FACULTY OF HEALTH SCIENCES Lindy Clemson Professor in Ageing & Occupational Therapy NHMRC Career Development Fellow Ageing, Work & Health Research Unit

 Moving from models of disablement to enablement ◦ 1997 version: Model of enabling disabling process (Brand & Pope) ◦ Occupational therapy models of environment- person-participation “We all have our abilities and disabilities. As we get older the disabilities become more obvious. You lose some sight, some hearing and maybe your balance is worse. But what you have done is focus on our abilities. No one else has done that.” Nancy, Stepping On, Clemson & Swann

 How do we embed concepts such as social cognitive theory into protocols and practice?  Understand key elements that make a difference  Knowledge transfer and preventing program drift  Sustainability 3

The enabling-disabling process Environment-person-participation models Explanatory frameworks Enabling Goal setting and choice Decision making: The Preventive Framework Motivations and intent Exerting control Self efficacy Beliefs about capabilities 4

 Understanding and using key concepts when working with older people to prevent falls  To become more aware  Make decisions to change lifelong habits  Incorporate and sustain changes over time 5

 Evidence based: ◦ 31% fall reduction (IRR = 0.69) ◦ maintained confidence (MES p=0.042) ◦ used more protective behaviours (FaB p=0.024) RCT Published Clemson et al. JAGS, 2004 Manual outlines how to run it Clemson, Swann & Mahoney 2011(3 nd Ed.) / Freiberg Press USA/Sydney University Press US training and Licensing (WIHA) Viewed as a self management program 6

 Multi-faceted → draws on best evidence ◦ Objectives designed for each session ◦ Homework to facilitate follow through  Based on adult learning principles  Strategies to enhance self efficacy in fall risk situations.  A decision making framework to explore barriers and options to managing risk  Variety of learning techniques including the use of story telling 7

 Engage people in what is meaningful and contextual  Sense of ownership  Use plain language  Develop trust  Training in cues to self-monitor exercise, group leader understands how to progress the exercises, links to falls  The importance of reflecting and evaluating; Reinforce accomplishments; Follow through  Use optimism and positive talk  Link strategies and skills to personal goals 8

Participating organisations = 16 Includes diverse cultural communities Turkish 3 Arabic 1 Polish 1 Indian 1 Korean 1 Geographical location Urban 13 Semi-rural 3 Dissemination study-offered training, Clemson, Mathews, Dean & Lovarini (Commonwealth community grant)

 Implementation – best investment ◦ Training workshops enabled uptake ◦ Creative and diverse funding options ◦ Planning sustainability in early stages ◦ Valued as core business ◦ Leadership- a champion to guide development ◦ Partnerships with local council and community groups ◦ Shift in roles ◦ Service provision across traditional boundaries

11 Program Sustainability in Diverse and Changing Organisational Contexts Program Sustainability in Diverse and Changing Organisational Contexts Program Benefits & Value People Committed & Skilled Support Tailored & Ongoing Program Network Motivation & Capacity

 Lifestyle-integrated Functional Exercise (LiFE) to reduce falls  3- arm RCT  Compared LiFE and a structured exercise program to gentle sham exercise  Reduced falls by 31% IRR=0.69  Home based, habit training 12  Clemson, Fiatarone Singh, Cumming, Bundy, Manollaras, Munro & O’loughlin   NHMRC project grant

13 Practice until mastered and then upgrade to a more difficult level Balance Principle Balance Strategy Reduce base of support Move to the limits of sway Tandem walk down the hallway One leg standing at the kitchen bench Lean as far as can cleaning teeth Tailored Activity examples

Many opportunities exist in everyday life activities to challenge balance and load muscles 14 I was looking for ways to make life easier by doing less – now I look for ways to make some things harder I do all the same things – just changed the WAY I do them

 Functional tasks should be a focus for protection from falling  Aim to provide choice - another home based falls prevention program that works  Positive outcomes: more energy, improved function and increased participation in daily life activity  We need environmental stressors as we age  A challenge to occupational therapists to expand our home visit focus and to physiotherapists to incorporate functional exercise 15

Beliefs Principles for balance and strength Belief that can work Self efficacy Habitual change Structural cues Planned implementation intentions (Holland, 2006) Active memory till embedded in routines Experience functional outcomes function, balance Goal achievement ?Central benefit model (Liu-Ambrose, 2012) ?Sense of control (not falling) 16

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