Strong and Steady. Structured exercise programme for older people evidenced to reduce falls.

Description

There is good evidence that tailored, specific exercise can improve postural stability and reduce other risk factors for falls and injurious injuries including osteoporotic fracture. It is essential, therefore, that Primary Health Care Teams and Social Services, ideally placed to detect individuals with a risk or history of falling, recognise the benefits of, and promote, referral into an appropriate exercise programme.

This programme has been specifically designed to improve postural stability and reduce the risk of falls. The Postural Stability Instructor Training has been developed by Later Life Training UK who has extensive expertise in the fields of research, exercise, medicine and general practice, falls and injury prevention, rehabilitation, education, social services and public health. The Postural Stability Instructors (PSIs) are trained to interpret the referral form from a hospital setting which has the necessary information for each of the participants. The PSI also has the responsibility to deploy skills to achieve fidelity to the structured programme.

A PSI has a responsibility to assess and safely progress a person at high risk of falls (and broader spectrum of falls risk) through the three phases; Induction /Skilling Up, Training Gain Phase and Maintaining Gains, to suit the motivational and behaviour change needs of each participant. Critically PSIs can help older people to maintain/regain their ability to get up off the floor (which helps reduce ‘long lies’, fear of falling and helps them remain independent). One of the key fidelity components of the programme; is training older people getting down to and up from the floor. This is particularly beneficial for the participants in the event of a fall, so that the participant has the knowledge, experience and skills to get up from the floor which could prevent the risk of a ‘long-lie’.

The Strong and Steady Programme in Wexford is a collaboration between the Physiotherapist Team in Wexford Integrated Care Team for Older People (WEXICOP) and Sports Active Wexford (SAW). It is a 20-week programme which initially consists of 6-weeks led by the physiotherapist and 14 weeks led by an exercise professional in Sports Active Wexford. The programme has now completed two full 20-week blocks in two sites across Wexford; Wexford Town and Enniscorthy. Another third block is in the process of being established and is expected to begin in September 2023.

Aim of Initiative

Most importantly the aim of the programme is to build older peoples confidence and reduce the risk of falls.
Other aims of the initiative include;
• Provide safe, effective/evidence-based exercise programme that are enjoyable.
• Provide graded transitions between primary care and community leisure settings.
• Build on the functional gains achieved through physiotherapy and occupational therapy.
• Provide support to physiotherapists working in clinical and community setting (partnership working).
• Provide social opportunities to increase long-term commitment to exercise.

Who is it aimed at

This Strong and Steady Programme is aimed at vulnerable older adults who have a fear of falling, and as a result let this fear affect them in their day-to-day activities. This is especially evident if the person has fallen previously.

Many people who have been to hospital and are at risk of falling will fall again and end up back in hospital. Our aim with this programme is to give these people extra support in increasing their balance, stability and confidence and prevent them re-entering the hospital system. There is also homework provided to encourage the participants to continue with the exercises at home and following the programme.

Many of these participants would not be able to attend due to transport or afford specialised physiotherapy sessions and this programme helps to break down these barriers as it is completely free of charge for the participants.

3 Steps critical to success

1. Collaboration with the Physiotherapists in WEXICOP.
   This partnership between Sports Active Wexford and the Physiotherapists allows for patients to perhaps be discharged sooner from pressured therapy services, help support gains achieved through the rehabilitation setting and further improve functional gains by longer term programmes in community exercise settings.
2. Successful Referral Pathway
   Partnership working is best practice when supporting and working with individuals at risk of falls. This referral pathway is designed for physiotherapists to communicate essential information that helps to ensure optimal outcomes for participants’ by working to achieve the 50-hour dose of strength, balance and functional movement that they need to reduce falls.

   To significantly change the functional trajectory of older people, they need to become more active and to progress their exercise plan from the point of discharge from therapy led services. Also, they are likely to need guidance to help change their behaviour over time.

   Thus, this referral pathway helps to support continued strength and balance exercise with trained exercise professionals. It also allows an exercise service, or an exercise professional to determine whether they have the scope of practice (competencies, specific training, experience, insurance) to work with their patient or whether you can help them find a better trained person to continue the care of their patient.

3. Linking participants back into their community setting.
   Another key step was to move the exercise programme from the hospital based setting into their own community setting. Many older adults experience pain from stiff joints, poor eyesight, poor proprioception, poor postural stability and fear of falling which can all lead to a vicious spiral of inactivity and reduced socialising. Thus, through the help of the Strong and Steady Programme, participants are encouraged to partake in the programme in their local community while building up the confidence and courage through physical activity. This also encourages socialising in their local community once again.

3 Challenges in Planning / Delivery

1. Recruiting Participants
   There are a number of inclusion/exclusion criteria to adhere to the fidelity of the Postural Stability Instructor Training. Thus, recruiting suitable participants was a challenge.
   To be eligible to join the exercise programme, an individual should have at least one of the markers listed below;
   • Fear of falling
   • Feeling unstable
   • History of falls (injurious / non-injurious)
   • Low bone density and/or family history of osteoporatic fracture.
2. Suitable Exercise Professionals
   It is crucial for the programme that the right type of exercise professional delivers the programme. The exercise professionals must consider the inclusion criteria of the participants for the programme and have an awareness of the barriers which older people face. The exercise professional should be committed to providing a quality service and express empathy.
3. Cost
   In order to break down cost barriers for participants the 20-week programme is completely free of charge. Thus can cause restraints on the delivery of the programme. The programme is heavily dependent on external funding streams currently.

3 Outcomes / Benefits

1. Meeting New People
   After the first programme finished, the participants were asked to provide feedback. One of the most important aspects of this programme was the social element; meeting new people.
2. Continuing to Exercise
   Another survey was completed with participants three months after the initial programme was delivered. All participants who took part reported continuing exercise and some have engaged in other activities such as yoga.
3. Understanding the importance of Exercise
   The follow up survey also highlighted that each participant recognised the importance of exercising in their normal day-to-day lives. Many noticing their ‘joints feel looser’ as well as over three quarter of the participants said they would recommend this to their friend. Many highlighted the need for their peers to also engage in this type of programme even before they have any falls.