Falls Services

Full Falls Assessment Provided

Falls Prevention

Falls prevention exercise has been proven to be extremely effective in reducing falls.

It plays an important role in the falls care pathway, both in terms of primary and secondary prevention, and can significantly contribute to reducing the financial burden on the healthcare system and social care by preventing fractures and avoidable hospital admissions.[1] Fall prevention and assessment services are not yet well structured or developed in Ireland. Most patients who fall do not receive a falls assessment service and there is rarely evidence based falls prevention exercise services available for these patients.

Falls: the facts

  • Ireland has an ageing population. Today 11% are aged 65 years or over (expected to increase to 18% by 2031)[2].
  • The prevalence of falls has increased from 19.6% in 2011 to 22.2% in 2013 (TILDA, 2014). The annual cost of falls in Ireland is estimated at €400 million[3]
  • Those who have a history of falls have poor outcomes with almost one third failing to regain independent living or dying within one year.[4]
  • Injurious falls, including hip fractures, are the leading cause of accident-related mortality in older people.
  • After a fall, an older person has a 50% probability of having their mobility seriously impaired and a 10% probability of dying within a year.
  • Falls destroy confidence, increase isolation and reduce independence, with around 1 in 10 older people who fall becoming afraid to leave their homes in case they fall again.
  • A tailored exercise programme can reduce falls by as much as 54%.

Almost 20 years of research into the subject has led to a very good understanding of exactly what kind of exercise and how much is needed to be effective in preventing falls.[5]

We know that a ‘dose’ of at least 50 hours is necessary to reduce falls.[6]

The Staying Strong, Staying Steady exercise classes are in accordance with Postural Stability Instructor in the Prevention of Falls qualification (PSI). PSI is underpinned by current evidence (Cochrane Reviews, Sherrington Falls Exercise Review, NICE falls guidance, FaME programme, ProAct65+ study) and recommended by the UK Dept of Health Prevention Package (2009), the RCP Audit of Falls Services (2012) and the Age UK Expert Series (2013), ProFaNE and ProFouND.

Improvements demonstrated in research trials include:

  1.  Reduced falls and injurious falls rate and falls risk
  2.  Reduced fear of falling and improved confidence
  3.  Reduced fracture risk/maintenance of bone health
  4.  Improved balance and lower limb strength
  5.  Improved function and quality of life
  6.  Improved social contacts

 

About the Staying Strong, Staying Steady Classes

The Staying Strong, Staying Steady Postural Stability Exercise Programme[7] is arranged in three stages.

Weeks 1- 11 is the Introduction and Skilling Up stage; weeks 12 -33 is the Training Gains Stage and weeks 34 -48 is the Maintaining the Gains Stage.

The programme includes seven evidence based activities: Targeted Resistance Training, Flexibility Training, Dynamic Endurance Training for Balance, Dynamic Balance Training, Adapted Tai Chi Training, Backward Chaining and Functional Floor Exercises.

Each weekly session is tailored to suit the participants and will include elements of ongoing assessment, education, accident prevention, and always finish up with ‘tea and chat’. The sessions are designed to be fun and sociable while still being sufficiently challenging to achieve the goal of improved postural stability.

Participants are encouraged to carry out supplementary home based session and will be provided with support and resources to help with this.

There will be a maximum of 15 participants per class.

The class will be an hour long, followed by 20 -30 minutes ‘tea and chat’.

 

 

Where + When?

The classes will initially be held in the Wellness Centre, Kilcock, Co. Kildare and will take place at 11.30 am Monday and/or Wednesday (to be confirmed). Additional programmes may start in Kilcock and further programmes may commence in Maynooth and further afield depending on demand.

It is intended to keep the programme running each and every week (with the exception of holiday periods) for as long as there is demand. Therefore if a participant wants to continue in the programme after stage 3, they will be able to do so as long as it continues to be appropriate for them. Where a participant has made significant improvements they will be encouraged on to appropriate progression programmes. I am currently investigating and setting up links to appropriate progression routes.

Costs?

For convenience classes will generally be organised into 6 week terms. The term will cost €50 when paid in advance, or €10 per class if paid weekly.

It is intended that participants are not excluded due to a genuine inability to pay; arrangements can be made and discussed privately.

Who is eligible?

Any individual who has one or more on of the following:

  • Fear of Falling
  • Feeling Unstable
  • History of Falls (injurious and non-injurious)
  • Low bone density and / or family history of osteoporotic fracture

Participants can be referred to the programme by their GP or they can self refer.

Where the participant self refers I will need to contact their GP for acknowledgement.

All participants whether GP referred or Self referred will need to attend for assessment.

The first class will begin as soon as there are sufficient participants (12) for a class. The maximum no. for a class is 15. Referrals after the programme begins will go on a list and will be invited to participate when a new programme begins or may be able to join an existing programme if a space becomes available and this is appropriate.

Exclusion Criteria:

People with the following health symptoms or conditions will not be accepted on the programme until such time as their GP or other medical adviser acknowledges that their condition permits safe participation.

Uncontrolled

  • Pain
  • Angina
  • Resting SBP>180mmHg or Resting DBP>100mmHg
  • Tachycardia>100bpm
  • Acute Systemic Illness (cancer, pneumonia)
  • Visual or Vestibular disturbances
  • Significant drop in BP during exercise
  • Unstable or Acute Heart Failure
  • Unable to maintain seated upright posture due to neurological deficits
  • Recent injurious fall without a medical examination
  • Impaired cognition (to the extent of being unable to follow simple movement instructions)
  • People who place themselves or others at risk.

 

GP Referral

If you are a GP and would like to refer your patient to the programme you can give them the leaflet about the programme and let them know that you are referring them to this programme. It will be their responsibility to make contact and arrange assessment (unless other arrangements have been made with the GP practice). It can help to focus on the positive benefits of the programme that will improve balance, mobility, improve health strength, confidence and enjoyment rather than a focus on falling risks, fear of falling or age, as many older adults, even those who have fallen recently consider advice about falls prevention as not relevant to themselves.

Self Referral

If you or a friend or family member would like to attend the classes, you simple need to contact me:

Fionnuala Corcoran, Kilcock Therapy 087 2848409

An initial phone conservation will establish initial eligibility and we will then arrange for you to attend for your full assessment.

Assessment

Prior to inclusion on the programme each participant needs to see me for assessment. This includes Health History (including acknowledgment from GP), Functional Assessment using validated measurement tools and includes Timed Up and Go, Functional Reach, 180 degree turn, Internal and External Shoulder Rotation, Hamstring Flexibility, Confidence in Maintaining Balance, and others as appropriate. Each participant will receive details of their assessment scores showing how they compare to others in their age group in the general population. These scores will act as a base line and will be re-measured throughout the programme allowing participants and provider to monitor progress.

This assessment takes approx. 1 hour and can be scheduled by contacting me :

Fionnuala Corcoran.   Kilcock Therapy 087 2848409

 

About your Instructor

Qualifications

Fionnuala Corcoran is a Physical Therapist .B.Sc and has recently completed further training for Postural Stability Instructor – Prevention of Falls (PSI).

PSI – This UK Level 4 (IE EQF Level 6) Specialist Postural Stability Instructor in the prevention of Falls qualification (PSI) is the first and only, evidence-based, accredited and endorsed L4 falls prevention qualification available in the UK. Its development, funded by the Department of Health, involved a National Advisory Group of experts. There are over 2000 qualified PSIs in the UK, working within the NHS Falls Prevention services and self employed. 54% of falls exercise services have a PSI qualified instructor working in the team.

The 6 day qualification, delivered by a multi-disciplinary team, teaches how to apply knowledge, through interactive workshops, of the practice of delivering, progressing and tailoring of the 7 evidenced based components of the Falls Management Exercise (FaME) published research intervention (dynamic endurance & balance, strength, approaches to get up from the floor, functional floor activities, flexibility and adapted Tai Chi).

 

The PSI Qualification is accredited by Queen Margaret University, endorsed by

the Chartered Society of Physiotherapy and recognised by the Register of Exercise

Professionals (REPs).

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Suitability for PSI Exercise Class – A Case Study

 

[1] www.ageuk.org.uk/professional-resources

[2] Department of Health, 2013

[3] Gannon et al, 2008

[4] Lord et al, 1992

[5] Cochrane Review, 2012. Interventions for preventing falls in older people living in the community.

[6] Sherrington et al. 2011 ‘Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations.’ New South Wales Public Health Bulletin

[7] Skelton, D., Dinan, S., Campbell, M., Rutherford, O., (2005). Tailored group exercise (Falls Management Exercise — FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age Ageing 34, 636–639. doi:10.1093/ageing/afi174