Prepared by Alex Black Research evaluation team: Alex Black, Rebecca Bell, Paul Bew, Sandy Brauer
Overview Project objectives were: • To establish falls clinics in the Northside HSD: – An opportunity to streamline and improve existing falls prevention services within the district – 1 x hospital clinic at Prince Charles Hospital – 2 x community clinics: Chermside and Redcliffe • To conduct falls assessment, provide appropriate advice and recommendations/interventions to clients attending the clinics • Project personnel: – 1 x project officer to establish the clinics
Overview Evaluation plan was: • To examine the effectiveness of the clinics in: – reducing rate falls and injury among attending clients – improving functional capacity among attending clients • Using repeated measures analysis: – Findings from baseline visit vs. 6-month follow-up visit
Falls Clinics Minimum Data Set (MDS) • Based on MDS used in Victorian Falls Clinic (Hill et al, 2008) • Falls history, in previous 6-months – Number of falls, injurious falls and falls requiring medical attention • Physical capacity measures: – Physical function questionnaires – Modified Barthel Index; Frenchay Activities Index – Dynamic Standing Balance – Step test – Mobility – Timed up and Go – Leg strength – Timed sit to stand – Walking speed – over 10m distance – Falls self-efficacy – Modified Falls Efficacy Scale • MDS collected at baseline and 6-month visits
Falls Clinics Minimum Data Set (MDS) • Benefit of using the MDS: – Outcome measures used in Victorian clinics: • In 454 clients, 50% reduction in falls, multiple falls and falls injuries – Provides a consistent, evidence-based approach to falls and balance assessment across the district – Standardises the outcome measures, equipment, forms and training requirements
Hospital Falls Clinic • Personnel: – Geriatrician, nurse, physio, OT + admin staff • Target population: high-risk older adults • 3 hour clinic run fortnightly: 2x new and 2x review clients • Clients spent 30 mins with each discipline + final case conference among staff • Referrals to existing services: – Exercise programs at Day Hospital, physio balance classes – Community services: home visits, or other allied-health services • Clients reviewed at 6-months
Community Falls Clinics • Personnel: – Physio, OT, nurse + admin staff • Target population: high-risk, but ambulatory, older adults • 2-hour initial assessment with physio, OT and nurse • 6-week program: 1-hr weekly exercise program run by physio + education sessions led by various allied-health professionals • 6 - 8 clients per class, depending on staff and location • Referrals to other services, e.g. allied-health, pharmacy review • Clients reviewed at 6-months
Baseline measures Hospital (n=52) Community (n=139) • • Oct 2007 and Sept 2009 Jan 2008 to Sept 2009 • • Around 2-3 new clients each Around 6-7 new clients each month month • • 77.3 years, 73% female 76.0 years, 66% female • • Lived with others (60%) or alone Lived with others (59%) or alone (35%) (37%) • • Had a resident carer (62%) or Had no carer support (60%) or a non-resident carer (33%) resident carer (33%), • • 1.2 community services 0.9 community services accessed (range 0 – 5): home accessed (range 0 – 5): home care (40%) and personal alarms care (37%) and community (23%) health centres (21%).
Baseline measures Hospital (n=52) Community (n=139) • • 7.4 ± 3.2 fall risk factors 5.7 ± 2.6 falls risk factors identified (range 0-15) identified (range 0-12) • • MOTOR FUNCTION: impaired MOTOR FUNCTION: impaired balance (81%); unsteady gait balance (58%); muscle weakness (67%); muscle weakness (56%); (53%); and unsteady gait (46%). reduced physical activity (50%); • MEDICAL: polypharmacy (56%); • MEDICAL: polypharmacy (62%); chronic medical conditions such falls risk medications (56%); as stroke or Parkinson’s disease osteoporosis (46%); and chronic (55%); medical conditions such as stroke or Parkinson's' disease (44%)
Baseline measures Hospital (n=52) Community (n=139) Falls history, in previous 6 months: Falls history, in previous 6 months: • • 75% 1 or more fall 68% 1or more fall • • 49% 2 or more falls 38% 2or more falls • • 61% 1 or more injurious fall 53% 1 or more injurious fall (90% needing medical attention) (70% needing medical attention) • • 4 recommendations (0-15) 2 recommendations (0-7) • • Exercise: balance class (62%) Exercise: home program (89%), and home program (14%) balance class (38%), tai chi (14%) • Medical: other health problems • (31%) and osteoporosis (29%) Behavioural: risk taking behaviour (10%) • Environmental: home visits (23%)
MDS change at 6-month Hospital (n=25) Community (n=26) Improved performance for: Improved performance for: • • Dynamic balance (47%) Dynamic balance (15%) • • Falls self-efficacy (13%) Walking speed (14%) • • Walking speed (10%) Small, but non-significant, improvements in remainder • Small, but non-significant, improvements in remainder 65% attendance rate: 23% attendance rate: • • Reasons: withdrew (19%), poor Reasons: unable (relocated or health (12%), or other reasons lost contact; 23%), poor health (5%) (14%), withdrew (14%) or passed away (2%) • No differences between • attendees and non-attendees Non-attendees were older, NO T
Falls at 6-months Risk reduced by ~60% Risk reduced by ~55% 80% 72% Baseline visit 64% 6-month visit 58% 60% 50% Percentage 44% 44% 40% 38% 40% 31% 27% 15% 20% 8% 0% 1+ Falls 2+ Falls 1+ Injurious 1+ Falls 2+ Falls 1+ Injurious falls falls HOSPITAL (n=25) COMMUNITY (n=26) Falls history, previous 6 months
Falls at 6-months Rate reduced by ~40% Rate reduced by ~60% 3 Baseline visit 2.5 2.4 Average number of falls 6-month visit 2 1.4 1.3 1.0 1 0.8 0.8 0.3 0 Falls Injurious falls Falls Injurious falls HOSPITAL (n=25) COMMUNITY (n=26) Falls history, previous 6 months
Summary • Falls clinics fill an important gap in falls services delivery: – Targets high-risk individuals likely to experience serious injurious falls – Provides an important referral point for other health care services: GPs, Allied-health, Emergency Depts • Existing health care services can be successfully transformed into dedicated falls clinics in Queensland, and these are effective in: – Improving some aspects of physical function – Reducing the rate of falls and injury in this high-risk population
Recommendations • Queensland Health Districts across the state need to establish falls clinics, which can be created using existing services, to reduce risk of falls in this high risk population • Queensland Health needs to provide centralised support for falls clinics (e.g. forms, training guides), and promote these services across the falls collaborative networks • Uncertain how upcoming National Reform will impact on organisational changes, particularly for the community falls clinics
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