Falls Prevention Program Keeping on your toes Staying

Falls Prevention Program: Keeping on your toes Staying active and independent OT Student: Jae-ellen Fowler

Program � Session 1: � Session 2: � Session 3: ◦ What are falls and the significance of them? ◦ Environment: Safety in and around your room ◦ Occupations: How to keep yourself safe in your daily activities ◦ Person: What you can do to stay independent and active

SESSION 1

What are falls and the significance of them?

What is a fall � “Involuntarily coming to rest on the ground, floor or lower level. Excluding intentional change in position to rest in furniture, wall or other objects” W. H. O. � Falls-related injuries are among the most serious and common medical problems experienced by older adults � Includes trips, slips and stumbles � not a normal part of ageing � preventable and predictable (Queensland stay on your feet, 2012; Australian Government, 2005; Mc. Clure et al. , 2008)

Causes for falls � Falls are often considered as accidents, but falls are rarely completely accidental � Reasons or causes are risk factors � More risk factors = greater chance of falling � Intrinsic (related to a person’s behaviour or condition) � Extrinsic (related to a person’s environment or their interaction with the environment) Discussion point: Can anyone name any falls risk factors that may affect them? (Australian Government, 2005; Queensland Government, 2004; Queensland stay on your feet, 2012; Queensland Government, 2006)

Intrinsic risk factors � Increased age � Being female � History of falls � Certain chronic medical conditions � Taking multiple medications – psychoactive � Poor nutrition � Unsteady gait – mobility aid � Sensory problems � Dizziness � Low levels of physical activity – decreased muscle strength � Slow reaction time � Concern for falling � Fatigue (Queensland stay on your feet, 2012; Queensland Government, 2006; NSW Government, 2009; Queensland Government, 2004)

Extrinsic Factors � Risky footwear e. g. High heels, slippers, thongs � Risky spectacles � Uneven or loose outside surfaces � Inadequate lighting � Slippery floors � Time of day – night � People traffic � Heights of chairs and beds � Unsecure floor coverings, rugs and cords � Housing and floor plan � Reaching outside the body’s safety zone (Queensland stay on your feet, 2012; Queensland Government, 2006; NSW Government, 2015)

Statistics on Falls � In QLD 1 in 3 older Australians will fall each year � Residents in Residential Aged Care Facilities experienced nearly 5 times the falls (Australian Government, 2005; NSW Government, 2009)

Statistics at Immanuel Gardens – Hostel on Trips/Slips/Falls � In the last 6 months. . . � 53 trips/slips/falls � 45 residents Areas of falls 5. 6% Dining Room 9. 5% Bathroom (Immanuel Gardens (Hosetl) – Buderim Facility, 2012) 5. 6% Outside 75% Bedroom

Statistics at Immanuel Gardens – Hostel on Trips/Slips/Falls Outcome of Injury of Falls 11. 3% Head injury 22. 6% Skin tears 5. 6% Bruising (Immanuel Gardens (Hosetl) – Buderim Facility, 2012) 47. 1% No injury

Impact of a fall � Cuts, bruising, abrasions, head injuries � Fracture – wrist, hip, trunk, neck � Hospitalisation � Death � Reduced mobility � Decreased independence � Transfer to Nursing Home � Loss of confidence � Concern for falling – withdrawal from activities � Decreased ability to participate in activities and enjoy life (Australian Government, 2005; Mc. Clure et al. , 2008; Hughes et al. , 2008)

You. Tube Clip

Safety in and around your room Discussion point: What are types of falls hazards in your environment that concern you? Bedroom? Bathroom? Outside?

Bedroom � Furniture ◦ Chairs and beds �appropriate height = popliteal crease + 5 cm �Armrests �Loose or trailing bed coverings �Matts ◦ Items are in accessible places �Too high or low heights �In front or on top of others (NSW Government, 2009; Queensland Government, 2011)

Bedroom � Appliances ◦ Light beside bed or a night light – easily reachable ◦ Cordless phone or phone beside bed, armchair or on desk ◦ No trailing cords (NSW Government, 2009; Queensland Government, 2011)

Bedroom � Walkways ◦ ◦ Adequate space and access Are clear Keeping doors fully open or closed Reducing clutter (NSW Government, 2009; Queensland Government, 2011)

Bathroom � Toilet seat and shower chair ◦ Proper height = popliteal crease + 5 cm � Make use of grab rails � Keep floors dry � Items are in accessible places ◦ Soap, shampoo, washers (Queensland Government, 2011; NSW Government, 2009)

Outside paths, walkways and stairs � Keep an eye out and report any hazards � Room for another person with a four wheeled walker � Take care when walking � Beware of uneven surfaces � Store walking aid safely � Well lit � Aren’t slippery � Safe and adequate hand rails (NSW Government, 2009; Queensland Government, 2012)

Spot the Trip Hazard! Coffee table in front of curtains High set shelf Low seated armchair Rug Items on floor – walkway unclear Trailing bed covers

References � � � Queensland stay on your feet. (2012, October 2). Retrieved from The Queensland Government web site: http: //www. health. qld. gov. au/stayonyourfeet/default. asp Australian Government: Department of Health and Ageing (2005). The national slips and falls prevention project. Mc. Clure, R. J. , Turner, C. , Peel, N. , Spinks, A. , Eakin, E. & Hughes, K. (2008). Population-based interventions for the prevention of falls-related injuries in older people. Cochrane Database of Systematic Reviews , Issue 1. doi: 10. 1002/14651858. CD 004441. pub 2. Queensland Government: Department of Health and Ageing (2004). Don’t fall for it! Falls can be prevented. Retrieved from http: //www. health. qld. gov. au/stayonyourfeet/for-seniors/resources-for-seniors. asp Queensland Government (2006). Statewide action plan: Falls prevention in older people 2002 – 2006. Retrieved from www. health. qld. gov. au/stayonyourfeet/documents/13693 a. pdf NSW Government (2009). Preventing falls and harm from falls in older people: Best practice guidelines for Australian residential aged care facilities. Retrieved from www. activeandhealthy. nsw. gov. au/assets/pdf/RACF_Guidelines. pdf NSW Government (2015). Prevention of falls and harm from falls amoung older people: 2011 – 2015. Retrieved from http: //www. health. nsw. gov. au/policies/pd/2011/PD 2011_029. html Immanuel Gardens (Hostel) – Buderim Facility (2012). Incident report forms: October – April 2012. Hughes, K. , van Beurden, E. , Eakin, E. G. , Barnett, L. M. , Patterson, E. , Backhouse, J. , Jones, S. , Hauser, D. , Beard, J. R. , & Newman, B. (2008). Older person’s perception of risk of falling. American Journal of Public Health, 98 (2), 351 – 357. Queensland Government (2011). How to stay on your feet: Checklist. Retrieved from http: //www. health. qld. gov. au/stayonyourfeet/for-seniors/resources-for-seniors. asp Queensland Government (2012). One step ahead: Preventing falls – a guide for older people. Retrieved from http: //www. health. qld. gov. au/stayonyourfeet/for-seniors/resources-for-seniors. asp

Falls Prevention Program: Keeping on your toes Staying active and independent OT Student: Jae-ellen Fowler

Program � Session 1: � Session 2: � Session 3: ◦ What are falls and the significance of them? ◦ Environment: Safety in and around your room ◦ Occupations: How to keep yourself safe in your daily activities ◦ Person: What you can do to stay independent and active

Last weeks session � Topics ◦ What are falls and the significance of them? ◦ Safety in and around your room Discussion point: Did anyone find the information last week relevant and/or useful? Discussion point: Would anyone like to share with the group any changes they made to their rooms?

SESSION 2

What you can do to keep yourself safe and active in your daily activities

Safe movements � Getting out of bed ◦ Roll on to side and sit up. Wait for dizziness to subside ◦ At night; night �Easy reach bedside light/nightlight and glasses �Bedcoverings �Other options – bedside commode, continence aids (Queensland Government, 2011)

Safe movements � In and out of a chair (without wheelie walker) – arm chair, dining chair, desk chair ◦ IN �Stand in front �Outstretch arms – armrests �Slowly lower yourself ◦ OUT �Hands on armrests �Feet flat and nose to toes �Pushing with hands �Pause to steady balance (Queensland Government, 2011)

Safe movements � When showering or going to the toilet ◦ Use of grab rails ◦ Use of shower chair (if you have one) ◦ Rest if you do become tired (Queensland Government, 2011; Queensland Government, 2012)

Making activities easier � Help conserve energy – for tasks you need to or enjoy doing � How? Rest – breaks during activities and in your day Organise your time Look at the tasks you need to do Timetable Avoid – cramming, skipping rest breaks, tire yourself during bad times of the day, work long without a break ◦ Problem tasks ◦ ◦ ◦ Discussion point: What tactics do you use to conserve your energy through the day or through an activity? (Metro North Health District, 2004)

Making activities easier � Handy hints; ◦ Organise the activity before starting ◦ Equipment can make things easier �Large, Large easy to grip handles �Non-slip matts �Long handles �Lightweight objects (Metro North Health District, 2004)

Making activities easier � Kitchenette ◦ ◦ ◦ in bedroom Items in reachable places Items close to where you use them Sit down to do activities – four wheeled walker Ask for assistance from staff Lightweight dishes and cups Pegboard for hanging utensils � Bedroom ◦ Fitted sheet and light sheets and blankets ◦ High bed – easier to get in and out of (Metro North Health District, 2004)

Making activities easier � Bathroom ◦ ◦ Use of shower chair Use of grab rails Avoid bending – shower caddy, soap on a rope Sit down to dry and dress yourself � Cleaning your room Spread tasks Get others to help – staff, family Long-handled equipment – avoid bending ◦ Arrange furniture – no lifting ◦ ◦ ◦ (Metro North Health District, 2004)

Making activities easier � Sitting ◦ ◦ ◦ at a desk Chair and desk encourage good posture Chair – good back support Feet rest flat on the floor Good lighting Equipment is in easy reach – phone, laptop Take stretch breaks often (Metro North Health District, 2004)

Safe use of walking aids � Wheelie walkers, sticks, frames, crutches � General tips; ◦ Avoid using to assist getting in and out of a chair ◦ Maintain walking aid – loose parts, worn stoppers, bent frames ◦ Wheelie walker – BRAKES ON! ON Use the seat to store items and as a resting seat � Physio can advise – walking aids steadiness and confidence to walk more (Queensland Government, 2012; Queensland Government, 2004; Life. Tec Queensland, 2012 a)

Safe use of walking aids – 4 ww � In and out of a chair – arm chair, dining chair, desk chair ◦ IN �Stand in front – balanced and standing still �Move the wheelie walker slightly forward and put BRAKES ON �Outstretch arms – armrests �Slowly lower yourself ◦ OUT �Wheelie walker in front – BRAKES ON �Hands on armrests �Feet flat and nose to toes �Pushing with hands �Pause to steady balance �Hands on wheelie walker – BRAKES OFF (Walkerfacts, 2010; Life. Tec Queensland, 2012 a)

Safe use of walking aids – 4 ww � Walking Place walker ahead before walking Gently roll walker forward as you walk – close Steps uneven, shorten your longer step Turning = stay within width of walker, roll walker around without twisting your back, always face the front of the walker ◦ When standing in kitchenette and bathroom = use counters for support, but keep walker within reach ◦ ◦ (Walkerfacts, 2010; Life. Tec Queensland, 2012 a)

Safe use of walking aids – walking frame � Walking ◦ Standing upright – feet together, both hands on frame ◦ Lift frame forward and put down (all four tips on ground) ◦ Step forward with one leg – placing weight through frame ◦ Step forward with other leg ◦ Be careful to not step too far forward (Walkerfacts, 2010; Life. Tec Queensland, 2012 b)

Safe use of walking aids - stick � 3 or 4 point stick with an offset base, straight side should be nearest to the body � Usually stick is on user’s unaffected side � Be careful not to store wooden sticks in direct sunlight or damp areas � Walking; ◦ Stick moved forward at same time as affected leg ◦ All walking sticks points firmly on the ground (Life. Tec Queensland, 2012 c)

Safe use of walking aids - stick � Steps and stairs; ◦ GOING UP �Unaffected leg first, first then stick and the affected leg to the same step ◦ GOING DOWN �Affected leg and stick first, first then the unaffected leg to the same step (Life. Tec Queensland, 2012 c)

Safe footwear � Types of footwear can ↑ risk of falls – making you trip, slip or stumble � Avoid wearing socks or stockings without shoes � Consider the state of your shoes; shoes ◦ ◦ ◦ Worn down - ↑ risk of falls Cleaned regularly Fix them or discard them – recovering from a fall is more costly (Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)

Safe footwear � Features of good shoes; ◦ Properly fitted – hold foot in place and adequate support �Fit comfortably and suit shape of foot �Ankle support (collar) �Avoid loose fitting sling backs, slippers, thongs or scuffs (Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)

Safe footwear ◦ Firm, flexible sole �Shoes with a tread sole – prevent slips �Thick, soft soles – reduce ability to read ground or floor surface �Test shoes flexibility ◦ Heel with a round, bevelled edge �Broad, slightly rounded heel less than 2. 5 cm (Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)

Safe footwear ◦ ◦ ◦ Have laces, zips or Velcro fastenings Lightweight Adequate width, depth and height in toe box Discussion point: Which of these shoes is safe? (Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)

Safe clothing � Long and loose clothing can upset balance and gait � Be aware clothing doesn’t trail around ankles or have loose parts (Queensland Government, 2012; Queensland Government, 2011)

Safe clothing � Problems with your waterworks; ◦ Consider the clothing you wear ◦ Avoid multiple layers and firm fitting outer garments ◦ Clothing with elasticised waist bands easier than buckles, buttons and zips (Queensland Government, 2012; Queensland Government, 2011)

Spot the trip hazard! Trailing cord High set board Turned up rug Coffee table blocking walkway Books on floor

References � � � � � Queensland Government (2011). How to stay on your feet: Checklist. Retrieved from http: //www. health. qld. gov. au/stayonyourfeet/for-seniors/resources-for-seniors. asp Queensland Government (2012). One step ahead: Preventing falls – a guide for older people. Retrieved from http: //www. health. qld. gov. au/stayonyourfeet/for-seniors/resources-for-seniors. asp Metro North Health District (2004). Energy conservation and work simplification. Occupational Therapy. Queensland Government: Department of Health and Ageing (2004). Don’t fall for it! Falls can be prevented. Retrieved from http: //www. health. qld. gov. au/stayonyourfeet/for-seniors/resources-for-seniors. asp Life. Tec Queensland (2012 a). Measuring and using a wheelie walke. Retrieved from http: //www. lifetec. org. au/home/content. asp? page. ID=205&main=205&sub=0 Walkerfacts (2010). Using a walker safely. Retrieved from http: //www. walker-facts. com/How-To-Use-a-Stable. Walker. asp Life. Tec Queensland (2012 b). Measuring and using a walking frame. Retrieved fromhttp: //www. lifetec. org. au/home/content. asp? page. ID=205&main=205&sub=0 Life. Tec Queensland (2012 c). Measuring and using a walking stick. Retrieved fromhttp: //www. lifetec. org. au/home/content. asp? page. ID=205&main=205&sub=0 Queensland stay on your feet. (2012, October 2). Retrieved from The Queensland Government web site: http: //www. health. qld. gov. au/stayonyourfeet/default. asp NSW Government (2009). Preventing falls and harm from falls in older people: Best practice guidelines for Australian residential aged care facilities. Retrieved from www. activeandhealthy. nsw. gov. au/assets/pdf/RACF_Guidelines. pdf

Falls Prevention Program: Keeping on your toes Staying active and independent OT Student: Jae-ellen Fowler

Program � Session 1: � Session 2: � Session 3: ◦ What are falls and the significance of them? ◦ Environment: Safety in and around your room ◦ Occupations: How to keep yourself safe in your daily activities ◦ Person: What you can do to stay independent and active

SESSION 3

Last weeks session � Topics ◦ How to keep yourself safe in your daily activities? Discussion point: Did anyone find the information last week relevant and/or useful? Discussion point: Would anyone like to share with the group any changes they made to their activities? - more conscious of their movements? - use of their walking aid? - checked and/or changed their footwear and clothing? - more conscious of their energy levels during activities or through the day?

What you can do to stay independent and active

Trouble with the water works � Is common and can be managed � Tips; ◦ Intake of fluid in small doses and spread throughout day ◦ caffeine and alcohol ◦ Exercises – 30 mins and pelvic floor muscles ◦ Give yourself time � your self awareness �Learn how much time you have ◦ fluids close to bedtime ◦ Good habits for bladder emptying; �Avoid ‘hovering’ �Good positioning (QLD Government, 2011; Australian Government, QLD Government & HACC, 2010; Continence Foundation of Australia, 2010 a)

Trouble with the waterworks � Finding your muscles (for women and men) ◦ Try to stop or slow the flow of urine midway through emptying the bladder. ◦ This is not an exercise, but a way of identifying your pelvic floor muscles. ◦ If you can, stop the flow of urine over the toilet for a second or two, two then relax and finish emptying without straining. ◦ DON’T DO THIS REPETITIVELY It is NOT RECOMMENDED AS A REGULAR EXERCISE

Trouble with the water works � Pelvic floor muscle exercises ◦ Imagine letting go like you would to pass urine or to pass wind. Let your tummy muscles hang loose too. See if you can squeeze in and hold the muscles inside the pelvis while you breathe. Some tensing and flattening of the lower part of the abdominal wall will happen. ◦ Try tightening your muscles really gently to feel just the pelvic floor muscles lifting and squeezing in. If you cannot feel your muscles contracting, change your position (e. g. Lying down, sitting or standing) and try again ◦ Relax ◦ Try holding the inward squeeze for longer (up to 10 seconds) seconds before relaxing. Repeat up to 10 times (Continence Foundation of Australia, 2010 b; Continence Foundation of Australia, 2010 c)

Good sitting position for bladder emptying (Australian Government, QLD Government & HACC, 2010)

Eating and drinking healthy � Maintain good health, strong bones and muscles and sufficient energy � Tips; ◦ Avoid skipping meals – 3 each day �Body misses out on important protein, fibre, vitamin, minerals and other nutrients ◦ Low alcohol intake �Affects your reflexes and balance � your risk of falls (Queensland Government, 2011; Queensland Government, 2004)

Vision � Eyes help to not only see obstacles and judge steps, steps but to keep your balance � Tips; ◦ Time to adjust to different levels of light �Hat and sunglasses outside �Stop, hold onto something and wait for eyes to adjust �Be aware of reflective surfaces – tiled floor ◦ Be aware of new vision problems – make sure glasses are working ◦ Wear prescribed glasses as recommended ◦ Keep glasses clean (Queensland Government, 2011; Queensland Government, 2004; Queensland Government, 2012)

Foot care � Ingrown toenails or painful feet and ankles can change the way you walk and your risk of falling � Tips; ◦ Keep an eye on your feet – daily �Signs of dry skin, brittle nails, burning or tingling sensations or feelings of cold, numbness or discolouration ◦ Check pantyhose or stockings are correct size and free of seams ◦ Avoid going barefoot ◦ Leave cutting corns and callouses to the podiatrist ◦ Bathe feet daily in lukewarm water, using a mild soap (Queensland Government, 2011; Australasian Podiatry Council, 2012)

Risk taking behaviour � Avoid rushing, doing several things at once or doing things beyond your own capabilities � your risk of falls ◦ e. g. climbing on chairs to reach for high objects � Take your time and respect your limitations � Make use of your buzzer and the staff (Queensland Government, 2012)

Increasing physical activity � Physical activity keeps us healthy, active, independent and the risk of falls � If you don’t use it, you lose it! it STAY ACTIVE! ACTIVE � Advisable to do at least 30 minutes of moderate physical exercise – preferably everyday ◦ Can be split into 3 x 10 minute blocks � Physical ◦ ◦ ◦ activities that are recommended are; Walking Group Exercise Class Yoga or tai chi Dancing Stair climbing Jogging

Increasing physical activity � Balance exercises ◦ Balance awareness �Stand comfortably with your feet shoulder width apart and concentrate on the feeling of the pressure of the floor under your feet. Have the table in front of you and a chair behind you. Feel the changes as you sway your body – back and forward, side to side. ◦ The square �Step into a square to begin this exercise (the square could be a tile, a carpet square, marked out by objects or even an imaginary square). Step out of and back into the square in each direction – forwards, backwards, to the left and to the right. (Queensland Government, 2010)

Increasing physical activity ◦ The Straight Line �Choose a straight line (e. g. join in the carpet, a line of tiles, the hallway, etc. ). Walk to the end of the line, putting your L foot on the line. Turn carefully and walk back again, putting your R foot on the line. ◦ The Chair �Sit on a chair (this can be a firm dining chair, or to make this exercise harder, choose a lower, softer chair). Move toward the front of the chair, have you feet slightly back, bring your “nose over your toes”, push down on the arms of the chair and straighten up to standing. Don’t forget to look ahead NOT down at the floor! Repeat. �To make the exercise harder you can also have a pillow or foam from the DTs that you stand on as you get up and down from your chair. Or you can do this exercise on different counts (8 to 4 counts) (Queensland Government, 2010)

Increasing physical activity � Body awareness, strength and stability exercises ◦ Weight transfer �Stand with your legs apart and feet parallel. Transfer your weight from one leg to the other. Concentrate on the feeling of your weight going through your leg. ◦ Body awareness �Sit down in a chair. And lift one leg and hold, then lift the opposite arm out as well. Switch to the opposite leg and arm. ◦ Exercise #1 �Stand straight holding on to something (kitchen counter, rail, chair, etc) for support. Lift your leg sideways and bring it back to the middle, keeping your trunk straight throughout the exercise. Repeat 10 times with EACH leg. (Queensland Government, 2010)

Increasing physical activity ◦ Exercise #2 �Stand straight holding on to something (kitchen counter, rail, chair, etc) for support. Bring your leg backwards keeping your knee straight. Do not lean forwards. Repeat 10 times with EACH leg. ◦ Exercise #3 �Stand using the wall or something (kitchen counter, rail, chair, etc) for support you. Lift one leg as if you are going to take a step. Repeat 10 times with each leg. (Queensland Government, 2010)

Spot the trip hazard High to reach board Step Trailing cord Pulled out draw Upturned carpet

Which shoe is the safest?

Demonstration � What can you spot wrong with this individual getting up from their chair? � What can you spot wrong with this individual using their walking aid?

References � � � � � Queensland Government (2011). How to stay on your feet: Checklist. Retrieved from http: //www. health. qld. gov. au/stayonyourfeet/for-seniors/resources-for-seniors. asp Australian Government, QLD Government & Home and Community Care (HACC) (2010). First steps in the management of urinary incontinence in community-dwelling older people: A clinical practice guideline for primary clinicians (3 rd edn. ). Continence Foundation of Australia (2010). Managing bladder problems. Retrieved from http: //www. continence. org. au/pages/managing-incontinence. html Queensland Government: Department of Health and Ageing (2004). Don’t fall for it! Falls can be prevented. Retrieved from http: //www. health. qld. gov. au/stayonyourfeet/for-seniors/resources-for-seniors. asp Queensland Government (2012). One step ahead: Preventing falls – a guide for older people. Retrieved from http: //www. health. qld. gov. au/stayonyourfeet/for-seniors/resources-for-seniors. asp Australasian Podiatry Council (2012). Your podiatrist talks about ageing. Retrieved from http: //www. apodc. com. au/brochures-and-pamphlets/ Continence Foundation of Australia (2010 b). Pelvic floor muscle exercises for women. Retrieved from http: //www. continence. org. au/pages/pelvic-floor-muscle-exercises-for-women. html Continence Foundation of Australia (2010 c). Pelvic floor muscle exercises for men. Retrieved from http: //www. continence. org. au/pages/pelvic-floor-muscle-exercises-for-men. html Queensland Government (2010). Finding your feet - Facilitator Manual. Retrieved from http: //www. health. qld. gov. au/stayonyourfeet/for-professionals/resources-prof. asp