Our Advanced Physiotherapy:

Proactive Healthcare Services offers high-quality care tailored to older adults, especially those dealing with chronic health conditions. Our aim is to optimise health & improve independence through a comprehensive, patient-centred approach.

Our specialist clinical knowledge in aims to address minor ailments, ensure regular medication reviews, promote health maintenance and reduce falls risks . Our approach is proactive rather than reactive, aiming to:

Improve older adults’ health and well-being.
Empower individuals to maintain their own physical abilities.
Maximise symptom control and reduce disease burden.
Reduce avoidable hospital admissions.
Ease the burden on strained NHS resources

The key aspects of our advanced physiotherapy:

Comprehensive Geriatric Assessment (CGA)

To ensure high-quality care for older adults, all our clinical assessments incorporate the patient-centred, individualised & whole-body approach of a Comprehensive Geriatric Assessment (CGA).

The benefits of CGA are well-documented*:

Improving independence
Slowing frailty progression
Reduce emergency hospital admissions
Reduce 30-day readmissions to the hospital

Through the implementation of CGA, we develop long-term strategies to support our patients needs, as such CGA is an essential management strategy for maintaining the health of older adults at any stage of frailty.

*https://www.bgs.org.uk/resources/resource-series/comprehensive-geriatric-assessment-toolkit-for-primary-care-practitioners

Falls Prevention

Around a 30% of over 65 year-olds & 50% of over 85 year-olds fall over each year in the UK.

Falls not only cause pain or injury (1 in 20 will fracture a bone or need hospital), they result in a loss of independence leading to a need for carers at home or even a care placement. Falls are the leading cause of injury related to death in older adults (1 in 3 people with a hip fracture die within a year).

Yet, targeted exercise regimes are reported to result in a 35% to 54% reduction in falls risks.

We provide specialist physiotherapy tailored to our patients mobility & functional problems, improving day-to-day function & independence. Our targeted exercise interventions for older adults focus on reducing the risk of falls by raising confidence, enhancing strength, maximising balance & improving safety. With clinical expertise in falls prevention, pulmonary rehabilitation, cardiac rehabilitation, Parkinson's disease, stroke recovery, joint replacement rehabilitation or bone fracture rehab. Additionally, we support chronic & painful conditions impacting mobility or function such as back pain, osteoarthritis and rheumatoid arthritis. We understand the effects of bladder or bowel problems or constipation on falls risk and limit quality of life. Therefore, we offer strategies to best manage these problems.

Likewise, the risk of a hospital admission or a fall increases with the number of medications an older adult takes. Adverse drug reaction related hospital admissions are estimated to be between 6% to 16%, although structured medication reviews have decreased in the community over the past few years. In 2023/24 primary care witnessed a 22% drop in structured medication reviews (SMRs) for care home residents & a 25% reduction in SMRs for those living with severe frailty. But we know targeted SMRs in frail older adults can lead to a significant reduction risk of medicine harm and predicts a potential hospital admission avoidance rate for adverse drug related admissions of 85%*.

* Pharmacy at home: service for frail older patients demonstrates medicines risk reduction and admission avoidance - The Pharmaceutical Journal

Medication Reviews

More than a quarter of the UK population lives with a long-term health condition, with older adults often managing two or more long-term conditions (comorbidity). As a result many older adults take numerous medications, which can lead to polypharmacy: a situation where patients are prescribed five or more medications. In an observational study of 1,187 hospital admissions in England in 2023, adverse drug reactions accounted for 16.5% of admissions & 40.4% were deemed avoidable or possibly avoidable*.

* https://doi.org/10.1136/bmjopen-2021-055551

Risks of Unsuitable Medications

Unfortunately, some medications may become unsuitable over time, especially without regular reviews. Yet, in 2023 NHS England removed some the financial incentive for Primary care networks to perform structured medication reviews (SMRs). As such 2023/24 witnessed a 22% drop in SMRs for permanent care home residents & a 25% drop in SMRs for those living with severe frailty* .

Prolonged use of unsuitable medications can result in hazardous outcomes including:

Falls
Delirium
Avoidable Hospital Admissions
Premature Death

*(NHS England - Network Contract Directed Enhanced Service - DES MI - July 2024).

https://pharmaceutical-journal.com/article/feature/less-is-more-the-struggle-to-prioritise-medication-reviews

Medication Optimisation

Medication optimisation is achieved by evaluating the benefit vs risk of each treatment, alongside the preferences and health status of our patients. Through our discussions encompassed upon evidence-based care and both the short-term & long-term benefits or risks of any medication. Using concepts such as the number needed to treat (NNT) AND number needed to harm (NNH), during our patient discussions aids shared decision making. Whilst in a NHS role our team are non-medical independent prescribers, we can ONLY PROVIDE ADVISE AND EDUCATION on medications during PHS sessions currently. Therefore, we recommend any final decisions regarding dose adjustments or discontinuation of any treatment is to made in consultation with the patient's GP. Thus, patients or their carer's are encouraged to consult their GP, with any medication changes made under GP supervision.

Frailty Consultancy for Primary Care

We are able to assist primary care settings with our specialist frailty consultancy, supporting with the medical complexities of older adult care. Through our clinical expertise we can offer education on all aspects of older adult care through peer discussions or clinical guidance on topics such as comorbidity, chronic disease management, medication optimisation and falls prevention. We can assist primary care networks to comply with the NHS long-term plan of enhanced health in care homes, included in the network contract direct enhanced services. For example, we can support any PCN to ensure every care home has a weekly 'home round' or each person living in a care home has a comprehensive, personalised assessment and participate in the development of a personalised care & support plan within 7 days of admission or readmission. Likewise, we can assist in identifying any individual suitable for a structured medication review.

Additionally, Proactive Healthcare Services provides clinical Physiotherapy expertise offering rehabilitation, falls prevention strategies alongside our expertise in advanced care planning for older adults.

Primary Care - Advanced Care Planning

We hold a strong emphasises on the importance of advanced care planning for older adults whilst they have the capacity to make decisions. These discussions allow individuals to express preferences for future treatments, care locations and even the preferred place of death. Ideally, advanced care planning occurs during periods of stable health, with a healthcare professional familiar with the individuals past medical history and understands the patient's needs or wishes. In contrast, reactive care planning often occurs during a hospital admission, which can feel impersonal to the patient or their family members.

Preemptive Advanced Care Planning for Frail Older Adults

Pre-emptive advanced care planning conducted in a calm, reassuring environment, offers a logical approach to guide future medical decisions when an older adult becomes acutely unwell. For many older adults a hospital admission is suitable when they become acutely unwell, with advanced care planning ensuring their wishes on the suitability for any invasive treatments are documented. However, for severely frail individuals a hospital admission may not always be the ideal location causing distress or agitation. Alternatively, comfort-focused community-based treatments may align better with the patient's needs in a environment more familiar to the individual. Advanced care plans ensure healthcare professionals can provide compassionate, individualised care with confidence, reducing the risk of unnecessary hospital admissions and supporting families to make decisions based on previously agreed treatment suitability, preferred places of treatment or even preferred location of death .

Training for High-Quality Advanced Care Planning

At Proactive Healthcare Services we offer training on how best to conduct high-quality advanced care planning, ensuring that it is carried out compassionately yet pragmatically, tailored to each patient's degree of frailty and treatment preferences.

Frailty Consultancy for Care Settings

Our specialised frailty consultancy aids care settings in the day to day support for frail older adults. This includes direct advise on individual patients, staff education or guidance on all aspects of frailty, falls prevention, medication optimisation and minor illness management. We can offer assistance with topics such as incontinence support, constipation awareness, urinary symptoms and UTIs, variable confusion vs delirium and all common older adult health issues. We support care setting to maintain the health of their residents, emphasising on comfort, reduce avoidable hospital admissions and improving quality of life.

Supporting Care Settings With CQC Compliance

Proactive Healthcare Services can assist all care settings to maintain or improve their Care Quality Commission (CQC) ratings. Be that maintaining an “outstanding” or “good” rating or assisting to enhance any ratings of “requires improvement” or “inadequate”. We offer time-sensitive support, including creating action plans following CQC inspections, to raise ratings in repeat CQC inspections.