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Better balance, less risk of falling – clinics and programme are getting results

April Falls 2016 at Waikato DHB

This month was April Falls – an awareness month about falls prevention. Throughout Waikato DHB staff have been promoting education and awareness of risks of falling throughout hospitals, other DHB facilities and in the community.

Fall prevention is part of Waikato DHB Older Persons and Rehabilitation team’s every day activities because a fall can be a significant setback for older or frailer people.

Often older people don’t see themselves as being at risk of falling, but when they connect it to their ability to stay in their own home or to keep doing things they enjoy, they are more than willing to become involved in falls prevention.

On Your Feet at Waikato DHB

Graded exercises are part of the On Your Feet programme at Waikato DHB.

Keeping people “fall free” in hospital and in their homes is a priority, and the team’s work with a Falls and Balance Clinic and the successful On Your Feet programme is recognised both nationally and internationally. On Your Feet won a DHB Patient Safety Award in 2015, and the programme will be presented at the World Congress on Active Ageing in Melbourne in June this year.

The results speak for themselves in terms of improved scores in key “risk of falling” indicators from the start of the programme to tests done following completion of the programme, plus very positive feedback from the patients themselves.

Falls and Balance Clinics are currently held at Waikato and Thames hospitals, and are going from strength to strength. The team is looking to set up On Your Feet programme at Matariki Continuing Care facility in Te Awamutu from July this year, and at other rural sites by the end of the year.

People are referred to these clinics by their GP or by medical and clinical nurse specialists in other hospital departments, and even from Emergency Department. They may be an inpatient or outpatient. For example, they may present to Emergency Department with a broken wrist, or be on a ward for surgery, but the underlying issue with falling or balance is noted and a referral to the clinic is made.

Increasingly the team is promoting the clinics to GPs so prevention can start earlier and hopefully avoid presentations at hospital with injuries from falls.

“We’ve had a fantastic response from GPs,” says gerontology nurse specialist Sharon Macpherson who, with physiotherapy manager Laura Bate, oversees the initiatives.

“Many referrals now specifically request falls assessment and consideration for the On Your Feet programme.”

The Falls and Balance Clinic involves assessment by a multi-disciplinary team (including a geriatrician). The team discusses all the patients attending the clinic and agree on which treatment pathway is most appropriate – an allied health clinic or a geriatrician clinic, or the On Your Feet programme. Some patients will also be referred to Disability Support Link, other specialists or community health providers.

How does the On Your Feet programme work?  The programme provides education and information plus proven strength, balance and cardiovascular exercises. It is a six-week programme for six to eight participants, and each week a different member of the multi-disciplinary team completes a 45-minute education session on topics such as nutrition and social issues, followed by a one-hour exercise session overseen by a physiotherapist and a therapy assistant.  After the sixth session each person gets an individual assessments and a plan for the future.

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