The Otago Program Home based falls prevention program for older - - PowerPoint PPT Presentation

The Otago Program

Home based falls prevention program for older adults

Yvette Chapman – Service Manager Renee Rabbitt – Program Manager/ OT

• HNE Health, Greater Newcastle Cluster Otago Exercise

Program commenced on the 31st January 2011

• Inclusion of clients with cognitive decline and with progressive

neurological conditions.

• This program is targeted at those clients living in the

community who are not able to access centre based rehabilitation or not suitable for a community based program

The Otago Program at HNEH

The Otago Program

• Individually tailored home based exercise program –

PT/OT/EP

• 5 to 6 home visits over 12 month period
• Phone coaching and follow up/booster visits if required
• Strength exercises 3 x per week and walk at least 2 x per

week, balance exercises daily (2hrs/week)

• Activity/Exercise Booklet and Diary
• Leg weights
• Outcome measures: TUG, Sit to stand x 5, Near Tandem

stance and FES –I, ZBI

Evidence for the Otago Program

• Four controlled trials conducted at the University of

Otago Medical School, New Zealand.

• 1016 people aged 65 to 97 living at home
• 35% reduction in both the number of falls and the

number of injuries resulting from falls in both men and women

• Improvements seen in strength, balance and

confidence in all ADLs

• Greatest effect in high-risk groups: over 80 yo who

had had a previous fall

Challenges

• Non recurrent funding (max 1.5 staff)
• Staff security and job security
• Collaboration to meet the needs of the wider

community and prevent falls

• To implement Otago across HNE LHD and all
• f NSW

Week 1

Home Visit Outcome measures

12 months

Home Visit Outcome measures Certificate of Achievement Evaluation Questionnaire

Week 2

Home Visit

Week 4

Home Visit

Week 8

Home Visit Outcome measures

3 months

Follow up phone call

4 months

Follow up phone call

5 months

Follow up phone call

6 months

Home Visit Outcome measures

Carer Present Osteo Arthritis (OA) Appropriate for Otago Program Discharge

Close Otago Service Request Refer to community exercise programs if appropriate

Yes No Yes No Yes No ZBI Pain Scale

Proceed with Otago program

Refer to

• Rehabili

tation

• COMPT
• RPDH
• WLCHC
• SCOT

Phase Change Treatment  Follow Up Phase Change Assessment  Treatment

Outcome Measures:

• Timed up and go (TUG)
• Sit to stand (STS)
• Near tandem stance (NTS)
• Falls Efficacy Scale – International (FES-I)
• Pain Scale
• Zarit Burden Interview (ZBI)
• Quality of Life Scale (QOL)

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Lives in their own home who have had a fall or have a fear of

falling

• Can mobilise within their own home +/- mobility aide
• > 65 years old or >45 years old for ATSI population
• Can exercise independently if they live alone
• Is medically stable i.e. no ongoing infections such as cellulitis,
• pen leg wounds, #’s
• Unable to participate in a group setting i.e. due to

anxiety/depression/CALD/cognitive/neurological/transport issues

Inclusion and Exclusion Criteria

Exclusion Criteria:

• Residents of aged care facilities
• People who have a terminal illness with a prognosis of less

than 12 months as the Otago program is a 12 month program

• People who are dependent on a wheelchair for mobility
• People who are only able to transfer from chair to chair.
• Current open service request to other GNC service e.g

rehabilitation, RPDH

Behaviour change and self management

• Motivational Interviewing Behaviour change/self Mx
• Adult learning principles
• Exercises need to be maintained to sustain the

benefits

• Start slowly and set realistic goals – short and long

term

• Provide ongoing support and telephone contact

between home visits

• Involve the person’s family
• Education re specificity in training

DVD

• Specificity
• Technique correction
• Education
• Follow up
• Understanding your clients
• Educational/cognitive level

Otago Outcomes

• Program Duration: 28 months
• Clients Referred: n = 946 clients
• Participants Assessed: n = 522 clients
• Clients unable to participate/culled: n = 220 clients
• Reduction in falls: 60% (but all data self reported and

not objective as per other outcome measures)

Non-specific Population n= 286 clients

5 10 15 20 25 30 35 Week 1 Week 8 6 Months 12 Months

Seconds (TUG, STS, NTS)

Points (FES-I)

TUG STS NTS FES-I

Non-specific Population Results

Week 1 – 12 months improvements

• TUG: 34% improvement (Av 7.3 secs)
• STS:

36% improvement (Av 9.2 secs)

• NTS:

39% improvement (AV 2.4 secs)

• FES-I: 16 % improvement (Av 5 points)

Neurologically Impaired Population n= 107 clients

5 10 15 20 25 30 35 40 Week 1 Week 8 6 Months 12 Months Axis Title TUG STS NTS FES-I

Neurologically Impaired Population Results Week 1 – 12 month averages

• TUG: 38% improvement (Av 11.2 secs)
• STS:

37% improvement (Av 10.9 secs)

• NTS:

39% improvement (AV 1.6 secs)

• FES:

18% improvement (Av 7 points)

5 10 15 20 25 30 35 Week 1 Week 8 6 Months 12 Months

Time in seconds (TUG, NTS, STS) Points FES-I

TUG STS NTS FES-I

Cognitively Impaired Population n= 52 clients

Cognitively Impaired Population results

Week 1 – 12 month averages

• TUG: 40% improvement (Av 12 secs)
• STS:

34% improvement (Av 10 secs)

• NTS:

101% improvement (Av 3 secs)

• FES-I: 1% decrease in confidence

Good news story – Mr R

• Initial Ax – afraid to mobilise outdoors with

4ww

• Reliant on walker indoors at all times
• Housebound unless assistance available
• Now mobilising outdoors daily for 35 -40

minutes with 4ww

• Indoors single point stick
• Wk 1 TUG 44.86s 4ww; wk 8 15.36s s/stick

Good News Story – Mrs T

Outcome Measure Week 1 Week 8 6 Months 12 Months TUG 17.81 secs 9.41 secs 8.38 secs 7.97 secs STS 20.06 secs 10.06 secs 11.02 secs 9.97 secs NTS 3.31 secs >10 secs >10 secs >10 secs FES 52 50 49 41

PHx: Vertigo, autonomic neuropathy, diabetic retinopathy, COPD, anxiety, HT, Type 1 diabetes

References

• Campbell, A.J. & Robertson, M.C. (2007). Otago Exercise

Programme to Prevent Falls in Older People: A home-based, individually tailored strength and balance and retraining programme.

• Clemson, L., Cumming, R.G., Kendig, H., Swann, M., Heard,
• R. & Taylor, K. (2004). The effectiveness of a community-

based program for reducing the incidence of falls in the elderly: A randomised trial. Journal of American Geriatric Society, 52: 1487-1494.

• Hill, K., Clemson, L. & Vrantsidis, F. (2006). Preventing falls –

a key to maintaining independence. In H. Mackey & S. Nancarrow (Eds.), Enabling Independence: A Guide for Rehabilitation Workers (pp.182-202). Melbourne: Blackwell Publishing Ltd.

References

• Sherrington, C., Tiedmann, A., Fairhall, N., Close, J., & Lord,

S.R. (2011) Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bulletin, 22: 78-83.