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Preventing Falls With Occupational Therapy

An older couple walk along the seashore

By Ashley Opp Hofmann

At least one out of every three adults over the age of 65 falls each year, but falls are not a natural part of the aging process. With the help of occupational therapy practitioners, older adults can take steps to reduce fall risk and safely increase their involvement in activities they value.

What Causes Falls?

Falls result from personal, environmental, and activity-based factors. Personal factors include such things as illness, behaviors, capabilities, medications, and fear of falling. Environmental factors are those outside of the older adult, such as hazards in the home, the stability of the shoes he or she wears, and the availability and use of mobility devices like canes or walkers. Finally, specific activities can place someone at risk for a fall when the demands of the activity exceed his or her abilities. For example, when someone who has poor balance stands on top of a step stool to reach into a cabinet, fall risk increases. “It is the interaction of these factors that typically leads to a fall,” says Elizabeth Walker Peterson, occupational therapist and clinical associate professor of occupational therapy at the University of Illinois at Chicago.

Older adults often make one of two main mistakes that increase their chances of falling. Some overestimate their abilities and take too many risks. Others are so concerned about falling that they cut back on activities they actually can do and lose leg strength and balance. Paradoxically, “research shows that fear of falling is a risk factor for falls,” says Peterson.

How Occupational Therapy Can Help           

Occupational therapy can help. The role of occupational therapy in fall prevention has been widely and increasingly recognized. “Occupational therapy practitioners consider how the individual functions in his or her day-to-day environment,” says Peterson. “They actively involve the client in the fall prevention process to better understand individual fall risk factors and intervention priorities. Teaching clients how to identify and solve problems is an important part of the occupational therapy process.”

Occupational therapy practitioners are aware of the research and evidence on fall prevention, and they know what strategies work. “In the last 10 years, we’ve learned a lot about why falls happen. Practitioners can use this evidence to prioritize and target the areas known to prevent falls,” says Peterson. Evidence indicates that fall prevention programs that address multiple risk factors are most effective. Among fall risk factors, leg weakness, poor balance, and taking multiple medications are especially important risks. A few targeted changes in these areas can significantly reduce the likelihood of falls.

Accessing Occupational Therapy

Older adults can access occupational therapy services for fall prevention in various settings, such as acute care hospitals, rehabilitation centers, outpatient clinics, and in the home via home health services. Also, some community centers and assisted living communities have occupational therapy practitioners on staff who can help with fall prevention.

Occupational therapy practitioners working in home health have a unique opportunity to understand factors that increase fall risk. They usually start creating a fall prevention plan by discussing the older adult’s typical and desired daily activities. To understand a client’s capabilities, the practitioner might ask the client to perform some typical activities, such as climbing stairs or getting in and out of the bathtub. To make activities safer and easier, the practitioner might suggest new ways to do things or recommend the use of adaptive equipment. The practitioner also helps to identify and address hazards in the home.

Reduce the Risk of Falls and Injuries

Regardless of the setting, though, occupational therapists can help older adults reduce their risk of falls. For example, in an outpatient clinic, an occupational therapy practitioner working with a client recovering from a wrist fracture due to a fall can provide exercises to help regain wrist movement, explore factors that contributed to the fall, and help to create a realistic fall prevention plan tailored to that person.

Even if there’s not an injury, “health care providers want to see older adults who have fallen,” says Peterson. “The sooner we see those who have fallen, the easier it is to understand factors that led to the fall, and Medicare reimbursement can usually be justified when the older adult has either fallen or has fall risk factors.”

Caregivers also have a role in preventing falls. “Falls are emotionally loaded,” says Peterson. Older adults might not want to admit they have fallen for many reasons, such as fear that it will raise doubts of their ability to live at home independently. She recommends that relatives and caregivers start talking as soon as possible about preventing falls. “Caregivers can support the older adult emotionally, let him or her know they care, and help the older adult implement fall prevention goals,” says Peterson.

Preventing falls is key, but reducing the chance of injury in the case of a fall also is extremely important. According to Peterson, screening for osteoporosis through a painless bone density test is vital. Older adults who have low bone mass are at greater risk for a fracture if a fall occurs. Osteoporosis can be managed medically with a physician’s help, and occupational therapy practitioners can help clients who have osteoporosis build bone mass through activity, thus increasing their ability to engage in day-to-day activities more easily.

Most importantly, older adults need to realize that resources exist to help them stay safe. “Older adults are not alone in their efforts to prevent falls—occupational therapy practitioners have strategies to help,” Peterson says. She tells older adults, “Be assertive in making your needs known, getting occupational therapy services, and requesting osteoporosis screenings. You are in the best position to know your own needs.”

Ashley Opp Hofmann is AOTA’s senior staff writer.

Find an Occupational Therapy Practitioner

Physicians, geriatric case managers, and other medical professionals can refer you to occupational therapy practitioners in your area specializing in falls prevention. Other sources for locating an occupational therapist include colleagues, family members, and friends who have received occupational therapy services, as well as your local telephone directory.

For more information

Fall Prevention for Persons With Disabilities and Older Adults

Occupational Therapy and Prevention of Falls

Modifying Your Home For Independence