BackgroundIt is estimated one in two adults age 80 and over fall each year, resulting in substantial morbidity and mortality rates among this oldest-old population. The Otago Exercise program (OEP) is an evidence-based fall prevention program shown to reduce falls by 35% among high-risk older adults. The OEP was designed to be delivered in the home by physical therapists. This model has encountered multiple implementation challenges in the United States health-care system, which has resulted in the development and testing of innovative models to support a broader reach and dissemination of this program.MethodsThe Northwest Senior and Disability Services is an Area Agency on Aging (AAA) serving a five-county region in Oregon. This AAA developed a model where a Certified Occupational Therapy Assistant (COTA) and exercise physiologist delivered the OEP with a physical therapist available to consult on all cases. Physical function assessments and self-reported perceptions about physical function were collected at baseline and 6 months.ResultsBaseline measures were collected on 239 participants enrolled in the OEP, and 62 participants at 6 months. Those who completed 6 months of the OEP demonstrated significant improvements in all physical function assessments and self-perceived functional improvements. A subset of this group that demonstrated improvements in the ability to rise from a chair also reported significantly fewer falls during the 6-month intervention.ConclusionInnovative models in which the OEP exercise sessions are delivered by non-physical therapists appear to be effective in improving physical performance measures and decreasing fall risk over a 6-month period. Because these models do not require a physical therapist, they may require fewer resources to implement. These findings have implications to inform implementation and dissemination strategies to bring the OEP to scale.

Hawaii's Medicaid-sponsored comprehensive home care program serves disabled people of all ages. A client survey explored the relationship between age and satisfaction with services. Most younger clients had become disabled through accidents, while older clients were disabled from multiple chronic conditions. Although satisfaction ratings were generally high, a statistically difference between ratings by age group occurred with the youngest patients expressing the least amount of satisfaction. Reasons for these findings and implications for program operation are discussed.

The common goal of the Hawaii-based Nursing Home Without Walls program is to prevent or delay institutionalization of the patient. NHWW provides health and social services to Medicaid recipients of any age who are certifiably in need of nursing home care, but who wish to receive long-term care services m their homes.