1. 1 Falls prevention for frail seniors: Falls Intervention Team (FIT) project Baycrest Toronto Public Health York Region Health Services Department Financial support: Population and Public Health Branch – Ontario Region, Health Canada

2. 2 The intervention consisted of 6 in-home visits: VisitHealth professional(s) Activities V1PHN and PTComprehensive assessment, Identification of modifiable risk factors, Instruction- Home Support Exercise Program (HSEP) V2PTMonitor and follow-up on recommendations from V1 Complete instructions to all 10 exercises on HSEP Reinforce calendar completion and monthly return. V3PHNReassessment for changes in modifiable risk factors Reinforce calendar completion and monthly return V4PHNReinforce recommendations and calendar review V5PHN telephone visitTelephone reinforcement of above V6PHNReview recommendations and discharge PHN = Public Health NursePT = physiotherapist

3. 3 T1Before the start of the program Collect baseline dataPre measurement T23 month post T1At the conclusion of the intervention period Post measurement T39 month post T16 month after completion of the intervention 6 month follow-up Measurement Times Performed by designated assessors Public Health Nurses

4. 4 RESULTS Range65-99 Mean84 91% are > 75 Gender Female86.4% Male13.6% Age Number of participants (6 month intake period) : Self referral133 T181 T267 T361

5. 5 Change in mean number of modifiable risk factors from V1 to V6 NumberV1V6Differencep value 677.516.43-1.08<.0001 Baseline frailty score & mean number of falls per person (previous 90 days) Frailty score# of clients % of total clients Mean Falls 02328.00.0 11417.11.0 22125.61.0 32429.32.0 Frailty score (developed for institutionalized seniors) (Hirdes 2003) 0 = low; 1&2 = mild; 3&4 = severe; 5 = death

6. 6 Change in Outcomes Measures over time* Measure (n) Baseline T1 Discharge T2 Follow-up T3 P value BBS (66)36.5342.12--<.05 BBS (57)--43.4640.37<.05 BBS (58)37.47--40.38<.05 ABC (66)42.9551.33--<.05 ABC (58)--52.5947.90<.05 ABC (59)41.93--47.59<.05 TUG (65)26.6023.83--<.05 TUG (56)--21.2326.55<.05 TUG (58)26.09--26.33>.05 *All data was paired for analysis at each time period RNLI (66)9.064.58--<.0001 RNLI (66)--4.85.49.048 RNLI (66)9.87--5.52.0001

7. 7 Exercise Adherence TimeNumber of clients % of adherence to exercise V1 to T26794.03% From V1 to T3 6573.85% T2 to T36558.46% Mean change in the number of falls per participant per month At Baseline, average number of falls per client per month =.38 Time Number of clients Change in values P value Baseline to T266-.27<.0001 T2 to T358-.06<.05 Baseline to T358-.35<.0001

8. 8 Of the 81 who started the in-home intervention program 82.7% were able to complete the 3 month program 75.35% were able to complete the 9 month follow-up visit Changes in measurements over time:  Falls: significant ↓ in the average number of falls significance level dropped between T2 and T3 when there was no active follow-up significant ↓ in average numbers of falls between baseline and 9 month post (T3)  Outcome measures: changes in outcome measures were mostly significant. consistent slight loss in gain when re-assessed at the 6 month follow-up (T3)  Number of modifiable fall risk factors: significant ↓ at program completion

9. 9 This 12 week self referral program delivered in the client’s home resulted in: decreased number of modifiable falls risk factors, increased social participation, improved balance and balance confidence, reduced number of falls.

10. FIT COMMUNITY BASED SUSTAINABILITY FRAMEWORK FIT CORE PARTNERSHIP York Region CCC* Toronto CCC* * CCC consists of approximately 30 community agencies FIT CORE PARTNERSHIP Baycrest Toronto Public Health (TPH) York Region Health Services (YRHS) Future Partnerships Arthritis Society Osteoporosis Society RGP YMCA project Markham Stouffville Hospital YRHS YR CCAC (Markham) Markham YMCA McConaghy Centre YRHS Rouge Valley Health System Centenary site - post ED visit TPH Supportive Housing Projects TPH CANES Rehab Express FIT Graduate Program Baycrest TPH YRHS St. Joseph Hospital 1)TPH and WTSS 2)TPH and Parks and Recreation St. Michael’s Hospital TPH COTA November 2006 Draft #4