OT? So What?

During the week I attended the College of Occupational Therapists Conference in Glasgow. The College of Occupational Therapists Specialist Section- Older People (COTSS-OP) conference ran simultaneously. It was really inspiring to hear many of the main keynote speakers, such as professor Michael Iwama, talking about preventative work and public health being important future arenas for OTs. The vital role OTs play in acute and emergency care settings was very much acknowledged, but the importance of linking well with community based services was very much at the forefront of the discussions.

I presented a facilitated poster discussion about my study visit to the University of Southern California. I outlined the background to the visit and then went on to the following:
 

'...Current hospital discharge practice can be frustrating for both OTs and older people themselves. It can be reductionist, grounded in a medical model and emphasise ‘safety’ at the expense of occupational engagement and enablement of valued daily activities. A paradigm shift on the part of policy makers, service managers and individual OTs is needed to change this. An understanding of the principles of the LRD model can provide a way forward.

I want to leave you with some points to ponder based on the opening plenary speech given by Professor Iwama and Jacqui Lunday Johnstone’s Keynote address to the COTSS-Older People’s conference. Professor Iwama challenged us to re-examine how and where we work and to look at the preventative and public health arenas as the future of Occupational Therapy. He asked us to consider the relevance of our services to the lives of the people and communities we serve. Jacqui Lunday Johnstone emphasised the need to demonstrate outcomes or the ‘added value’ that occupational therapists provide- what she termed the ‘So What?’. Both affirmed that the unique skills of OTs, if fully utilised can have real impact on the hospital to home interface. Using an approach inspired by Lifestyle Redesign® could help to make this a reality.

Imagine the older people who use your service being asked two questions:

1. Was the OT service you received relevant to your life?
2. If you received a service, So What? What was the added value it brought?

If the answers you think you would get are not what you would wish them to be, then it is time to begin looking at the reasons and to think about whether using aspects of Lifestyle Redesign® could be a way to change the answers in future.'

blue Zones

 

Z

The final post in this year’s Blogging from A to Z Challenge and fittingly it is a subject that looks to the future. My theme for the month has been ‘Age Proof Your Life”. My posts have included ideas that we can all do as individuals as well as some that work at the level of a whole community or government policy.

I began this blog because I was awarded a Winston Churchill Memorial Trust travel award in 2011 and it is also satisfying that my final post is inspired by the work of another Churchill Fellow, Jan McClory. I heard Jan speak at the recent AGM of the Scottish Association of Churchill Fellows. Her subject was “Old and Healthy? Can Scottish Communities ever become Blue Zones?

Jan is a Social Worker based in Scotland and spoke about the factors that contribute to Scotland’s poor health record- now being recognised as more complex than the oft mentioned issues of poverty and poor diet. She explained that there has been a lot of research into the factors that are present in communities around the world that have long life expectancy- and perhaps more important, healthy long lives. Examples of communities that have been studied are in parts of Japan, Costa Rica, Sardinia, Greece and Loma Linda in California.

These communities with healthier, happier and more productive older citizens have become known as Blue Zones. Pilot projects are being carried out in the US to see if the same can be achieved in communities there. Pilot sites are Minnesota, Iowa and Beach Cities, Los Angeles. Very specific methodologies are used and all aspects of life within the community are included- home, work, the town, friends and so on.

 Jan’s full report will very soon be available on the Winston Churchill Memorial Trust website and can be found by following this link (not yet live at the time of writing this post):

http://www.wcmt.org.uk/fellowships/fellows-reports.html?option=com_reports&task=listReps&Itemid=13&rep_search=1&year=2012&cat=&country=&author=McClory&phrase=Phrase

I am very much looking forward to reading the full report.

Thank you to everyone who has taken the time to read and comment on the posts in this series. I hope you have enjoyed reading them and that you have found some inspiration to help you Age Proof your life.

P is for Pledge

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P

Physical Activity Pledge

Physical activity is increasingly being shown to be one of, if not the, most important thing that almost everyone can do to improve their health. More importantly, the benefits will stay with you and help to maintain good health and avoid problems as diverse as dementia, heart disease and diabetes- all of which become a higher risk as you get older.

The great thing is that doing more physical activity does not have to mean that you have to do high impact sports if you don’t enjoy them. Walking the dog, making short journeys on foot instead of taking the car, playing with the grand children, taking the stairs instead of the lift can all add up. Better still the amount of exercise being recommended to get all these benefits is only about 30 minutes a day, and that can be made up of 3 x10 minute slots if you prefer.

Occupational therapists are one of the Allied Health Professionals in Scotland who have signed up to the Scottish Government Pledge to get Scotland more active. You can read more about the Pledge by following this link

http://www.cot.co.uk/news/calls-action/ahps-pledge-increase-physical-activity-scotland

An occupational therapist looks at a person’s whole lifestyle and can help find ways to incorporate health promoting activities- such as exercise- into daily routines. They work with you to find ways of being more active that are manageable and enjoyable.

For a fun presentation that is under 10 minutes long follow this link- you won’t need any further persuasion!

http://www.youtube.com/watch?v=aUaInS6HIGo

Lifestyle..

L
 

Lifestyle Redesign®

“..is a process of acquiring health promoting habits & routines in daily life” (Clark et al 1997)

“…is the process of incorporating health promoting habits & routines in your daily life. OTs look at how you ‘occupy’ your time and how the daily activities you engage in affect your overall health, wellness & life satisfaction” University of Southern California Faculty Practice

Four core beliefs of the Occupational Therapy profession informed the development of Lifestyle Redesign®:

• Occupation is life itself
• Occupation can create new visions of possible selves
• Occupation has a curative effect on physical and mental health and on a sense of life order and routine
• Occupation has a place in preventive care (Mandel et al 1997)

The concept is now widely recognised in occupational therapy and health literature (see report tab at top of page for more detailed information). The term ‘Lifestyle Redesign’ is trademark protected, but any OT can draw upon the methodology. I suggest reading the report as above as a starting point.

Gardening Gracefully...

G

Gardening Gracefully….

Enjoyment of a garden and of actually being able to do the gardening is a pleasure for many people. Gardens provide beauty, peace and fresh air- as well as exercise working on them. They may even provide food for the household.

In older age, some aspects of gardening can become physically difficult. Age Proof your life by thinking ahead and making changes gradually so that you are able to enjoy your garden for as long as possible. Read on for some ideas from people who have done just that.

• Ian says ‘I had always cursed the steep slope on the lawn that was such a chore to mow- even when I felt fully fit. I recently had it dug up and replaced it with low maintenance shrubs. Now that they are getting established they are so much more interesting to look at- especially as I chose varieties that the birds love, they don’t need much attention and I only wonder why I didn’t do it sooner! It has inspired me to look at the rest of my garden and bit by bit make it less labour intensive’

• Fran explains ‘I have been finding it hard to bend to get at borders. My son built some raised beds for me close to the house. I can get at them easily and I am really enjoying being able to plant them up and look forward to being able to potter around working on them and enjoying the evening sun, without having to worry about getting down on my knees or straining my back.’

• Sheila says ‘Mum always loved her garden but dementia means that she is no longer able to do the jobs she used to. We find that she is most peaceful when she is in her garden. Walking around it with one of her family or sitting out in the sun listening to the birds seems to give her enjoyment.’

• Bob tells ‘I moved into a Sheltered Housing flat and to be honest didn’t miss the garden at first, it had become a chore as I got slower, but now I am here I have started growing houseplants on my windowsill, that is work enough for me now! There is a garden area where I can sit out on a bench and watch someone else do the work!’

D is for Driving....

 

D

 

Driving for older people

When to give up driving is a question that has big implications for independence. It is not only the ability to drive and get form A to B but the sense of being independent and in charge of one’s own life that is so important. The ability to drive can make it possible to join in social activities, visit family and be independent for jobs like shopping. Not driving can limit opportunities to be part of the wider community.

In the UK a full driving licence lasts until the age of 70, then has to be renewed every 3 years. There is no charge or test involved. It is a driver’s responsibility to inform DVLA of any medical condition that could affect driving- some mean that you must not drive for a period of time.

Generally older drivers are safe behind the wheel, they are experienced drivers and don’t take risks. However they are more likely to have accidents at junctions and can be more seriously injured in the event of an accident.

Some warning signs that tell you it might be time to think about giving up are:

• You find driving more stressful
• Your eyesight is getting worse
• Your reactions are slower than they used to be
• Others have suggested it is time to give up… especially if they have been in the car with you!

Age proofing your life means thinking of ways that you could cope without a car- and it is worth thinking ahead and familiarising yourself with these well before you stop driving. What is public transport like in your area? You may be entitled to free or concessionary travel. Maybe you could try a bus trip with a friend who knows the system before setting out alone. Are there other ways to do your shopping? If you use a computer there are on-line delivery services. Do you know if local shops deliver? Perhaps you could share a taxi with friends for a social outing. The cost of keeping a car ‘on the road’ is high and if you are only driving a few times a week, it may even be cheaper to use taxis.

If the prospect of giving up driving is years in the future, it is still worth thinking about where you are living and how manageable things would be without a car.

What is it that being able to drive allows you to do- and how else could you do the same?

The Royal Society for Prevention of Accidents (RoSPA) offers Experienced Driver Assessments, not a test but a good way to get an opinion about your driving ability. This link will give you more information.

Happy Motoring!

Choosy about Chairs...

 

C

Are you sitting comfortably?

Getting in and out of chairs is something that often becomes more difficult as we age. One of the main reasons is that the large muscles of the legs tend to become weaker, but aches and pains from arthritis and various other complaints can also play a part. Luxurious deep, wide armchairs with squashy cushions make for a lovely soft landing when sitting down, but it can be an inelegant struggle to get back up again!

If you are in the market for a new chair, think ahead and aim to choose something that is not just stylish but practical as well as comfortable. The ideal is to aim to be seated comfortably, but not slouched in the chair, so a fairly straight, high back to the chair is an advantage. You want to have your knees level with your hips and your feet firmly on the floor. If the chair is too low your knees will be higher than your hips and more effort is needed to get up. If the chair is too high your feet will be dangling, this is not comfortable and can lead to swollen feet and ankles. The chair should be reasonably firm to provide support. Don’t forget to look at how wide the seat of the chair is, aim to feel supported in it without it being tight. Check the ‘depth’ of the chair- the distance from back to front- make sure the back supports you without needing lots of cushions behind you and that most of your upper leg is supported. Firm armrests are important as these give support to push up from. If at all possible try the chair in the showroom before you buy as mistakes can be costly. If you prefer lounging on the couch, remember that these offer less support when sitting and when getting up. You might want to think about a chair and use a footstool to put your feet up.

If you are unable to try out a chair, you may want to ask your Occupational Therapist for advice or help with measurements. Your OT can also help if you are not able to buy a new chair as there may be equipment that could be used to make the chair you have more suitable for you.

So, this is great, you know what to look for in a chair to make getting in and out of it easier. But, as always, prevention is better than cure and age proofing your life involves keeping strong, particularly in your leg muscles, for as long as possible. So don’t neglect the exercises or activities you enjoy that make you use your leg muscles, walking is one of the best and the sooner you begin the better!

Bathing Beautifully....

B

Bathing beautifully…

 

 

There is something horribly undignified about the idea of getting stuck in the bath- and in fact it can be serious if you really can’t get out and there is no-one to summon for help. Best to avoid this happening in the first place by thinking ahead.

Having a bath is a luxury lots of people don’t want to do without. It’s so relaxing and soothing for aches and pains. The process of getting in and out has a few danger points-

• Slipping and losing your footing.
• Teetering on one foot at a time while stepping over the side of the bath.
• Lowering down from standing to sitting in the bottom of the bath… and then getting back up.

Slipping is less likely using a non-slip mat, but wash and rinse it regularly or soapy residue will make it slippery too! Also, try to avoid bath oils as they make for a very slippery surface.

The teetering on one foot can be avoided by using a bath seat that allows you to sit your bottom down first (thus getting your centre of gravity safely landed) then swing your legs over the side. Or have a grab rail fitted on the wall to hold onto.

The getting up and down can be solved by sitting up on a seat placed in or over the bath so you are not right in the bottom of the bath. However this is not always popular as you don’t get to lie flat out in the bath. The height of luxury may be a powered bath lift or even a ‘walk-in’ bath- both cost a bit (or a lot) of money but might be worth it if you love your bath.

A shower could be the answer, but if it is over the bath you still have the stepping in and out issue to think about, and slipping…

The better your balance and the stronger your muscles, especially in your legs, the longer you will feel confident to get in and out of the bath, so keep up the exercise as much as possible. It can be a good idea to have your bath when someone else is around in the house.

Many people actually decide that they are happy just to have a strip wash and not worry about using the bath or shower. If you are a younger friend or relative worrying about someone not having a bath or shower, so long as they are managing to keep clean and are happy with this, don’t forget the generation who are in their 70s, 80s and above probably didn’t grow up with the idea that having a bath or shower daily was essential, in fact many grew up in homes with no inside bath and maybe no hot water, so it may be that ideas of what is essential differ between the generations!

If bathing is becoming a struggle, don’t wait for a disaster- plan ahead and ask your Occupational Therapist for advice.

Age Proof Your Life

 

A

Age Proof Your Life

The population of the developed world is getting older.

• One in 4 babies born today will live to be 100
• The number of people aged over 65 is expected to rise by 50% in the next 20 years
• The number of over 85s is predicted to double in the next 20 years and treble in the next 30 years
• 3.8 million older people live alone, 70% of these are women
• These figures are based on the UK, but other comparable countries may be ‘ageing’ even faster!

My theme for this year’s A-Z Challenge is Age Proof Your Life.

As an Occupational Therapist (OT) with over 20 years experience, mainly in working with older people, I have had the privilege of witnessing at close hand the ways that many people cope with the challenges of growing older, whether in good health or poor, whether surrounded by family or alone and whether financially comfortable or not.

Last year I used the A-Z Challenge to reflect on a study visit I had just completed to the USA (I am UK based) to study Lifestyle Redesign®, an occupational therapy approach that enables people to make changes in their lives that are long lasting and health promoting. Research has shown that this approach has benefits for the health and wellbeing of older people that are sustainable and reduce the need to use health and social services. Lifestyle Redesign® is based in the theories of the OT profession and also those of Occupational Science. To read my report click the WCMT Study Visit report tab above.

I will draw on this experience as well as the theories and evidence that underpin the profession of Occupational Therapy. An OT can help you to live life your way. OTs believe that you are what you do and we look at ‘occupations’ as the meaningful activities in your everyday life. OTs look at the whole person and how occupation shapes your life. An OT can help find ways to incorporate health promoting activities and routines into daily life resulting in greater life satisfaction, health and wellbeing.

An OT can help you continue to have an active life as you get older by finding ways to make everyday tasks easier or by helping you to try something new to aid independence. An OT can offer solutions and alternative ways of doing things when everyday activities become difficult to help you to get the most from life.

When illness, injury, disability prevent you from doing the activities that are meaningful in your life, an OT can help restore health, independence and wellbeing.

OTs are experts in understanding and working with the complex interaction between an individual with all their preferences, abilities, limitations and aspirations, their home situation and lifestyle and their occupations.

So whether you are an older person, looking to the future, an OT yourself or just interested- I hope you will find my posts this month interesting and stimulating.

I will not be presenting lots of ‘heavy duty’ theory, but where relevant I will try to provide links or references for further reading for those who do want to read further.

Key References

Craig, C & Mountain G (2007) Lifestyle Matters. An Occupational Approach to Healthy Ageing. Speechmark. UK

Jackson, J. (1996). Living a meaningful existence in old age. In R. Zemke & F. Clark (Eds.), Occupational science: The evolving discipline (pp. 339-361). Philadelphia, PA: F.A. Davis Company.

Mandel, D. R., Jackson, J. M., Zemke, R., Nelson, L. & Clark, F. A. (1999). Lifestyle redesign®: Implementing the well elderly program. Bethesda, MD: The American Occupational Therapy Association.

Keeping up with the blogs...

I have started following a couple of great new blogs and want to share them with my followers- thank you to everyone for keeping on reading my blog!

• Age Scotland (the Scottish 'arm' of Age UK) is a charity that works to improve the lives of all people in  later life. Age Scotland celebrates ageing and challenges ageist prejudice.

• KT-Equal is a consortium of UK researchers dedicated to extending quality life for older and disabled people.

Both have really interesting blogs that are regularly updated and that you can easily sign up to follow. They both fit in completely with the whole ethos of Lifestyle Redesign and all my learning during my travel award.
To see what they have to offer look at 'Blogs I am following' (scroll down the right hand side of this page).

Winston Churchill Memorial Trust Award Ceremony

Last month I attended the WCMT award ceremony in Westminster, London (right next to the Abbey) for those who have recently completed their travel fellowships. The ceremony was organised very much like a graduation and there was lots of time to meet other 'Fellows' before and after the formalities. The guest of honour was Baroness Tanni Grey-Thompson, who spoke about her athletic career and her subsequent involvement with the WCMT. She is an inspiring role model and I think we all felt it an honour to have her present our award.

Receiving my award from Baroness Tanni Grey-Thompson

The whole day was so inspiring. I met people who have done such a range of travel fellowships, the variety of things covered is incredible. The ways that people intended to make use of their learning was also very interesting. Many people, and the WCMT staff, felt that the benefits would be apparent over time, not always immediately. Long lasting and profound changes have been seen in the future work of many Fellows. I felt more and more aware of the great honour that I have had in recieving a travel award- and very concious of the motto engraved on the medallion, 'With Opportunities Comes Responsibility'.

Study Visit Report

At last my report is completed and available through the Winston Churchill Memorial Trust website. I have added a link to the web page- go to the tab at the top of this page and you will find it, or use this link in your browser:

http://goo.gl/6KaFm

Z is for zeitgeber.......

Zeitgeber- literally ‘time giver’.

Our daily rhythms and routines are governed and influenced by a number of factors. Internal factors set by hormonal levels and circadian rhythms such as sleep/wake cycles may operate at a cellular level and remain roughly consistent but not exactly in synch with a 24 hour clock. Zeitgebers exert influences on our internal ‘body clocks’.

Examples of physical zeitgebers are noise or daylight, social zeitgebers could be meal times or bed time rituals. Zeitgebers are very important to maintain synchronicity between an individual and their environment e.g. helping to conform to the 24 hour cycle that governs most people’s lives as work and other activities are arranged to start and finish at set times daily.

We can experience the disruption of this relationship when we travel across time zones and have ‘jet-lag’. Any disruption in zeitgebers, such as a traumatic life event, can lead to a period of instability as usual routines are disrupted, literally enough to disrupt internal rhythms as the expected prompts no longer occur- perhaps this is why family holidays are said to be one of the most stressful occasions!

Zeitgebers can be used to help ‘train’ into a desired pattern of daily life or to reinforce and maintain stability. In order to perform at our best we need to be in balance with our internal rhythms. Occupational therapists may find that considering the implications of this can be helpful when working with individuals, especially those who are in a disrupted situation, such as an acute admission to hospital.

Y is for Yerkes-Dodson....

 

Yerkes & Dodson were the psychologists who defined the Yerkes-Dodson Law in the early 20^th Century.

This theory shows that human performance and learning of new skills varies with ‘arousal’ level. Arousal means interest, excitement or stress- a certain amount is good and increases ability to learn, but too much and performance begins to deteriorate. There are some classic graphs that demonstrate this- here is a link to a website that explains it in simple terms and gives the original reference too.

I chose this subject for my Y post as I thought it links quite closely with the concept of ‘flow’ (see F) used in occupational therapy. Flow occurs when someone is fully engaged in an activity, the activity needs to have the right balance of challenge and skill, so a certain amount of stress is involved- flow will not occur of the task is boring, but too much stress i.e. the task is too difficult, and flow will not occur either.

Whether we think of it as the Yerkes-Dodson Law or as the concept of ‘flow’, these are both ways of helping us understand the importance of pitching activities at the right level if they are to be effective, and that level will be different for every individual.

X is in neXt....

 

As in what’s next for this blog- OK cheating a bit I know, but X is difficult!

This blog began as a diary of the study visit I carried out earlier this year. I will continue to use it beyond the end of the A-Z challenge to record the experiences I have of putting my learning into action and sharing what I have learned. This will be an evolving process over time, so I will have plenty to write about.

The other day I did an informal presentation to the Occupational Therapy Support Workers group where I work, we had some really interesting discussions about the experiences I had and the similarities and differences between our workplace and those I visited. I was really inspired by their enthusiasm, interest and openness to new ideas.

I hope some of you who have become followers of this blog during the A-Z challenge will continue to follow and find this blog interesting and informative. I’ll try to keep it that way!

 

W is for Winston Churchill Memorial Trust…

 

Winston Churchill is an iconic figure in British history, best known for having been Prime Minister during the Second World War. On his death in 1965, a memorial fund was set up and the decision was made that instead of a building or statue, a ‘living memorial’ would be created. The Winston Churchill Memorial Trust (WCMT) funds travel awards for British citizens to travel abroad to learn and share knowledge and skills for the benefit of themselves, for Britain and for the countries they visit. WCMT’s slogan is ‘travel to make a difference’.

The study visit to Los Angeles that I undertook earlier this year has been the subject and inspiration for this blog. I owe a great debt of thanks to the WCMT for funding my visit and for their support throughout the whole process.

Last weekend I attended the Scottish Winston Churchill Fellows AGM. Three recent fellows gave presentations that demonstrated the wide range of subjects that are included. One was about hydro-electric schemes in Africa, one about early years parenting skills in Italy and the Netherlands and one about reducing losses in fishing vessels in North America. They were all fascinating and it was clear why the speakers had chosen their topic and how they planned to make use of their learning.

WCMT is developing the ways that it supports fellows once they return from their studies and is working to develop links and mentorship for key areas of study.

The whole experience has been a real once in a lifetime opportunity, and in many ways, the visit is only a beginning. I would very much encourage you to follow this link to the WCMTwebsite for more information.

V is for Value....

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‘Valuing the ordinary’ is a concept used in the development and use of the Lifestyle Redesign® approach in Occupational Therapy (OT). It can be incorporated into any OT intervention.

Valuing the ordinary simply means taking note of and seeing as important, the everyday ‘trivia’ of someone’s life. Our lives are all made up of a patchwork of everyday small tasks and concerns that create a whole.

Allowing some time to focus on small and seemingly unimportant matters, can have positive effects in that it allows the person, rather than the illness or problem to be the focus. Exploring the ordinary may give the starting point that allows someone to begin to envision a new possible self as the OT uses the opportunity to be positive about progress and to help someone see new possibilities for the future.

Reading about this, I was reminded of the quote from one of the OTs working in the Pressure Ulcer Prevention Study at the University of Southern California during my recent study visit there: “If it’s valuable to you, it’s valuable to me”.

U is for University of Southern California...

 

The University of Southern California (USC) is a privately funded university located across 2 campuses in central Los Angeles. Occupational Therapists (OTs) have been educated here since 1942 and many of the profession’s famous names are alumni e.g.Mary Reilly and Gary Kielhofner.

Mission and Vision

‘The mission of the USC Division of Occupational Science and Occupational Therapy is to maximize the potential of people to construct healthy, satisfying and productive lives by generating knowledge of value to society, advancing the profession and educating generations of practitioners, researchers and leaders.

Our Vision

We envision the Division of Occupational Science and Occupational Therapy as a hub of innovation and leadership where we study participation in daily activities defined in the discipline as “occupation” and its relationship to healthy living over the lifespan. We aim to establish occupation as an essential component in health and well-being. We promote this perspective by educating a global community of researchers and practitioners and advancing practice models about occupation that are science-driven and address health and societal needs.’

(Division website at http://ot.usc.edu/)

In addition to the two University owned hospitals, close links are maintained with clinical partners at Rancho Los Amigos National Rehabilitation Centre, Children’s Hospital and others. A global network of contacts including Ghana, Hong Kong & Romania is well established.

There are 3 main ‘arms’ of the Division’s work:

·      Research- the Division is currently operating with a research ‘portfolio’ of over $8 million. The studies in progress have potentially powerful implications for OT practice and range from community based lifestyle interventions to neuro-imaging following stroke to improve rehabilitation methods. Numerous peer reviewed publications have contributed to the aim of generating ‘rigorous science with clinical relevance’

·      Clinical Practice/Care Services- clinical OT staff work within the USC Occupational Therapy Faculty Practice and Keck Medical Center at USC Hospital. Lifestyle Redesign® forms the basis for the Faculty Practice programmes. In addition to meeting patient needs, the clinical practitioners are closely involved with the teaching and research ‘arms’.

·      Training/Education- the entry-level Masters programme has recently been remodeled and includes foundations and essential core studies, practice ‘immersions’ (Paediatrics, Mental Health & Adult Physical Rehabilitation/Geriatrics), academic fieldwork, leadership development and specialty focused elective placements.

 During my visit I had the opportunity for involvement in all three areas and was able to gain an appreciation of how closely interwoven they are and how Lifestyle Redesign® is applied in many different situations.

The opportunity to have this in depth experience was made possible by a Winston Churchill Memorial Trust travel award (more about this when we reach W). The purpose of my visit was to investigate how Lifestyle Redesign® could be used to improve the hospital/home interface for older people. This blog began as a record of my experiences during the visit and now continues as a reflection and record of progress since my return to the UK.