By Zach Read – zread@unch.unc.edu

Two years ago, the Carolina Geriatric Education Center at the UNC School of Medicine began training physical therapists to use the Otago Exercise Program. The reaction from physical therapists and patients has been overwhelmingly positive.

For older adults, a fall can have serious consequences. It may lead to reduced mobility, early nursing home admission, higher health care costs, and even premature death.

“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 Carolina Geriatric Education Center (CGEC) 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 know about evidence-based fall prevention, the better the 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 provide 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 which changed how she works. “We should have offered something like this a long time ago. It is an enormous benefit to my patients for me to follow them for 12 months in a thorough strength, endurance, and balance program. We may no longer see the regression and recurrent therapy referrals for patients who have had on-and-off therapy for years.”

One of the unique aspects of Otago is that it is done in the privacy of the home. When done correctly, Otago produces a fall-reduction rate of 35-40 percent.

Patient feedback has been overwhelmingly positive. “First, it’s empowering,” explained Shubert. “Patients don’t see PTs as frequently with Otago, so there is greater ownership by the patients. At any time the patient is working on five to ten of the 17 exercises, which means they’re not overwhelmed. They have an opportunity to master the exercises, seeing themselves getting stronger because they know what their baseline is.”

The original program focused on training frail adults over 80 years old; the CGEC believes the therapy is appropriate for frail 65-year-olds as well. If physiologically, someone 65 is more like an 80-year-old, then they’re appropriate for the training.

The CGEC 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 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.

CGEC’s bottom-up, top-down educational approach is helping to start conversations between patients and their doctors. If patients tell their doctors they want Otago, the doctors need to ask what it is and come to CGEC to 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