Research evaluation team: Alex Black, Rebecca Bell, Paul Bew, Sandy - - PowerPoint PPT Presentation

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
• Around 2-3 new clients each

month

• Jan 2008 to Sept 2009
• Around 6-7 new clients each

month

• 77.3 years, 73% female
• Lived with others (60%) or alone

(35%)

• Had a resident carer (62%) or

non-resident carer (33%)

• 1.2 community services

accessed (range 0–5): home care (40%) and personal alarms (23%)

• 76.0 years, 66% female
• Lived with others (59%) or alone

(37%)

• Had no carer support (60%) or a

resident carer (33%),

• 0.9 community services

accessed (range 0–5): home care (37%) and community health centres (21%).

Baseline measures

Hospital (n=52) Community (n=139)

• 7.4 ± 3.2 fall risk factors

identified (range 0-15)

• MOTOR FUNCTION: impaired

balance (81%); unsteady gait (67%); muscle weakness (56%); reduced physical activity (50%);

• MEDICAL: polypharmacy (62%);

falls risk medications (56%);

• steoporosis (46%); and chronic

medical conditions such as stroke or Parkinson's' disease (44%)

• 5.7 ± 2.6 falls risk factors

identified (range 0-12)

• MOTOR FUNCTION: impaired

balance (58%); muscle weakness (53%); and unsteady gait (46%).

• MEDICAL: polypharmacy (56%);

chronic medical conditions such as stroke or Parkinson’s disease (55%);

Baseline measures

Hospital (n=52) Community (n=139)

Falls history, in previous 6 months:

• 75% 1 or more fall
• 49% 2 or more falls
• 61% 1 or more injurious fall

(90% needing medical attention) Falls history, in previous 6 months:

• 68% 1or more fall
• 38% 2or more falls
• 53% 1 or more injurious fall

(70% needing medical attention)

• 4 recommendations (0-15)
• Exercise: balance class (62%)

and home program (14%)

• Medical: other health problems

(31%) and osteoporosis (29%)

• Environmental: home visits

(23%)

• 2 recommendations (0-7)
• Exercise: home program (89%),

balance class (38%), tai chi (14%)

• Behavioural: risk taking

behaviour (10%)

MDS change at 6-month

Hospital (n=25) Community (n=26)

Improved performance for:

• Dynamic balance (47%)
• Falls self-efficacy (13%)
• Walking speed (10%)
• Small, but non-significant,

improvements in remainder Improved performance for:

• Dynamic balance (15%)
• Walking speed (14%)
• Small, but non-significant,

improvements in remainder 65% attendance rate:

• Reasons: withdrew (19%), poor

health (12%), or other reasons (5%)

• No differences between

attendees and non-attendees 23% attendance rate:

• Reasons: unable (relocated or

lost contact; 23%), poor health (14%), withdrew (14%) or passed away (2%)

• Non-attendees were older, NO T

Falls at 6-months

72% 44% 64% 58% 31% 50% 44% 8% 40% 38% 15% 27%

0% 20% 40% 60% 80% 1+ Falls 2+ Falls 1+ Injurious falls 1+ Falls 2+ Falls 1+ Injurious falls HOSPITAL (n=25) COMMUNITY (n=26)

Percentage Falls history, previous 6 months

Baseline visit 6-month visit

Risk reduced by ~60% Risk reduced by ~55%

Falls at 6-months

2.4 1.3 2.5 1.4 1.0 0.8 0.8 0.3

1 2 3 Falls Injurious falls Falls Injurious falls HOSPITAL (n=25) COMMUNITY (n=26)

Average number of falls Falls history, previous 6 months

Baseline visit 6-month visit

Rate reduced by ~40% Rate reduced by ~60%

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