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Occupational Therapy and Prevention of Falls

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Slips, trips, and falls in and around the home are frequently the cause of injuries to older adults. In 2009, 2.2 million older adults visited the emergency room for injuries related to falls, with many of these injuries resulting in decreased independence, a need for long-term-care support, and increased risk for early death. Falls remain the leading cause of injury death among older adults, with a 2010 estimated total medical cost for fatal and nonfatal fall injuries of $28.2 billion (Centers for Disease Control and Prevention, 2011).

Occupational therapy practitioners are uniquely suited to address fall prevention with older adults. Research has shown the cause of falls to be multi-factorial in nature, influenced by conditions within the individual, within the environment, and as a result of the interaction between the two. The most successfully proven falls prevention initiatives are those that use a multi-faceted approach. Occupational therapy practitioners are skilled at evaluating and addressing both the person and the environment to maximize independence for older adults. Linking clients' goals and priorities with modifications and adaptations that support their ability to participate in meaningful activities are hallmarks of occupational therapy.

The Role of Occupational Therapy
Occupational therapy practitioners work with the client and his or her caregivers to scan the home environment for hazards and evaluate the individual for limitations that contribute to falls. Recommendations often include a combination of interventions that target improving physical abilities to safely perform daily tasks, modifying the home, and changing activity patterns and behaviors. Occupational therapy services regularly include training clients, families, and interdisciplinary team members on strategies to support these fall prevention initiatives.

In addition to direct care for older adults, occupational therapy practitioners can assist in falls prevention on a larger scale through consultation to staff of community centers, nursing homes, and assisted living environments. Identifying environmental factors that contribute to falls and implementing the occupational therapy recommendations to remove these elements can improve safety and reduce health care costs while enhancing the participation of older adults in those communities.

Addressing Broader Ramifications
Fear of falling can be both a risk factor for falls and a consequence of falling. Defined as a lasting concern about falling that leads to an individual avoiding activities that he or she remains capable of doing, fear of falling often leads to self-limitation in performing activities and tasks that people need to complete in order to remain as independent as possible. As a consequence of these self-limiting behaviors, older adults experience decreased physical functioning which then contributes to an increased risk for falls. Occupational therapy practitioners assist older adults in recognizing and addressing fear of falling through focusing on the client's individual, specific concerns. For example, a client may avoid sleeping in bed after falling at night while attempting to walk to the bathroom. The intervention then focuses on strategies designed to reduce falls risk, such as bed mobility, nighttime bathroom needs, and safety, which enhances the client's confidence in his or her ability to go from the bed to the bathroom during the night.

Occupational therapy practitioners assist in breaking the cycle of inactivity and sedentary lifestyle that increase the risk of falling. Staying active and safe are common goals of older adults. By helping them reach these goals, occupational therapy practitioners empower older adults to maximize their ability to live life to its fullest.

Examples of Fall Risk Factors Addressed by Occupational Therapy

Intrinsic

  • Lower-extremity weakness
  • Impaired balance
  • Cognitive impairment
  • Urinary incontinence
  • Sensory impairment
  • Fear of falling

Extrinsic

  • Throw rugs and loose carpets
  • Lighting glare
  • Pets
  • Clutter
  • Uneven sidewalks
  • Thresholds
  • Unstable handrails

Conclusion

Preventing falls and alleviating the fear of falling are cost-effective interventions that promote the safety and well-being of older adults. Many payers, including Medicare, will pay for these services as part of a covered occupational therapy benefit.
The profession of occupational therapy focuses on a person's ability to participate in desired daily life activities or "occupations." Aging can affect this ability, whether we continue to live in familiar surroundings or transition to new ones. As people age, occupational therapy practitioners use their expertise to help them prepare for and perform important activities and to fulfill their roles as community dwellers, family members, friends, workers, leisure devotees, or volunteers.

Reference
Centers for Disease Control and Prevention. (2011). Falls among older adults: An overview. Retrieved from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Revised by Pamela Toto, PhD, OTR/L, BCG, FAOTA, for the American Occupational Therapy Association. Copyright © 2012 by the American Occupational Therapy Association. This material may be copied and distributed for personal or educational uses without written consent. For all other uses, contact copyright@aota.org.