Ops review appendix 3 final report may 2016

Rooftops Housing Active Lifestyles Program Evaluation

Dr Yvonne Thomas Institute of Health and Society University of Worcester

June 2016

Contents Forward 1.0 The Importance of Wellbeing in Community Living Older People 2.0 The Active Lifestyle Program and Evaluation Process 3.0 Results of the Follow-Up 4.0 Participants Self rating on Wellbeing 5.0 Personal Goals for Improvement 6.0 Health and Wellbeing at Baseline and Follow-Up 7.0 Physical Wellbeing - Personal Fitness MOT Results 8.0 Activities to Promote Physical Activity 9.0 Mental Wellbeing 10.0 Discussion 11.0 Conclusion

Page 3 4 6 7 10 11 13 18 21 22 24 26

Case Studies Case Study 1: Reducing Social Isolation Case Study 2: Weight Loss Project Case Study 3: From Wheelchair to Walking Aid Case Study 4: ‘A bit of me time’

6 15 16 23

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Forward With life expectancy increasing it is imperative that older people stay healthier for longer so that they can fully enjoy their additional years of life.

I have great pleasure in presenting this final report by Dr Yvonne Thomas on the Evaluation of the Rooftops Health and Wellbeing Project. The evaluation project was conducted in collaboration with Kim Skipsey, Active Lifestyles Co-ordinator and the Active Lifestyle officers employed at Rooftops Housing. A special mention is deserved for Catherine Banwell who collated all the results for the initial interviews and assessments and the 6 month follow up data and sent them to the University evaluation team.

The report outlines the methods and results obtained from six month follow up interviews conducted by the Activity Lifestyles officers. The final section of the report discusses the results in relation to the aims of the Active Lifestyles Programme and the Rooftops goals for enhancing the wellbeing of its residents. The report references some case studies of individuals who have been involved in the Active Lifestyle programme. These case studies have been provided by the Active Lifestyles officers, with permission of the individuals concerned.

Louise Jones Strategic Director for Health and Wellbeing University of Worcester

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1.0 The Importance of Wellbeing in Community Living Older People Promoting the wellbeing of older people is increasingly important in the UK as life expectancy increases and older people make up a greater proportion of the population. It has been estimated that by 2020 one in 5 citizens with be over 65 years (Nice, 2008). Old age is characterised by physical and cognitive changes and while life expectancy increases the imperative is to ensure that older people stay healthier for longer, and enjoy to the full the additional years of life. Wellbeing includes physical, psychological and social factors and is not confined to the absence of disease.

According to Age UK (2014) wellbeing of older people can be promoted by lifestyle, diet, and physical activity. Lifestyle choices include a range of factors that affect the day to day activities that individuals engage in including caring for self and home, having social contact and achieving the things that are important to the individual. In essence wellbeing in old age is achieved by having the ability to participate in a life of meaning. For many older people who live alone this can be limited by issues such as finances, transport, and confidence. The consequence of being unable to satisfy individual needs through active lifestyle over time can seriously impact on mental wellbeing.

1.1 Factors that Influence Wellbeing in older people i.

Older adults typically lead sedentary lives, spending more than 10 hours a day sitting or lying, with activity decreasing sharply over the age of 75years. Being inactive in old age increases the risk of poor health and disability, and increases the risks of falls (British Heart Foundation). ii.

Older people experience higher rates of disease and disability. While many conditions can be effectively treated to encourage function, older people may be by pain experienced from muscular skeletal conditions such are arthritis and back problems, shortness of breath and reductions in stamina associated with cardio respiratory disease, or loss of sensory function associated with visual and hearing impairment.

There is a tendency in older adults and the community generally to view such impairments as normal and expected part of old age and as a consequence the reason for reducing participating in activity and social events.

iii.

Financial issues have an indirect influence on health and wellbeing in old age, higher levels of poverty restrict social activities, influence diets, and can restrict the level of interests and activities outside the home.

iv.

Loneliness has a known influence of health and wellbeing. About 30% of older people feel lonely either always or sometimes, and this rises to 50% for those over 85years (Age UK). Being married and having close friendships correlates with high levels of wellbeing. In older age wellbeing may be influenced by the loss of spouse and of siblings, and bereavement and depression resulting from such loss may be overlooked.

These factors are often experienced simultaneously in old age, and the interplay of several factors for each person is experienced in a unique way. Many older people appear to be

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resilient in the face of such adversity, and continue to live independently and positively despite experiences several of the above factors. Others are less able to maintain a positive outlook and may become more anxious and depressed by their situation. 1 in 5 older people experience depression according to the Royal College of Psychiatrists. One symptom of depression is a loss of interest and enjoyment in life and a general loss of energy. These symptoms may be perceived by others as ‘giving up’, rather than an indication of depression.

The Aim of the Active Lifestyles Programme is to ‘improve the quality of life of people and the communities in which they live.’

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2.0 The Active Lifestyle Program and Evaluation Process The evaluation was conducted by the University of Worcester, Institute of Health and Society,

by Dr Yvonne Thomas, Principal Lecturer and Course Leader for Occupational Therapy. Ethical Approval for the study was obtained through the University of Worcester IHS Ethics Committee in April 2015, based on the development of a formal interview schedule and a recognised Mental Wellbeing Assessment. The analysis of the data obtained from this study was conducted by Emma Preece, IHS Senior Research Assistant and Sessional Lecturer in Psychology and PhD candidate.

The evaluation is based on the initial assessment and 6 month follow up data of Active Lifestyles participants conducted by the options advisor. All data collection has been performed by Rooftops Housing Group (RH) staff in the context of the assessment and care pathway, and de-identified prior to being forwarded to the research group for collation in April 2016.

The data collection for this phase includes: i.

Phase One: Initial Individual Assessment for Active Lifestyle programme Personal wellbeing and lifestyle Assessment including:  Measurement of BMI  Perceptions of level of independence and general wellbeing  Physical Wellbeing as assessed through the Fitness MOT  Emotional Wellbeing as assessed through the WEMWBS  Individual Goals setting

ii.

Phase Two: 6 month follow up Assessment of Support Needs Personal wellbeing and lifestyle Assessment including:  Measurement of BMI  Perceptions of level of independence and general wellbeing  Physical Wellbeing as assessed through the Fitness MOT  Emotional Wellbeing as assessed through the WEMWBS

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2.1 Case Study 1: Mr and Mrs Moran After visiting Mr and Mrs Moran to complete a MOT it became apparent that Mr Moran suffers with depression and they are both socially isolated. Mrs Moran is wheelchair bound and Mr Moran is her main carer. When we asked what they would like to improve and work towards in the following 6 months they explained that they would like to reduce their social isolation and attend events/outings. We agreed to send out monthly newsletters and weekly activity time tables in order for them to join in; Mr and Mrs Moran have now both attended various events/outings including Mr Moran joining our Cherry Orchard Bowls team. The couple are making new friends and having a better quality of life. Below is them enjoying an outing to Weston!

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3.0 Results of the Follow-Up 3.1 Demographic Information The sample for the baseline of the evaluation consisted of 66 females (75.9%) and 21 males (24.1%). The mean age of the baseline sample was 78.56 (9.08) years with the mean age of female residents who participated in the evaluation being slightly older (Mean = 79.51, SD = 9.18) than that of male residents (Mean = 76.00, SD = 8.43) who participated in the evaluation.

Age composition of the sample at baseline 39

40 35

30

FREQUENCY

30 25 20

15 10

8 5

4

1

5 0 51-60

61-70

71-80

81-90

91-100

Missing

AGES (YEARS) Figure 1 – Age composition of the sample at baseline

3.2 Age at 6 Month Follow Up The sample at the six-month follow-up consisted of 43 females (78.2%) and 12 males (21.8%).

The mean age of the follow up sample was 79.16 (8.70) years and once again the mean age of female residents (Mean = 79.74, SD = 8.58) who participated in the evaluation was slightly older than that of male residents (Mean = 77.08, SD = 9.18) who participated in the evaluation.

It is important to note that while the age range both at initial assessment and at follow up interview spanned almost 50 years, the majority of participants in the programme were between 70 years and 90 years of age.

51-60 years 61- 70 years 71- 80 years 81- 90 years 91 – 100 years

N= 2 N= 2 N= 23 N= 21 N=4

Therefore, the participants are in a time of higher risk to wellbeing and general decline in physical and emotional wellbeing.

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For the 55 Participants at Follow-up 75% lived alone 22% lived with someone else 3% did not answer 13 individuals had a hospital admission during the past year 3.3 Participants Perspectives on Wellbeing and Influencing Factors At the initial interview all participants were asked to identify what wellbeing meant to them and the words used were recorded. Three prompts were provided to encourage participants to think broadly about the factors that might impact on their wellbeing.

There were; a) Do you think that wellbeing is more about your physical or your psychological state and why? b) What about your family and community do they affect your wellbeing at all? c) Are there any other aspects of life that affect your wellbeing?

Content analysis of the results demonstrates that:  28 (32.2%) individuals stated that wellbeing referred to their physical health  7 (8.0%) indicated that it referred to their psychological health  45 (51.7%) stated that it referred to both their psychological and physical health A full analysis of participant’s perceptions of wellbeing demonstrates that the majority of participants recognised that both physical and psychological factors affected their wellbeing.

There was also some indication that people understood that physical fitness and activity affected their psychological mood and that feeling low or anxious affected their physical wellbeing. However a number of participants didn’t or couldn’t answer this question. This indicates that a small percentage of individuals would benefit from an introduction to health education and information regarding self-help strategies to improve health and wellbeing. If people do not understand the link between activity and both physical and psychological wellbeing, they are less likely to take up opportunities to engage in the Active Lifestyles programme.

Physical Factors that Influence Wellbeing Included; My age and the aging effects on body Being able to get around a lot Doing the things I used to do Being fit and active Feeling unwell Being independent Being active helps with my wellbeing Walking

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Psychological Factors that Influence Wellbeing Inwardly feeling low If your mind is great, your body is great Worry about dementia Feeling safe and secure Being socially isolated

At initial interview family and community were recognised by more than 50% as a positive influence on wellbeing; however 30 individuals stated that family were either not an influence or a negative influence. Participants recognised that regular contact with family helped them in a good way, and phone or skype calls were valued. Other participant’s identified regular visits from family, whether visits were daily or fortnightly, and practical assistance received from family is appreciated.

Other Factors that Effect Wellbeing Existing health Conditions Sensory Impairment (sight and hearing loss) Bereavement loss of partner and friends Partners’ health and caring responsibilities Lack of transport Social isolation Loss of independence Being a long way from family

A range of factors were identified which had a negative influence of wellbeing, as illustrated below.

Figure 2 – Factors negatively impacting on the samples wellbeing at baseline

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4.0 Participants Self rating on Wellbeing When asked to rate their current wellbeing on a scale of 1-10, 47 individuals who subsequently completed the follow-up assessment also provided a response at baseline and scores ranged from 1-10. However, the average score was a moderate 6.87 (SD = 2.06). In contrast, 55 individuals responded to this question at follow-up and scores ranged from 2-10.

The average wellbeing self-rating score at follow-up was slightly higher (Mean = 7.35, SD = 2.05) that that observed at baseline (Mean = 6.89, SD = 2.25). However, a Wilcoxon Signed Rank test revealed that this increase was not statistically significant (Z = -1.539, p > 0.05). This suggested that although there was an increase in self-rated wellbeing between baseline and follow-up, most of the participants perceived little change in their wellbeing across the two time points.

At baseline (n =79) participants self-rating of wellbeing, was generally moderate to high. 6 individuals scored themselves below 5 on the wellness scale, 73 individuals scored themselves over 5 on this measure. However, data was not available for 8 individuals.

FREQUENCY

Frequency of wellbeing scores for the baseline sample 20 18 16 14 12 10 8 6 4 2 0

20 17 12 9 6 3

1

2

9

8

0

WELLNESS SCALE Figure 3 – Frequency of wellbeing scores for the baseline sample

These qualitative data obtained from the interviews support the information gained from the Fitness MOT and provide evidence that mobility, social isolation and health, have the biggest impact on wellbeing. These issues are being addressed through the Active lifestyles program and are beginning to have an impact on the wellbeing of individual; however longer term follow up would be beneficial.

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5.0 Personal Goals for Improvement At baseline, participants were asked which aspects of their lives they would most like to improve. The proportion of participants who indicated each area for improvement is outlined below;      

21 (25.30%) stated that they would like to focus on reducing their social isolation 22 (26.5%) stated they would like to improve their physical health 14 (16.9%) stated that they would like to improve their balance, flexibility and mobility 3 (3.60%) indicated that they would like to improve their psychological wellbeing 1 (1.2%) stated that they would like to relocate and 22 (26.5%) stated that there were no aspects of their lives which they would like to improve during the intervention Some Personal Goals Included: “Keeping in touch with people, not used to being the main carer for husband” “Wellbeing, mind and relaxation” “Not happy since husband passed” “Drink less alcohol” “Would like to be closer to my family”

The baseline sample were also asked to consider one or more action plans for improving their wellbeing. Out of the sample of 87 individuals,         

24 (27.6%) stated that they would try to engage in more exercise 23 (26.4%) stated that they would try to attend more activities 11 (12.6%) identified that they would try to improve their understanding of healthy lifestyles 8 (9.2%) stated that they would attend PSI classes 6 (6.9%) expressed the desire to find a befriender 3 (3.5%) stated that they would monitor their health 2 (2.3%) expressed the desire to use mobility aids 2 (2.3%) stated that they would like to relocate 1 (1.2%) identified that they would like to take more time for themselves

This suggests that while a quarter of the sample did not identify specific areas for improvement in their wellbeing, most of the sample identified aspects of their lives they would like to develop in the aim of improving their wellbeing. For those who did not identify goals for improvements in lifestyle, a lack of knowledge or awareness of possibilities could be consider the issue rather than assuming that those individuals are satisfied with their current lifestyle. This is especially important for people who are depressed and may be unable to anticipate positive change, or lack motivation to try to change their lives.

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Examples of Action Plans “Resident has diabetes and would like to know what he can eat. Go to workshop. Also look into exercise classes to get stronger” “Go on more trips to meet people, so not alone all the time” “Exercises to keep my back straight and shoulder up” “befriending, also go to Wednesday Lunch Club”

5.1 BMI Score The fitness MOT includes measurement of weight and height and can used to calculate the body mass index for each participant.

Table 1 presents the descriptive statistics for the demographic characteristics of the samples at baseline and at the six-month follow-up.

Table 1: Sample characteristics at baseline and follow-up Baseline Six-Month Follow-Up Characteristic N Mean (SD) Range N Mean (SD) Age (years) Overall 86 78.56 (9.08) 46.00 55 79.16 (8.70) Males 21 76.00 (8.43) 35.00 12 77.08 (9.18) Females 65 79.51 (9.18) 46.00 43 79.74 (8.58) Height (cm) Overall 85 160.37 (10.81) 66.00 55 159.94 (10.71) Males 20 173.40 (6.50) 30.50 12 174.13 (6.98) Females 65 156.36 (8.46) 55.80 43 155.98 (7.83) Weight (kgs) Overall 84 73.78 (17.78) 97.30 55 76.10 (18.51) Males 19 82.87 (17.45) 79.40 12 91.94 (13.93) Females 85 71.13 (17.36) 76.20 43 71.69 (17.27) BMI Score Overall 84 28.85 (7.52) 50.60 55 29.78 (7.48) Males 19 27.54 (5.91) 26.30 12 30.47 (5.14) Females 65 29.23 (7.93) 50.60 43 29.58 (8.06)

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Range 44.00 36.00 44.00 66.00 25.40 43.10 86.37 47.63 64.14 47.50 19.50 47.50

6.0 Health and Wellbeing at Baseline and Follow-Up 6.1 Weight At baseline, based on the 84 individuals who provided sufficient details to calculate their BMI, more than half of the participants were classified as either overweight or obese as demonstrated below and in Figure 1.    

5 (5.95%) individuals were classified as underweight (BMI < 18.5) 23 (27.38%) were classified as being an optimal weight (BMI 18.5 – 25.4) 30 (35.71%) were classified as overweight (BMI 25.5 – 30.4) 26 (30.95%) were classified as obese (BMI > 30.4)

Figure 4 – Percentage of individuals within each BMI category at baseline (based on the complete sample)

Notably, the baseline BMI statistics for the 54 individuals who later completed the follow-up condition were also very similar to those of the complete baseline sample, as demonstrated below. Furthermore, few changes were observed between baseline and follow-up, other than an increase in the number of individuals categorised as overweight; 

1 (1.82%) individuals were classified as underweight (BMI < 18.5) at follow-up, compared to 2 (3.7%) of the 54 individuals who also completed the baseline assessment

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  

10 (18.18%) were classified as being an optimal weight (BMI 18.5 – 25.4) at follow-up, compared to 12 (22.2%) of the 54 individuals who also completed the baseline assessment 27 (49.09%) were classified as overweight (BMI 25.5 – 30.4) at follow-up, compared to 20 (37%) of the 54 individuals who also completed the baseline assessment 17 (30.91%) were classified as obese (BMI > 30.4) at follow-up, compared to 20 (37%) of the 54 individuals who also completed the baseline assessment

Figure 5 – Percentage of the 55 individuals within each BMI category at follow-up

6.2 Changes in BMI at follow-up (N= 54) Table 2: Chi Square Anaylsis BMI Category Baseline Underweight 2 (3.7%) BMI < 18.5 Optimal Weight 12 (22.2%) BMI 18.5 – 25.4 Overweight 20 (37%) BMI 25.5 – 30.4 Obese 20 (37%) BMI > 30.4

Follow up 1 (1.82%) 10 (18.18%) 27 (49%) 17 (30.9%)

Chi Square analysis was performed to identify if there were any significant differences between baseline and follow-up BMI. This revealed that there were significant differences between baseline and follow-up (χ2 (9, N = 51) = 79.218, p < 0.001). Examination of the cases suggested that this was due to a higher proportion of the follow-up sample being categorised Active Lifestyle Program Report - 2016

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as overweight (N = 27/55, 49.09%) than those categorised as overweight at baseline (N = 20/54, 37%). However 3 individuals who were obese at baseline were no longer in the obese category at follow up, and one individual who was underweight at baseline was optimal weight at follow up.

6.3 Case Study 2: Weight Loss Project Three residents have shone with their willpower to lose weight.

Terry Reid (The Court), Joan Rodgers (Seward Close) and Frank Nash (Community), together lost a total of 58 lbs as seen today in Tesco’s photoshoot 29 bags of sugar.

What they had to say about the project, Joan said “it’s been absolutely wonderful; following a visit to the doctors he has informed me that my blood pressure had gone down, along with my blood sugar results. I am now more aware of my sugar intake so no longer need the monitor and have learnt a lot about calories. I have joined the lunch club at Ferry View, made new friends and am very happy with how I feel” Terry explained that the weight had started to pile on but was shocked when he was actually weighed on his MOT. He’s cut out the cakes and biscuits, he and his wife are shopping and cooking healthier. Terry loves the walking group set up by Active Lifestyles and says” it’s amazing how its gets people together, making new friends and relieves isolation” Frank having lost the most, just over 2 stone, said we came along at the right time; he’d taken to his sofa, eating all the wrong things, and felt low and unfit. He’s now out and about, has less knee and leg pains and his breathing has improved. Frank recently attended a Walking Football session in Malvern, he would never have been able to participate before, he even managed without his inhaler!

While there have clearly been some exciting results for some individuals, the increase in the number of individuals who were overweight at follow-up, require further exploration.

Increasing activity and interests could in itself stimulate people’s appetite, with many social activities including and providing food and beverages, resulting in increased daily calories. It is important to provide education on healthy snacks and encourage foods such as fruits rather than cakes. This finding could also be attributed to seasonal factors due to the follow-up occurring after the winter period when mobility may have been restricted.

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6.4 Independence As a group, the 87 participant’s self-rated level of independence was predominantly high to moderate (88.5%) at baseline:   

10 (11.5%) indicated that their level of independence was low 49 (56.3%) indicated that their level of independence was moderate 28 (32.2%) stated that their level of independence was high

Furthermore, a very similar pattern was also observed during the six-month follow-up.

Indeed, 87.4% of respondents indicated that their level of independence was high to moderate.   

8 (14.5%) indicated that their level of independence was low at follow-up, compared to 4 (7.3%) of these 55 individuals at baseline 24 (43.6%) indicated that their level of independence was moderate at follow-up, compared to 30 (54.5%) of these 55 individuals at baseline 23 (41.8%) stated that their level of independence was high at follow-up, compared to 21 (38.2%) of these individuals at baseline

However, despite the increase in self-rated independence, Chi Square revealed that there were no significant differences in self-rated mobility between baseline and follow-up (χ2 (4, N = 55) = 6.337, p > 0.05). The findings on independence need to be interpreted in the context of this predominantly older age group, living independently in the community. Perceptions of independence relate to being able to do the activities that individuals want to do. Selfperceptions may be affected by both increasing desire to do more and by the availability of carers or family members to assist individuals in their daily activities.

When asked if they used a walking aid at baseline, only 7 (12.7%) of the 55 individ uals who completed both baseline and follow-up assessments indicated that they used a walker, while 48 (87.3%) of this sample indicated that they did not. In contrast, at the six-month follow-up, 12 respondents (21.8%) indicated that they used a walker while 43 (78.2%) indicated that they did not. This increase in the use of walker at follow-up is possibly explained by better understanding of the value of using a walking aid to allow more activities, rather than that there was a decrease in mobility between baseline and follow-up.

Case Study 3: Mary Upton – From Wheelchair to Walking Aid Mary was referred to the Active lifestyles programme by the Options Advisor and completed a fitness MOT to highlight the areas for improvement. In this initial meeting, it became apparent that she was socially isolated and if she was to go out it would onl y be with her husband. Mary insisted that she wasn’t able to walk and spent her time in a wheelchair. We discussed the different activities available and she showed an interest in the exercise class held at Ferry View. As the couple have no transport and the public transport is minimal transport was offered to take the Mary for the first few weeks as well as accompany her until she felt confident to attend on her own. This was a success for the first few weeks however unfortunately due the lack of people attending, the class had to finish.

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The PSI class at Wallace House was not an alternative for Mary, and therefore an exercise class in Bengeworth has been established which Mary attends. She has found this activity to be really beneficial, and her mobility has improved significantly. Mary no longer uses wheelchair, she is able to walk and stand with the use of a stick!

The results of the follow up interviews suggest that there has been an increase in participantsâ&#x20AC;&#x2122; perception of support from family, friends and the wider community. Notably, at the sixmonth follow-up, 54 (94.7%) of respondents stated that they received support from family members, friends or the wider community while only 3 (5.3%) of respondents stated that they did not. However, Chi Square revealed that there were no significant differences on the participants perceived level of support at baseline and follow-up up (Ď&#x2021;2 (1, N = 53) = 0.057, p > 0.05). Therefore, while there was a tendency for participants to perceive a more extensive support network following the intervention, this was not statistically significant.

Table 3: Follow up on participantsâ&#x20AC;&#x2122; perception Support from Family and Baseline Friends and the Wider Community Yes 32 (58.2%) No 23 (41.8%)

Follow Up

54 (94.7%) 3 (5.35)

Rooftops housing residents were initially referred to the Active Lifestyles programmes by the Options Advisors. In the initial assessment of residents needs the Options Advisors determine the available assistance that can be provided to older residents and encourage individuals to accept more help from paid carers and from their own families.

While it is tempting to think that higher levels of support would be indicative of lower levels of independence, the changes reported here can be explained by a greater level of acceptance of the need for help, and greater involvement of family and friends in daily activities. There is a possibility that these results will continue to develop over time due to behaviour changes and further research may be required to investigate participants perceived level of support at a later date.

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7.0 Physical Wellbeing - Personal Fitness MOT Results The Personal Fitness MOT is based on the British Heart Foundation (BNF), Functional Fitness Programme. The MOT tool was developed by Glasgow Caledonian University (GCU) in 2011, and has guidelines for older adults 60 years and over. This tool has been promoted as a means for professionals to assess the needs of community dwelling adults and provide an indicator of risk for community living. The components of the MOT used in this project are shown in Table 4: Table 4: Components of the Fitness MOT, and possible indications MOT Component (Female and Physical Assessment Possible Indications Male upper and lower scores) 30 second chair rise Lower limb strength and Independent living, (F=17-3 stands, M=19-7 Power morbidity and mortality stands) Chair sit and reach Hamstring flexibility Walking ability (F=12 to -10cms, M= 10 to 16cms) Back scratch Shoulder flexibility Everyday tasks (F=5 to -20cms, M=0 to 25cms) Timed 8ft up and go Mobility, agility related to Risk of falls (F=4-11 secs, M=4-10 secs) walking ability and balance Hand grip strength Wrist strength Risk of fall (F= 9-28 kgs, M= 15-44 kgs) Single leg stance Balance Risk of fall (F = 29 -0 secs, M = 45-0 secs) Table 5 presents the average data for each of the physical health assessments conducted during the baseline and six-month follow-up stages of the evaluation. It is notable that at baseline, more than half of the participants (N = 49, 56%) did not complete the Chair Sit and Reach test which requires hamstring flexibility and indicates walking ability and climbing stairs. The 38 (44%) who did complete this test scored at the lower limits of the task suggesting that mobility was limited at baseline. Table 3 also demo nstrates that similar findings were observed at the six-month follow-up.

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Table 5: Physical Health Assessment Measure 30 sec chair stand (stands) Average Males Females Chair sit and reach (cm) Average Males Females Back scratch (cm) Average Males Females Times 8 ft up and go (sec) Average Males Females Hand grip strength (kg) Average Males Females Single leg stance (sec) Average Males Females

Baseline Overall N* Mean (SD)

Range

Six-Month Follow-Up N** Mean (SD)

Range

83 19 64

9.33 (4.00) 9.16 (4.65) 9.38 (3.84)

18.00 18.00 16.00

55 12 43

9.49 (4.39) 10.67 (4.60) 9.15 (4.32)

17.00 13.00 17.00

38 8 30

-.69 (11.78) -1.54 (12.92) -0.47 (11.69)

55.00 40.50 55.00

27 5 22

4.07 (7.16) 5.80 (8.47) 3.68 (7.00)

30.00 23.00 30.00

66 17 49

-16.08 (17.23) 19.76 (18.68) -14.80 (16.72)

90.00 89 85

41 8 33

-17.04 (17.50) -11.13 (21.89) -18.47 (16.35)

41.00 59.00 70.00

86 20 66

13.06 (7.42) 12.09 (4.96) 13.36 (8.02)

45.83 20.32 43.88

55 12 43

13.08 (5.64) 10.51 (4.22) 13.79 (5.81)

25.32 15.07 23.84

87 21 66

19.30 (8.25) 28.12 (9.70) 16.49 (5.29)

43.00 33.20 25.10

55 12 43

19.55 (8.73) 30.33 (11.45) 16.54 (4.60)

41.90 33.70 18.90

72 17 55

7.70 (7.53) 10.07 (10.15) 6.96 (6.46)

37.58 34.73 37.17

45 10 35

7.58 (8.81) 12.53 (11.37) 6.16 (7.55)

40.69 32.10 40.69

Note: * Baseline sample size = 87, ** Follow-up sample size = 55

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The scores which were recorded for the physical health assessment at baseline were compared to those observed during the follow-up using Wilcoxon Signed Rank tests. This revealed that there were no significant differences between the performance of the participants who completed the baseline and follow-up assessments for the following assessments; Table 6: Baseline follow up

Measure 30 second chair stand Chair sit and reach

Back scratch

8 ft up and go

Hand grip strength

Single leg stance

Baseline N = 54 Mean = 9.09 SD = 3.77 N1 = 26 Mean = -2.63 SD = 12.53; N = 47 Mean = -16.91, SD = 18.05 N = 55 Mean = 13.24 SD = 7.03 N = 55 Mean = 20.28 SD = 8.87 N = 47 Mean = 7.22 SD = 5.68

Follow up N = 55 Mean = 9.49 SD = 4.39 N2 = 27 Mean = 4.07 SD = 7.16 N = 41 Mean = -17.04 SD = 17.50 N = 55 Mean = 13.08, SD2 = 5.64 N = 55 Mean = 19.55 SD = 8.73 N = 45 Mean = 7.58 SD = 8.81

Z = -1.357 p > 0.05 Z = -2.108 p < 0.05* Z = -.923 p > 0.05 Z = -.801 p > 0.05 Z = -.801 p > 0.05 Z = -.712 p > 0.05

However, there was a significant difference in the scores for the chair sit and reach task (p < 0.05). This suggests that while there were no statistically significant improvements in most of the physical health assessments between baseline and follow-up, there was a significant improvement in the Chair Sit and Reach test, which as mentioned previously requires hamstring flexibility.

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8.0 Activities to Promote Physical Activity 8.1 Indoor Bowls

Four indoor blowing groups have been established through the Activities for All project, run in conjunction with Sports for All. This partnership helped with the initial set up and introduction to the local bowling clubs members who have shown our groups the tips and rules on how to play. Rooftops members have embraced this activity and are practising and working their way towards our RIO â&#x20AC;&#x201C; Rooftop Indoor Olympics event including competitions with Broadway, Pershore, Evesham and Gloucester.

Bredon Bowling Club invite Rooftops clients in for a lesson in bowls.

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9.0 Mental Wellbeing Mental Wellbeing was measured using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). This 14-item scale appears to have good face validity, as it covers concepts associated with positive mental health, including both hedonic and eudemonic aspects, positive affect, satisfying interpersonal relationships and positive functioning (Tennant et al, 2007).

The distribution of scores on the WEMWBS for the complete sample who completed the baseline assessment is presented in Figure 6. The average score on the WEMWBS was 53.09 (9.35) at baseline, which suggested that overall the sample scored moderate to high on the mental wellbeing scale.

Figure 6 â&#x20AC;&#x201C; A histogram depicting the distribution of scores on the WEMWBS at baseline

However, when comparing the baseline averages for the 49 participants who also completed the follow-up assessment, this revealed that the baseline mean for this sample was slightly lower (Mean = 51.88, SD = 9.09) than that of the complete sample at baseline (Mean = 53.09, SD = 9.35). Figure 4 presents a similar distribution of scores on the WEMWBS for the 55 individuals who completed the assessment at follow-up. Indeed, the average score on the WEBWBS at follow-up (Mean = 54.59, SD = 9.85) was only slightly higher than that observed at baseline (Mean = 53.09, SD = 9.35).

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Figure 7 – A histogram depicting the distribution of scores on the WEMWBS at follow-up

A Wilcoxon Signed Rank test was subsequently conducted to investigate if there was a significant difference between scores on the WEMWBS at follow-up and baseline. This revealed that the difference between participants’ average scores on the WEMWBS at baseline and follow-up bordered on being statistically significant (Z = -2.000, p = 0.046). These results suggest that while there was a trend for WEMWBS scores to increase, at the time of the follow-up this was not statistically significant at 6 months, and long term follow up may be indicated.

Case Study 4: Pauline Newman – ‘A bit of me time’ Pauline recently moved into one of our schemes after living in the community. Pauline wasn’t involved in any activities until we visited to complete an MOT with her. Pauline spends her time doing a lot for others, but rarely takes the opportunities to do anything for herself. On completion of the initial interview and Fitness MOT she thought it would be good for her to join in and have a bit of me time. A cooking class was established at Cherry Orchard House which Pauline attended and was very keen to participate in; she now also goes to the exercise class in Bengeworth which is proving to be a real benefit to her and her health.

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10. Discussion The baseline data on 90 Rooftops residents, aged between 51 and 97yrs (mean age of 78 yrs), who completed the Personal Wellbeing and Lifestyles assessment between April and November 2015, demonstrates the current, pre-intervention level of physical fitness and mental wellbeing. It is of note that more than 60% of participants were overweight or obese.

After 6 months in the programme, follow up interviews were conducted with 55 of the participants to evaluate the efficacy of the programme and determine the benefits for individuals. It is important to note that the follow up interviews occurred over winter time, a season when people tend to experience more illness and will be less inclined to engage in activities outside of the house. A mixture of statistical and narrative information is provided in this report to show that while the benefits are not yet demonstrating striking improvements in the wellbeing of all participants, there have been a number of interesting, indicative and individual benefits from participation.

The results of the evaluation highlight the range and interplay of factors tha t contribute to wellbeing in older aged adult. The mean age of the participant is almost 80 years old and many participants experience a range of risk factors including poor health, living alone and limited mobility. Initially participants rated themselves as having moderate to high levels of independence. However the results of the Fitness MOT suggest that most have limited mobility and levels of fitness and spent much of the time in sedentary activities. It is debatable whether this perception of independence in older people should be interpreted positively, or whether independence is consistent with living alone, having few support and having to manage as best as you can, with limited opportunities to get out and meet others.

At follow-up there was no clear evidence of physical improvement in most of the measures covered on the Fitness MOT. One exception was in the â&#x20AC;&#x2DC;Chair Sit and Reachâ&#x20AC;&#x2122; test which demonstrated a significant improvement. This test indicates a greater level of hamstring flexibility and increased mobility. The statistical finding is consistent with a number of individual case studies provided by the activity coordinators and an increased use of walking aids in the participant group. The Active Lifestyles programme appears to have had a beneficial effect on individualâ&#x20AC;&#x2122;s mobility and activity in the community.

Wellbeing is more than physical fitness and for this elderly population there is clear indication that psychological wellbeing is an important contributor to overall wellbeing. While the statistical evidence from the WEMWBS does not demonstrate improvement in overall mental wellbeing, the self-rated assessment of wellbeing does show a tendency towards improvement, and suggests that a longer follow up period may have been beneficial. Given that some of the participants participated in activities on a weekly or less regular basis, the tendency to high level of psychological wellbeing is promising and may correlate to the higher level of perceived, family, friend and community support.

The result indicate that in the short time that the programme has been running there has been steady increase in the number of individuals participating in the activities and this has led to positive changes in physical activity and self-perceptions of wellbeing for the 55 participants that were involved in the follow-up. A significant proportion of individuals

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assessed at the start of the project were not available of follow-up for a variety of reasons and therefore the results presented are limited and should be interpreted with some caution.

However changing health behaviours is rarely easy and generally involves repeated starts and returning to old patterns. For older people behaviour change, in the context of poor health, social isolation and lack of transport will be particularly challenging and repeated opportunities and encouragement are needed to engage a higher proportion of Rooftops residents. For some individuals who had difficulty discussing the physical and psychological factors that influence wellbeing, further health education may be needed prior to promoting wellbeing through the activity programme. The individual Activity Lifestyle Assessment is a positive and educational process through which the officers provide individuals with clear information about their BMI, current level of fitness, compared to norms and the opportunities available to them. For some individuals this process may need to be repeated 6 monthly or annually to plant the seeds of the health promotion message.

As 9% of older people experience depression, it is likely that non participation in activities or in any health promotion activities may be symptomatic of an underlying depressive illness.

Screening for depression by using the Beckâ&#x20AC;&#x2122;s Depression Inventory may be appropriate for some individuals who self-rate wellbeing as low, or show no motivation for change.

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11. Conclusion There is little doubt that the participants in this evaluation have experienced some physical and psychological benefit from participation in the Active Lifestyle programme, although the results of the 6 month follow up does not provide statistical evidence of the result. Further follow up after 12 months may produce more convincing data; however the case studies included present a variety of narrative accounts of the value of participation. The main benefits identified by this report are increased mobility and improved self-perception of wellbeing and support from family friends and community.

The individual face to face assessment by Active lifestyle Officers including the Fitness MOT, provide individuals and couples with basic health education regarding physical and psychological benefits of engaging in the activity programme. The invitation was taken up more enthusiastically by some, while others will need rather more than one interview to engage in a new health behaviour. Where people have low motivation to change and self-rate their wellbeing as low, it would be prudent to screen for depression.

Weight management is an important feature of the programme and the follow up results demonstrate that some individuals gained weight during the 6 months. Education o n healthy foods and low carbohydrate snacks during activities should be considered. Regular weigh -ins are already taking place and provide support and encouragement for those who want to lose weight. By implementing a 6 monthly review and further follow up seasonal weight gain and effects of depression may eliminated.

The main implication and recommendation resulting from this 6 month evaluation, is the need for a longer term follow-up and continuation of the project, with further effort to engage those individual who have declined participation to date, through health education.

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Author: Dr Yvonne Thomas Senior Lecturer/Course Leader Occupational Therapy Institute of Health & Society University of Worcester email: y.thomas@worc.ac.uk tel: 01905 54 2610

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