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Icon: Multifaceted InterventionsMultifaceted Interventions: Stepping On

Clemson, et al.

This study used a series of small group sessions to teach fall prevention strategies to community-dwelling older adults. The fall rate among participants was reduced about 30 percent compared with those who did not receive the intervention. The intervention was especially effective for men. The fall rate among male participants was reduced almost two-thirds.

Population

Participants were individuals who had fallen in the previous year or who were concerned about falling. All were 70 or older and lived in the community. Most study participants were female.

Geographic Locale

Sydney, Australia

Focus

Improve self-efficacy, empower participants to make better decisions and learn about fall prevention techniques, and make behavioral changes.

Program Setting

Initial sessions were conducted in easily accessible community settings. Refreshments were provided before and after the sessions to give participants an opportunity to talk to each other and with the facilitators and content experts. Follow-up visits took place in the participants’ homes.

Content

The program addressed multiple fall risk factors: improving lower limb balance and strength, improving environmental and behavioral safety in both the home and community, and encouraging visual and medical screenings to check for low vision and possible medication problems.

Each session covered a different aspect to reducing fall risk:

  • Session 1: Risk appraisal; introducing balance and strength exercises
  • Session 2: Review and practice exercises; how to move safely in the home
  • Session 3: Hazards in and around the home and how to remove or reduce them
  • Session 4: How to move safely in the community; safe footwear and clothing
  • Session 5: Poor vision and fall risk; the benefits of vitamin D, calcium, and hip protectors
  • Session 6: Medication management; review of exercises; more strategies for moving safely in the community
  • Session 7: Review of topics covered in program
  • Follow-up home visit: Review fall prevention strategies; assist with home adaptations and modifications, if needed
  • Three-month booster session: Review achievements and how to maintain motivation

Duration

  • Seven weekly 2-hour program sessions
  • A 1- to 1½-hour home visit, 6 weeks after the final session
  • A 1-hour booster session 3 months after the final session

Delivered by

An occupational therapist (OT) facilitated the program and conducted the home visits.

A team of content experts, trained by the OT and guided by the Stepping On manual, led the sessions. These included:

  • A physical therapist who introduced the exercises and led a segment on moving about safely.
  • An OT who led segments on home safety, community safety, behavioral methods to sleeping better, and hip protectors.
  • An older adult volunteer from the Roads and Traffic Authority who spoke on pedestrian safety.
  • A retired volunteer nurse from the Medicine Information Project who discussed how to manage medications.
  • A mobility officer from the Guide Dogs who spoke on coping with low vision (The Stepping On manual has a topics section that outlines the information required to run this session).

Minimum Level of Training Needed

The program should be facilitated by a health professional with experience both in group work and in working with older adults in community settings.

This program requires a physical therapist, an OT, a person trained in road safety for older drivers who can discuss pedestrian safety, a low vision expert, and a nurse or community pharmacist who can discuss medications. Other potentially useful content experts include a podiatrist or perhaps a nutritionist. All content experts need to receive training in fall prevention.

Key Elements

Using content experts is critical. It is also important to let each expert know what is expected of them, to provide feedback, and to make sure each focuses on fall prevention.

The Stepping On manual is essential for all program facilitators and provides a step-by-step guide to running the 7-week group program. It outlines topic areas and provides the background information for each content expert.

Chapters include:

  • Essential background information for understanding the conceptual underpinning of the program and the group process
  • Valuable content information for all the key fall prevention areas that can be used to train local experts participating in the program
  • A guide to useful resources
  • Handouts for group participants
  • Ideas on recruitment and evaluation

Work is ongoing to develop training workshops and certification for Stepping On program leaders.

Available Materials

The program manual Stepping On: Building Confidence and Reducing Falls. A Community-Based Program for Older People by Dr. Lindy Clemson is available at

Freiberg Press Inc. PO Box 612 Cedar Falls, IA 50613, United States E-mail: bfreiberg@cfu.net

Study Citation

Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. The effectiveness of a community-based program for reducing the incidence of falls in the elderly: A randomized trial. Journal of the American Geriatrics Society. 2004 Sep;52(9):1487-94.

Contact

Practitioners interested in using this intervention may contact the principal investigator for more information:

Lindy Clemson, PhD
Associate Professor in Ageing, Head of Discipline (Occupational Therapy)
Faculty of Health Sciences, The University of Sydney
Cumberland Campus, PO Box 170
Lidcombe 1825, Australia
Tel: +61 (2) 9351 9372
Fax: +61 (2) 9351 9166
E-mail: lindy.clemson@sydney.edu.au

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