Technology, Falls and Older People – NIHR CLAHRC Greater Manchester Research Internship

Author:Ellen Martinez

Author: Ellen Martinez

Falls Occupational Therapist

Ellen is an Occupational Therapist working in the Falls Prevention Team in Community Services at CMFT.

How did I get here?

I am an Occupational Therapist, currently working within the Falls Prevention team at CMFT. While I take a keen interest in research and new ways of working, it can be difficult to make time in every-day work to keep up with the latest developments.

My busy caseload means completing further study would be quite a leap – finding the time, let alone the funds, would be a challenge. But when I heard that NIHR CLAHRC (Collaboration for Leadership in Applied Health Research) Greater Manchester were offering a 6 month research internship, I thought it would be a great opportunity for me.

The aim of the internship is to encourage a better connection between research and front-line healthcare, ensuring that best research is applied to our practice and that new innovations are developed in collaboration with healthcare staff and patients. The internship would provide the opportunity to carry out a small research project related to my work whilst gaining experience and knowledge of the research world.

My project: Technology, Falls and Older People

One in three people over the age of 65 admit to having had a fall in the last year. Falls can have big consequences for older people – not only can they sustain serious injury, but can lose their confidence and independence. Going into hospital or moving to a nursing home also puts greater demand on the NHS. So it comes as no surprise that preventing falls has been on the agenda for a number of years.

There is a big evidence base for falls prevention and we know what works: long-term strength and balance exercise programmes to improve strength and balance. What’s more, we know these are most effective when people complete the exercises three times a week. Some older people can’t get out to do their exercises, so the Community Falls Service support them via visits and home exercise programmes instead. We know that, left to their own devices, people don’t do their exercises as often as we’d like…but then, how many of us, hand on heart, can say we follow exercise guidance? Our challenge is to motivate older people to do their exercises at home enough for them to benefit by preventing more falls.

Unsurprisingly, there’s lots of interest in using new technology in falls prevention to prompt and motivate people to complete their exercises. Through my NIHR CLAHRC Greater Manchester internship I have got involved with a research study being conducted by the University of Manchester. The study, called ‘Can smartphone and teleconferencing technology be used to deliver an effective home exercise intervention to prevent falls amongst community dwelling older people?’ will recruit patients from the Community Falls Service’s case-load at CMFT.

The project team are developing a falls app, which will enable clinicians to set and record goals with their patients, programme their exercises and send motivational messages, amongst other features. The app also includes the ability to monitor falls and alert a family member or carer if a fall has occurred.  Using smart phones, the study will also look at whether it would be feasible to deliver a strength and balance exercise programme remotely via Skype. At first I was concerned that this would mean that patients would lose their face-to-face contact with the health professional. However, the sessions are in addition to the visits conducted by the healthcare professional and will hopefully allow staff to monitor and motivate patients more frequently as time spent travelling and organising home visits will be reduced.

Any new technology like this falls app, needs to work for the older people who will be using it, be easy to use and meet their needs. The project I am completing for my  internship will bring older people and clinical staff together for a series of App Development Workshops to enable them to be involved in shaping the technology. If we don’t develop the technology with older people in mind, how are we really going to expect them to use it? – Will it just end up in a drawer along with their hearing aid?

Enthusiasm, persuasion and networking

Older people won’t want new technology

I am not sure this will work with our client group

Not many people have got to grips with a mobile, let alone a smart phone

These are just some of the things I’ve heard when I’ve started talking about the project. Already I have learnt that a big part of the research role is in promoting and convincing people about the merits of the project. To allow a project to gain momentum, you really need to be enthusiastic about your subject. I have been involved in lots of networking with different people, attended meetings, talked to practitioners and patients, to explain encourage and enthuse, which took me a little outside my comfort zone, but I have realised that these are keen skills of the researcher.

I have also had a lot of positive reactions from people about the falls app, which have sparked off some more ideas for research – such as using apps in Intermediate Care, or encouraging older adults to use social networking to reduce social isolation.

My view is that that apps and smart phone technologies are all around us, and they’re not going away. Today’s young people have grown up with these technologies, and don’t know a world before smart phones and social networking. So it stands to reason that these ‘digital natives’ will want to use technology to enhance and monitor their health as they get older. I hope that technology will always be an aid to better care, and not a replacement to the hands on and personal touch that only interaction with a real life clinician can give you!

In the real world research doesn’t always go to plan!

As part of my Internship I have been working closely with Dr Helen Hawley-Hague at the University of Manchester, This has been a two-way learning experience, Helen has talked me through research processes such as how to apply for ethical approval. I had the chance to show Helen some of the challenges I face in my role in Falls Prevention in Central Manchester.  I carefully arranged for her to join me on a series of home exercise visits, only for us to arrive at the first patient’s home to find that she had gone to visit her sister! At the coalface of healthcare, the best laid plans can sometimes go awry. Our second visit was much more positive, and my patient was keen to join in the longer-term research project. She did not seem daunted by the technology and we talked about how it could work for her. Where research meets practice like this is where we will create something that really works for our patients.

Where to now?

I am really enjoying being part of a research project – the feeling that you can think differently, and that change and innovation needn’t be off-putting, is quite refreshing. It has got me thinking again, and I’m learning a lot about being part of a larger clinical trial. I would encourage anyone to take up the NIHR CLAHRC Greater Manchester internship if it is offered again in the future and you have something you would like to research or learn more about in your area of work or you want to develop your research skills. I don’t know where the next step on the journey is going to take me? I believe that engaging with research should be an integral part of what we do as clinicians. It’s the best way that we can ensure what we do is based on the best evidence, and that the research that is carried out is relevant to our work and the communities that we serve, for now and for the future.