Stepping On
Presented by the
Wisconsin Institute for Healthy Aging,
Wisconsin Department of Health
Services, and their partners
Why is Stepping On Needed?
• 1 in 3 adults aged 65+ falls every year
• Falls-related injuries are the leading cause
of death in Wisconsin for older persons
• Majority of falls occur at home
• Falls are not a normal part of aging; they
are preventable
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Consequences of Falls
• 40% of nursing home admissions had a fall in the
prior 30 days
• WI Hospital and ED visits = $800M each year
• 70% of costs are borne by Medicare & Medicaid
• Cost of doctor visits, time off work, caregivers, etc.,
in addition to ED costs
• Emotional toll
• Fear of falling leads to reduced activity and
isolation, causing and increased risk for falls
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The Stepping On Program
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Developed in Australia by Dr. Lindy Clemson, OT
Tested/implemented in community setting
2-hour sessions once a week for 7 weeks
Follow-up home visit
Follow-up booster session
8-12 participants
Led by 2 trained Leaders
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Stepping On
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Evidence-based
Meets AoA’s highest standard
Developed by Dr. Lindy Clemson and Megan Swann
Brought to U.S. by UW’s Dr. Jane Mahoney
Developed over years of:
– pilot-testing
– refinement
– evaluative research
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Stepping On’s Core Principles
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Facilitation to effect behavior change
Decision-making as a process
Principles of adult education
Self-efficacy as a tool for change
Mastery experience as a tool for change
Group process
Preventive Framework
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Outcomes
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Intervention group: 31% reduction in falls
Maintained confidence in more mobile ADL tasks
Used more protective behaviors
After 14 months
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59% still doing exercises
70% followed up with home visit recommendations
More subjects had vision checks
Less likely to start taking new psychotropic drug
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Target Population
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Age 60+
At risk of falling
Has fallen in past year or has a fear of falling
Lives in own home or apartment
Cognitively intact
Walks independently or with cane; walker
occasionally or for outdoor use
• Speaks and understands English or the language
in which the class is being provided
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Stepping On is CDC-Approved
because it’s “Multifactorial”
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Strength and Balance Exercises
Vision
Medication Review
Home Modification
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Topics
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Building trust, risk appraisal
Strength and balance exercises, homework
Home hazards and safety modifications
Community safety
Bone health
Medication management
Sleep medication alternatives
Safe footwear and safe clothing
Vision and falls
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Stepping On: By the Week
1. Introduction, Overview, Choosing What to Cover
2. The Exercises and Moving About Safely
3. Advancing Exercises and Home Hazards
4. Vision and Falls, Community Safety and Footwear
5. Medication Management, Bone Health and
Sleeping Better
6. Getting Out and About
7. Review and Plan Ahead
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Dissemination in Wisconsin
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Began in Wisconsin in 2007
Range of agencies offer the workshop
Range of sites host the workshops
Range of professionals or lay individuals
who serve as leaders
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Leader Qualifications
and Characteristics
• Health care provider, aging network
professional, public health educator, or fitness
instructor
• Experience leading groups of older adults
• Can demonstrate exercises, modify, and
advance
• Comfortable tightly following manual
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Leader Expectations
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Attend entire 3 full-day Leader training
Work with a sponsoring organization
Lead workshops in pairs, both trained or 1 + peer
Lead at least 2 workshops each year
Follow program manual
Secure and distribute weights to workshop participants
Prepare and use a Stepping On Display
Copy and distribute Exercise Manual and handouts
Invite, prepare, and host 4 guest experts
Follow WIHA administrative protocols
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Are You Ready?
• Identify the local sponsoring organization
• Have 2 individuals trained or ready to be
trained as Leaders
• Communicate with the local ADRC/aging unit
to coordinate
• Together, review the Planning Guide
(see next slides)
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Stepping On
Leader & Local Partner Organization
Planning Guide
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Identify local sponsoring organization
If not the county ADRC/aging unit, make contact with it
Identify 2 Leaders – already trained or need training?
Select dates and times for first workshop
Select and reserve site, room, room arrangement
Will workshop be free or a fee?
What agency will submit workshop notification to WIHA?
What agency will receive workshop registrations?
Continued...
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Stepping On
Planning Guide, cont’d
• Outreach and Marketing
– See WIHA website materials – don’t reinvent the wheel
– Presentations
– Health care provider recommendations
• Supplies needed
– Display
– Exercise Manual and other weekly handouts Projector / DVD
player
– Easels, blank flipchart pads
– Refreshments
– Data Collection materials
• Funding Needed?
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Website for Leaders
www.wihealthyaging.org
– Click on FOR LEADERS ONLY
– Click on Stepping On
– username: leaders@wihealthyaging.org
password: wihaleaders
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Support for Leaders
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WIHA website
Listserv
WIHA Leader Newsletter
Regular Leader conference calls or
meetings where available
• Technical assistance
• Leader Coaching and Fidelity Coaching
• Healthy Aging Summit
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Leader Training
• Come in pairs, or alone only if county already has a trained
Leader with whom to partner
• 3 full days – must attend all to learn:
– Evidence base for falls prevention
– Underpinning concepts of Stepping On
– Curriculum for Stepping On
– Group facilitation techniques, including practice
– Marketing, recruiting, partnership strategies
• Learn WIHA protocols and support available
• During first workshop, may have fidelity coaching
session
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Leader Training – To Apply:
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Leader Application – link on WIHA website
Complete application; pay fee
Commit to requirements
Attend in pairs, unless already a leader in
county
• Commit to requirements
• With Sponsoring Organization, complete
Planning Guide
• 20-person limit
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WIHA Collects Data On:
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Leaders
Workshops
Participants
Why?
–Funders
–Policymakers
–Program planning
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? ? ? Questions ? ? ?
• Betsy Abramson 608-243-5691
betsy.abramson@wihealthyaging.org
• Valeree Lecey 262-785-2577
valeree.lecey@gwaar.org
• Anne Hvizdak 715-677-3037
anne.hvizdak@dhs.wisconsin.gov
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THANK YOU!
We look forward to working with you
to expand Stepping On in Wisconsin