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| Preventing
falls through safe, active and independent living |
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SAIL
Click on any of the following topics for more information about the SAIL Project
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SAIL is a health promotion project focussing on falls prevention for community dwelling older people. The SAIL project aims to improve the health, wellbeing and mobility of older people so that they continue to live in their own homes with greater confidence, independence and security. The goal of the SAIL project is to:
This catchment area includes the local government areas of City of Greater Geelong, the Surf Coast Shire, Borough of Queenscliff and Colac-Otway Shire as far down the coast as Apollo Bay. The SAIL project will work with a range of existing services and programs throughout the region to develop an integrated, multi-sectorial falls prevention program. The success of the SAIL project is dependent upon community services
and older people working together to design proactive approaches
to reduce falls in the home and in the local area. A partnership
approach to falls prevention is vital because of the complex personal
and environmental factors known to contribute to falls. COMMUNITY ADVISORY GROUP is a group of community members who provide advice and guidance on the development and implementation of SAIL project strategies from the perspective of the project's target group; ie. Community-dwelling older people aged 65 years and over. The Community Advisory Group meets bi-monthly. SAIL REFERENCE GROUP is made of up representatives from
organisations and services from the Barwon Region that have some
involvement or interest in falls prevention. They are considered
the key stakeholders of the SAIL project and are important in ensuring
the broad implementation of strategies. The Reference Group meets
bi-monthly and is chaired by Dr Neil Crompton from the Barwon Health
Falls and Mobility Clinic.
Falls - why they are such an issue Falls are of particular concern for older people and are recognised as a major public health issue. One in every three older people who live in their own home will fall each year. Falls are the leading cause of injury-related deaths, hospital admissions and emergency department presentations in older Victorians aged 65 and over. Most falls result from the interaction of multiple risk factors and situations. Research has clearly identified the risk factors associated with injurious falls in community dwelling older people (National Ageing Research Institute (Hill, 2000)). These are:
It is important to note that most of these factors are amenable
to interventions that can reduce the likelihood of a fall or diminish
the severity of the resulting injury. Injurious falls are more likely to occur in the home than any other location and people over 80 years of age comprise 47.9% of fall-related presentations to hospital emergency departments. Nearly 93% of falls deaths in older persons occurred in persons aged 75 years and older. Fractures account for around half of the primary injury recorded by emergency departments. Most common fracture sites are:
In the Geelong region, the Barwon Health Emergency Department sees around 38,000 people per year. During 2001, 7,992 people aged 65+ presented to the Emergency Department and of these 612 or 7.6% presented due to injury following a fall. Around 64% of these patients were admitted to hospital and 31.7% discharged directly home with 3.9% being transferred to another hospital facility (Victorian Emergency Minimum Data set, VISAR, Monash University). Near falls or falls that do not result in injury can also affect a person's functioning and independence. The simple fear of falling can lead to loss of confidence with a resulting self-imposed reduction in physical activity and an increased dependence on family and community services. What works in falls prevention The research tells us that older people fall for a variety of reasons and many will have more than one single risk factor, which has contributed to their fall. Programs designed to prevent falls in older people therefore need to employ a broad range of strategies working not only in the health sector but also with sectors including local government, the recreation sector, and the tertiary education sector. Program strategies must also be evidenced-based. The following areas have good evidence to support positive outcomes for falls prevention and will be the key strategies employed in the SAIL project:
Education Surveys of older Australians have indicated that that there is a low personal perception of falls risk and therefore this population will not be receptive to " falls prevention" messages. It is therefore more useful to concentrate on positive messages about how to stay active and independent (Commonwealth Department of Health and Aged Care, 2000). Exercise
Environment Clinical Assessment and Review The most well regarded research demonstrating effective interventions for reducing falls in older people is Tinetti's (1994) study of older community dwelling adults. This study evaluated an intervention program aimed at modifying and reducing specific risk factors to prevent selected subjects falling. The risk factors included persons that had postural hypotension, took benzodiazepines or other sedatives, poly-pharmacy (four or more medications), were unable to transfer safely, had environmental hazards, had impaired gait, had impaired arm or leg strength or had reduced range of motion. Results showed that a multiple risk factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community. After one-year follow up there were statistically fewer falls and less risk factors proving sustainability of the improvements. There is some evidence that trained health professionals and volunteers can be used effectively to screen older people for falls risk and identify appropriate actions to minimise future risk of falling (Fabacher et al 1994 and Carpenter and Demopoulos 1990 cited in Hill 2000). Injury Minimisation Multiple interventions The SAIL project is funded by Foothold on Safety through the Department of Human Services. Projects are provided with funds up to $135,000 over a four-year period. SAIL project funding is structured in the following way:
In the first two years of the project, funding is being used to employ 2 part-time project officers. Funding in years 3 and 4 is aimed at supporting the sustainability of falls prevention within the Region with less reliance on activities being driven by project staff. There are currently 15 Foothold on Safety projects being funded in Victoria .The Department of Human Services supports the project officers through quarterly Foothold on Safety Network meetings. These meetings provide opportunities for sharing resources and information between new and established projects throughout Victoria. The Safe, Active and Independent Living project - SAIL - commenced in February 2003 with the secondment of Sue Morgan from Barwon Health Primary Care team 3 days per week to work as Project Officer. The first five months of the SAIL project have focussed on developing linkages with existing services and programs and creating a profile for the SAIL project within the Region. Activities have included:
Activities planned for the period July 2003 to June 2004 include:
The SAIL project team - Sue & Libby!! If you would like more information about the SAIL project you can contact either member of the SAIL team:
Falls prevention services and programs in the Barwon Region Barwon Health
Community Rehabilitation Centres (CRCs) provide multi-disciplinary assessment and rehabilitation on an outpatient basis to people living at home or in alternative accommodation. The services include physiotherapy, occupational therapy, speech therapy, social work, nursing, neuropsychology, clinical psychology, geriatric medicine and specialist in rehabilitation medicine. All clients require a referral via their GP or another health service provider. CRCs also run a number of specialised groups. The programs offered differ slightly between the two CRCs. For more information contact:
Home-based rehabilitation (HBRP) provides rehabilitation programs for suitable clients within their own homes. The HBRP offers a personalized multidisciplinary service that could involve the following team members: medical rehabilitation specialist, physiotherapy, occupational therapy, speech pathology and social work. GP's and other health service providers can make referral to HBRP. For more information contact:
Falls & Mobility Clinic is a clinic based multidisciplinary assessment for people at risk of falling or whose mobility is deteriorating. The program aims to prevent falls and injury and optimise mobility. Clients with complex medical conditions and those who have multiple risk factors for falling are most suited to attending the Falls & Mobility Clinic. This is a diagnostic service; the majority of treatment interventions are referred to mainstream service providers. Referrals are accepted from health professionals and a letter from the client GP is required prior to assessment. For further information contact:
Bellarine Community Health Service Inc. provides community health services in Ocean Grove, Portarlington, Queenscliff, St Leonards & Drysdale. Individual allied health care including physiotherapy, occupational therapy, dietetics and district nursing is available. Health promotion programs include a Weight Resistance Training course and the Better Health Self Management course. For more information about services at each site contact:
Colac Area Health provides primary, acute and rehabilitation programs including physiotherapy, podiatry, occupational therapy and nutrition. Programs include balance and mobility groups, an older men's exercise group and women's exercise group, Women On The Move program, Better Health Self Management course and hydrotherapy groups:
Eric Hart Day Care & Day Therapy based at Lara provides physiotherapy, occupational therapy, podiatry, and a nursing continence adviser. The Day Therapy Centre runs groups relevant for older people at risk of falling including a pulmonary rehabilitation group and a falls & balance group. The day centre offers an adult activities program. For more information contact:
Hesse Rural Health Service provides community health services by district nurses and community health nurses from centres in Beeac, Leigh and Winchelsea. Other services include physiotherapy, diabetes education, Well Women's Clinic podiatry and weekly GP clinic. Health promotion programs include swimming and a strength -training program.
Lorne Community Hospital provides acute, residential and primary care health services including physiotherapy, podiatry and community nursing. A community health nurse runs a range of programs including an older person's exercise group and a vision impaired support group. For more information contact:
Otway Health and Community Services based in Apollo Bay provides acute care, primary health care and home care services. Services include physiotherapy, occupational therapy, community nursing, tai chi classes, personal care, home care, and property maintenance.
Vision Australia Foundation provides multi-disciplinary rehabilitation services including a low vision clinic, assessment and support services for people experiencing vision and sensory loss and other physical disabilities. For more information contact:
Local Government provides a range of home care, personal care, respite care and home maintenance programs for older people. For more information contact the relevant shire office:
Community-based exercise and physical activity programs
Geelong & Surf Coast Life Activities Clubs are auspiced by the GP Association and provide a wide variety of activities ranging from mild exercise to mental stimulation, from fitness to fun. For more information contact:
GPs for Grey Power is an innovative program managed by the Geelong GP Association in partnership with the Life Activities Club aimed at encouraging participation by older adults in strength training. A medical clearance is required prior to commencing the program. For more information contact
Bayside Active Adults in Geelong provides exercise classes and activities for adults wishing to remain fit and strong while having fun. For more information contact:
Community Neighbourhood Centres offer a variety of physical activity programs particularly suited to the older person including, Tai Chi, yoga, gentle exercise and walking groups. Programs change regularly depending on community demand. For more information contact:
Some useful websites:
References Campbell A. J. et al (1997) Randomised control trial of a general practice of home based exercise to prevent falls in elderly women. BMJ, Vol l 315. Commonwealth Department of Health and Aged Care (2000) National Falls Prevention for Older People Initiative "Step out with Confidence". Commonwealth of Australia Cumming R. G. et al (1999)Home Visits by an Occupational Therapist for Assessment and Modification of Environmental Hazards; A Randomised Trial of Falls Prevention. Day, L. et al (2002) A randomised factorial trial of falls prevention among community dwelling older people. BMJ Vol 325 Feder G. et al (2000) Education and debate- Guidelines for the prevention of falls in people over 65. BMJ Vol 321 Hill, K., Smith, R., Murray, K., Sims, J., Gough, J., Darzins, P., Vrantsidis, F., Clark, R. (2000) An analysis of research on preventing falls and falls injury in older people: community, residential aged care and acute care settings. Commonwealth Department of Health and Aged Care. Tinetti, M et al. (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community. The New England Journal of Medicine, Vol 331, No 13. Wolf, S et al (1996) clinical investigation-reducing frailty and
falls in older persons: an investigation of tai chi and computerised
balance training. JAGS 44: 489-497 |
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Community-Based
Falls Intervention Database|
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