Changing the conversation about health

Fit as a Fiddle

CoM Tags:

College of Medicine, innovations network, research, lifestyle

fit as a fiddle is funded by the Big Lottery Fund as part of their Wellbeing programme 2013-2015.

It is designed by older people for older people to help improve their physical health and mental well being. fit as a fiddle comprises three projects:

1. fit for the future: improving mental and physical wellbeing of older people with long term conditions through increased activity.

2. The dementia friendly programme: reviewing and developing local Age UKs generic services to cater for the needs of older people with dementia, and to develop appropriate wellbeing activities. We work with two consultancies Innovations in Dementia and Dementia Adventure

3. Cascade Training programme: supporting training programmes for volunteers working with targeted groups of older people who traditionally have low levels of participation in health and wellbeing activities eg older men, older people from BME communities, people in sheltered housing and residential care, and isolated and older people.

Year established
2007 (extension funding from 2013 – 2015)
Number of staff
5 full time equivalent staff in the Age UK office
Number of users
Fit for the future users: 1750, Dementia: 240, Cascade: 3840.
Is there a charge to users?
There is only a charge on the fit for the future projects, where the local Age UK may choose to charge for the activity as part of its sustainability plan.
What makes your project sustainable?
fit as a fiddle uses a range of methodologies to ensure the long term sustainability of the project as follows;

  • The training of volunteers to act as ‘buddies’ to support older people with long term conditions to access opportunities for exercise, healthy eating, managing their conditions and socialising.
  • Share best practice via Webinars, DVDs and events, nationally and locally.
  •  The development of service delivery models, which can be commissioned by Public Health, Adult Social Care and Clinical Commissioning groups. 
  •  Working in partnership with other organisations to provide sustainable service delivery models to enable access for older people who are traditionally excluded, for example those with dementia, older men, BME communities.
The extension projects are a result of learning from fit as a fiddle, they combine the key elements from fit as a fiddle, including Social Prescribing, Volunteering, and Resources. Building on our learning and robust evidence base about what works in terms of increasing activity in older people through project activities and specific interventions.We have learnt that individuals with multiple long term conditions need more tailored support and activities designed to help them manage their conditions. Often they need support and motivation from a peer to encourage them to continue for 12+ weeks so they can see an impact on their health. The current programmes therefore focus on older people with long term conditions and those from groups who are traditionally excluded or overlooked, including older men, BME and faith communities, and people living with dementia and their carers.The fit as a fiddle extension funding runs from 2013 – 2015 and therefore the current projects are currently delivering. A full evaluation of the current three projects including recommendations and learning is expected in Summer 2015.
Quotes from users
“I haven’t been to my doctors since I’ve been here. Before, I would have goe 5 or 6 times a year.”“When you get old you don’t think you can do things, so you don’t try. It has given me confidence I now know I can do anything”“I don’t fall over so much. I feel much more confident that I am not going to fall. It’s really tremendous what it has done for my balance”“Because we get so encouraged and praised, by each other, you don’t feel like a senior citizen no more. That’s what it has done for me”
Patient-Centred, whole person preventative approach
fit for the future is founded on the principle of placing the older person at the centre of their own care plan. A personal, tailored plan detailing interventions including practical, non-clinical support that can be delivered by the local Age UKs or other local organisations is co-developed for each older person on the programme. The aim is to ensure older people have access to a tailored package of low-level community support that helps improve their wellbeing.The dementia friendly programme places older people at the centre of service delivery and development by engaging the local Age UK’s to review and develop generic services to support the needs of people in later life with dementia, especially those with early onset of dementia. People with dementia will be included in the consultation and review process, and will be encouraged to help develop appropriate wellbeing services, including those which increase physical activity levels using the expertise from our two consultancy organisations.The Cascade Training programme aims to train volunteers to support and buddy older people, encouraging them to attend activities and day opportunities which will increase their mental and physical well beingwhilst also building the capacity of the local organisation This approach is based on previously successful tried and tested fit as a fiddle approaches to person-centred work.
Evidence informed practice/audit and evaluation
Well-being is a broad ranging concept affected in a complex way by a person’s physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment. Actions to support older people’s well-being needs to address all these inter-related factors. The fit as a fiddle final evaluation 2012, showed that a more holistic, person centred approach to services and activities across the well-being spectrum can increase healthy life expectancy, delaying the need for more intensive, costly health and
social care and therefore enabling older people to live active, engaged and successful lives for as long as possible.An analysis of treatment quality from the English Longitudinal Study of Ageing, detailed in a report commissioned by Age UK in May 2013: “Health Care Quality for an Active Later Life” highlighted the shortfalls in current healthcare provision. The overall impression is that there remains substantial scope for improving treatment quality in order to help achieve active, pain free and successful later lives. Examples include: Many older people with diabetes report that they did not receive training in self-management of their condition. Many people with osteoarthritis reported that they were not advised on how to slow progression of their disease or control joint pain. Many people who had experienced a fall reported that health care professionals did not check for the underlying causes of their fall.In the extension fit for the future programme, participants are being invited to take part in a longitudinal survey, which will register the amount of exercise taken, their eating habits and their general state of wellbeing. The surveys will be completed at the start of intervention, after 3 months and then again at 9 months. A full evaluation will be available in Summer 2015. The fit as a fiddle programme is being evaluated by an external evaluator commissioned by Age UK, as well as by BIG’s Portfolio evaluator, Ecorys.
Multi-disciplinary collaboration, and professional communication
The Cascade Training Programme focuses on accessibility of health and wellbeing services by working with five organisations nationally to develop quality assured training for volunteers, using well-developed and previously piloted training packages, in local Age UKs and other organisations. These volunteers will then work with older people from traditionally excluded groups. The partners are; The National Association for the Providers of Activities for Older People (engaging those living in sheltered and residential housing), Sporting Equals (BME communities), Age UK West Cumbria (social isolated older people), Age Concern Central Lancashire (Older men) and Community Network(telephone befriending). Excluded groups include older men, those living in sheltered and residential housing, socially isolated older people and BME communities.The Dementia Friendly programme will support local Age UKs via consultancy from experienced dementia consultants, who will assist them in carrying out audits and developing action plans. The two consultants work in the field of dementia and have expertise around the involvement and engagement of people with dementia and their carers in designing services, ensuring that those voices are heard and recommendations acted upon. The process has been previously piloted with a project funded in 2012 (Dept Health Strategic Partnership funds) with positive feedback and results. Local Age UKs participating reported significant organisational commitment to increasing access to their mainstream services for people with dementia, and making services more dementia friendly. The current dementia friendly programme will include significant opportunities through meetings, training and briefings to develop collaboration and sharing of good practice, both amongst project participants, the wider partnership of local Age UKs and across the national charity and VCS.

 Through fit for the future, our local Partners are developing strong links with their Clinical Commissioning Groups and Health and Well-being boards and GPs to provide referrals to the programme, and to develop an evidence base around the impact of prevention services.

Contact details
Age UK
Tavis House
Tavistock Square
WC1H 9NAt: 020 303 31374