© University of New Hampshire – Northeast Passage Recreation for those ageing with and into disability CACL Living Well in Our Communities: Thriving As We Age May 7, 2013 Concord, NH

© University of New Hampshire – Northeast Passage Northeast Passage Living Beyond Disability Using sport and recreation to assist individuals with disabilities to define, pursue and achieve their goals

© University of New Hampshire – Northeast Passage Northeast Passage Established in 1990 to fill gaps in services In 2000, merged with the University of New Hampshire Nationally recognized leader in field of Therapeutic Recreation and Adapted Sports

© University of New Hampshire – Northeast Passage Programs Adaptive Sports & Recreation Recreational Therapy Teaching and Research

© University of New Hampshire – Northeast Passage Difference between Adapted Sports and Therapeutic Recreation

© University of New Hampshire – Northeast Passage Aging into disability

© University of New Hampshire – Northeast Passage Physical Decline Decreased Strength, Endurance, Mobility, Flexibility, Balance Increased Fatigue Weight Pain Cycling Three wheels Bike path Tandems Gardening Large garden Smaller garden Garden mobility aid Extended handles Raised garden beds

© University of New Hampshire – Northeast Passage Cognitive Deficit Concentration Memory loss Problem solving Planning Impulsivity Safety Awareness App store Support Find your car Organizers Reminders Map My… Games Memory games Problem solving games GameChanger

© University of New Hampshire – Northeast Passage Social/Emotional Isolation Loss of friends Pass away Move away Difficulty making new friends Loneliness Loss of identity Frustration Anger Low motivation Depression

© University of New Hampshire – Northeast Passage Benefits of Recreation Increase in physical activity and fitness, Social connectedness, Community engagement, Family relationships, Practice of functional skills in all domains, Stress management Self efficacy

© University of New Hampshire – Northeast Passage Identify the right activity Recreation is personal What do you like? Recreation is part of our definition Who are you? Recreation is familiar Talk about a great memory. Recreation is holistic Why do you like this activity?

© University of New Hampshire – Northeast Passage Making it Work What does this activity require? What do I have? What do I need to change or supplement?

© University of New Hampshire – Northeast Passage Activity Modifications Intensity Rules Duration

© University of New Hampshire – Northeast Passage Support systems Who is out there? What role do you want them to play? Friends, family, new people, volunteers, professionals

© University of New Hampshire – Northeast Passage Equipment Modifications Alternate use for typical stuff Adapted equipment

© University of New Hampshire – Northeast Passage Select a New Activity What did you get from the old activity? What new activity fills that need?

© University of New Hampshire – Northeast Passage PATH Promoting Access Transition and Health Assessment Comprehensive intake interview In clients home Set goals Planning Goals set based on input from client, caregivers, family and therapist Intervention visits, supplemented by phone consults and online support over six to eight months. Evaluation Attainment of personal goals Standardized pre /post test QoL, Happiness, HRQol

© University of New Hampshire – Northeast Passage Comprehensive Assessment Examine  Current level of physical, psychosocial, and cognitive function  Current level of community interaction  Past, present and potential interests for involvement  Knowledge of accessible resources  Risk factors with potentially negative health impacts  Perceived and real barriers to participation  Personal network, care givers, and support systems  Set goals for intervention

© University of New Hampshire – Northeast Passage General Treatment Areas 1. Wellness Education 2. Resiliency education and technique development 3. Individualized Fitness Plan 4. Practical Functional Skill Development 5. Community Integration in Home Community 6. Resource & Network Development 7. Support Network Development 8. Individual and Family Recreation Skill Development 9. Care giver training, support, relief

© University of New Hampshire – Northeast Passage Qualitative Research Results for Ageing into/with Disability Increased sense of self efficacy Perceptions of improved quality of life Improved social participation and engagement with the community Reduction in healthcare utilization Positive changes to health and the physical domain Partnership approach to treatment Emphasis on home-based intervention Personal meaning that informed treatment goals

© University of New Hampshire – Northeast Passage Case study  72 years old, lives alone,  Primary Diagnosis – post polio managed well until past eight years.  Secondary Dx - High BP, High Cholesterol, Pre diabetic, over weight, deconditioning

© University of New Hampshire – Northeast Passage Goals  TR GOALS  Improve overall health and fitness  Increase knowledge of community resources  Develop leisure interests  Personal goal  Improve endurance to enable a visit to her place of birth on an island off the coast of Maine.

© University of New Hampshire – Northeast Passage Outcomes  Health and fitness through cycling, aquatics and walking  Weight was 242, now 205  Cholesterol was 227, now 200  BP was 196/90, now 140/80  Blood sugar was A1c 6.1 pre diabetic, now 5.9 no longer pre diabetic  Community Resources & Leisure interests  Gained proficiency on computer to find events and resources  Joined walking club and YMCA  Returned to the island in late July

© University of New Hampshire – Northeast Passage Tom’s story

© University of New Hampshire – Northeast Passage Questions Contact: Jill Gravink, MS, CTRS/L Northeast Passage 4 Library Way Durham, NH