Active IQ Level 3 Diploma in Supporting Clients with Long-term Conditions (sample manual)

Manual
Level 3 Diploma in
Supporting Clients with
Long-term Conditions
Version AIQ005801

The prevalence of long-term conditions
Section 1
The prevalence of long-term conditions
The prevalence of people living with long-term conditions (LTCs) is increasing, which is placing an ever-growing
burden on health care and society, with current policies and care frameworks considered unsustainable over the
coming years (NHS England, 2019).
PREVALENCE OF LONG-TERM CONDITIONS
AND THE SOCIOECONOMIC IMPACT
Long Term Conditions are those that cannot, at present, be cured, but people living
with these conditions can be supported to maintain a good quality of life.
People over aged 85 years are
more likely to be living with a long
term condition including fraility.
% of population in England
aged over 85 years
4.1 4.2 4.4 4.6
3.8
3.3
2.4 2.5 2.8
1971
1976
1981
1986
1991
1996
2001
2006
2011
People might be living with more than one
long term condition. Of the people who report
that they live with long term conditions;
24% have
two long term
conditions…
…and 20% more live
with three or more
long term conditions.
18%
of people
living with a long
term condition
smoke
People who smoke
are more likely to
have flare ups in
their condition
and more likely
to be admitted to
hospital.
People living with a long term condition
are less likely to be working than the
general population.
People living with a long term condition are more likely to use health and care
services. They account for:
More information about enhancing the quality of life for people living with long term conditions can be found at www.england.nhs.uk/house-of-care/
50%
of all GP
appointments
64%
of all hospital
outpatient
appointments
70%
of all hospital bed
days
The socioeconomic impact of LTCs
70%
of total health and
social care spend
72%
of the general
population are
in work
59%
of people with
long term
conditions are
in work
35%
of people
with a mental
health
condition are
in work
Figure 1.2: Prevalence of LTCs and the socioeconomic impact (NHS England, 2019)
Unsurprisingly, people living with LTCs make up a high proportion of those accessing health and social care services
in the UK. There are some astounding statistics regarding the cost of supporting people living with LTCs:
The health landscape
• For every £10 spent on health and social care, approximately £7 is spent on those living with LTCs.
• 50% of all GP appointments, 64% of outpatient appointments and 70% of all inpatient bed days
are for people living with LTCs.
• On average, it costs health and social care approximately £1,000 per year to support someone
who does not have an LTC. This figure rises to £8,000 for those living with three or more LTCs – an
eight-fold increase.
NICE (2015)
And from an economic perspective:
• Work absence due to sickness costs the UK economy an estimated £22 billion per year, and
although not all of this can be attributed to LTCs and an exact figure would be considered conjecture, it can
still be accepted that a considerable proportion will be directly related (The Work Foundation, 2016).
• For example, mental ill health, which sits under the LTC umbrella, cost the UK economy £25 billion*
in lost productivity in 2015, with 17.6 million working days
lost to mental illness (Oxford Economics, 2016).
*This figure includes the cost of those unable to join the workforce due to
mental ill health and those who have to reduce their working hours or leave
employment entirely to care for someone with a mental illness.
ACTIVITY
Research the most
recent statistics for the
prevalence of long-term
conditions and compare
these to global prevalence.
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The prevalence of lifestyle behaviours associated with long-term conditions
Section 2
Smoking
It is now commonly accepted that smoking is harmful to a person’s health and can increase the risk of a range of
LTCs. However, this was not always the case – in the first half of the 19 th century, cigarettes were actually promoted
as a supplement to good health, as the images below show:
As Figure 2.5 shows, current statistics in the UK suggest that the number of adults smoking is decreasing every
year, with 19.8% (7.7 million) of the population smoking in 2011, reducing to 14.9% (6.1 million) in 2017 – this
equates to approximately 1.6 million fewer smokers.
30
UK, 2011 to 2017
The health landscape
20
10
0
2011
2012
2013
2014
2015
2016
2017
England
Wales
Scotland
Northern Ireland
United Kingdom
Figure 2.5: Proportion who were current smokers, all persons aged 18 years and over
(Annual Population Survey – Office for National Statistics)
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Section 3
Sociodemographic factors
The following infographic adds further detail to the three determinants of health identified above and includes some
other important factors that influence the health of an individual.
Income and social status
There is a linear relationship between
income and social status, and health
status – the more socially deprived,
the poorer the health status, and vice
versa. Higher incomes and social
status are linked to better health.
Education
Societies with better education are
more likely to have people living more
healthily, whereas lower education is
associated with poor health.
Physical environment
Safe water, clean air and healthy workplaces all
contribute to good health. Furthermore, people
in employment are healthier, particularly those
who have more control over their working
conditions.
Social support networks
Greater support from families,
friends and communities is linked to
better health. Culture, customs and
traditions, and the beliefs of the family
and community, all affect health.
Genetics and personal behaviour
Hereditary factors influence lifespan, healthiness
and the likelihood of developing certain illnesses.
Also, as already discussed, personal lifestyle
behaviours play a significant part in determining
health, e.g. physical activity levels, diet, etc.
Health care services
Societies that offer better health
care services have higher rates of
mortality and better health overall.
Gender
Men and women suffer
from different types of
diseases at different ages.
Figure 3.1: Factors that influence the health of an individual
86
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Behaviour change theories and techniques
Section 1
Maslow’s hierarchy of
needs
In 1943, Maslow suggested that there
is a hierarchy of needs and that selfactualisation
sits at the top. Before
self-actualisation can be achieved, other
needs take priority and these must be
achieved first, as shown opposite.
Formal theory
Figure 1.4: Maslow’s hierachy of needs
1. Cognitive evaluation theory (CET). This mini-theory is concerned with intrinsic motivation, defined as performing
an activity or behaviour for its own sake or enjoyment. In other words, the activity itself is rewarding and no other
reward is necessary. Spontaneous play is a good example of intrinsically motivated behaviour in children. For adults,
play may take on forms such as artistic, musical or literary creativity, or be demonstrated in sports or exploration.
CET focuses most on the basic needs for autonomy and competence, and how these are supported or thwarted to
generate or undermine intrinsic motivation (Deci, Koestner and Ryan, 1999).
2. Organismic integration theory (OIT). Extrinsic motivations are the subject of this mini-theory, although it is used
as a blanket term for any behaviour that is performed in order to achieve an outcome outside of the behaviour
itself. Extrinsic motivation is not a single entity, but takes many forms including external regulation, introjection,
identification and integration. The important difference between the different types of extrinsic motivation is the
degree to which a person internalises the motivation. The social environment is critical in determining the degree of
internalisation through the extent to which the basic needs of autonomy and relatedness are supported or thwarted.
OIT therefore addresses the extent to which a social environment fosters or inhibits internalisation of extrinsic
motivations (Ryan and Deci, 2000).
Behaviour change for clients with long-term conditions
Regulation Introjection Identification Integration
Figure 1.5: Relationship between extrinsic motivation and autonomy and relatedness in environment
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Behaviour change theories and techniques
Section 1
Motivators to behaviour change
A key component of motivational interviewing and other behaviour change techniques is a focus on the positive
and avoidance of negative talk. Fitness professionals should latch on to the reasons why an individual would like to
change their lifestyle behaviours for the better and use these to increase the amount of ‘change talk’.
Motivators for people with long-term conditions include:
Being in less pain.
Being able to play
with their children.
Having more
energy and being
happier.
Improving
confidence and
self-esteem.
Living longer.
Having a better
social life.
Goal setting
Avoiding hospital
admissions or
having to go into a
care home.
Less reliance on
medication.
Avoiding surgery.
Figure 1.21: Examples of motivators to behaviour change in those with long-term conditions
Behaviour change for clients with long-term conditions
Goal setting has a pivotal role to play in successful behaviour change. There are strong links between goal setting
and developing self-efficacy. Goal setting is essential for the pacing of programme developments and progressions;
it also forms an important part of the review process and assists client motivation.
Goals are individual to each person and the nature of their long-term condition(s), but it is likely that they will include
one or more of the following for most clients:
• An improvement in overall health and quality of life.
• A reduction in pain.
• An improvement in ability to function.
• An adoption of suitable coping strategies.
• The use of strategies to prevent the development of chronicity.
• An increase in knowledge and understanding of symptoms. (CSP, 2006)
Goals and objectives need to be agreed in partnership with the client, and stated in a language the client can
understand.
The fitness professional should also not assume what the client wants. Instead they should explore the client’s
wants and needs and steer them towards a more active, self-management approach to their condition.
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Section 2
Lifestyle advice and education
The guidelines cover a range of population groups, including under-5s, children and young people (5–18 years),
adults (19–64 years), older adults (65 years and over), pre and postnatal women and disabled adults. For the
purpose of this qualification, this section will focus on adults and older adults.
Figure 2.1: The current physical activity guidelines for people aged 19 and older
394
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Section 2: Monitoring and adapting physical activity programmes for clients with long-term conditions
Unit 5
Stages of monitoring
Monitoring progress includes reviews and checks that are made:
• Pre-session – before the session starts.
• Mid-session – during the exercise session.
• Post-session – at the end of the session, when exercise has finished.
Post-session checks
Post-session checks will focus on client recovery (heart rate, blood pressure,
etc) and gathering feedback from clients to inform future sessions. The exercise
referral instructor should discuss progress and developments with clients and
agree any necessary adjustments to the exercise programme for next time.
Post-session
checks
It may also be worthwhile using this time to advise clients of what they might
expect over the 24–48 hours following activity: muscle soreness, tightness,
fatigue, fluctuations in energy levels, etc.
Mid-session checks
During exercise and throughout the exercise session, ongoing
monitoring enables the exercise referral instructor to:
• Determine how well clients are coping with the exercise
programme.
• Check how clients are feeling about the exercise.
• Identify any changes in clients’ response to exercise.
• Identify any changes that need to be made to the exercise
(regressions or progressions).
• Provide continuing help and support to clients.
Different methods of monitoring can be used during the session (e.g.
observation, questioning, RPE), which are discussed later in this unit.
Pre-session checks
Pre-exercise checks may include checking for:
• Contraindications that present, e.g. high blood
pressure or heart rate, or changes in condition
(unstable).
• Changes in the client’s health status, e.g. new
symptoms, new medication or a deterioration of
an existing condition (this may be uncontrolled or
unstable).
• Specific condition checks, e.g. availability of
inhalers or checking pre-exercise blood sugar
levels.
• Confirmation of necessary medication – both
its availability and that the client has taken it at
the correct time prior to exercise, if appropriate.
Pre-session
checks
STEP 1
Mid-session
checks
STEP 2
STEP 3
Planning and adapting physical activity for clients with long-term conditions
Any clients presenting with unstable or uncontrolled
conditions or contraindications should be signposted
back to the GP for further checks prior to exercising.
Clients without appropriate medication should be
advised to defer exercise.
Figure 2.1: Session monitoring steps
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