The OT/OTA Role in Implementing the AGS/BGS Clinical Practice Guidelines

Improve Public Policy Response and Medicare Coverage for Fall Prevention and Intervention
July 2010

Developed by the American Occupational Therapy Association under a contract with the National Center for Injury Prevention and Control (2009-Q-11452)

The AGS/BGS Clinical Practice Guidelines for the Prevention of Falls in Older Persons were developed to assist health care professionals in assessing and managing fall risks in older adults. They were first published in 2001 and have been recently revised based on the latest research available. Although some of the guidelines are geared toward physicians and other medical professionals, there are many applicable recommendations that occupational therapists (OT) and occupational therapy assistants (OTA) can use when working with older adults.

The first section of the guidelines addresses the screening and assessment process. According to the AOTA Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy (Black & Eberhardt, 2005), the OT directs the evaluation process and all initial contact with the client, including

  • determining the need for service,
  • defining the problems within the domain of OT that need to be addressed,
  • determining the client’s goals and priorities,
  • establishing intervention priorities,
  • determining specific further assessment needs, and
  • determining specific assessment tasks that can be delegated to the OTA. (Black & Eberhardt, 2005)

Although the AOTA guidelines are clear that the OT is ultimately in charge of assessing and interpreting the results, the OTA does have a role in contributing to the evaluation process by gathering assessment data and providing observations to the OT for interpretation. When evaluating for fall risk according to the AGS/BGS guidelines, the OT should perform the assessments addressing gait and balance, while either the OT or OTA can obtain the client’s fall history, medication information, and history of relevant risk factors. Upon gathering all the information from the evaluations, the OT and OTA can collaborate with the client to discuss possible interventions that address specific fall risks, including referral to other qualified professionals. When planning interventions, the OT has overall responsibility for intervention implementation, but the OTA is responsible for collaborating with the OT, the client, and any family members in implementation.

Occupational therapy’s role in fall prevention is multi-factorial and includes physical interventions, environmental modifications, and behavioral adaptations. According to the AGS/BGS Guidelines, these should include adaptating or modifying the home environment to mitigate identified hazards and facilitate greater participation in daily activities, exercise (particularly balance, strength, and gait training), and promotion of the safe performance of daily activities. Either occupational therapy practitioner can carry out these interventions after the OT has determined the client goals and the intervention plan. The OTA may select and modify the therapeutic activities as long as they are within the client’s goals. The OT is responsible for supervising the OTA and conducting regular meetings to reevaluate treatment and guide the client’s treatment. The OT must measure and interpret outcomes according to preselected assessments to determine when the client is ready for discharge. The OTA may provide the client with appropriate materials and resources (such as referral to community programs) for post-discharge support from treatment.

The OT and OTA work together with the client, family, and other health care professionals to prevent falls in those at risk. By working within the AGS/BGS Guidelines, occupational therapy practitioners can provide the client with the most up-to-date, evidenced-based intervention available to prevent further falls from impeding the client’s chosen occupations.