Occupational Therapy perspective of FAll PREVENTION PROGRAMME

1
FALL PREVENTION IN THE ELDERLY
AKPA IFEANYI VICTOR
(BMR (OT) Ife) MSc. PH(In View)
(OCCUPATIONAL THERAPY PERSPECTIVE)

2
OUTLINES
• Introduction
• Epidemiology of falls in the elderly
• Risk factors of fall in the elderly
• Effects of fall in the elderly
• PEO Model
• Assessment
• Occupational therapy Prevention Intervention
• Conclusion

3
INTRODUCTION
• A fall is considered an unplanned sudden event that results in a
person coming to rest inadvertently on the ground or floor or
other lower level.” (WHO 2018)
• Elderly/Older adults are adults over the age of 65 years (WHO,
2018)

4
INTRODUCTION Contd.
• Greater declines in Basic Activities of Daily (BADLs) and
Instrumental Activities of Daily Living occurs in Elderly fallers than
in non fallers and well detailed fall prevention programs has been
effective in help increasing level of activity participation among
fallers (Kiel et al. 2012).
• An effective fall prevention program involves a multidisciplinary
approach, where a couple of individuals/profession have a role to
play.

5
EPIDEMIOLOGY OF FALLS IN THE
ELDERLY
• Approximately 30% of individuals over 65 years of age fall at least
once a year, and about half of these do so recurrently (BC Injury
Research, 2012)
• In Nigeria, 26.5% accidental domestic deaths in persons aged 70
years and above, 77% of which occurred from a fall from a height
or on the same level, constituting the most common mechanism
of injuries leading to death in the elderly (Seleye-Fubura, 2003)

6
RISK FACTORS
• Intrinsic risk factor: Intrinsic risk factors are personal traits of
an individual that increase their risk of falling
• Extrinsic risk factor: Extrinsic causes are social and physical
factors that relate to an external environment, unrelated to
disease or drug use for example slippery floor finish
• Combined risk factor: this involve a combination of the
intrinsic factors and extrinsic factors

7
INTRINSIC RISK FACTORS
• Impaired Activity of Daily Living
• Alteration to gait, balance and mobility, or muscle weakness
• Older person’s perception of functional ability and fear of falling
• Visual impairments
• Cognitive impairment and sensory deficit
• Cardiovascular pathology
• Musculoskeletal impairment
• Medications prescribed

8
EXTRINSIC RISK FACTORS
• Environmental factors: Presence of home hazards such as poor
lighting, loose rugs, stairs, slippery surfaces, irregular floor
surfaces, improper assistive devices such as walking aids, Clutter
and No support in bathroom
• Poor footwear

9
EXTRINSIC RISK FACTORS CONTD.

10
EFFECTS OF FALL
• ACTIVITIES OF DAILY LIVING (ADLS): Decreased level of
participation in important ADLs, Decreased level of functioning and
independence
• PHYSICAL: Bruising, fracture, brain haemorrhage, skin tear which
can eventually lead to hospitalization and/or death
• MENTAL/PSYCHOLOGICAL: Depression, loss of confidence, fear of
falling, anxiety and restriction of lifestyle
• SOCIAL: Inability to leave home (real or imagined), long term care,
inability to follow hobbies and social withdrawal

11
PEO MODEL
• The ‘person-environment-occupation’ model provides a useful
framework for understanding both the content and process of
delivering occupational therapy falls prevention interventions.
• This model proposes that these three components continually
interact and change, and that this impacts on a person’s
performance or function. the better ‘fit’ between the
components, the better their performance or function.

13
ASSESMENT
• FALL HISTORY (SPLATT CONCEPT)
 S- Symptom as time of fall(s)
 P- Previous numbers of fall or near fall(s)
 L- Location of Fall(s)
 A- Activity at time of Fall(s)
 T- Time of fall(s) and Time on the ground
 T- Trauma or injury with Fall(s) (Physical, psychological,
emotional)
• INCIDENT REPORT

14
ASSESMENT CONTD.
• Fall Efficacy Scale- International (FES-I): FES-I was developed as
part of the Prevention of Falls Network Europe (ProFaNE) project
from 2003 to 2006, following an intensive review of fear of
falling, self-efficacy and balance confidence questionnaires
• FES-1 Ranges from scores 16-64, 16-19 indicating low fear of fall,
20-27 indicating Moderate fear of fall, 28-64 indicating High fear
of fall

16
ASSESMENT CONTD.
• NEUROLOGIC EXAMINATION
 Cognitive screening
 Sensation
 Proprioception and Stereognosis
• ENVIRONMENTAL ASSESSMENT: Intended to identify
hazardous conditions within the home, and out outside the
home.
 Home Falls and Accidents Screening tool (HOME FAST),
Weadsmead Home safety assessment

17
OCCUPATIONAL THERAPY
INTERVENTION
 Occupational therapy interventions addressing personal risk
factors
 improve falls self efficacy, which is essentially the degree of
confidence that a person has in carrying out everyday activities
without falling
 Education on Fall prevention programs (WHAT and WHY)

18
OCCUPATIONAL THERAPY
INTERVENTION
 Occupational therapy interventions addressing environmental
risk factors
 This entails making structural modifications that create safe
environment for participation in ADLS
 Occupational therapy interventions addressing activity in
(‘occupation’) related risk factors.
 This entails making recommendations on safe method of
performing activities.

19
OCCUPATIONAL THERAPY INTERVENTION
(Modifications and recommendations)
 Electric Chords should be placed along Walls (not under floor
finishes like rug or carpet)
 Floor should be cleared of clutters
 Stepstools or ladders is to be avoided
 Use of Non slipped rubber tips under furniture to prevent
sliding
 Shelves are to be placed to avoid overreaching.

21
 BEDROOM SAFETY
• Bed should be of seat height, stable and firm to get in and out
easily
• Eyeglasses, canes and walkers are to placed within reach
• If Unsteady on feet while dressing, sitting should be
encourage
• Long and loose clothing should be avoided

23
 BATHROOM SAFETY
• rubberized slip-resistant mat used around the bathroom (bath
tub)
• Installation of slip resistant grab bars in bathrooms and by
toilet
• Shower bench or chair when showering (A shower chair
should have back support and rubber tipped feet)
• Toilet seat should be raised to seat level

25
 LIGHTING
• Light switches should be accessible at room entrances
• Night lights in bed rooms, stairs and hall ways
• Use of touch sensitive lamps
• Light lamps should be placed at easily accessible locations
• Lighting must be adequate

26
 STAIRS SAFETY
• Stairs should be well lit
• handrails at the correct height should be install on both sides
of the stairs
• Mark step edges with outdoor reflective tape
• Outdoor high steps can be converted to ramps
(1 inch ratio 12 inches) i.e slope ratio of 8.3%

28
 FOOT WEAR
• Foot wear with proper soles should be recommended
(nonskid soles, low heel and a good tread)
• Foot wear with worn out soles should be replaced
• Foot wears should be fitted

29
CONCLUSION
• Management is multifactorial and it involves working with
other interdisciplinary team in order to achieve a good
outcome.
• Home safety interventions delivered by an occupational
therapist are more successful than those which were not.
• Several randomized controlled trials have established the
efficacy of home safety modifications in reducing falls, hence
the role of Occupational therapy cannot be overlooked, in
order to have an effective Fall prevention program.

31
REFRENCES
• World Health Organization (2018). Definition of fall and fall related
injuries: promoting a national falls prevention plan.
• Publication Manual of the American Psychological Association, 6th
edition (American Psychological Association, 2009).
• ballinger c, clemson l (submitted). translating falls prevention for adults
with intellectual disability: strategies and opportunities. submitted to
world Federation of occupational Therapists congress, 2014.

32
REFRENCES
• Stalenhoef PA et al. (2012). A risk model for the prediction of recurrent falls in
communitydwelling elderly: A prospective cohort study. Journal of Clinical Epidemiology,
55(11):1088- 1094.
• Smith M. Medication & The Risk of Falls in the Older Person: The Facts. Produced on behalf of
WAM Falls in Elderly Steering Group. 2014.
• Campbell AJ, borrie mJ, spears GF, Jackson sl, brown Js, Fitzgerald Jl. circumstances and
consequences of falls experienced by a community opulation 70 years and over during a
prospective study. Age Ageing 1990;19(2):136-41.
• Mackenzie l, byles J, Higginbotham n. Designing the home falls and accidents screening tool
(Home FAst): selecting the items. Br J Occup Ther 2000;63(6):260-9.

Occupational Therapy perspective of FAll PREVENTION PROGRAMME

More Related Content

Similar to Occupational Therapy perspective of FAll PREVENTION PROGRAMME

Recently uploaded

Occupational Therapy perspective of FAll PREVENTION PROGRAMME

Editor's Notes