Sport Bay of Plenty
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Falls Prevention Referral

Falls Prevention Referral Form - St John staff

Sport Bay of Plenty is the lead provider for an initiative that aims to decrease the incidence and severity of falls in older adults. As the lead provider, Sport Bay of Plenty are co-ordinating the provision of community based exercise classes that focus on strength and balance around the Western and Eastern Bay of Plenty.

Once referred to the programme, Sport BOP will contact the client to discuss class options available in their local area.

KOYF SBOP lockup logo

* = Required Field

REASON FOR REFERRAL: Check those that apply

CLIENT DETAILS

Medical Information: (please select if any apply to this client and provide additional information if appropriate)

Respiratory condition:

Heart condition:

Submit

Complete another referral

EXCLUSION AND INCLUSION CRITERIA

Inclusion Criteria:

These classes are designed for and are suitable for:

  • Any older adults (65+) who could benefit from improving their strength and balance. Note, patients under 65 years are welcome to be referred if they are at risk of falling or have a history of falls.
  • Older adults with the potential and physical capability to be ambulatory even if limited initially.
  • Older adults who rely on a walking aid such as a walking stick or frame.
  • Older adults with very limited mobility can attend if they have someone to support them.

Exclusion criteria

These classes are not suitable for:

  • Older adults needing a level of support that would disrupt the teaching of the class or who need full time care.
  • Older adults with conditions that prevent them from following instructions and participating without disrupting other
  • Older adults who have any of the following medical conditions: unstable angina, unstable high or low blood pressure, uncontrolled diabetes.
  • Older adults who have acute medical conditions such as a recent cardiac, neurological, respiratory issue or a recent joint replacement.
  • Older adults with very limited mobility and no one to support them in a class.

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x3 May 2016

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