getting to know others in the group and making friends'
The NICE guidance PH16 was published after the group had run for two complete sessions. However using the PH16 assessment tool it was noted that the group met all three criteria for occupational therapy interventions.

Key learning points

· It was beneficial bringing in local advisors to lead specific sessions. They brought with them their own expertise and a variety of approaches which made the programme more interesting and relevant for the participants.
· The most recent group included three outings to local resources which again added variety. Future groups might benefit from more involvement in local resources e.g. a visit to the local library, visiting a local drop in centre where older adults from the community meet for coffee and a chat. These would be resources which the group participants would be able to make use of after the group concluded.
· Locating the group in the day room of a local sheltered housing complex worked well as it was a venue in the community which was known to some of the participants, which had no association with the Health Board.
· It was difficult for some of the service users to disengage after twelve weeks as they had become dependent on the group. It would be helpful to incorporate into the final sessions activities to prepare the participants for disengaging.
· The group did not specifically target carers. Many of the participants live alone and do not have carers. It was felt that the needs of carers would be best met in a carers group.
· For future groups it would be helpful to canvas service users at the assessment stage regarding areas of interest to them, perhaps using a lifestyle questionnaire.
· Instead of having feedback regarding individual sessions at the end of the programme it may be better to seek this weekly while the topics are still fresh in the participants minds.
· There is a need to develop the outcome measures for the group to better highlight the benefits for service users.

Contact details

Name:
Elizabeth Smith
Job:
OT Technical Instructor
Organisation:
Older Adult CMHT
Email:
Elizabeth.Smith@ggc.scot.nhs.uk

Sector:
Primary care
Is the example industry-sponsored in any way?
No