Preventing falls in mental health: a pilot RCT

Brief name: Adapted Stepping On program The intervention comprises a tailored program based on the Stepping On falls prevention program. The intervention materials include the Stepping On program manual (used by the program facilitator and available from Sydney University Press at https://sydneyuniversitypress.com.au/products/124823), program handouts (used by the program facilitator and participants which are available to download at no cost from Sydney University Press at https://sydneyuniversitypress.com.au/products/124823#) and simple equipment such as ankle weights and assistive devices that can be used in the home. In this trial the Stepping On program will be tailored/adapted to the needs of older people with a mental illness who have an increased risk of falling compared to the typical older person living in the community. Program adaptations will be developed by an expert panel including mental health consumers. The Stepping On program will be adapted to include eight weekly sessions (compared to seven sessions in a typical program) plus a booster session at one month (compared to three months in a typical program). This tailoring of the program will enable more time for and repetition of program content, allow more time for participants to practice the exercises, reduce the content of each session, expand on topics more relevant to older adults with mental health conditions and permit close follow up of participants to ensure continuation of the fall prevention strategies practiced during the program. Other adaptations include a greater use of visual (rather than text-based) educational materials, regular practice and simple progression of the program exercises and a greater focus on topics such as sleep and medication management. Specific session topics will include: Session 1: Introduction, overview and risk appraisal Session 2: Exercise and moving about safely Session 3: Home falls hazards Session 4: Community safety and footwear Session 5: Vision, transportation safety Session 6: Medication management, sleeping better and mobility mastery experiences Session 7: Vitamin D and calcium Session 8: Reviewing and planning ahead Session 9: One-month booster session Activities in the program are based on a typical Stepping On program and include practice, discussion, educational content, decision-making, strategy development and sharing of experiences through story-telling. The program will be delivered by an allied health professional experienced in the delivery of Stepping On and be conducted in a community-based setting such as a community mental health service. Strength and balance exercises are effective in preventing falls, are an essential component of the Stepping On program and will be included in this trial. Exercise instruction will be provided by a physiotherapist. The balance and strength exercise manual used in the Stepping On program is available to download at no cost from the University of Sydney Press website at: https://cdn.shopify.com/s/files/1/2667/8266/files/Stepping_On_Balance_and_Strength_Manual.pdf?415. The manual will be used by participants to guide safe practice of the exercises at home and includes information on the types of exercises to do and how frequently they should be done. Adherence to the exercises will be monitored by the program facilitator through the use weekly exercise records maintained by the program participants. Adherence to the program will be measured using a program attendance sheet.