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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