Preventing falls in Aboriginal communities
Compared to the general older Australian population, older Aboriginal and Torres Strait Islander people were experiencing falls at twice the rate and are three times more likely to experience depression and dementia.
The research team at NeuRA (Neuroscience Research Australia), is looking to identify why the higher prevalence of dementia and falls in Aboriginal and Torres Strait Islander populations to identify new areas to include in healthy ageing programs, aimed at reducing falls and dementia in Aboriginal and Torres Strait Islander people.
The leading cause of injury-related hospitalisation for older Aboriginal people in NSW is falls, yet there was no culturally specific or appropriate fall prevention programs until The Ironbark Project began.
Commencing in 2015 the George Institute’s Ironbark Project, has been trialled at six sites across NSW including Umina, Nowra, Mt Druitt, Ulladulla, Redfern and Windsor.
The George Institute performed an analysis of fall-related hospitalisation data from a 10 year period (2003-2012), from all public and private hospitals in NSW.
Through this work, they found fall-related hospitalisations for older Aboriginal people increased at approximately twice the rate than for other older Australians over the study period.
NSW Health has reported similar findings: rates of fall-related hospitalisations for older Aboriginal people in NSW have been reported to be up to 2.4 times higher than for other older Australians.
Falls can lead to increased isolation, loneliness and depression for older people.
For older Aboriginal people, who play a large role as custodians of culture and knowledge, the inability to play a leading role in the family and fear of losing the ability to pass on culture and knowledge is high.
Researchers identified there were very few programs that addressed falls or fall prevention used by Aboriginal people, many mainstream services were not always considered to be culturally appropriate or relevant for Aboriginal participants.
Ten yarning circles were held with Aboriginal Community members across NSW, where it was revealed many Aboriginal people believed falls were a downfall of getting older and that a culturally appropriate program to prevent falls was needed.
“All aspects of the project have been overseen by an Aboriginal steering committee,” Julieann Coombs, Aboriginal Research Officer, said.
“The Ironbark Project sought to answer the questions “what did Aboriginal people and communities want and what would their falls program look like, when developed in partnership with Aboriginal people and communities.”
The Ironbark Project is an on-going, group-based, strength and balance exercise class with an education component held within yarning circles.
The program runs for one 1.5-hour session each week. Participants are guided through a 45-minute class of gentle exercise by a trained Aboriginal facilitator, focusing on improving their strength and balance followed by a half hour informal discussion about falls and fall prevention.
“The yarning both ways sessions have been insightful to all participants with everyone involved in sharing their stories on each weeks’ topics including eyesight, footwear, medications, healthy diet and how to get up from a fall,” Ms Coombes said.
The program sessions were held at culturally safe community locations already familiar to and accessed by many local older Aboriginal people and many participants have found value in the program.
One participant said the program was terrific, “I got my strength back, I met new people, made new friends and got a life again. I could not move - I was a really old person - and now I feel young again. It gives me something to look forward and I need to keep the joints working.”
Another from the Nowra group enjoyed the program too: “You learn so much. You go out now and stand tall, you feel confident and you don’t feel like a little old lady.”
“It’s not just good physically, it is good mentally. I go around to others that live in my retirement village and move hazards. I never sit down at home and I like doing my exercises,” she said.
“The participants enjoyed using a familiar venue, with familiar staff, which they had experience in travelling to,” Caroline Lukaszyk, project manager, said.
Falls prevention resources were made available to participants to take home and continue to practice their strength and balance exercises learnt in class.
The Umina group recorded great progress and as a group decided to switch their morning tea to include healthier options.
“Clients balance has improved so much, clients are taking more interest in getting healthy and changing eating habits. Some clients have reported weight loss and an ability to stay on their feet longer. All clients have spoken about how they feel more confident out in public and using stairs. One client now no longer needs his stick for the exercises and no longer feels off balance,” Liz Hillmann, Aboriginal Site Manager, Umina said.
Ms Coombes said the project has enabled older Aboriginal people to have control of their own health, with Aboriginal community involved from the very beginning.
“Many people have now found they do not need to use their canes or walking sticks as much and are feeling stronger, more confident and have even lost that extra weight they have been trying to get rid of for years,” Ms Coombes said.
“Some have started up walking groups together with other program participants and healthy eating is now becoming part of their new healthy lifestyles.”
Aboriginal research assistants visited each participating community at the beginning of the program, collecting strength and balance measurements. This was repeated at three months and at the end of the pilot program, at six months.
“We have seen improvements in the time it has taken participants to walk four meters at each of the six pilot sites, from the beginning of the program, at three months, and at the end of the program. This shows that the mobility of participants has improved over the six months. The time taken to complete five ‘sit-to-stand’ exercises has also become much shorter at all six sites, showing that people have better leg strength,” Ms Coombes said.
The pilot program ended in July 2016 however, we are currently applying for funding to start a number of Ironbark project sites across the country, running these for a longer time period as part of a definitive trail.
The Ironbark Project was funded by the NSW Health and Aboriginal Injury Prevention and Safety Promotion Demonstration Grants Program.