Week 12 Flashcards
An unexpected/unintentional event in which the person comes to rest on the ground, floor, or lower level
Fall
- Don’t have to fall onto the ground
- May occur as result of slip or trip e.g., slip and fall
Slip vs Trip
Slip: occurs when too little friction or traction between feet and the walking surface
Trip: Occurs when foot strikes an object or irregular surface and momentum throws you off balance
Why is it important to be consistent on which definition (trip, slip) you use with client?
- Keeping you and pt on same page is critical. What you call a fall may not be what a pt calls a fall
- Can give visualization as demonstration
- Whatever definition you choose, be consistent
T/F: Significantly more falls in community-dwelling OA compared to nursing home OA
False. Significantly higher fall rates in nursing homes
-Fall rates depend on the setting
What is the leading cause for:
- fatal injuries
- nonfatal injuries
- hospital admissions for trauma?
Falls. 2.2 million spent on fall issues related to ER visits annually
Of the following, which are the top 5 strongest risk factors for falls? A. Muscle weakness B. History of falls C. Balance deficits D. Use of AD E. visual deficits F. Arthritis G. Impaired ADL H. Depression I. Cognitive impairment J. Age>60 K. Gait deficits
B. History of falls G. Impaired ADL K. Gait deficits A. Muscle Weakness D. Use of AD -Surprisingly, not cognitive
The more fall risks one has, the more likely to…
Fall in an annual period. Linearly exponential
Outcomes of falls include…?
- Injuries (skin abrasions, bruises)
- Costs (ER visits)
- Loss of independence (maybe early admission to nursing home)
- Psychological trauma (fear of falling again)
- Death
How may a fall affect loss of independence in an OA?
May cause early admission to a nursing home
How may a fall cause psychological trauma in an OA?
They may have a fear of falling again
Hip fractures are often caused by …
falls
Who is more likely to fall and get a hip fracture–men or women?
Females more likely b/c osteoporosis
How does age affect the risk hip fractures from falling ?
Older=more likely to fall
- 85 and older much more likely to sustain hip fracture than 65
- 20% OA who sustain hip fracture from fall die in a year
Are older males or females more likely to sustain fatal injury from fall and hip fracture
- Males more likely to sustain fatal injury–die from fall
- Relates to infection post-fall
- Perhaps more riskier behaviors e.g., putting up christmas lights
Lasting concern about falling that can lead to an individual avoiding activities that he/she remains capable of performing
Fear of Falling (FOF)
Confidence or ability to avoid falls
Falls efficacy /falls self-efficacy
Focus on balance; how confident you are that you will be able to avoid loss of balance
Balance confidence
How afraid of falling you are
Fear of falling
All of the following except which are all possible consequences of FOF: A. Fall B. Decreased balance confidence C. Decreased QOL D. Anxiety E. Loss of appetite F. Depression G. Restricted activity H. Functional decline
E. Loss of appetite.
How may FOF cause depression?
Individual may be so afraid, they don’t want to leave house or engage in activities, so they have limited social circle
How may FOF cause a functional decline?
May have a fear of any movement, so don’t do as much
What is the AGS Fall Prevention Decision Guide?
- Tool when screening a pt
- How pt responds lets you know if you’re going to do a more elaborate tool
When using a fall screening tool like the AGS Fall Prevention Decision Guide, how do you know if you should do a more elaborate tool afterwards?
It pt reports fall in past year, do a more comprehensive assessment
Who should you do a fall prevention screen with?
Almost every OA!
Self-report vs. performance-based falls prevention assessments
With performance based, actually watching them do the activity
Screening vs. comprehensive assessments for fall prevention
Comprehensive: what you do after you screen for risk. Can be balance or confidence assessment
Examples of different areas of focus for fall prevention assessments…
Balance, functional mobility, home environment
How can we assess fall history retrospectively?
- Look at hospital admissions
- Ask pt (in the past X years/months/days, how many times have you had a fall BUT define fall first). Common time frame to ask is 12 months/1 year. But may say shorter time like 6 months if they’ve had a lot of falls since it’s hard to remember
- refer to chart that includes fall hisotry
How to assess fall history prospectively
Use fall diary/calendar
Why may using self-report to assess fall history be problematic
- May not be accurate
- May be afraid of the consequences if they say they’ve fallen e.g., may lose independence and go to nursing home
- Staff may not report if they feel they’ll get into trouble
What details should you find out about when looking at one’s fall history?
- Details about where they fell, context around fall
- Type of shoes
- If distraction occurring
- Drinking enough water (dehydration may cause low BP/orthostatic changes, so feel dizzy and fall)
- Get insight into their own falls (if person doesn’t tell us they understand why they fell, may be cognition or not paying attention–different ways to then direct tx)
What is the Timed up and go test (TUG)?
A gait and mobility assessment:
- Need arm chair
- When you say go, they get up and walk around 3 meter space and sit down
- Amt time to sit is outcome
- Can do it faster paced or ask them to hold cup of water to make harder
What is the Gait Speed test
Gait and mobility assessment:
- Put piece of tape on floor 4 m apart and mark on wall
- Ask them to start walking past line, don’t slow down
- Time takes to traverse certain amount of time is gait speed
- Easy to do in clinic-takes little time
- Don’t count first m because just getting started and gait hasn’t normalized
What is the 6-minute walk test?
Gait and mobility assessment:
- Amount distance person can travel for 6 minutes for 2 sets of cones
- Can see quality of walk change over time
What is the Tinetti Performance Oriented Mobility Assessment (POMA)?
Gait and mobility assessment
- Multiple tasks to do
- Have to push person unexpectedly
- Tests their rxn
- Have to be ready to catch them
What is the Dynamic Gait index
Gait and mobility assessment:
- Normal walking
- Talk while walking, head turning while walking
What are contextualized gait and mobility assessments?
- Watch walk into or out of room
- Watch walk to bathroom as ex
Balance test where you step out as far as you can and return to normal stance
Maximum step length. If they can’t return, then they have stepped out too far. A lot of people over and under shoot.
In the Max step length, who often overshoots?
Males and younger adults usually overshoot during max step length.
Balance test where you fix a ruler to the wall and they reach arm as far as they can without taking a step.
Functional reach test. The distance from where they start to end is functional reach.
30 sec balance test where you ask pt to stand on one foot (they may brace themself against wall).
Unipedal stance test. As soon as they put foot on ground, stop time.
30 sec balance tests where you ask pt to stand with one foot in line with another
Tandem stance test
With tandem and unipedal stance tests, what results would show that pt is at high risk, especially for injurious falls?
It pt can’t hold stance for 5 seconds
Balance test that looks at horizontal movement around pt’s BOS
Postural sway. More likely to research in lab than clinic Force plates pick up sway. Can challenge by pick up something, on one foot, close eyes. More sway, higher risk for falls
Balance test where pt stands up and down for 30 seconds
30 second chair stand
Balance test that requires 14 different balance tasks for pt to perform e.g., stand up from chair, stand on one foot
Berg Balance Scale. Usually done by PT
Who usually does the Berg balance scale
PT. Balance test that requires 14 diff balance tasks for pt to perform e.g., stand up from chair, stand on one foot
The following is an example of what kind of balance test:
Reach down to pick up a slipper
Contextualized balance test. Or reach down to floor, to counter
How can you test for FOF?
- May ask Yes/No e.g., are you afraid of falling
- Likert: how afraid of falling are you on scale from 1-10
6 item test asking person about specific activities and how confident they won’t lose balance in situations
Activities-specific Balance Confidence (ABC) scale. Shorter version of 16 item test. May ask about walking across room, walking on icy sidewalk
In this assessment, ask about an individuals “concern” for falling in different situations e.g., going to shop, going up/down stairs, walk around neighborhood
Falls Self-Efficacy Scale-International (FES-I)
In the Falls Self-Efficacy Scale-International (FES-I), why do they use the term “concern” rather than “fear”
B/c some people may be less likely to admit they have a concern rather than a fear. Concern doesn’t express the emotional distress that is often associated with the word fear. Some–males especially–may be unwilling to admit fear
Test that asks pt about activity restrictions and patterns of activity e.g., do you ever avoid cleaning house b/c fear of falling
- Survey of Activities and Fear of Falling in the Elderly (SAFFE)
- Contextualizes fear in activity participation and patterns
- If you see pattern of avoidance, think about how fear is impacting life
Cognition screening test in which includes simple questions and problems in number of areas: orientation, repeating list of words, math, basic motor skills
Mini Mental Status Exam (MMSE)
Cognition test that asks pt to attend to two things simultaneously e.g., walk and talk, do math while walking, hold cup of water while walking
Dual Task Performance. But if assessment memory, may not be good indication of whether or not they’re at risk for fall
What does the Dual Task Performance test?
-Dual processing
-Executive functioning
-Reaction time
(all part of preventing falls)
Cognition test that asks pt to do normal task e.g., pay bills, cook
Routine Task Inventory
-Relevant to OT!
Examines the implementation of four basic tasks that are essential for self-maintenance and independent living: simple cooking, telephone use, medication management, and bill payment.
Executive Function Performance Test
-Performance based test
72 item checklist of fall hazards in pt’s home
Westmead Home Safety Assessment (WeHSA
Pros and Cons to the Westmead Home Safety Assessment (WeHSA)
WeHSA: 72 item checklist of fall hazards in pts home Pros: -Very practical -Thorough -Looks at pt's capacity e.g., vision, general mobility Cons: -May take 2 visits to complete -Costs money -Only available if clinic subscribes to
This assessment looks at whether the pt’s home is a good fit for him/her (not the REIS!)
Comprehensive Assessment and Solution Process for Aging Residents (CASPAR)
- Measure doorway, sink height, toilet seat height
- enables an older adult, family, and/or caregivers to identify high-priority home problem areas that are in need of modification
Pros and cons of the Comprehensive Assessment and Solution Process for Aging Residents (CASPAR)
CASPAR: Looks at whether pt’s home is good fit e.g., measure doorway, sink height, toilet seat height
Pros:
-Can be administered by anyone
-Free
-Get person’s perspective on their functional capacity
Cons:
-Pretty long assessment
25 item assessment looking at fall risks at home–answer yes or no to each question e.g., are mats secured to floor, can person get in and out of bed easily and safely
Home Falls and Accidents Screening Tool (HOME FAST)
-Quick tool
30-item scale that assesses older person’s awareness of
and practice of behaviors that could potentially protect against falling e.g., I notice spills on floor, I adjust lighting to suit my eyesight
Falls Behavioral Scale (FaB)
- Answer never, sometimes, often, always
- Person’s behavior in their environment is critical when it comes to falls
- Can be used as an educational tool when assessing
- Can be part of intervention–get them to self-reflect on falls
How can the Falls Behavioral Scale (FaB) be used as part of an intervention?
Since it looks at OA’s awareness of behaviors that could protect against falling in their environment, can be used to help get them to self-reflect on falls
Why are stools not ideal for OA?
- No foot support
- Not stable
- No back rest
T/F: In order to prevent falls, an OA should use a walker to help get out of the chair
False! Fall risk!
Why are shag rugs no good for OA?
They may affect one’s balance
Why is it important for an OA’s bed to be the right height for him/her?
If bed is too high or low, fall risk
T/F: The best setting to do a fall risk intervention is in one’s home
False. Can do in variety of settings including:
- Community based
- Assisted living/long term care
- Acute care/inpatient
- Home care
- Primary care
How can exercise help prevent falls?
- Muscle weakness is a significant fall risk
- But optimal type, duration ,and intensity of exercise unknown
When using exercise an an intervention for fall risks, why is the amount of exercise important?
- If too much exercise, may cause fatigue and low endurance, thus increasing fall risk.
- Must understand pt to know their capacity
T/F: There is strong evidence for balance training to prevent falls, but less evidence for resistance or aerobic training
True. Can incorporate balance training in daily life e.g., ask person to stand on one foot while making coffee. But be safe. Duh.
How can medication contribute to falls risk and how can we help with this?
- More meds=more at risk for fall
- Make sure they’re taking as prescribed e.g., with food
- Look at their activities and patterns to find out their high risk time and plan schedule around
There is increasing evidence that which supplement may reduce fall and fracture rates of OAs?
Vitamin D
What surgical repair for a health issue has helped prevent falls?
Repair of vision
How can we help if an OA is at risk for falls due to BP/pulse changes?
- Can monitor orthostatic changes
- Ask them to wait 10 seconds after lying down to sit up
What home environments are the highest risk for falls?
- Bathroom
- Kitchen
- Stairs
- Spaces they spend most time in
Besides environmental factors, what other factors are important to address when working with OA on falls prevention?
Must address environment AND behaviors in order for intervention to be effective
Why are matts on the tub floor problematic for OA?
- Water can get underneath and become more of risk than if nothing were on the floor.
- Grippy surfaces on the tub are better
Why are tub benches often problematic?
-Hazard if they stick out of the bathtub–water trickles down side of bench ont floor and makes slippery
What is a good alternative to a hospital bed for fall prevention?
Rails on side of bed
Why is lighting at night (e.g., lit pathway to bathroom) important for OA?
They often get up during the night
What type of clothing is risky for an OA to wear?
- Big, Lose
- Bathrobe around leg
- Too long pajamas/nightgown
T/F: It is better for OAs to have a softer carpet in case they fall
False. Better to have harder carpet for firmer surface
Interventions to address stove safety with OA?
- Slide base surfaces for the stove so pt can slide hot pan off surface instead of lifting it
- Clearing area so that less risk of bumping into something if carrying a hot pot and not paying attention
Why are coffee tables often problematic? How can you help with this?
- Often low and not in FOV–may bump shin against and lose balance
- Can move coffee table to side of couch or against wall so don’t hit when get up
How can we address ability for OA to easily access phones at home?
- Multiple phones in multiple locations
- Educate about keeping phone with you so don’t rush to get
What can you do if a couch is too low for OA?
Chair risers!
If OA often leaves bags/purse on floor, causing fall risk, how can we address?
Promote behavior change of not putting bags on the floor
If carpeting is a fall risk for OA, but they don’t want to get rid of it, what can we suggest?
Getting adhesives to prevent slips
If an entranceway step is causing an OA to trip often, what change can be made?
-Beveled thresholds, so not a lip
If OA does not want to get rid of a rug in an entranceway/exit, what can we suggest?
Securing rug down
How can color of objects help prevent falls?
High contrast lighting/rugs, etc to help better visualize
How can we address FOF?
-Get psychological background
-Use self-efficacy thry: Can discuss mastery of experiences, small baby steps towards goal so not afraid
-practice going up and down stairs (first with gait belt)
Model to help them do something safely and successfully e.g., don’t wear heels, educate family on how they can role model fall prevention and safety
Should increasing falls efficacy always be the aim of FOF intervention?
- Some level of fear may be protective
- takes extra caution when performing activity, but restriction of activity impacts life
- Need just right level of confidence (enough confidence so not restricting activity, but still careful)
Who can we educate about fall prevention and risks?
- Client
- Family
- Caregivers
- Coworkers
- Staff
When is it best to educate OAs about falls risks and prevention?
- Tend to address after fall
- BUT good idea to do at any time–both fallers and non-fallers
- Post fall is good teaching moment–very receptive after fall
- May need to address those without risk differently
- Unfortunately, intervention development not given a lot of time–sometimes just pamphlet
How can Video clips be used as both an assessment and intervention for fall prevention?
- Assessment: maps your understanding; given clip, identify fall risk
- Intervention: In VR clip, women gives narrative; requires adult to view 2 videos identify fall risk in both of videos. Helps them connect different situations
App about fall risks that allows OAs to react with the environment via 360 video
Safety First in MovingUp app
- Opportunity to explore and identify environment
- Cardboard version of VR goggles
- Educate on different tips
Why may fall alarms not be effective in preventing falls?
If response time is too slow
T/F: Hip protectors for OA have shown to be very effective against hip fractures
False. Hi protectors don’t show much protection against fractures
Why are hip protectors problematic for OA?
- Aren’t very effective
- OA may not feel attractive in them (padded but, thigh)
- May be standard practice in settings
For fall prevention, is it better to be in socks or barefoot on tile floor?
Barefoot, so no slipping.
Why may AE be problematic for OA in preventing falls?
They may be bad if they are getting one that wasn’t prescribed
This community-based program is a lifestyle approach to help you change everyday habits – even the way you stand up or pick something up – into a way of improving your strength and balance.
- Lifestyle-integrated Functional Exercise (LiFE)
- Done by OT, good resource
May may fall prevention differ between OT and PT?
- OT has more contextualized assessment/interventions
- OT looks at balance confidence/falls efficacy
- OT looks at environmental mods/home safety
- OT: risk strategies with routine
- OT: Occupational risk factors
- PT: Gait screening
- PT: balance testing
- PT: strengthing
- PT: exercise plan
- PT: footwear assessment
According to Clark, why do many OA refrain from engaging in activities?
- As a result of mistreatment or general fear for personal safety, many OA refrain from engaging in activities
- Home and community safety can be a sensitive topic, as group participants may have been exposed to trauma or violence
According to Clark, what are two specific safety-related concerns that cause activity restriction?
Fear of falling and fear of crime
According to Clark, in addition to engaging in the Lifestyle Redesign Program, what else can OA do to practice home and community safety strategies?
-Engage in outings and special events
What suggested activities does Clark list for helping pts with safety in the home?
- Completing home safety evaluation and recommend modifications for each participant. Use either a standardized home safety eval or pictorial aid in group session
- Set up emergency phone numbers and medication lists with participants
- Rehearse safe risk taking, body mechanics, joint protection, energy conservation techniques
According to Clark, what can we do with pts during sessions after we present them with AE as a strategy to improve safety?
Allow time for practice using these devices and techniques within an occupational context e.g., lifting items with reachers, use magnifying sheet o read article, open jars with rubber grip
According to Clark, what sort of assessment is an important component of fall prevention in OA?
Conducting a multifactor fall risk assessment. A self-assessment of their own risks can help OAs understand their own personal fall risk
According to Clark, what has been associated with feelings of anxiety, decreased QOL, and functional decline?
FOF, falls risk
According to Clark, How can OTs use outings and exploration to address pt’s fear with going out?
- Encourage pt to be actively involved in planning of outings
- Before venturing out, do trial run for potential problems
- Initially, keep plans simple and close to home, then once they know they can succeed, more willing to participate in longer more involved outings
- Build relationships and social networks and develop abilities in more complex, less controlled environments
- Practice personal safety strategies throughout
