Falls prevention remains a key focus for researchers, but are changing funding policies impeding the right information reaching older people at risk of falling in their homes?
As a person ages, the likelihood of them falling increases. A person over 65 years old has a one in three chance of falling in a year, a risk that increases to a one in two chance for those aged 80 and over. As balance wanes, muscles weaken, vision becomes more impaired, and medical conditions take their grip, older people can find themselves at risk of falling even within the most familiar environments.
Falls can be devastating for older people. Beyond the possibility of cuts, bruises, and broken bones, there is the blow to their confidence that really takes its toll on their ability to live independently. Research shows that the knock-on effect of a fall is significant: if a person falls and loses confidence, they are likely to exercise less, thereby reducing their muscle condition and increasing their risk of another fall.
Beyond the physical and social aspects, there are the economic costs to consider. Falls often result in an older person needing to move into hospital or rest home-level care, placing further burden on a health budget already under strain.
New Zealand has long been heralded as a world leader in falls prevention. Drawing on a vast body of research, the Otago Exercise Programme (OEP) is recognised internationally as an effective method for helping to reduce the number of falls in older people. For those eligible – typically those over 80 (or over 65 for Māori and Pacific) living independently who are deemed to be at risk of falling – the programme involves a provider visiting the person six times during a year to assess health, strength, and balance and to teach and monitor a series of exercises.
All evidence suggests that the OEP is an excellent initiative. A growing bank of participants’ success stories helps to back up the claim that the programme is proven to reduce falls and fall-related injuries by 40 per cent. Eighty-seven year old Rowley features among these case studies, proudly announcing his recent avoidance of a fall when he tripped and was able to quickly regain balance, something he attributes to the OEP.
However, despite its acclaim, the programme no longer receives public funding. ACC formerly funded the provision of the OEP to eligible seniors but withdrew its funding for the programme nearly two years ago.
Nick Conn, director of Willis Street Physiotherapy in Wellington, says that prior to ACC’s funding withdrawal, his team delivered the OEP to 620 individuals per year in the Wellington and lower North Island area. Now this figure is reduced to a mere one or two privately funded patients per year.
“The OEP is now delivered only in small pockets and poorly funded,” says Conn. “The only area that I am aware of which has a larger programme running is Canterbury, where the DHB fund it.”
The only loophole that might see an older person receive partial cover from ACC for the OEP is if they have a fall, lodge a claim with ACC, and find an OEP provider who can claim a partial payment from ACC for each session. It would appear the attitude towards falls is becoming increasingly more about reaction than prevention.
The OEP is not the only programme to fall victim to a lack of funding. More recently, ACC also withdrew its funding for modified Tai Chi, another programme proven to improve strength and balance and decrease falls. The ACC funding had enabled organisations to train approximately 1000 modified Tai Chi leaders, but funding was withdrawn on the grounds of not being cost-effective.
It would be easy enough to jump aboard the ‘let’s berate ACC’ bandwagon at this point, but it is fair to say the organisation has continued to show its support for initiatives like modified Tai Chi and the OEP. Its website is brimming with information on such programmes and on keeping older people safe at home. Yet with its funding pared right back, it is hard to believe that falls prevention is given the same importance it was several years ago. According to its website, ‘in the short term, ACC is focussing on delivering low-cost evidence-based fall prevention programmes such as the Vitamin D programme’.
As a result of ACC’s retraction of funding in this area, the onus has fallen increasingly on district health boards (DHBs) to fund such programmes. Of the additional funding received from the Government for hospital and community services in recent years, most DHBs have, in turn, offered small increases to providers of community services, which help ensure older people are safe in their home.
However, the changes have left the general public and even health professionals confused about the options open to them, begging the question of whether falls prevention for older people in the community is still being given the attention it warrants.
Yet despite some ambiguity around funding, the emphasis on falls prevention remains strong and is a key focus of the New Zealand Injury Prevention Strategy 2005-2015, with DHBs, national agencies, and community organisations all involved in providing awareness campaigns and programmes around falls prevention.
The Canterbury Clinical Network is a notable example, leading the way with its community-based falls prevention programme, which is specifically funded to reduce the number of elderly sustaining falls-related injuries. The programme is executed by ‘falls champions’ – typically physiotherapists or registered nurses dedicated to primary care in geographical clusters to provide falls prevention services to elderly clients in their homes. The falls champions support community service providers and retirement villages in falls prevention strategies, such as the Modified Otago Exercise Programme (MOEP). They also mentor volunteers to deliver ‘Stay On Your Feet’, a programme based on the MOEP but aimed at a slightly younger, more active population.
Waikato DHB has also gained recognition for ‘Upright’, its falls minimisation programme. Although primarily aimed at hospital patients, plans are under way for rolling out the falls prevention programme to the community, with Rural and Community Services staff completing the Upright online education programme.
Age Concern has been instrumental in promoting awareness of falls intervention throughout the country with programmes like ‘Step ahead’, ‘Steady as you go’, and ‘Sit and be fit’, all aimed at maintaining and improving strength, balance, and mobility.
Conn says community-based exercise programmes are good for those fit and active enough to participate, but for a house-bound older person, their options are likely be fewer.
“They may be able to access community physiotherapy through a GP referral,” he says.
New Zealand researchers continue to churn out leading research in the field of falls prevention. It seems the concern is not the level of importance placed on falls prevention for independent older people, rather the level of funding for programmes in this area. While commitment to falls prevention programmes appears to remain strong, the challenge will be to retain emphasis in preventing, rather than reacting to, falls.
Interventions to prevent falls:
- strength or balance training
- medications review
- vitamin D supplements
- vision assessment
- home hazard assessment
- taking into account individual risk factors.