Whaioranga te Pa Harakeke – the effect of a Paearahi intervention on unintentional injury and recovery from injury in older Maori

Description of intervention(s) / exposure: Koeke (older Maori) injury-specific intervention Paearahi (health navigators) will deliver the intervention to koeke in their own homes (or in a mutually agreed location). Participants will be able to invite whanau (family members/support people) to be present during the consent process and intervention delivery. The intervention detailed below relates to the injury-specific intervention, which is a being tested in the current study. The intervention will include the following components: - home assessment to assess the risk of injury hazards and development of an action plan to address issues. This includes assessing for trip hazards, lighting issues, functioning smoke alarms - teaching strength and balance exercises that can be undertaken in their own homes and which are responsive to the individual needs and capabilities. Examples of exercises are: hamstring curls, small squats, back leg raises, side leg raises, toe stand, flamingo, walking the line, wall push-up, hip flex, step over, sit to stand. Participants will be advised to do all these exercises (approximately 30 minutes) three times a week as they are able. Participants will be asked to record frequency and duration. - education about injury prevention, rehabilitation and Accident Compensation Corporation (ACC) access - falls-risk assessment and basic health screening (https://www.hqsc.govt.nz/assets/Falls/PR/LSFL-AAA-Information-poster-Jun-2018.pdf) to identify whether referral to other health and social service providers* is required. The health screening involves asking simple questions within a number of different domains (including physical function, feet, vision, continence, nutrition, and medications). For example, in the continence domain, participants will be asked: do you have trouble making it to the toilet in time? *Referral pathways are already established within the current hauora practices and would follow the same pathways that are already available. However, paearahi will help koeke navigate these systems. Providers that are likely to be referred to include: general practitioners, Geriatric/Gerontology Nurse Specialist referral (likely initiated through GP), practice nurse, pharmacist medicine review, occupational therapist, physiotherapist, rongoa practitioners, counsellors, optometrist, podiatrist, nutritionist, community exercise programmes, social and welfare services. The intervention will be delivered over a 12-week period with the paearahi making at least 4 in-person/telehealth visits (initial visit plus every 4 weeks; duration of one hour) and weekly phone calls. There will be no maximum number of visits as the model is designed to respond to holistic needs, although it is unlikely that more than 12 visits (i.e once weekly) would be undertaken. The weekly phone-calls will be ‘check-ins’ so would be a minimum of 5 minutes for each person, but could be longer if action or follow up was required. Participants will be asked how they are doing, if they have sustained any injuries and if they are managing exercises. Any action identified in the in-person or telehealth visits will be discussed. No physical informational material will be provided as a standard part of the intervention. Multiple components will be undertaken at each visit. Paearahi will record all interactions on pre-designed data collection forms including frequency and duration of interactions. Participants will be given a diary or wall calendar to record exercise frequency and duration and injuries. For the home assessment, issues identified and action taken will be recorded by the paearahi. For the education session, the paearahi will record that it has been completed and who was present during the education (may be family members/support people also present). Paearahi training for the injury prevention/rehabilitation component will require completion of 4 x 3hour modules, likely delivered over a two week period. Module One will focus on injury in older adults and the research protocol, Module Two will focus on home assessment and referral pathways, Module Three will focus on the health assessment and referral pathways, Module Four will focus on research data collection, documentation, and evaluation. The training will be delivered in person by different researchers and health professionals, dependent on the specific module. Where specific content is delivered by experts who live outside the study location, video conferencing will be used - this is likely to only happen for the module one (injury in older adults and study protocol). Paearahi will be required to read the study protocol, some background information specific to each module as well as the data collection forms prior to the module. Module One will be delivered by a clinical academic general practitioner with expertise in falls prevention in older adults, and the study principal investigator. Module Two will be lead by one of the research team members with expertise in workforce development; expertise will be brought in from community occupational therapists. Module Three will be lead by the managers from the three research general practices (registered clinicians) with input from the expert GP already mentioned. Module Four will be led by the researcher leading the evaluation with input from the principal investigator.