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ARCHA: The ExtraCare FOCUS Intervention

FOCUS Project

Last November, FOCUS News interviewed Prof. Carol Holland, from Lancaster University who is leading the FOCUS Intervention team in England, and Dr. Holly Gwyther from Aston Research Centre for Healthy Ageing (ARCHA), one of the psychologists managing the intervention in Birmingham. 

FOCUS News: ARCHA is implementing the FOCUS pilot in England. Could you please give a glimpse of what is happening there to our readers?

Carol Holland: The intervention is a collaboration between Aston Research Centre for Healthy Ageing and the ExtraCare Charitable Trust. Our intervention takes place within ExtraCare settings across England, but primarily in the Midlands

FOCUS News: For those outside England, what is ExtraCare?

Carol Holland: Well, ExtraCare is a supportive independent living retirement community for older adults. ExtraCare communities comprise a purpose-built “village” made up of self-contained apartments and bungalows arranged around a complex. Residents have access to a range of community facilities including leisure and fitness facilities, a café or restaurant, hobby rooms and shops. They also have access to a range of health and social care support services if required, for example, a well-being advisor, a ‘locksmith’ for cognitive assistance, falls prevention schemes, housekeeping services and personal care. The communities offer a programme of activities and entertainment. 

FOCUS News: What is the intervention really about? In simple words, how does it work?

Holly Gwyther: So, the intervention is integrated into an annual ‘well-being’ assessment, which takes around two hours to complete and thoroughly examines a person’s physical, cognitive and emotional well-being.  For example, we are measuring things like body mass index, blood pressure, cholesterol and blood sugar readings, which give us an idea of a person’s physical health, but we also test their perception and memory, we evaluate their quality of life and well-being, and test their resilience and the conditions of the environment where they live.

FOCUS News: That is huge! Still, what is the aim of collecting all that data?

Holly Gwyther: The idea is that after completing the assessment, we calculate the participant’s frailty index, based on an accumulation of deficits model, or as we prefer to think of it, their resilience score.. The idea is that by knowing how resilient (or frail) a person is, we can then suggest ways that people can either stabilise or improve their score, and make themselves more resilient to frailty.  An intervention addressing frailty in a mixed group of older adults, many of whom are not frail, should improve resilience for all. 

FOCUS News: How does that connect with previous work done within FOCUS and the other FOCUS pilots running in Europe?

Carol Holland: The intervention adopts several recommendations from the FOCUS project guidelines, such as health psychology components like goal setting and behaviour change strategies; social aspects, such as group-based and or fun-promoting activities; and taking ownership of health by setting SMART goals, which stands for specific, measurable, achievable, relevant and timed.

Based on their resilience (frailty) scores, participants are asked to look at their lives and think consciously about their health and wellbeing. Any areas in which people are less resilient are prioritised by researchers and participants are encouraged to set a SMART goal to improve their wellbeing, increase resilience and hopefully prevent, reverse or reduce their risk of frailty in the future. SMART goals are used to address lifestyle behaviours across the different domains involved in frailty, for example, exercise, nutrition, social interaction, intellectual engagement.

FOCUS News: So, I understand that goals to improve resilience scores are set by participants themselves, but which type of goals might they choose or are they allowed to choose?

Holly Gwyther: Yes, goals are chosen by the participants themselves and they can target anything that they like, for example, physical health issues, cognition and memory, or social interaction. There are many existing activities in the ExtraCare village, for example, line dancing, reminiscence groups or bridge clubs, and we suggest that people start with one of those. However, other activities can be chosen. Some of the example goals that people have set include joining a choir or scrabble club, joining a group exercise or balance class such Otago, or just doing a Sudoku once a week. For us, social interaction is very important and we positively encourage it!. We ask that people take part in the intervention for 24 weeks. 

FOCUS News brought to you a couple of snapshots of some of the ARCHA sessions.