By Ania Basiukiewicz

Research suggests that falls are the leading cause of injuries among older adults, such that 20 to 30 per cent of older adults living independently experience one fall each year.  Canadian physical activity guidelines recommend that older adults get at least 150 minutes of moderate physical activity weekly, participate in activities to help strengthen muscle and bone at least twice weekly, and engage in physical activities that will help enhance balance and prevent falls.

To help improve the health of seniors in the community, Trillium Health Partners created the Strong and Steady Falls Prevention Program  (Strong and Steady) for adults 65 years and over who are at risk of falls. The program aims to improve their strength, balance, endurance and gait. To deliver Strong and Steady, THP partnered with the City of Mississauga to design a program that allows hospital staff to work out of a bright, attractive and well-equipped community location easily accessible to seniors. The city also operates its own Stronger and Steadier recreation program at the same location, and seniors can choose to enrol in it after graduating from the hospital program.

“The strong relationship between Trillium Health Partners and the City of Mississauga has allowed a unique hospital-municipal health integration model to emerge. Such a partnership between the hospital and city is pioneering – no one else has ever provided an exercise program in this format. Delivering hospital-level rehabilitation in the community setting is powerful because it helps people truly focus on wellness, and not illness, and offers other opportunities for older adults as well, including increased ways to remain social,” says Brenda Callaghan, Community Development Coordinator, Therapeutic Programs, City of Mississauga.

Strong and Steady is offered twice a week in 6 week sessions, and combines 2 hours of exercise and 2 hours of education weekly, tailored to each individual participant. The class size is capped at 12 participants to ensure individual attention is given, and patients attend twice per week. Participants are either hospital patients or are referred by physicians in the community. The program begins with a comprehensive falls prevention assessment by a geriatrician or nurse practitioner as well as a physiotherapist to better understand the reasons for falls, then, if able to do so, participants can continue with the group exercise and education component.

“Many older adults have a challenge finding and adjusting to a regular exercise routine, especially after they’ve been in the hospital or have had a fall. The Strong and Steady program offers a valuable opportunity for peer to peer support, helping older adults connect and share experiences, such as coping after a fall, building the hope, motivation and confidence to continue participating in an exercise program,” says Sabina Sobota, PTA/OTA at Trillium Health Partners’ Falls Prevention Program.

Because of its co-location in the community centres with the city-operated Stronger and Steadier Program, Strong and Steady makes it a lot easier for older adults to continue an exercise program in the community: graduates of Strong and Steady are already familiar with the facilities, have often made friends and are thus more willing to join the more advanced community exercise program to maintain their physical activity gains.

“Without Strong and Steady, I would not have learned as much as I know now about preventing a fall. A big thing for me to be aware of now when I’m out and about or even at home, is to always keep both my hands free so that I can quickly regain balance if I need to. I wouldn’t have known to think of this before. I also feel I really benefitted from learning different exercises, nutrition and helpful tips about how to set my home up to be safer,” says Phyllis McKibbin, Trillium Health Partners patient and Strong and Steady participant.

Trillium Health Partners  has been operating Strong and Steady since 2011. The program is now offered at two community centres in Mississauga, which are easily accessible to the hospital’s patients. Trillium Health Partners’ Strong and Steady program currently has an average class attendance of 2,000 people annually. The unique partnership between the city and hospital reflects Trillium Health Partners’ mission of building a new kind of health care for a new community, where an interconnected system of care is organized around patients inside and outside the hospital.