The Otago Program Home based falls prevention program for older adults Yvette Chapman – Service Manager Renee Rabbitt – Program Manager/ OT
The Otago Program at HNEH • 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 • 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 of NSW
Yes ZBI Carer Present Week 1 No Home Visit Outcome measures Yes Pain Scale Phase Change Osteo Arthritis Assessment Treatment (OA) No Week 2 Home Visit Proceed with Yes Otago program Appropriate for Week 4 Otago Program No Home Visit Refer to - Rehabili tation Week 8 - COMPT Home Visit - RPDH Outcome measures - WLCHC - SCOT 3 months Follow up phone call Outcome Measures: - Timed up and go (TUG) 4 months - Sit to stand (STS) Follow up phone call - Near tandem stance (NTS) 5 months - Falls Efficacy Scale – International (FES-I) Follow up phone call - Pain Scale - Zarit Burden Interview (ZBI) 6 months - Quality of Life Scale (QOL) Home Visit Outcome measures Phase Change Treatment Follow Up 12 months Discharge Refer to community exercise Home Visit Outcome measures programs if appropriate Close Otago Service Request Certificate of Achievement Evaluation Questionnaire
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, open 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 35 30 25 Seconds (TUG, STS, NTS) 20 TUG STS Points (FES-I) NTS 15 FES-I 10 5 0 Week 1 Week 8 6 Months 12 Months
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 40 35 30 25 TUG Axis Title STS 20 NTS FES-I 15 10 5 0 Week 1 Week 8 6 Months 12 Months
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)
Cognitively Impaired Population n= 52 clients 35 30 Time in seconds (TUG, NTS, STS ) 25 Points FES-I 20 TUG STS NTS 15 FES-I 10 5 0 Week 1 Week 8 6 Months 12 Months
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 PHx: Vertigo, autonomic neuropathy, diabetic retinopathy, COPD, anxiety, HT, Type 1 diabetes Outcome Week 1 Week 8 6 Months 12 Months Measure 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
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.
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