• National Institute for Health and Clinical Excellence (NICE). Occupational therapy interventions and physical activity interventions to promote the mental wellbeing of older people in primary care and residential care. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Oct. 50 p. (Public health guidance; no. 16). [23 references]

This is the current release of the guideline.

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?

General practitioners (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 to 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

None provided

The type and quality of supporting evidence is identified and graded for each recommendation (see Appendix C of the original guideline document).

• National Institute for Health and Clinical Excellence (NICE). Occupational therapy interventions and physical activity interventions to promote the mental wellbeing of older people in primary care and residential care. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Oct. 50 p. (Public health guidance; no. 16). [23 references]

Not applicable: The guideline was not adapted from another source.

2008 Oct

National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.]

National Institute for Health and Clinical Excellence (NICE)

NICE Project Team
Public Health Interventions Advisory Committee (PHIAC)

NICE Project Team Members: Mike Kelly, CPHE Director; Tricia Younger, Associate Director; Linda Sheppard, Analyst; Clare Wohlgemuth, Analyst; Bhash Naidoo, Technical Adviser (Health Economics)

Public Health Interventions Advisory Committee (PHIAC) Members: Professor Sue Atkinson, CBE Independent Consultant and Visiting Professor, Department of Epidemiology and Public Health, University College London; Mr John F Barker, Associate Foundation Stage Regional Adviser for the Parents as Partners in Early Learning Project, DfES National Strategies; Professor Michael Bury, Emeritus Professor of Sociology, University of London, Honorary Professor of Sociology, University of Kent; Professor Simon Capewell, Chair of Clinical Epidemiology, University of Liverpool; Professor K K Cheng, Professor of Epidemiology, University of Birmingham; Ms Joanne Cooke, Director, Trent Research and Development Support Unit; Dr Richard Cookson, Senior Lecturer, Department of Social Policy and Social Work, University of York; Mr Philip Cutler, Forums Support Manager, Bradford Alliance on Community Care; Professor Brian Ferguson, Director, Yorkshire and Humber Public Health Observatory; Professor Ruth Hall, Regional Director, Health Protection Agency, South West; Ms Amanda Hoey, Director, Consumer Health Consulting Limited; Mr Alasdair J Hogarth, Head Teacher, Archbishops School, Canterbury; Mr Andrew Hopkin, Assistant Director, Local Environment, Derby City Council; Dr Ann Hoskins, Deputy Regional Director of Public Health/Medical Director, NHS North West; Ms Muriel James, Secretary, Northampton Healthy Communities Collaborative and the King Edward Road Surgery Patient Participation Group; Dr Matt Kearney, General Practitioner, Castlefields, Runcorn, GP Public Health Practitioner, Knowsley; Ms Valerie King, Designated Nurse for Looked After Children, Northampton PCT, Daventry and South Northants PCT and Northampton General Hospital, Public Health Skills Development Nurse, Northampton PCT; Professor Catherine Law, Professor of Public Health and Epidemiology, UCL Institute of Child Health, University College London; Ms Sharon McAteer, Public Health Development Manager, Halton and St Helens PCT; Mr David McDaid, Research Fellow, Department of Health and Social Care, London School of Economics and Political Science; Professor Klim McPherson, Visiting Professor of Public Health Epidemiology, Department of Obstetrics and Gynaecology, University of Oxford; Professor Susan Michie, Professor of Health Psychology, BPS Centre for Outcomes Research & Effectiveness, University College London; Dr Mike Owen, General Practitioner, William Budd Health Centre, Bristol; Ms Jane Putsey, Lay Representative, Chair of Trustees of the Breastfeeding Network; Dr Mike Rayner, Director, British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford; Mr Dale Robinson, Chief Environmental Health Officer, South Cambridgeshire District Council; Ms Joyce Rothschild, Children's Services Improvement Adviser, Solihull Metropolitan Borough Council; Dr Tracey Sach, Senior Lecturer in Health Economics, University of East Anglia; Professor Mark Sculpher, Professor of Health Economics, Centre for Economics (CHE), University of York; Dr David Sloan, Retired Director of Public Health; Dr Dagmar Zeuner Joint Director of Public Health, Hammersmith and Fulham PCT

All members of the Public Health Interventions Advisory Committee are required to make an oral declaration all potential conflicts of interest at the start of the consideration of each public health intervention appraisal. These declarations will be minuted and published on the National Institute for Health and Clinical Excellence (NICE) website.

Members are required to provide in writing an annual statement of current conflicts of interests, in accordance with the Institute's policy and procedures.

Potential members of the Public Health Programme Development Groups (PDG), and any individuals having direct input into the guidance (including expert peer reviewers), are required to provide a formal written declaration of personal interests. A standard form has been developed for this purpose which also includes the Institute's standard policy for declaring interests. This declaration of interest form should be completed before any decision about the involvement of an individual is taken.

Any changes to a Group member's declared conflicts of interests should also be recorded at the start of each PDG meeting. The PDG Chair should determine whether these interests are significant.  If a member of the PDG has a possible conflict of interest with only a limited part of the guidance development or recommendations, that member may continue to be involved in the overall process but should withdraw from involvement in the area of possible conflict. This action should be documented and be open to external review. If it is considered that an interest is significant in that it could impair the individual's objectivity throughout the development of public health guidance, he or she should not be invited to join the group.

This is the current release of the guideline.

None available

This summary was completed by ECRI Institute on February 3, 2009.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.