Falls in older adults can often be attributed to modifiable individual or environmental risk factors. In many cases, falls are caused by a combination of these risk factors. However falls amongst older adults in the community are preventable and reducing these risk factors can significantly reduce the likelihood of a fall occurring. The Falls Prevention Model of Care recommends that, where possible, a multifactorial approach to the prevention of falls should be adopted by older adults to reflect their complex and diverse range of risk factors.
The Stepping On program aims to address the major risk factors for falls and support older adults to improve their self-efficacy, explore different coping strategies, and encourages behavioural change to reduce their risk of slips, trips and falls.
Evaluation of the Stepping On program has reported a 31% reduction in participant falls1. Participant’s efficacy beliefs in coping with challenging functional tasks in the home and community also significantly improved. Moving about safely within the local community to, for example post a letter or do the grocery shopping, is of high importance to many older adults. These results demonstrate that older adult’s confidence to participate in activities of daily living has increased and their risk of falls when doing so has decreased. These findings add to the growing support of the effectiveness of multifactorial programs for preventing falls in the community setting.
Stepping On is delivered by trained health and community care professionals to groups of older adults living in the community. The program is often facilitated by a single occupational therapist or physiotherapist, whilst individual content areas are delivered by other health professionals over the course of the program. Specific areas of content include addressed during the program are:
- Lower-limb balance and strength exercises,
- Coping with visual loss and regular visual screening,
- Medication management,
- Environmental and behavioural home safety, and
- Safety in the community.
The Stepping On program has been developed using adult learning principles to increase the knowledge and skills of participants in relation to falls prevention, recognising that older adults have the capacity for learning and change. Specific techniques such as story-telling and mastery experiences within the group context, as well as the use of decision-making theories are used. These guide participants in exploring and overcoming barriers to behavioural changes required to reduce falls risk factors. Each two-hour session also provides time to reflect on learning, sharing accomplishments and ends in planning actions or homework to complete during the week.
A key component of the Stepping On program is the teaching and continued practice of evidence-based strength and balance exercises. A physiotherapist or exercise physiologist is best equipped to teach participants to perform and advance the exercises during three of the seven sessions. A pharmacist, low vision expert and community safety expert will also deliver one session each.
At the completion of the seven week program, each participant also receives an in-home assessment by an occupational therapist. The occupational therapist can help to reinforce the importance of taking action to prevent falls and make practical suggestions to assist the client to make modify their behaviour or environment.
For more information about the Stepping On Program visit: http://www.steppingon.com/.
- Clemson L, Cumming R, Kendig H, Swann M, Heard R, and Taylor K. The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial. Journal of American Geriatric Society 52: 1487-1494, 2004.