1. AN EVALUATION OF THE FALLS EXERCISE SERVICE FOR OLDER PEOPLE (AGED 65+) WHO HAVE FALLEN IN GLASGOW, SCOTLAND. The Community Falls Prevention Programme (CFPP) is part of the referral pathway for community dwelling people aged 65 and older, living in Greater Glasgow and Clyde, UK, who have had a fall [1]. Referrals to the CFPP between Jan 2007-Jun 2008 averaged 177 patients/month. The CFPP runs strength and balance exercise sessions (in collaboration with Culture and Sport). All classes are evidence based [2,3] led by trained postural stability instructors [4]. There are three tiers of group class (to meet functional needs) offering between 10- 28 weeks, reaching the required dose of balance exercise recommended [5]. Exercise to reduce falls is a recommended part of any multifactorial intervention to reduce falls [6]. Introduction To evaluate the effectiveness of exercise sessions delivered by the CFPP in terms of falls risk. Aim: Skelton DA 1, Neil F 1, Anderson M 2 1School of Health & Social Care and HealthQWest, Glasgow Caledonian University, UK; 2 Community Falls Prevention Programme, Greater Glasgow and Clyde NHS, UK. Method: Results Conclusion. References: [1] http://library.nhsgg.org.uk/mediaAssets/library/nhsggc'strategy'osteoporosis'falls'prevention'2006-2010.pdf [2] Skelton DA, et al. Age Ageing. 2005 [3] Robertson MC, et al. Brit Med J. 2001 [4] Skelton DA, et al. J Aging Phys Act. 2004 [5] Sherrington C, et al. J Am Geriat Soc. 2008 [6] ABS/BGS. J Am Geriatr Soc 2001 http://sud.editme.com. Contact: Dr Dawn Skelton, Reader in Ageing and Health, School of Health and Social Care, Glasgow Caledonian University: dawn.skelton@gcal.ac.ukhttp://library.nhsgg.org.uk/mediaAssets/library/nhsggc'strategy'osteoporosis'falls'prevention'2006-2010.pdf [2http://sud.editme.com. During 2007 attendees at 7 classes, 274 patients, had baseline and follow- up functional tests following average 11.9 weeks of exercise sessions. All assessments by the same investigator. Main outcome measures: Tinetti scores, 180 degree turn, functional reach, timed up and go, confidence in maintaining balance, Tinetti’s Falls efficacy Scale and the Elderly Mobility Scale. All data was normally distributed (Paired t-tests). All outcome measures showed significant improvements (Table 1). The change in Tinetti Balance Score was, however, duration dependent, with the change in score in those attending 12- 16 weeks (n=91,2.0±2.1,p<0.01), or those attending 16 weeks or more (n=58,2.5±2.5,p<0.01) (Figure 1). The exercise sessions appear to reduce risk of falls (based on balance, mobility and confidence outcomes). As duration of attendance was correlated with balance outcomes, it is important to encourage long term adherence. The tiered exercise programme delivered by the CFPP is evidence based and, based upon small audits, effective in terms of improvements in known risk factors for falls and injury. As part of a multifactorial intervention strategy admissions due to falls have reduced significantly over the last ten years. Transport is provided free where required. These classes are generally offered to patients once or twice weekly. The patients are also instructed on an individual basis and encouraged to undertake exercises at home. In some cases they are encouraged to record this in a diary. Classes are based on the FaME [2] and the Otago programme [3], last one hour and are delivered by Postural Stability Instructors [4] or Physiotherapists. Intervention: TABLE 1: Improvements in Outcome Measures following exercise sessions TestNumber of clients Before exercise sessions After exercise sessions P-value Tinetti Balance Score 27423.124.80.000 180 deg turn2535.550.000 Functional Reach 11219.220.90.000 EMS*12919.019.10.391 TUAG13718.616.30.000 ConFBal16219.416.90.000 Tinetti FES4329.321.50.0002 Note: clients attended on average 11.9 weeks of exercise. Paired t- tests used. All data normally distributed. FIGURE 1: Duration dependence balance outcomes Note: n=274, average attendance 11.9 weeks in this sample The timed up and go (TUAG) post- exercise came close to the 16 second cut off for “low risk” of falls [6], the confidence in maintaining balance score showed considerable confidence improvements in maintaining balance during activities of daily living and the falls efficacy scale changes suggest considerable reduction in self-efficacy to prevent falls and fear of falling. The Tinetti Score showed considerable improvement, however, the change was dependent on duration of exercise attendance. As the class attendance is targeted at between 12 and 18 weeks, every effort should be made to ensure the participants attend for as long as possible to maximise balance improvements. Those attendees that drop out of sessions before 12 weeks are unlikely to see clinically significant changes in their balance. This is in line with the recent systematic review of exercise [5] where a dose of at less than 50 hours confers little benefit to fall risk reduction. In 2006 a falls and bone health strategy [1] was launched although work towards aspects of this strategy has been ongoing since 1998. Over a ten year period in Greater Glasgow and Clyde, there has been a reduction in admissions due to falls at home of approximately 32%. This is a real reduction as the population of 65+ over this time period has only fluctuated by 1.5%. Discussion FIGURE 2: Ten year trend in Admissions due to falls To evaluate the effectiveness of the Greater Glasgow and Clyde Strategy and implementation of falls services, data were obtained from ISD on hospital admissions over a ten year period (Figure 2).