Prepared by Alex Black

Research evaluation team:

Alex Black, Rebecca Bell, Paul Bew, Sandy Brauer

Overview

Project objectives were:

• To establish falls clinics in the Northside HSD:– An opportunity to streamline and improve existing falls

prevention services within the district

– 1 x hospital clinic at Prince Charles Hospital– 2 x community clinics: Chermside and Redcliffe

• To conduct falls assessment, provide appropriate advice and recommendations/interventions to clients attending the clinics

• Project personnel:– 1 x project officer to establish the clinics

Overview

Evaluation plan was:

• To examine the effectiveness of the clinics in:– reducing rate falls and injury among attending clients– improving functional capacity among attending clients

• Using repeated measures analysis:– Findings from baseline visit vs. 6-month follow-up visit

Falls Clinics Minimum Data Set (MDS)

• Based on MDS used in Victorian Falls Clinic (Hill et al, 2008)• Falls history, in previous 6-months

– Number of falls, injurious falls and falls requiring medical attention

• Physical capacity measures:– Physical function questionnaires – Modified Barthel Index; Frenchay

Activities Index

– Dynamic Standing Balance – Step test– Mobility – Timed up and Go– Leg strength – Timed sit to stand– Walking speed –over 10m distance– Falls self-efficacy – Modified Falls Efficacy Scale

• MDS collected at baseline and 6-month visits

Falls Clinics Minimum Data Set (MDS)

• Benefit of using the MDS:– Outcome measures used in

Victorian clinics:• In 454 clients, 50% reduction in

falls, multiple falls and falls injuries

– Provides a consistent, evidence-based approach to falls and balance assessment across the district

– Standardises the outcome measures, equipment, forms and training requirements

Hospital Falls Clinic

• Personnel:– Geriatrician, nurse, physio, OT + admin staff

• Target population: high-risk older adults• 3 hour clinic run fortnightly: 2x new and 2x review clients• Clients spent 30 mins with each discipline + final case

conference among staff

• Referrals to existing services:– Exercise programs at Day Hospital, physio balance classes– Community services: home visits, or other allied-health

services

• Clients reviewed at 6-months

Community Falls Clinics

• Personnel: – Physio, OT, nurse + admin staff

• Target population: high-risk, but ambulatory, older adults• 2-hour initial assessment with physio, OT and nurse• 6-week program: 1-hr weekly exercise program run by

physio + education sessions led by various allied-health professionals

• 6 - 8 clients per class, depending on staff and location• Referrals to other services, e.g. allied-health, pharmacy

review

• Clients reviewed at 6-months

Baseline measures

Hospital (n=52) Community (n=139)

• Oct 2007 and Sept 2009• Around 2-3 new clients each

month

• Jan 2008 to Sept 2009• Around 6-7 new clients each

month

• 77.3 years, 73% female• Lived with others (60%) or alone

(35%)

• Had a resident carer (62%) or non-resident carer (33%)

• 1.2 community services accessed (range 0–5): home care (40%) and personal alarms (23%)

• 76.0 years, 66% female• Lived with others (59%) or alone

(37%)

• Had no carer support (60%) or a resident carer (33%),

• 0.9 community services accessed (range 0–5): home care (37%) and community health centres (21%).

Baseline measures

Hospital (n=52) Community (n=139)

• 7.4 ± 3.2 fall risk factors identified (range 0-15)

• MOTOR FUNCTION: impaired balance (81%); unsteady gait (67%); muscle weakness (56%); reduced physical activity (50%);

• MEDICAL: polypharmacy (62%); falls risk medications (56%); osteoporosis (46%); and chronic medical conditions such as stroke or Parkinson's' disease (44%)

• 5.7 ± 2.6 falls risk factors identified (range 0-12)

• MOTOR FUNCTION: impaired balance (58%); muscle weakness (53%); and unsteady gait (46%).

• MEDICAL: polypharmacy (56%); chronic medical conditions such as stroke or Parkinson’s disease (55%);

Baseline measures

Hospital (n=52) Community (n=139)

Falls history, in previous 6 months:

• 75% 1 or more fall• 49% 2 or more falls• 61% 1 or more injurious fall

(90% needing medical attention)

Falls history, in previous 6 months:

• 68% 1or more fall• 38% 2or more falls• 53% 1 or more injurious fall

(70% needing medical attention)

• 4 recommendations (0-15) • Exercise: balance class (62%)

and home program (14%)

• Medical: other health problems (31%) and osteoporosis (29%)

• Environmental: home visits (23%)

• 2 recommendations (0-7) • Exercise: home program (89%),

balance class (38%), tai chi (14%)

• Behavioural: risk taking behaviour (10%)

MDS change at 6-month

Hospital (n=25) Community (n=26)

Improved performance for:

• Dynamic balance (47%)• Falls self-efficacy (13%)• Walking speed (10%) • Small, but non-significant,

improvements in remainder

Improved performance for:

• Dynamic balance (15%) • Walking speed (14%)• Small, but non-significant,

improvements in remainder

65% attendance rate:

• Reasons: withdrew (19%), poor health (12%), or other reasons (5%)

• No differences between attendees and non-attendees

23% attendance rate:

• Reasons: unable (relocated or lost contact; 23%), poor health (14%), withdrew (14%) or passed away (2%)

• Non-attendees were older, NO T

Falls at 6-months

72%

44%

64%

58%

31%

50%

44%

8%

40% 38%

15%

27%

0%

20%

40%

60%

80%

1+ Falls 2+ Falls 1+ Injurious falls

1+ Falls 2+ Falls 1+ Injurious falls

HOSPITAL (n=25) COMMUNITY (n=26)

Pe

rce

nta

ge

Falls history, previous 6 months

Baseline visit

6-month visit

Risk reduced by ~60% Risk reduced by ~55%

Falls at 6-months

2.4

1.3

2.5

1.4

1.0

0.8 0.8

0.3

0

1

2

3

Falls Injurious falls Falls Injurious falls

HOSPITAL (n=25) COMMUNITY (n=26)

Ave

rage

nu

mb

er o

f fa

lls

Falls history, previous 6 months

Baseline visit

6-month visit

Rate reduced by ~40% Rate reduced by ~60%

Summary

• Falls clinics fill an important gap in falls services delivery:– Targets high-risk individuals likely to experience serious

injurious falls

– Provides an important referral point for other health care services: GPs, Allied-health, Emergency Depts

• Existing health care services can be successfully transformed into dedicated falls clinics in Queensland, and these are effective in:

– Improving some aspects of physical function– Reducing the rate of falls and injury in this high-risk

population

Recommendations

• Queensland Health Districts across the state need to establish falls clinics, which can be created using existing services, to reduce risk of falls in this high risk population

• Queensland Health needs to provide centralised support for falls clinics (e.g. forms, training guides), and promote these services across the falls collaborative networks

• Uncertain how upcoming National Reform will impact on organisational changes, particularly for the community falls clinics

Cover pageOverviewProject objectivesEvaluation plan

Falls Clinics Minimum Data Set (MDS)Hospital Falls ClinicCommunity Falls ClinicsBaseline measuresMDS change at 6-monthFalls at 6-monthsSummaryRecommendations