falls prevention programs: updates and strategies for ... · (seated knee extension, standing hip...

Improving the lives of 10 million older adults by 2020

Falls Prevention Programs:

Updates and Strategies for

Participant Progression

May 24, 2017

• Otago - Tiffany Shubert, Otago, Shubert Consulting• A Matter of Balance - Patti League, A Matter of Balance, MaineHealth• Stepping On – Shannon Myers, Stepping On, Wisconsin Institute for Healthy Aging• Tai Chi for Arthritis - Ileina Ferrier, Tai Chi for Arthritis, Tai Chi for Health• Ayden Jones, UNC Asheville

Improving the lives of 10 million older adults by 2020 | © 2017 National Council on Aging 2

Speakers

Otago - Tiffany Shubert, President, Shubert Consulting; Director of User Experience, SuperflexTech

A Matter of Balance - Patti League, Program Manager, A Matter of Balance, MaineHealth

Stepping On – Shannon Myers, Stepping On Faculty Trainer, Wisconsin Institute for Healthy Aging

Tai Chi for Arthritis - Ileina Ferrier, Master Trainer, Tai Chi for Health Grantee - Ayden Jones, Falls Prevention Programs Project Manager,

UNC Asheville

Moderator

Ellen Schneider, National Council on Aging

The Otago Exercise Program

Updates &

Opportunities

Health Indicators & Risk

-Fear of Falling

-Falls in past year

-Fall-related injuries

Fall-related hospitalizations

-Fall-related ED visits

Personal Characteristics

-Age

-Sex

-Race/Ethnicity

Contextual & Risk Factors

Outputs

Functional

Performance

-TUG

-30-Second Chair

Stand

-4-Stage Balance

Outcomes

Strength

Outcomes

Otago

Education

Program

Intervention

Balance

Flexibility

Mobility

17 Exercises *

Perceived

Functional

Performance

-General Health

-Satisfaction

-Confidence

-Difficulty

TIME

Walking Program

(30 minutes/day;

3x/week)

*17 Exercises of the Otago Exercise Program (led by a PT)

WARM-UP ACTIVITIES STRENGTH EXERCISES

(n = 5)

(seated knee extension, standing hip abduction, standing knee flexion, toe

raises, heel raises)

BALANCE EXERCISES

(n = 12)

(standing on one foot, tandem stance, heel-toe walk, heel-toe walk

backwards, side step, backwards walk, figure 8 walk, squats, sit-to-

stand from a chair, heel walking, toe walking, stair climbing)

*17 Exercises of the Otago Exercise Program (led by a PT)

WARM-UP ACTIVITIES STRENGTH EXERCISES

(n = 5)

(seated knee extension, standing hip abduction, standing knee flexion, toe

raises, heel raises)

BALANCE EXERCISES

(n = 12)

(standing on one foot, tandem stance, heel-toe walk, heel-toe walk

backwards, side step, backwards walk, figure 8 walk, squats, sit-to-

stand from a chair, heel walking, toe walking, stair climbing)

The Balancing Act

Most effective for

• High fall risk

• Too frail to participate in a community class

• May need a PT due to medical/fall risk complexity

Secret Sauce

• Doing structured and progressive exercises for an extended period of time

• May not necessarily need a skilled PT to provide supervision of exercises

Acceptable Modifications

• Setting

• Home

• Outpatient/Pace/Adult Day Health

• Community

• Duration – Difficult to manage in home health and Part B

• Focus on first 8 weeks as the clinical stage

• Rest of program can be self-management

• 8 week minimum, 6 months ideal

• Delivery

• PT/PTA

• PT Consultant with at least one licensed provider and experienced personal trainer

What does US implementation look like?

Study #1

• What happens when the OEP is disseminated in the US as part of a “crowdsourced” project?

• What do outcomes look like at 8 weeks?

Alternate Models

Otago Exercise Program Guidance Statement

Coming soon!

Source: Adapted from Mahoney, et al.

• Most appropriate for frail older adults – entry point to the fall prevention continuum

• For more frail/impaired (think ALF) can be paired or potentially after a MOB or Stepping On class

• Upon completion of OEP should transition to community-based balance or exercise class

• If unable to travel – should continue with an in-home program

• Consider virtual options

Virtual OEP – Stand Tall

11

Stand Tall Kiosk

• Dedicated space to set up Stand Tall kiosk

• All-in-one: Large screen TV, Kinect Camera, computer, internet access , VERA software

• Sessions designed to provide optimal dose and intensity of exercises for 30 minutes, three times a week

• System alerts to pain or missed sessions, allowing one study personnel to monitor results of all users

www.reflexionhealth.com

Questions?

Tiffany E. Shubert, PhD, PT

[email protected]

A Master of Balance: Volunteer Lay Leader Model

What New?A Matter of Balance

Patti LeagueA Matter of Balance

MaineHealth’s Partnership for Healthy Aging

Motivation

The term motivation refers to factors that activate, direct, and sustain goal-directed behavior... Motives are the "whys" of behavior - the needs or wants that drive behavior and explain what we do. We don't actually observe a motive; rather, we infer that one exists based on the behavior we observe."(Nevid, 2013)

Activation- to set in motion, mobilize, to turn on, awaken

Perseverance- steadfastness, endurance, resolution

Moving forward: Once participants are motivated supplying options to continue their new found behavior can be a part of longer lasting behavior change

https://www.youtube.com/watch?v=A-Rji1bYPIw

https://www.youtube.com/watch?v=A-Rji1bYPIw

Guam

Hawaii

Northern

Marianas

AK

MT

ID

WA

CO

WY

NV

CA

NMAZ

MN

KS

TX

IA

WI

IL

KY

TN

INOH

MI

ALMS

AR

LA

GA

FL

SC

WV VA

NC

PA

VT

RI

ME

NHOR

SD

ND

MO

OK

NE

NY

CT

MA

N

J

MDDE

MOB Lay Leader Model Master Trainer Sites by State

A Matter of Balance (MOB) Lay Leader Model Master Trainer Sites by State

500 Master Trainer Sites in 40 States and the US Virgin Islands

Translations :A Matter of Balance/VLL

Spanish- Coach/Participant workbook DVDs with

Voiceover from Terra Nova Films

Chinese- Coach and Participant workbook DVDs

Cantonese/ Mandarin Voiceover from Terra Nova Films

Low Vision- Coach instruction materials; Participant

workbook in 12 & 20 font; Audio Exercise CD; Audio

Participant workbook

Portuguese- Participant Workbook with DVDs scripts

Coach Handbook coming soon

Vietnamese- Participant Workbook with DVDs scripts

Russian- Participant Workbook with DVDs scripts

Japanese and Korean translation in the works

Video Update: New faces coming

Fear of Falling: A Matter of Balance

Exercise: It’s Never too Late

These two videos set the tone for the discussions in A Matter of Balance- being updated. Reshooting of participants and the narrator

underway with Terra Nova Films in Illinois.

Which one is not like the other?

The importance of fidelity in EBPs

Maintaining Fidelity

Are you still a Duck? Deliver the class according to the manuals!

Contact Information

Patti League RN Program ManagerA Matter of Balance

[email protected] for Healthy Aging

[email protected]

www.mainehealth.org/pfha

mailto:[email protected]


STEPPING ON:

Shannon Myers,

Stepping On Faculty Trainer

Program Implementation Director

Stepping On Leader Training Materials

Stepping On Master Trainer Manual: (1) per Master Trainer

E:\Stepping On Master Trainer Manual – updated 5-2012\mt manual part 1 (3).docx


Stepping On Master Trainer Toolkit: (1) per Master Trainer

Stepping On Leader Toolkit: The following are the titles’ of the documents on the “Table of Contents” and where they are saved on your flash drive. Make (1) folder for each Trainee.

Left side of folder: E:\Stepping On Leader Toolkit\Left side of folder

Table of Contents Name File Name in Folder Preparation

Stepping On Note Card SO Note Card.doc 1. Print on Bright White Cardstock 2. Cut in half and fold

Preventive Framework Bookmark SO Preventive Framework bookmark, WIHA logo and green.pdf

1. Print on Bright White Cardstock 2. Cut and laminate

Stepping On Leader Training Agenda NA Master Trainer (typically Val), will provide before training

Stepping On State PowerPoint

NA Master Trainer (typically Val), will provide before training

Comments about STEPPING ON by Participants

SO Exs and Testimonials.doc 1. Print double sided

Phrase Bubbles for Stepping On Display

SO Phrase Bubbles for Laminating.doc

1. Print on Bright White Cardstock 2. Laminate

Right side of folder: E:\Stepping On Leader Toolkit\Right side of folder


None SO Leader Toolkit Labels – new-Avery5164.doc

1. Print on Avery White Shipping Labels - #5164 or #5264 (3 1/3” x 4”)

None Cover Page with Logos – Out-of-State.doc

1. Add/Change Month and Year 2. Enter out-of-state organization

contact information None Thank you with Logos.doc None Table of Contents and Instructions for Stepping On Leader Toolkit

Table of Contents Instrs for SO Leader Toolkit – with page numbers – Out-of-State.doc

1. Add/change contents as needed

Fact Sheet of Stepping On - WIHA SO Fact Sheet – WIHA.doc None Quick Overview of the Stepping On Program

SO Session 1 Overview of the Program.pdf

None

Summary of Key Elements of Program SO Summary of Key Elements of Workshop.doc

None

Stepping On Brochure SO Brochure.pdf SO Brochure.pub

None

WHAT IS STEPPING ON

• High Level, Evidence-based Community Fall Prevention program.

• Shown to reduce falls by 50%

• Multifaceted: Guest Experts, Peer to Peer Learning, Uses vignettes, handouts and decision making processes

• 7 weeks (2 hours/session)

• Topic covered: Strength & balance exercises, vision, medication management, moving out and about, footwear, identifying and problem-solving home and community hazards.

• Benefits: Build confidence, peer to peer learning, become more aware and reduce































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WHAT STEPPING ON CURRENTLY LOOKS LIKE

• Individual licenses nationwide: 30 Licenses

• Number of active states: 20 States

• Number of leaders nationwide: 554 Nationwide plus 425 in WI

• # of Master Trainers nationwide 61 nationwide, plus 7 in WI

• # of Workshops nationwide 285 Nationwide, plus 189 WI (474)































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WHAT’S NEW IN STEPPING ON

• Sensory Toolkit

• Support Calls

• ILC’s: Green Bay, Stevens Point, and Madison

• WIHA collaborated with Security Health Plan (SHP)to launch the “Stepping On Falls Prevention Pilot Initiative”

• 4 counties in central Wisconsin.

• Marshfield Clinic Health System, SHP offers Medicare plans throughout its 46-county service region.

• First pilot a success, SHP has committed to a partnership with WIHA and is contracting to expand the Stepping On Program to other counties on a rolling basis over the next several years.

• WIHA will build on access to the health system to discuss introduction of the STEADI clinical assessment tool.































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THE FUTURE OF STEPPING ON

• Updating the Leader Training

• Developing a Fidelity Coach Training

• Developing a Stepping On Graduate Program

• Various Adaptations

• Pisando Fuerte

• Other cultural adaptions beginning – Hmong, MCI Veterans, Cancer Patients, African Americans































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SHANNON MYERSSTEPPING ON FACULTY TRAINER

PROGRAM IMPLEMENTATION DIRECTORWISCONSIN INSTITUTE FOR HEALTHY AGING

[email protected]































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2017 UPDATES

• Online Lessons, August

• USA Master Trainers

• Clarify TCA and TCAFP

• Fidelity Checklist for

Grantees and Instructors

Tai Chi for Arthritis U.S. Administration for Community Living Falls Prevention Grantee

Fidelity Checklist

Purpose The purpose of this checklist is to provide U. S. Administration for Community Living falls prevention grantees a guide to facilitate and maintain standards of the Tai Chi for Arthritis for fall prevention protocol. Program Tai Chi for Arthritis (TCA), developed by Dr. Paul Lam at the Tai Chi for Health Institute (TCHI), is used for fall prevention and is an evidenced based program recommended by the CDC. Evidence has shown that the TCA program reduced recurring falls by nearly 70%, marking this program as one of the most effective approaches for older people who are more likely to fall due to lack of confidence, muscle weakness, poor vision, poor balance and the effects of medication. Outcome The TCA protocol has been shown to: •Improve balance•Increase muscular strength •Improve mobility •Increase flexibility •Improve psychological health •Decrease pain •Prevent falls

Participant’s guide to achieve best results

• Attend tai chi classes for one hour per week for 16 weeks or two hours per week for eight weeks.

• Practice at home when you can for a suggested time of half an hour daily, or at least four days per week. For example, one half hour or two fifteen minute sessions.

• Use Instructional DVD and/or charts for home use, if desired. • Wear loose comfortable clothing and flat soled shoes to practice

tai chi. • Remember to drink water. • Check with your doctor before you begin a tai chi class. • Sit down whenever you need to during class. • Feel comfortable to inform the instructor of any health

conditions you wish to disclose.

March, 2017

Name: Date:

Instructor qualification

☐ Must hold current TCH board certification ☐ CPR certified☐ Able to provide modified movements to reduce risk of injury for older participants and those with arthritis. Adapt

movements, such as implementing Seated Tai Chi as a starting exercise for participants who have mobility issues

Instructor Attire☐ Proper tai chi clothing and shoes (TCH Blue Shirt or TCH Patch and Instructor Badge)

Providing Safe Environment☐ Clear and level Floor☐ Adequate lighting ☐ Accessible Studio, especially for those with health conditions ☐ Emergency Plan☐ Chairs available☐ Nearby washroom☐ Limited outside distraction

Teaching Protocol for Instructors ☐ Uses Progressive Stepwise Teaching Method☐ Includes warm up and cool down exercises☐ Demonstrates one or two movements per lesson, progressively leading to the completion of the six basic core

and six advanced extension movements☐ Demonstrates breathing techniques☐ Incorporates tai chi principles, including those relating to the improvement of physical and mental balance☐ Encourage participants to stay within their comfort zone

Instructor Fidelity Checklist

CREATE A SUSTAINABLE PROGRAM

• Create a practice participants will want to repeat.

• Look at your teaching style (Too much/too little, can they hear you?)

• “Listen to the Incoming Force” (Are you listening to needs?)

• Appropriate modifications in movements• Stay with protocol and provide variety

(Depth, Principles, Breath work)• Going too fast (Pace and lessons, Allow

time for Stillness)• Social element (Tea afterwards,

opportunity to socialize)

Tai chi’s flowing, predetermined movements facilitates one’s inner awareness. It is that personal discovery of being uniquely

human that empowers us to better health and sustainability.

“Welcome to your tai chi journey”

Fall Prevention in North Carolina

Ayden Jones, Fall Prevention Programs Manager

Mission:Develop equitable opportunities that lead to healthy North Carolina Communities.

As some of the greatest gaps in health care and equitable health outcomes focus on older adults and adults with disabilities, NCCHW addresses these issues through a focus on Fall Prevention and Chronic Disease Self Management programs

NCCHW works to impact policy, build capacity, and ignite community initiatives by working through a web of cross sector relationships organized around building healthier places throughout the state.

▪ Residents aged 65 and older account

for 88% of all fall deaths and 73% of

nonfatal fall hospitalizations in NC.

▪ Each week, there are 1,189

emergency department visits among

residents aged 65 and older and 17

deaths due to fall injuries in NC.

▪ By 2018 all 100 of NC counties will

have more residents 65+ than 0-17.

The Burden of Falls in North Carolina

North Carolina Division of Public Health, released October 2016

healthyagingnc.com

A vision for the future

• Single point of entry

• Centralized, Statewide

Coordination efforts

• Data Collection

• Current events/articles

• Fall Prevention Continuum

Programs for Fall Prevention

Otago

A Matter of Balance

Tai Chi for Arthritis

YMCA: Moving for

Better Balance

healthyagingnc.com

Building a Continuum of Care

● Build a safety net for older adults to be supported and always have accessible programs

● Build skill sets and self efficacy in incorporating fall prevention strategies

● Build social connectedness that is threaded through each program

● Offer programs during transitions of care

CDSME programs on the continuum

Clinical and Community Partnerships

Area Agencies on Aging

Genesis Rehabilitation

Accountable Care Organization (Mission Health Partners)

Home Health Agencies

Centers for Independent Living

Church health and wellness initiatives

Thank you!

[email protected](828) 250-3991


falls prevention programs: updates and strategies for ... · (seated knee extension, standing hip...

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