The Otago Exercise Program (Otago) is an individually tailored, home-based, balance and strength fall prevention program that is delivered by a physical therapist over the course of 52 weeks.
Otago began in New Zealand and was developed, tested, and demonstrated to be most effective for reducing falls and fall-related injuries among high risk individuals: adults more than 80 years of age and those who have had a previous fall within one calendar year. Otago also increased the percentage of older adults who were able to live independently in their community.
Background on Older Adult Falls
Public Health Burden in the United States
- Falls occur frequently among older adults. More than 30 percent of people aged 65 and older who live in the community fall each year. The incidence increases to 50 percent for those aged 80 and older.3, 4
- Two-thirds of those who fall will do so again within 6 months.5
- Twenty to thirty percent of those who fall suffer moderate to severe injuries that make it difficult to get around or to live independently, which increases their risk of early death.6
- Older adults who fall are more likely to move into long-term care.
- Falls are the leading cause of injury, deaths, and hospital admissions for traumatic injuries among people aged 65 and older.3, 4
- In 2009, approximately two million older adults were treated in hospital emergency departments for fall injuries and 581,711 were hospitalized after being treated.6
- Data from 2007 show that 18,334 older adults died from injuries related to unintentional falls.6
Cost of Falls
- In 2000, the total direct medical costs of fall injuries for people aged 65 and older was $19.2 billion or $28.2 billion in 2010 dollars; two-thirds of these were hospital costs.6
- By 2020, the annual direct and indirect cost of fall-related injuries for people aged 65 and older is expected to reach almost $55 billion (in 2007 dollars), $32.4 billion of which will be covered by Medicare.6, 7
- An observational study of 1,017 seniors published in 1996 established the effects of fall severity on total annual health care costs.8 – Older adults having one fall without serious injury during the course of one year incurred an additional annual cost of about $3,500 (in 2010 dollars) compared with those who did not fall. – Having two or more falls without serious injuries increased costs by about $16,500.3– Having one or more falls that involved at least one serious injury increased health care costs by about $27,000.
Evidence-based Fall Prevention Programs
- Research has shown that fall prevention programs for high-risk older adults can produce a netcost savings of almost nine dollars for each dollar invested.7
- Programs designed to prevent falls can: 1) save hospital admission and long-term care costs; 2) help older adults living in communities maintain their independence; and 3) help older adults increase their leg strength and improve their balance.1
- A fall prevention meta-analysis showed that exercise programs that included at least 50 hours of exercise and that challenged balance were associated with significant reductions in fall rates.9
Background on Otago
- Otago is a muscle strengthening and balance retraining program delivered at home by a physical therapist with Otago training through a minimum of seven home visits as well as monthly phone calls when there is not a home visit over the course of a year.
- Otago was developed and tested by the New Zealand Falls Prevention Research Group in New Zealand.
- Otago is one of a few fall prevention programs that improves strength and balance and reduces falls and fall related injuries among older adults. Other interventions that address falls, some of which are funded by CDC, can be found in A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, 2nd Edition, 2010
Who Can Benefit from Otago?
Evidence shows that Otago is most effective in reducing falls among persons 80 years of age and older with a history of falls in the previous year. In clinical practice, the physical therapist should determine if others would also benefit from this program.
- Otago is most effective for older adults who have fallen and who have moderate to severe decreased strength and balance due to multiple risk factors, such as arthritis, de-conditioning, and inactivity. Participants should be living in the community and able to walk in their own home with or without a walking aid.
- Older adults who are less than 80 years of age and who are falling, as well as adults who are too frail to do standing exercises may require a more individualized physical therapy program.
- Older adults with mild strength and balance deficits may need a more challenging program than those in Otago and may benefit from other evidence-based fall prevention programs such as Tai chi: Moving for Better Balance.
- Older adults who fall due to syncope, vertigo, severely impaired vision, some neurologic conditions, or who have significant cognitive impairment may not benefit from Otago. These older adults should be referred to their primary health care provider who can prescribe treatment or refer them to appropriate specialists.
References / Additional Information
- The National Council on Aging publication, Partnering to Promote Health Aging: Creative Best Practice Community Partnerships www.healthyagingprograms.org/content.asp?sectionid=92&ElementID=160 – This manual describes ways to build partnerships at the state and local level between aging services, community health, and public health services that promote healthy aging.
- Falls Free: A National Falls Prevention Action Plan, National Falls Prevention Action Plan http://www.healthyagingprograms.org/content.asp?sectionid=69&ElementID=220 – A collaboration between The National Council on the Aging (NCOA), the Archstone Foundation and the Home Safety Council that describes specific goals and strategies to reduce falls among older adults to maximize their quality of life and independence.
- California Blueprint For Falls Prevention, Preventing Falls in Older Californians: State of the Art www.archstone.org/publications2292/publications_show.htm?doc_id=246660 – This a white paper that describes state-of-the-art approaches to reduce the falls risk. It highlights the challenges of implementing fall prevention programs in California. The intent of the white paper and accompanying documents is to provide the building blocks for a long-term collaborative effort to reduce falls among California’s older population.
- Queensland, Australia Statewide Action Plan: Falls Prevention in Older People 2002–2006 http://www.health.qld.gov.au/stayonyourfeet/documents/13693.pdf – The action plan lays out a five-year framework and coordinated plan on how Queensland, Australia can address falls among older adults. The plan addresses this topic because older adult falls have been identified as a significant risk to health in Queensland.
- Washington State Department of Health Report-Falls Among Older Adults: Strategies for Prevention http://www.doh.wa.gov/hsqa/emstrauma/injury/pubs/FallsAmongOlderAdults.pdf – This report includes a discussion about the problem of older adult falls in the State of Washington and provides strategies and best practices for preventing them. It also describes strategies for program evaluation.
- Community Toolbox for Public Health Partnerships http://ctb.ku.edu/en/default.aspx – The Community Toolbox is a free global resource providing information and guidance about essential skills for building healthy communities. The toolbox promotes community health and development by connecting people, ideas, and resources. It was developed and is managed by the Work Group for Community Health and Development at the University of Kansas.
- Partnership Self-assessment Tool http://partnershiptool.net/ – This tool was created by the Center for Advancement of Collaborative Strategies in Health and was designed to help partnerships assess how well their collaborative processes are working and to identify specific areas in which to focus to enhance their collaborations.
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC) http://www.cdc.gov/injury/about/index.html – NCIPC focuses on preventing injuries and violence and on reducing their consequences. The Division of Unintentional Injury Prevention is a center within NCIPC and is involved in preventing home and recreational injuries, including older adult falls. This site provides information about other CDC-funded fall prevention programs such as Stepping On, and Tai chi: Moving for Better Balance. The NCIPC site also contains statistics and information about injuries and injury prevention.
- Preventing Falls: What Works -A CDC Compendium of Effective Community-based Interventions from Around the World (2010) http://www.cdc.gov/HomeandRecreationalSafety/Falls/preventfalls.html#Compendium – The compendium was developed to help health practitioners effectively address the problem of older adult falls. It describes fall interventions that have scientific evidence supporting their effectiveness and includes information for practitioners and senior service providers who would like to implement fall prevention programs.
- The American Geriatrics Society http://www.americangeriatrics.org/ – The American Geriatrics Society (AGS) is a non-profit organization devoted to improving the health, quality of life, and independence of older adults by implementing and advocating for programs revolving around patient care, public policy, research, and professional and public education. The AGS/British Geriatrics Society Clinical Practice Guideline was developed for clinicians and provides recommendations about how to address older adult falls and fall prevention.
- Thomas S, Macintosh, and Halbert J. Does the ‘Otago Exercise Programme’ Reduce Mortality and Falls in Older Adults?: A Systematic Review and Meta-analysis http://ageing.oxfordjournals.org/content/39/6/681.abstract – Reviewers evaluated the effect of the Otago Exercise Programme (OEP), older adult fall rates and the risk of death, and explored the effect of differing levels of compliance with the program. The authors concluded that the OEP significantly reduced the risk of falling and death among older adults living in the community.
- Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. Does a home based strength and balance programme in people aged ≥80 years provide the best value for money to prevent falls?: A systematic review of economic analyses of falls prevention interventions http://bjsm.bmj.com/content/early/2009/08/06/bjsm.2009.060988.abstract – This review investigated the monetary value of different strategies to prevent falls among community-dwelling older adults through a systematic review of relevant peer-reviewed journal articles. The authors concluded that the best value was single factor interventions such as the Otago Exercise Programme.
- Campbell AJ and Robertson MC. A comprehensive approach to fall prevention on a national level: New Zealand http://www.sciencedirect.com/science/article/pii/S0749069010000522 – This article includes a discussion about the importance of individual assessment and treatment for older adults who are at high risk of falling and the benefits of fall prevention programs. It also describes two successful New Zealand interventions: 1) the Otago Exercise Programme, and 2) community Tai chi classes.
- American Board of Physical Therapy Specialists http://www.abpts.org/About/ – The American Board of Physical Therapy Specialists (ABPTS) oversees the certification and recertification of clinical specialists, including geriatric certified specialists and neurologic certified specialists. This site provides information about the certification process, including eligibility requirements and the application, along with additional resources and describes how to check on your application status.