Stepping On Program The FCNN Stepping On Program is supported, in part, by a Live Well at Home grant from Minnesota Department of Human Services.

Today’s Agenda Introduction – Sharing a Falls Story How Significant is the Problem Introduction to the Stepping On program The Stepping On Participant: Who Benefits? Content of Stepping On workshops Sampling the Stepping On program – interactive participation Q & A

Sharing a Falls Story Tell Your Partner About a Time You Fell… Source: scottrosenberglaw.com Source: sweetadditions.net What happened? What was the result of the fall? What caused the fall?

How Significant is the Problem? Statistics in the United States for Falls: 1 out of every 4 people, 65 years & over fall each year. More than 95% of hip fractures are caused by falling, usually by falling sideways. Falls are the most common cause of traumatic brain injuries (TBI). Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall. Source: CDC, STEADI: October, 2016 and NCOA Falls Prevention Facts, 2016

MN Falls Statistics In Minnesota, falls are the leading cause of injury related death and injuries requiring hospitalization or treatment, with the vast majority of these occurring among older adults Falls contribute significantly to depression, loss of mobility, and loss of functional independence among older adults Minnesota has the fourth highest death rate for unintentional falls in the United States Factors contributing to falls include decreased lower body strength, balance, and endurance; complications from chronic conditions; use of medications; weakened vision; and unsafe home and community conditions Source: CDC, STEADI: October, 2016 and NCOA Falls Prevention Facts, 2016

Introduction to the Stepping On Program Copyright Sydney University Press

How Was the Stepping On Program Developed/Evaluated? The program is the work of Dr. Lindy Clemson, an Occupational Therapist from Australia. It has been adapted in Wisconsin for use in United States. The program was published in the September 2004 issue of the Journal of American Geriatrics Society: Clemson, L., Cumming, R., Kendig, H., Swann, M., Heard, R. and K. Taylor. (2004). The effectiveness of a community-based program for reducing the incidence of falls in the elderly: A randomized trial. Journal of American Geriatrics Society. 52(9):1487-1494. Dr. Clemson found that those completing Stepping On experienced a 31% reduction in falls. Her research demonstrated that the program was effective in preventing falls in community-residing older adults.

A Randomized Control Trial (RCT) of Stepping On National Health and Medical Research Council (NHMRC): Provided funding to run 3-year trial Results published in the Journal of the American Geriatrics Society, Clemson, et al. 2004

A Randomized Control Trial (RCT) of Stepping On, Cont’d. RCT – Stepping On Intervention: 7 (2 hours each) sessions plus a follow up home visit later, plus a three-month booster session (control = 7 social visits) Content based on current evidence and emerging evidence Up-skilling of local experts who introduced key content areas Reflection, sharing accomplishments, practice, planning action and homework

Stepping On in Wisconsin In 2004, the Aging and Disability Resource Center of Kenosha County started working with the Stepping On Program with Sandy Cech, RN who was Wisconsin’s Content Expert for the program. Dr. Jane Mahoney, lead researcher at the University of Wisconsin, Madison and Sandy Cech, RN worked with Dr. Clemson to adapt the program for the United States. Currently, dissemination research is being conducted and dissemination of the Stepping On program nationwide.

How Much Difference Does Stepping On Make in Key Participant Outcomes in WI? Total Falls in past six months after completing the workshop: 60% decrease in falls among those who filled out the 6 month follow-up survey. Doctor Visits in past six months after completing the workshop: Net increase of 50 doctor visits (7%) among those who filled out the follow-up survey Emergency Department Visits in past six months after completing the workshop: 9% decrease in Emergency Department visits among those who filled out the 6 month follow-up survey. This translates to a savings of $15,370 (based on the average ED visit cost of $1,537 for those age 65+, because 94% of SO participants are age 65 or older.)

Stepping On Participants: Who Benefits? The Stepping On Falls Prevention program is ideal for older adults who: Are at risk of falling for a number of reasons. Have had a fall in the past year, or have a fear of falling. Walk independently, may use a cane indoors or out, or a walker for outdoor use only Are cognitively intact Live in their own home or other independent living facility Are able to speak conversational English or the language in which the group is being facilitated.

Content of Stepping On Workshops Copyright Sydney University Press

Stepping On - The Conceptual Basis: Small group cognitive-behavioral approach enhancing self-efficacy Decision making theory to guide participants in exploring barriers and options - THE PREVENTIVE FRAMEWORK Adult learning principles to develop skills and knowledge Strategies to encourage behavioral change & follow- through

Stepping On - Overview of Sessions Building trust, risk appraisal, introduce balance and strength exercises Review exercises, moving about safely Home hazards Community safety and safe footwear Vision and falls Bone health Medication management Sleep alternatives Mobility mastery experiences Safe bus and train travel Home visit Booster session

The Preventive Framework 1. What are the causes of falls and the consequences? 2. How can you stop falls in the future? 3. How can you make this happen? 4. Are there any barriers to making this happen? 5. How can you keep this happening?

Sampling the Stepping On Program Story Telling in Facilitating Learning and Confidence Home Hazards Slides with discussion and home hazard screening DVD vignettes with discussion Balance and Strength Exercises Reading a supplement label and determining vitamin D intake Performing a safe shoe audit

Story Telling in Facilitating Learning & Confidence Understand personal experiences Different meanings of events for different people Vulnerable factor Accepting environment Leaders share their own stories Story Telling is a Valuable Way of Learning! Listen to this story about Mrs. Jardine…..

Where Do Falls at Home Occur? Living areas 30% Garage & Outdoors 25% Bedroom 20% Kitchen 10% Stairs & Steps 9% Bathroom 6% VISS, 1994, et al. 1997

When do Most Falls Occur?

Most Common Home Fall Hazards Slippery surfaces Obstacles in traffic ways Poor lighting Reaching – Climbing Steps & Stairs Pathways Floor mats Footwear Bath Spills on floor

Preventing Falls In and About the Home YOU CAN EITHER: Change things around the house - e.g. better lighting, fasten loose mats. Change the way you do things - e.g. slow down getting the phone.

Plan to Make Your House Safe What is the hazard? What can I do to change it?

Shoes around bed

Standing on a chair to reach

Long clothing

Photosensitive Night light

Stairs with grip

Handle in the shower

Curbs

Strength & Balance Exercises The Goals of Exercise Sessions During Stepping On: To motivate participants to exercise To explain - why and how of exercising To practice with participants To challenge - everyone is different To encourage changing habits - the start of regular lifelong exercise habits Let’s Try the Exercises!

Exercises at a glance

Reading a Supplement Label Nature Made Calcium Citrate with Vitamin D

What makes a shoe a SAFE shoe?

Questions? Questions? Thank You! The FCNN Stepping On Program is supported, in part, by a Live Well at Home grant from Minnesota Department of Human Services.