Care homes for older people and access to outdoor mobility and spaces

Amanda King is an Occupational Therapist currently working in Nottingham, UK and tweeting at @Alk768.  She has used a recent Masters in Research Methods to investigate rehabilitation in the context of outdoor mobility for care home residents. Here she describes her research journey to date.shutterstock_958782

I am an NHS Occupational Therapist working in a multi-disciplinary service which provides physical rehabilitation to promote the functional recovery, well-being and independence of older people living in the community. One of the reasons I chose to work with older people, once qualified, was due to spending time in care homes as an undergraduate student. I developed a project, Care Homes Activities Team (CHAT), which involved persuading twenty six occupational therapy students to volunteer to design and deliver a range of activities to the residents of six different care homes, over a period of three months. This experience allowed us to develop our activity provision skills and promote occupational therapy in care homes. It also provided valuable additional resources to the care homes whose staff and residents were very appreciative of the time and energy given by the students.  

What was particularly striking were the challenges for the students who wanted to take residents on trips out of the care homes, either for a walk or to the shops, a park and so on. Barriers included students not being ‘insured’ and therefore needing a member of the care staff to accompany them, lack of suitable transport and general staffing resource issues. Six years on, I continue to feel motivated to increase opportunities for care home residents to engage in meaningful activities in and outside of the care home environment.

There are sound physical and mental health reasons why older people in care homes should be supported to go outside more, for instance, a therapeutic garden and exposure to outdoor activities have been shown to improve sleep patterns, mood and quality of life and reduce agitation and depression for people with dementia. There is evidence that outdoor mobility rehabilitation provided by NHS therapists can increase outdoor mobility participation for stroke patients, but this intervention required the participants to be cognitively intact. As 80% of people living in care homes are cognitively impaired, the intervention given to stroke patients might not be suitable. At present there is no specific intervention that aims to increase outdoor mobility for people living in care homes and there is no rigorous published data that describes the problem.

In July 2013, I was successful in achieving a place on the National Institute of Health Research (NIHR) funded ‘Masters in Research Methods (Health)’ programme at the University of Nottingham and I now have an excellent opportunity to explore the problem further. One of the course requirements is a sixty-credit dissertation, which takes the form of a PhD proposal; this necessarily involves completing a small empirical project and ethical approval is currently being sought. It is my intention to interview care home residents and staff about their views and experiences of access to outdoor mobility and spaces and also to ask care home managers in the local area to complete a questionnaire about how often residents get out and what helps and hinders this activity. With the expertise and support of Professor Pippa Logan (Academic Supervisor) and Dr Adam Gordon (Clinical Supervisor) at the University of Nottingham, the long term aim is to develop and evaluate an evidence-based outdoor mobility rehabilitation programme suitable for use in care homes.

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