Specialist PSI Exercise

Module

Implementation

Making it work

and making it sustainable

Different models, but similar principles

Specialist PSI Exercise

Module

IDEALLY - An Integrated

Falls and Fracture Prevention Service

• multi-professionalMedical and Nursing staff, Therapists, Social Workers, Exercise Professionals

• multi- agencyLocal health authority, Social services. Local authority , Leisure Services, Sports

Development Service, Voluntary sector

• co-ordinated

Working to agreed protocols, Working to agreed pathways, Utilising agreed communication pathways

• and integrated serviceUsing a regular mechanism of meeting to agree strategy and review progress

towards objectives

Specialist PSI Exercise

Module

What should a service consider?

Aims of Service• To provide a seamless service across all

agencies• To promote personal responsibility for healthy

active ageing• To pro actively identify those at risk of falls and

osteoporosis• To ensure appropriate assessment and

interventions for those at risk

Specialist PSI Exercise

Module

3-tiered inter agency assessment process:-

3. Specialist falls assessment

2. Determine risk factors

1. To identify a falls problem

Specialist PSI Exercise

Module

Getting falls and fractures on the map

• ? Trigger questions on falls and fractures in– A & E– GPs– Single Assessment process?

• Educating others– Pharmacy, Opticians, Chiropodists, Day Centres– etc

Specialist PSI Exercise

Module

Exercise Continuum 3 components:-

1. Community exercise opportunities that offer varied and progressive programme

2. Specific falls prevention (and injuries from falls) rehab class and

3. home based exercise programme

Specialist PSI Exercise

Module

How?• Clinical Exercise Specialists creating links between health

and leisure

• Nationally validated courses:- CBE, OEP, PSI available to all professional groups

• Additional ‘top up’ training to develop skills and standards of practice across all areas

• ‘Code of practice’ – agreed minimum standards for all instructors in both health and leisure

• List of approved classes (monitored and evaluated on a regular basis)

Specialist PSI Exercise

Module

Community Exercise Programme

Aim: to ensure that all older adults have

easy access to a regular, safe and effective

local exercise class

• community

• sheltered housing complex

• day centre

• residential home

Specialist PSI Exercise

Module

Home based exercise programme

OTAGO

Chair Based Exercise Class

(Community based)

Exercise Referral Scheme

12 weeks

PSI/Rehab based exercise group

12 weeks

Community based classes for older people

OTAGO exercise classes

(Community based)

Falls AssessmentIdentification of a falls problem and screening to determine risk factors

Cambridgeshire Falls Prevention EXERCISE PATHWAY

Motivation Screening Pathway

Specialist PSI Exercise

Module

Transport issues……Funding issues

• Link in with other services – Exercise Referral– Mental Health priorities– Social Care funding– Leisure Services

• Consider self funding after initial period?– Often more valued and attendance better!

• Consider ‘buddying’ shemes to aid travel– Going with people on the bus– Providing a lift– Bring along family (and their car!)

Specialist PSI Exercise

Module

Challenges for future• Keeping falls and osteoporosis on agenda

(different priorities across primary and secondary care and community)

• financial constraints - demonstrating cost effectiveness

• ongoing organisational changes

• staff - rapid turnover - low morale

Specialist PSI Exercise

Module

Conclusions

• Falls and Fracture Prevention Services have come a long way in past 6 years.

• In order to ensure ongoing funding locally, we must convince commissioners of cost effectiveness in terms of:-

- preventing falls related injuries.

- maintaining independence and improved QOL for those at risk of falls and fractures (eg. Evaluation!)

Be clear about the specific needs of this group of people (Not all exercise is the same!)