Aging In Place Flashcards
Aging in place
The ability to live in one’s home and community safely, independently, and comfortably regardless of age, income, or ability level
Aging in place: social connection
Community that older adults live in provides social interactions with others in neighborhood and fosters social connections which create attachment to neighborhood
Aging in place: sense of security and familiarity
Prefer familiarity of their home and people around them
Aging in place: sense of I and autonomy
Value their ability to make own decisions, which remaining in their home allows them to do
Safe at Home Checklist
Assesses the inferior/exterior of home, home safety, accessibility issues, and fall hazards
Home Assessment Profile
Performance based, safety and functional performance in living space, observe mobility in various rooms and specific activities performed in those spaces, scored on perceived level of hazard
Home Safety Assessment Tool (HSSAT)
Checklist to identify and correct hazards in the home that pose a fall risk, pictures to ID hazards, also used as a resource as it provides solutions
Comprehensive Assessment and Solution Process for Aging Residents (CASPAR)
Identify aging in place needs by collecting information used by building professionals and OTs to specify modifications, home environment and client’s ability/preferences and interaction of the 2
Client Clinician Assessment Protocol (C-CAP)
Clients’ self-reported perceptions of their abilities, difficulty and safety of performing activities in the home and community, 22 functional items and OT observation
Falls Behavioral Scale (FaB)
Evaluates behavioral factors that could protect against falling, 30 items
10 behavioral dimensions
1) cognitive adaptations
2) protective mobility
3) avoidance
4) awareness
5) pace
6) practical strategies
7) displacing activities
8) being observant
9) changes in level
10) getting to the phone
Home Environment Assessment Protocol Revised (HEAP-R)
Home based self-reporting and observation assessment to help family caregivers of persons with dementia learn through education, skill building, and environmental strategies
Domains: hazards, adaptations, visual cues, clutter, and comfort in 8 areas of the home
Home Falls and Accidents Screening Tool (HOME Fast)
Identify people at risk of falling because of hazards within the home, dichotomous, mark whether or not a hazard is present, higher score higher the fall risk
Non OT Home Fast for nonclinical caregivers
In-Home Occupational Performance Evaluation (I-HOPE)
Targets activities performed in the home essential for aging in place, abilities vs environment, person-environment misfit
Before and after home mod, client’s perspective and satisfaction
Subscores: activity, performance, satisfaction, total battier severity
IHOPE Assist used by informal caregivers
Safety Assessment of function and Environment for rehabilitation health outcome measurement and Evaluation (SAFER-HOME)
Assesses person’s ability to safely carry out functional activities in the home, can be used to measure effectiveness of intervention, interview, and observation
Westmead Home snd Safety Assessment (WeHSA)
Targets fall risks, systematic and extensive list to identify potential hazards in/around the home organized by section
Check for Safety: A home fall prevention checklist for older adults
Used by individuals/family, identify and eliminate fall hazards, organized by areas in the home
Homefit Guide (AARP)
Used by individuals/families help people stay in their home, DIY fixes
Remodeling Today guide: design ideas for kitchen and bathroom
Used by individuals/families, ideas/solutions to incorporate into universal design
Home modifications
Adding lighting, lights on sensors to turn with movement, hallway, and near bathroom
Add ramp to enter, stair lift, handrails
Bathroom modifications: grab bars, removing step over tubs, tub transfer bench, extended shower head, raised toilet
Outcomes for Home Modifications
Functional performance
Improve caregiving outcomes
Fall reduction
Strong evidence it reduces falls, moderate with dementia
Home technology increases cognitive function and independent living
Factors improved by Home Modifications
Accessibility
Adaptability
Universal design
Factors improved by Home Modifications: accessibility
Making doorways wider, clearing space for wheelchair, lowering countertops, installing grab bars, placing switches at easily reached level
Factors improved by Home Modifications: adaptibility
Changes that can be made quickly to accommodate needs of client, installing grab bars, moveable caninets
Factors improved by Home Modifications: Universal Design
Features built into home when blueprints are drawn-appliances, fixtures, and floor plans for all people to use easily
5 best home modifications
1) widening doorways
2) install ramps including indoor threshold ramp
3) kitchens mods
4) bathroom mods
5) flooring modifications, remove/place carpet, tape throw rug
Aging in place: Caregiver education
During education, think of needs of caregiver as well, depression is common as well as emotional exhaustion, burnout
Caregiver support group delays placement
OT role is to emphasize positive aspect of care and shift attitudes of care practice
Social determinant of health effect
On aging in place
Educational and financial considerations
HS or higher education levels are 30% more likely to make home modifications
Lower income rent making it more difficult to complete home modifications
Not everyone can afford home mods be aware of financial barriers
Most Adverse Events in SNF/IRF
Pressure ulcers, delirium, and medication errors
Adverse events in SNF interventions
Fall preventions
Infection management
Techniques to address feeding/swallowing
Medication management
Self management of existing conditions (DM)
Fall prevention intervention: exercise
3x/week for 30-40 minutes
Resistance, balance, and aerobic exercises lead to decreased falls
Fall prevention intervention: education
Risk screening, types of falls, mechanisms of falls, preventative ideas and goal setting reduces risk of falls, moderate evidence for 1:1 education in IRF
Fall interventions: multi-factorial interventions
Fall risk cards with info (nursing), strengthening (PT), education (OT), and hip protectors (OT, PT,Nursing)
Moderate evidence for multicomponent and discipline in home health and IRF
Assessment areas for fall risk in community dwelling adults
Balance, gait, strength, vision, medication, cognitive health, orthostatic hypotension, and environmental hazards
Assessment areas for fall risk in community dwelling adults
Balance, gait, strength, vision, medication, cognitive health, orthostatic hypotension, and environmental hazards
30 second chair stand
repetitive sit to stands from chair without arms for 30 seconds to assess leg strength and endurance in adults at risk for falls
4 stage balance test
static balance, hold 4 positions for 10 seconds with no AD, standing with feet side by side, placing instep of 1 foot so it is touching the other, placing one foot in front of the other, and standing on 1 foot, for anyone at risk for falls
Activities Specific Balance Confidence Scale
fear of falling, rate self-confidence of not loosing balance in 11 various activities in adults at risk for falls
Balance Error Scoring System
static postural stability in TBI/concussion pt, assesses balance on firm ground, foam board, standing on BLE, standing on one leg
Balance Evaluation Sustem Test (BESTest)
multifactorial assessment looking at biomechanical restraints, stability limits, transitions/anticipatory/reactive sensory, orientation, and stability in gait
Brunnel Balance Assessment
Functional balance assessment for adults post stroke, 12 point ordinal scale based on sitting, standing, and stepping
Berg Balance
assessment of mobility and balance in older adults in clinic setting
Choice Stepping Reaction Time
assess mobility and balance for adults at risk for falls by looking at sensorimotor, speed, and balance during stepping reaction
* Predictor of Falls, provides a composite measure of fall risks
Clinic test of Sensory Organization and Balance (CTSIB)
sensory interaction and balance in children and adults at risk for falls, assess balance under sensory conditions that cause instability
CTSIB Sensory conditions
1)
Community Balance and Mobility Scale
mobility and balance screening used in clinic setting for those who are mobile and high functioning
laundry basket task
Comprehensive Fall Risk Screening instrument
multifactorial, self-report questionnaire for adults at risk for falls
5 categories:
1) h/o falls
2) medication management
3) vision
4) home environment
5) physical functioning
Dizziness Handicap Inventory
self-answered checklist for degree which places pt at risk for falls in adults experiencing persistent dizziness and instability
Dynamic Gait Index
Record gait performance in adults with vestibular dysfunction to assess likelihood of fall
8 tasks including
1) walking
2) changing gait speed
3)walking with head turns in vertical and horizontal planes
4)stepping over and around obstacles
5) stairs
4 point scale
Edmonson Psychiatric Fall risk assessment
assesses fall risks in adults in inpatient psychiatric facilities, 9 categories
score of 90+ indicates high fall risk
can be observed or self-report
Elderly Falls Screen (EFST)
multifactorial fall screen in community dwelling adults who are independent functionally, self administered questionnaire and observations of gait patterns
Fall risk Check List
part of STEADI kit, multifactorial assessment on falls, h/o medications, gait, strength, balance, vision, postural hypotension, and risk factors in adults at risk for falls
Fall-Risk Screening Test
self-administered multifactorial in community dwelling older adult
Falls Behavioral Scale (FAB)
identify clients awareness of behaviors that will increase likelihood of falling in the home environment
Falls Efficacy Scale
assesses fear of falling and confidence in older adults, survey regarding activities relater to self-perceived confidence, 10 pt scale, rates “can they perform the task without falling
Falls Prevention Strategy Survey
use in MS*****, ,multifactorial assessment, self-report regarding protective behaviors related to fall risk
Fall Risk Assessment Tool (FRAT)
subacute and residential residents, screens for fall risk in subacute setting, risk factor checklist, fall risk status and action plan
5 time STS (FTSTS)
identifies balance dysfunction by assessing LE strength and change during transitional movements in adults at risk for falls
4 step square test
screens mobility and balance by assessing adult at risk for falls to step over low obstacles and change direction
Fullerton Advanced Balance Scale
multi-factorial balance assessment, instructing pt’s to demonstrate static and dynamic movements while observing. Pt received score on how successful and safely that have completed ease movement
Get UP and Go
assess balance in elderly and anyone at risk for falls
Functional Reach Test
screens mobility and balance in adults at risk for falls
Hendrich-II Fall risk Assessment
used in acute care , fall risk in hospitalized patients
Home Assessment Profile
Client’s living environment, quantative home assessment that evaluated perform and safety for fall risk in the home environment
HOME-FAST
questions about home environment, determine need for additional resources and referral for more detailed assessment, self-report yes/no,
Missouri Alliance for Home Care (MAHC)
10 fall risk, client’s home, self answered questionnaire yes = 1 point
Morse Fall Risks
assesses fall risk in hospitalized pts’ pin LTC and hospital, very quick and simple way to assess pt’s risk and likelihood
Multi-direction Reach test
designed to measure mobility and balance, reaching in 4 directions in adults at risk for falls
Personal Risk Factors Fall Prevention Checklist
identifying fall risk with yes/no questions, fall h/o, medication , and fear of falling
Push and Release test
identifies client’s instability before experiencing a fall, assesses correctional response to regaining balance
Home Screen Scale
Client’s home, identifying environmental and behavioral risks tha tincrease risk of falls
Single Leg stance
adult’s with fall risk without presence of disease, amplitude and speed of sway
Spartanburg Fall Risk Assessment Tool
acute care population, identifies fall risk
STEADI Fall risk Assessment
fall risk assessment and care management, self-administered checklist
toolkit provides clinician resources and pt education
STRATIFY
used in acute care setting and LTC, fall risk in hospitalized patients, predicts chances of Falling
Tandem Stance
Balance screen for anyone, stand heel to toe and shake head yes/no
TUG
assesses mobility and balance, time participant takes to stand up walk 3 meters turn and walk back and sit down, 3 trials
Tinetti Performance Oriented Mobility Assessment (POMA)
assess balance/mobility, measures gait/balance to determine mobility status and changes overtime
28 tasks in balance/gait, observation on 3 point scale
3 total measures: overall gait assessment, overall balance assessment, and combined score
University of Illinois Chicago Fear of Falling
fear of falling in community-dwelling elderly, self-answered rating scale
Falls treatment
Remediation of balance
Therapeutic exercise
CBT
Falls treatment: remediation of balance
key focus
Address proper of alignment, weight shifting, and postural adjustments
incorporate above into occupation based activities
Fall treatment: exercise
3 hours/week including balance challenging exercises such as reducing BOS, altering COG, and decreasing arm support (most effect)
yoga/tai chair
Fall treatment:CBT
addresses fear of falling and activity avoidance to reduce falls
increase self-confidence, improving physical well-being, and promote sense of control
strategies for performing activities safely
Shifting negative thought patterns, set goals
decrease environmental hazards
Stay Active and Independent for Life (SAIL)
community based program, combines exercise and education to reduce falls and increase functional abilities
Stopping Elderly Accidents, Deaths, and Injuries (STEADI)
training, tools, and resourcecs for providers by CDC
Screen-Assess-Intervene
Screen resulting not at risk, focus to prevent future risk with fall prevent
Screen resulting in risk, evaluate gait, strength, balance, home environment/ID hazards, assess BP, assess visual acuity, footwear, vitamin D intake then intervene based on results
My Mobility Plan
mobility planning tool from CDC, evidence based
Components:
myself= health management
My home= home modifications, reducing hazards
My community= how do I plan to get around
can be used by adult children or caregivers
Behavioral Risk Factors regarding Falls
choices individual makes interacting in their environment
ie standing on chair/table, not using AD
Modifications for Falls tx
home modifications, AE use, fall recovery, proper footwear, task modification (compensatory/adaptations)
Root of Fall risk
intrinsic: individually oriented, health conditions, state of being, degree of function, muscle weakness, gait/balance disorders, sensory loss, decreased mental status, and medication
Extrinsic: environmentally oriented, shared common environment ie throw rugs, clutter, decreased light
Psychosocial effects of Falls
(+) correlation between falls and anxiety, increased anxiety linked with increased falls
Depressive sx associated with fall risk factors such as slow walking speed, decreased cognition, slow reaction time
Fall prevent should include addressing depressive symptoms
