Relying on your instincts – Brightwater at Home’s Instinct program
Did you know falls are the leading cause of injury hospitalisations and injury fatalities in Western Australia?
In 2021, individuals aged 65 years or more experienced the highest number of falls-related hospitalisations. This is according to the 2023 Western Australian Falls Report[i] from Injury Matters and the WA Department of Health. The report goes on to say older adults have longer hospital stays as a result of a fall. Individuals aged 85 years or more can expect to spend 9.1 days in the hospital compared to an average 7.1 days.
That’s why Senior Physiotherapist Claire Myhill and Senior Occupational Therapist Suzanne Kerr are so passionate about finding ways to help with falls prevention. Brightwater has an award-winning Falls Improvement Program within their Brightwater At Home. The two therapists wanted to create something that would help improve falls outcomes for people living in their own homes.
As part of Brightwater’s Allied Health Team, Claire and Suzanne were encouraged to develop their innovative ideas of how services can be improved for Brightwater home care clients. The Outcome was a pilot programme for Instinct which was successful This has led to the Instinct Programme became part of Brightwater at Home services.
What is the Instinct program?
Claire had identified a lot of the community exercise groups were shutting down and there wasn’t much available for Brightwater at Home clients to attend. Both Suzanne and Claire envisioned a program that integrated physiotherapy (PT) and occupational therapy (OT) and Multi-disciplinary education. Claire and Suzanne incorporated evidence-based practise in their areas of expertise and aimed to make the program as functional as possible for people living at home.
“Brightwater backed us all the way to give it a go and get a pilot group started,” Suzanne said.
The program was named Instinct because it combines the functional tasks people perform in their own home with evidence-based PT practise.
“People don’t realise you can actually address your balance issues and learn and retrain by doing activities at home,” Suzanne said.
“The exercises in Instinct benefit you every day” and compliment any PT exercise programme already in place.
Improving balance and confidence
Instinct participants perform functional tasks aimed at functional tasks that include bending, reaching and turning.
It’s not uncommon to have older people lose their confidence doing tasks around the home, which as a result impacts their quality of life. They become more reliant on other people to care for them and slowly lose their independence.
Attending the Instinct group builds up confidence to engage in activities they may not have felt able to complete before.
“We make sure their balance is better, their strength is better, so they can do things around the home safely.”
How the Instinct program works
Instinct is a 10-week, multidisciplinary program incorporating exercise, education, and social interaction. All exercises and activities are evidence-based to ensure the participants are getting the most benefit from the time they invest.
Every session includes an hour of exercises starting with a warm-up and ending with a cool down period. Each person rotates through approximately 10 stations designed to give maximum OT and PT benefits. At the end of the hour is a 30-minute education session.
“Our idea is to promote education in the program so everyone can become more in charge of their own healthcare. The education varies from week to week,” Suzanne said.
“We have an OT talking about the home environment and common risks, Physio to explain the physiology behind exercise and set home exercise programmes. Dieticians, podiatrists and Nurses also provide education to address various aspects of health care relevant to falls prevention. Its important to have a Multi-Disciplinary Team approach so clients have a coordinated informed approach to falls prevention.
Social connection cements the success of Instincts
Because OT and PT disciplines worked together to develop the Instinct program, the exercise activities are designed- to have a functional and physical outcome. People have become much more engaged while doing the activities because they have a deeper understanding of why they’re doing them and how they’re helping. Each participant gets an individually tailored program they can practise at home. Community activities are also considered for each person so they can incorporate different activities like classes at community centres or hydrotherapy.
“All the current research shows that to create change in an individual’s risk of falls, education and exercise within a multidisciplinary programme is most effective,” Claire said.
“A big part of the success of Instinct has been the social aspect.
“They all get to know each other and have fun and after the session they all set together to enjoy a meal, which everyone loves.” “It’s been great for people on their own who often miss eating with their families.”
Instinct produces outstanding results for all involved
The improvements have been remarkable, surpassing the expectations of Claire and Suzanne and delighting the people benefiting from improved balance. Pre-assessments and final assessments are completed, which show the impact the program has had for each person.
“We have objective measures including the Berg Balance Scale, the Short Physical Performance Battery, and the Functional Reach Test, which are used as falls predictors,” Claire said.
“Most clients have gone from a high risk to moderate risk, or a moderate risk to low risk in only 10 weeks.”
The therapists believe it’s not one thing that’s made the program a success, but all the aspects of the programme combined. Both say the continuity of having the group together over a 10-week period and having time to reflect and react to the education portion has been vital. It’s the richness of disciplines collaborating and refining the programme which has assisted in it becoming so successful.
At the end of the 10-week pilot program, a questionnaire was distributed to the participants, asking for suggestions on how to improve Instinct.
Benefits of Instinct extend outside the program
The social time at the end has also been invaluable to reinforce the education. Behaviours have changed in line with the new information received and participants eagerly share how they’ve implemented advice from the Instincts program, whether it’s eating more protein, scheduling an appointment with a podiatrist or seeing a dietician.
What was originally envisioned as a 10-week program has grown into an ongoing demand for continuing falls prevention and balance training. An advanced group has been formed for people who are able to take on more complex exercises. The complexity comes in when you’re multi-tasking and using cognitive and physical aspects together.
“We’re working on balance issues, but also speed, and hand and eye coordination.”
Those who are able may elect to go to the HUR Gym, Brightwater’s state-of-the-art exercise equipment for seniors and people with disabilities. The equipment is from Helsinki University Research (HUR) and was developed in Finland, using 25 years of research and development. All equipment uses air resistance to reduce stress on joints and connective tissues.
Brightwater at Home’s Allied Health team enthusiastic about Instinct program
What started as an idea has turned into a program going beyond improved balance, and the effect is felt by everyone involved. Brightwater is running multiple Instincts sessions, including advanced courses. A Lifestyle Coordinator has been added to help extend the social activities that have been embraced by the participants.
“The objective measures we took showed significant improvements. I couldn’t believe the impact,” Claire said. “From the beginning to the end, they improved. You know you’ve made a difference.
Suzanne is equally enthusiastic about the Instinct program’s outcomes. Both find it inspiring and motivating as a therapist to be involved in such positive changes for clients.
For more information about preventing falls
If you would like more information about the Falls Improvement Program or Brightwater at Home’s Instinct program, give us a call on 1300 223 968 or email [email protected]
[1] Injury Matters: Sweeney, R., Menezes, S. and Meade, R. (2023). 2023 Western Australian Falls Report. Perth, Western Australia: Injury Matters.
