Meeting the Psychological Needs in Relation to Older People Who Have Fallen - PowerPoint Presentation

1. Meeting the Psychological Needs in Relation to Older People Who Have FallenElizabeth BaikieConsultant Clinical PsychologistFalls Prevention & Management in Older People 06/05/2022elizabeth.baikie@nhslothian.scot.nhs.uk

2. OverviewPsychological Needs/Values & Life Satisfaction/Quality of LifePsychological Consequences of FallsIdentifying & Managing Fear of FallingSupporting People to Regain Confidence and Reduce Anxiety after a Fall

3. Psychological Needs and Quality of life NEEDS QOLAutonomy Sensory abilities Autonomy Past, present and future activitiesCompetence Social participation Attitudes towards death and dying IntimacyRelatedness(Self-Determination Theory, Deci & Ryan, 1985)WHOQOL-OLD (Power, Quinn Schmidt, 2005)24 items: 6 facets rated on a 5-point Likert scale

4. Values –what we find meaningful in life(Acceptance and Commitment Therapy)Family relationsMarriage / couple/ intimate relationsParentingFriendships / social relationshipsEmploymentEducation / training / personal growthRecreationSpiritualityCitizenship /communityPhysical wellbeing(NB lockdown: not going out or having visitors affected mood, as did mobility)

5. Needs of people [with or without dementia] living in care homes during the COVID-19 PANDEMIC (Marshall, James and Carter, NHS Tees, Esk and Wear Valleys, 2020)The Needs Tree: the 8-needs frameworkPhysical comfort and freedom from painControl over environment and possessionsOccupation and explorationPerception of safetyEsteemLove and belongingPositive touchfun

6. Role of ActivityDepression was the most powerful predictor of QOLRegular participation in physical activity important for QOL, as well as physical and cognitive function, preventing obesity (Borowiak & Kostka, 2004).Satisfaction of the psychological needs of autonomy, competence and relatedness was related to exercise, intrinsic motivation and self-determined autonomy (Kirkland et al, 2011)Cl Satisfaction of these basic psychological needs is important when considering exercise and how it relates to falls reductionPurposeful activities can improve mood

7. Psychological Consequences of FallsFear, anxiety, loss of confidence and subsequent increasing activity avoidance, social isolation and frailty (Parry et al, 2014, STRIDE study)Reduction in pleasurable/purposeful activities Reduction in quality of lifeDepressionPTSD (Chung et al, 2009); (Jayasinghe et al, 2014) (Anger)

8. Psychosocial Consequences of FallsMaintenance of anxietyOver-protectiveness of relatives: “You sit down, I’ll do it”.“Don’t go out in the garden on your own, bending can lead to over-balancing” Reduction in sense of control, incl. role reversalStaff behaviour?Safety versus risk and autonomy

9. Falls and Fear Of Falling: which comes first (Friedman et al, 2002)Falls at baseline were an independent predictor of developing FOF 20 months laterFOF at baseline was a predictor of falling at 20 monthsWomen with a history of stroke were at risk of both at follow-up. Parkinson’s disease, comorbidity and racial background predicted falls, whereas GHQ score, age and taking 4 or more meds predicted fear of fallingIndividuals who limit activites because of FOF are at high risk of faling, due to decline in function, also they have a higher prevalence of risk factors

10. How Does Fear of Falling Develop? Situational triggers/associations may lead to specific avoidanceEg steps up to church – has not been back sinceRushing for waiting taxi and over-balancingRushing when door or phone has rungprevious fall on bus or stepping on to a busCombined with health factors

11. AttributionsCauses of falls may be:Extrinsic, eg obstacles loose mats, wet leaves, tramlinesIntrinsic, eg eyesight, medicationAttributions may be specific or general

12. Changes in ThinkingIncreased awareness of ageing after a fall“I fell because I’m getting older/old now. I’d better be careful” v “I fell because the plumber left his bag in the dark hall.”Increased concern about physical health“I’m dizzy all the time. Seems to have started after my TIAs. I’m likely to fall outside on my own”. I’d better not go out v “Sometimes I feel dizzy. It’s worse when I get up quickly. I’m ok if I get up slowly and am fine with short walks”.

13. AvoidanceAvoidance may generalise, eg original fall due to trip at home leading to avoidance of going outStrengthens fear/phobic avoidanceLeads to deconditioning and poorer balance

14. Maintenance of anxietyCognitive Behavioural approach - vicious circleThoughtsI fell so I must be getting old and infirmFeelingsAnxiety/panicPhysical feelingsDizzy-ShakyBehaviourHyperventilationReduction in physical activity-Avoids walking alone or going out alone-

15. 3. Psycho-education (from Heather Langham, 2013))Maintenance of anxietyCognitive Behavioural approach - vicious circleThoughtsIf I walk by myself I will fall over and hurt myselfFeelingsAnxiety/panicPhysical feelings-Heart race increases-Breathing quickens-ShakyBehaviour-Avoids walking alone-Seeks staff support if needs to walk anywhere

16. Six Types of Helping Strategies (Scally & Hopson, 1977)Giving advice: offering your opinion on best course of actionGiving information needed for a particular situationDirect actionTeachingSystems changeCounselling Counselling and Helping, Barrie Hopson. In Psychology and Medicine (1981) ed. Chapman & Gale. Pub. The British Psychological Society

17. Interdisciplinary interventions for fear of falling (Gomez & Curcio, 2007)Medicine: Aim - decreasing medical risk factors Management of falling risk factors: visual deficit, arthritis, dizziness, polypharmacy and drug reactions, orthostatic hypotension anxiety & depression, patient and caregiver education

18. Physiotherapy: Aim – increasing functional ability in physical and instrumental ADLIndividualised and group-based interventions Transfers trainingAerobic endurance, flexibility, strength, and balance trainingWalking in extreme situations program (opened and closed eyes)Landing and standing strategiesAssistive devices adaptationHealth promotion and education in falling risk factors

19. Psychology: Aim - improving emotional functioning and adapting behaviour changeCognitive-behavioural therapyPatient and caregiver trainingManagement of anxiety and depressionOccupational therapy: Aim - obtaining competent and safe performance Adaptive rehab in items of Self Efficacy scaleEnvironmental risk assessmentAdaptive strategies in extreme situations

20. Social work: Aim – increasing social participationStimulating familiar activities and help supportPromoting social contacts and social participationCase management as necessaryPatient and caregivers education

21. AssessmentIdentify triggersSpecific situations*Cognitions/thinking style, eg mental filter, prediction, mountains and molehills, catastrophising and black and white thinkingPrevious fallKnowing someone who’s fallenCoping strategiesWeigh up pros and cons of change, eg reduction in social isolation*www.getselfhelp.co.uk/unhelpful.htm

22. Psychological interventions continuedOveractivity/rest cycle and pacing(NB pain) Selection, optimisation and compensation for activites, e.g., golf; playing a few holes, going to the practice range etc.Systemic work with families – not ‘all or nothing’Doing things in a graded way or together

23. ConclusionsIdentify the person’s goals*Promote motivationCost/benefit analysisProvide psychoeducation about anxietyIdentify relevant cognitions and thinking styleIdentify safety behavioursWork with other colleagues *eg the environment: ‘PJ paralysis’ (2019) *behavioural charts