An Inventory of Canadian Programs for the Prevention of Falls Among Seniors

An Inventory of Canadian Programs for the Prevention of Falls Among Seniors
An Inventory of Canadian Programs
for the Prevention of Falls
Among Seniors
Living in the Community
Prepared on behalf of
the Federal/Provincial/Territorial Committee
of Officials (Seniors) for the Ministers Responsible for Seniors
September 2001
An Inventory of Canadian Programs for the
Prevention of Falls & Fall-related Injuries Among
Seniors Living in the Community
Prepared on behalf of the Federal/Provincial/Territorial
Committee of Officials (Seniors) for the
Ministers Responsible for Seniors
September 2001
Participating Jurisdictions:
Government of British Columbia
Government of Alberta
Government of Saskatchewan
Government of Manitoba
Government of Ontario
Government of Québec
Government of New Brunswick
Government of Nova Scotia
Government of Prince Edward Island
Government of Newfoundland and Labrador
Government of the Northwest Territories
Government of Nunavut
Government of Canada
The opinions expressed in this document are those of the authors and do not necessarily reflect the position
of the F/P/T Ministers Responsible for Seniors.
Additional copies of this document are available from:
Division of Aging and Seniors
Health Canada, Address Locator 1908 A1
Ottawa, Ontario
K1A 1B4
Tel: (613) 952-7606
Fax: (613) 957-9938
Internet: http://www.hc-sc.gc.ca/seniors-aines
© Minister of Public Works and Government Services Canada, 2001
Cat. No.: H39-594/2001E
ISBN: 0662-30984-7
Également disponible en français sous le titre :
Répertoire des programmes canadiens de prévention des chutes chez les aînés vivant dans la communauté
FPT Inventory of Community-Based Falls Prevention Programs
TABLE OF CONTENTS
Acknowledgements
I. Introduction ......................................................................................................
II. Methods ............................................................................................................
A. Overview ......................................................................................................
B. Criteria for a Fall Prevention Program to be Included in the
Federal/Provincial/Territorial (F/P/T) Inventory...........................................
C. Inventory Data Collection Form ………………………………………… ...
D. Distribution of the Inventory Data Collection Form …..………………… ..
E. Compiling and Summarizing Results ...........................................................
III. Results ...............................................................................................................
A. Program Characteristics ...............................................................................
B. Targeted Risk Factors for Falls and Fall-Related Injury ..............................
C. Intervention Approaches ...............................................................................
D. Program Effectiveness ..................................................................................
IV. Conclusions .......................................................................................................
V. References .........................................................................................................
2
2
3
5
5
5
6
9
13
14
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Figures:
Figure I: Fall and Fall-Related Risk Model ......................................................
8
Tables:
Table 1: Program Characteristics
1a. Western Canadian Provinces .................................................................
1b. Central and Northern Canadian Provinces and Territories ….. .............
1c. Atlantic Canadian Provinces .................................................................
16
19
24
Table 2: Risk Factors and Interventions
2a. Western Canadian Provinces .................................................................
2b. Central and Northern Canadian Provinces and Territories ....................
2c. Atlantic Canadian Provinces .................................................................
25
28
33
Table 3: Program Description and Evaluation
3a. Western Canadian Provinces .................................................................
3b. Central and Northern Canadian Provinces and Territories ...................
3c. Atlantic Canadian Provinces .................................................................
34
41
52
Appendices:
A. Inventory Cover Letter
B. Data Collection Form
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2
2
ACKNOWLEDGEMENTS
This inventory of Canadian programs for the prevention of falls and fall-related injuries
among seniors living in the community was prepared for the officials of the federal,
provincial and territorial Ministers Responsible for Seniors in response to the Ministers’
request for a review of fall prevention programs and practices and to provide the evidence
for effective approaches for reducing injury among seniors as well as efficient means of
delivering prevention programs.
The document presented here addressed the first of these three objectives and consists of
an overview and summary of 58 Canadian programs designed to prevent falls among
seniors living in the community.
On behalf of this project, we would like to extend our appreciation to all of those who
took the time to respond to the fall prevention inventory and to those who distributed
copies of the Inventory Data Collection Form at meetings, conferences and through the
electronic mail list serves of their organizations.
Thanks to Victoria Scott, R.N., Ph.D., Steven Dukeshire, Ph.D., Elaine M. Gallagher,
R.N., Ph.D., and Andria Scanlan, Ph.D. for their preparation of this study.
FPT Inventory of Community-Based Falls Prevention Programs
I. INTRODUCTION
The personal, economic and societal costs of falls among seniors in Canada is enormous,
yet, up to now, relatively little has been done to address this serious health threat. This
lack of action exists in the context that one third of seniors fall each year (O’Loughlin,
1993) and approximately half of these falls result in minor injury, and up to 25 percent
result in serious injury such as fractures or sprains (Alexander et al., 1992, Nevitt et al.,
1991). Further, many seniors never fully recover from their injuries, leaving them with
chronic pain, reduced functional abilities, curtailment of activities all of which may lead
to future falls and a fear of falling again (Grisso et al., 1990, Nevitt et al., 1991, Tinetti et
al., 1994). Such consequences often lead to reduced independence for seniors and all too
frequently result in institutionalization, as evidenced by the fact that 40 percent of all
nursing home admissions can be directly attributable to an elderly person having had a
fall (Rawsly, 1998). Those not admitted to nursing homes may become more dependent
on others, often creating an additional caregiving burden for the families of seniors
injured by a fall.
Recognizing the large personal, societal, and economic impact of falls among seniors, the
Federal/Provincial/Territorial Ministers Responsible for Seniors have taken a leadership
role in forging a strategy to reduce this serious health threat. Their 1999 report entitled,
“Enhancing Safety and Security for Canadian Seniors: Setting the Stage for Action,”
succinctly highlights the threat for seniors of injury due to falls and suggests steps to
reduce this national problem.
In August 2000, the Federal/Provincial/Territorial Ministers Responsible for Seniors
continued their work by commissioning a study with the goal of understanding both past
and current initiatives to reduce falls among community-dwelling seniors and, based on
the findings, to develop recommendations for future fall prevention programs. To
accomplish this goal, the project was mandated to meet the following three objectives:
1) Develop a national inventory of all programs in Canada designed to reduce falls or
fall-related injuries among community-dwelling seniors;
2) Conduct a literature review to assess the evidence of the effectiveness of
interventions to reduce falls and fall-related injuries among community-dwelling
seniors; and
3) Develop a Best Practices Guide for falls practitioners and policy makers around
the development and implementation of programs designed to reduce falls or fallrelated injuries among community-dwelling seniors.
The current document is the first of three documents resulting from this project. It
presents the results from the compilation of a Canadian inventory of community-based
fall prevention programs to better understand the scope and type of fall prevention
activities already being offered to community-dwelling seniors in Canada.
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II. METHODS
A. Overview
The first step in developing an F/P/T inventory of fall prevention programs was to
implement a process to identify community-based fall prevention programs from across
Canada and to collect information about these programs that could be summarized into
this inventory. The process used to identify and collect information around existing
community-based fall prevention programs in Canada is described below.
B. Criteria for a Fall Prevention Program to be Included in the F/P/T Inventory
To be included in this inventory of community-based fall prevention programs for
seniors, the program had to meet all of the following criteria:
1)
2)
3)
4)
prevention of falls or fall-related injuries is one of the program goals
seniors (although not necessarily exclusively to seniors) target population
community-based (non-institutional)
Canadian-based
C. Inventory Data Collection Form
An Inventory Data Collection Form was developed for nation-wide distribution to learn
about fall prevention programs directed toward community-dwelling seniors. The
research team felt that to reach as geographically wide an audience as possible, to achieve
a high response rate and to easily incorporate the collected information into the final
document, the Inventory Data Collection Form had to meet the following design
requirements:
1) completion and return by either electronic (e-mail) or non-electronic means (fax
or regular mail)
2) format that is easy-to-follow and complete
3) short (one page) and quick completion (under ten minutes)
4) distribution in both English and French
Keeping the above requirements in mind, an initial draft of the Inventory Data Collection
Form was developed by the research team and then piloted by 28 advisory members of an
Adult Injury Prevention Network (AIMNet) in British Columbia. This process resulted in
minor editorial changes. The final Inventory Data Collection Form (Appendix B)
requested respondents to supply the following information about the fall prevention
program with which they were involved:
1)
2)
3)
4)
name of the program
name, address, telephone number, e-mail of contact person(s)
name and address of organization offering the program
funding source(s) for the program
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5) funding duration
6) scope of program (national, provincial, or local)
7) specific location(s) where the program was offered
8) target population ages
9) approximate number of people served per year
10) program goals
11) risk factors targeted
12) description of program (maximum150 words)
13) description of program evaluation (if available, maximum 150 words)
It was also requested that copies of the program and evaluation be sent to the researchers
for their resource library, if such materials were available.
D. Distribution of the Inventory Data Collection Form
The main distribution method was through the electronic mail list serves of organizations
that included in their membership practitioners, researchers or seniors who were
interested in falls prevention. The Inventory Data Collection Form was distributed
electronically through the list serves in late October and early November of 2000 in either
French or English depending on the language of the list serve. The distribution included
a short cover letter (Appendix A) explaining the goals of the project and requesting that
anyone involved with a community-based fall prevention program for seniors complete
the attached form. The Inventory Data Collection Form was attached to the e-mail in
both Microsoft Word and WordPerfect formats. Respondents were asked to open the
attachment, complete the information, and e-mail or fax the completed attachment back to
the researchers. Respondents were also asked to distribute the form to anyone they knew
involved in initiatives for the prevention of falls among seniors. The following list serves
and distribution channels were used for the circulation of the Inventory Data Collection
Form.
1. Alberta Centre for Injury Control and Research
The Alberta Centre for Injury Control and Research has the goal of reducing the
frequency and optimizing the treatment and rehabilitation of injuries in Alberta by
providing coordination and support for injury-control programming, research, information
sharing, and education. The Centre provides support for agencies, practitioners, and other
key stakeholders who do work related to injury prevention, emergency medical services,
acute care and rehabilitation. A copy of the Inventory Data Collection Form was
circulated to all members and partners of the Alberta Centre for Injury Control and
Research through their electronic mail list serve.
2. British Columbia Injury Research and Prevention Unit
The British Columbia Injury Research and Prevention Unit (BCIRPU) has the goal of
reducing injuries and their consequences through conducting and disseminating evidencebased injury research, establishing ongoing injury surveillance, facilitating and
coordinating injury prevention efforts, providing information and support to injury
prevention and control professionals, and distributing injury-prevention knowledge. Over
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one hundred individuals and groups identified as participating in, or likely to be aware of
community-based fall prevention programs for seniors, were contacted from the contact
list of BCIRPU.
3. Canadian Association of Gerontology (CAG)
At the CAG conference in October 2000, a number of participants from across Canada
with an interest in falls prevention among seniors offered to distribute the inventory
document via their list serve connections to others who are providing services to seniors
in their regions.
4. Community Health Promotion Network Atlantic
The Community Health Promotion Network Atlantic (CHPNA) provided access to a list
serve serving the four Maritime Provinces. The goal of this organization is to provide
information, support, and networking opportunities for individuals and organizations
involved with and interested in health promotion.
5. Québec
Respondents from the public health network in charge of injury prevention participated.
6. SMARTRISK
SMARTRISK is a national, nonprofit organization dedicated to preventing injuries and
saving lives by helping people see the risks in their everyday lives and showing them how
to take those risks in the smartest way possible. Their list serve includes many
practitioners and researchers throughout Canada interested in the prevention of falls.
7. Adult Injury Management Network (AIMNet)
Approximately 150 Inventory Data Collection Forms were distributed to members of the
Adult Injury Management Network (AIMNet), a provincial injury prevention network
based in British Columbia. Its core functions include; education/dissemination,
community development, communications and investigation.
8. Distribution at National Conferences related to Injury Prevention and Seniors’ Health:
Approximately 100 Inventory Data Collection Forms were distributed to participants at
each of two national conferences: the Canadian Conference on Injury Prevention and
Control (Kananaskis, Alberta on October 19-20, 2000) and the Canadian Association on
Gerontology Annual Conference (Edmonton, Alberta on October 26-28, 2000).
9. Personal Contacts
Two of the researchers (Drs. Gallagher and Scott) have an extensive network of research
and practice-based colleagues and contacts throughout Canada with an interest in the
prevention of falls among seniors. Members of this network were contacted to determine
their knowledge of existing community-based fall prevention programs and asked to
distribute Inventory Data Collection Forms to anyone they knew who was associated with
a community-based fall prevention program in Canada. In addition, in response to the
initial low number (five) of programs submitted from the four Atlantic provinces, one of
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the researchers (Dr. Dukeshire) made personal contacts with key persons in all four
Atlantic provinces to determine whether programs had been missed through the other
distribution methods.
E. Compiling and Summarizing Results
The information as provided by respondents to the Inventory Data Collection Form is
summarized in tabular form in this report with only minor editorial changes to increase
readability1. Tables 1, 2 and 3 present the characteristics and risk factors targeted for
each program, providing a brief description of activities and evaluation.
It should be noted that some programs submitted for the Inventory were under
development at the time of their submission. Because they had not yet been
implemented, there is little information available at this time. However, these are
included for future reference.
III. RESULTS
The Canadian inventory of falls and fall-related injury prevention programs is presented
in Tables 1-3 with information presented from each province and territory by region
(Western Canada, Central and Northern Canada, and Atlantic Canada). This format was
used to facilitate practitioners and researchers in locating programs of interest by region.
Under each region, the programs are listed in alphabetical order by each province or
territory. The following is an overview of the results of the Inventory.
A. Program Characteristics
Responses to the Inventory Data Collection Form were received from the operators of 58
programs across Canada with 22 responses from Western Canadian provinces, 31 from
Central Canadian provinces and 5 from Atlantic Canada. There were no programs
submitted from northern provinces or territories.
As shown in Tables 1a, 1b and 1c, information on funding for the programs indicated
multi-sourcing, with the Regional Health Authorities as the most frequently mentioned
source. Others were sponsored with municipal funding through fire and rescue
departments or municipal councils, some through community groups, and some through
national bodies such as the Red Cross, Health Canada, or Veterans Affairs Canada.
Others were funded through special grants, such those issuing from the International Year
of the Older Person. Some program respondents did not report their funding duration. Of
1
Only information provided by respondents to the Inventory was used in describing and interpreting the
results. Therefore, it is emphasized that the information concerning the programs included in this report has
not been verified for accuracy by the authors of this report. If further information about a program is
desired, please contact the designated contact person for the program.
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those who did, there were 9 reports of long-term or on-going funding. However, the
majority reported a limited funding term of 2 years or less.
Target populations were mainly persons over the ages of 55, 60 or 65 years (see Tables
1a, 1b and 1c). Some programs stated that all seniors or elderly people were targeted;
others specified only frail or inactive seniors, and several targeted only seniors who were
living independently. Three programs included interventions that included caregivers and
one program was for caregivers of housebound seniors. There was only one program that
mentioned that their target population included health professionals and service
providers. The number of people served varied widely from 13 to 135,000.
The goal of most programs was to provide education and information for seniors on the
risk factors associated with falls. Many programs set targets for reducing the incidence of
falls and fall-related injuries in their regions and most stated specific strategies for
reaching those goals. The most frequently mentioned strategy was to promote physical
activity, improving balance and muscle strength. Some programs included innovative
strategies such as snow shoveling by volunteers and the wearing of padded hip protectors
by seniors to reduce hip fractures due to a fall.
English was the most common language of the reported programs; however 10 were
offered in French, 4 in Chinese and 3 offered in other languages, including Italian and
Vietnamese.
B. Targeted Risk Factors for Falls and Fall-related Injury
The risk factors targeted by the fall prevention programs were categorized as biological,
behavioural, environmental, and/or socio-economic. These categories are based on the
health determinants model, so as to reflect the multitude of influences that impact the
health and safety of seniors right from early childhood and might increase the risk of
falling in later life. There is an emphasis on risks that are amenable to change and the
categories reflect the importance of environmental risk factors such as those that are
influenced by codes and standards for buildings and regulations for the manufacturing of
safety devices and mobility equipment. While the separations between these categories
are arbitrary -- as most fall-related injuries result from the overlapping and compounding
effects of multiple factors -- the four categories are useful to understand the contribution
of like-clusters of factors and to identify target areas for risk reduction.
1. Biological Risk Factors
Biological factors include those pertaining to the human body and are related to the
natural aging process as well as the effects of acute and chronic health conditions (such as
the effects of a stroke, Parkinson’s disease, arthritis, or osteoporosis). Examples of
biological factors include chronic illness, physical disability, cognitive impairment, gait
disorder, poor vision, diminished proprioception, dizziness, postural hypotension, sensory
changes, and physical changes due to a previous fall or frequent falling. Many of these
FPT Inventory of Community-Based Falls Prevention Programs
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factors are associated with advanced age and some, such as osteoporosis, are more
common among women.
2. Behavioural Risk Factors
Behavioural risk factors include those concerning human actions, emotions or choices.
Examples of behavioural factors include taking high risk medications, taking multiple
medications, lack of exercise, poor diet, inappropriate footwear, lack of assistive devices,
inappropriate use of mobility aids, and not using injury protective devices. For some
older adults, choices are made due to lack of awareness of the fall risks involved. For
others the issue is risk-taking behaviours, when actions are taken despite the known risk.
Examples include climbing unsteady ladders or walking without a mobility aid when one
is required. Also included under behavioural factors are reactions to previous falls, such
as fear of falling, which may lead to inactivity that puts a person at increased risk of
future falls.
3. Environmental Risk Factors
Environmental risk factors, those that involve an individual’s surroundings, include home
hazards, community hazards, poor building design, inadequate building maintenance,
unenforced codes or safety regulations, unsafe stair design, poor lighting/sharp contrasts,
slippery or uneven surfaces, obstacles, and a lack of handrails, curb ramps, rest areas,
lighting, or grab bars.
4. Socio-Economic Risk Factors
Socio-economic risk factors are those concerning the influence and interaction of social
conditions and economic status of individuals at risk and the community capacity to
respond to the problem. Examples include low income, low education levels,
unemployment, inadequate housing, lack of support networks, social isolation, and a lack
of access to appropriate health or social services. The role of these factors is poorly
understood as they are often only indirectly linked to being at risk of falling. An example
is the inability to benefit from printed resources on strategies for preventing falls due to
illiteracy, or muscle weakness due to a lack of funds for a nutritional diet.
Figure I illustrates these factors and suggests the interconnection between the contribution
of these factors to falls and fall-related injuries. The arrows indicate the direction of
relationship between the factors.
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Figure I
Fall and Fall-related Risk Model
Behavioural fall risk factors
Environmental fall risk factors
-
-
Poor building design / maintenance
Lack of handrails, grab bars, or curb
ramps
Obstacles (scatter rugs, clutter,
sidewalk furniture)
Poor lightening or sharp contrasts
Uneven or slippery surfaces
Lack of sidewalks / sidewalk
maintenance
Unsafe stairs
Lack of rest areas
Risk-taking behaviors
Wearing inappropriate shoes
Lack, or inappropriate use, of
mobility aids
Taking ‘high risk’ medications
Taking multiple medications or
excessive alcohol
Depression
Poor diet
Reactions to falls – fear of falling
FALLS
& FALLRELATED
INJURIES
Biological fall risk factors
-
-
Gender and advanced age
Chronic and acute health conditions
(Stroke, Parkinson, Arthritis,
osteoporosis)
Impaired balance/gait
Diminished lower limbs strength
Poor vision/hearing
Diminished proprioception
Dizziness, postural hypotension
Foot problems
Limitations in ADL/ IADL
Cognitive impairments
Socio-economic fall risk factors
-
Income inadequacy
Illiteracy
Inadequate housing
Lack of access to health/social services
Lack of community capacity/resources
Lack of social support networks
Living alone, social isolation
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An initial examination of the risk factors targeted by the programs revealed that some
respondents interpreted this question differently from what had been intended. We
intended this question to identify targeted risk factors associated with falling and fallrelated injuries. However, some respondents only listed “falls” as a risk factor, perhaps
because they viewed falls as covering all risk factors for injury. Further, a number of
respondents did not answer this question or provided little information. Therefore, to
supplement this with more complete information, additional targeted risk factors that
were identified in the program descriptions were extracted and added to the risk factors
column in Tables 2a, 2b, and 2c.
Tables 2a, 2b, and 2c present a list of the risk factors targeted by each program as well as
matching each risk factor with one of the four categories. As can be seen from these
tables, most programs adopted a multi-risk factor reduction strategy to reduce falls and
therefore targeted two or more categories. Behavioural risk factors were the most
frequently addressed, followed closely by biological and environmental risk factors. No
programs specifically targeted socio-economic risk factors.
C. Intervention Approaches
The falls programs for the current review were categorized according to four types of
approaches that predominated among the responses received. It is recognized that these
categories are overlapping and often used in combination. Each is briefly described
below.
1. Behavioural Change Approach
The aim here is to change actions taken by individuals, by actively engaging with them
regarding medication use, activity levels, the proper use of mobility aids and proper
footwear, protective equipment, such as hip protectors.
2. Educational Approach
This approach aims to raise individuals’ awareness and knowledge of falls and fall risk
factors via programs such as one-to-one counseling, group sessions, exercises classes, and
media campaigns. Unlike behavioural approaches where there is usually a followthrough component, educational approaches often only consist of a passive presentation
of information with the goal of increased knowledge rather than demonstration of change.
For instance, a program distributing a list of home hazards associated with falling
(educational approach) is less likely to ensure change has taken place, compared to a
program where seniors’ homes are assessed for hazards, in conjunction with their ability
to function in their environments, and, changes to reduce their risk of falling were tailored
to the individual, and where required, facilitated through subsidies and assistance
(behavioural approach).
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3. Physical/Environment Approach
Physical/environment approaches are those where the program aim is to improve safety
by modifying physical structures, removing physical hazards, or having individuals wear
protective equipment. Examples of physical/environment approaches include installing
grab bars in bathrooms and introducing snow and ice removal.
4. Regulatory Approach
Regulatory approaches are those where the aim of the program is to change policy and/or
regulations or to have people advocate for change. Examples of regulatory approaches
include legislation for standards regarding assistive devices and citizen-groups lobbying
governments or organizations to change or adopt policy related to falls prevention.
These approaches are not mutually exclusive. For example, a group education session
that included both encouraging seniors to identify home hazards by providing a home
check-list and an exercise video would be considered to have used an education approach
(group session), a physical/environment approach (home hazard checklist), and a
behavioural change approach (exercise).
Tables 2a, 2b, and 2c present the type of approaches taken by the programs included in
the Inventory. The majority of programs reported using an educational approach to
change behaviour related to falling. Educational approaches typically consisted of
information delivered in group sessions, although a few programs used individual
sessions or widespread media campaigns. All of the education approaches focused on
changing more than one risk factor, with most aiming to increase awareness and
knowledge, and/or change behaviour around multiple risk factors.
Behavioural change was the focus of several programs. A number of programs focused
on encouraging seniors to identify and modify home hazards. None included actually
making the home modifications for seniors. One program did involve removing an
outdoor physical hazard (snow) and another involved phoning a hotline so that seniors
could report sidewalk hazards for referral to the municipality for repair.
Even though no program reported a regulatory approach to reducing falls and fall-related
injuries, three did indicate that a component of their program tried to increase advocacy,
primarily through the formation of coalitions or by having participants identify falling
hazards within the community and reporting them to municipal authorities.
Examination of the Inventory reveals that three programs with a wide impact are being
implemented in multiple sites. However, this does not imply that single-site programs are
of lesser quality. Two of the programs offered at multiple sites are, Steady As You Go!
and First Step : Falls Prevention Starts With You! These programs were purposely
designed to allow for easy adaptation and implementation by other organizations and
communities. A third program, mandated by the Ontario Ministry of Health, requires all
37 local health boards in the province to develop programs to reduce fall-related injuries
among seniors in their region by 20% for the year 2010. These programs involve
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multiple methods and are described in greater detail below. Their emphasis here reflects
the detailed information received in the multiple responses to the inventory and is not
intended to imply that they are more effective than other programs. A new fall prevention
initiative recently launched by Health Canada and Veterans Affairs Canada is also
described, as are a number of similarly funded projects which will be operational by the
latter half of 2001.
Steady As You Go! (SAYGO)
A number of programs submitted to the inventory reported using the SAYGO program
either exclusively or as part of a larger fall prevention initiative. SAYGO, developed and
tested in Edmonton, Alberta, is a cognitive/behavioural fall prevention intervention for
healthy community-dwelling seniors. It includes a multifactorial risk abatement
approach, with a focus on identifying and reducing community hazards.
Participating seniors attend two 90-minute sessions one month apart. At the first session
they receive the Client Handbook and Fitness Video and they begin, with the guidance of
client materials and the group session facilitator, to identify their personal risks for falls.
Over the intervening month, seniors implement their own strategies to reduce their risks
and at the second session share what they have done, giving each other good ideas on
how to prevent falling.
Because the program is relatively simple to implement with a step-by-step guide, and a
focus on personal mentoring to new users, many Canadian communities have
implemented SAYGO. This high level of generalizability is underscored by nine
programs submitted for the F/P/T inventory who reported using SAYGO either
exclusively or as part of a larger fall prevention program.
The Edmonton evaluation of SAYGO used a randomized control trial of 660 individuals,
and revealed that participants who took the program made significant changes in 8 out of
9 risk factors measured after one month. Fewer program participants reported falling
compared to controls over a four-month follow-up period (17% versus 23%), although
the difference did not reach statistical significance. Further, individuals who reported
falling in the year prior to the program were twice as likely to report falling in the fourmonth follow-up if they had not participated in the SAYGO program (Robson, Edwards,
Gallagher & Baker, 2001).
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First Step: Falls Prevention Begins With You!
The First Step : Falls Prevention Begins With You! program consists of a 27 page booklet
allowing seniors to identify fourteen different risk factors for falling and instructions on
how to modify each of these risk factors, including who to call and where to go for help.
Although the booklet was originally developed for use in the Burnaby region of British
Columbia, it can be easily adapted to other areas by modifying information concerning
the community resources portion. The developers of the First Step program encourage its
adaptation for distribution in other communities and will even provide a disk with a
template of the booklet for revision. Because the First Step program can be adapted and
distributed easily and is relatively inexpensive, it can readily be implemented by other
organizations and communities. Highly generalizable, four programs in the Inventory
reported using this program either exclusively or as part of a larger falls reduction
initiative. An evaluation of the First Step program sponsored through the Adult Injury
Management Network (AIMNet), conducted through telephone and in-person interviews
with seniors who received the booklet, revealed that 96% of them read the booklet, 65%
used the booklet to identify their major risk factors for falls, 11% used the list of
organizations and contacts, and 40% made changes to their environment or behaviour.
There were very high levels of satisfaction with the overall program as well as the
readability of the booklet, the wording, and the layout.
Injury Prevention Including Substance Abuse Prevention Program (Ontario)
The Injury Prevention Including Substance Abuse Prevention Program is mandated by
the Ontario Ministry of Health, through the Health Protection and Promotion Act. One of
the stated objectives of this program is to reduce the rate of fall-related injuries in the
elderly (aged 65+ years) that lead to hospitalization or death by 20 per cent by the year
2010. Through this program, each of the 37 Ontario boards of health is expected to
support policies and educate seniors and other targeted groups to prevent fall-related
injuries in seniors. Education initiatives must include the risk factors associated with fallrelated injuries and strategies to prevent these injuries. At a minimum, the boards of
health are expected to develop, maintain membership, and actively participate in a fallrelated injury prevention coalition and to promote and provide, on an annual basis,
educational information and activities regarding fall risk factors. These activities are to
include at least one community-wide education campaign and one or more community
events (depending on population) that involve public interaction and participation and
provide information and/or skill building.
Consequently, all 37 local boards of health in Ontario provide a fall prevention program
in their health unit areas, many of which are described in the tables attached. The
Alcohol Policy Network at the Ontario Public Health Association has recently finalized
the Directory of Substance Abuse and Injury Prevention Contacts in Public Health, 2000.
Section 2, on pages 51 to 53, and pages 65 to 66 of Section 3, contain information on
health unit fall prevention programs and resources. This document can be downloaded at:
FPT Inventory of Community-Based Falls Prevention Programs
12
http://www.apolnet.org/resources/res_apn.html. Section 2 also contains web site and
e-mail addresses.
Also in Ontario, the Trauma Prevention Council of Central West Ontario
(http://www.traumaprevention.on.ca) has received funding to develop a comprehensive
community-based model (program) for the prevention of falls among seniors. The threeyear project will involve other partners and use materials already developed, including the
Are You in Jeopardy and Stepping Out Safely resources. Pages 45 to 53 of their
document Does Your Injury Prevention Program Work? contains materials for the
planning of fall prevention programs, including a Haddon Matrix analysis, a logic model,
work sheets, evaluation outline and information on best practices.
Health Canada and Veterans Affairs Canada: Fall Prevention Initiative
At the time this inventory was being compiled, a Fall Prevention Initiative was being
launched by Health Canada and Veterans Affairs to provide funding for fall prevention
programs targeted toward community-dwelling veterans and seniors in three pilot regions:
Atlantic Canada, British Columbia, and Ontario. The focus of this initiative is to fund
fall prevention programs using a population health approach to increase awareness and
reduce risk factors for falling. Programs beginning in 2001 will last up to three years, and
end in May 2004. Evaluation will be an integral part of each funded project as well as the
national initiative. It is expected that this coordinated effort will help identify effective
population health strategies and increase our understanding of effective means for
reducing risk factors associated with falls among seniors.
D. Program Effectiveness
Twenty-six programs reported either completing or processing some type of evaluation.
They varied greatly from randomized control trials to informal participant feedback. Of
the programs that reported participant satisfaction or program ratings, all indicated that
participants were highly satisfied and evaluated the program favourably. The programs
assessing changes in risk factors generally reported a successful reduction in risk factors,
although most did not report their methodology in enough detail to verify the accuracy or
interpretation of their conclusions. Two programs reported measuring changes in falls.
As noted above, the SAYGO program used a randomized trial and found that program
participants were less likely than controls to report falling in the four months after taking
the program, although this difference did not reach significance. Further, of participants
who reported falling in the year prior to the intervention, those in the control group were
twice as likely to fall than program participants in the four months following the program
(Robson, Edwards, Gallagher & Baker, 2001). Results from the Sunnybrook Falls
Prevention Program, which included exercise and education components targeted toward
seniors with a history of falls or near falls, indicated high levels of participant
satisfaction, significant improvements in balance and gait, and fewer falls reported during
the intervention and follow-up, although it was not indicated how the falls data were
collected (other than by subjective report) or over what time period.
FPT Inventory of Community-Based Falls Prevention Programs
13
IV. CONCLUSIONS
The Federal/Provincial/Territorial Ministers Responsible for Seniors have identified
injury prevention as a major health concern among seniors. Because falls account for the
large majority of injuries to seniors, reducing the physical, emotional, and financial
hardships associated with injuries will require the development and delivery of effective
programs to reduce falls and fall-related injuries. This F/P/T inventory of communitybased fall prevention programs was compiled to better understand the issues around
delivery of fall prevention programs in Canada.
Despite an extensive national search using both electronic and non-electronic distribution
media, only 58 programs were identified across the country. Nonetheless, it appears as if
the number of programs will be growing in quantity and improving in quality. Steady As
You Go! and First Step: Falls Prevention Starts With You! have been adapted and
implemented by a number of communities and organizations across the country. The
injury prevention initiative mandated by the Ontario Ministry of Health will continue to
enhance falls prevention, given that all 37 health units in Ontario have seniors’ fall
prevention programs in place, expertise is developing and some research is underway.
The Health Canada/Veterans Affairs Fall Prevention Initiative will serve to raise
awareness of the issue of falls among community-dwelling seniors and provide the
impetus for the development of fall prevention programs. Thus a fall prevention
inventory compiled in another five years would include many more fall prevention
programs.
Although there is no way of knowing what percentage of Canadian programs were
actually captured in this inventory, there is evidence that a majority were identified. For
example, two of the researchers (E. Gallagher and V. Scott) have extensive contacts in
British Columbia through their work with AIMNet and other organizations, and likely
would have been aware of programs in that province that were not captured through the
data collection process. As well, when a low number of responses were noted from the
four Atlantic provinces, one of the researchers (S. Dukeshire), made personal contact with
key stakeholders in all four provinces and was unable to locate any additional programs
(although one program was identified much later through another source). Thus, we are
confident that the Inventory does represent many of the programs offered in Canada. We
do acknowledge the possibility that smaller community-based programs may have been
missed.
Overall, the vast majority of programs used an education approach for seniors to take an
active role to reduce their risk factors for falling and/or to reduce environmental falling
hazards in their home. These programs tended to adopt a multi-factorial approach to falls
prevention, with the goal of targeting two or more falls risk factors. Such an approach
seems appropriate given the multifaceted, interdependent complexity of fall risk factors
and the general agreement that multi-factorial risk reduction strategies are likely to have
the greatest impact on reducing falls among seniors. Understandably, no program
reported trying to change social or economic risk factors because these types of risk
FPT Inventory of Community-Based Falls Prevention Programs
14
factors are likely remote causes of falling and are difficult to change. However, socialeconomic risk factors can be considered in developing fall prevention programs. For
example, fall prevention programs can be targeted toward economically disadvantaged
populations or the intervention can include components to help these groups receive the
full benefit of the intervention (e.g., subsidies to assist with home modifications or fitness
programs).
Relatively few programs conducted an evaluation, yet it is only through evaluation that
we can determine the effectiveness of the program for changing risk factors and/or
reducing falls or fall-related injuries. While recognizing that program evaluation may be
difficult when staff and budgets are limited, and when achieving an adequate sample size
and comprehensive data collection present challenges, programmers should at least
attempt an evaluation, preferably designing programs with evaluation strategies in place
at the beginning.
Collecting information on the reduction in falls and/or fall-related injuries, participant
satisfaction and assessment of the program, and changes in risk factors that result from
the program is the prime activity. Client satisfaction and evaluation of a program can be
assessed using a short survey and changes in risk factors can be determined with simple
assessments conducted at the beginning and end of the program. For example, asking
participants about attempts to change risk factors, and their perceptions of success in
doing so; maintaining a diary of falls throughout the program to measure a reduction in
falls when compared to the number of falls they had in a set time period prior to entering
the program. Such an understanding will help current programs refine their methods for
reducing falls and allow new programs to learn from the experiences of previous
programs. The Best Practices Guide, developed as part of this initiative, includes a
section that outlines the importance of evaluation and provides guidelines and
suggestions for successfully carrying out an evaluation.
Our findings indicate a need for implementation of more Canadian fall prevention
programs, to be developed using the best knowledge available concerning the risk factors
associated with falling and evidence concerning the effectiveness of modifying these risk
factors to reduce falls among seniors. Literature reviews yield information. The
systematic review conducted as part of this project, found in the companion document
produced for this project, A Best Practices Guide for the Prevention of Falls Among
Seniors Living in the Community (2001), is a good example. Finally, to recognize
successful strategies and refine programs for the reduction of falls, the evaluation of
participant satisfaction and rating of the program for changes in falls, fall risk factors and
impact on falling patterns, must proceed.
FPT Inventory of Community-Based Falls Prevention Programs
15
Table 1a: PROGRAM CHARACTERISTICS: Western Canadian Provinces
Name of Program
Choice
Contact name
&
Organization
Donnie McIntosh,
Good Samaritan
Society
http://www.gss.org
Lakeland Injury
Control Project "For
Safety's Sake"
Denise Matiushyk,
Lakeland Regional
Health Authority
Link to Health
Medical Equipment
Loan (MELS)
Services (Western
Canada)
Prevention before the
Fall
Snow Rangers
Steady As You Go!
Location
Alberta
(Edmonton)
Funding Source
&
Funding Duration
Capital Health Authority
Target Population
Oldest old
primarily in the
southwest and
southeast areas of
Edmonton
Older adults
age 55
Alberta
(Lakeland
Regional Health
Authority area)
Alberta Health and Wellness
- Health Innovation Fund
Cathy Fornier,
Canadian Red Cross
Society
Alberta
Local region
Fund-raising initiatives
Canadian Red Cross
Society
Alberta,
British Columbia,
Manitoba
Liza Sunley,
Alberta Centre for
Injury Control and
Research
Anette Jorgensen,
Canadian Red Cross
Society
Alberta
(Edmonton)
Alberta
(Calgary)
None
(in its 3rd winter)
55+
Ellie Robson,
Population Health,
Capital Health Region
Alberta
1.
2.
65+
Number of
people served
Program Goals
Languages
To maintain independence of
frail or disabled seniors, while
meeting their special needs.
English
Potentially:
21,728 people
over 55 in area
To reduce hospitalizations due
to falls by seniors by 40% by
year 2003.
English
1,300 in 76
classes; 254
Instructors
trained
To improve physical fitness.
English
55,000
To provide low cost short-term
loan service of health
equipment.
August 2000 - June 2003
Grants
Inactive Seniors
65+
55+
To improve or maintain ability
to perform everyday activities.
English
All Capital Health
Region citizens
(including seniors)
Local health regions
Regional Public Health
English
45
To recruit volunteers for snow
shoveling for a waitlist of
approx 200 seniors and people
with disabilities.
English
To reduce risk factors, falls,
injury rates, environmental
hazards, costs.
English
To increase awareness.
Steady As You Go!
Jeanne Annett,
Alberta
Aspen Regional Health (Aspen Health
Region)
Authority
Aspen Regional Health
Authority treats it as a
long-term budget item.
60+
Steady As You Go!
Sheryl Jackson,
Regional Public
Health, David
Thompson Health
Region
Health Unit
65+
Alberta
(David Thomson
Health Region)
FPT Inventory of Community-Based Falls Prevention Programs
12 communities: To reduce fall-related injuries.
Approx 150/year
To maintain independence and
increase quality of life by
reducing injury from falls in
seniors living at home.
16
English
English
Table 1a: PROGRAM CHARACTERISTICS: Western Canadian Provinces (con’t)
Name of Program
Steady As You Go!
Contact name
&
Organization
Kathy Roth,
Chinook Health
Region
Location
Alberta
(Lethbridge)
1.
2.
Funding Source
&
Funding Duration
Seniors' Health
Pop Health, CHR
Target Population
Number of
people served
65+
Program Goals
Languages
To reduce falls.
English
1 year
Elaine Gallagher &
Adult Injury
Management Network Victoria Scott,
University of Victoria
(AIMNET)
British Columbia
Fall Prevention
Program
British Columbia
(Fort St. John)
Deborah Peck &
Caroline Dunford,
North Peace CHSS &
North Peace CHC
Health Canada
funding: 1999 - 2001
1.
2.
North Peace CHSS
Private donation
Anyone interested
in adult injury
prevention
35
To promote the health of older
Canadians through the
prevention of unintentional
injuries.
English
Seniors (relatively
independent) and
caregivers
New program -3 sessions to
date
To increase activity and
balance, quality of life and
education and awareness
about falls.
English
Kamloops First Step
Program
Joan Wilson,
Kamloops Fall
Prevention Network
British Columbia
(Kamloops)
Fire and Rescue Dept.,
City of Kamloops
65+
NOHR Community
Interventions to
Reduce Falls and
Fractures among
Seniors
G. Dewey Evans,
North Okanagan
Health Region
British Columbia
(Vernon, Salmon
Arm, Enderby,
Armstrong,
Revelstoke)
Health Board
65+
Safe Step Prevention
Program
Lynn Cregg-Guinan,
Osteoporosis Society
British Columbia
(Vancouver,
Victoria)
1.
Short term
Assessment and
Treatment Centre,
Vancouver General
Hospital
Steady as you Go!
Jenny Elliot,
Day Unit, Vancouver
General Hospital
British Columbia
(Vancouver
General Hospital,
BC STAT Centre)
Esther Brisch,
British Columbia
North West Health Unit (Telkwa,
Houston, Kitimat)
Tom MacLeod,
British Columbia
The First Step: Fall
(Prince George)
Prevention Starts with Northern Interior
You!
Regional Health Board
To decrease injuries and
suffering.
Approx. 3000 in To reduce/prevent falls and
accidents and improve safety.
the first year
To reduce falls and fractures.
English
!" South
Fraser HR:
588
!" Capital HR:
396
300/year
To provide education and
awareness about fall
prevention.
English
To maximize independence in
the frail elderly.
English
Ongoing
South Fraser Health
Region
Jan 2000 - Mar 2001
2. Capital Health Region
Sept 2000 - May 2001
Regional Continuing Care
55+
Frail elderly with
multipathology
Health Unit
Seniors
45
To increase awareness,
strength, agility.
English
Northern Interior Regional
Health Board
60+
2000
To engage in health promotion
and reduction of risks.
English
Ongoing
FPT Inventory of Community-Based Falls Prevention Programs
English
17
Table 1a: PROGRAM CHARACTERISTICS: Western Canadian Provinces (con’t)
Name of Program
Contact name
&
Organization
Myrtle Linden,
The First Step: Fall
Prevention Starts with Burnaby Coalition to
You!
Prevent Falls
Community Services
for Seniors, Primary
Health Program,
Seniors Health
Resource Team
Sonja Lundstrom,
Winnipeg Regional
Health Authority
Fall Prevention Week
Toolkit
William Osei,
Coalition for Fall
Prevention Among
Seniors.
Leslie Rea- Winichuk
& Sarah Nixon-Jackle,
Saskatoon District
Health - Public Health
Services
Safe Communities Seniors Fall
Prevention
Location
British Columbia
(Vancouver,
Duncan)
Manitoba
(Winnipeg)
Funding Source
&
Funding Duration
Grants from special projects
by Burnaby firefighters
Manitoba Health
demonstration project
Target Population
Number of
people served
Program Goals
Languages
Older adults
200+
To empower seniors.
English
55+
1500
To enable seniors to live
independently.
English
To increase health promotion.
Saskatchewan
None
55+
Saskatchewan
(Saskatoon)
Public Health
55+ communitydwelling seniors
FPT Inventory of Community-Based Falls Prevention Programs
Ongoing
Distributed to all
health
promotion
contacts in SK
Education
presentations:
500. Exercise
program: 100
To prevent Illness and injury.
To reduce falls and injury
among older adults.
To plan, develop, implement
and evaluate program for
preventable falls in older
adults.
18
English
English
Table 1b: PROGRAM CHARACTERISTICS: Central & Northern Canadian Provinces & Territories
Name of Program
Christmas Gift
Package
Contact name
&
Organization
Marnie Garrett,
Lambton Health Unit
Location
Ontario
(Sarnia)
1.
2.
Ontario
(12 sites)
1.
Developing a
Community-Based
Education Program
for Older Persons
Brian J. Gleberzon,
Canadian Memorial
Chiropractic College
Don’t Fall in the Fall
Kathy Nesbitt,
Ontario
The Elgin Safety Team (Elgin)
for Adults
1.
Sonja Habjan,
Sister Margaret Smith
Centre
1.
Education/Early
Intervention ProgramFalls Prevention
Session
2.
Ontario
(Thunder Bay)
2.
3.
4.
2.
Funding Source
&
Funding Duration
Lambton Health Unit
Lambton Safe
Community Council
1 month
Ontario Chiropractic
Assoc.
Ontario Ministry of
Health Senior's
Secretariat
The Elgin –St. Thomas
Health Unit
VON volunteer Program
Novartis
Private donations
Ontario Ministry of
Health & LTC
Ontario Substance
Abuse Bureau
Target Population
50+
Number of
people served
50-125
Older persons
Program Goals
Languages
To inform and assist older
adults in enhancing home
safety during the winter
months, in a creative way.
English
To dispel any myths older
persons may have about
osteo-arthritis and
osteoporosis.
English
Seniors
400
Community living
seniors, 55+
40
English
To provide
education/information about
risk factors for falling to seniors
who are hard to reach or are at
risk.
65+
25
To decrease falls through
exercise and education.
English
!" Seniors 65+
!" Caregivers
!" Health
professionals
!" Service
providers
!" Volunteers
Approx. 1000
To reduce deaths and
disabilities.
English
Chinese
French
Italian
Vietnamese
65+
2000
Care providers
English
Ongoing
Fall Prevention
Program
Grace Castro-Nolet &
Jane Stewart-Gray,
SCO Geriatric Day
Hospital
Ontario
(Ottawa)
Fall Prevention
Program
Ginette Asselin,
Region of OttawaCarleton
Ontario
(Ottawa-Carleton)
Fall Prevention
Program
Sandra Vessel,
Injury and Substance
Abuse Prevention
Team,
York Region Health
Services Dept.
Ontario
(Newmarket,
Aurora,Vaughan,
King, Georgina,
East Gwillimbury,
Whitchurch,
Richmond Hill,
Markham)
FPT Inventory of Community-Based Falls Prevention Programs
Part of regular budget
1.
2.
Ministry of Health (50%)
York Region (50%)
To increase awareness of fall
prevention.
To reduce falls by 20% by the
year 2010.
Ongoing
19
Chinese
English
Italian
Table 1b: PROGRAM CHARACTERISTICS: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Contact name
&
Organization
Fort Frances Senior's Dorothy Poperchny,
Coalition
Northwestern Health
Unit
Healthy Aging & Adult Colleen Stahlbrand,
Hamilton-Wentworth
Wellness
Falls/Prevention
Social and Public
Health Services
Division
Elsie Petch &
Home Safe Home
Elizabeth Smith
Road Show: Injury
South Riverdale
Prevention for
Seniors in the
Community Health
Community
Centre
Location
Funding Source
&
Funding Duration
Target Population
Number of
people served
Program Goals
Languages
Ontario
(Fort Frances)
None
Seniors 50-85+
6400
To provide education about fall
prevention.
English
Ontario
(Hamilton,
Hamilton
Wentworth)
Ministry and municipality
65+
Approx. 2500
To reduce fall related injuries
by 20% by 2010.
English
Ontario
(Toronto)
Ministry of Health: Ontario
To develop educational
approaches and materials
about injury prevention in
English and Cantonese.
English
Cantonese
Ongoing
Midlife-Seniors
To ensure community
involvement.
To develop a culturally and
linguistically sensitive
educational program.
Home Support
Exercise Program
Nancy Ecclestone,
Canadian Centre for
Activity & Aging
Ontario
1.
2.
Health Canada
City of London
65+ (frail elderly)
100+
To encourage seniors to
recognize risk s for injury.
To promote fitness mobility,
independence of homebound
older adults.
English
1998 – 2000
Home Support
Exercise Program
Injury Prevention
Including Substance
Abuse Prevention
Program
Living it Up
Etheleen Porter
Brysch,
Thunder Bay District
Health Unit
Lorraine A. Cass,
Population Health
Service, Public Health
Branch, Ontario
Ministry of Health and
LTC
Ontario
(Thunder Bay)
Health Unit
ongoing
Caregivers of
housebound
seniors
13
English
Ontario
(37 Health units)
1.
Province of Ontario 50%
65+
Ontario
population 65+
English
2.
Local municipalities 50%
Marnie Garrett,
Lambton Health Unit
Ontario
(Sarnia)
50+
5000
Lambton Health Unit
6 months
FPT Inventory of Community-Based Falls Prevention Programs
To create an easy-to-use
resource indexing physical
activity.
20
English
Table 1b: PROGRAM CHARACTERISTICS: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Markham Stouffville
Rehabilitation
Program
Contact name
&
Organization
Tina Healey,
Markham Stouville
Day Hospital
May Home
Improvement Sale
Marnie Garrett,
Lambton Health Unit
Location
Ontario
(Markham)
Funding Source
&
Funding Duration
Ontario Health Insurance
Plan
Target Population
Number of
people served
Program Goals
Languages
60+
40+
To educate seniors who have
had a fall or many falls.
English
50+
250
To allow home safety
improvement items to be more
accessible cost-wise to older
adults.
English
65+
To raise public awareness on
fall prevention strategies
through community education.
English
Seniors living
independently
English
To reduce injuries among
seniors living independently
and improve their quality of life.
To increase knowledge about
falls, physical activity, home
adjustments resources.
English
English
Ongoing
Ontario
(Sarnia)
Lambton Health Unit
2 weeks every May
North York Coalition
for Seniors' Falls
Prevention
Mary Jane Hurley,
Sunnybrook &
Women's College
Health Sci. Centre
Ontario
(North York)
Older and Wiser
Safety Awareness
Coalition
Beth Peterkin,
Older and Wiser
Safety Awareness
Coalition
Ontario
International Year of the
Older Person grant
1999
1.
2.
Public Awareness
Campaign. Avoiding
Trips, Slips and
Broken Hips
Safe Step
Etheleen Porter
Brysch,
Thunder Bay District
Health Unit
Shirley Albinson,
Kingston, Frontenac,
Lennox & Addington
Falls Prevention
Coalition
Seniors Med-Safe
Program
Donna Basler
Ontario
Public Health Nurses, (Central West)
Regional Public Health
Dept.
Steady As You Go!
Etheleen Porter
Brysch,
Thunder Bay District
Health Unit
Grant via The
International Year of the
Older Person
(Ontario Senior’s
Secretariat)
Community donations
Ontario
(Thunder Bay)
Health Unit
55+
Ontario
(Kingston)
1.
Kingston General
Hospital
No deadline
2. Greater Kingston Area
Safe & Sober
Community
No deadline
3. Community Alliance
December 2000
Regional Municipality of
Niagara
60+
135,000
To prevent falls by seniors.
65+
Potentially:
65000
English
To reduce the number of fallrelated injuries in the senior
population that lead to
hospitalization or death by 20%
by the year 2010.
1.
2.
65+
Ontario
(Thunder Bay)
FPT Inventory of Community-Based Falls Prevention Programs
Health Unit
Lakehead University
In progress
To demonstrate the
effectiveness of Tai Chi in
improving muscle strength &
balance.
21
English
Table 1b: PROGRAM CHARACTERISTICS: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Sunnybrook Falls
Prevention Program
The Power Program
Contact name
&
Organization
Susan Maddock &
Sue Gal,
Sunnybrook and
Woman's HSC
Location
Ontario
(Toronto)
Funding Source
&
Funding Duration
Ontario Health Insurance
Plan
Target Population
65+
Number of
people served
37
Program Goals
To increase balance &
confidence.
Languages
English
To improve gait.
6 weeks
To decrease falls.
To provide education, exercise
and nutrition.
Seniors
English
Chinese
Rosslyn Bentley,
Baycrest Centre for
Geriatric Care, North
York General Hosp.,
Yee Hong Centre for
Geriatric care
Ontario
Index of Available
Documentation and
Resources for the
Prevention of
Falls of the Elderly in
their homes
Charles Lemieux,
Public Health Dept.
for the Gaspé
Peninsula and
Madeleine Islands
(Gaspé Peninsula Director of the Public Health
Dept.
and Madeleine
Islands)
Ongoing
65+
Unknown
To identify equipment and
resources needed to prevent
falls in the home and exact
methods for obtaining
necessary safety equipment.
French
PIED Program
Enriched physical
exercise program
Yvonne Robitaille &
Francine Trickey,
Montreal Regional
Public Health Dept.
Québec
(Montreal)
60+ living
independently in
the community
60 per year
To increase balance and leg
strength.
English
French
Pilot Project for the
Prevention of Falls
among the Elderly
residing in the
Community
Denise Gagné,
Québec Public Health
Office and CLSC for
two territories of the
region.
1.
2.
3.
Baycrest Centre for
Geriatric Care
North York General
Hospital
Yee Hong Centre for
Geriatric Care
A variety of organizations
offer the program
periodically.
To promote knowledge and
awareness about behavioural
and environmental fall risks.
Québec
(Territories of the
CSLC HauteVille-des-Rivières
and La Source)
Each of the organizations
involved has submitted a
request to the Regional
Health and Social Services
Office for funding for
evaluation.
1 year for evaluation and
continuous funding for the
intervention
FPT Inventory of Community-Based Falls Prevention Programs
65+
Number
receiving
services each
year not yet
computed.
Starting with
clients receiving
services in their
own homes by
CSLC.
To enable participants to
assess their home and make
simple changes.
French
To reduce falls among elderly
residing in the community
through attention to risk factors
of those currently receiving
home services.
22
Table 1b: PROGRAM CHARACTERISTICS: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Regional Pilot-Project
for the prevention of
falls of the elderly in
their homes. For
implementation in the
CSLC’s.
Safety Installations in
the Bathrooms of the
Elderly
Contact name
&
Organization
Claude Bégin,
Québec Public Health
Dept. and Regional
Health and Social
Services Office
Daniel Gagné,
Public Health Office,
Rouyn-Noranda
Location
Québec
(Region of
Lanaudière)
Québec
(AbitibiTémiscamingue)
Funding Source
&
Funding Duration
Regional Budget
Target Population
Number of
people served
55+
Program Goals
Languages
To keep the elderly in their own French
homes.
3 years: April 2001 - March
2004
Regional Health and Social
Services Dept. of the AbitibiTémiscamingue Region,
Public Health Office
50-75 years
Region-wide
(Unknown)
To heighten the awareness
among the children (aged 4555 years) of elderly of safety
measures for the prevention of
falls.
French
To reduce the number of falls
that occur in bathrooms.
French
2 years
Safety in the
Bathroom: Sensitizing
Guide Concerning the
Installation, the
Handling and the
Maintenance of
Safety Measures for
the Elderly Residing
at home
Charles Lemieux,
Québec province
Public Health Office for
the Gaspé Peninsula
and the Madeleine
Islands.
Health and Social Services
Ministry, General Dept. for
Public Health.
1997 - 2000
Unknown
Independent
seniors or those
with slight mobility
problems, residing
in their own homes
Partners: CLSCCHSLD, Regional
Public Health Offices
The Problems of Falls Helene BélangerOutside the Home
Bonneau, Public
Health Dept. for
Montreal Centre
1.
Québec
(Health
2.
Emergency
Centres, Montreal
and Jesus
Islands)
FPT Inventory of Community-Based Falls Prevention Programs
Québec Health and
Social Services Ministry
Public Health Dept. for
Montreal-Centre
55+
To provide information to those
who work with the elderly in
their homes (nurses,
physiotherapists, and program
leaders) on appropriate safety
practices and equipment for
bathrooms.
To make modifications to
bathrooms
To study the incidence and
circumstances of falls that
occur outside the home.
12 Months
23
English
French
Table 1c: PROGRAM CHARACTERISTICS: Atlantic Canadian Provinces
Name of Program
Contact name
&
Organization
Funding Source
&
Funding Duration
Nova Scotia
The First : Fall
Prevention Starts with
You!
Healthy Active Living
Program for Older
Adults
Location
T. Farrow (English) & New Brunswick
Margaret Richard
(French),
Provincial coordinators
Target Population
Number of
people served
Older adults
1.
Provincial government
Program Goals
Languages
To empower seniors.
English
50+
10,000 in nine
months
To reach isolated as well as
active seniors.
English
French
65+
500
To promote health by seeking
collaborative ways to address
the issues.
English
!" Sport and Culture
Secretariat
!" Family and Community
Services
Injury Prevention In
Seniors
Watch Your Step
“Parachute”
Heather Oakley,
Saint John Regional
Hospital
Tamra Farrow,
Community Health
Promotion Network
Atlantic
New Brunswick
(Saint John)
New Brunswick
1.
Injury Prevention Expo
1. Health Canada
2. Veterans Affairs Canada
To improve access to health
information and ultimately
create a healthy aging
population.
To form partnership to develop
and deliver fall prevention
strategies to NB seniors.
Seniors
English
French
first phase
Falls Prevention
Services – Specialty
Rehab Program
Linda Doody,
Dept. of Health and
Community Services
Newfoundland
Dept. of Health and
Community Services
Frail elderly
Pro Hip Protectors
Dr. Barry Clarke,
LTC Veteran’s
Memorial Building
Nova Scotia
(Halifax)
Veterans Affairs Canada
65+
FPT Inventory of Community-Based Falls Prevention Programs
To raise awareness of falls
prevention to older adults and
general population.
To provide comprehensive
assessment, treatment and
education.
50
To identify those at risk and
provide them with hip
protectors.
24
English
English
Table 2a: RISK FACTORS AND INTERVENTIONS: Western Canadian Provinces
Name of Program
Contact name
&
Organization
Location
Targeted Risk Factors
Risk Factor Categories
Biol
Choice
Donnie McIntosh,
Good Samaritan
Society
Alberta
(Edmonton)
!" lack of social supports
!" personal care
!" emergency response
Lakeland Injury
Control Project "For
Safety's Sake"
Denise Matiushyk,
Lakeland Regional
Health Authority
!" environmental hazards
!" need for toileting alarms
!" need for hip protectors
Link to Health
Cathy Fornier,
Canadian Red Cross
Society
Alberta
(Lakeland
Regional Health
Authority area)
Alberta
!"
!"
!"
!"
!"
Beh
Env
x
Intervention Approaches
Soc/
Eco
Beh
Chg
Educ
x
x
physical health
disease prevention
control and management outcomes
lifestyle behavioural outcomes
skill and health related fitness –
balance, strength, coordination
!" improper use of or lack of access to
health care equipment
x
!"
!"
!"
!"
!"
!"
lack of physical activity
transportation
medications
home safety
hearing and vision
awareness
!" outdoor environment hazards
!" falls (snow removal)
x
Phys/
Env
x
x
x
x
x
x
Canadian Red Cross
Medical Equipment
Loan (MELS) Services Society
(Western Canada)
Alberta,
British Columbia,
Manitoba
Prevention before the
Fall
Liza Sunley,
Alberta Centre for
Injury Control and
Research
Alberta
(Edmonton)
Snow Rangers
Anette Jorgensen,
Canadian Red Cross
Society
Alberta
(Calgary)
Steady As You Go!
Ellie Robson,
Population Health,
Capital Health Region
Alberta
!" cognitive/behavioural
!" environment
!" behaviour/prevention practices
x
x
x
x
x
x
Steady As You Go!
Jeanne Annett,
Aspen Regional Health
Authority
Alberta
(Aspen Health
Region)
!"
!"
!"
!"
!"
!"
!"
x
x
x
x
x
x
FPT Inventory of Community-Based Falls Prevention Programs
paying attention
taking risk
footwear, foot care
medication,
vision
hazards
balance, leg strength
x
x
x
x
x
x
25
Reg
Table 2a: RISK FACTORS AND INTERVENTIONS: Western Canadian Provinces (con’t)
Name of Program
Contact name
&
Organization
Location
Targeted Risk Factors
Risk Factor Categories
Biol
Beh
Env
x
x
Soc/
Eco
Intervention Approaches
Beh
Chg
Educ
Phys/
Env
x
x
x
Steady As You Go!
Sheryl Jackson,
Alberta
Regional Public Health, (David Thomson
Health Region)
David Thompson
Health Region
!" awareness of falling risk
!" leg strength and balance
!" environment
x
Steady As You Go!
Kathy Roth,
Chinook Health Region
Alberta
(Lethbridge)
!" physical strength and environmental
factors including failing eyesight
etc.
x
Adult Injury
Management Network
(AIMNet)
Elaine Gallagher &
Victoria Scott,
University of Victoria
British Columbia
x
x
x
x
x
x
Fall Prevention
Program
Deborah Peck &
Caroline Dunford,
North Peace CHSS &
North Peace CHC
Joan Wilson,
Kamloops Fall
Prevention Network
G. Dewey Evans,
North Okanagan Health
Region
British Columbia
(Fort St. John)
!"
!"
!"
!"
!"
!"
!"
!"
x
x
x
x
x
x
!" multiple risk factors including those
addressed by SAYGO and First
Step
!" risk of injury from a fall
x
x
x
x
x
x
!" physical health
!" environmental and host risk factors
x
x
x
x
!" fall-related fracture risk
x
x
x
x
x
x
x
Kamloops First Step
Program
NOHR Community
Interventions to
Reduce Falls and
Fractures among
Seniors
Safe Step Prevention
Program
Short Term
Assessment and
Treatment Centre,
Vancouver General
Hospital
Steady as you Go!
Lynn Cregg-Guinan,
Osteoporosis Society
Jenny Elliot,
Day Unit, Vancouver
General Hospital
Esther Brisch,
North West Health Unit
British Columbia
(Kamloops)
British Columbia
(Vernon, Salmon
Arm, Enderby,
Armstrong,
Revelstoke)
British Columbia
(Vancouver,
Victoria)
British Columbia
(Vancouver
General Hospital,
BC STAT Centre)
vision,
medication
leg strength
paying attention
risk taking
community hazards
foot care and footwear
awareness of risk of falls and
unintentional injuries
!" balance, strength and flexibility
British Columbia
(Telkwa, Houston, !" pain
!" incontinence
Kitimat)
!" polypharmacy
!" nutrition
!" vision
FPT Inventory of Community-Based Falls Prevention Programs
x
x
x
x
x
26
Reg
Table 2a: RISK FACTORS AND INTERVENTIONS: Western Canadian Provinces (con’t)
Name of Program
Contact name
&
Organization
Location
The First Step: Fall
Prevention Starts with
You!
The First Step : Fall
Prevention Starts with
You
Tom MacLeod,
Northern Interior
Regional Health Board
Myrtle Linden,
Burnaby Coalition to
Prevent Falls
British Columbia
(Prince George)
Community Services
for Seniors, Primary
Health Program,
Seniors Health
Resource Team
Fall Prevention Week
Resource Kit
Sonja Lundstrom,
Winnipeg Regional
Health Authority
Manitoba
(Winnipeg)
William Osei, Coalition
for Fall Prevention
Among Seniors.
Saskatchewan
Safe Communities Seniors Fall
Prevention
Leslie Rea- Winichuk & Saskatchewan
Sarah Nixon-Jackle,
(Saskatoon)
Saskatoon District
Health - Public Health
Services
British Columbia
(Vancouver,
Duncan)
FPT Inventory of Community-Based Falls Prevention Programs
Targeted Risk Factors
!"
!"
!"
!"
!"
!"
!"
!"
!"
footwear
fear of falling
anxiety
depression
alcohol use
cognition
environment
environmental risks
personal behaviour
!"
!"
!"
!"
!"
!"
!"
!"
!"
!"
!"
!"
!"
!"
!"
dizziness
medication
alcohol use
foot problems
weak muscles/stiff joint
continence
vision/hearing difficulties
sleep difficulties
concentration
shortness of breath
home hazards
walking hazards
balance
medication use
building and community
environment hazards
!" mobility aids
Risk Factor Categories
personal risk factors,
lifestyle,
behaviour
health surroundings
exercise
medication use,
plus risk factors addressed by
SAYGO
Beh
Chg
Beh
Env
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Educ
Phys/
Env
Biol
!" dangerous homes
!" ice hazards
!" health lifestyles
!"
!"
!"
!"
!"
!"
!"
Soc/
Eco
Intervention Approaches
x
27
Reg
Table 2b: RISK FACTORS AND INTERVENTIONS: Central & Northern Canadian Provinces & Territories
Name of Program
Contact name
&
Organization
Location
Targeted Risk Factors
Risk Factor Categories
Biol
Beh
Env
Intervention Approaches
Soc/
Eco
Beh
Chg
Educ
Phys/
Env
x
x
Christmas Gift
Package
Marnie Garrett,
Lambton Health Unit
Ontario
(Sarnia)
!" awareness of fall risk
!" home hazards
Developing a
Community-Based
Education Program for
Older Persons
Don’t Fall in the Fall
Brian J. Gleberzon,
Canadian Memorial
Chiropractic College
Ontario
(12 sites)
!" safety proof home (home hazards)
!" lack of exercise
!" poor nutrition
Kathryn Nesbitt,
Elgin Health Unit
Ontario
(Elgin – St. Thomas
Health Region)
!"
!"
!"
!"
!"
!"
safe medication use
exercise
home hazards
use of assistive devices
osteoporosis
alcohol and medication misuse
x
!"
!"
!"
!"
!"
!"
!"
!"
impaired balance and mobility,
environmental hazards
medication,
unsafe behaviour factors
medications associated with falls
polypharmacy
impaired musculosketal function
environmental hazards
x
x
x
x
x
x
x
x
x
x
x
x
!"
!"
!"
!"
!"
gait
balance
medication,
physical activity
environmental risk factors (lighting,
rugs, safety devices, etc.)
x
x
x
x
x
x
Education/Early
Intervention ProgramFalls Prevention
Session
Fall Prevention
Program
Sonja Habjan,
Ontario
Sister Margaret Smith (Thunder Bay)
Centre
Grace Castro-Nolet &
Jane Stewart-Gray,
SCO Geriatric Day
Hospital
Ginette Asselin,
Region of OttawaCarlton
Ontario
(Ottawa)
Fall Prevention
Program
Sandra Vessel,
Injury and Substance
Abuse Prevention
Team, York Region
Health Service Dept.
Fort Frances Senior's
Coalition
Dorothy Poperchny,
Northwestern Health
Unit
Colleen Stahlbrand,
Hamilton-Wentworth
Social and Public
Health Services
Division
Ontario
(Newmarket,
Aurora, King,
Vaughan, Georgina,
East Gwillimbury,
Whitchurch,
Richmond Hill,
Markham)
Ontario
(Fort Frances)
Fall Prevention
Program
Healthy Aging & Adult
Wellness
Falls/Prevention
Ontario
(Ottawa-Carlton)
Ontario
(Hamilton, Hamilton
Wentworth)
FPT Inventory of Community-Based Falls Prevention Programs
x
x
x
x
x
x
x
!" lack of exercise
x
!" unsafe streets
!" lack of partners to support policy
x
Reg
x
x
x
x
x
x
change to make communities
healthier and safer
28
x
x
Table 2b: RISK FACTORS AND INTERVENTIONS: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Contact name
&
Organization
Location
Targeted Risk Factors
Risk Factor Categories
Biol
Beh
Env
Intervention Approaches
Soc/
Eco
Beh
Chg
Educ
Phys/
Env
x
x
Home Healthcare
Equipment Service
(HHES)
Canadian Red Cross
Society
Ontario
!" improper use of or lack of access
to health care equipment
x
Home Safe Home
Road Show: Injury
Prevention for Seniors
in the Community
Elsie Petch &
Elizabeth Smith
South Riverdale
Community Health
Centre
Nancy Ecclestone,
Canadian Centre for
Activity & Aging
Ontario
(Toronto)
!" intrinsic/individual
!" extrinsic/structural & environmental
x
Ontario
!" inactivity
!" frailty
x
x
x
Etheleen Porter
Brysch,
Thunder Bay District
Health Unit
Lorraine A. Cass,
Population Health
Service, Public
Health Branch,
Ontario Ministry of
Health and LTC
Ontario
(Thunder Bay)
!" inactivity and poor balance
x
x
x
x
Ontario
(37 Health units)
!" lack of community injury
x
x
Living it Up
Marnie Garrett,
Lambton Health Unit
Ontario
(Sarnia)
!" prior falls
!" muscle strength
!" reduction in medical conditions
x
Markham Stouffville
Rehabilitation
Program
Tina Healey,
Markham Stouville
Day Hospital
Ontario
(Markham)
!" lack of physical assessment for fall
risk
x
May Home
Improvement Sale
Marnie Garrett,
Lambton Health Unit
Ontario
(Sarnia)
North York Coalition
for Seniors' Falls
Prevention
Mary Jane Hurley,
Sunnybrook &
Women's College
Health Sciences
Centre
Ontario
(North York)
!" home hazards
!" lack of funds to purchase safety
equipment
!" lack of knowledge of fall risk
!" lack of knowledge of best
prevention strategies
!" lack of knowledge of
supports/resources for prevention
Home Support
Exercise Program
Home Support
Exercise Program
Injury Prevention
Including Substance
Abuse Prevention
Program
FPT Inventory of Community-Based Falls Prevention Programs
x
x
x
prevention coalitions
!" lack of educational information on
prevention
Reg
x
x
x
x
x
x
x
x
x
x
x
29
Table 2b: RISK FACTORS AND INTERVENTIONS: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Contact name
&
Organization
Location
Targeted Risk Factors
Risk Factor Categories
Biol
Older and Wiser
Safety Awareness
Coalition
Public Awareness
Campaign. Avoiding
Trips, Slips and
Broken Hips
Safe Step
Seniors Med-Safe
Program
Steady As You Go!
Sunnybrook Falls
Prevention Program
The Power Program
Index of Available
Documentation and
Resources for the
Prevention of
Falls of the Elderly in
Their Homes
Beth Peterkin,
Older and Wiser
Safety Awareness
Coalition
Etheleen Porter
Brysch,
Thunder Bay District
Health Unit
Shirley Albinson,
Kingston, Frontenac,
Lennox & Addington
Falls Prevention
Coalition
Donna Basler
Public Health Nurses,
Regional Public
Health Dept.
Etheleen Porter
Brysch,
Thunder Bay District
Health Unit
Susan Maddock &
Sue Gal,
Sunnybrook and
Woman's HSC
Rosslyn Bentley,
Baycrest Centre for
Geriatric Care, North
York General Hosp.,
Yee Hong Centre for
Geriatric care
Charles Lemieux,
Public Health Dept.
for the Gaspé
Peninsula and
Madeleine Islands
Beh
Env
Soc/
Eco
Intervention Approaches
Beh
Chg
Phys/
Env
Reg
x
x
x
x
x
x
Educ
Ontario
!" home safety including fire,
!" medications
x
Ontario
(Thunder Bay)
!" lack of knowledge about risk
factors
!" decreased physical activity
!" medication and alcohol use
!" pedestrian fall hazards (unsafe
sidewalks)
!" medications
x
x
x
x
Ontario
(Central West)
!" medications
x
Ontario
(Thunder Bay)
!" exercise
!" awareness
!" prevention strategies
x
x
Ontario
(Toronto)
!"
!"
!"
!"
!"
!"
!"
x
x
x
x
x
x
x
Ontario
(Kingston)
Ontario
Québec
(Gaspé Peninsula
and Madeleine
Islands)
FPT Inventory of Community-Based Falls Prevention Programs
!"
!"
!"
!"
!"
!"
!"
weakness
balance
knowledge
prevention
injury prevention
diet restrictions
exercise
lack of physical activity
poor diet
medications
excess alcohol
balance
improper use of walking aids
installation of home safety
equipment
!" osteoporosis
x
x
x
x
x
x
x
x
x
30
Table 2b: RISK FACTORS AND INTERVENTIONS: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Contact name
&
Organization
Location
Targeted Risk Factors
Risk Factor Categories
Biol
Beh
Env
Soc/
Eco
Intervention Approaches
Beh
Chg
Educ
Phys/
Env
PIED Program
Enriched physical
exercise program
Yvonne Robitaille &
Francine Trickey,
Montreal Regional
Public Health Dept.
Québec
(Montreal)
!" balance and leg strength
!" obstacles in the home environment
!" unsafe behaviours (e.g.,
medications)
x
x
x
x
x
x
Pilot Project for the
Prevention of Falls
among the Elderly
residing in the
Community
Denise Gagné,
Québec Public
Health Office and
CLSC for two
territories of the
region.
Québec
(CSLC Haute-Villedes-Rivières and La
Sources Regions)
x
x
x
x
x
x
Regional Pilot-Project
for the Prevention of
Falls of the Elderly in
Their Homes. Project
for the Implementation
in the CSLCs.
Claude Bégin,
Québec Public
Health Dept. and
Regional Health and
Social Services
Office
Québec
(Region of
Lanaudière)
!"
!"
!"
!"
!"
!"
!"
!"
!"
!"
!"
!"
x
x
x
x
x
x
Safety Installations in
the Bathrooms of the
Elderly
Daniel Gagné,
Public Health Office,
Rouyn-Noranda
(AbitibiTémiscamingue)
x
x
Safety in Bathroom:
Sensitizing Guide
Concerning
Installation, Handling
and the Maintenance
of Safety Measures for
the Elderly Residing at
Home
Charles Lemieux,
Public Health Office
for the Gaspé
Peninsula and the
Madeleine Islands.
Partners: CLSCCHSLD, Regional
Public Health Offices
Québec
(Throughout the
Province)
x
x
!"
!"
!"
!"
!"
!"
!"
FPT Inventory of Community-Based Falls Prevention Programs
decreased lower limb strength
gait
decreased vision
medications
cognitive difficulties
postural hypotension
osteoporosis
environmental factors in the home
decrease lower limb strength
gait and balance
decreased vision
use of psychotropic and cardiovascular drugs
polypharmacy
environmental risks in the home
cognitive difficulties
postural hypotension
osteoporosis
lack of safety equipment in the
bathrooms
lack of knowledge about risk
factors for falling among children of
elderly people
!" lack of safety equipment in the
bathrooms (e.g., grab bars)
!" inability to install and maintain
bathroom safety devices
!" behaviour of persons at risk of
falling when taking a bath
x
x
x
x
31
Reg
Table 2b: RISK FACTORS AND INTERVENTIONS: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Contact name
&
Organization
Location
Targeted Risk Factors
Risk Factor Categories
Biol
The Problems of Falls
Outside the Home
Helene BelangerBonneau, Public
Health Dept. for
Montreal Centre
Québec
(Health Emergency
Centre, territory of
Montreal and Jesus
Islands)
FPT Inventory of Community-Based Falls Prevention Programs
!" socio-demographic characteristics
(age/gender)
!" environmental hazards at the site
of the fall
!" weather conditions
Beh
Intervention Approaches
Env
Soc/
Eco
x
x
Beh
Chg
Educ
Phys/
Env
x
32
Reg
Table 2c: RISK FACTORS AND INTERVENTIONS: Atlantic Canadian Provinces
Name of Program
Contact name
&
Organization
Location
Targeted Risk Factors
Risk Factor Categories
Biol
Beh
Healthy Active Living
Program for Older
Adults
New Brunswick
T. Farrow
(English) &
Margaret Richard
(French),
Provincial coordinators
!"
!"
!"
!"
medications
poor nutrition
lack of physical activity
poor stress management
x
Injury Prevention In
Seniors
Heather Oakley,
Saint John Regional
Hospital
New Brunswick
(Saint John)
!" knowledge gaps in health
x
Watch Your Step
“Parachute”
Tamra Farrow,
Community Health
Promotion Network
Atlantic
Linda Doody,
Dept. of Health and
Community Services
New Brunswick
!" home environment
!" knowledge gaps in falls prevention
x
Newfoundland
!" falls
!" home exercise, information and
equipment to promote safety and
independence
x
Dr. Barry Clarke,
LTC Veteran’s
Memorial Building
Nova Scotia
(Halifax)
!" risk for hip injury
Falls Prevention
Services – Specialty
Rehab Program
Pro Hip Protectors
FPT Inventory of Community-Based Falls Prevention Programs
information
Env
Soc/
Eco
Intervention Approaches
Beh
Chg
Educ
x
x
Phys/
Env
x
x
x
x
x
x
x
x
x
33
Reg
Table 3a: DESCRIPTION AND EVALUATION: Western Canadian Provinces
Name of Program
Choice
Contact name
&
Organization
Donnie McIntosh,
Good Samaritan
Society
Alberta (Edmonton)
Lakeland Injury
Control Project "For
Safety's Sake"
Denise Matiushyk,
Lakeland Regional
Health Authority
Alberta
(Lakeland Regional
Health Authority area)
Link to Health
Cathy Fornier,
Canadian Red Cross
Society
Alberta
Description
CHOICE is a program designed to help meet the challenges of
caring for an older individual with long term health needs at home
by providing medical, social and supportive services from a single
source. The program emphasizes independence, continued
community residence, family support and minimal disruption of the
person's life and is aimed at those individuals who could not live at
home without support.
Lakeland SAYGO (Steady As You Go), a fall prevention program for
seniors, has placed resources throughout Lakeland Health Region
so that Lakeland seniors can continue to take a proactive approach
to safety awareness and fall prevention. 106 facilitators have been
trained and SAYGO facilitator training manuals, handbooks, and
videos have been placed in Health Unit libraries throughout the
region, for use by staff or residents who would like to learn about
the SAYGO project or get a SAYGO group started. Betty Gray, of
the Action for Health, handed the SAYGO project over to the Injury
Control Project in October 2000. The team will work with
rehabilitation teams, physicians, lodge recreation therapists, senior
groups and interested individuals and communities to determine
needs and work with older adults to look at strategies to address fall
prevention.
In the Link to Health Activity Guide there is a chapter on balance
activities as well as a chapter on strength and endurance exercises.
In the leader training manual, muscular endurance and balance is a
main part of the activity. The recommended time on these activities
is 10-15 minutes of a Link to Health Session. The number of
sessions per week can vary from 1-3. Over 12 weeks, a Link to
Health program might meet from 12 to 36 times. Skill related
fitness includes: agility, balance, coordination, speed, power and
reaction time. Health related fitness includes: cardiovascular
fitness, strength and endurance, flexibility, body composition and
freedom from injuries.
FPT Inventory of Community-Based Falls Prevention Programs
Evaluation
Under Development
None given
Based on the Canadian Red Cross Fun and Fitness program
developed in Saskatchewan in 1969, the first program materials
were published and leader training became available in certain
parts of Canada by 1980. In 1991, as the program came to serve
more people, the Red Cross discovered that it needed to expand
the program material. In creating the Link to Health program
(1997), extensive research on physical activity and aging was
accumulated and evaluated by 25 professionals for use in the Link
to Health program. Health, physical education, and program
experts reviewed the program materials whereupon it went through
major upgrading and revisions in 1997 with a revision team
comprised of several university professors and fitness experts
throughout Canada.
34
Table 3a: DESCRIPTION AND EVALUATION: Western Canadian Provinces (con’t)
Name of Program
Medical Equipment
Loan (MELS)
Services
Prevention before the
Fall
Snow Rangers
Steady As You Go!
Contact name
&
Organization
Canadian Red Cross
Society
Alberta,
British Columbia,
Manitoba
Liza Sunley,
Alberta Centre for
Injury Control and
Research
Alberta (Edmonton)
Anette Jorgensen,
Canadian Red Cross
Society
Alberta (Calgary)
Ellie Robson,
Population Health,
Capital Health Region
Alberta
Description
Evaluation
A low cost, short-term loan service offers a variety of health care
equipment to individuals in communities and provides mobility
equipment to residents who are recovering in their own homes from
illness, injury or surgery. Information is given on the proper use of
the equipment. The equipment loaned helps with fall prevention
including walkers, crutches, canes, wheelchairs and bath aids
(stools and seats).
None given
The Red Cross began the equipment loans program in 1945. Since
that time there has been little change in the basic service. The
program has been evaluated and updated about every 10 years
and is currently being evaluated in several areas to ensure it meets
current standards and practices.
None given
Snow Rangers recruits volunteers all year round to shovel
sidewalks for seniors and persons with disabilities. The program is
offered every time it snows.
Volunteers and seniors or persons with disabilities from all parts of
the city are matched. While no strict evaluation has yet been
conducted, feedback from seniors matched has been good. We
have a waiting list of 200 waiting for a volunteer for this year
compared to the first year of operation, where 25 were matched.
Program priority is to focus recruitment in communities with a high
number of seniors.
Steady As You Go is a cognitive/ behavioral brief intervention,
which also includes an environmental focus and is targeted at the
reduction of falls of healthy and transitional (between health and
frailty) community-dwelling seniors. The program is offered to small
groups of seniors by trained senior facilitators who are then
supported by a health professional (usually a nurse). Participating
seniors attend two 90-minute sessions one month apart. At the first
session they receive the Client Handbook and Fitness Video and at
this time they begin to identify personal risk factors for falls. Over
the intervening month, seniors implement their own strategies to
reduce their risks and at the second session they share what they
have done. The purpose of the original Steady As You Go
(SAYGO) study was to translate successful falls research into a
brief, yet effective community intervention and it included a multifactorial, risk-abatement approach as well as a cognitive-behavioral
and environmental focus.
The evaluation design and methods involved a randomized control
trial, which was conducted in urban and rural areas with 660 eligible
seniors participating. The results were that seniors who completed
the program made significant reductions in eight of the nine
personal risk factor categories addressed in the program, as
measured one month after taking the program. Measured over a
four-month period, the intervention group had fewer seniors who fell
(17%) when compared to the control group (23%). Using a
multivariate logistic regression model, seniors who did not
participate in the program were 1.5 times more likely to have a fall
than those who did not. Among seniors who had fallen in the year
prior to taking the SAYGO program, those in the control group were
2 times more likely to have a fall than those in the treatment group.
For this group who had fallen, the intervention group had
significantly fewer seniors who fell (20%) when compared to seniors
in the control group (33%). The implications of this study are that
falls research has now provided enough guidance for the design of
a practical and effective fall prevention initiative that could easily be
implemented in other communities.
FPT Inventory of Community-Based Falls Prevention Programs
35
Table 3a: DESCRIPTION AND EVALUATION: Western Canadian Provinces (con’t)
Name of Program
Steady As You Go!
Steady As You Go!
Contact name
&
Organization
Jeanne Annett,
Aspen Regional Health
Authority
Alberta
(Aspen Health Region)
Sheryl Jackson,
Regional Public
Health, David
Thompson Health
Region
Alberta
(David Thomson
Health Region)
Description
Evaluation
Program strategies include the use of trained peer facilitators who
work with groups of seniors in the community and assist
participants in learning how to use the program. A guidebook,
exercise video, educational sessions and self-monitoring are used.
Program objectives are introduced in two 90-minute sessions, one
month apart. The first session reviews the risk factors involved in
falling. Topics include: paying attention, taking risks, balance, leg
strength, footwear, foot care, medication, vision, hazards in and
around the home and in the community. Participants also discuss
the importance of increasing leg strength and balance for
preventing falls and are encouraged to take part in a 20-minute
physical exercise program or participate in an organized exercise
group. The guidebook helps participants assess risk factors within
their home and community. The home video introduces the issues
of falling and validates the need for falls prevention. The second
part is a program of 20 exercises. Participants are encouraged to
continue their learning with the use of these resources on their own
for the time between sessions. After one month, they meet again
for the purpose of sharing their experiences of what they have
learned and how they have been able to reduce their risks of falling.
No formal evaluation has been conducted to determine the
effectiveness of this program in reducing fall-related injuries in our
health region. Although recent local statistics do indicate a slight
reduction in fall-related injuries with this target group, we are
reluctant to make hasty assumptions especially since we have only
reached 3% of the older adults in this region. The experience of
using this program in the Aspen region has been documented in a
study with the use of a 4-step model of dissemination and
quantitative evaluations are included.
Designed for seniors living in the community at home or in a
senior’s complex. It is offered in 2 segments and each segment is
approximately 2 hours. It is given to seniors by seniors. There is
an expectation that the senior can do their own assessment of their
environment and then is responsible to exercise according to the
exercise video that is available for purchase. If the senior is frail,
the assessment is done by a health care professional. The
volunteer seniors that present the program have a training period
provided by a professional. This program was developed in
Edmonton and is used extensively throughout the province.
There has been a program evaluation. A randomized control trial
was conducted in 1996/97. There was not a significant difference
in fall rates at the time of the evaluation but there was a significant
reduction in ‘risks’ for falls, which was demonstrated to be
sustained.
FPT Inventory of Community-Based Falls Prevention Programs
36
Table 3a: DESCRIPTION AND EVALUATION: Western Canadian Provinces (con’t)
Name of Program
Description
Evaluation
Program strategies include the use of trained peer facilitators who
work with groups of seniors in the community and assist
participants in learning how to use the program. A guidebook,
exercise video, educational sessions and self-monitoring are used.
The objectives are introduced in two 90-minute sessions, one
month apart. The first session reviews the risk factors involved in
falling. Topics include: paying attention, taking risks, balance, leg
strength, footwear, foot care, medication, vision, hazards in and
around the home and in the community. Participants also discuss
the importance of increasing leg strength and balance for
preventing falls and are encouraged to take part in a 20-minute
physical exercise program or participate in an organized exercise
group. The guidebook helps participants do assessments of risk
factors within their home and community. The home video
introduces the issues of falling and validates the need for falls
prevention. The second part is a program of 20 exercises.
Participants are encouraged to continue their learning with the use
of these resources on their own for the time between sessions.
After one month, they meet again for the purpose of sharing their
experiences of what they have learned and how they have been
able to reduce their risks of falling.
No formal evaluation has been conducted to determine the
effectiveness of this program in reducing fall-related injuries in our
health region. Although recent local statistics do indicate a slight
reduction in fall-related injuries with this target group, we are
reluctant to make hasty assumptions especially since we have only
reached 3% of the older adults in this region. The experience of
using this program in the Aspen region has been studied with the
use of a 4-step model of dissemination. Quantitative evaluations
are included in this paper.
Elaine Gallagher &
Adult Injury
Management Network Victoria Scott
University of Victoria
(AIMNet)
British Columbia
AIMNet was formed to forge partnerships and links across the
province. It brought together representatives from organizations
serving seniors and persons with disabilities, health care
practitioners, aboriginal people, local and provincial government
personnel, educators, and researchers. The strategic actions for
AIMNet included: coalition building and networking; community
development; communication, consultation and education; reaching
to Canada and beyond; research proposals and projects.
An external evaluator was retained in order to determine the impact
that AIMNet had on community and organizational activities to
reduce seniors injuries. Qualitative interviews were conducted with
key informants and they were transcribed and analyzed. For
themes and sub-themes. Seven themes emerged including:
networking, community development, communication (including
consultation and education), reaching out beyond the network,
creating new knowledge through research, impacting on seniors
and other perceived benefits.
Fall Prevention
Program
Combination of ‘Steady as You Go’ booklet, ‘First Step’ booklet
and local resources, used. Sessions run for 1/ ½ hours and
includes a variety of speakers, equipment demonstrations and a
fitness/balance video.
None given
Burnaby First Step Booklet was reorganized to meet the needs of
Kamloops seniors, with the help of a student nurse from University
of Cariboo College. Volunteers from a retired firefighters group
were involved in dispensing the booklet at flu clinics, seniors
centers and seniors housing complexes throughout Kamloops.
This booklet is also being used in the hospital ER department.
None given
Steady As You Go!
Kamloops First Step
Program
Contact name
&
Organization
Kathy Roth,
Chinook Health
Region
Alberta
(Lethbridge)
Deborah Peck &
Caroline Dunford,
North Peace CHSS &
North Peace CHC
British Columbia
(Fort St. John)
Joan Wilson,
Kamloops Fall
Prevention Network
British Columbia
(Kamloops)
FPT Inventory of Community-Based Falls Prevention Programs
37
Table 3a: DESCRIPTION AND EVALUATION: Western Canadian Provinces (con’t)
Name of Program
NOHR Community
Interventions to
Reduce Falls and
Fractures among
Seniors
Safe Step Prevention
Program
Short term
Assessment and
Treatment Centre,
Vancouver General
Hospital
Contact name
&
Organization
G. Dewey Evans
North Okanagan
Health Region
British Columbia
(Vernon, Salmon Arm,
Enderby, Armstrong,
Revelstoke)
Lynn Cregg-Guinan,
Osteoporosis Society
British Columbia
(Vancouver, Victoria)
Jenny Elliot,
Day Unit, Vancouver
General Hospital
British Columbia
(Vancouver General
Hospital, BC STAT
Centre)
Description
Evaluation
The interventions are being developed with local health authorities
and community groups.
Outcome measure is reduced number/rate per 10,000 of
hospitalized falls and hip fracture.
This partnership project targets seniors susceptible to falls and
employs strategies to reduce the risk of falling and decrease the
incidence of fractures, disabilities, deaths and other related
impacts. The one-hour workshops based on the “train the trainer’
models are delivered where seniors congregate.
None given
Small groups of clients attend health education sessions. The
physiotherapist provides information on fall risk factors present in
individual clients. The objective is to facilitate the cooperation of
individual clients with the interdisciplinary team in alleviating the risk
factors and teaching clients how to cope with their problems. The
sessions are approximately 50 minutes. Only a small percentage of
clients attend the sessions but all clients are treated by the
appropriate discipline to deal with risk factors. Clients attend the
Day Unit twice weekly for three months (average).
Funding has been secured to research the reliability of a tool to
assess fall risk, which has been developed by the physiotherapist.
The STAT Centre is ‘Evaluated” on a regular basis by Quality
Improvement Committees and the accreditation process.
None given
Esther Brisch,
North West Health Unit
British Columbia
(Telkwa, Houston,
Kitimat)
Tom MacLeod,
Self-assessment tool provided to enable seniors to identify risks
The First Step: Fall
and suggest ways to address them.
Prevention Starts with Northern Interior
You!
Regional Health Board
British Columbia
(Prince George)
Steady as you Go!
FPT Inventory of Community-Based Falls Prevention Programs
None given
Based on Burnaby booklet, evaluated by BC Injury Research
38
Table 3a: DESCRIPTION AND EVALUATION: Western Canadian Provinces (con’t)
Name of Program
Contact name
&
Organization
Myrtle Linden,
The First Step: Fall
Prevention Starts with Burnaby Coalition to
You!
Prevent Falls
British Columbia
(Vancouver, Duncan)
Description
Evaluation
The program consists of a self-assessment and self-empowerment
booklet for seniors to take control over their risks for falling.
Educational sessions are given wherever seniors and their
caregivers can be found. The formal sessions are given at the
request of any senior or group that wishes to learn about fall
prevention. A train-the-trainer draft model for delivery assists in the
dissemination of information (to relieve the chair who has been the
sole deliverer of formal sessions). It is envisioned that the Coalition
will offer a half-day workshop to individuals willing to participate in
this model. A workshop for instructors who work in the area of
fitness for seniors is being developed so that they will be able to
include the needed information in their courses. Simon Fraser
Health Region is working on building a coalition and then efforts will
be made to implement a region-wide fall prevention strategy.
The B.C. Injury Research and Prevention Unit in collaboration with
the Burnaby Coalition evaluated the coalition process and the use
of the First Step booklet. A focus group of six members of the
coalition that developed the program found the following strengths;
a broad spectrum of representation from the community,
commitment to a common goal, sharing the workload, and setting
specific timelines for activities and events. Challenges identified
included; a lack of funding and time, finding direction and focus,
and keeping the coalition process active after completion of the
main task. Telephone interviews were conducted with two groups
of seniors: those who requested the booklet by mail and those who
attended the half-day launch event. In-person interviews conducted
with the seniors attending group presentations revealed that
respondents were highly satisfied with the readability of the booklet,
the wording and the layout as well as with the overall booklet.
Ninety-six per cent of participants reported reading the booklet,
65% used the booklet to identify their major risk factors for falls,
11% of participants used the list of organizations and contacts and
40% of participants made changes to their environment or
behaviour.
Community Services
for Seniors, Primary
Health Program,
Seniors Health
Resource Team
Sonja Lundstrom,
Winnipeg Regional
Health Authority
Manitoba
(Winnipeg)
We are in the process of doing chart audits and collecting the data
To enable seniors to live independently in a health-conducive
from our computer entries. We hope this will completed by the end
community by providing primary health care, health promotion,
of November with a report by December/January
illness and injury prevention and disability postponement for
optimum quality of life. A registered nurse and an occupational
therapist provide these services. Targeted individuals are aged 55+
living in 5 apartment blocks in the River East area, 55+ individuals
who are members of Good Neighbours Seniors Centre and
members of the community at large. Outcomes include; increased
appropriate use of medication, appropriate use of mobility aides,
use of home management strategies related to presenting issue;
improved building and community physical environment to address
the issues of instrumental activities of daily living; improved and
maintained physical and mental capacities through health
promotion strategies.
Fall Prevention Week
Resource Kit
William Osei,
Coalition for Fall
Prevention Among
Seniors,
Saskatchewan.
An evaluation form was included regarding the resource kit and
The coalition planned a provincial Fall Prevention Week held Nov.
those received had positive feedback.
6-12, 2000. A resource kit of materials for use by health districts
and other stakeholders included a list of suggested activities to plan
for the week, a fall fact sheet, risk assessment clinic information,
order forms for fall prevention video, sample presentation on falls
and a fall prevention checklist.
FPT Inventory of Community-Based Falls Prevention Programs
39
Table 3a: DESCRIPTION AND EVALUATION: Western Canadian Provinces (con’t)
Name of Program
Safe Communities Seniors Fall
Prevention
Contact name
&
Organization
Leslie Rea- Winichuk
& Sarah Nixon-Jackle,
Saskatoon District
Health - Public Health
Services
Saskatchewan
(Saskatoon)
Description
Public health nurses in the Older Adult program provide an hour
education session to groups of seniors in the community. The
objectives of the sessions are to: become aware of the causes of
falls; learn tips and checks to remove avoidable hazards for
ourselves and our environment; learn of local resources to support
or assist to reduce/eliminate risks. Written resources are provided
to participants.
FPT Inventory of Community-Based Falls Prevention Programs
Evaluation
None given
40
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories
Name of Program
Christmas Gift
Package
Developing a
Community-Based
Education Program
for Older Persons
Don’t Fall in the Fall
Education/Early
Intervention ProgramFalls Prevention
Session
Contact name
&
Organization
Marnie Garrett,
Lambton Health Unit
Ontario
(Sarnia)
Description
Evaluation
The focus of the Christmas Gift Package program is a bright red
pail fitted partially with sand and scoop to use outside the front/
back door to deal with icy steps and walkways. As well, flashlight
and batteries, advanced foot care program coupons, Meals on
Wheels coupon, Health Heart pins, CMHC home safety
assessment guide, “Living it Up” – a Lambton County Activity
Guide, candy, eau de toilette samples, pickle pickers, lid grabbers
and pamphlets advertising seniors’ associations’ handyman
services are included and packaged festively. Fifty packages were
created for a cost of $10 each. The intent is for these to be
purchased for the older adult for use in their homes.
None given
To help dispel any myths older persons may have about osteoarthritis and osteoporosis and about the chiropractic approach to
care, and to suggest ways to safety-proof a person’s home, slides,
anatomical models and handouts are used by 7 chiropractic interns
in various senior’s centers. There is also a discussion on exercise,
nutrition.
Kathy Nesbitt,
Half-day workshops for community dwelling seniors highlighting
The Elgin Safety Team different risk factors through skits, presentations, etc. Resources
used are: “You Can Prevent Falls” flipchart, brochures, placemats
for Adults.
and displays adapted from Brant Co. We also use the Safe Living
Ontario
Guide for Seniors, Physical Activity Guide for Older Adults and
(Elgin)
Knowledge is the Best Medicine.
None given
Sonja Habjan,
Sister Margaret Smith
Centre.
Ontario
(Thunder Bay)
Because it is a new program limited evaluation is being conducted.
Evaluation by seniors who participated in the program: 87% felt the
content of the session was “very good” or “good”, 90% felt the style
of the session was “very good” or “good”, 84% felt the usefulness of
the session was “very good” or “good”, 64% of participants
indicated they will make some changes in their behavior because of
the information they learned.
Brian J. Gleberzon,
Canadian Memorial
Chiropractic College
Ontario
(12 sites)
The Education/Early Intervention program consists of 7 sessions
(one of them being Falls Prevention Session) using a multidisciplinary approach and designed for presentation in a community
where seniors live or congregate. Each session is targeted toward
adults over the age of 55, and their care providers. The length of
the sessions is between 45 to 60 minutes, with another half hour for
conversations with individual participants if needed. After each
session, the participants are given written education material.
FPT Inventory of Community-Based Falls Prevention Programs
None given
41
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Fall Prevention
Program
Fall Prevention
Program
Contact name
&
Organization
Grace Castro-Nolet &
Jane Stewart-Gray,
SCO Geriatric Day
Hospital.
Ontario
(Ottawa)
Ginette Asselin,
Region of OttawaCarleton.
Ontario
(Ottawa-Carleton)
Description
Evaluation
Hosts a 35- member fall prevention coalition. Provides fall
prevention education sessions and displays (English and Chinese)
for groups of seniors and health professionals, fall prevention
clinics for seniors in apartment buildings and community settings,
fact sheets, resources, newsletter inserts for health professionals
and seniors in English, Chinese, and Italian, personal consultation
and education and advocacy for safe environments, home visits
referred by health professionals. Develops policies and education
e.g. training for caregivers and home support workers on a home
exercise program to prevent falls for their clients/family members.
Monitoring of Incidence: a periodic analysis of the incidence, impact
and health care resource usage is drafted and widely distributed to
key health care planners, funding bodies and agency leaders.
Highlights of the coalition’s activities over the past five years include
distribution of a simple, self-administered risk assessment tool
(translated into English, Chinese and Italian) to over 29,000 seniors
and their caregivers. Group education sessions have reached over
10,000 seniors. There have been 40 media campaigns. One-onone counseling has been provided to 600 seniors by public health
nurses during falls clinics and at follow-up visits. Annual
newsletters are distributed to 1,500-3,000 care providers and
physicians, highlighting the latest research findings on falls
prevention. A directory of “Falls Prevention and Rehabilitation
Resources” was distributed to over 800 providers. A workshop,
“Strategies for Falls Prevention”, drew representatives from over
50% of all long term care facilities in York Region. Public health
nurses have worked with individuals, seniors, and groups to
advocate for safer sidewalks in Markham, longer lights and
crosswalks in Newmarket, improved sidewalk clearing and repair.
York Region Community Coalition members and The Centre for
Activity and Aging were involved with organizing and delivering
home support exercise program workshops for groups of
homemakers in York Region during the fall of 1998 and the winter
of 1999. Over 250 workers have received the training and can
provide this program to their clients.
Components of the program include awareness activities and
planning social marketing strategies. The theme identified by
seniors is “ Cherish Your Independence -- For Seniors A Fall Can
Take It Away”. The following resources were developed on the risk
factors for falls and areas of intervention:
!" a Senior’s Guide to Preventing Falls (booklet),
!" fact sheets available in English, French, Chinese, Vietnamese
and Italian,
!" three pamphlets (Are you at risk? Tips to Relax, Puzzled about
a Gift for Seniors?)
Additional awareness strategies include submission of articles to
various seniors and community newspapers, presentations to
community groups, and displays at community events. Fall
prevention clinics are held in locations where there is a higher
concentration of frail/high-risk seniors. Seniors identified at risk for
falls are offered a home visit. Fall prevention workshop and
presentations were designed for health professionals and service
providers. They include information on risk factors and areas of
intervention.
None given
FPT Inventory of Community-Based Falls Prevention Programs
42
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Contact name
&
Organization
Fall Prevention
Sandra Vessel,
Program
Injury and Substance
Abuse Prevention
Team,York Region
Health Services Dept.
Ontario (Newmarket,
Aurora, King,
Vaughan, Georgina,
East Gwillimbury,
Whitchurch, Richmond
Hill, Markham)
Fort Frances Senior's Dorothy Poperchny,
Coalition
Northwestern Health
Unit.
Ontario
(Fort Frances)
Healthy Aging & Adult Colleen Stahlbrand,
Hamilton-Wentworth
Wellness
Falls/Prevention
Social and Public
Health Services
Division.
Ontario
(Hamilton, Hamilton
Wentworth)
Home Healthcare
Equipment Services
(HHES)
Canadian Red Cross
Society
Ontario
Home Safe Home
Road Show: Injury
Prevention for
Seniors in the
Elsie Petch &
Elizabeth Smith
South Riverdale
Community Health
Description
Evaluation
Clients are selected from those already attending day hospital who
have a Folstein Score of 24/30 or above. Services provided
include: pre & post measures; home visit using Westmead home
safety assessment; exercise program taken from Canadian Centre
for Activity and Aging; personal risk factors identified; medications
reviewed; education series including, ‘How to get up from a Fall’;
benefit of exercise and risk factors; follow-up at 3 and 6 months.
Berg balance scale, timed up-and-go, sit-to-stand, 6-minute walk,
program evaluation questionnaire, number of home modifications
identified, change in personal risk factors.
Fall prevention is part of the integrated senior’s program series.
Ten seniors signed up for exercise program. 54% of respondents
found out about a service/resource in the community that they
previously did not know about.
Public health nurses provide: group education aiming at riskreduction and healthy lifestyle choices through educational drama,
displays, presentations, health and safety fairs; liaison as key
resource to community leaders, health care and service providers,
staff of senior and recreational facilities; co-ordination and support
for volunteers in their work; for community groups in their efforts to
promote, maintain and improve health; advocacy for equal access
and reduced barriers to health information and service i.e.
community audit for safer streets; in partnership with the
community, support for policy change to make our communities
healthier and safer; collaboration with partners and participation in
coalitions for research, resources and program development, i.e.
Central West Coalition of Health Depts., Seniors Safety Committee
(local, multidisciplinary).
Individual programs evaluated on an ongoing basis
A low cost, short-term loan service offers a variety of health care
equipment to individuals in communities and provides mobility
equipment to residents who are recovering in their own homes from
illness, injury or surgery. Information is given on the proper use of
the equipment. The equipment loaned helps with fall prevention
including walkers, crutches, canes, wheelchairs and bath aids
(stools and seats).
The Home Safe Home-Road Show (HSH-RS) is a unique seniors
injury prevention project located principally in the South Riverdale
Community of East Toronto. The goal of the project is to enhance
and maintain the health and independence of the well elderly
The Red Cross began the equipment loans program in 1945. Since
that time there has been little change in the basic service. The
program has been evaluated and updated about every 10 years
and is currently being evaluated in several areas to ensure it meets
current standards and practices.
FPT Inventory of Community-Based Falls Prevention Programs
The HSH-RS Project is a model for health promotion and injury
prevention in the senior population, and a strategy which can easily
be transferred to different community groups and populations. It is
evident that the main focus of this project is to improve life
43
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Community
Contact name
&
Organization
Centre
Ontario
(Toronto)
Description
population in the community, through an innovative and respectful
educational approach to injury prevention. The challenge of the
HSH-RS was to develop injury prevention approaches and
messages, which would reach the largest population possible with
particular emphasis on a multi-cultural urban population. It
recognizes the importance of senior health promotion and
preventive strategies to ensure a healthy future for the elderly.
Evaluation
satisfaction of the elderly, and in turn increase the seniors’ sense of
quality of life. It is strong in emphasizing personal risk assessment.
A key area of the project was home safety, strategies for which
were discussed by staff and participants for making minor home
repairs and adjustments. The project encouraged its participants to
increase their awareness of risk in everyday activities. It was
successful in encouraging the participants to spread safety
information to others.
Participants of the workshop felt they had learned a lot of very
useful information and that the manuals will help them in their work.
The developer evaluated the program extensively. I have used it in
a senior’s apartment building and assessed the progress of
participants. There was an improvement in balance, flexibility and
muscle strength after 3 months.
Home Support
Exercise Program
Nancy Ecclestone,
Canadian Centre for
Activity & Aging.
Ontario
This is a 4-hour workshop for home support workers, volunteers
and family caregivers. Participants learn the skills to assist family
and homebound seniors in doing physical activity while they are in
the home. This program was developed by: The Centre for Activity
& Aging, in London, Ontario. This is one of many relevant
programs described on their web site: http://www.uwo.ca/actage/
Home Support
Exercise Program
Etheleen Porter
Brysch,
Thunder Bay District
Health Unit.
Ontario
(Thunder Bay)
The Home Support Exercise Program (HSEP) was developed by
the Canadian Centre for Activity and Aging in 1996. It is comprised
of 10 simple yet progressive exercises designed to enable frail,
homebound older adults to maintain or improve their functional
mobility and independence. Training resources, including a
facilitator guide, resource manual, picture package and video, have
been developed along with a HSEP workshop and training program
for the trainer. Collaborative work has already begun in order to
develop a model program for implementation of the HSEP and
dissemination of the program across the province. The HSEP has
been pilot-tested through a volunteer visitor network. The Centre
will continue to investigate this mode of delivery, along with the
delivery of the program through informal caregivers such as family
or friends.
Injury Prevention
Including Substance
Abuse Prevention
Program
Lorraine A. Cass,
Population Health
Service, Public Health
Branch, Ontario
Ministry of Health and
LTC.
Ontario
(37 Health units)
To reduce the rate of fall-related injuries by 20% in the elderly, aged No formal evaluation of this program has been done by the Public
Health Branch. However, all 37 health units provide information on
65 or more, that lead to hospitalization or death by the year 2010.
Mandatory Program Indicators to the Branch on a yearly basis.
To develop, maintain membership, and actively participate in a
community injury prevention coalition and substance abuse
prevention coalition. To promote and provide on an annual basis,
educational information and activities on three of the topics
identified. Provide at least one community-wide education
campaign annually. The campaign must use three of the following:
television, radio, newspapers, posters/pamphlets and the Internet.
FPT Inventory of Community-Based Falls Prevention Programs
The HSEP pilot was completed in 1998 to evaluate the
effectiveness of the program through formal support service
providers (Community Care Access Centers and home care
agencies). Development and formative evaluation was conducted
and published in the Journal of Aging and Physical Activity. A
controlled research project has been conducted (1998-2000) to
further evaluate the effectiveness of the program in enhancing and
maintaining client mobility and independence, and to investigate the
feasibility of delivery of the program through a home care network.
Client assessment took place in homes before and after the 16week intervention. Home support workers were trained to provide
ongoing motivation and support to their clients during their weekly
home care visits. Data collection has been completed and analysis
is in progress. Preliminary results suggest that the HSEP is
beneficial in improving client physical and psychological well-being,
as compared to non-exercising control clients. The program can be
successfully implemented through the home care network. Based
on falls statistics, the HSEP has potential as a fall prevention
strategy.
44
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Living it Up
Markham Stouffville
Rehabilitation
Program
Contact name
&
Organization
Marnie Garrett,
Lambton Health Unit.
Ontario
(Sarnia)
Tina Healey,
Marhkam Stouville
Day Hospital.
Ontario
(Markham)
Description
Evaluation
A free simple-to-use booklet outlining alphabetically all activities
offered in Lambton County, complete with telephone number and
name of contact person.
None given
The hospital runs a falls clinic once a week through our out- patient
day hospital rehabilitation program. A nurse sees the patient for 30
minutes, a physiotherapist for 45 minutes and then the geriatrician
for 45 minutes. Recommendations are made, such as using
appropriate walking aides, having physiotherapy, or medication
adjustment. The entire assessment is covered by OHIP and is
funded by the hospital’s operating budget.
None given
May Home
Improvement Sale
Marnie Garrett,
Lambton Health Unit.
Ontario
(Sarnia)
During the month of May, 13 retailers offer a discount on home
improvement items related to safety, i.e., grab bars, stair nails, tub
guards, floor repair items, night-lights, 2-way tape. The sale is
extensively advertised through radio and print media. A draw for a
home safety evaluation and $100 worth of repairs done by Handy
Man Services of the Lambton Seniors Association was a new
feature during May 2000 (the second event).
None given
North York Coalition
for Seniors' Falls
Prevention
Mary Jane Hurley,
Sunnybrook &
Women's College
Health Sciences
Centre.
Ontario
(North York)
The North York Coalition developed and produced a Falls
Prevention Guide, which we are distributing to as many seniors as
possible. The guide is also now available on a web site for easier
access by health professionals and others.
None given
FPT Inventory of Community-Based Falls Prevention Programs
45
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Older and Wiser
Safety Awareness
Coalition
Contact name
&
Organization
Beth Peterkin,
Older and Wiser
Safety Awareness
Coalition.
Ontario
Description
To enhance the lives of older persons in five key areas of concern:
1.
Independence: give support to enable seniors to remain at
home as long as possible.
2.
Participation: for seniors to maintain an active role in decisionmaking and communication within the community.
3.
Care: to ensure that seniors receive enhanced personal care,
whether it be at home or in a treatment center.
4.
Self-Fulfillment: allow seniors the opportunity to learn and grow
in all areas.
5.
Dignity: to ensure that seniors receive the utmost respect and
dignity.
Evaluation
Evaluation of this program is still it its infancy. The safety checklist
completed by home care workers are being repeated at 6 to 12
month intervals in order to measure a change in attitudes and
behaviors with regards to home safety. Subjective reports received
to date indicate a high level of satisfaction with the program and a
willingness for continued involvement
This program began as a fire safety initiative and quickly expanded
to include other safety issues. Focus groups held with seniors’
groups actually identified home safety and telephone scams as
their main areas of concern. Accomplishments to date include:
increased awareness in the general public of potential dangers to
seniors living independently; education of seniors who are living
independently about how to be safer in their homes; development
and distribution of the Older and Wiser Safety Binder; free
distribution and installation during the first year of over 100 needed
smoke alarms in seniors’ homes with regular battery checks and
replacement during home visits; 300 safety placemats have been
delivered to seniors living independently; partnerships were
developed with over 40 community groups and organizations which
further strengthened the promotion of seniors’ safety; service
providers completed a safety checklist on each home visit. This
program is being expanded through the production of 200,000
decks of playing cards with safety messages. The Ontario Fire
Marshal’s Public Safety Council is working with the coalition by
assisting with card distribution to seniors across the Province of
Ontario.
Public Awareness
Campaign. Avoiding
Trips, Slips and
Broken Hips
Etheleen Porter
Brysch,
Thunder Bay District
Health Unit.
Ontario
(Thunder Bay)
Video on falls prevention shown on cable television, articles in
newspaper. Presentations are given to seniors, caregivers and
volunteers. Display development and distribution of Seniors Home
Safety Kits. A fall prevention coalition was developed.
FPT Inventory of Community-Based Falls Prevention Programs
Project still in progress, however requests for the kits are a positive
sign. We are using the Logic Model for evaluation and will look at
process as well as outcome.
46
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Safe Step
Contact name
&
Organization
Shirley Albinson,
Kingston, Frontenac,
Lennox & Addington
Falls Prevention
Coalition.
Ontario
(Kingston)
Description
Evaluation
Complementary strategies include: newspaper articles; health talks
on local television station; displays on fall prevention at seniors
health fairs and malls; Positive Steps Fall Prevention and Exercise
Program promoted to seniors living in geared-to-income housing;
Steady As You Go Falls Prevention Program was implemented in 5
senior housing complexes. Partnerships with the College of
Nursing and College of Kinesiology assisted the implementation of
the exercise programs in seniors housing facilities. Safe use of
medication, education presentations are presented on separate
occasions to groups who receive fall prevention education.
A progress evaluation was done in the Step Safe project. Surveys
done by the local radio station, CKWS, have shown that they reach
264,748 people between Napanee and Kingston, minimum of once
a week. Of those reached 52% are male and 49% are female. For
National Seniors Week the four commercials were shown 90 times.
Seniors Med-Safe
Program
Donna Basler
Public Health Nurses,
Regional Public Health
Dept.
Ontario
(Central West)
A Medication Record Booklet (MRB) and computer-generated
printout enhance the drug prescribing system. Computer software
allows pharmacists to include the directions for use of prescription
and over-the-counter medication on the drug profile. By routinely
placing the current computer-generated drug profile in the MRB,
pharmacists provide seniors with a tool that they can use with
confidence to transmit vital information to health care professionals.
Requesting the MRB at each medical appointment, facilitates
regular medication review and encourages the active participation
of seniors in their health care. The combined effort of all
community partners to promote the use of the MRB should sustain
its use among seniors. This community-based strategy should
reduce fall-related injuries and hospitalizations where medication
use is a risk factor.
To date, one community has been evaluated and several more
communities are in the evaluation process at this time. The goal of
evaluating the Medication Record Program in Port Colborne was to
determine the level of community awareness six months after the
program’s launch. Three evaluation approaches were used
consisting of 1) a respondent survey (n=113 seniors age >65);
2) in-depth telephone interviews with seniors (n=8); and,
3) physician questionnaires (n=4). The most substantial data set
was the respondent survey, which took place on Seniors’ Day in
each of the 4 pharmacies. Of the seniors surveyed in the
pharmacies (n=113), 88.5% were taking prescription medications
and 51% indicated knowing about the MRB. Thus, the goal of
awareness of the MRB was achieved. Of the seniors surveyed,
36% had the MRB. Thirty-six per cent of seniors surveyed were
found to be taking 4 or more prescription medications. A direct
correlation was found between the number of medications a senior
was taking and the use of the MRB. There was also an in-depth
qualitative telephone interview and evaluation of physician
responses.
Sunnybrook Falls
Prevention Program
Susan Maddock & Sue
Gal. Sunnybrook and
Woman's HSC .
Ontario
(Toronto)
The Falls Prevention Program combines an exercise intervention
and educational component with the aim of preventing falls in
community-dwelling seniors. Participants attend twice weekly for
six weeks for 45 minutes of exercise. The exercise circuit consists
of seven, 5-minutes stations including: stationary bicycles, quads,
over a roll, various balance exercises, the parallel bars with and
without a step, sit-to-stand from a chair using proper technique,
bridging, and gait training (including how to turn safely). We also
briefly ran a chair exercise program consisting of sitting and
standing exercises, but for our population and environment, we
preferred the circuit. The educational component consists of a
home safety discussion/lecture with an OT, instruction on a home
exercise program (balance exercises), and learning how to get up
Injury and social isolation resulting from a fall, present major health
issues for elderly persons. This project was developed to evaluate
a program aimed at improving gait and balance in order to
decrease the incidence of falls. The main component of the
intervention is exercise. Subjects were 51 seniors over the age of
65, living in the community, with a history of falls or near falls, and
the ability to walk 60 meters. Participants completed a 45-minute
exercise circuit, twice a week for 6 weeks. An OT conducted one
home safety educational session. Outcome measures included the
Berg Balance and Tinetti Gait Scales, which were tested before and
after the intervention and again three months later. The Falls
Efficacy Scale was used for the first 19 subjects and then
abandoned. Falls were monitored by subjective report. Clients
FPT Inventory of Community-Based Falls Prevention Programs
47
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Contact name
&
Organization
The Power Program
Rosslyn Bentley,
Baycrest Centre for
Geriatric Care, North
York General Hosp.,
Yee Hong Centre for
Geriatric care.
Ontario
You Can Prevent
Falls
Kathryn Nesbitt,
Elgin Health Unit.
Ontario
(Elgin - St Thomas
Health Region)
Description
Evaluation
also completed satisfaction questionnaires. Improvements in Berg
from the floor. Clients who live alone are given information on
scores were statistically significant with an average increase of 5
lifeline. Before each session clients are asked if they have had a
fall or a near-fall and the group discusses strategies to prevent falls. points.(C.I.=3.66-6.09, p=.001). Tinetti Gait scores improved by an
average of 1.09 (C.I.=0.59-1.58, p=.001). Analysis of the Falls
Efficacy Scale did not demonstrate any significant results or trends.
Subjects reported less falls during the intervention and at follow-up,
and subjectively felt that they benefited from the program.
Attendance was excellent and feedback on the satisfaction
questionnaire was very positive. There are conflicting results in the
literature, regarding the effect exercise has on falls. There is
growing evidence that exercise does play an important role in falls
prevention in seniors, however, relatively few programs in the
community include an exercise component. Our evaluation
suggests that our protocol resulted in several beneficial outcomes,
and exercise can play an important role in falls prevention.
POWER is a program of education, nutrition and exercise geared to None given
the needs of the older adult. The program was devised through a
multi-disciplinary planning team drawn from the partner
organizations, Baycrest Centre for Geriatric Care, North York
General Hospital, Yee Hong Centre for Geriatric Care and Toronto
Public Health. This partnership has provided the following benefits:
a greater pool of expertise to develop the teaching material; more
clients reached over a great geographical area; opportunities to be
more culturally sensitive with delivery of a program in Chinese.
networking and cross-organizational peer support provided; and
increased opportunities for collaborative resource use and
research. The program is aimed at seniors who are living in the
community with a diagnosis of osteoporosis who have not yet been
educated about their condition and who have not yet achieved lifestyle changes that might make a difference to their quality of life. It
is taught over 7 weeks, and consists of three elements: education,
exercise and nutrition.
Half-day workshops for community-dwelling seniors highlighting
None given
different risk factors through skits, presentations, etc.. Resources
used are: You Can Prevent Falls, flipchart, brochures, placemats
and displays adapted from Brant Co.. We also use the Safe Living
Guide for Seniors, Physical Activity Guide for Older Adults and
Knowledge is the Best Medicine.
FPT Inventory of Community-Based Falls Prevention Programs
48
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Index of Available
Documentation and
Resources for the
Prevention of
Falls of the Elderly in
their homes
(documentation
published in 1999).
PIED Program
Enriched Physical
Exercise Program
Contact name
&
Organization
Charles Lemieux,
Québec Public Health
Department, Gaspé
Peninsula and
Madeleine Islands.
Québec
Yvonne Robitaille &
Francine Trickey,
Montreal Regional
Public Health Dept.
Québec
(Montreal).
Description
This index lists available documentation and resources for the
prevention of falls for the elderly living in their own homes. Each
listing is done according to type (guide, poster, video, study,
games, education, etc.), and relevant risk factors (physical
activities, nutrition, safety measures in the home, etc.). The
documentation lists the author, year of publication, cost and how to
obtain it. The index enables one to quickly find desired
documentation or resources.
None given
The first edition of P.I.E.D. is offered to groups of 15 seniors, 3
times a week:
• Group exercises (2X60 minutes a week) target the
physical components of balance and leg strength
(muscle strengthening, routines, etc).
• Tai Chi (1X60 minutes a week) use some of Taoist Tai
Chi movements or the Tai Chi developed in the FICSIT
study (Wolf et al., 1996).
• Group discussions (6 meetings).
In 1996, the Montreal Regional Public Health Department tested the
program. The objectives of the quasi-experimental study were: to
describe the population reached by the program; to measure
participant satisfaction; and, to measure the impact of the program
on targeted fall risks. Members of the experimental group (n=30)
were independent seniors aged 60 to 70 (80% women) who had
fallen in the previous year. Subjects in the control group (n=20)
had the same characteristics but were from a different
neighbourhood. Overall participation rate was 72%, including three
dropouts. Participants and session leaders alike expressed a high
degree of satisfaction with all aspects of the program. Subjects in
the experimental group demonstrated improvement on 4/5 balance
tests compared to controls. Two of these tests were statistically
significant. For 7/10 computerized balance tests, relative
improvement was higher for the experimental group (non-significant
result). By the end of the program, participants showed better
knowledge of risk factors and reported more safe behaviours than
subjects in the control group.
The next edition of P.I.E.D. will include strategies targeting bone
mass maintenance, medication management and maintenance of
gains in balance and strength. The intervention components will
include :
• group exercises (2X60 minutes a week);
• home exercise training (once a week); and,
• group discussions (10 meetings).
Pilot Project for the
Prevention of Falls
among the Elderly
residing in the
Community
Denise Gagne,
Québec Public Health
Department and CLSC
in two territories of the
region.
Evaluation
Pilot project of multifactorial interventions and plan of individual
intervention following from the recognized risk factors. The clients
are people aged 65+ at risk, from the two territories of the CLSC.
The objectives are:
!" To reduce the incidence of falls
!" To reduce emergency visits and hospitalizations
!" To reduce hip fracture
!" To reduce secondary mortality resulting from falls
FPT Inventory of Community-Based Falls Prevention Programs
None given
49
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
Regional Pilot-Project
for the Prevention of
Falls of the Elderly in
their homes. For
implementation in the
CSLCs.
Contact name
&
Organization
Claude Bégin,
Public Health
Department, Regional
Health and Social
Services Office of
Lanaudière
(Region of
Lanaudiere).
Safety Installations in
the Bathrooms of the
Elderly
Daniel Gagne,
Regional Health &
Social Services
Department for the
Abitibi-Témiscamingue
Region, Public Health
Management.
(Rouyn-Noranda)
Charles Lemieux,
Safety in the
Bathroom: Sensitizing Québec province
Guide Concerning the
Installation, the
Handling and the
Maintenance of
Safety Measures for
the Elderly Residing
at Home
(published in 2000)
Description
Evaluation
The project will be implemented within the services offered by the
CLSC to keep the elderly in their own homes in the region of
Lanaudière. The target population using these services is 55 years
of age and older, divided into two groups. Group 1 includes users
between the ages 55-64; this group receives information on the
prevention of falls in the home (1 leaflet) and on the inappropriate
use of drugs (1 leaflet). Group 2 includes users aged 65 and older.
These users are selected according to their degree of autonomy
(semi-ambulatory) and admission conditions. They also receive
two leaflets. The users of group 2 admissible to the project are
invited to participate on a volunteer basis. Upon their acceptance
an assessment of the risk factors is made and a list of
recommendations is given to them. The CSLC and the Public
Health Department will continue the follow-up care of the
participants for three years.
A video describing safety measures for the bathroom especially
designed for the children (45-55) of the elderly to heighten their
awareness of safety measures for the prevention of falls
experienced by their parents.
No evaluation has been made. The project is being elaborated
(pre-implementation). An evaluation will be made about the
implementation proceedings and the results of the risk factors.
The Guide covers safety measures for the bathroom with a focus on
the prevention of falls. It lists the possible fall risks, a description of
measures to be taken in bathroom installations (availability of
equipment, such as grab bars), the behaviour of the elderly when
taking a bath and the maintenance of a safe bathroom. Additional
teaching aids enable the instructors to propose and assess the
following sensitizing activities for the elderly:
!" a description of the equipment and resources available for the
elderly;
!" a list of modifications in the installation, behaviour and upkeep;
!" suggestions for games/exchanges/lectures.
Prior to its wide distribution, the Guide was assessed by the staff of
the CSLC Mer et Montagnes and by 4 groups of seniors residing in
the Gaspé region. Two groups belonged to seniors’ clubs and two
groups belonged to a day-care centre for seniors with mobility
problems (36 persons altogether). The seniors participated in
sensitizing activities consisting of a talk only, or of a talk followed by
games. The effectiveness of these activities has not yet been
assessed. The results have, however, enabled us to show that the
different sections of the Guide were pertinent, that the presentation
was appropriate and that the Guide could be widely diffused. The
participants declared satisfaction with the contents. Following the
activities, 94% of the participants declared to have learned
something new, 71% intended to modify the installation of their
bathroom and 86% intended to modify their behaviour. The daycare participants enjoyed the sensitizing activities more than the
those in the seniors’ clubs; they learned more and intend to modify
their bathrooms and to modify their behaviour. The talks followed
by games were more profitable than the activities consisting of a
talk only.
FPT Inventory of Community-Based Falls Prevention Programs
None given
50
Table 3b: DESCRIPTION AND EVALUATION: Central & Northern Canadian Provinces & Territories (con’t)
Name of Program
The Problem of Falls
Outside the Home
Contact name
&
Organization
Helene BélangerBonneau, Québec
Territory of Health
Emergencies
(Montreal Island and
Jesus Island).
Description
Evaluation
The context: The problem of falls outside the home has hardly been
studied and there are no data available for the Province of Québec
(except for limited data provided by a pilot project). Falls outside
the home are not classified as such in the international
classification CIMA-9. Importance of falls outside the home: The
extent of the problem of falls outside the home has not been
defined. According to some studies the extent of falls outside the
home varies from 40% to 56%, or to 70%. Climatic conditions
seem to influence the number of falls. Definition of a fall outside
the home: falls outside the home have been outlined according to
the definitions of the Kellog international Work Group, 1987, to
which some elements were added to adapt their definition to our
project. The definition of falls outside the home includes the
following elements:
!" A fall can occur in an urban environment, a garden, a park, in
the street (sidewalk and road), in an outdoor parking lot or on
an external staircase; and,
!" The fall does not occur in a home, in the workplace, in an
institution or a shopping mall.
The evaluation’s main objective was to conduct a feasibility study of
the pilot project, by identifying the degree to which the program has
been realized in its various sectors, including:
!" detection of incidence (use of chart);
!" plan of intervention (degree of achievement of planned
objectives);
!" intervention (proportion of recommendations followed by the
persons, the network and the attending physicians); and,
!" identification if the offer of services corresponds to the
demand.
FPT Inventory of Community-Based Falls Prevention Programs
51
Table 3c: DESCRIPTION AND EVALUATION: Atlantic Canadian Provinces
Name of Program
Healthy Active Living
Program for Older
Adults
Contact name
&
Organization
T. Farrow
(English) &
Margaret Richard
(French),
Provincial coordinators
New Brunswick
Description
Evaluation
The Healthy Active Living Program for Older Adults is a community- None given
based fully bilingual program that has been successfully operating
since 1993 throughout the Province of New Brunswick. Designed
and delivered ‘for seniors by seniors’ and through health education,
personal empowerment and prevention, the program is helping
seniors improve their quality of life. The main topic areas covered
by the program include: wise use of medication, healthy eating,
stress management, physical activity, and healthy choices. All
sessions are free-of-charge and delivered by trained volunteers,
part-time trainers and resource persons. To date over 74,000 New
Brunswick seniors have been exposed to the program, 2,400
workshops have been delivered and 970 communities visited.
Other activities started by part-time trainers and volunteers include;
Community Advisory Committees, social activities, walking clubs,
care facility tours, and health fairs.
Heather Oakley,
Saint John Regional
Hospital
New Brunswick
(Saint John)
Tamra Farrow,
Community Health
Promotion Network
Atlantic
New Brunswick
Production of education material for seniors. Our Injury Prevention
Expo is a week-long event held twice a year. It includes both
seminars and workshops on safety for seniors. The last day of the
week, we have a “Fair” where over 35 exhibitors are available to
interact/provide info for seniors.
Solicit partnerships of health professionals, CMHC, community
leaders, senior’s organizations. Legion members to promote
awareness. Deliver presentations to groups on falls prevention.
Provide general info, home checklist, self-assessment for risk of
falling, tips to prevent trips, slips and falls, and resource list.
Under development: evaluation plan includes gathering statistics
from the Trauma Registry over the next 5 years
Falls Prevention
Services – Specialty
Rehab Program
Linda Doody,
Dept. of Health and
Community Services
Newfoundland
The program provides individual training and education for clients
and caregivers. It runs twice a week for six weeks and each
session lasts 2-3 hours, providing comprehensive assessment,
treatment and education with supplemental home exercise
program. Information and equipment to promote safety and
independence addressed. Clients are seen at each session by the
physiotherapist and occupational therapist.
None given
Pro Hip Protectors
Dr. Barry Clarke,
LTC Veteran’s
Memorial Building
Nova Scotia
(Halifax)
The Pro-Hip model hip protector appears to be associated with
improved compliance with wear schedules. Findings provided and
recommendations for additional design modifications aimed at
further enhancement of compliance are made.
None given
Injury Prevention in
Seniors
Watch Your Step
“Parachute”
FPT Inventory of Community-Based Falls Prevention Programs
None given
52
V. REFERENCES
Alexander, B. H., Rivara, F. P., & Wolf, M. E. (1992). The cost and frequency of
hospitalization for fall-related injuries in older adults. American Journal of Public Health, 82(7),
1020-1023.
Grisso, J. A., Schwarz, D. F., Wishner, A. R., Weene, B., Holmes, J. H., & Sutton, R. L.
(1990). Injuries in an elderly inner-city population. Journal of the American Geriatrics Society,
38(12), 1326-1331.
Nevitt, M. C., Cummings, S. R., & Hudes, E. S. (1991). Risk factors for injurious falls: A
prospective study. Journal of Gerontology, 46(5), M164-170.
O'Loughlin, J. L., Robitaille, Y., Boivin, J. F., & Suissa, S. (1993). Incidence of and risk
factors for falls and injurious falls among the community-dwelling elderly. American Journal of
Epidemiology, 137(3), 342 - 354.
Rawsly, E. (1998). Review of the literature on falls among the elderly. Image: Journal of
Nursing Scholarship, 30(1), 47-52.
Robson, E., Edwards, J., Gallagher, E., & Baker, D. (2001). Steady As You Go (SAYGO):
A Falls Prevention Program for Seniors Living in the Community. Unpublished manuscript.
Tinetti, M., Mendes de Leon, C., Doucette, J., & Aker, D. (1994). Fear of falling and fallrelated efficacy in relationship to functioning among community-living elders. Journal of
Gerontology, 49(3), M140-147.
FPT Inventory of Community-Based Falls Prevention Programs
53
Appendix A
Inventory Cover Letter
FPT Inventory of Community-Based Falls Prevention Programs
54
From: Drs. Victoria Scott, Elaine Gallagher, Steven Dukeshire and Andria Scanlan
Re: Older Adults Fall Prevention Inventory
Date: October 18, 2000
Dear AIMNet Steering Committee Members:
Our apologies if this has arrived to you previously from another source, and if this is the case
please ignore the following.
Our research team is currently conducting a project for the Federal/Provincial/Territorial Offices
for Seniors that has as its goal the development of a Best Practices Guide for fall prevention
among community-based seniors. Part of our mandate for this project is to assemble an
inventory of Canadian programs designed to reduce falls and/or falls-related injuries among
seniors at home or within the community. We are interested in all types of community-based
programs including, but not limited to, individual and group programs; community organization
efforts; policy, regulation, or legislative changes; and environment, product, or equipment
modifications. Please note that, although extremely important, fall prevention programs targeted
only toward individuals living in an institutional setting will not be included in this particular
inventory. To be eligible to be included in this inventory, programs must have as their
primary purpose the prevention of falls or fall-related injuries among community-dwelling,
older adults in Canada.
If you are currently involved in a Canadian fall prevention program for seniors, would you please
fill out the Data Collection Inventory form attached and e-mail, fax or mail it to us prior to
November 15, 2000. If you offer more that one program please fill out a separate form for each
program. In addition, if you know anyone else who is involved in a community-based fall
prevention program for seniors, it would be greatly appreciated if you could pass this information
on to them, or send us their name, e-mail/phone number so that we may contact them. For those
who are receiving this document via e-mail, the attached Data Collection Inventory form is in a
‘Rich Text Format’ that should be able to be opened in Word or WordPerfect. If you have any
difficulties opening this document please let us know what format works best for you and we will
try to meet your needs.
Thank-you for your time in this matter.
Sincerely,
Victoria J. Scott, RN. PhD
Steven Dukeshire, PhD
Elaine M. Gallagher, RN, PhD
Andria Scanlan, PhD
Contact Information: Dr. Victoria Scott: e-mail: [email protected]; Telephone: (250) 721-7959;
Fax: (250) 721-6499
FPT Inventory of Community-Based Falls Prevention Programs
55
Appendix B
Data Collection Form
FPT Inventory of Community-Based Falls Prevention Programs
56
Data Collection Form for the Canadian Falls Prevention Program Inventory
Please complete by Nov. 15, 2000 and return to: Dr. Victoria Scott, Adult Injury
Management Network
e-mail: [email protected] OR Fax: (250) 721-6499
To complete this form as an e-mail attachment, first save it as a Word or WordPerfect
document, and after completing the form and closing the document, return it as a new
attachment to your return e-mail.
Information Requested
Please provide your responses in this column
Name of Program:
Name, address, telephone number,
e-mail of contact person(s):
Name and address of organization
offering this program:
Funding source(s):
Funding duration:
Is the program being offered nationally,
provincially or locally?
Please specify location(s)
(e.g. town, city, region, province):
Target population ages:
Approximate number of people
served per year:
Program goals:
Risk factors targeted:
Program description (maximum 150 words – if necessary, additional information may be attached):
Program evaluation (maximum 150 words, including main findings): OR: ! no evaluation conducted.
If possible, would you please mail a copy of your program and/or evaluation report to: Dr.
Victoria Scott, AIMNet, Centre on Aging, University of Victoria, P.O. Box 1700, Victoria, B.C.,
V8W 2Y2
Thank you for contributing to the Canadian fall prevention program inventory. We are
recommending to Health Canada that all participating organizations receive a copy of the final
inventory and the ‘ A Guide for the Best Practices in Fall Prevention’.
FPT Inventory of Community-Based Falls Prevention Programs
57
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