1. 27 th April 2012 Jackie Riglin Falls Prevention Co-ordinator, Cambridgeshire Community Services Clinical Associate for Falls, Royal College of Physicians Older people’s experiences of therapeutic exercise as part of a falls prevention service

2. Overview  Background  Results of national questionnaires around therapeutic exercise:-  Learning from older people’s experiences  Implications for practice

3. Background  Part of national audit programme for falls and bone health  Builds on previous work  Patient focus groups, 2008  Patient experience questionnaire, 2010

4. Objective 1: Improve outcomes and improve efficiency of care after hip fractures – by following the “Blue Book ” standards Hip fracture patients Objective 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care Non-hip fragility fracture patients Objective 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention Individuals at high risk of 1st fragility fracture or other injurious falls Older people Objective 4: Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards Stepwise implementation DH Prevention Package 2009

5. Results of national questionnaires around therapeutic exercise What did older people say?  96% found exercises beneficial  92% satisfied with exercise programme

6.  ‘I don’t know how to express my gratitude for all the help they have given. They have been wonderful. They have restored my confidence.’  ‘I have never done anything like this before and would not have tried it without the advice and encouragement I was given. I was nervous at first but I gained confidence and got to enjoy it. I slowly noticed the benefits and I looked forward to going each week.’

7. 84% felt reason for referral explained  272 commented on explanations given by HCP and social workers  Role of friends and family also important  ‘family explained it was to help me get mobile again.’  ‘I had friends who went to the local class and they said it had helped and they walked more easily.’

8.  Health promotion initiatives also mentioned ‘Council open days have advice on many things for senior citizens and we were informed about the falls prevention programme’  Some pro-active in seeking help ‘My husband and I attended a programme several years back, finding it beneficial. Enquired if our GP would refer us again.’

9. 70% had opportunity to raise concerns about an exercise programme  ‘I was concerned about my fragile bones. The physio assured me of the programme’s safety.’  I was assured that if I found the exercises too strenuous or uncomfortable I would be able to rest at any time until I felt I was ready to try again.’

10. 79% felt programme appropriately timed  ‘ Perhaps if my exercise programme had been sooner I may have avoided some of the falls. Just a thought!’  ‘I’ve been falling over and not hurting myself for years I hadn’t realised that other people don’t fall over as much as me! I didn’t know until I was hospitalised recently after a fall that there was help available.’

11. 86% are continuing to exercise  ‘I continue to exercise because my walking is stronger and my morale is higher – not only because of the exercises but my being with other people in the same boat.’  ‘I continue to exercise because it helps me remain functional and independent. I hope to be able to continue attending for years, having seen how the exercises help those older than me.’

12. 1. Many NHS providers are not delivering evidence based interventions for ↓ falls  Only 26% participants used ankle weights  Less than 50% felt exercises were progressed  Only 35% attended a class for >12 weeks  Only 45% supervised at home for > 12 weeks

13. 2. Patients need to be aware of benefits of exercise Most common reasons given by staff for patients declining an exercise programme:-  Don’t feel exercise will help or is necessary  Feel too old to exercise

14. 3. Appropriate training needed for those delivering exercise programmes  Only 54% sites have staff with PSI training  Only 41% sites have staff with Otago training  38% respondents not aware of level of training of those leading classes in community

15. 4. Funding priorities can be a barrier to delivering exercise to ↓ falls  Wide variation in waiting times  1-14 weeks for a home programme  1-26 weeks for a class  Transport difficulties  Cost and availability of equipment  Lack of follow up classes in community

16. Comments from participants  ‘I feel frustrated about the delay between being referred to the exercise programme and being able to attend. A shorter waiting time might have reduced the risk of me falling and breaking my hip’  ‘Since problem is one’s balance, then assuming one can get to the class by public transport is…shall I say…NOT SENSIBLE’

17. 5. Lack of follow up classes for ↓ falls in community  9% sites had no follow on classes  38% sites had only 1 follow on class  22% had only 2 classes  7% had 5+ classes

18. Examples of types of exercise being continued with:-  ‘I continued to exercise at home on an ad hoc basis, was not stringent with the exercises but did what was easy.’  ‘I do some exercises from TV called chair aerobics.’  ‘I continue with my tennis elbow and pelvic floor exercises rather than my falls exercises.’

19. Key messages  Implementation of evidence based exercise interventions by healthcare providers is incomplete and varies widely across different sites  There is lack of long term follow up classes for ↓ falls in the community

20. Recommendations  Commissioning of an integrated exercise continuum across health and local authority/ voluntary sector  National and local monitoring of quality of training and delivery exercise programmes to ↓ falls