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

Abstract

We describe the reach of the scale-up of Stepping On, a fall prevention program targeting community-dwellers aged ≥65years in NSW, along with fall-related ambulance service use and fall-related hospitalisations after scale-up. Data on program provision were received from Local Health Districts. Routinely collected fall-related ambulance usage and hospital admissions in NSW residents aged ≥65years between 2009 and 2015 were compared within Statistical Local Areas prior to and following the implementation of Stepping On using multilevel models. Between 2009 and 2014 the program was delivered in 1077 sites to 10096 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 75-84years may have been moderated by the Stepping On program (rate ratio 0.97, 95% CI 0.93-1.00, P=.045). 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 75-84years 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.