training, and walking, all of which are included in the Otago program, which is supervised and progressed by a clinician. 5. Research indicates that early fall prevention interventions should include lower extremity strengthening, balance exercise, and correction of home hazards in order to have the most immediate effect on fall prevention. Research does not indicate at this time that reducing fear of falling or improving somatosensation alone will have an immediate effect on future falls. ● History of falls. ● Medication review of relevant medical risk factors. ● Detailed evaluation of gait, balance, and mobility. ● Detailed neurologic evaluation. ● Assessment of lower extremity strength, cardiovascular status, visual acuity, and feet and footwear. ● Assessment of ADLs, fear of falling, and their home environment. Interventions should be tailored to the older adult’s functional level based on their own risk factors for falls and should be evidence-based. Interventions should include the following: ● Balance exercise. ● Strengthening exercise. ● Gait training. ● Adapting the home environment. ● Management of foot problems and footwear. Further research is needed for effective fall prevention for more frail or institutionalized older adults. Therapists should promote a sense of urgency in their communities that results in a wider implementation of fall risk screenings, fall prevention interventions and education, and a team approach to attacking this epidemic. 160. This article is posted on the AOTA website as a guide for occupational therapists interested in fall prevention. ● Chase CA, Mann K, Wasek S, Arbesman M. Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community dwelling older adults. Am J Occup Ther. May/June 2012. ;66; :2284-291. This article is also posted on the AOTA website as a guide for occupational therapists interested in fall prevention. Fall Prevention Programs Each of these links will provide more details on the specific fall prevention program identified, along with information on training/certification as needed: ● Otago certification : (http://www.med.unc.edu/aging/cgec/exercise-program) ● Matter of Balance : http://www.mainehealth.org/mob ● Stay Active and Independent for Life (SAIL) : https://www.doh.wa.gov/YouandYourFamily/ InjuryandViolencePrevention/OlderAdultFalls/ StayActiveandIndependentforLifeSAIL ● Stepping On : https://wihealthyaging.org/stepping-on. ● Tai Chi : http://taichiforhealthinstitute.org/how-to-become-an- instructor-of-dr-lams-program-3/ Fall Prevention Materials Each of the following links will take you to helpful websites that share educational handouts, screening materials, and patient education information related to fall prevention: ● Toolkit for National Fall Prevention Awareness Day : https://www.ncoa.org/healthy-aging/falls-prevention/falls- prevention-awareness-day/(https://www.ncoa.org/healthy- aging/falls-prevention/falls-prevention-awareness-day/).
challenging. Irene was able to perform the TUG requirements without physical assistance. 3. Irene relied on her visual system for balance as evidenced by her mCTSIB performance. Irene’s history of lower extremity sensory loss and vestibular hypofunction could also affect her reliance on vision. 4. Irene would benefit from the Otago exercise program, which has been proven to decrease falls in homebound older adults. Irene meets the definition of a homebound older adult. She would benefit from strengthening, balance Conclusion This course has exposed the learner to compelling information that described the falls epidemic, a healthcare emergency for older adults. Anyone over 65 years of age is at risk for falls simply because of their age. This risk is compounded by the numerous intrinsic and extrinsic factors that influence an older adults’ ability to respond physically, mentally, and socially to falls and to their consequences. Through accurate screening for fall risk, differential diagnosis of the fall etiology, and effective multifactorial treatment planning, knowledgeable therapists can have a positive effect on the quality of life of older adults at risk for falls. Several national health organizations have reviewed or conducted research and their recommendations can be summarized as: ● Ask all older adults about falls and injurious falls in the past 12 months. ● Ask all older adults if they have difficulty with balance or walking. ● Adults with a single fall or with difficulty with gait or balance screenings should have a multifactorial fall risk evaluation performed by a trained clinician. ● Older adults with a single fall but no trouble with gait or balance do not need a multifactorial fall risk assessment. A multifactorial fall risk assessment should include the following: Resources National Fall Prevention Guidelines & Position Papers ● Centers for Disease Control and Prevention, National Center for Injury Preventions and Control, Division of Unintentional Injury Prevention. STEADI (Stopping Elderly Accidents, Deaths, and Injuries) Tool Kit for Health Care Providers. Available at: Retrieved from https://www.cdc.gov/steadi/ index.html. Accessed July 13, 2018. This is an excellent website for resource materials for healthcare providers and older adults , along with patient education handouts and screening forms. ● American Geriatrics Society (AGS) and British Geriatrics Society (BGS) Panel on the clinical Clinical Practice Guideline for the Prevention of Falls in Older Persons. AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons. 2010. Retrieved from http://www. geriatricscareonline.org/ProductAbstract/updated-american- geriatrics-societybritish-geriatrics-society-clinical-practice- guideline-for-prevention-of-falls-in-older-person-and- recommentdations/CL014. Accessed November 18, 2016. This link provides a full description of the most recent practice guideline related to fall prevention in older adults, written from a physician prospective. Or access a free copy of the guideline at https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1532- 5415.2001.49115.x; Accessed July 13, 2018. ● US Department of Health and Human Services Administration for Community Living: A profile of Older Americans 2016: https://agingstats.gov/docs/LatestReport/Older-Americans- 2016-Key-Indicators-of-WellBeing.pdf. Accessed July 13, 2018. This link provides up -to -date statistics regarding our the older population and their changing health conditions. ● Leland NE, Elliott SJ, O’Malley L. Murphy SL. Occupational therapy in fall prevention: current evidence and future directions. Am J Occup Ther. March/April 2012. ;66; :149-
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