This study evaluated a falls prevention program ("The Stay Standing Program") delivered by community care workers to older home care clients. The program consisted of twice weekly exercise and education sessions over 8 weeks. Care workers were trained to deliver the sessions and measure clients' falls risk indicators before and after. The results showed that after the program, clients demonstrated statistically significant improvements in tests of lower body strength, balance, walking speed, and falls self-efficacy. The study concludes that the program is effective at improving functional independence and that care workers can successfully deliver falls prevention with proper training.

1. BACKGROUND
Older
people
prefer
to
remain
in
their
own
home
as
they
age.
In
2012-­‐13,
more
than
82,000
older
people
needed
community-­‐based
support
to
remain
living
in
their
own
homes.
Older
Home
Care
recipients
are
amongst
the
highest
risk
populaDon
for
falling.
Around
30%
of
community
dwelling
people
aged
65+
fall
at
least
once
per
year,
resulDng
in
restricDon
of
acDvity,
fear
of
falling,
reduced
quality
of
life,
loss
of
independence
and
social
capital.
The
availability
of
a
skilled
workforce
to
deliver
person-­‐centred
falls
prevenDon
to
maximise
funcDonal
independence
in
older
people
is
a
key
challenge.
Research
shows
that
pre-­‐packaged,
populaDon
level
falls
prevenDon
is
effecDvely
(and
cost-­‐effecDvely)
delivered
by
trained,
supported
non-­‐exercise
personnel
(Robertson
et
al,
2001).
STUDY
AIM
To
evaluate
whether
a
pre-­‐packaged,
best-­‐pracDce
populaDon
level
falls
prevenDon
program
(“The
Stay
Standing
Program”)
delivered
by
community
Care
Workers
improves
falls
risk
indicators
in
Home
Care
supported
older
adults.
METHODS
• Care
Workers
trained
to
deliver
The
Stay
Standing
Program
via
online
modules
and
a
pracDcal
workshop.
All
program
resources
were
pre-­‐packaged
and
provided
to
Care
Workers
in
USB
format;
• Groups
of
up
to
10
Home
Care
clients
(service
levels
1
to
2)
aZended
the
program
in
community
venues
for
8
x
2
hour
weekly
sessions;
• Group
parDcipant
falls
risk
indicators
were
measured
by
trained
Care
Workers
in
the
1st
and
8th
program
sessions
using
the
30
second
Chair
Stand,
Timed
Up
and
Go
and
Near
Tandem
Stand
tests,
and
the
Short
Form
Falls
Efficacy
Scale-­‐InternaDonal.
Pre-­‐
and
post-­‐program
outcomes
were
evaluated
using
Student’s
t
test
and
linear
regression
staDsDcal
analysis;
• An
Exercise
Professional
instructed
parDcipants
in
6
“Otago
Exercise
Programme”
lower
limb
funcDonal
strength
and
balance
exercises;
• ParDcipants
developed
personalised
SMART
goals
to
reinforce
the
link
between
exercise
pracDce
and
funcDonal
independence.
They
were
also
given
a
home
exercise
manual
and
logbook;
• Care
Workers
briefly
supervised
exercise
technique
(5
minutes)
at
subsequent
program
sessions.
4.Impact
of
Stay
Standing
Program
on
SF-­‐FES-­‐I
p<0.01
(Student’s
paired
t)
3.Impact
of
Stay
Standing
Program
on
Near
Tandem
Stand
Test
(adj
for
mobility)
p=0.002
(linear
regression)
2.
Impact
of
Stay
Standing
Program
on
Timed
Up
and
Go
Test
(adj
for
mobility)
p<0.05
(linear
regression)
1.
Impact
of
Stay
Standing
Program
on
30
Second
Chair
Stand
Test
p<0.001
(Student’s
paired
t)
PopulaRon
CharacterisRcs
Total
Age
(mean
±
SD)
82
±
6
years
Community
dwelling
(supported
with
Home
Care
packages
levels
1-­‐2):
53
• AmbulaRon
-­‐
independent
48
• AmbulaRon
-­‐
walking
sRck
3
• AmbulaRon
–
4
wheeled
walker
2
Bridging
the
Gap
to
Build
Falls
Risk
ReducRon
Capacity
in
Community
Care
Monique
M.
King
Stay
Standing
Pty
Ltd,
Sydney,
NSW,
Australia.
Copyright
2015
Stay
Standing
Pty
Ltd
ACN
152
542
366
30 Second Chair Stand - Baseline 30 Second Chair Stand – 8 weeks
Mean 7.61 8.98
Std. Deviation 3.04 2.88
Std. Error of Mean 0.4257 0.4034
Timed
Up
and
Go
-­‐
Baseline
Timed
Up
and
Go
–
8
weeks
Mean
14.302
13.528
Std.
DeviaRon
5.976
10.738
Std.
Error
of
Mean
0.82
1.39
Near
Tandem
Stand
-­‐
Baseline
Near
Tandem
Stand
–
8
weeks
Mean
14.302
13.528
Std.
DeviaRon
5.976
10.738
Std.
Error
of
Mean
0.82
1.39
SF-­‐FES(I)
-­‐
Baseline
SF-­‐FES(I)
–
8
weeks
Mean
12.6
10.7
Std.
DeviaRon
4.36
3.11
Std.
Error
of
Mean
0.599
0.427
CONCLUSIONS
• The
Stay
Standing
Program
significantly
improves
indicators
for
funcDonal
independence
in
community
supported
older
adults
receiving
level
1
and
2
Home
Care
packages;
• The
Stay
Standing
Program
Facilitator
training
and
program
delivery
model
is
effecDve
in
building
falls
prevenDon
and
group
facilitaDon
capacity
in
community
Care
Workers;
• With
7
weeks
of
home
exercise
pracDce,
independently
mobile
older
people
demonstrate
greater
improvements
in
balance
indicators
than
those
reliant
upon
a
walking
aid
for
indoor
mobility;
• FuncDonal
walking
speed
appears
unaffected
by
the
program.
DISCUSSION
The
Stay
Standing
Program
is
a
best-­‐pracDce,
quality
accredited
falls
prevenDon
program
targeDng
a
high
falls
risk
community
dwelling
group.
The
online
and
live
workshop
“Train
the
Trainer”
model
allows
for
flexibility,
strong
reach
and
equity.
Program
delivery
by
trained,
supported
Care
Workers
is
a
pracDcal,
resource-­‐
and
cost-­‐
effecDve,
Primary
partnership
approach
to
enhance
self-­‐management
of
falls
risk
and
independence
in
older
community
dwelling
adults.
Further
invesDgaDon
of
Primary
Care
falls
prevenDon
program
partnerships
with
Home
and
Community
Care
organisaDons
to
strengthen
a
PaDent-­‐Centred
Primary
Care
model
is
warranted.
REFERENCE
Robertson
MC,
Gardner
MM,
Devlin
N,
McGee
R
and
Campbell
AJ
(2001)
EffecDveness
and
economic
evaluaDon
of
a
nurse
delivered
home
exercise
programme
to
prevent
falls.
2:
Controlled
trial
in
mulDple
centres.
BMJ
2001;322:701
RESULTS
The
30
Second
Chair
Stand
and
Falls
Efficacy
Scale
demonstrated
staDsDcally
significant
(p<0.05)
improvements
under
Students
paired
t
test,
however
the
Near
Tandem
Stand
(p=0.0574)
and
Timed
Up
and
Go
(p=0.3717)
test
results
did
not.
Under
a
linear
regression
model
adjusDng
for
mobility
(taking
into
account
5
people
dependent
upon
walking
aids
for
indoor
mobility)
all
tests
demonstrated
staDsDcally
significant
results
including
the
Near
Tandem
Stand
(p=0.002)
and
the
Timed
Up
and
Go
(p<0.05)
tests.
Stay
Standing
Program
ParRcipant
Demographic