Maintaining independence: 2010 Wellness and Fall Prevention clinic

1. Shelly McEwen1, Erica Carleton2 & Dr. Shanthi Johnson3 1Population and Public Health Services, 2Research and Performance Support, Regina Qu’Appelle Health Region 3Faculty of Kinesiology and Health Studies University of Regina Maintaining independence: 2010 Wellness and Fall Prevention clinic

2. Older Adult Falls • Falls are a significant threat to the health, safety and independence of older adults resulting in high mortality and morbidity rates • Current cost/burden • Majority of falls happen to older adults within the community • Numbers

3. More than just numbers • Athletes and Children • Mild Falls very dangerous for older adults due to a combination of: • High incidence of falls • High injury susceptibility • High prevalence of clinical disease • Physiological age-related changes

4. Risk Factors for Falls • Biological/Medical, Behavioral, Environmental and Social/Economic • Lack of knowledge • Falls not seen as personally relevant

5. Fall Prevention • Cost effective strategy to reduce direct and indirect cost of falls • Falls Predictable and Preventable • Public Health Programs focus on reducing injury: • Severity • Frequency • Impact

6. Regional Priorities • Fall Prevention • In alignment with Ministry of Health and Safe Saskatchewan • Development of Fall Prevention Strategy and implementation by 2012

7. PPHS Approach • Best Practice • Multi-factorial, Multidisciplinary, Environmental, Health strategies • Targeting High Risk Population • Older adult, female, over 80, low socio-economic status, chronic health conditions, socially isolated • Collaborative • Older adults, Community, Business, Health Region • Interprofessional

8. Best Practice Team • Community based multi-factorial interventions • Included health professionals from • Nursing • Vision • Physical Therapy • Occupational Therapy • Kinesiology • Pharmacy • Nutrition • Podiatry • Social Work (Client Assessment)

9. Value of Intercollaborative Practice • Separate and shared knowledge and skills synergistically influence client care • Positive influence on: • Population health and client care • Access and wait times • Communication, coordination of care and client safety • Recruitment and retention of health care professionals • Satisfaction among clients and health care professionals • Health human resources Sources: Canadian Physiotherapy Association, Canadian Health Services Research Foundation, Centre for the Advancement of Interprofessional Education

10. Fall Clinics • Population and Public Health Services (RQHR) clinic model development • Model developed around an injury prevention approach in Victoria, Australia • Clinics • 2 Pilot Clinics in Regina • 4 additional clinics (end of June 2011)

11. Fall Clinics: Recruitment • Targeted community dwelling elderly residents at high risk for falls • Identified through an environmental scan

12. Fall Clinics: Procedure • Pre-clinic • Engaging Community • Education on fall prevention • Appointment bookings • Pre-clinic questionnaire • Clinic procedure • Clients saw all 9 health professionals • Fall risk factors were assessed (standardized testing) • Interventions & referrals were made • Post-clinic • Satisfaction questionnaire • Clinic results forwarded to family physician • Follow-up phone calls • 3 months (completed) • 6 months (in progress)

13. Fall Clinic: Objectives • Increase the knowledge and capacity of the clinic participants, to decrease their risk for falls • Increase health system efficiency through inter-collaborative practice, both internally and externally • Contribute to best practice and research

14. Fall Clinics: Outcomes • Incidences of falls • 12 months before clinic • 3 and 6 months following clinic • Fall efficacy • Activity Specific Balance Confidence Scale (ABC) • Fall knowledge • Falls Risk Behaviours and Perceptions Scale • Fear of falling • Health behaviour • Physical Activity level • Nutrition • Referrals

15. Results: Demographics • 66 clinic participants • 18 unable to provide follow-up at 3 months • Average age of participants was 73 • Most participants were female (82%), with low socioeconomic status (63%) & less than a grade 12 education (73%)

16. Results: Falls • 44% participants had fallen in the 12 months prior to the clinics • 17% had fallen at the 3 month follow-up • No significant difference in fall efficacy • Significant decrease in fear of falling from baseline to 3 months • Significant increase in fall knowledge from baseline to 3 months

17. Results: Health Behaviours • Exercise • Significant increase in the subjective amount of physical activity participants completed at 3 months • Nutrition • 49% made dietary changes to improve their nutrition at 3 months

18. Results: Referrals • All health professionals made a total of 140 referrals • The most commonly made referrals were to • Podiatry (27) • Vision (19) • Family Doctor (18) • Physical Therapy and Occupational Therapy made the most referrals (59)

19. Conclusion • The clinics were successful at increasing the knowledge and capacity of participants to minimize their risk for falls • Significant improvement in fall knowledge • Decreased fear of falling • Increase in physical activity

20. Conclusion • The clinics also enhanced inter-collaborative practice • Delivery of the clinic by multiple disciplines • Number of referrals • Wide variety of internal and external health resources

21. Conclusion • The findings provide a model for best practice • Can be integrated into future fall prevention programming, learning and practice

22. Looking forward • Increased Access to Falls Clinics • Two in urban RQHR in June 2011 • Two planned in rural RQHR in Fall 2011 • Community Stepdown • Environmental Fall Resource Kits • Shared with other health regions • MOH Sharepoint • Physical Activity • Knowledge Exchange and Translation • Model of Clinics shared Provincially and Nationally

23. Last Words • Majority of older adult falls happen within the community (70%) • Fall Clinics are one approach which older people with high levels of fall risk can be managed • Prevention of falls for older adults involves multiple interventions • Falls are predictable and preventable • Fall Prevention: Cost Effective Strategy

24. Questions ???