York Region Falls Prevention

Falls Prevention & Policy Network Symposium 2007

Program Synopses

York Region Health Services

Falls PreventionProgram Synopsis

The York Region Falls Prevention Program incorporates Ottawa Charter principles through a logic model framework to facilitate comprehensive program planning, implementation and evaluation. In order to ensure accountability, quality and effectiveness, a Balanced Scorecard approach is also used to measure performance in four quadrants; health determinants and status; community engagement; resources and services; and integration and responsiveness.

The York Region Falls Prevention focus:

1. Actively partners with other community services and agencies to work towards falls prevention.
2. Raises community awareness through education by providing workshops, displays, media campaigns, and media releases.
3. Monitors falls morbidity and mortality rates through community assessments, provincial and federal health status reports, and through falls prevention clinics and screening tools.
4. Provides telephone counselling and personal consultation upon request.
5. Provides resources upon request (fact sheets, newsletter inserts etc.) for health professionals and seniors (English, Chinese, and Italian).
6. Conducts personal falls risk assessment through:
7. falls prevention clinics for seniors in apartment buildings and community settings
8. FIT (Falls Intervention Team) Project - an in-home falls risk assessment and counselling program for seniors living in Markham to help them reduce their risk for falling. Upon completing this program, seniors will graduate from their homes to a safe community setting, the Markham YMCA, to participate in a gentle exercise program with the goal of increasing physical activity and providing social opportunities. This program, the Active for Life Program, is a partnership between York Region Health Services, MarkhamStouffvilleHospital and the Markham YMCA.

Haliburton, Kawartha, PineRidgeDistrictHealthUnitFalls Prevention 2007

CurrentFalls Prevention Initiatives:

Research:

We are currently in the process of creating a strong evidence base (both community specific and general) for future falls prevention programming. In addition to literature

Falls Prevention & Policy Network Symposium 2007

Program Synopses

reviews, we will be planning community forums, focus groups and needs assessments to assess community specific falls prevention needs. Topics for research will include policy development in relation to falls prevention, health professionals education in relation to falls prevention, falls prevention through the lifespan, the built community in relation to falls prevention and general, local falls prevention needs.

Incentive Item:

We are creating note pads with Senior Health messaging (targeting falls prevention risk factors without using the term falls prevention), with the theme “Recipe for Good Health. The risk factors that were targeted include: physical activity, regular health check ups (medical, hearing and vision), nutrition, home safety, slowing down/paying attention.

New displays:

We are creating displays with the same theme as our incentive items – A recipe for Good Health. We will have separate panels for : Winter safety, SMART MOVES, Assistive devices, Foot wear, Medications, Home safety

Seniors Health and Safety Fairs:

In each county we are participating in and planning several seniors’ health and safety fairs. See “Coalitions” section below for more information about seniors health fairs we are planning.

Ontario Seniors Secretariat Presentations:

We have all registered as presenters and have had 3 presentations done in City of Kawartha Lakes

Presentations/consultations/resource distribution:

On a daily basis we do consultations to the public and other health professionals, respond to requests for presentations/workshops/displays and participation in health and safety fairs, and requests for resource distribution.

Coalitions:

NorthumberlandCounty

HKPR falls prevention staff in NorthumberlandCounty work with other community partners as part of the Northumberland Fall Prevention Coalition (NFPC). In 2007, the NFPC is working on their No-Falls Fashion Show project with funding from the New Horizons for Seniors program. Several No-Falls Fashion Shows will be held in different communities throughout the County this Spring (June) and Fall. The events will showcase home safety products, equipment, funding sources for home safety projects, local programs and services that all contribute to keeping our seniors healthy and

Falls Prevention & Policy Network Symposium 2007

Program Synopses

independent. The events are designed to be fun, social opportunities that will serve to link local residents and caregivers to the products, services and programs they could be accessing.

City of Kawartha Lakes

The Kawartha Lakes Falls Prevention Coalition has applied for and received funding from the Older Adults Association of Ontario to implement a Seniors Health and Safety fair. We will be expanding on our annual seniors’ health and safety fair, which showcased local organizations and businesses who target seniors in relation to health and or safety, by providing transportation, lunch and a wide variety of presentations and workshops.

HaliburtonCounty

HKPR falls prevention staff are a part of the Haliburton County Joint Accessibility Advisory Committee. The committee is working at educating the public on accessibility issues – mainly through the Barrier-Aware Working Group. This local initiative will be implemented in 2007 to recognize and award local businesses and organizations for being Barrier-Free.

SIMCOE MUSKOKA DISTRICT HEALTH UNIT

• We currently do not have any Falls Prevention initiatives going other than the development of a Falls Prevention Coalition in Barrie, Ontario.

• We provide presentations and displays in our communities and respond to requests from the community.

• We really like the Ontario Seniors Secretariat [OSS] Falls Prevention Seminar and Sages program that was included.

• We envision promoting older adults to facilitate the Sages Program independently or through the coalition.

Breaking Down Barriers: Integrated Falls Prevention for Frail Older Home Care Clients

A collaborative research project between the Halton Region Health Department, McMasterUniversity, Community Rehab, the Hamilton Niagara Haldimand Brant and the Mississauga Halton Community Care Access Centre (CCAC)

Falls Prevention & Policy Network Symposium 2007

Program Synopses

Since 2001, public health nurses have been helping Halton seniors identify and address the most common threat to their independence and wellbeing: falls.

This year, the Health Department has joined McMasterUniversity, Community Rehab, the Hamilton Niagara Haldimand Brant and the Mississauga Halton CCAC in a study to evaluate the effects and costs of an integrated and interdisciplinary team approach to falls prevention for frail older adults receiving home care services. The study is funded by the Canadian Patient Safety Institute.

The team includes a CCAC case manager, a public health nurse, an occupational therapist, a physiotherapist, a dietician and a pharmacist who together will provide a proactive, coordinated, multifactorial and evidence-based approach to falls prevention.

This is the first randomized controlled trial of its kind in Canada.

Lessons learned from the study will forge a process for building partnerships among individuals, service providers and organizations to enhance the quality of life for frail older home care clients, while generating cost savings by decreasing the use of acute hospitalization through the prevention of falls.

For more information on the Falls Prevention Research Collaborative, please contact

Dr. Maureen Markle-Reid, School of Nursing, McMasterUniversity at 905-525-9140, ext. 22306 or .

Ontario Injury Prevention Resource Centre

The Ontario Injury Prevention Resource Centre (OIRPC) provides the following services across Ontario:

• Consultations to support the needs of community injury prevention projects.
• Networking supports and referrals to facilitate connecting those involved with injury prevention.
• Learning and training opportunities for skill development in injury prevention.
• Resources, information, research and evaluation on key injury prevention topics, population groups and a Catalogue of Best Practices.

Examples of specific activities related to falls prevention include:

Report-- Injuries among Seniors in Ontario: A Descriptive Analysis of Emergency Department and Hospitalization Data

This report presents patterns of emergency visits and hospitalizations for a variety of factors, such as age, sex, month of admission, cause of injury, and discharge status. In addition, injury patterns are broken down by region and Local Health Integration Network.

Catalogue of Best Practices

The Catalogue of Best Practices is a listing of interventions that have been deemed to be best practices, by researchers or organizations that have conducted systematic reviews of the relevant literature. The OIPRC has selected these based upon their adherence to a set of screening criteria developed by the Advisory Committee.

The initial catalogue features a comprehensive set of practices identified and reviewed by Ontario researchers with funding from the Ontario Neurotrauma Foundation (ONF). OIPRC has partnered with the ONF to abstract and web-enable 36 best practices from their initial four compendium volumes of best practices in neurotrauma prevention. One specific area of prevention in the catalogue is fall related injuries.

Ontario Injury Compass

The Ontario Injury Compass provides an analysis of injury issues in Ontario. Each report focuses on a single injury issue, providing Ontario hospitalization and emergency department data broken down by age, sex and region, along with prevention tips and a list of additional resources. Issues are produced monthly in PDF format and distributed electronically and also posted on the OIPRC website.

Recent issues related to falls include:

March 2007: Wheelchair and Walker Injuries

September 2006: Falls Among Seniors

June 2006: Stair-RelatedFalls

Contact information

Contact us to request a consultation or for information to help you address the issue of injury prevention in your community:

Ontario Injury Prevention Resource Centre

790 Bay Street, Suite 401

Toronto, OntarioM5G 1N8

Phone: (416) 977-7350

Toll Free: 1-888-537-7777

E-mail:

For more information visit

Canadian Health Network

The Canadian Health Network (CHN) offers Canadians bilingual information they can trust on Healthy Living, Disease and Injury Prevention. Through the Injury Prevention

Falls Prevention & Policy Network Symposium 2007

Program Synopses

affiliate organization, SMARTRISK, CHN builds and maintains a collection of information resources on a wide range of topics and facts related to unintentional injury, as well as resources on several ways to reduce the risks of injury.

From among the topics in the collection, CHN strives to offer high-quality resources about research and education on healthy aging and prevention of seniors falls. There are over 60 resources and FAQs specifically oriented toward understanding the causes of seniors falls and the evidence-based steps to help avoid them. The resources on CHN also offer tools for self-assessment, for home modifications that help reduce risks of falls and for maintaining appropriate levels of physical activity that contribute to build strength and improve balance throughout the aging process. Attention to proper use of medication is also indicated. CHN provides links to other resources and organizations of interest as well as information for community services.

The resources on CHN undergo a strict quality assurance process. SMARTRISK leads an advisory committee that reviews and recommends additions to the collection.

CHN is brought to you by the Public Health Agency of Canada and major health organizations across the country.

Please find below a sample of the information resources regarding seniors falls on CHN:

Toronto Public Health

Falls Intervention Team (FIT) Community-Based Sustainability Program (CBSP)

The FIT CBSP programs are built on the original FIT program and protocol. The FIT CBSP will build, drive, and lead the sustainability agenda required to support FIT’s goal to become a leader in programs that enhance, support and provide resources for community-dwelling seniors. The mission of the FIT CBSP is to assist in reducing

Falls Prevention & Policy Network Symposium 2007

Program Synopses

hospitalization rates, support new initiatives for sustainable falls prevention programming, supporting service integration and collaboration with community partners through efficient and cost effective programs for seniors.

GEM-FIT I Demonstration Project

Summary

The GEMFIT I Demonstration Project is a comprehensive interdisciplinary falls intervention and prevention project that aims to reduce the incidence and consequences of falls in seniors who present to St. Michael’s Hospital (SMH) Emergency Department. The objectives are to decrease the number and or degree of participants’ modifiable risk factors for falling, and the number of falls; to adhere to the Home Support Exercise Program (HSEP) at least 3 times weekly (one or more of the prescribed exercises performed at least 3 times weekly); and to demonstrate selfreports of increased scores in social participation (daily functioning domains and perceptions of self). This model includes the original FIT Phase I protocol which consisted of standardized client assessment home visits by a public health nurse (including a joint home visit with a communitybased physiotherapist) before a series of six scheduled intervention home

Falls Prevention & Policy Network Symposium 2007

Program Synopses

visits by a PHN over a period of 10 to 12 weeks. Follow-up assessment home visits were done upon completion of the intervention and again, six-months post completion. The GEM-FIT I project will be an evaluation of an alternative service delivery pathway which involves SMH Emergency Department staff and communitybased occupational therapists. A prepost design will be used to measure changes in functional ability (balance, strength, and flexibility) and quantitative statistics will examine the number and changes in modifiable risk factors, adherence to the HSEP, and selfreports in daily functioning domains and perceptions of self. It is hoped that this alternative pathway will be integrated with normal services of communitybased service providers in the future. The partners are St. Michaels’ Hospital, Toronto Public Health, Toronto-Central CCAC and COTA Health.

RougeValley Health System Centenary (RVC)

GEM-FIT Pilot Project

Summary

GEM-FIT II (Rouge Valley Health Services) Pilot Project is built on the success of the original Fall Intervention Team (FIT) – Comprehensive, multi-factorial, multi-disciplinary, cross-sectoral, and individualized model. The project goal is to reduce the prevalence and complications of falls for at risk seniors, 75 years and older, who have been discharged home from the Rouge Valley Health System Centenary (RVC) Emergency Department. The project objectives are: to establish a Hospital - Community partnership and collaboration with Toronto Public Health (TPH), Rouge Valley Centenary (RVC), and community support agencies i.e. Central East – Community Care Access Centre (CE-CCAC); to create an innovative and evidence-based multi-disciplinary team approach falls prevention model to increase service to seniors and foster a seamless system of care; and to enhance Emergency Department (ED) discharge planning by integrating the identification of clients at high risk of falling with a community-based, best-practice falls intervention and prevention model.

The project operational committee members are Central East Community Care Access Centre – Scarborough Branch, Manager Client Services Central East Community Care Access Centre – Scarborough Branch, Manager of Rehab Services. RVHS, Centenary Site: Geriatric Emergency Department (ED) Management Nurse, ED Clinical Practice Leader, ED Physiotherapist, ED Registered Nurse, Manager of Emergency Department.

St. Joseph’s Health Centre (SJHC)-Mary McCormick (Mary Mc) FIT

Pilot Program

Summary

The SJHC-Mary Mc FIT Pilot Program is an innovative, modified FIT falls prevention model designed to reduce falls incidence in frail community-dwelling seniors aged 75

Falls Prevention & Policy Network Symposium 2007

Program Synopses

years and older who are isolated and unable to attend community recreation programs twice per week. They may be referred from their general practitioner, or have been recently discharged from St. Joseph’s Health Centre Emergency Department with a referral to the Elderly Community Services. This model is designed to increase capacity, client services and program sustainability through the integration and partnerships of community stakeholders. The objectives are (a) to increase access to a best-practice falls prevention service delivery from acute care to community care, (b) to implement the FIT alternative service model as per partnership agreement and (c) to improve cross-sectoral collaboration between acute and community health care for the provision of a coordinated health care service which reduces direct and indirect costs. An assessment will be done by a physiotherapist to distinguish if the referred senior is a candidate for the FIT program (a series of five home visits by a PHN who will be responsible to implement the recommended intervention) or if he/she is more suitable for a program at the Mary McCormick Recreation Centre. Seniors, who complete the FIT program, will again be assessed by the physiotherapist to see if they then will be a candidate for the program at Mary McCormick Recreation Centre. The outcome of the SJHC –Mary Mc FIT Pilot Program is the integration of frail, isolated seniors back into the community with specified programs to foster a sense of belonging by providing an intergenerational link between age cohorts. The partners are St. Joseph’s Health Centre, Toronto Public Health and Mary McCormick Recreation Centre City of Toronto.

LIFE-KEN-FIT

Summary

The LIFE-KEN-FIT pilot project aims at reducing the incidence and consequences of falls in adults over 59 who live in a Toronto Homes for the Aged supportive housing building (111 Kendleton Dr) and TCHC buildings (101 and 121 Kendleton Dr). The purpose is to evaluate the effectiveness of the original FIT protocol and an alternative FIT service delivery pathway. Participants will be randomly assigned to either Group 1 or Group 2. Group one participants will have 5 home visits (HVs) by a public health nurse (including one joint HV by a physiotherapist & PHN) plus a telephone call. The participants will be encouraged to do the home support exercises (HSEP) in their homes. Group two participants will have 3 HVs (including a joint HV by a physiotherapist & PHN) plus a telephone call. The participants will be encouraged to attend group HSEP conducted at 111 Kendleton lounge. The evaluation will be a pre-post intervention design. It is anticipated that there will be no significant differences between the two groups. Since group two is less intensive with existing community resources, this LIFE-KEN-FIT pathway will substantially contribute to the FIT sustainability framework. The partners of the project are Toronto Public Health, CANES Home Support Services and Closing the Gap Health Care Group.