FACULTY OF HEALTH SCIENCES

Lindy Clemson Professor in Ageing & Occupational Therapy

NHMRC Career Development Fellow Ageing, Work & Health Research Unit

Moving from models of disablement to enablement ◦ 1997 version: Model of enabling disabling process

(Brand & Pope) ◦ Occupational therapy models of environment-

person-participation

“We all have our abilities and disabilities. As we get older the disabilities become more obvious. You lose some sight, some hearing and maybe your balance is worse. But what you have done is focus on our abilities. No one else has done that.”

Nancy, Stepping On, Clemson & Swann 2008

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How do we embed concepts such as social cognitive theory into protocols and practice?

Understand key elements that make a difference

Knowledge transfer and preventing program drift

Sustainability

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• The enabling-disabling process

• Environment-person-participation models

Explanatory

frameworks

• Enabling

• Goal setting and choice

• Decision making: The Preventive Framework

Motivations

and intent

• Exerting control

• Self efficacy

Beliefs about

capabilities

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Understanding and using key concepts when working with older people to prevent falls

To become more aware

Make decisions to change lifelong habits

Incorporate and sustain changes over time

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Evidence based: ◦ 31% fall reduction (IRR = 0.69) ◦ maintained confidence (MES p=0.042) ◦ used more protective behaviours (FaB

p=0.024)

RCT Published Clemson et al. JAGS, 2004

Manual outlines how to run it Clemson, Swann & Mahoney 2011(3nd Ed.) / Freiberg Press USA/Sydney University Press

US training and Licensing (WIHA)

Viewed as a self management program

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Multi-faceted → draws on best evidence ◦ Objectives designed for each session

◦ Homework to facilitate follow through

Based on adult learning principles

Strategies to enhance self efficacy in fall risk situations.

A decision making framework to explore barriers and options to managing risk

Variety of learning techniques including the use of story telling

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Engage people in what is meaningful and contextual

Sense of ownership Use plain language Develop trust Training in cues to self-monitor exercise, group

leader understands how to progress the exercises, links to falls

The importance of reflecting and evaluating; Reinforce accomplishments; Follow through

Use optimism and positive talk Link strategies and skills to personal goals

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Participating organisations = 16

Includes diverse cultural communities

Turkish 3 Arabic 1

Polish 1 Indian 1 Korean 1

50%

25%

13%

6% 6%

Welfare- not for profit

Community Health

Local Govt.

Food Services

Religious

Geographical location

Urban 13 Semi-rural 3

Dissemination study-offered training, Clemson, Mathews, Dean & Lovarini (Commonwealth community grant)

Implementation – best investment ◦ Training workshops enabled uptake ◦ Creative and diverse funding options ◦ Planning sustainability in early

stages ◦ Valued as core business ◦ Leadership- a champion to guide

development ◦ Partnerships with local council and

community groups ◦ Shift in roles ◦ Service provision across traditional

boundaries

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Program Sustainability in Diverse and Changing Organisational Contexts

Program

Benefits

& Value

People

Committed

& Skilled

Support

Tailored

& Ongoing

Program Network

Motivation & Capacity

Lifestyle-integrated Functional Exercise (LiFE) to reduce falls

3- arm RCT Compared LiFE and a structured

exercise program to gentle sham exercise

Reduced falls by 31% IRR=0.69 Home based, habit training

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Clemson, Fiatarone Singh, Cumming, Bundy, Manollaras, Munro & O’loughlin

NHMRC project grant

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Practice until mastered and then upgrade to a more difficult level

Balance Principle

Balance Strategy

Reduce base of support

Move to the limits of sway

Tandem walk down the hallway

One leg standing at the kitchen bench

Lean as far as can cleaning teeth

Tailored Activity examples

Many opportunities exist in everyday life activities to challenge balance and load muscles

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I was looking for ways to make life easier by doing less – now I look for ways to make some things harder

I do all the same things – just changed the WAY I do them

Functional tasks should be a focus for protection from falling

Aim to provide choice - another home based falls prevention program that works

Positive outcomes: more energy, improved function and increased participation in daily life activity

We need environmental stressors as we age

A challenge to occupational therapists to expand our home visit focus and to physiotherapists to incorporate functional exercise

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Beliefs

• Principles for balance

and strength

• Belief that can work

• Self efficacy

Habitual change

• Structural cues

• Planned

implementation

intentions (Holland,

2006)

• Active memory till

embedded in routines

Experience

functional

outcomes

• function, balance

• Goal achievement

• ?Central benefit

model (Liu-Ambrose, 2012)

• ?Sense of control

• (not falling)

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