1. Improving Falls Clinic client engagement in falls prevention activities Kirsten Black 1, Dr Keith Hill 1, Dr Michael Dorevitch 2, Dr Neil Crompton 3, Kathryn Bieser 3 1 National Ageing Research Institute, 2 Bundoora Extended Care Centre, 3 Barwon Health

2. Background Previous research (MDS project, NARI, 2004) indicated varying levels of compliance across client groups and types of interventions Overall 17% of interventions were not undertaken and a further 19% partially undertaken 38% of clients not returning for follow-up assessments Lack of documentation regarding why interventions were not undertaken

3. Funding Safety Innovations In Practice Program (MK III), Australian Safety and Quality Council. This project aims to identify strategies to improve engaging Falls Clinic clients in activities identified as likely to minimise future risk of falling. Project aim

4. Clinics involved: Royal Melbourne Hospital; Royal Park Campus (Previously MECRS) Bundoora Extended Care Centre Barwon Health With input from: Consumer Health Forum of Australia Advisory group including clients who had been to a Falls Clinic

5. Methodology Surveys to clients and carers on waiting lists Surveys to clients and carers after an assessment Clinic staff to record reasons for not undertaking recommendations as discussed at follow-up assessments Telephone interviews with clients who missed follow-up assessments

6. Participants 25 clients on waiting lists returned surveys 46 clients completed a survey after initial, 6- 8 week or 6-month assessment 92 clients had compliance with recommendations recorded by Falls Clinic staff 8 clients who did not return for a scheduled review were interviewed (telephone) In total, feedback from 171 clients

7. Clients waiting for assessment (n=25) 63% female, mean age 77 (SD=8.9) Waiting time: median 6 weeks [IQ range 3 weeks-3 months] 12% other languages (Italian, Greek, Assyrian) 83% of referrals from GPs (also medical specialists, hospitals and allied health)

8. 83% reported that falls and falls risk could be reduced Most anticipated benefits from the clinic; eg: –Improved balance and strength; –Reduction in falls; –Finding the cause of falling/info about capabilities; –Increased confidence; –Get up independently after a fall; and –Taught to walk properly. However, 6 were unsure/didn’t think they would benefit & another didn’t expect longterm benefits Clients waiting for assessment (n=25)

9. Most identified strategies for reducing falls (walking properly, improving balance, environmental modifications, exercise, eyesight) All reported trying at least one strategy to reduce falls: –exercise (60%) –using a walking aid (56%) –getting assistance with activities (36%) –changing shoes (20%) 72% were currently undertaking exercise (walking)

10. Clients waiting for assessment (n=25) Exercise program clients would consider if tailored to their fitness level

11. Clients waiting for assessment (n=25) 4 respondents not prepared to exercise - ‘frightened’, ‘too old’, ‘wary about walking in the streets’ 72% preferred exercises at home rather than centre 56% preferred exercises on their own; 28% with people they knew & 24% with people they may not know 7 respondents would not consider using a gait aid (reduces independence/embarrassing) 2 would not consider hip protectors (didn’t think they needed them) & 2 didn’t know what they were

12. Clients after assessment (n=46) 63% female; median age 79 years [75-84] 94% preferred English (other languages- Italian, Latvian, Hungarian) Most clients planned/had undertaken most of the interventions recommended by Clinic and anticipated/already had perceived benefits Barriers to undertaking interventions were identified Clients satisfied with information provided by clinics and felt adequately involved in developing intervention plan.

13. Staff forms (n=92)

14. Barriers to undertaking interventions Clients and staff identified similar barriers: Service level: –system failures (appointments not made) –other health practitioners not supporting Clinic recommendations –appointment still being arranged/demand for services

15. Barriers to undertaking interventions Client level: –cost (home modifications) –waiting for family assistance (home modifications) –client unwell/aggravates existing condition –dementia –client considers intervention inappropriate for them –client doesn’t see the need/low motivation –not wanting therapy (CRC) –hip protectors wrong size

16. Telephone interviews Interviews with 8 clients who did not attend for a follow-up assessment found: –3 did not return due to to being unwell at the time of the appointment –1 reported that it was too difficult to get there –1 was feeling well and didn’t feel there was a need to go –1 didn’t think it would help –1 care had taken a different focus and was seeing other specialists regarding strength in legs –Most had undertaken interventions and were satisfied with the Falls Clinic approach, however, 5 clients did not perceive any benefits from attending the Clinic

17. Framework & Recommendations Provide additional written information to supplement verbal information Clarify relevance of interventions/consider pre- clinic survey Provide options for client/carer to select interventions where alternatives available Trial/ensure appropriateness of intervention/active role in prescription Support mechanism for potential low compliers

18. Framework & Recommendations Consider a case coordinator - follow through intervention plan Follow-up clients who do not return for review/offer alternative appointment if appropriate Follow-up services/practitioners where recommended actions not implemented Routine use of interpreters for clients requiring one (minimise using family members/carers for translating information).

19. Acknowledgements Barwon, BECC and Royal Melbourne (RPC) Falls Clinics Clients and staff who completed surveys and telephone interviews. Full report will be available on NARI and VFCC websites soon: www.nari.unimelb.edu.au (under public health research/falls prevention)