Empowering Residents to Reduce Falls Risk - Wongaburra

Falls prevention includes identifying & addressing risks

Falls are a significant cause of harm for the ageing population and resultant injuries generate substantial costs for the health care system. Falls resulting in minor or no injury can also have negative consequences with residents becoming fearful of falling and withdrawn from physical activity which can weaken muscles and further increase the risk of falling. Many falls can be prevented by identifying and addressing falls risk factors which can either be intrinsic (medical conditions) or extrinsic (environmental hazards). An effective falls prevention program requires the use of multifactorial strategies tailored to each individual resident’s risks factors. As we age our muscle mass and strength deteriorates, bones weaken and joints become less flexible. Consequently poor balance and mobility is a common falls risk factor among the elderly and exercise programs have proven to be a successful strategy in improving muscle and bone strength and mobility.

Wongaburra Society a not for profit organisation has been providing care and services since the 22nd of August 1970 initially caring for 12 residents and today service 128 residents. Wongaburra was established by the Beaudesert Chamber of Commerce to serve the elderly of the shire and have been participating in the QPS Benchmarking Program since 1st of January 2006. Wongaburra comprises of hostel level care, nursing home, respite care, extra services, level 1 & 2 home care services and the folks (friends old and young looking at keeping socially fit) program. Wongaburra recently introduced an eight week group falls prevention program and share their success in reducing falls and improving residents balance and confidence.

Group Falls Prevention Program

Wongbaurra coordinated an eight week RACA (Residential Aged Care Access) group falls prevention program conducted onsite by Allied Health Professionals which was sponsored by Medicare Local. RACA provides residential aged care facilities with access to allied health services and education for residents and employees to improve the quality of care provided. The group falls prevention program was held from the 9th of January to the 27th of February 2015. 12 high risk fallers from both the hostel and nursing home were nominated for the program following a process of analysing falls trend data and results and collaborating with the clinical team including RN’s and charge nurses to identify residents at risk. Each resident was asked if they would like to participate in the program and the choice was completely up to each individual.

Education for Residents and Staff

The residents who participated in the program received education from selected health professionals each week which covered the following topics and each session was designed to meet key objectives and learning outcomes;

• 

  Appropriate footwear is an important factor to reduce falls
  Week 1: Introduction to falls,
• Week 2: Impact of strength and balance on risk of falling,
• Week 3: Impact of the environment on risk of falling,
• Week 4: Impact of medications on risk of falling,
• Week 5: Impact of footcare and footwear on risk of falling,
• Week 6: Impact of continence on risk of falling,
• Week 7: Impact of vision and healthy eating on risk of falling,
• Week 8: Evaluation and final assessment.

Figure 1: Example Content of Presentation: Impact of footcare and footwear on risk of falling;

Staff were also able to attend the sessions to learn about falls prevention strategies and causal and risk factors. Wongaburra regularly distribute training resource guides to staff providing information about key topics with questionnaires attached to assess their knowledge. Staff are provided with feedback of their results and a summary of the areas they need to improve upon. Wongaburra have developed some fun and innovative ways of promoting learning to engage as many staff as possible to participate in training exercises. The “falls awareness resource and crossword” was recently distributed to all employees including support service and care staff and a 70% participation rate was achieved. Staff were able to learn the training material in their own time and complete a crossword which allowed staff to test their knowledge and the information learned to raise awareness on the topic of falls prevention.

Exercise Regime

Following the education session provided each resident participated in a 30 minute falls prevention exercise program lead by a physiotherapist including a variety of exercises adapting speed, volume and difficulty as per below which were specifically designed to strengthen muscles and improve balance;

• Sit to stand,
• Toe/heel raises,
• Squats,
• Hip abduction and/or extension,
• Side steps (one step each direction),
• Marching with rail for support,
• Standing balance – feet apart/together eyes open/closed, tandem stance & single leg stance,
• Standing arm movements.

Measuring the Success of the Program

Outcome Measures:

To monitor the success of the group falls prevention program each resident completed outcome measures at the start of the program and in the final session to assess the improvements achieved. These assessments are commonly used by health care professionals to measure falls risks and included;

1. 

   Ongoing assessments assist in measuring success of the program
   Timed Up and Go (TUG): this measures mobility and static and dynamic balance of residents. The test measures the time taken by an individual to stand up from a chair, walk 3 metres, turn around, walk back to the chair and sit down. A score of 14 seconds or longer to complete the test indicates that the individual has a high risk of falling.
2. Falls Efficacy Scale (FES): this measures an individual’s fear of falling by asking a series of questions to determine how confidently they feel they are able to undertake activities without falling e.g. getting dressed etc. The lower the score the more able the resident is to complete tasks independently.

A comparison of the initial and final TUG (Timed Up and Go) and FES (Falls Efficacy Scale) measures were used to assess the success of the program. The results demonstrate that 80% of residents increased their TUG score indicating improved standing strength and balance with the overall average increase equating to 15.68%. 80% of residents also improved their FES scores with residents gaining more confidence in performing activities of daily living without falling and an overall average improvement of 45.06% was noted.

Satisfaction Survey:

Wongaburra also engaged residents who participated in the program in a satisfaction survey to gain feedback on the falls prevention program. The majority of resident’s strongly agreed or agreed with the questions expressing satisfaction with the program. 60% of residents felt very comfortable participating in the program and would highly recommend the falls prevention program to their friends. The full results can be found below;

Other Initiatives

In addition to the group falls exercise program and existing falls prevention measures such as sensor mats, fall out mattresses, high low beds etc. Wongaburra also provide a Tai Chi program which has been operational for over 12 months and is open to both residents and the community to attend. Thai chi relieves stress, improves balance and can assist with falls prevention, promotes mobility, improves posture, blood circulation and overall health and chronic conditions.

A fairly new initiative is the introduction of the men’s shed which was established in February 2015 to provide activities that are appropriate to male residents providing a place to relax, have a chat and work with their hands. The men’s shed consists of a number of large workbenches, hundreds of tools, paints and a television. The men’s shed was initially conducted on a weekly basis and has been so popular that this is now held twice a week on a Monday and Friday and is also open to the community to come and join in on activities. Engaging residents in activities at times when falls most often occur can be used as a strategy to minimise falls.

Outcomes of Falls Prevention Strategies

The falls prevention program has led to a continual decline in the falls rate over the past 2 quarters from September 2014 (124.8%) to March 2015 (33.8%) and the falls rate is currently performing well below the industry benchmark as per the QPS Trend Graph below.

Figure 2: Resident Falls (TOTAL) General - Trend Graph;

The successful implementation of balance and strength training exercise programs relies on raising awareness of how undertaking these exercises has the potential to improve balance and prevent falls as demonstrated by the Wongaburra group falls prevention program. Conveying to residents how these exercises can improve their quality of life including maintaining independence, improving confidence and the ability to undertake activities of daily living independently is essential. It is also important to involve all stakeholders in falls prevention strategies e.g. residents, staff and relatives who can assist in identifying falls risk factors and monitor strategies.

Joan Hawkins

OHS Officer /Training Coordinator