February 08, 2012

Falls and Fall Prevention

One of the very first lectures I attended when I started graduate school was on falls and fall prevention. Since then, we have had numerous lectures on the topic. I’m starting to think the topic might just be something to make note of as OTs.  So, here’s a little synopsis on what I’ve managed to retain from those lectures, followed by a list of appropriate Assessments (click on the name to direct you to the website).

Definition of fall: “A subject’s unintentionally coming to rest on the ground or on some other lower level, not as a result of major intrinsic event, for example, stroke or syncope or over whelming hazard that would result in a fall by most young, healthy persons” (Tinetti, et. Al., 1988). 33% of community dwelling elders, age 65 or older, fall at least 1 or more times a year, and the frequency increases with age. Falling leads to loss of mobility and independence; it affects all body systems.

As occupational therapists, some things to take into consideration when working with someone at risk of falls are height of fall, impact surface (concrete, rug, linonieum), shock absorbers (loss of subcutaneous fat, decreased muscle bulk), decreased protective reflexes (slow righting reflexes), and psychological injury.

There are other risk factors such as: age related changes (decreased visual acuity), balance (increased postural sway), musculoskeletal (forward shift in center of gravity), cognitive (changes in attention load for gait), chronic diseases or extrinsic factors such as slippery surface, obstacles in pathways, and poor illumination.

After the risk factors have been considered, a fall risk assessment including the patient’s physical, mental, and environmental aspect needs to be administered, as all three result in poor quality of life.

Here is a list of most of the falls assessments I am familiar with (Please suggest any other ones I might have missed):

- refers to the degree of confidence a person has in performing common activities of daily living without falling (Tinetti, Richman, & Powell, 1990). Also, refer to the following website:

-  assess the role of fear of falling in activity restriction (Lachman, M. E., 1998).

- evaluate day-to-day behaviors related to falls in older people. Also, refer to the following website:

4. The Safety Assessment of Function and the Environment for Rehabilitation (SAFER)

*need to purchase

*need to be certified to administer

8. Community Participation Indicators Version V 4.0

13. Get Up & Go (Tinetti)

- Tinetti Gait and Balance Assessments
- Foam and Dome Test

A few other great resources I’ve come across:
* Geriatric Examination Tool Kit provided by Missouri.edu. The kit includes assessment of gait, balance, fatigue, vision, manual muscle test, pain, reaction time, vestibular and transfers.

-Clemson, Cumming & Heard, 2003

-Lachman, M. E., Howland, J., Tennstedt, S., Jette, A., Assman, S., & Peterson, E. (1998). Fear of Falling and Activity Restriction:  The Survey of Activities and Fear of Falling in the Elderly. Journal of Gerontology:  Psychological Sciences, 53B, P43-P50.

-Podsiadlo, D., Richardson, S. (1991). The timed ‘Up and Go’ Test: a Test of Basic Functional Mobility for Frail Elderly Persons. Journal of American Geriatric Society 39:142-14

-Rosemary Bakker, MS, ASID. Weill Medical College of Cornell University. Division of Geriatrics and Gerontology

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