How to Reduce Fall Risk

(HealthNewsDigest.com) - One in three adults over the age of 65 falls every year resulting in injuries ranging from scrapes and bruises to hip fractures. In recognition of Fall Prevention Awareness Day on September 23rd, Home Care Assistance interviewed Julie Groves, occupational therapist and owner of Therapy In Your Home - OT, PT, ST, a specialized outpatient therapy service.

A: I like the philosophy of being an OT, which is staying active, adapting to what you can’t change and recognizing the psychological implications of disability. I like having the understanding that if the person is having trouble, changing the environment and task may help him or her function better.

A: When looking at the individual, I would consider which medications are being taken, how regular is his or her eating schedule and how much fluid is he or she consuming on a daily basis. These are outside factors that can contribute to dizziness and can cause cognitive changes or mood disorders, all of which can affect fall risk.

I would also look at the communication style between the senior and the family or the senior and the caregiver. Phrases such as “Don’t get up without your walker” or “I told you not to lean over” are ineffective. If the person didn’t remember to do something as instructed the first time then relying on their memory isn’t the answer and those types of commands will only be upsetting to him or her. It’s important to know that we can educate loved ones and caregivers about memory loss and how to compensate for it without communicating in a way that will likely decrease confidence or cause frustration in the individual.

On top of outside factors and memory loss there may be motor cognitive issues (cognitive issues that impact motor function) that impact balance and increase fall risk; this is an under-recognized problem with significant ramifications. Reflex timing, decreased motor response quality such as not knowing what to do when one loses his or her balance, and impaired memory can all be a source of confusion and increased fall risk.

Occupational therapists also look at the individual’s learning skills to determine whether he or she would be better off with a walking aide or more confused and at risk of a fall using one. OTs can also look at how engaged the person is when performing activities so that they know how likely he or she is to fall when up and completing tasks. Does he or she become distracted easily? Does he or she focus well on something when it’s a task that he or she cares about?

A: The common fall risk assessments are a good place to start. Following the completion of these assessments, I would look at the below list of questions to assess why the person was at risk, how at risk was he or she, and offer some suggestions about how to change the situation.

How many times can a person stand up and sit down well? (This shows his/her balance and strength)
How far can a person reach without moving his or her feet? (This shows balance and accommodation to loss of balance)
How well does a person stand – how does he or she get started and how steady is he or she once up? (This demonstrates his/her ability to plan movements and accommodation to change)
Can the person get up off the floor well? (This single exercise might make the most difference in confidence, strength, endurance and balance as well as confidence for the client, caregiver or family)
Can the person roll and change positons on the bed well? (These moves help people remember how to move well, maintaining motor cognitive skills and motor memory)
How clear is the floor where he or she walks and what is the quality of the things the person hangs on to walking around?
How well can he or she see changes in walkways such as steps or bumps? How is his or her vision and the person’s ability to use their vision (e.g. looking around a room)?
How variable is his or her skill level when it comes to walking based on fatigue, blood pressure, hunger, medication, pain, etc.?

A: It is important to understand that strength is not enough to maintain balance. Engaging in meaningful, active tasks is one way an occupational therapist can help people maintain balance. Routine exercises tend to lack interest and effectiveness. However, exercises are a good start and more effective if the person keeps them up. Another way to start working on balance is to “just stand up” because once the person is able to stand more easily, the more likely he or she is to be active, which is the best exercise of all.

Julie Groves, Occupational Therapist (OTR/L), graduated with a degree in Occupational Therapy from the University of Puget Sound in Tacoma, Washington and has over 30 years of professional experience in occupational therapy. Groves currently serves on the Board of Coda Alliance, Silicon Valley Community Coalition for End-of-Life Care and is a regular speaker at the San Jose State Occupational Therapy Department. Her awards include the Occupational therapy Association of California President Award (1991) and Special Contribution Award for the Santa Clara Chapter OT Association (1993), and she is a Bay Area leader in the field of occupational therapy. She was just nominated for the Occupational Therapy Association of California’s Entrepreneur of the Year Award.