Preventing falls in mental health: a pilot RCT

INTERVENTION: Brief name: Adapted Stepping On program The intervention comprises a tailored program based on the Stepping On falls prevention program. The intervention materials include the Stepping On program manual (used by the program facilitator and available from Sydney University Press at https://sydneyuniversitypress.com.au/products/124823), program handouts (used by the program facilitator and participants which are available to download at no cost from Sydney University Press at https://sydneyuniversitypress.com.au/products/124823#) and simple equipment such as ankle weights and assistive devices that can be used in the home. In this trial the Stepping On program will be tailored/adapted to the needs of older people with a mental illness who have an increased risk of falling compared to the typical older person living in the community. Program adaptations will be developed by an expert panel including mental health consumers. The Stepping On program will be adapted to include eight weekly sessions (compared to seven sessions in a typical program) plus a booster session at one month (compared to three months in a typical program). This tailoring of the program will enable more time for and repetition of program content, allow more time for participants to practice the exercises, reduce the content of each session, expand on topics more relevant to older adults with mental health conditions and permit close follow up of participants to ensure continuation of the fall prevention strategies practiced during the program. Other adaptations include a greater use of visual (rather than text‐based) educational materials, regular practice and simple progression of the program exercises and a greater focus on topics such as sleep and medication management. Specific session topics will include: Session 1: Introduction, overview and risk appraisal Session 2: Exercise and moving about safely Session 3: Home falls hazards Session 4: Community safe CONDITION: Injuries and Accidents ‐ Fractures Mental Health ‐ Other mental health disorders Mental illness;Risk of falls; ; Mental illness ; Risk of falls PRIMARY OUTCOME: The number of falls experienced by participants after the program. This outcome will be measured in two ways: 1) through review of participants’ medical records to determine falls‐ related events prior to and after the program and 2) participant self‐reported data recorded on a falls calendar.[Three months (at program completion) and 12 months (post program completion).] SECONDARY OUTCOME: Falls risk will be measured using the Falls Risk for Older People – Community setting (FROP‐COM)(Russel et al, 2008). ; [Three months (at program completion)] Balance, strength and mobility will be measured using the Short Physical Performance Battery (SPPB)(Lauretani et al, 2018). ; [Three months (at program completion)] Falls risk in the home environment will be measured using the Home Falls and Accident Screening Program (HOME FAST)(Mackenzie et al, 2002). ; [Three months (at program completion)] Falls self‐efficacy will be measured using the Falls Efficacy Scale – International (FES‐I)(Yardley et al, 2005). ; ; [Three months (at program completion)] INCLUSION CRITERIA: • Consumers aged 50 years or over. • Have a mental health diagnosis. • Not in an acute phase of their illness • Living in the community. • Registered with the Older Person’s Mental Health Service at two sites in Sydney, Australia. • Willing to provide written informed consent.to participate in the study. • Be eligible and willing to participate in the adapted Stepping On program: had fall in the past year or fearful of falling, Independent in walking with or without a walking stick, cognitively intact (no evidence of dementia) and bble to understand and converse in English.