Turn Your Back on Falls!PARC Conference 2007…Building MomentumFebruary 5th 2007

Turn Your Back on Falls!PARC Conference 2007…Building MomentumFebruary 5th 2007 Julie Lévesque

Chair Ottawa Falls Prevention CoalitionAgente de planification, programmation et recherche, Santé publique Outaouais

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Turn Your Back on Falls: The Stand Up! experience in Ottawa 2005-2006

Turn Your Back on Falls: The Stand Up! experience in Ottawa 2005-2006 The magnitude of the problem:

Statistics on Falls An Evidenced Based Falls

Prevention Program: Stand Up! PIED

What is it? How good is it?

The Ottawa experience with this program

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Falls StatisticsFalls Statistics 1 in 3 adults age 65 and over, fall

every year:

88,995 (2001) 29,665 falls

221,680 (2028) 73,893 falls

Falls major cause of hospitalisation

Factor in nearly half of all nursing home admissions

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Falls and InjuriesFalls and Injuries Almost half of seniors who fall

experience a minor injury, and 5 to 25% sustain a serious injury such as a fracture or a sprain. (Alexander, Rivara, Wolf, American journal of public health1992)

Even without a serious injury, a fall often cause a loss of confidence and curtailment of activities leading to a decline on health and function. 

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Falls in OttawaFalls in Ottawa

In Ottawa for 2003, 6290 seniors required medical intervention and hospitalization because of a fall-related injury

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Falls StatisticsFalls Statistics

2006, Ontario cost of unintentional falls

seniors 55+, $962 million

(Smartrisk).

Burden on informal caregivers (wives

and daughters)

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10Source: The Ontario Injury Compass is produced by SMARTRISK

11Source: The Ontario Injury Compass is produced by SMARTRISK

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Hospitalization rate due to Falls by age group City of Ottawa, 2002-2004

Hospitalization rate due to Falls by age group City of Ottawa, 2002-2004

0

1000

2000

3000

4000

5000

6000

1997

1998

1999

2000

2001

2002

2003

Year

Rat

e/10

0,00

0

65-74

75-84

85+

0

1000

2000

3000

4000

5000

6000

1997

1998

1999

2000

2001

2002

2003

Year

Rat

e/10

0,00

0

65-74

75-84

85+

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Hospitalization rate due to Falls by age group and gender, Ottawa 2002 - 2004

Hospitalization rate due to Falls by age group and gender, Ottawa 2002 - 2004

0

1000

2000

3000

4000

5000

6000

7000

65-74

75-84

85+ 65-74

75-84

85+ 65-74

75-84

85+

2001 2002 2003

Year

Rat

e/10

0,00

0

Males

Females

14

0

2000

4000

6000

8000

10000

12000

14000

2002 2003

Year

Rate

/100,0

00

65-74

75-84

85+

Emergency room visit rate due to Falls by age group, Ottawa 2002-2003

Emergency room visit rate due to Falls by age group, Ottawa 2002-2003

15

0

2000

4000

6000

8000

10000

12000

14000

16000

65-74 75-84 85+ 65-74 75-84 85+

2002 2003

Year

Rat

e/10

0,00

0

Males

Females

Emergency room visit rate due to Falls by age group and gender, Ottawa 2002-2003

Emergency room visit rate due to Falls by age group and gender, Ottawa 2002-2003

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Stand Up! PIED- Montréal Québec- 1996Stand Up! PIED- Montréal Québec- 1996

Developed in close collaboration with community workers, P.I.E.D.* is aimed at reducing three of the risk factors associated with falls:

Impaired balance Dangers in the home

Unsafe behaviours

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Stand Up! PIEDStand Up! PIED

1. To improve balance and leg strength

2. To develop the ability to make adjustment in the home and adopt

safer behaviours

3. To enhance a feeling of effectiveness related to fall

prevention

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Stand Up! PIEDStand Up! PIED

4. To help maintain bone density;

5. To encourage regular practice of physical activity.

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Stand Up! PIEDStand Up! PIED

The program lasts 12 w eeks and consists of

three components:1. Group exercises to improve

balance and muscle strength (Tai

Chi)

2. Exercises at home

3. Information sessions on fall

prevention

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VideoVideo

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Exercises

at home

1 X week

20-30min

A multifactorial program - 12 weeks

15 to 20 participants age 60 and over

Group

Exercises

2 X week

one hour

Prevention

sessions

1 X week

30 min

The Stand Up! programThe Stand Up! program

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Physical activities for individuals or groupsMunicipal recreationPrivate recreation centresCommunity agenciesActive Life Program(Fitness walking groups)Safety promotionPublic policiesSafer environments

Stand Up! Program (PIED)

Integrated program of dynamic balance

Home Care Falls Prevention Program Regional pilot project -fall prevention for seniors living at home MARCHE program: Mobilization program for the elderly to reduce falls in the home

Preventive Medical Intervention Approach

Elderly peoplein the population

Older adultswith risk factors

PROMOTION PREVENTION

O.A. LIVING AT HOME O.A. HOSPITALIZED/LTC

REHABILITATIVE CARE

For the population at large For the individual

High-risk older adultswith a history of falls

Older adults withinjury or disability

Communitydevelopment interventions

Preventivemedical

interventions

Older adultsin the population

Non-personalizedmultifactorialinterventions

Personalizedmultifactorialinterventions

Adaptation/readaptationinterventions

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Evaluation of Stand Up! Montreal- Outaouais and OttawaEvaluation of Stand Up! Montreal- Outaouais and Ottawa

1996 in Montreal2004-2006 Outaouais2005 Ottawa

Looked at: Profile of participants Levels of participation and satisfaction Effects on balance and lower

extremities strength

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http://santepub-mtl.qc.ca/english/elderly.html

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REPORT January 2007

Stand Up! \ PIED

Falls Prevention Program for seniors in Somerset West- a pilot 2005

Ottawa Public Health

Ginette.asselin@ottawa.ca

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Montréal:

3 groups 1996 36 participants

participation rate 73%

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PROFILE OF PARTICIPANTS- Outaouais Fall 2004 to Spring 2006

PROFILE OF PARTICIPANTS- Outaouais Fall 2004 to Spring 2006

12 groups: 167 participants 143 remained with the program until the end

Registrations: 272 registrations, including 105 waivers before the 1st meeting and 24 withdrawals after the 1st meeting

Age : Average: 70Median: 70Variation: 52-89Age groups: 50-59: 10% (17)

60-69: 34% (57)70-79: 41% (68)>80: 15% (25)

Gender: Female: 92% (154)Male: 8% (13)

Fall in the past 12 months:

Yes: 26%No: 74%

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Participation in Stand Up! Ottawa Participation in Stand Up! Ottawa

14 women, 2 men Youngest 59 y. o. oldest 90 y.o. mean age of 74.8

Number of participants at entry into program

Number of participants at end of program

Overall participation rate in weekly group exercise

sessions

Retention

16(1 starting week 3)

12 70.3%75%

(12/16)

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EFFECTIVENESS- Outaouais experienceEFFECTIVENESS- Outaouais experience

Balance:

Overall, there was an average improvement in 4 tests and significant improvement in >1/4 tests in 7/12 groups

Muscular strength:Overall, there was average and significant improvement in 1/1 test in 9/12 groups

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0

10

20

30

40

50

Functional reach Tandem (e.o.) Tandem (e.c.) Sit-to-stand** Unipodal

Initial/Pre program Final/ Post program

Results Ottawa Pilot 2005 Balance and strength testing

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SATISFACTION of Participants:SATISFACTION of Participants:

Satisfaction level: Very satisfied and satisfied (content, atmosphere and facilitator)

Improved balance and leg muscular strength observed throughout the program

Desire to continue the physical activity on their own or to remain with the PIED program

Social network, respect among participants

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SATISFACTION of Co-facilitators:SATISFACTION of Co-facilitators:

Liked the experience, sense of feeling useful, liked the atmosphere, participant acceptance

Ready to do it again in alternating shifts (significant availability for just 1 person)

Progress observed in participants

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SATISFACTION of Facilitators:SATISFACTION of Facilitators: High level of competence, responsibility, creativity,

etc.

Interest in the group, in the community, in promotion/prevention, etc. vis-à-vis their respective educational background

Diversification of the daily approach

Difficulties managing the caseload despite additional time being granted to prepare meetings or having substitute workers on certain territories

The co-facilitation of workers facilitated the implementation of the program on certain territories

Participant progress observed and achieved through the administration of tests

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Lessons learned- what’s needed to deliver this programLessons learned- what’s needed to deliver this program

Trained professionals (health or physical activity specialists)

One day training and peer mentoring is necessary for professional staff to be able to deliver the program independently.

The Program tools are easy to use and well received by the participants.

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Lessons learned- what’s needed to deliver this programLessons learned- what’s needed to deliver this program

Consistent, on time and as scheduled

If more than 15 participants two staff should be present

A committed Seniors’ serving Agency and seniors group

Ongoing professional support Ottawa Public Health.

Safety of participants is paramountFor QA deliver as program protocol

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Recommandations:Recommandations:

Increase # registrations to 30 (waiting list) No repeat twice in a row at the same place or 2 groups at

the same time, same place Press releases, brochures, posters, presentations and

word of mouth best to promote and recruit- start 2 months prior to planned start of program

Start mid September and end of February are best.

Repeat pre- and post-program tests under the same conditions

Adjust the material and exercises (weight transfer, hygiene…)

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Stand Up! PIED after the pilot…Stand Up! PIED after the pilot…

4 groups in 2006… New Horizons Funds

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Budgetary considerationsBudgetary considerations

To deliver a program within your community : community agency partner

two trained professionals (88 hours total)

a safe comfortable facility

equipement as per program protocol ( $700 to 750$)

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Roles of partners- Public HealthRoles of partners- Public Health

Regional operational mechanism for implementation

Securing budgets Organize training Support implementation

Promotion of programme; Recruitment of participants; Purchase of materials or

equipment; Tools for implementing

programme; Training and upgrading for

professionals

Delivery of Programme as support

Evaluation, recommendation

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Roles of partners- Seniors’ Health Social Service AgencyRoles of partners- Seniors’ Health Social Service Agency Mobilize partners in making the Stand Up

Programme accessible and available. Participate in delivering training on the

programme. Implement the programme:

Promotion of programme; Recruitment of participants; Pre/post programme assessment of

participants (Weeks 1 and 12); Facilitation of 20 sessions over 10

weeks. Participate in assessing the programme

and developing recommendations

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Role of seniors’ community groups/ associationsRole of seniors’ community groups/ associations

Define the extent of their participation in the implementation of the Programme

Promotion of programme and recruitment of participants

Assist with logistics for sessions (reserving rooms and

audiovisual equipment, setting up rooms, etc.)

Provide feedback re success or difficulties

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Finale… Stand Up in OttawaFinale… Stand Up in Ottawa

Become an integral part of community based seniors health programming on a regular basis in Ottawa.

A new solution for groups interested in preventing falls among seniors.

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For more information…For more information…

Ginette.asselin@ottawa.ca

(613) 580-6744 ext.26236

http://santepub-mtl.qc.ca/programmechute/

standup.html