Population Health Initiative
on Falls: Making the Connections to Tackle Stairs and Grab Bars
A Forum hosted by
the University of Ottawa Institute on Health of the Elderly associated
with SCO Health Service and the Community Health Research Unit
March 25-26, 2003
First off, and again,
THANK YOU for participating in this two-day forum. This was a history-making
opportunity to bring together scholars, policy makers, programmers,
and other decision-makers and advocates with a vested interest in
addressing environmental concerns and falls prevention.
Goals of the forum
- Stimulate intersectoral
dialogue on a population health approach to promote access to
safe grab bars and safe stairways in Canada.
- Identify grab bar
and stairway designs that are most likely to facilitate independent
living at home by older persons
Objectives of the
- To share information
To come to consensus
on recommendations for safe stairs and grab bars and the role
of bodies, such as CPHA, in promoting these recommendations.
To develop an action
plan and strategies for establishing and sustaining inter-sect
oral collaboration to improve research transfer to decision makers
To identify strategies
to mobilize communities to support safe stairs and universal access
to grab bars
- current knowledge
on preventing falls, grab bar safety, stairway safety/usability;
- surveillance systems
and information technology tools that may inform modifications
to the built environment for fall prevention;
- how National codes
are developed and enforced;
- how research can
be used to support recommendations for changes to building codes.
The forum was attended
by 57 participants from 29 different local, provincial, national,
and international organizations. Included were policy makers, researchers,
public health programmers, housing officials, homebuilders, surveillance
specialists, advocates for safe stairs, and legal representatives.
Overview of forum
The first afternoon consisted
of a series of presentations on relevant topics, including:
- community research
- community research
on grab bars
- lab studies on stairs
- lab studies on grab
- the role of information
technology and surveillance systems in injury prevention
- the process of development,
modification, and implementation of National Building Codes
- challenges to effecting
changes in National Building Codes
NOTE: These presentations
are available electronically upon request.
The second day began
with 2 panel discussions that centered on:
- identifying ways in
which intersectoral collaborations can be better established and
- specific recommendations
for changes to National Building Codes for stairs and grab bars
and evidence required to better advance these recommendations.
The forum concluded with
three working groups:
- one group was tasked
to begin a draft communiqué to be presented as a motion
at the 2003 CPHA annual general meeting.
- one group discussed
how to improve the transfer of research to policy and practice
- one group discussed
strategies to increase awareness, acceptance, and expectations
around safe stairs, grab bars, and other home safety devices designed
to prevent injuries.
Outcome of working
Working group on draft
- Lisa Ashley
- Larry Chambers
- Michelle Coghlan
- Sabrina Farmer
- Bonnie Lee
- Donna Lockett
- Jake Pauls
- Carolyn Williams
A draft communiqué
was initiated. As a follow-up, Donna Lockett and Lisa Ashley continued
to work and refine the draft, entitled "Falls among seniors
as a priority public health issue". Feedback on the draft was
provided by members of the working group and by CPHA. A final version
was presented as a motion to CPHA by Dr. Larry Chambers and Jane
Underwood on May 9, 2003. The motion was accepted by CPHA. In the
motion, the CPHA was challenged to:
- Urge the federal government
to develop policy and recommendations to the National Building
Code of Canada for building codes related to stair design and
installation of grab bars to bathtubs.
- Encourage the Canadian
Institutes of Health Research and the federal, provincial and
territorial governments to establish national working and research
groups comprised of inter-sectoral, multidisciplinary leaders
in the field to promote research and development on falls prevention.
- Urge the federal
government to establish a national surveillance system for tracking
falls and related injuries.
In addition, members
of this forum submitted input into the public consultation process
and recommended building code changes proposed by the National Building
Codes and Ontario Provincial Building Codes.
Working group on research
- John Archer
- Ian Brodie
- John Cook
- Nancy Edwards
- Robert Howlett
- Lian Kitts
- Frank Knoefel
- Marilynn Kuhn
- Julie Levesque
- Jeff Levitt
- Tammy Lipskie
- Karen McNaught
- John Miller
- Tom Parker
- Barbara Schulman
- Jennette Toews
- Eileen Woodford
The group discussed challenges
to developing codes, given the current state of research. Knowledge
and transfer were discussed.
The key challenges to
developing evidence-based codes discussed were:
- The tradition of the
National Research Council to base decisions on "hard"
sciences, as opposed to social sciences.
- The vast volume of
information available and the need to better synthesize information
for decision makers.
- The challenge of enforcing
codes at the provincial level.
- The potential conflict
of interest for the NRC to conduct "human factor" research.
- The fact that many
professionals are not aware of the need or options to address
barrier-free design or are resistant due to perceived cost implications.
- The diversity and
intersectoral nature of sources of information on this issue that
are not captured in more traditional literature.
Recommendations to improve
research transfer were identified:
- When framing questions
related to the built environment, researchers need to think about
how they can frame their questions with codes in mind.
- Information needs
to flow bi-directionally, that is, from academics to decision
makers and from decision makers to academics.
The peer review process
should include people whose work relates to the built environment.
- Curricula for relevant
professions (e.g. architects) should include concepts such as
- Policy practicums
for population health PhD students in built environment policy
settings should be considered.
- A course on working
with and engaging policy makers should be included in post-graduate
- Nancy Edwards' interns
and PhD students should tour the NRC research facilities.
- Potential sources
of funding need to be explored, e.g. Industrial Research Assistance
Program (IRA), CIHR, NSERC, Federal government policy research
funding, research chairs programs.
Working group on community
- Dot Bonnenfant
- Mary Lou Boudreau
- Jean-Remi Champagne
- Lynn Chisholm
- Rob Howlett
- Cathie Kissick
- Margaret Levy
- Maryan O'Hagan
- Verna Popejoy
- Scott Puddicombe
- Vanessa Secan
- Darene Toal-Sullivan
- James Watske
- Claire Zanetti
The group discussed the
need to increase awareness around environmental risk factors for
falls and injuries and the need to "normalize" devices
such as bath grab bars and handrails for stairs.
They discussed reasons
why have groups with the greatest vested interest (e.g. seniors)
not been pushing for safe stairs/railings/grab bars:
- Marginalized people
don't see themselves as a driving force.
- People don't want
to 'see' disability or frailty in themselves.
Recommendations for promoting
normalization were identified:
- Using a multigenerational
approach, for example, getting children and youth involved in
advocacy via school curriculum (eg: geometry, problem solving,
family studies), programs, projects and community service.
- Using financial incentives
- Insurance reductions
for installation of grab bars, stair railings, 7-11 stairs
- Tax deductions
(or rebates) for cost of installing grab bars and making changes
to increase stair safety.
- Targeting industry
and business professionals, including:
NOTE: The Tools for
Living Well Project, a HC/VAC funded project sponsored by the
University of Ottawa and CAOT, is working with businesses in these
- Renovators and
homebuilders to increase awareness of how addressing features
that increase safety can increase the value and desirability
of a house;
to enhance options for improved style and aesthetics of grab
- retailers to provide
evidence-based information and greater access to assistive
- Make this a "Hot
Topic": Education and information needs to be presented in
a format that is compelling and interesting. Messages need to
reflect capacity and interest of audience:
- Messages to Governments:
- fall prevention
(correcting stairs, installing grab bars) keep people
out of hospitals;
- fall Prevention
is a cost savings for our health care system;
- building codes
need to be brought up to date using latest research results.
- Messages to the
public and professionals (e.g. through PSAs);
- falls are
due, in part, to environmental features such as unsafe
stairs, lack of grab bars, lack of light, unsafe rails;
- falls don't
have to happen and risk can be lowered by making basic
environmental safety changes (e.g. fixing stairs, installing
proper grab bars and railings);
- falls can
affect all ages and modifying the environment can increase
safety for children, youth, pregnant women, adults, disabled,
Feedback from the
Overall the comments
suggested that the forum was very informative and provided an opportunity
for intersectoral dialogue. Feedback from the forum indicated that
participants found the information provided by the presentations
and panel discussions to be useful and relevant (means 4.4 each
on a scale of 1-5). Forum participants found the action planning
session to be good as well (mean 4.0 on a scale of 1-5).
The need for follow-up
opportunities (that is, a follow-up forum) was expressed by participants
via suggestions that more time be provided to:
- explore individual
issues in greater detail;
- allow for more dialogue;
- deal with concrete
follow-up issues, such as who will take a lead, potential timing-scheduling
of events, how follow-up will be established.
This two-day forum was
a stimulating opportunity for academics, policy makers, and program
decision-makers to share knowledge, identify challenges and opportunities
to developing better intersectoral collaborations, and develop strategies
to ensure that building codes are evidence-based and reflect a broader
population health approach to preventing injuries related to falls.
However, this event was but a first step. We need to build upon
the momentum that was generated during this two-day event. We need
to reach out to each other to continue dialoguing, problem solving,
and taking action to prevent falls. We would encourage participants
to consider taking a lead on a follow-up opportunity to build on
the action planning that was initiated during this inaugural forum.
As stated by Nancy Edwards
during her opening remarks, "like the minuet, at first glance
choreographing fall prevention looks simple but we actually find
it to be exceedingly complex. A wide array of perspectives is required
to put together the dance that prevents a fall." However, like
an improvisation, falls prevention will require that we "think
of the possibilities, listen to the music
move. This two-day forum brought together some of the key perspectives
that are required to tackle the problem of environmental hazards
related to falls. We have thought of the possibilities; listened
to the discourse, dialogued and debated. Now let's move.
Nancy Edwards speaking
at the Fall Prevention Forum, Ottawa, March, 2003.