Student-run falls prevention programmes for older adult community members: a pilot study

Introduction

Aotearoa New Zealand is steadily aging, with the number of people aged 65 years and over projected to double by 2036.¹ These demographic shifts present a significant challenge across the health care system, including in managing the risk of falls, for which age is a key risk factor.^2,3 Falls represent a significant public health concern due to their substantial impact on morbidity, mortality, and health care costs.^4,5 Falls not only result in physical injuries but also have significant psychological repercussions, leading to decreased quality of life and increased fear of falling.^6,7

Numerous local programmes and interventions have shown promising outcomes in reducing falls rates.^8,9 For instance, the local Ministry of Health has developed public-facing resources, and the Best Practice Advocacy Centre (BPAC) has released evidence-based guidelines for health care providers and caregivers to assess and manage fall risk. The Otago Exercise Programme, a home-based regimen developed by the New Zealand Falls Prevention Research Group, is associated with a reduction of up to 35% in fall risk through tailored exercises that improve strength, balance, and mobility.¹⁰ Despite the proven efficacy of such programmes, the incidence of falls remains high.¹¹ Primary health care providers often lack the time, human resources, and training needed to implement falls prevention programmes and strategies effectively.^12,13

In recognition of the risks faced by older adults in the community, a pilot student-led community-based falls prevention programme was undertaken at the Waikato Institute of Technology (Wintec), the largest vocational education provider in the Waikato region of New Zealand.¹⁴ Student-led interventions or clinics (SLCs) are health care services at which students are engaged in the direct delivery of health care under supervision.¹⁵ A growing body of literature demonstrates positive outcomes from SLCs for both student learning¹⁶ and client health.¹⁷

The pilot intervention programme involved students from a range of health care courses and postgraduate students in sport and exercise science. O’Cathain et al.’s framework of actions for intervention development was adopted.¹⁸ Table 1 provides a summary of the framework and the corresponding activities undertaken in the development of this programme.

Methods

Results

Eight people participated in the pilot programme, with seven completing the post-programme survey. Participants were all female (n = 8), with a mean age of 71 years (see Table 2).

Responses to Likert scale questions (see Supplementary File S2) show a high level of participant satisfaction with the programme, with all seven participants strongly agreeing that they were satisfied. Participants also expressed high confidence (four strongly agree, two agree, one neutral) in their ability to avoid falls after completing the programme, and in identifying and mitigating falls risks in their home (five strongly agree, one agree, one neutral) and surroundings (five agree, two strongly agree). Participants reported better understanding of the relationship between nutrition, vitamin D, and falls, and of the importance of healthy feet and good footwear.

Participants found a wide range of aspects from the programme helpful, including the information provided regarding hazards in the home and environment (P1: ‘The things in the home that are bad for falls’). Also appreciated was nutritional information regarding healthy food options and the link between nutrition and falls risk (P6: ‘My knowledge about nutrition and diet to keep balance and coordination’). Several participants reported benefitting from the exercises undertaken as part of the programme, such as P5: ‘clear instructions and a variety of exercises, especially the games’. More practically, participant P5 reported that the help provided with transport to the programme was important. Participants also reported enjoying opportunities to engage with others and learn from their experiences, and the friendly and supportive staff.

In terms of suggestions for improvement, some participants did not articulate any changes: ‘I have none – I found the programme most comprehensive’ (P2) and ‘I felt it’s very nicely organised, adequate information and easily understood’ (P4). Some did note the small number of people attending and suggested larger numbers: ‘A pity more did not come’ (P5). Some practical suggestions included having a ‘a summary session, briefly summarising the overall content of the course’ (P7) and including ‘more hands-on training rather than videos’ (P3).

When asked about challenges they faced implementing what they learned in the programme, some participants recorded no challenges. These included P2: ‘I really didn’t have any’ and P7: ‘No hurdles. I’ve really taken on board the nutrition information regarding the proportion of protein, carbs and vegies on my plate.’ Some participants did note some specific physical challenges: ‘Some exercises were hard for me but good to do to my ability’ (P1) and ‘My problem was my hip is getting worse so that I can’t do as much as I would like and see more improvement’ (P5). One participant noted fear as a barrier: ‘Fear of the escalators (top to down) at the mall scraping my heel; needed to get timing right’ (P6).

Discussion

Participants in this falls prevention programme, which was developed and delivered by students, me perceived the programme as effective in enhancing their knowledge and preventing falls, with participants appreciating a wide range of aspects, from practical advice to social interaction. The programme provided opportunities to share personal anecdotes, exchange strategies for independent living, and express any lingering concerns regarding falls-related issues. The importance of knowledge in reducing both falls and falls-related injuries is well recognised.¹⁹ Furthermore, findings from the survey emphasise that psychosocial elements are critical to the effectiveness of health promotion activities, which seem particularly easy to foster in student-led settings.

The findings corroborate the key points raised in the literature regarding falls. Gardiner et al. highlight that many older people value independence and reject being labelled as ‘at risk of falling’ due to the perceived implication of dependency.²⁰ However, some embrace the risk and opt for cautiousness as a personal strategy. El-Khoury et al.’s meta-analysis of the effectiveness of fall prevention exercise interventions for older adults found that the exercise programmes designed to prevent falls appear to be effective in preventing both falls and injuries caused by falls, as well as the rate of falls leading to medical care.²¹ Their findings demonstrate exercise’s beneficial impact on preventing injurious falls, particularly falls with severe consequences, offering valuable evidence for health care providers to promote exercise fall prevention programmes and for decision makers to allocate funding to these programmes. A New Zealand study noted the factors associated with falls-related injury were female sex, older age, living alone, Parkinson’s disease, stroke/cardiovascular disease, falls, unsteady gait, tobacco use, and being underweight. The authors suggest that it is important to reduce both falls and falls-related injuries by having knowledge of associated risk factors so that focused intervention programmes can be developed.¹⁹ The present study suggests such knowledge can be fostered effectively in student-led settings.

Our pilot programme has demonstrated efficacy and underscored the relevance and utility of the educational topics covered, providing insights for future programme enhancement. They include the incorporation of practical, real-life examples; the reinforcement of collaborative partnerships with community health providers, enhancing clients’ understanding of referral processes to health services available in the community; and the advantages of smaller, more personalised groups tailored to individual needs. This approach ensures programme responsiveness to evolving needs and emphasises our commitment to empowering communities through knowledge dissemination and self-care advocacy, in alignment with the overarching goals of primary health care.

While the study was conducted with a small group of clients, limiting its generalisability to larger populations or diverse demographic groups, the results provide valuable insights and a benchmark for subsequent full-scale implementations of falls prevention programmes. Future research could explore the scalability and sustainability of such programmes in broader community settings.

Conclusion

A student-led falls prevention programme may reduce falls and enhance knowledge among older adults by providing practical advice, social support, and personalised health promotion approaches. This pilot study highlights the potential benefits of student-led health initiatives in primary health care strategies.

Supplementary material

Supplementary material is available online.