Example of Successful Falls Exercise Services – Cambridgeshire 2009

Cambridgeshire Falls Prevention Services (early 2009)
An article about the wider services delivered by the Cambridgeshire Falls Services and how exercise fits into their holistic approach visit.

Total population: 225,600
Population aged 65+: 35,900

In 2008, about 716 falls screens were completed by healthcare professionals in order to determine the individual’s risk factors for falling. This includes direct falls referrals and those identified through the Single Assessment Process.

As a result of screening, 566 older people were offered a health funded evidence based exercise programme and 463 accepted. Of these, 341 opted for a home based Otago exercise programme and 122 for a group Otago programme.

1965 people attended local authority run Otago/PSI classes in the community. This will include those using the classes as an exit route from therapy programmes (classes are not time limited) and those who see the classes advertised and attend having had no contact with health based services.

Health Costs 2008

Clinical Exercise Specialist: £25,500
(remit for training and supporting staff trained, linking with local authority)
Staff costs for classes (led by postural stability instructors): £4439
Staff costs for home exercise programmes (OEP leaders): £33,636
Equipment (ankle weights): £746

Cambridgeshire Falls Prevention Services has, to date, held five OEP courses training approximately 75 OEP leaders. These include 50% health care professionals (mainly therapists and therapy assistants) and the other 50% are exercise professionals who have previously attended the Chair Based Exercise Leader’s Course. Following the OEP training each exercise professional is currently running weekly, community-based OEP group sessions that cost each participant £2 per class (about $3 US and CAN). The sessions are subsidized by the City Council’s “Forever Active” program . The participants can keep coming to class for as long as they wish to (i.e. no discharge). In addition, there are future plans to set up more challenging sessions for participants to graduate to providing a seamless provision of exercise opportunity that all services strive to achieve.

The majority of health care professionals use the OEP as a home exercise program delivered in the older person’s home, however, some physiotherapists also provide once-weekly, hospital-based group sessions. The participants are from the wards and are additionally encouraged to perform the OEP balance exercises on a daily basis. This is the brainchild of Simon Hanna, clinical exercise specialist for Cambridgeshire Falls Prevention Services, who advised that one exercise card was attached to the end of each bed on the ward so that the patients, when encouraged to do so by nurses, simultaneously get up and perform the exercises in a circuit-style session by moving from one card at the end of a bed to the next. Their exercise technique is monitored by the physiotherapist in the group session. On discharge from hospital each patient is referred into one of the community sessions.

The Forever Active scheme works closely with the Falls Prevention Service to deliver exercise sessions within Cambridge City for the 50+ age group. The scheme has recently re structured the chair based sessions within the programme to a four level structure – chair based classes (CBE - predominantly residential), chair based + (including optional standing), Strength and Balance classes (OEP) and Strength and Balance Plus classes (PSI). Level 5 classes are sessions for the Active 50+, such as exercise to music, aqua, pilates and sports specific. This new structure has enabled Instructors to be specific with regard to the exercises delivered within the classes and has made referrals from Health Professionals onto the classes a lot more straight forward, with regard to knowing which class will be suitable. The only draw back is that participants are often keen to attend a class, which is local to them, or where their peers attend rather than one which is best suited to their level of ability.