Turn Your Back on Falls! PARC Conference 2007 …Building Momentum February 5th 2007 Julie Lévesque Chair Ottawa Falls Prevention Coalition Agente de planification, programmation et recherche, Santé publique Outaouais

2 Turn Your Back on Falls: The Stand Up! experience in Ottawa 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

3 Falls 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

4 Falls 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.

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

6 Falls Statistics  2006, Ontario cost of unintentional falls seniors 55+, $962 million (Smartrisk).  Burden on informal caregivers (wives and daughters )

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10 Source: The Ontario Injury Compass is produced by SMARTRISK

11 Source: The Ontario Injury Compass is produced by SMARTRISK

12 Hospitalization rate due to Falls by age group City of Ottawa,

13 Hospitalization rate due to Falls by age group and gender, Ottawa

14 Emergency room visit rate due to Falls by age group, Ottawa

15 Emergency room visit rate due to Falls by age group and gender, Ottawa

16 Stand Up! PIED- Montréal Québec 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

17 Stand 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

18 Stand Up! PIED 4. To help maintain bone density; 5. To encourage regular practice of physical activity.

19 Stand 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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21 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! program

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23 Physical activities for individuals or groups Municipal recreation Private recreation centres Community agencies Active Life Program (Fitness walking groups) Safety promotion Public policies Safer 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 people in the population Older adults with risk factors PROMOTIONPREVENTION O.A. LIVING AT HOME O.A. HOSPITALIZED/LTC REHABILITATIVE CARE For the population at large For the individual High-risk older adults with a history of falls Older adults with injury or disability Community development interventions Preventive medical interventions Older adults in the population Non-personalized multifactorial interventions Personalized multifactorial interventions Adaptation/ readaptation interventions

24 Evaluation of Stand Up! Montreal- Outaouais and Ottawa  1996 in Montreal Outaouais 2005 Ottawa  Looked at:  Profile of participants  Levels of participation and satisfaction  Effects on balance and lower extremities strength

25 mtl.qc.ca/english/ elderly.html

26 REPORT January 2007 Stand Up! \ PIED Falls Prevention Program for seniors in Somerset West- a pilot 2005 Ottawa Public Health

27 Montréal: 3 groups participants participation rate 73%

28 PROFILE OF PARTICIPANTS- Outaouais Fall 2004 to Spring 2006 l 12 groups: 167 participants 143 remained with the program until the end l Registrations: 272 registrations, including 105 waivers before the 1st meeting and 24 withdrawals after the 1st meeting l Age :Average: 70 Median:70 Variation:52-89 Age groups: 50-59: 10% (17) 60-69:34% (57) 70-79:41% (68) >80:15% (25) l Gender:Female:92% (154) Male:8% (13) Fall in the past 12 months: Yes: 26% No: 74%

29 Participation in Stand Up! Ottawa l 14 women, 2 men l 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) % 75% (12/16)

30 EFFECTIVENESS- Outaouais experience l Balance: Overall, there was an average improvement in 4 tests and significant improvement in > 1/4 tests in 7/12 groups l Muscular strength: Overall, there was average and significant improvement in 1/1 test in 9/12 groups

31 Results Ottawa Pilot 2005 Balance and strength testing

32 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

33 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

34 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

35 Lessons 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.

36 Lessons 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 paramount  For QA deliver as program protocol

37 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…)

38 Stand Up! PIED after the pilot… 4 groups in 2006… New Horizons Funds

39 Budgetary 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 ( $700 to 750$)

40 Roles 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

41 Roles 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

42 Role 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

43 Finale… Stand Up in Ottawa l Become an integral part of community based seniors health programming on a regular basis in Ottawa. l A new solution for groups interested in preventing falls among seniors.

44 For more information… (613) ext mtl.qc.ca/programmechute /standup.html