UNC Health Talk

The Otago Exercise Program reduces falls among older adults

by Zach Read – zread@unch.unc.edu

For older adults, a fall can have serious consequences. It may cause a hip fracture or result in head trauma. It may lead to reduced mobility, early nursing home admission, higher health care costs, and even premature death.

While it’s true that the odds of falling dramatically increase with age, research shows that older adults who participate in prevention programs reduce their likelihood of falling. At the Carolina Geriatric Education Center (CGEC), located at the UNC Center for Aging and Health, recognizing the consequences of falls and finding ways to reduce them is a priority.

“The problem of falls is an unrecognized health care crisis that costs the United States more than $28 billion a year,” said Jan Busby-Whitehead, MD, professor and division chief of geriatric medicine and director of the UNC Center for Aging and Health. “Patients are afraid of falling and afraid to tell their health care providers when they have fallen. We need to get proactive to prevent as many falls as possible.”

For the past two years, the CGEC, with the help of the CDC, has been educating health care providers and older adults about an effective and accessible fall-prevention program called Otago. Developed by the New Zealand Falls Prevention Research Group in the late 1990s, the Otago Exercise Program improves strength and balance for patients, includes in-home physical therapy, and requires fewer one-on-one sessions over the course of a year. The CGEC has trained nearly 400 PTs in all 50 states and as far away as the United Kingdom and Australia.

The CGEC believes that the more providers who are knowledgeable about evidence-based fall prevention, the better we can message to older adults that they can take steps to reduce their chances of falling, and the more likely they’ll be to try prevention programs that give them better strength and balance.

“It’s very important that patients get the message that while not all falls are preventable, they can do a lot to modify their risk,” said Tiffany Shubert, PhD, MPT, scientist for the UNC Center for Aging and Health. “It’s like a heart attack. You can’t prevent a heart attack, but you can modify your risk factors through programs like Otago.”

Mary Catoe, PT, GCS, took the online Otago training offered by the CGEC, and it has changed how she works. “Looking back, we should have been offering something like this a long time ago,” said Catoe. “It is an enormous benefit to my patients to have the opportunity for me to follow them for 12 months in a thorough strength, endurance, and balance program. I believe I will no longer see the regression and recurrent therapy referrals for several of my patients that have had on-and-off therapy for years.”

One of the unique aspects of Otago is that it is done in the privacy of one’s home, and when done correctly, older adults achieve the minimum dose of balance exercises necessary to achieve a protective effect. Otago, when done properly, produces a fall-reduction rate of 35-40 percent.

According to Shubert, patient feedback has been overwhelmingly positive for a number of reasons. “First, it’s empowering,” explained Shubert. “Patients don’t see PTs with the same frequency with Otago, so there is greater ownership and engagement by the patients. Otago only has 17 exercises, but at any time the patient is working on 5 to 10, which means they’re not being completely overwhelmed. So patients have an opportunity to learn and master the exercises, and they see themselves getting stronger because they know what their baseline is.”

Although the original program focused on training on frail adults over 80 years old, the CGEC believes that the therapy is perfectly appropriate for frail 65-year-olds as well.

“We’re letting clinicians identify people who are more appropriate,” said Shubert. “There is physiological age versus chronological, so if physiologically someone who is 65 is more like an 80-year-old, then they’re appropriate for the training.”

The CGEC’s Otago training program services physical therapists around the world. The large number of retirees living in and relocating to North Carolina make the state a particularly appropriate place to introduce Otago. In North Carolina, falls are the number one reason both for emergency department admission and accidental death for older adults. The CGEC is pushing to raise awareness about Otago among all levels of care providers locally, including within UNC Hospitals.

“We’re getting widespread interest in fall prevention from all providers,” said Shubert. “We have a project with Orange County EMS that we’re hoping to launch this month. Basically, we’re creating critical mass of providers educated in effective fall prevention and a pipeline linking older adults to these providers.”

While Otago needs to catch on with health care providers, the CGEC’s bottom-up, top-down educational approach is helping to start conversations between patients and their doctors.

“If patients tell their doctors that they want Otago, then we want the doctors to ask what it is and come back to us so that we can facilitate the care.”

To learn more about Otago, please visit the Otago resources page on the Geriatric Education Center site: http://www.med.unc.edu/aging/cgec/exercise-program