Falls Falls Prevention Occupational Therapy Perspective Sarsha Pincini

Falls & Falls Prevention Occupational Therapy Perspective Sarsha Pincini, Samantha Webber, Lauren Morley & Casey Rynne.

Introduction What is a fall? ● Unintentional change in position, causing individual to land at a lower level 1 Why are falls an issue? ● Decreased mobility 2 ● Decline in participation in activities 2

Red Lotus - Environment INDOOR ENVIRONMENTS ● Unsuitable footwear, lack of grab rails, foot stools, mats, obstacles/clutter, inadequate lighting, safety equipment, uneven carpeting, insufficient entrances 38 OUTSIDE ENVIRONMENT ● Holes in pavements, broken steps, dogs, elevator door, differences in ground levels 3 ASSISTIVE DEVICES ● Potential contributors to falls 4 ● Situations when assistive devices present when falls occurred 4

Red Lotus - Environment Natural ● leaves, rocks, shrubs 9 ● rain, frost snow 9 ● cold months 10

Red Lotus - Environment Political ● 25% of falls outside home 11 ● Grab rails on stairs 11 ● Coloured stripping on stairs or slippery surfaces 11 ● Buildings should be falls safe. 11

Red Lotus - Environment Social ● Increasing number of older adults choosing to live independently 6 ● Poor social engagement, poor nutritional status, vulnerability to various illnesses 12 ● Fear of falling → restriction in social activities → social isolation 6, 8

Red Lotus - Environment Economic ● High cost in society & a burden in the healthcare system 3, 13 ● Falls cost 86. 4 million 4 ● Cost after falling vs. fall prevention methods 10 ● Cost of a fall was much higher than the cost to prevent 7 ● Elderly are more susceptible to financial limitations 6

Red Lotus - Person Age ● increase chance of diseases 14 -15 ● More likely to fall within home 14 -15 ● decline in physiological/physical/ cognitive state 14 -15 Gender ● Women have a higher percentage of falls, regardless of age 16 ● Different roles/tasks/requirements 16

Red Lotus - Person Ethnicity Western Countries Carpeted floors and wear shoes in house 17 -18 Koren Ondol floors (heated floor) and take shoes off 17 Hispanic Inclines people to live in close social proximity to family/community 18 Genetics Factors are hard to prove as causation, but contribute to risk factors 16

Red Lotus - Person Socio-economic Status Education: ● ● Exposure to different environments: playgrounds/activities. 14, 15, 1719 Determines amount of knowledge/awareness about dangers/risk factors. 14, 15, 1719 Determines safety of environment. 14, 15, 1719 More physical activities 14 Employment: ● Exposure to different work environments/conditions e. g. slippery floors. 14, 19 ● Exposure to different tasks/activities e. g. displacing body movements. 14 ● Working long hours/multiple jobs. 17 ● Inadequate breaks = more chance of fatigue, dizziness, passing out. 17 Income: ● ● ● If income is insufficient, this may lead to multiple jobs, more stress, less focus. 14, 19 With low income increases chances of living in low socioeconomic areas. 15 In low socioeconomic areas: there may be less money/priority for safety features e. g. barriers, outdoor stairs. 17

Red Lotus - Person Cognitive ● Lack of knowledge about the risk factors of falls/preventative strategies. 17, 22 ● A fear of falling. 17, 22 ● Limited hazard awareness. 17, 22 ● Resistant to preventative measures e. g. grab rail. 17, 22 ● Different beliefs about appropriate roles. 17, 22 ● Intellectual disability including dementia. 17, 22

Red Lotus - Person Behaviours- Mental. 14, 17, 20 -23 ● Balance perception, proprioception, muscle strength, and attention = harder to compensate to hazards ● Use of psychoactive drugs ● Intellectual disability ● Mental disorders can interfere with neurotransmitters and can interfere with motor function ● Personality ● Ability to focus

Red Lotus - Person Behaviours - Physical 14, 17, 20 -23. ● ● ● Displacing activities e. g. climbing ladders, sports, stairs (more common in young) Routine nondisplacing daily activities (more common in elderly) Nutritional deficiency ● ● ● ● Gait and balance problems Physical fitness Medication Physical ability Physical inactivity Muscle strength/function Co-morbidities ● ● ● ● ● Chronic disease Osteoarthritis Use of walking aid Body balance Previous falls One leg balance Foot wear Household/outdoor activities Frailty

Red Lotus- Person Over 80’s Living Alone

Red Lotus - Outcome Physical ● 69% Injured after a fall. 24 -28 ● 49% Require medical attention. 24 -27 ● 7% Fracture a bone. 24 -27 ● 20% die within a year. 24 -27

Red Lotus - Outcome Social ● Social Isolation. 25 -27 ● Social Dependence. 25 -27 ● Decreased Social Activities. 25 -27 Mental ● Increased Anxiety. 25 -28 ● Increased Fear of Falling. 25 -28 ● Depression. 25 -28 ● Post Traumatic Stress. 28

Red Lotus - Outcome Spirituality ● Sense of hopelessness. 2428 ● Wanting to die. 25

SOLUTION: Falls Prevention 1. Primary prevention: preventing a fall from occurring by acting on causes (i. e. risk factors). 29 2. Secondary prevention: preventing or reducing the seriousness of an injury by implementing protective mechanisms (eg. hip protectors). 29 3. Tertiary prevention: reduce seriousness of an injury immediately after a fall by providing medical treatment and rehabilitation to stabilise and restore physical and mental function. 29

Reorientate Health Services ● Falls prevention takes a preventative approach, as opposed to a treatment approach to promote health ageing and maximise independence. 30 Stay on Your Feet: an initiative which aims to raise awareness and educate individuals and health practitioners on preventative measures. 31

Strengthen Community Actions ● Stay on Your Feet campaign encourages self-assessment to understand personal risk factors. 31 o AIM: educate and promote individuals to seek professional advice. 31

Professional Involvement: Assessing Risk Factors A thorough assessment involves the following: ● establish falls history (e. g. when, where and potentially why a fall occurred). 32 ● identify medical conditions (including mental state). 32 ● review medications. 32 ● assess physical conditioning (e. g. blood pressure and heart rate). 32 ● evaluate vision, gait, balance and lower limb sensations. 32 ● assess living environment for potential hazards. 32 ● review assistive walking device (ensure correct fitting & safe use). 32

Interventions to Prevent Falls ● Exercise Programs: strengthen muscles and improve dynamic balance especially tai chi. 33 -35 ● Mobility Aids: provide stability and improve balance (e. g. walking frames and walking sticks). 36 ● Footwear: shoes with minimal heel, slip-resistant sole, ankle support. 31 ● Modify or Reduce Medications: which cause postural hypotension or syncope, impairing balance. 37 ● Environmental Modifications: ample lighting; remove tripping hazards (e. g. rugs); instal rails in bathrooms and stairs; non-slip mats in wet areas (e. g. kitchen, bathroom). 2 ● Nutrition: vitamin D/calcium (supplements) to strengthen bones. 37, 38

Developing Personal Skills Education is vital to ensure communities and individuals understands risk factors and the evidence to support the importance of interventions. 2

Creating Supportive Environments Environment hazards are the number one cause of falls among the elderly. 35

Building Healthy Public Policy National Best Practice Guidelines: Preventing Falls and Harm From Falls in Older People: Best Practice Guidelines. 39 QLD: Falls Injury Prevention Model Policy. 40 NSW: Prevention of Falls and Harm from Falls among Older People Policy. 41 SA: Fall and Fall Injury Prevention and Management Policy. 42

Social Justice “to advance human well-being by improving health. . . by focusing on the needs of the most disadvantaged” 43 ● Ageing Population: trends predict that the percent of the total population aged 75+ will increase from 6. 4 to 14. 4 by 2060 44 ● Falls not regarded as an important health concern 45

Implications: Occupational Therapy Occupational Therapists: ● ADVOCATE for and ENABLE independence. 46

Professional Guidelines 1. All older persons should be asked yearly if they have experienced any falls. 47 2. Those who report falls should be assessed for steadiness. 47 3. Those who demonstrate difficulties, should be further assessed. 47

Universal Design ● Incorporates products and features which can be utilised by everyone 48 ● Advocate for policies/legislations which ensures the built environment enables access for all 48

Conclusion OT’s have a role in assessing personal and environmental risks to ensure maximal engagement in occupations

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