Formative process evaluation of the Falls Management Exercise (FaME) Programme in Lincolnshire
Evaluation in progress. Expected Completion October 2024
What does the research mean for local Authorities?
People aged 65 years and over are at risk of falls and fall-related injury. Falls bring pain and distress to individuals, and can lead to increased use of NHS and Social Care services. Like many local authorities, Lincolnshire County Council want to support older residents and prevent falls where possible.
Strength and balance programmes can help prevent falls, and the Falls Management Exercise (FaME) Programme has been shown to decrease the number of falls and increase physical activity levels and wellbeing amongst older adults.
While FaME is a tried and tested intervention, local conditions such as infrastructure, rural and coastal geographies, and deprivation may present particular challenges to the implementation of FaME. It is important to understand whether good outcomes can be achieved, and maintained, in Lincolnshire. Undertaking a process evaluation of FaME may help identify whether barriers arise in Lincolnshire which may hinder the acceptability and implementation of any wider roll out. These findings will also have implications for other local authorities interested in providing strength and balance programmes.
What does the evaluation research mean for the Public?
In the UK 30% of people over 65, and 50% of people over 80, fall at least once a year, bringing the risk of injury, pain, distress, loss of confidence and independence to older adults and their family and carers. Strength and balance programmes like FaME may help prevent falls and their consequences. The study will examine whether FaME is accessible and acceptable to older adults, and what the impact is on their lives.
How are the public involved in the evaluation?
We have three public members supporting this work. Clare James sits on PHIRST Insight’s management group and has contributed to the design of the study and will support our public engagement work throughout the study. We also have two public members who live in Lincolnshire, volunteer with Age UK, and know the area and its residents well. All three have contributed to the study design including the research materials and will be members of the study management group throughout. They are also keen to ensure that the findings of the study are made available to the public in a meaningful and accessible way.
Lay summary of research
Background: People aged 65 years and over are at risk of falls and fall-related injury. Falls and fracture risk increases owing to a decline in muscle strength, balance, and physical function. This risk can be reduced by strength and balance exercise.
The Falls Management Exercise (FaME) Programme is a 24-week community-based programme. It delivers exercise classes supervised by a Postural Stability Instructor (PSI) combined with home-based exercise. FaME classes include functional floor and gait skills, with endurance, flexibility and strength and balance exercise. It has been shown in clinical trials to increase physical activity and prevent falls and is one of only two structured exercise programmes supported by Public Health England (PHE).
Lincolnshire County Council have commissioned One You Lincolnshire (OYL) to deliver FaME to around 300 older residents at risk of falls between May 2023 and June 2024.
Lincolnshire is a very large, rural county, and the fourth most sparsely populated county in England. Poor road and rail infrastructure and 80km of coastline lead to fundamental difficulties in the provision of services. Nearly one quarter of the population are aged 65 and over.
While FaME is a tried and tested intervention that has been shown to reduce the rate of falls, increase physical activity levels and improve wellbeing, poor infrastructure, rural and coastal geographies, and deprivation may present particular challenges to the implementation of FaME in Lincolnshire. The County Council are therefore keen to understand whether good outcomes can be achieved and maintained there. This evaluation of FaME may help identify whether barriers arise in Lincolnshire which may hinder the acceptability and implementation of any wider roll out.
The research questions are:
- How is FaME being delivered in Lincolnshire?
- Is the FaME intervention accessible and acceptable to the intended target population?
- What are the outcomes for those who complete the FaME intervention, and how are these achieved?
We will undertake a mixed-methods process evaluation.
One You Lincolnshire have been commissioned to collate a range of data monitoring the delivery of FaME and outcomes for participants. This includes measures of participants’ strength, balance and flexibility at the start and end of the programme, as well as measures of physical activity levels, experience of falls, and wellbeing. The study team will use this data to determine the outcomes for participants who complete the programme.
We will also interview a range of stakeholders involved in FaME in Lincolnshire, including those who commission and manage the service, the instructors who deliver the classes, and health professionals who refer residents to the programme. We will also interview people who take part in FaME, including those who complete the whole programme, and those who drop-out or don’t want to take part. The study team will also observe some FaME classes.
The study research questions and design have been developed in collaboration with key stakeholders from the outset.
Marta Kowalczyk, Public Health Programme Manager, Lincolnshire County Council County Offices, Newland, Lincoln LN1 1YL.
Mobile: 07747 460153
PHIRST Insight Research Team
Professor Rona Campbell, Professor Frank de Vocht, Tricia Jessiman.