Falls and Injuries Prevention Exercise Service (FIPES)
| Description | Falls and Injuries Prevention Exercise Service provides an evidence based exercise programme for frail elderly patients with a history of accidentals falls or a profound fear of falling. |
|---|---|
| Setting | Exercise classes are run at various venues across Wandsworth |
| Populationting | Frail elderly patients with a history of accidentals falls or a profound fear of falling. |
| Intervention summary | Evidence based exercise classes targeted at improving lower body strength and power |
| Outcome Summary | Assessment of patients before entry to FIPES and every three months. |
| Startup Cost | Not known |
| Running Cost | Total running costs: £75 000 per annum Current running costs are approximately £120 per class, which includes transport for ten participants, instructor for 1.5 hours and venue costs. |
| Funding | Mainstream funding for the Wandsworth Primary Care Trust |
| Started | 2000 |
| Ended | Ongoing |
| Location | Wandsworth, London, England |
| Contact |
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Background
The Falls and Injuries Prevention Exercise Service (FIPES) provides an evidence based exercise programme for frail elderly patients with a history of accidentals falls or a profound fear of falling.
FIPES receives referrals from a wide range of medical agencies (physiotherapists, occupational therapists, GPs, consultant geriatricians and other falls related services such as the Wandsworth Teaching Primary Care Trust (tPCT) Integrated Falls Prevention Service. In addition, we receive referrals from social services and, occasionally, from lay people in day centres and the community.
Patients entering FIPES may be referred to other services such as local day hospitals and the Integrated Falls Prevention Services if they are too frail for our classes. They may also be referred to the Chair-Based Exercise Service that is run in the Local Authority (LA) sheltered housing schemes. (The Chair Based Exercise Service started as a local initiative between Public Health Department, the LA Departments of Housing and Sports Development.) Fitter patients may be referred to other exercise classes targeting independent older people – many of which are run in partnership with the Sports Development Department of the LA.
What is the problem you are trying to solve?
FIPES aims to reduce the risk of accidental falls in vulnerable patients through the use of exercise targeted at increasing lower body strength and power, as well as improving balance, confidence and walking ability.
What local organisations are involved?
We work with several medical agencies (see Background) and the LA Departments of Housing and Sports Development.
How many people are running this project and who are they?
The project is overseen by Ted Poulter, older persons’ exercise practitioner, based in the Public Health Department of Wandsworth tPCT. At present, one of the specialist exercise instructors from FIPES works two half-days each week on administration. There is a small amount of secretarial backup, about half a day per week.
What local population are you targeting?
Frail elderly people with a history of accidental falls or a profound fear of falling
How many people are you targeting?
We have in the region of 150 patients in the service (average for 2006).
Interventions
What interventions are you using to address the problem?
We provide exercise classes based on exercises targeted to increase lower body strength and power, as well as improve balance, confidence and walking ability.
Is the project design based on evidence? If so, please state reference.
Various studies have shown exercise targeted at risk individuals reduces the risk of falling 1 2 3 . Targeted exercise is also supported by current National Institute for Health and Clinical Excellence guidelines 4 .
Outcome
What outcomes or planned outcomes are you measuring?
All participants are assessed at entry into the service and then at every three months. Assessments are by means of validated field tests such as Timed Up and Go, and 180° turn, in addition to questionnaires such as SF36 (a multipurpose, short form health survey yielding an 8-scale profile of functional health). The values found in the assessments may be used to refer to either multi-disciplinary investigation or other exercise classes if improvement is great enough. No specific targets in terms of patient outcomes are set; the major day to day target is to maintain class attendance at around 12 per class to maximize the use of resources, in particular with regards to transport to and from the classes. We plan to assess the impact of the classes on the number of falls in the future.
Do you have any outcomes or results yet? If so, what are they?
Class sizes are well maintained at around 12 clients per class, which is quite demanding in such a vulnerable population. Average attendance for individuals is about 85%.
Is your project relevant to a government target or guideline?
National Service Framework for Older People: Sections 6 and 8 5 .
Feedback
What obstacles did you have to overcome to set up this project?
I was not at the PCT when the project started.
What have you learned about the project so far?
The demand for administrative backup is very high, particularly with such a frail population. However, working with such a population is also providing many opportunities to study the care afforded to these patients. For example, the prescribing they receive (patients receiving more than four medications is a risk factor for falling 1 6 ), and the use of bisphosphonates and calcium supplements for treating osteoporosis.
What would you do differently?
The service is under constant review in an effort to achieve the best use of resources. Current issues under review are: the option of charging patients a small contribution to their transport costs; limiting attendance at classes to a defined period of times (say, six to nine months); and the provision of additional educational materials to enhance adherence with home exercise.
References:
- Campbell A, Borrie M, Spears G. Risk factors for falls in a community-based prospective study of people 70 years and older. Journal of Gerontology. 1989; 44: M112-117.
- Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group exercise (Falls Management Exercise -- FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age & Ageing. 2005; 34(6):636-639.
- Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database of Systematic Reviews. 2003; Issue 4. Art. No.: CD000340. DOI: 10.1002/14651858.CD000340.
- National Institute for Clinical Excellence. Falls: The assessment and prevention of falls in older people, Clinical Guideline 21. National Institute for Clinical Excellence. November 2004. http://www.nice.org.uk/CG021NICEguideline (accessed 24 April 2007).
- Department of Health. The National Service Framework (NSF) for Older People. 2001. www.dh.gov.uk (search for 23633, accessed 24 April 2007).
- Robbins AS et al. Predictors of falls among elderly people. Results of two population-based studies. Archives of Internal Medicine. 1989; 149:1628-1633.