FALLS-EDU: Feasibility of a Student-Led Falls Prevention and Education Program for Community-Dwelling Older Adults in a University Health Clinic Setting

The intervention consists of two core components: 1. Falls Risk Screening/Assessment/Stratification 2. Tailored Falls Risk Management Who delivers the intervention: Senior (4th/5th year) osteopathy students under the direct supervision of experienced, registered osteopaths (clinical educators) at the university clinical teaching setting Mode of delivery: Face-to-face, one-on-one consultations within a supervised clinical teaching setting, one month apart. Additional follow-up one phone call between sessions (at around 2 weeks after initial consultation) Duration/frequency: - Two x 1-hour in-person consultations over 4 weeks - One follow-up phone call two weeks after the initial consultation - approximately 5-10 minutes INTERVENTION: (1) Falls Risk Screening/Assessment/Stratification. a) Screening and Assessment i. Case history including history of falls and falls risks ii. Patient-Reported Outcome Measures (Short FES-I) b) Assessment: iii. Physical Performance Measures - QuickScreen© Clinical Falls Risk Assessment; Timed Up and Go (TUG) test c) Stratification Using the results from the Falls Risk Screening and Assessment protocol elements (QuickScreen© Clinical Falls Risk Assessment, TUG and falls history) participants will be stratified into one of three risk categories: Low Risk, Intermediate Risk or High Risk. (2) Management Plan All participants will receive education and printed resources. Risk-specific components include: a) Low Risk: - Education on falls risk factors (https://cdn.activeandhealthy.nsw.gov.au/assets/Healthy-ageing-resources/Falls-prevention.pdf)- e.g., polypharmacy, vision issues (https://cdn.activeandhealthy.nsw.gov.au/assets/Healthy-ageing-resources/Eye-health.pdf), incontinence (https://cdn.activeandhealthy.nsw.gov.au/assets/Healthy-ageing-resources/Bladder-and-bowel-health.pdf), footwear, fear of falling. - Flyers: >> home safety checklist (https://www.cdc.gov/steadi/pdf/steadi-brochure-checkforsafety-508.pd ), >> get-up-from-floor technique (https://www.injurymatters.org.au/wp-content/uploads/2021/06/Up-Off-The-Floor-Arms-and-Knees.pdf) >> footwear checklist (https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0011/258536/Falls-Prevention-Foot-Care-and-Footwear.pdf) - Self-monitoring diary - Semi-individualised Modified Otago Exercise Program (OEP) (e.g. strength exercises sit-to-stand, heel and toe raises; and balance exercises such as tandem stand, one leg stand). >> Individualisation is informed by each participant’s falls risk stratification (low or intermediate risk) based on screening and assessment results, including the QuickScreen© Clinical Falls Risk Assessment, TUG, and a brief functional history. Senior student osteopaths, under clinical supervision, will assess each participant’s functional capacity and select a maximum of 2 lower limb strength and 2 balance exercises from the modified OEP menu that are safe and appropriate for home use. The exercises and prescription is based off level A and B of the OEP, and have deliberately been chosen to suit a student-led, feasibility trial format within a clinical education setting. >> Mode of administration: face-to-face, with the senior student osteopath team (under clinical supervision) prescribing a home-based program for the participant to complete independently at home. This occurs in consultation 1 (baseline). Then participants can choose to complete the exercises at home. The student team will conduct a follow-up telephone call to the participant at 2 weeks to check in and see if the participants have any questions/ challenges with the home exercises. At the second consultation (week 4), the student team will run through the previously prescribed exercises with the participant, and then make an informed decision (under clinical supervision) about whether to progress the participant in terms of repetitions, sets or other exercises. >> Intensity: Low to moderate, assessed informally via functional performance and self-reported exertion. >> Frequency: Participants will be recommended to perform their prescribed exercises up to 2-3 times per week. >> Duration: The program runs over a 4-week period. >> Monitoring adherence: A self-monitoring exercise diary is provided to track completion. It will also be discussed during a follow-up phone call at week 2 and reviewed again during the second clinic visit at week 4. - GP letter suggesting periodic monitoring b) Intermediate Risk: - Includes all low-risk strategies - Additional recommendation in GP letter to continue OEP for 12 months, preferably under allied health supervision. This recommendation is up to the GP and patient to organise. c) High Risk: - Education materials only – no home exercise prescribed due to safety concerns and risk mitigation in a student clinic setting - GP letter strongly recommending further multidisciplinary assessment - Example referrals: physiotherapist, exercise physiologist, falls clinics (e.g. community Falls and Balance Service or similar). To be organised by the GP within the patient's local setting and within their care preferences. Monitoring adherence: - Face-to-face session attendance checklist - Telephone call attendance - Exercise diary (self-monitoring)