‘Steady As You Go’ peer-led, community-based fall prevention exercise classes for older adults: Falls, Injuries, and Costs

Abstract

Falls are common in older adults and are a major concern for individuals and health care funders. Interventions addressing strength and balance have been shown to be effective in fall prevention. Steady As You Go (SAYGO) is a community-based, peer-led, fall prevention exercise class adapted from the home-based Otago Exercise Programme (OEP) in New Zealand. It has been operating since 2003, and currently more than 40 classes are operating in the Otago region. Although this programme has been shown to increase and maintain strength and balance, and decrease fall incidence, information regarding circumstances and consequences of falling, costs associated with injurious falls, and class attendance is unknown. The aim of this study was to investigate the rate of falls, circumstances and consequences of fall events, types and costs of medical treatment sought following falls, and class attendance over 12 months in older adults participating in the SAYGO programme. Two hundred and ten participants from 17 existing SAYGO peer-led groups were recruited into a prospective cohort study. Fall rate in the previous year and data regarding years of participation in the SAYGO were obtained via a baseline questionnaire. Over the 12-month study period, the number of falls and fallers was collected via monthly fall calendars. Data about circumstances and consequences of falls were gathered via standardised fall event questionnaires. Information regarding types and costs associated with medical treatment sought after an injurious fall was gathered via phone-administered questionnaires. Follow-up phone calls were conducted to gather incomplete or missing fall and injury data. Negative binomial regression analysis adjusting for age, sex, number of medications, and total months of follow-up was used to examine whether long-term participation in SAYGO influenced fall incidence. Class attendance was monitored on a weekly basis and mean attendance was calculated. All analyses were conducted on participants that completed the 12-month study period except for the negative binomial regression analysis, for which the whole cohort was included. One hundred and seventy four older adults completed the 12-month follow-up (mean age 77.5 [SD 6.5] years, 160 females, 14 males). Mean years of SAYGO participation was 4.3 years (SD 2.5). Crude rate of falls for those that completed the 12-month follow-up was 0.85 per person year (PY). Exclusion of participants who fell more than five times decreased the crude fall rate from 0.85 to 0.69 falls per PY. Out of 148 total falls, 45% resulted in minor injuries, and 18% were classified as injurious falls that resulted in the participant seeking medical attention (all females). Six fractures (4%) were reported and none were femoral. Falls one year prior to the study and falls over the 12-month study period were highly correlated (r=0.897, p<0.001). Higher number of medications predicted more falls (incidence rate ratio [IRR] 1.29, 95% CI 1.04-1.61, p=0.019). Long-term SAYGO participation (≥3 years) resulted in lower fall incidence (IRR 0.91, 95% CI 0.84-0.98, p=0.02). The majority of falls occurred outdoors and more people fell in winter. The total estimated cost for all injurious falls was NZ$6,946. The average attendance rate over the 12-month follow-up was 73% with 31.5 classes attended out of 41.7 on average. Findings of this study suggest that sustained participation in SAYGO reduces fall incidence. Additionally, only a minority of falls resulted in the participant seeking medical treatment, suggesting that participation in the SAYGO classes may decrease the severity of fall-related injuries. More falls and injuries occurred outdoors, supporting other evidence that this cohort may be more active and robust than others in this age range. The SAYGO programme appears to be a low cost, effective fall prevention model with high attendance rates. Prospective, controlled studies on community translation of fall prevention exercise programmes into peer-led models are needed to confirm and extend these findings.