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

of 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,

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

0

5

10

15

20

25

30

35

Week 1 Week 8 6 Months 12 Months

Seco

nd

s (T

UG

, STS

, NTS

) P

oin

ts (

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

0

5

10

15

20

25

30

35

40

Week 1 Week 8 6 Months 12 Months

Axi

s Ti

tle 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)

0

5

10

15

20

25

30

35

Week 1 Week 8 6 Months 12 Months

Tim

e in

se

con

ds

(TU

G, N

TS, S

TS)

Po

ints

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.