Read Standard 4: Keeping active

Ageing and frailty standards
Healthcare Improvement Scotland

Standard statement

Older people living with frailty are supported to keep active to maintain and improve mobility, independence and function.

Rationale

Keeping physically active and mobile can reverse or prevent frailty and falls.48 People with frailty may experience a sense of achievement, satisfaction and confidence from physical activity.49 People who maintain their mobility may experience a higher quality of life as they age.50 People should be supported to engage in meaningful and purposeful physical activity and to do things that are important to them.51-53 Individuals should be enabled and supported to make informed choices about movement and activity.54

Significant lack of mobility may lead to general deconditioning or specific conditions such as pressure ulcers. Deconditioning is a deterioration of physical and functional abilities. It can be caused by inactivity, bed rest or a highly sedentary lifestyle.55 It can occur during periods of immobility, such as an acute illness, injury, surgery or hospital stay. Up to 65% of older people experience a decline in function when they are in hospital.55

Sarcopenia is an age-related progressive loss of muscle mass, function and strength. People who live with sarcopenia are three times more likely to fall than people who do not.56 A comprehensive assessment should be undertaken to reduce falls in older adults who are likely to experience a fall.57

 

Criteria

4.1

Organisations work together to:

  • improve access to leisure activities and green space
  • increase opportunities for people to engage in physical activity.
4.2
Organisations work together to ensure that older people with frailty can travel, access shops and facilities and maintain independence.
4.3

People can access community-based activities to improve balance, muscle strength and bone health.

4.4

People have access to services, technology and equipment to support independence and manage activities at home.

4.5

People with advanced frailty are supported to undertake physical activity based on their own values and priorities.

4.6

People are provided with accessible advice and information about:

  • how to improve or maintain mobility, strength and balance
  • how to reduce deconditioning
  • their likelihood of falling
  • setting physical activity goals that are important to them.
4.7

The care planning process includes a multidomain falls assessment57 that covers:

  • mobility
  • sensory function
  • activity of daily living
  • cognitive function
  • autonomic function
  • medical diagnoses
  • medication and polypharmacy
  • nutrition and hydration
  • risk of falls caused by the person’s environment or footwear.
4.8

People who may be likely to fall are offered preventative interventions, where appropriate, which:

  • reflect their goals and outcomes
  • are delivered by a specialist multidisciplinary team
  • maintain their skills and function
  • include a community-based progressive exercise programme for a minimum of 12 weeks57
  • include provision of equipment such as walking aids.
4.9

People who may be likely to fall are involved in discussions about:

  • appropriate adaptations to the person’s home (or care home)
  • suitable care or living arrangements.
4.10

Staff are trained and supported to:

  • promote and encourage mobility and independence in all care settings
  • understand the psychological barriers to activity
  • reduce the likelihood of falls
  • reduce the risk associated with not moving
  • provide tailored education on safer mobility.
4.11

Organisations ensure that policies and environments enable physical activity and movement.

4.12

People with frailty being considered for planned or elective surgery are offered advice and support on prehabilitation to maximise physical health before their operation.

4.13

People with frailty can receive a home assessment to optimise their independence and safety at home (or their care home).

4.14

Organisations invest in and provide access to technology to:

  • enable people to maintain mobility and independence in the community
  • encourage movement and activity
  • provide data to reduce falls in the environment
  • detect when a fall has happened
  • enable the person to call for help.

What does this standard mean for...

What does the standard mean for people?

  • You will be encouraged and supported to keep active as you age.
  • You will be supported to focus on daily activities and functional movement.
  • You will have a care plan to reduce the likelihood of falling.
  • You will be encouraged and enabled to be as mobile and independent as possible, including when you are in hospital.
  • If you have a fall, you will be offered appropriate support and rehabilitation.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

  • work with people to help them keep active
  • know the likely causes of falls
  • take proactive steps to prevent falls
  • have the right knowledge and experience to promote keeping active and encourage independence
  • undertake an assessment of a person’s likelihood of falling and act on it
  • work in partnership across different sectors to reduce the likelihood of falls
  • know the impact of not moving and the risks associated with being sedentary for long periods of time
  • are aware of and follow referral pathways for rehabilitation across the Health and Social Care Partnership.

What does the standard mean for the organisation?

Organisations:

  • develop and review high quality, accurate information on safer mobility in a range of different languages and formats
  • demonstrate strong collaborative leadership to balance the safety of older people with the promotion of independence and physical activity
  • have processes and protocols in place to reduce the likelihood of falls
  • provide access to equipment to reduce the risk of falls and encourage safe movement
  • provide access to evidence-based interventions to reduce the risk of falls and encourage safe movement.

Examples of what meeting this standard might look like

  • Referrals to community social activity groups such as walking groups.
  • Use of wearable technology, including step counters and activity trackers.
  • Implementation and development of dementia-friendly communities.
  • Evidence of balance and strength activities delivered in the community.
  • Audit of ambulance and community alarm calls related to older people experiencing falls.
  • Creative approaches to introduce meaningful activity.
  • Established multiagency pathways to physiotherapy, occupational therapy and rehabilitation.
  • Pathways in place to trigger a comprehensive review of potential reasons for falls.
  • Data on length of stay in hospital, falls and readmission rates as a result of falls.
  • Evidence of activity or rehabilitation plans.