staying active and independent ot student: jae-ellen fowler

Falls Prevention Program:

Keeping on your toesStaying active and independent

OT Student: Jae-ellen Fowler

Session 1:◦ What are falls and the significance of them?◦ Environment: Safety in and around your

room Session 2:

◦ Occupations: How to keep yourself safe in your daily activities

Session 3:◦ Person: What you can do to stay independent and

active

Program

SESSION 1

What are falls and the significance of

them?

“Involuntarily coming to rest on the ground, floor or lower level. Excluding intentional change in position to rest in furniture, wall or other objects” W.H.O.

Falls-related injuries are among the most serious and common medical problems experienced by older adults

Includes trips, slips and stumbles not a normal part of ageing preventable and predictable

What is a fall

(Queensland stay on your feet, 2012; Australian Government, 2005; McClure et al., 2008)

Falls are often considered as accidents, but falls are rarely completely accidental

Reasons or causes are risk factors More risk factors = greater chance of falling Intrinsic (related to a person’s behaviour

or condition) Extrinsic (related to a person’s

environment or their interaction with the environment)

Causes for falls

(Australian Government, 2005; Queensland Government, 2004; Queensland stay on your feet, 2012; Queensland Government, 2006)

Discussion point: Can anyone name any falls risk factors that may affect them?

Increased age Being female History of falls Certain chronic

medical conditions Taking multiple

medications – psychoactive

Poor nutrition Unsteady gait –

mobility aid Sensory problems

Intrinsic risk factors

Dizziness Low levels of physical

activity – decreased muscle strength

Slow reaction time Concern for falling Fatigue

(Queensland stay on your feet, 2012; Queensland Government, 2006; NSW Government, 2009; Queensland Government, 2004)

Risky footwear e.g. High heels, slippers, thongs

Risky spectacles Uneven or loose outside

surfaces Inadequate lighting Slippery floors Time of day – night People traffic Heights of chairs and beds Unsecure floor coverings,

rugs and cords

Extrinsic Factors Housing and floor plan Reaching outside the

body’s safety zone

(Queensland stay on your feet, 2012; Queensland Government, 2006; NSW Government, 2015)

In QLD 1 in 3 older Australians will fall each year

Residents in Residential Aged Care Facilities experienced nearly 5 times the falls

Statistics on Falls

(Australian Government, 2005; NSW Government, 2009)

In the last 6 months..... 53 trips/slips/falls 45 residents

Statistics at Immanuel Gardens – Hostel on Trips/Slips/Falls

Areas of falls

75% Bedroom9.5% Bathroom

5.6% Dining Room5.6% Outside

(Immanuel Gardens (Hosetl) – Buderim Facility, 2012)

Statistics at Immanuel Gardens – Hostel on Trips/Slips/Falls

Outcome of Injury of Falls

47.1% No injury

5.6% Bruising

22.6% Skin tears

11.3% Head injury

(Immanuel Gardens (Hosetl) – Buderim Facility, 2012)

Cuts, bruising, abrasions, head injuries

Fracture – wrist, hip, trunk, neck

Hospitalisation Death Reduced mobility Decreased

independence Transfer to Nursing

Home Loss of confidence

Impact of a fall Concern for falling –

withdrawal from activities

Decreased ability to participate in activities and enjoy life

(Australian Government, 2005; McClure et al., 2008; Hughes et al., 2008)

YouTube Clip

Safety in and around your room

Discussion point: What are types of falls hazards in your environment that concern you? Bedroom? Bathroom? Outside?

Furniture◦ Chairs and beds

appropriate height = popliteal crease + 5cm Armrests Loose or trailing bed coverings Matts

◦ Items are in accessible places Too high or low heights In front or on top of others

Bedroom

(NSW Government, 2009; Queensland Government, 2011)

Appliances◦ Light beside bed or a night light – easily

reachable◦ Cordless phone or phone beside bed, armchair or

on desk◦ No trailing cords

Bedroom


Walkways◦ Adequate space and access ◦ Are clear◦ Keeping doors fully open or closed◦ Reducing clutter

Bedroom


Toilet seat and shower chair ◦ Proper height = popliteal crease + 5cm

Make use of grab rails Keep floors dry Items are in accessible places

◦ Soap, shampoo, washers

Bathroom

(Queensland Government, 2011; NSW Government, 2009)

Keep an eye out and report any hazards Room for another person with a four

wheeled walker Take care when walking Beware of uneven surfaces Store walking aid safely Well lit Aren’t slippery Safe and adequate hand rails

Outside paths, walkways and stairs


Spot the Trip Hazard!

High set shelf

Trailing bed covers

Low seated armchair

Rug

Coffee table in front of curtains

Items on floor – walkway unclear

Queensland stay on your feet. (2012, October 2). Retrieved from The Queensland Government web site: http://www.health.qld.gov.au/stayonyourfeet/default.asp

Australian Government: Department of Health and Ageing (2005). The national slips and falls prevention project.

McClure, R. J., Turner, C., Peel, N., Spinks, A., Eakin, E. & Hughes, K. (2008). Population-based interventions for the prevention of falls-related injuries in older people. Cochrane Database of Systematic Reviews, Issue 1. doi: 10.1002/14651858.CD004441.pub2.

Queensland Government: Department of Health and Ageing (2004). Don’t fall for it! Falls can be prevented. Retrieved from http://www.health.qld.gov.au/stayonyourfeet/for-seniors/resources-for-seniors.asp

Queensland Government (2006). Statewide action plan: Falls prevention in older people 2002 – 2006. Retrieved from www.health.qld.gov.au/stayonyourfeet/documents/13693a.pdf

NSW Government (2009). Preventing falls and harm from falls in older people: Best practice guidelines for Australian residential aged care facilities. Retrieved from www.activeandhealthy.nsw.gov.au/assets/pdf/RACF_Guidelines.pdf

NSW Government (2015). Prevention of falls and harm from falls amoung older people: 2011 – 2015. Retrieved from http://www.health.nsw.gov.au/policies/pd/2011/PD2011_029.html

Immanuel Gardens (Hostel) – Buderim Facility (2012). Incident report forms: October – April 2012. Hughes, K., van Beurden, E., Eakin, E. G., Barnett, L. M., Patterson, E., Backhouse, J., Jones, S., Hauser, D.,

Beard, J. R., & Newman, B. (2008). Older person’s perception of risk of falling. American Journal of Public Health, 98 (2), 351 – 357.

Queensland Government (2011). How to stay on your feet: Checklist. Retrieved from http://www.health.qld.gov.au/stayonyourfeet/for-seniors/resources-for-seniors.asp

Queensland Government (2012). One step ahead: Preventing falls – a guide for older people. Retrieved from http://www.health.qld.gov.au/stayonyourfeet/for-seniors/resources-for-seniors.asp

References

http://www.health.qld.gov.au/stayonyourfeet/default.asp

http://www.health.qld.gov.au/stayonyourfeet/for-seniors/resources-for-seniors.asp

http://www.health.qld.gov.au/stayonyourfeet/documents/13693a.pdf

http://www.activeandhealthy.nsw.gov.au/assets/pdf/RACF_Guidelines.pdf

http://www.health.nsw.gov.au/policies/pd/2011/PD2011_029.html



Session 1:◦ What are falls and the significance of them?◦ Environment: Safety in and around your room

Session 2:◦ Occupations: How to keep yourself safe in

your daily activities Session 3:

◦ Person: What you can do to stay independent and active

Program

Topics◦ What are falls and the significance of them?◦ Safety in and around your room

Last weeks session

Discussion point: Did anyone find the information last week relevant and/or useful?

Discussion point: Would anyone like to share with the group any changes they made to their rooms?

SESSION 2

What you can do to keep yourself safe and active in your daily activities

Getting out of bed◦ Roll on to side and sit up. Wait for dizziness to

subside◦ At night;

Easy reach bedside light/nightlight and glasses Bedcoverings Other options – bedside commode, continence aids

Safe movements

(Queensland Government, 2011)

In and out of a chair (without wheelie walker) – arm chair, dining chair, desk chair◦ IN

Stand in front Outstretch arms – armrests Slowly lower yourself

◦ OUT Hands on armrests Feet flat and nose to toes Pushing with hands Pause to steady balance

Safe movements


When showering or going to the toilet◦ Use of grab rails◦ Use of shower chair (if you have one)◦ Rest if you do become tired

Safe movements

(Queensland Government, 2011; Queensland Government, 2012)

Help conserve energy – for tasks you need to or enjoy doing

How?◦ Rest – breaks during activities and in your day◦ Organise your time◦ Look at the tasks you need to do◦ Timetable◦ Avoid – cramming, skipping rest breaks, tire

yourself during bad times of the day, work long without a break

◦ Problem tasks

Making activities easier

(Metro North Health District, 2004)

Discussion point: What tactics do you use to conserve your energy through the day or through an activity?

Handy hints;◦ Organise the activity before starting◦ Equipment can make things easier

Large, easy to grip handles Non-slip matts Long handles Lightweight objects



Kitchenette in bedroom◦ Items in reachable places◦ Items close to where you use them◦ Sit down to do activities – four wheeled walker◦ Ask for assistance from staff◦ Lightweight dishes and cups◦ Pegboard for hanging utensils

Bedroom◦ Fitted sheet and light sheets and blankets◦ High bed – easier to get in and out of



Bathroom◦ Use of shower chair◦ Use of grab rails◦ Avoid bending – shower caddy, soap on a rope◦ Sit down to dry and dress yourself

Cleaning your room◦ Spread tasks◦ Get others to help – staff, family◦ Long-handled equipment

– avoid bending◦ Arrange furniture – no lifting



Sitting at a desk◦ Chair and desk encourage good posture◦ Chair – good back support◦ Feet rest flat on the floor◦ Good lighting◦ Equipment is in easy reach – phone, laptop◦ Take stretch breaks often



Wheelie walkers, sticks, frames, crutches General tips;

◦ Avoid using to assist getting in and out of a chair◦ Maintain walking aid – loose parts, worn

stoppers, bent frames◦ Wheelie walker – BRAKES ON! Use the seat to

store items and as a resting seat Physio can advise – walking aids

steadiness and confidence to walk more

Safe use of walking aids

(Queensland Government, 2012; Queensland Government, 2004; LifeTec Queensland, 2012a)

In and out of a chair – arm chair, dining chair, desk chair◦ IN

Stand in front – balanced and standing still Move the wheelie walker slightly forward and put

BRAKES ON Outstretch arms – armrests Slowly lower yourself

◦ OUT Wheelie walker in front – BRAKES ON Hands on armrests Feet flat and nose to toes Pushing with hands Pause to steady balance Hands on wheelie walker – BRAKES OFF

Safe use of walking aids – 4ww

(Walkerfacts, 2010; LifeTec Queensland, 2012a)

Walking◦ Place walker ahead before walking◦ Gently roll walker forward as you walk – close◦ Steps uneven, shorten your longer step◦ Turning = stay within width of walker, roll walker

around without twisting your back, always face the front of the walker

◦ When standing in kitchenette and bathroom = use counters for support, but keep walker within reach

Safe use of walking aids – 4ww

(Walkerfacts, 2010; LifeTec Queensland, 2012a)

Walking◦ Standing upright – feet together, both hands on

frame◦ Lift frame forward and put down (all four tips on

ground)◦ Step forward with one leg – placing weight

through frame◦ Step forward with other leg◦ Be careful to not step too far forward

Safe use of walking aids – walking frame

(Walkerfacts, 2010; LifeTec Queensland, 2012b)

3 or 4 point stick with an offset base, straight side should be nearest to the body

Usually stick is on user’s unaffected side Be careful not to store wooden sticks in

direct sunlight or damp areas Walking;

◦ Stick moved forward at same time as affected leg

◦ All walking sticks points firmly on the ground

Safe use of walking aids - stick

(LifeTec Queensland, 2012c)

Steps and stairs;◦ GOING UP

Unaffected leg first, then stick and the affected leg to the same step

◦ GOING DOWN Affected leg and stick first, then the unaffected

leg to the same step

Safe use of walking aids - stick

(LifeTec Queensland, 2012c)

Types of footwear can ↑ risk of falls – making you trip, slip or stumble

Avoid wearing socks or stockings without shoes

Consider the state of your shoes;◦ Worn down - ↑ risk of falls◦ Cleaned regularly◦ Fix them or discard them – recovering from a

fall is more costly

Safe footwear

(Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)

Features of good shoes;◦ Properly fitted – hold foot in place and adequate

support Fit comfortably and suit shape of foot Ankle support (collar) Avoid loose fitting sling backs, slippers, thongs or

scuffs

Safe footwear


◦ Firm, flexible sole Shoes with a tread sole – prevent slips Thick, soft soles – reduce ability to read ground or

floor surface Test shoes flexibility

◦ Heel with a round, bevelled edge Broad, slightly rounded heel less than 2.5cm

Safe footwear


◦ Have laces, zips or Velcro fastenings◦ Lightweight ◦ Adequate width, depth and height in toe box

Safe footwear

Discussion point: Which of these shoes is safe?


Long and loose clothing can upset balance and gait

Be aware clothing doesn’t trail around ankles or have loose parts

Safe clothing


Problems with your waterworks;◦ Consider the clothing you wear◦ Avoid multiple layers and firm fitting outer

garments◦ Clothing with elasticised waist bands easier

than buckles, buttons and zips

Safe clothing


Spot the trip hazard!Trailing cord

High set board

Turned up rug

Coffee table blocking walkway

Books on floor



Metro North Health District (2004). Energy conservation and work simplification. Occupational Therapy. Queensland Government: Department of Health and Ageing (2004). Don’t fall for it! Falls can be prevented.

Retrieved from http://www.health.qld.gov.au/stayonyourfeet/for-seniors/resources-for-seniors.asp LifeTec Queensland (2012a). Measuring and using a wheelie walke. Retrieved from

http://www.lifetec.org.au/home/content.asp?pageID=205&main=205&sub=0 Walkerfacts (2010). Using a walker safely. Retrieved from

http://www.walker-facts.com/How-To-Use-a-Stable-Walker.asp LifeTec Queensland (2012b). Measuring and using a walking frame. Retrieved from

http://www.lifetec.org.au/home/content.asp?pageID=205&main=205&sub=0 LifeTec Queensland (2012c). Measuring and using a walking stick. Retrieved from

http://www.lifetec.org.au/home/content.asp?pageID=205&main=205&sub=0 Queensland stay on your feet. (2012, October 2). Retrieved from The Queensland Government web site:

http://www.health.qld.gov.au/stayonyourfeet/default.asp NSW Government (2009). Preventing falls and harm from falls in older people: Best practice guidelines for

Australian residential aged care facilities. Retrieved from www.activeandhealthy.nsw.gov.au/assets/pdf/RACF_Guidelines.pdf

References




http://www.lifetec.org.au/home/content.asp?pageID=205&main=205&sub=0

http://www.walker-facts.com/How-To-Use-a-Stable-Walker.asp



http://www.health.qld.gov.au/stayonyourfeet/default.asp

http://www.activeandhealthy.nsw.gov.au/assets/pdf/RACF_Guidelines.pdf

Session 1:◦ What are falls and the significance of them?◦ Environment: Safety in and around your room

Session 2:◦ Occupations: How to keep yourself safe in your

daily activities Session 3:

◦ Person: What you can do to stay independent and active

Program

SESSION 3

Topics◦ How to keep yourself safe in your daily activities?

Last weeks session

Discussion point: Did anyone find the information last week relevant and/or useful?

Discussion point: Would anyone like to share with the group any changes they made to their activities?

- more conscious of their movements?- use of their walking aid?- checked and/or changed their footwear and clothing?- more conscious of their energy levels during activities or through the day?

What you can do to stay independent and

active

Is common and can be managed Tips;

◦ Intake of fluid in small doses and spread throughout day

◦ caffeine and alcohol◦ Exercises – 30 mins and pelvic floor muscles◦ Give yourself time

your self awareness Learn how much time you have

◦ fluids close to bedtime◦ Good habits for bladder emptying;

Avoid ‘hovering’ Good positioning

Trouble with the water works

(QLD Government, 2011; Australian Government, QLD Government & HACC, 2010; Continence Foundation of Australia, 2010a)

Finding your muscles (for women and men)◦ Try to stop or slow the flow of urine midway

through emptying the bladder. ◦ This is not an exercise, but a way of identifying

your pelvic floor muscles. ◦ If you can, stop the flow of urine over the

toilet for a second or two, then relax and finish emptying without straining.

◦DON’T DO THIS REPETITIVELY. It is NOT RECOMMENDED AS A REGULAR EXERCISE.

Trouble with the waterworks

Trouble with the water works

(Continence Foundation of Australia, 2010b; Continence Foundation of Australia, 2010c)

Pelvic floor muscle exercises◦ Imagine letting go like you would to pass urine or to

pass wind. Let your tummy muscles hang loose too. See if you can squeeze in and hold the muscles inside the pelvis while you breathe. Some tensing and flattening of the lower part of the abdominal wall will happen.

◦ Try tightening your muscles really gently to feel just the pelvic floor muscles lifting and squeezing in. If you cannot feel your muscles contracting, change your position (e.g. Lying down, sitting or standing) and try again

◦ Relax◦ Try holding the inward squeeze for longer (up to

10 seconds) before relaxing. Repeat up to 10 times

Good sitting position for bladder emptying

(Australian Government, QLD Government & HACC, 2010)

Maintain good health, strong bones and muscles and sufficient energy

Tips;◦ Avoid skipping meals – 3 each day

Body misses out on important protein, fibre, vitamin, minerals and other nutrients

◦ Low alcohol intake Affects your reflexes and balance your risk of falls

Eating and drinking healthy


Eyes help to not only see obstacles and judge steps, but to keep your balance

Tips;◦ Time to adjust to different levels of light

Hat and sunglasses outside Stop, hold onto something and wait for eyes to

adjust Be aware of reflective surfaces – tiled floor

◦ Be aware of new vision problems – make sure glasses are working

◦ Wear prescribed glasses as recommended◦ Keep glasses clean

Vision

(Queensland Government, 2011; Queensland Government, 2004; Queensland Government, 2012)

Ingrown toenails or painful feet and ankles can change the way you walk and your risk of falling

Tips;◦ Keep an eye on your feet – daily

Signs of dry skin, brittle nails, burning or tingling sensations or feelings of cold, numbness or discolouration

◦ Check pantyhose or stockings are correct size and free of seams

◦ Avoid going barefoot◦ Leave cutting corns and callouses to the podiatrist◦ Bathe feet daily in lukewarm water, using a mild

soap

Foot care

(Queensland Government, 2011; Australasian Podiatry Council, 2012)

Avoid rushing, doing several things at once or doing things beyond your own capabilities

your risk of falls◦ e.g. climbing on chairs to reach for high objects

Take your time and respect your limitations

Make use of your buzzer and the staff

Risk taking behaviour


Physical activity keeps us healthy, active, independent and the risk of falls

If you don’t use it, you lose it! STAY ACTIVE! Advisable to do at least 30 minutes of

moderate physical exercise – preferably everyday◦ Can be split into 3 x 10 minute blocks

Physical activities that are recommended are;◦ Walking Group◦ Exercise Class◦ Yoga or tai chi◦ Dancing◦ Stair climbing◦ Jogging

Increasing physical activity

(Queensland Government, 2004; Queensland Government, 2012; Queensland Government, 2011)

Balance exercises◦ Balance awareness

Stand comfortably with your feet shoulder width apart and concentrate on the feeling of the pressure of the floor under your feet. Have the table in front of you and a chair behind you. Feel the changes as you sway your body – back and forward, side to side.

◦ The square Step into a square to begin this exercise (the square

could be a tile, a carpet square, marked out by objects or even an imaginary square). Step out of and back into the square in each direction – forwards, backwards, to the left and to the right.



◦ The Straight Line Choose a straight line (e.g. join in the carpet, a line of

tiles, the hallway, etc.). Walk to the end of the line, putting your L foot on the line. Turn carefully and walk back again, putting your R foot on the line.

◦ The Chair Sit on a chair (this can be a firm dining chair, or to

make this exercise harder, choose a lower, softer chair). Move toward the front of the chair, have you feet slightly back, bring your “nose over your toes”, push down on the arms of the chair and straighten up to standing. Don’t forget to look ahead NOT down at the floor! Repeat.

To make the exercise harder you can also have a pillow or foam from the DTs that you stand on as you get up and down from your chair. Or you can do this exercise on different counts (8 to 4 counts)



Body awareness, strength and stability exercises◦ Weight transfer

Stand with your legs apart and feet parallel. Transfer your weight from one leg to the other. Concentrate on the feeling of your weight going through your leg.

◦ Body awareness Sit down in a chair. And lift one leg and hold, then lift

the opposite arm out as well. Switch to the opposite leg and arm.

◦ Exercise #1 Stand straight holding on to something (kitchen

counter, rail, chair, etc) for support. Lift your leg sideways and bring it back to the middle, keeping your trunk straight throughout the exercise. Repeat 10 times with EACH leg.



◦ Exercise #2 Stand straight holding on to something (kitchen

counter, rail, chair, etc) for support. Bring your leg backwards keeping your knee straight. Do not lean forwards. Repeat 10 times with EACH leg.

◦ Exercise #3 Stand using the wall or something (kitchen counter,

rail, chair, etc) for support you. Lift one leg as if you are going to take a step. Repeat 10 times with each leg.



Spot the trip hazard

Step

High to reach board

Trailing cord

Upturned carpetPulled out draw

Which shoe is the safest?

What can you spot wrong with this individual getting up from their chair?

What can you spot wrong with this individual using their walking aid?

Demonstration


Australian Government, QLD Government & Home and Community Care (HACC) (2010). First steps in the management of urinary incontinence in community-dwelling older people: A clinical practice guideline for primary clinicians (3rd edn.).

Continence Foundation of Australia (2010). Managing bladder problems. Retrieved from http://www.continence.org.au/pages/managing-incontinence.html

Queensland Government: Department of Health and Ageing (2004). Don’t fall for it! Falls can be prevented. Retrieved from http://www.health.qld.gov.au/stayonyourfeet/for-seniors/resources-for-seniors.asp


Australasian Podiatry Council (2012). Your podiatrist talks about ageing. Retrieved from http://www.apodc.com.au/brochures-and-pamphlets/

Continence Foundation of Australia (2010b). Pelvic floor muscle exercises for women. Retrieved from http://www.continence.org.au/pages/pelvic-floor-muscle-exercises-for-women.html

Continence Foundation of Australia (2010c). Pelvic floor muscle exercises for men. Retrieved from http://www.continence.org.au/pages/pelvic-floor-muscle-exercises-for-men.html

Queensland Government (2010). Finding your feet - Facilitator Manual. Retrieved from http://www.health.qld.gov.au/stayonyourfeet/for-professionals/resources-prof.asp

References


http://www.continence.org.au/pages/managing-incontinence.html



http://www.apodc.com.au/brochures-and-pamphlets/

http://www.continence.org.au/pages/pelvic-floor-muscle-exercises-for-women.html

http://www.continence.org.au/pages/pelvic-floor-muscle-exercises-for-men.html

http://www.health.qld.gov.au/stayonyourfeet/for-professionals/resources-prof.asp

staying active and independent ot student: jae-ellen fowler

Documents

queensland government

nsw government

fallsaustralian government

falls statistics

life australian government

falls risk factors

fallingfatigue queensland

fallsrelated injuries