Scale‐up of the Stepping On fall prevention program amongst older adults in NSW: Program reach and fall‐related health service use

Abstract

Issue addressed We describe the reach of the scale‐up of Stepping On, a fall prevention program targeting community‐dwellers aged ≥65 years in NSW, along with fall‐related ambulance service use and fall‐related hospitalisations after scale‐up. Methods Data on program provision were received from Local Health Districts. Routinely‐collected fall‐related ambulance usage and hospital admissions in NSW residents aged ≥65 years between 2009 and 2015 were compared within Statistical Local Areas prior to and following implementation of Stepping On using multilevel models. Results Between 2009‐2014 the program was delivered in 1,077 sites to 10,096 older adults. Rates of fall‐related ambulance use and hospital admissions per 100‐person‐years were 1‐2 in people aged 66‐74, 4‐5 in people aged 75‐84 and 12‐13 in people aged ≥85. These rates increased over time (p<.001). The interaction between time and program delivery was not significant for fall‐related ambulance use or hospital admissions. The time‐related increase in fall‐related ambulance usage in people aged 75‐84 years may have been moderated by the Stepping On program (rate ratio 0.97, 95% CI 0.93–1.00, p=.045). Conclusions There was no indication of a reduced rate of fall‐related ambulance use or hospital admissions across the entire sample. Ambulance call‐outs for falls in people aged 75‐84 years may have reduced following program participation. So what? Program scale‐ups need to reach a large proportion of the target population with a focus on those groups contributing most to fall‐related health service utilisation. Linking individual participants’ health data as part of large‐scale evaluations may provide better insights into program outcomes.