What’s the difference between quality of life, and quality of care? And how does the distinction change the way we should think about aged care? Also on the show – how to improve your running technique.

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Presenter/Producer: Ellen Leabeater
Producers: Ninah Kopel, Jake Morcom

Speakers:
Richard Baldwin- Associate Professor, Faculty of Health UTS & Fellow of the Australasian College of Health Management
Maureen Berry, Activities Officer, Macquarie Lodge Aged Care Plus Centre
Enoch Lam – Running coach, OneBody Health+Fitness
Dr Lee Wallace – Sport Science lecturer, UTS
Shona Blair – iThree Institute, UTS

START OF TRANSCRIPT

Ellen Leabeater: Hi, Welcome to the show, Ellen Leabeater with you. Today, how to improve your running technique.

Male: I’ve heard of some, you know, really sort of simple ways of doing it. Like, some people will say, if you’re watching someone run towards you, you shouldn’t see the soles of their feet.

Ellen Leabeater: And, how Manuka honey could be the next big thing in treating antibiotic resistance.

[Music plays]

Ellen Leabeater: But first on the show, if you’ve ever had to find an aged care facility for a loved one, you know how hard it can be. Maybe you’ve done it for a family member who isn’t as strong and healthy as they once were, which in itself is hard enough to come to terms with. But on top of this emotional stress, you have to pour over pamphlets and websites, comparing costs, locations and facilities. Ninah Kopel has been looking at the aged care system and what needs to change.

Ninah Kopel: It’s quiet because it’s lunchtime here at Macquarie Lodge Aged Care Plus Centre, and today is “fish day”, one of the residents’ favourites. Maurine Berry is an activities officer here at the centre and she’s taking me around, introducing me to some of her friends.

[in the Macquarie Lodge Aged Care Plus Centre]

Maureen Berry: (to a male resident) this is Ninah – she’s from the radio station.

Male resident: Lena?

Maureen Berry: Ninah.

Male resident: Lena?

Maureen Berry: Ninah!

Ninah Kopel: with an N.

Male resident: Where does the N go?

Ninah Kopel: At the beginning.

Male resident: Oh, yeah (laughter). How are you mate?

Ninah Kopel: I’m good! How are you?

Male resident: I’m resigned to dying here, so I’ve got to fit in with their procedure…

Ninah Kopel: And that means playing the games…

Male resident: Yes, that’s right, yes. We’ve got a very good activities lady here.

Maureen Berry: Oh, that’s nice…

Male resident: We couldn’t do without her.

[return to interview between Ninah Kopel and Maurine Berry]

Maureen Berry: We have residents’ meetings once a month, and I always put it out there what sort of activities they would like to do, you know. We’ve started knitting and I’ve got so many squares coming out my ears, so we’re starting to knit them together and we’re going to make a blanket.

Ninah Kopel: Just from chatting to everyone, it’s clear to me that food and bingo are the biggest crowd drawers around here.

Female resident: Food – the food’s good. Just saying how…I have to be very careful now (laughter)!

Ninah Kopel: But not everyone likes the same activities. When Noreen introduces me to Maurie, she’s busy helping her friend. The skin of the fish is crispy today and her friend is struggling with it, so Maurie’s cutting it up and feeding it to her…

Maurie: Now that they’ve gotten older, they don’t like the crunchy things.

Ninah Kopel: When she’s not at meals and helping out her friends, Maurie likes to spend time in her room, colouring-in and doing puzzles. While she doesn’t go to many of the group activities, she’s been here ten months and seems to feel right at home.

Maurie: The minute I walked in the door, I felt a love that was here.

Ninah Kopel: But this wasn’t the same for the first aged care facility Maurie went to, which she really didn’t like.

Maurie: (Unclear) At the other place there was screaming all night, lights flashing on – don’t have that here.

Ninah Kopel: So when it comes to choosing an aged care facility for our loved ones, how do we know that we’re making the right choice? In Australia we have an aged care quality agency and every three years it measures all aged care facilities to ensure they’re meeting minimum standards. According to Richard Baldwin, Associate in the Faculty of Health at UTS, 96% of them at any one time have full accreditation. But that doesn’t necessarily help families make their choice.

Richard Baldwin: There’s a debate in the industry about whether that really measures quality. What is does is it acknowledges that those services are meeting minimum standards, so we’re not in a position of actually saying whether one provider provides higher quality than another, or one sector provides higher quality than another. What we do know is that if you look at the international evidence, for-profit providers come out as providing higher quality of care in those studies where it’s been possible to measure the quality of care. And that’s a consistent finding over a number of decades and a number of countries. Now that doesn’t mean that for-profit providers provide bad care. It doesn’t mean that at all – and most for-profit providers meet minimum standards and provide good care. But what the international evidence says is that if you are going to have a system – if you are going to change your system and change the balance between for-profit and not-for-profit providers, then you ought to think carefully about whether you want to go down a policy pathway that is going to see for-profit providers predominate in the market as they have in other countries that have gone down this pathway.

Ninah Kopel: When we are talking about measuring quality, what are the actual things that we’re looking for?

Richard Baldwin: Well there are two main areas where you might want to measure quality. One is quality of care and the other one is quality of life and they’re sort of broad catch-all categories and some indicators slip from one to the other depending on who’s talking at the moment. But quality of care means that if you’ve got residents who are dependent on high-quality nursing care – they’re primarily in their bed most of the day or severely disabled – then you want to make sure that the quality of care is measured around things like admissions to hospitals, infection rates or bed ulcers or what have you. Of course, not everybody that’s in residential aged care is bed bound, and an increasing proportion of people in residential aged care with dementia are still physically well. So, for those, you would be concerned – and also for the people in bed – about their quality of life: things like dignity and privacy, capacity to make decisions about food and entertainment… And at the moment we don’t have a system across Australia that collects data and enables consumers and governments for that matter to compare quality of life and quality of care across the whole system.

Ninah Kopel: So if you were in the situation where a loved one or a family member was going into aged care and you were considering these things – you were considering quality of life and quality of care – how would you go about making the decision about going to the right place? Is there any information available?

Richard Baldwin: There’s very little information available other than what you do by phoning around and, you know, checking up your contacts, asking your GP. It’s a very… those circumstances where as a family member you have to make the decision about residential aged care for a loved one are usually taken in some sort of crisis. So, Mum or Dad’s fallen over, gone into hospital – it’s clear that they’re not going to be looked after at home again and the hospital wants them out of the acute care bed and you start hunting around for a facility that you’re happy with. Under the current system, across the country, bed occupancy is around 93%. Now that varies a little bit from location to location but what it means is that a lot of the services that you try the first time are going to be full or near full, and so you don’t necessarily end up with the place that you would choose. And of course a lot of the discussions about quality and choice in aged care fail to take into consideration that when you’re buying or purchasing services in residential aged care, you’re buying a bundle of attributes. So you’re buying care, you’re buying a lifestyle, you’re buying location, you’re buying that’s affordable and there might be some other aspects of that – hotel services for example, food and comfort. So families will often be forced to make some decisions. They might say, well, we want our loved one to be in a facility that’s close by even if the quality isn’t as high as we would like. So they’ll trade off quality for location. Another family might say, no, we want the highest value, we’re prepared to pay more even if that means going to a place that’s further away. So these are individual decisions, and we don’t have a rating system that tells us how one service rates on a lifestyle and quality of accommodation versus quality of care etcetera. So it’s very difficult for individuals to make those decisions at the moment.

The government is moving down that pathway with the “my aged care” website where it started off a couple of years ago requiring aged care providers to put their prices up on the “my aged care” website against the characteristics of their particular facility, and there’s been a program of developing quality indicators. Three of them have been trialled to date and individual providers will be able to put up the statistics around their quality indicators up on the “my aged care website”, but of course they’re a small number of indicators and it’s early days, and it will be some years I will suspect before that systems fully up and running.

Ninah Kopel: And surely if those organisation are providing that information themselves, they have a vested interest in selling their services.

Richard Baldwin: Yes, one would hope that over time that system would have some validity and reliability to it so that the way that the data is collected and the way that the data is analysed and the way that the data is reported is the same for all services. I think we’ve got a way to go for that to happen yet.

Ninah Kopel: Is there somewhere else in the world that’s got this right? That has some sort of comparison system that we can look to as a way of moving forward?

Richard Baldwin: Well both the United States and the United Kingdom use a star-rating system, which a number of advocates claim is more consumer-friendly than the Australian system. Of course star-rating systems have their shortcomings and their criticisms as well. The United States, because of some reforms that were legislated a couple of decades ago, collects an enormous amount of data and their star-rating system is based on, you know, very large data sets. I can’t tell you how accurate that is but at least it provides some level of information. There’s research saying that consumers use that information, that rating system, and understand it. That research also suggests that they don’t 100% rely on it. So it’s just another piece of information that they use in making a decision about a particular facility.

Ninah Kopel: I wanted to ask more about this idea of “life care” – so quality of life as opposed to quality of care. So when we talk about this quality of life, what are the factors that can be forgotten.

Richard Baldwin: Quality of life is important for all residents, and it’s particularly important for what we used to call low-care residents – that is those older people who still have a level of functionality in relation to activities of daily living, but can’t live independently. And also for people with greater disabilities, we’ve tended not to focus on leisure activities, in other words, the common experience that people complain of is you go to visit a place and there’s one television in the corner and it’s turned on to one program and everybody’s sitting around, forced to watch the same program. So, that’s one area. Dignity and privacy are big issues. They’re part of the certification standards, but of course that might vary from one individual to another. Of course, what we’ve got between rural and metropolitan services is the amount of money that’s available to those facilities to put in the services that meet individual needs.

Ninah Kopel: From government?

Richard Baldwin: Well, from government but also from consumers. These days, most consumers who purchase a refundable accommodation deposit for their accommodation will rely on the value of their house for the level that they can pay and, understandably, the more you pay probably the higher quality facility that you’re going to get. So, people in the bush who’s house prices are generally lower than those in the city can afford less when they go into residential aged care, and so they might be struggling more to get the choice of leisure activities and standard of accommodation etcetera that they would wish for.

Ellen Leabeater: Richard Baldwin, associate in the Faculty of Health at the University of Technology Sydney and fellow of the Australasian College of Health Management ending that report by Ninah Kopel.

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Ellen Leabeater: Well, running is fast becoming one of the most popular forms of exercise. Nearly two million Aussies have taken up the habit as an easy way to get fit. It’s popularity is partially down to it’s convenience. All you need is a pair of shoes and maybe a running buddy and you’re good to go. Running has been something we as humans have been doing for hundreds of years. But just because we have evolved to run, doesn’t mean we’re necessarily running correctly. Half of all adults who run regularly get injured each year, so what can you do to reduce injury?

[Running sounds, heavy breathing]

Ellen Leabeater: I’m at a run training session in Baulkham Hills in Sydney’s north-west. It’s a bit more structured than my normal run, usually a run around the block, but I’m hoping the coach tonight can improve my technique. We start off with a warm-up run, then move into some drills.

Enoch Lam (running coach): OK we’re going to slowly move more into our dynamic movement, so first one just a little bit of a bounce, knee up…

Ellen Leabeater: There’s some jogging on the spot before we have to break out into a sprint, as well as drills more focussed on the proper movement of the feet and legs. Then, a five kilometre time trial. Something to improve on over the coming weeks.

Enoch Lam: All right, similar thing, but this time, up and then…

Ellen Leabeater: Enoch is the running coach for tonight.

Enoch Lam: My name’s Enoch, and I look after all the running here at One Body.

Ellen Leabeater: So what do you look for in a good runner?

Enoch Lam: Ah, I look at their body positioning, so, it doesn’t matter what body shape or body type you are – everyone can run efficiently and economically and it’s just fitting it to their unique body shape.

Ellen Leabeater: Right, so what sort of injuries do you commonly see among runners.

Enoch Lam: Definitely a lot of knee injuries and a lot of hip injuries as well, and they’re usually just from overuse and just high-impact from just too much running with maybe an incorrect technique or just poor posture.

Ellen Leabeater: And how do you fix it? What sort of techniques do you use?

Enoch Lam: Um, so, if we take it a step back, there’s definitely a lot of strengthening work that we have to do. So we have to strengthen the right muscles for their running, and then in terms of technique, we really have to look at their body posture, so just make sure that they’re not hunching over too much, that they’re engaging the right muscles when they run, and that they’re just striking the ground in an efficient way.

Ellen Leabeater: But what does it mean to run efficiently? Dr. Lee Wallace is a sports science lecturer at the University of Technology Sydney.

So, what does a correct running technique look like?

Lee Wallace: It’s a pretty hot topic the running technique topic. There are a lot of things there that our researchers in our field will agree on. Generally, the most important is running with correct cadence.

Ellen Leabeater: So, what’s that?

Lee Wallace: Roughly running with around 180 strikes per minute, so you’re feet will come into contact with the ground 180 times. Equally as important to that would be landing with your feet directly underneath your body. So the most common mistake people will make is to overstride which tends to mean that your foot will come into contact with the ground in front of your body rather than under your body, and in doing that, that increases the force going through your body.

Ellen Leabeater: People have different running styles, correct?

Lee Wallace: Yes.

Ellen Leabeater: How do you differentiate between a person’s individual running style and one that isn’t technically correct?

Lee Wallace: Sometimes it’s hard to see; sometimes it’s easy to see. There’s a whole business of analysing running technique. I’ve heard of some really simple ways of doing it like some people will say, you know, if you’re watching people run towards you, you shouldn’t see the soles of their feet, because if you’re seeing the soles of their feet then they’re lifting their feet to high. Other people will get you on a treadmill and do some video work and look at where, you know, your body is positioned compared to your foot contact time. Some people look at the wear pattern on the bottom of your shoes and ascertain where you’re striking the ground and the way your foot’s moving.

Ellen Leabeater: When we’re talking about foot strike, there is the ongoing argument of whether forefoot, mid-foot or the heel is the best way to strike. Have we got a consensus on this yet?

Lee Wallace: There’s definitely no consensus. There is a consensus in that it’s more important where your foot strikes in relation to your body rather than how your foot is actually striking. I mean, you can overstride and still be a mid-foot striker. You can stride correctly and run on your heel, so, it tends to be that when your foot comes more underneath your body, you’ll move to more of a mid-foot to forefoot, but it’s not always the case.

Ellen Leabeater: What about surfaces? Sand, grass, concrete – what does the most damage and what’s the best for runners.

Lee Wallace: The surface really is secondary to the actual technique of the runner. In saying that, it’s more likely in the general population that the technique of a runner is not going to be perfect, therefore, softer surfaces would reduce the impact forces, however, that’s not to say running on hard surface you’re going to get injured or vice versa. I’ve actually heard the opposite as well, that a soft surface will increase whatever it is that you’re doing. Like if you’re over-pronating, a soft surface will increase your over-pronation. So surface wise, I would say soft surfaces you’re less likely to get injuries, but that does not necessarily mean that’s always the case either.

Ellen Leabeater: We started off by saying that as humans we’ve evolved to run, it’s natural to run – is our 21st Century running style different to what we would have seen a couple of hundred years ago?

Lee Wallace: There was a book that came out Born to Run a few years ago now. It started a big craze in minimalist running. It actually reads that the inclusion of cushioning systems through our heel has essentially changed our running technique to land more on our heels.

Ellen Leabeater: So that’s in running shoes.

Lee Wallace: Yeah, in running shoes. I mean in running shoes of the 70s and 80s. Today’s running shoes are probably evening out a little bit more. There’s probably a little bit more variety in running shoes now to accommodate all kinds of different forms of running. But we started out in minimalist shoes and went to heavily cushioned shoes, particularly in the rear foot, and now we’re coming full circle back to more minimalist running shoes. So running shoes have got different heel drops in them. So you’ve got… so what is a minimalist shoe versus what is a shoe that’s heavily cushioned. Traditional running shoes have got a 12 to 14mm heel drop, which means… so when you read about a running shoe it will have this term “12mm drop”. It’s referring to the difference in drop between the heel and the toes, so if the heel is sitting 22mm off the ground and the toe is sitting 10mm off the ground, then it’s a 12mm drop between them both. So, the argument is, how does a running shoe promote the way you run? And that’s why the minimalist shoe craze has come in in the first place, so a more minimalist shoe with less of a heel drop, so 0 to4mm drop between the back and front of the shoe is said to promote more mid-foot and forefoot running technique.

Ellen Leabeater: So, more quote “natural running” style?

Lee Wallace: Yeah, using your arch as a shock absorber. So when you think about your body, your heel itself is not a good shock absorber. Your heel essentially is a fatty pad on the end of a bone, where as your arch, containing many joints, many small bones – the actual arch itself works as a spring to produce forces and propel yourself forward. So the thought is landing further forward on your foot would reduce impact forces and also increase propulsion.

Ellen Leabeater: So, with the shoes with the big heel drop, it’s kind of making runners hit the ground heel first? From the weight of the shoe? Or…

Lee Wallace: It doesn’t make you hit the ground first with your heel, but if you did hit the ground first with your heel, it’d be less noticed because the cushioning will compensate for the… you won’t feel the thud because you’ve got the cushioning there.

Ellen Leabeater: So it’s kind of like a bit of spring.

Lee Wallace: It’s kind of like a spring, it’s kind of like it wil disguise the impact forces. So, there’s one thought that with more of a heel – more of a cushion in the heel – because you can run this way and you potentially could be overstriding, it’s less noticeable, therefore you’ll be disguising your poor technique. So then we go the other way and we say, well, let’s put a more minimalist shoe on, let’s use our feet as a natural shock absorber as they’ve been designed to do, however, because you’re muscles in the lower legs mightn’t be as developed around your feet, you know, you’re Achilles, your calves have been shortened from everyday wear and use or walking around in heels. All of a sudden, you put this minimalist shoe on and your foot is subject to more loading force than it’s used to and you become injured that way. So it seems like you can be injured in both ways quite easily.

Ellen Leabeater: There is… I’ve heard the argument before that sometimes it’s not technique, it’s not surface, it’s the fact that you’ve changed shoes that causes injury.

Lee Wallace: Yeah, that could be true as well. Like anything, any change. Some people are like… I was talk about it as, like, Mack trucks versus Ferrari. It’s got nothing to do with how you look or how you run – some people are resilient to change and some people are not. You’ve got some people where just the slightest tweak of anything and bang, they’ll get injured. And other people change all day long, whatever shoes, it doesn’t matter, they’ll just run in whatever. So, it’s an interesting one as well.

Ellen Leabeater: What about the future of running science and running research. Where do you see that heading?

Lee Wallace: I mean, they’ve still got to answer the debate really. The news forums wouldn’t be running so hot if we had all the answers on minimalist vs. rear-foot, so there’s definitely still more research there. More research without shoe companies involved – that’s another area of massive debate for people is, like, who’s funding half of these research projects. But yeah, still the debate on what’s better – forefoot, midfoot, rear foot – but I think we’re satisfied about where the foot should land underneath the body. I think we’re satisfied with that.

[Running audio]

Ellen Leabeater: With all that in mind, if you are a runner looking to improve your technique, Enoch says you should head to your local run club.

Enoch Lam: Um, so, most of your local running clubs should provide you with a fair bit of information to help you. So a lot of the athletics clubs do a lot of work with that. I know NSW Athletics help a lot in terms of their running development, but apart from that, yeah, it is true – it is quite hard to find stuff out there and I think to find something that suits you personally is quite tough.

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Ellen Leabeater: You’re listening to Think:Health on 2SER 107.3. Online at 2SER.com or on your favourite podcast app.

[Music plays]

Ellen Leabeater: Now we have something extra to share with you this week. If you like Think:Health, you might enjoy one of our other Think shows – Think:Sustainability. We’re joined now by Jake Morcom, the producer of the program. Hello!

Jake Morcom: Hi Ellen.

Ellen Leabeater: Think:Sustainability looks at practical solutions for a better planet, and you’ve got a story for us this week that ties in with health.

Jake Morcom: Yeah, so you’ve heard of antibiotic resistance right?

Ellen Leabeater: Yeah.

Jake Morcom: Basically, this means when we use too many drugs to treat an infection, we can develop a resistance to that drug, and then sometimes can be stuck with that infection if we don’t respond to other medications. And that’s pretty scary. So scary, that some scientists are calling it as big of a threat to humanity as climate change.

Ellen Leabeater: Whoa…

Jake Morcom: Yeah, so a group of researchers at UTS are currently looking at whether Manuka honey, which is a honey found here in Australia and New Zealand, might just help fight wound infections in particular.

Ellen Leabeater: Here’s Shona Blair from the “ithree institute” at UTS to explain in more detail.

Shona Blair: It’s really exciting and very interesting because this compound, this special compound that we now know is in Manuka honey that’s come directly from the flower – as the bees go to the flower they collect the nectar, take it back to the hive and ripen it into honey – many honeys have some degree of antimicrobial activity because of the natural process of making honey and the bees adding a variety of enzymes, but the Manuka type honeys from Australia and from New Zealand have a special compound that’s come directly across from the flower and this has really high levels of activity when you take out all the other things that are in normal honeys, they’re still really, really powerful at killing germs, and that’s what we’ve found in hospitals and nursing homes for things like really bad non-healing ulcers on legs and things for diabetic patients or elderly patients. Manuka honey seems to be able to kick-start the healing process, it clears up the infection and actually stimulates the healing as well.

Jake Morcom: And with the research that you’re doing with Manuka honey, and taking into consideration how it’s been used traditionally in the past, what are you finding now in terms of effective ways of wound treatment or even using it for it’s anti-microbial properties.

Shona Blair: I’ve been particularly interested in looking at how we can use honey, particularly Manuka type honeys, to kill or inhibit these really nasty, multiple drug resistant bugs. They call them “super-bugs” often in hospitals – something like Golden Staph is an example. The reason we’re so fearful of these organism is that fifty years ago, if you got a scratch and you got an infection for this, no problem, I’ll give you a little bit of penicillin or another type of antibiotic and you’ll be fine. But now, because these bugs have been so constantly exposed to these types of drugs, they’ve developed resistance. And now a fairly simple scratch or a simple operation or side effects after chemo – all these types of things can become very very dangerous again because they’re very very hard to treat. Obviously honey isn’t something that you could use for a systemic infection or for an infection right inside an internal organ or something like that, however, most infections start from the outside, so it’s a great dressing to put on straight away after surgery, after any sort of trauma, and it stops these bugs, it kills these super bugs, these multi-drug resistant organisms, these antibiotic resistant microbes that we’re frankly terrified of.

Ellen Leabeater: Jake Morcom speaking there to Shona Blair from the “ithree institute”, and if you want to hear more from Think:Sustainability, head to 2SER.com/thinksustainability or subscribe in your favourite podcast app.

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Ellen Leabeater: Don’t forget, if you’d like to find out more about anything you’ve heard today, you can visit us at 2ser.com/thinkhealth. We’re also available on demand. Just search for Think:Health in your favourite podcast app.

Please remember that journalists are not doctors. If we’ve made you ask questions, go and see your GP. This show is produced with the support of the University of Technology, Sydney, Faculty of Health. I’m Ellen Leabeater, see you next week for more in health research and news.

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