Living Well – HSE Primary Care Multidisciplinary Falls Education & Positive Ageing Workshops

Description

In an effort to ensure the evolving needs of the diverse community we serve are met, a population profiling needs assessment of our Community Healthcare Network Ballyfermot & Palmerstown was completed. This needs assessment identified that service users most at risk and vulnerable in our community are frail older persons. Falls are one of the biggest risks for the frail older person, with research showing that 30 percent of older people experience at least one fall a year (National steering group on prevention of falls, 2008). In an effort to reduce falls and fall related hospitalisation, the Multidisciplinary Team (MDT) recognised it is important to widely and holistically target falls education and prevention through a collaborative multidisciplinary approach.

Working together primary care colleagues in Dietetics, Nursing, Occupational Therapy, Physiotherapy, Social Work, and Social Prescribing designed a targeted and holistic six week series of falls education and positive ageing workshops with a seasonal approach for the specific time of year. Each of the workshops was delivered by a different Health and Social Care Professional with the approach to falls education being specific to that discipline but also building on the information given by other MDT colleagues to provide consistent and reinforced messages on falls management. Our initiative was developed in line with our Community Healthcare Organisation (CHO) falls pathway to ensure consistency of the message and education being delivered.

The workshops run weekly over 6 weeks with each session lasting approximately 1.5hours. Over the course of the workshops the participants are educated on: the environmental risk factors contributing to falls; how to reduce slips, trips, falls and encourage activity; nutrition relating to falls and sarcopenia (progressive and generalised skeletal muscle disorder that is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality) frailty and self-care; anxiety management to reduce social isolation; and services and supports available in the community.
Each workshop includes a social element with time dedicated to group bonding and sharing of information. It also allows space for the service user to confidentially speak to the facilitator about personal issues if any arise. Each session is individually evaluated by all participants to ensure the group has evolved to best meet the needs of the attendees.
Average workshop attendance has been 10 participants. As this is a new initiative we aim to increase participation to approximately 25 participants per workshop. To date participants have predominantly female, approximately 80%. All participants are from our catchment area of Ballyfermot, Chapelizod, Palmerstown, Parkwest, Quarryvale, Inchicore, Bluebell, and Islandbridge. Participants are recruited by each discipline involved in the workshop screening their waitlist for suitable candidates, advertisement to all stakeholders in the community seeking referrals and advertising that self-referrals are also accepted – we endeavour to ensure the group is as accessible as possible in our community. All referrals are screened to ensure suitability for the group and clients are notified if they are successful in securing a place. Our main admission criteria is that referral are for frail older people living in our catchment area who would benefit from attending and are comfortable in a group setting. We opted to facilitate the workshops with these as our main admission criteria to ensure the group was as inclusive and accessible as possible to all of the frail elderly in our community. At the end of the group if the need is identified or becomes apparent, with consent, participants are referred for additional supports including to therapists on our own multidisciplinary Primary Care Team for 1:1 or further group support, community services or are they encouraged to link with their GP for specific supports.

Aim of Initiative

To provide a multidisciplinary targeted, seasonal and holistic approach to falls education and positive ageing to reduce age related frailty, falls risk and social isolation for older people in the community.

Who is it aimed at

The initiative is aimed at frail people over the age of 65 years living in Community Healthcare Network 7, Ballyfermot & Palmerstown, who are comfortable in a group setting. Our catchment area includes: Ballyfermot, Chapelizod, Palmerstown, Parkwest, Quarryvale, Inchicore, Bluebell, and Islandbridge.

3 Steps critical to success

1. • Identifying the need(s) of the targeted cohort of service users.
   • Coming together as a multidisciplinary team (MDT) to create the group. This was a new approach for our team as up to this point all groups facilitated had been uni-disciplinary in design and delivery.
   • Openness amongst all MDT members to evolve service provision in a way that best meets the holistic needs of the population we serve.
   • Ensuring all planning meetings were inclusive so that the MDT could agree upon the most effective collaborative way of promoting positive ageing and falls management to reduce the risk of falls and isolation for the frail elderly in our community.
   • Deciding on criteria for group admission.
2. Identifying the best location and environment to facilitate the group to ensure it was easily accessible and lowered any potential stigma for those attending.
3. Referrals were sought from all key stakeholders in the local community including GP’s, all colleagues in our Community Healthcare Network and Ballyfermot Chapelizod Partnership. Most importantly self-referrals were also sought and accepted to ensure that the group was easily acceptable.

3 Challenges in Planning / Delivery

1. At a time of challenging staffing levels, setting the clinical time aside to develop, plan and organise a group in the face of high demand and long wait times. In doing so, also changing our mind-sets from a uni-disciplinary to a multidisciplinary way of working.
2. Identifying the best placed most inclusive venue for delivering the workshops.
3. Ensuring the participants could hear audio that was played during some sessions, resulting in the purchase of speakers.

3 Outcomes / Benefits

1. Participants in the workshop have reported less worries and anxiety relating to falls.
2. Participants have stated they are informed and empowered regarding falls prevention and avoidance. They have stated that they also developed an awareness of how to take care of themselves in the event of a fall.
3. Participants are aware of the services and supports available from their local primary care centre to support falls education, prevention and positive ageing.