Shock As ACC Cans Falls Prevention Programme
30 OCTOBER 2009
Shock As ACC Cans Internationally Acclaimed Falls Prevention Programme
The New Zealand Association of Gerontology (NZAG) is shocked at ACC’s proposal to cease funding the Otago Exercise Programme for Falls Prevention (OEP). It joins with the Australian and New Zealand Society of Geriatric Medicine in calling for an explanation from ACC and Government Ministers.
The NZAG concern stems from the fact that falls are the leading cause of injury hospitalisation and in the top three causes of injury-related death in New Zealand. The cost to society of falls is very high and can have a major effect on quality of life, especially for older people. New Zealand’s population is ageing and falls are more common in older people.
New Zealand is leading the way with its Exercise Programme for Falls Prevention which targets people mover 80 years old who have had a fall and are living in the community. The OEP is a home-based, individually-prescribed exercise programme that takes place over a twelve-month period. It consists of a series of progressive leg-strengthening and balance-retraining exercises that a trained instructor prescribes during a series of six home visits.
After more than ten years the programme is showing show real benefits and is also shaping best practice. It is internationally respected and other countries are beginning to implement it. The OEP has been proven to reduce falls in people over 80 years old, by 35%, which means a significant reduction in related injuries and subsequent treatment costs.
Many older people living at home join the OEP after a fall because they are afraid of falling again, sustaining a serious injury and possibly ending up in care.
Elizabeth Sutherland is 83 and lives on her own in Hamilton. She had always helped others until she lost her balance and fell, damaging her hip and sustaining a wrist fracture. She was in severe pain and couldn’t even turn over in bed by herself.
“I was always very healthy and this was a severe blow, both mentally and physically. I was appalled to think I couldn’t manage,” she says. “Then I got on to the OEP and started to do balance and muscle strengthening exercises. As I got stronger, the pain grew less and my balance improved. I now only use a walking stick when I go out in public. I’m determined to keep exercising until I have the confidence to get rid of that too. It would be terribly short-sighted to remove such a very effective programme. It’s a lot cheaper than full time care or having a hip operation.”
This story is a similar one to many others in the community. Joan Pottelwell is 85 years old. Things didn’t go well for her after a hip replacement and she ended up in excruciating pain in a wheelchair. Her daughter took her home to care for her.
“I thought I’d eventually have to go into a rest home as I didn’t want to be a burden to my daughter.” Fortunately Joan was told about the OEP and within two weeks of daily exercises she started to notice an improvement. After two months she was not only able to go out without a walking stick, but has also lost her fear of falling.
Joan Pottelwell was one of the lucky ones. A recent New Zealand study showed that about 20% of hip fractures in older people result in death within 12 months. Only 48% of patients regain their pre-fracture level of mobility by 12 months and at the time of discharge 56% needed a walking frame. People on the programme have been shown to regain their mobility quicker and therefore their independence
The estimated cost of hospitalisation for a hip fracture is between $21,000 and $28,000. This does not consider other costs after the patient leaves hospital, which can include rest home care. An independent Norwegian study showed the costs saved by the OEP are nearly twice the cost of implementing the programme.
NZAG President, Dr Valerie Wright-St Clair says, “The OEP makes sense from both an economic and public good perspective. We believe ACC’s decision to stop the OEP is a step backwards for injury prevention and health promotion for older people. We are seeking a robust debate with the Ministers for ACC, Health and Senior Citizens.
“As the lead agency in the NZ Falls Prevention Strategy that involves other sectors, ACC is cutting funding to a key component, the OEP, without taking into consideration the impact on the other areas of the health system and on older people.
“Not only is exercise good for preventing falls, it is emerging as the single best therapeutic intervention for older people. ACC has a primary role in injury prevention, yet it is effectively terminating a programme that is a world leader and actually saves money overall, in order to manage its own budget.
“There has to be some rational debate on this issue between the different parties so this programme is not lost in order for one part of the sector to save money”, Dr Wright-St Clair says.