Dance to Health (a falls prevention dance programme for older people)

Dance To Health Abingdon - Photo Helen Murray

Aim: To demonstrate that a suitably constructed arts programme can address a major challenge in the health system and go to scale

Objectives: PILOT (with key activity periods)

1. Assemble the required organisational, human and financial resources (July 2014 to January 2015).
2. Connect the worlds of dance and older people’s physiotherapy and exercise (February 2015).
3. Establish partnerships with Arts Council England National Portfolio dance organisations already expert in working with older people, and create and deliver a training programme for professional dance artists to learn the two evidence-based falls prevention exercise programmes – ‘PSI/FaME’ and ‘Otago’ (April and May 2015).
4. Prepare and deliver six pilot evidence-based programmes in:
i. London with East London Dance (July 2015 to January 2016).
ii. Cheshire with Cheshire Dance (November 2015 to April 2016).
iii. Oxfordshire with South East Dance (January to June 2016).
5. Present national and local celebration events (February and June 2016 respectively).
6. Research and evaluation covering process, outcomes, cost-effectiveness, a business model for roll-out and the first survey of UK older people’s dance activities (January 2015 to July 2016).

ROLL-OUT PHASE 1

1. Business modelling (November to December 2015).
2. Codification (November 2015 to March 2016)
3. Sales programme (January to July 2016).
Funding: PILOT (£357,500)
AmicusHorizon Housing Association
Arts Council England
City Bridge Trust
Esmee Fairbairn Foundation
Garfield Weston Foundation
Guy’s and St Thomas’ Charity
Jewish Care
Oxfordshire Community Foundation
Peter Sowerby

ROLL-OUT PHASE 1 (£109.250 preparation budget)

Aesop Pioneer Group
Anonymous trust
Esmee Fairbairn Foundation
People Dancing (Foundation for Community Dance)
Peter Sowerby Foundation
Context: Falls are extremely traumatic for older people and a major challenge to the health system. They are the most frequent and serious type of accident in people aged 65 and over. 25% of ambulance calls are due to older people’s falls. After a fall, an older person is 50% likely to have seriously impaired mobility and 10% will die within a year. Falls destroy confidence, increase isolation and reduce independence. They cost the NHS £2.3 billion per year.
Current falls prevention exercise programmes face several challenges:

  • Programmes are ‘dull as ditchwater’ (Royal College of Physicians Clinical Falls Lead).
  • Only 38% of services use the evidence-based programmes, PSI/FaME and Otago. These reduce falls by 55% and 35% respectively.
  • Provision is patchy, and take-up, retention, adherence and completion are low.
  • Maintenance programmes are rare (without them, strength and balance improvements are lost in 12 months and so health investment is wasted).
  • Programmes for frailer older people tend to be delivered one-to-one and do not address isolation.

Location/ Age UK Cheshire – Castle Community Centre, Northwich
Setting: AmicusHorizon Housing Association – Lansdowne Green Estate, London
Jewish Care – Redbridge Jewish Community Centre
Oxfordshire County Council – Abingdon and Banbury Health and Wellbeing Centres
Wulvern Housing Association – Deva Point, Blacon near Chester

Description of the arts activity

For roll-out, each local Dance to Health programme has two elements: a six-month ‘Improvement Programme’ (PSI/FaME or Otago) funded by the health sector and an ongoing, financially sustainable ‘Maintenance Programme’.

Trained dance artists embed the principles of the physiotherapy exercise in fun, sociable and creative dance sessions, delivered twice-weekly for the Improvement Programme and weekly for Maintenance.

The courses provide opportunities for involving participants in programme design and delivery. They draw on awareness of their own bodies and experiences. The sessions include themes and music suggested by participants.

Every programme is delivered with support Peer Motivators (older volunteers with some previous experience of and interest in dance).

Details of the project participants

Dance to Health provides both primary and secondary falls prevention groups.

  • Primary falls prevention (PSI/FaME) for groups of up to 20 older people. A typical group member is relatively inactive, has not had a major fall but is in danger of one.
  • Secondary falls prevention (Otago) for groups of up to 12 older people. A typical group member is frailer than a primary falls prevention group member. They are likely to have had one or more major falls already.

Age of participants has ranged from 60 to 95. During the pilot period of Dance to Health, participants self-referred following suitability criteria included in project publicity. As Dance to Health rolls out nationally most participants will be referred by GPs and other health professionals.

Project management

Delivery is co-ordinated by a full-time Dance to Health Project Manager, managed and supported by Aesop.

Fidelity to FaME and Otago has been confirmed and will continue to be assessed by Later Life Training, the leading provider of specialist, evidence based, effective exercise training for health and exercise professionals working with older people.
Each Dance to Health group is also quality assured by a regional Lead Dance Artist.

There is no cost to participants for the Improvement programme. As Maintenance programmes are developed, part of their move to sustainability will include making an affordable charge to participants for the weekly sessions.

Evaluation methods and findings

Evaluation of the pilot was undertaken by three independent institutions:

  • For process and outcomes – Sidney De Haan Research Centre for Arts and Health.
  • For health economics – London School of Economics.
  • For social enterprise models for falls prevention services and Slimming World case study – University of Middlesex Business School.
  • Plus, for overview of current older people’s dance activity in the UK – People Dancing (Foundation for Community Dance).
    Process evaluation was done through questionnaires and focus groups, with additional data collection and qualitative evaluation done in house.
    The following outcomes are measured (with standard scales where available):
  • Dance interest and ability (bespoke – no standard scale available)
  • Group identification (scale developed at Dundee University)
  • Social relationships (de Jong Gierveld Loneliness Scale)
  • Mental health and wellbeing (Warwick-Edinburgh Mental Wellbeing Scale)
  • General health (EQ-5D and SF-12)
  • Independence and control over life (OPQOL)
    A full evaluation report will be available in the autumn of 2016.
    Findings include:
  • Dance to Health address the problems with standard falls prevention exercise. It is an effective, cost-effective and enjoyable alternative.
  • Only 40% of people who join standard falls prevention courses complete the course. Dance to Health has achieved 73%.
  • The London School of Economics has found that Dance to Health is capable of generating better outcomes and is more cost effective compared to PSI/FaME [health sector falls provision] or no intervention.
    The participants have made dramatic progress with their strength and balance and don’t want the programme to stop. “We are enjoying moving in ways we didn’t think were possible anymore.” “I enjoy it because I didn’t realise how much mobility I still had, it gives me hope. It makes me feel free.”
Supported using public funding by the Arts Council England