Falls Prevention, Part 2

Last month's Clinical Corner article addressed risk factors associated with falls at home or in the community. The risk factors were categorized as biological, behavioural, socio-economic and environmental. For more details on the risk factors associated with falling, refer to Falls Prevention, Part 1. This month, Clinical Corner will address evidence-based strategies to reduce the risk of falls for older adults living in the community.

The Aging, Community and Health Research Unit (ACHRU) of McMaster University identified 7 evidence-based falls prevention interventions for community-dwelling older adults (n.d.). While some of the strategies are beyond the scope of an occupational therapist or physiotherapist, it remains important to understand the multifactorial and multi-disciplinary strategies that have been identified for individuals at high risk for falls. Individuals who are at high risk for falls include those who have had an injury as a result of a fall, those who have had more than one fall in the past year, and those who have difficulty with gait or balance (Public Health Agency of Canada, 2014). The interventions cited by ACHRU for falls prevention are:

• A comprehensive risk assessment for clients at high risk for falls. "The assessment includes a medical history, physical exam, functional and environmental assessments followed by interventions tailored to the individual." (p. 1.)
• An exercise program to improve strength, gait and balance. Either home-based or group exercise classes that are progressive and tailored to the individual were found to be effective.
• Vitamin D supplements.
• Home safety assessment using a validated tool, followed by environmental modifications.
• Medication review of the total number of medications taken or dosage of medications associated with increased risk of falls.
• Vision assessment.
• Falls prevention education for the individual.

Let's look more closely at some of the falls prevention interventions provided by therapists.

Home Safety Assessment

A home safety assessment should include an evaluation of the environment to determine factors present that contribute to the risk of falling, as well as a functional assessment to evaluate the interaction of the client with their environment (Pynoos, Steinman, and Nguyen, 2010). Factors that might contribute to falls within the home include clutter; tripping hazards, such as throw rugs or loose electrical cords; poor lighting; lack of grab bars or slip resistant mats in the bathroom; and lack of stair rails (Province of British Columbia, 2018). An occupational therapist should evaluate the home environment and provide recommendations to address any modifications required. A therapist should also assess activities of daily living (ADL), including transfers, and provide recommendations for improved safety in performing ADLs and for any required equipment, such as a bathtub transfer bench. There are several checklists and assessment instruments available for therapists to use to ensure that all components of a home safety assessment are completed thoroughly.

A home assessment may also include an assessment for mobility equipment. If the client has a mobility device, the therapist will assess for its correct use. If the client does not have a mobility device, the therapist will evaluate the potential need for a device (Public Health Agency of Canada, 2014).

Exercise Program

Exercise programs aimed at decreasing the risk of falls for older adults are most effective when they address balance, gait and strength training (Public Health Agency of Canada, 2014). Recommendations for exercised-based interventions include:

1. "Exercise must provide a moderate or high challenge to balance;
2. Exercise must be of a sufficient dosage to have an effect;
3. Ongoing exercise is necessary;
4. Fall prevention exercise should be targeted at the general community as well as those at high risk of falls;
5. Fall prevention exercise may be undertaken in a group or home-based setting;
6. Walking training may be included in addition to balance training, but high risk individuals should not be prescribed brisk walking programs;
7. Strength training may be included in addition to balance training;
8. Exercise providers should make referrals for other risk factors to be addressed." (Public Health Agency of Canada, 2014, p. 33).

Education

Falls prevention education may be required for the individual at risk for falls, as well as any caregivers, if appropriate. Education may be provided as a part of a home safety assessment or follow-up and as a part of exercise instruction. Multi-disciplinary falls prevention programs aimed at seniors exist in various health care centres. Education in falls prevention for the individual often is a component of the program.

Summary

Just as there are many factors that contribute to the risk for falls, there are many interventions to address the risks. A multi-disciplinary, multi-factorial approach is important to take for older adults who are identified at high risk for falls.

References

1. Aging, Community and Health Research Unit. (n.d.). Engaging community organizations in fall prevention for older adults: Moving from research to action. Retrieved from https://www.publichealthontario.ca/
2. Province of British Columbia. (2018). What contributes to falls? Retrieved from https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/disease-and-injury-care-and-prevention/fall-prevention/what-contributes-to-falls
3. Public Health Agency of Canada. (2014). Seniors’ falls in Canada. Second Report. Retrieved from https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/assets/pdf/seniors_falls-chutes_aines-eng.pdf
4. Pynoos, J., Steinman, B.A., & Nguyen, A.Q.D. (2010). Environmental assessment and modification as falls-prevention strategies for older adults. Clinics in Geriatric Medicine. (26), 633-644. DOI: https://doi.org/10.1016/j.cger.2010.07.001