Lower the risk of falls for your elderly clients
Lower the risk of falls for your elderly clients
Prevention is worth a pound of cure
Falls are a major cause of injury-related deaths among seniors, but private duty providers can take many precautions to help keep their patients safe.
"Falls are a huge issue in the elderly," says Dee Flaspoehler, MHSA, PT, physical therapy supervisor at the St. Francis Health System inpatient rehabilitation center in Greenville, SC. Flaspoehler works with patients heading home after being hospitalized for ailments such as strokes.
To understand the impact falls have on elderly patients, consider these statistics:
· Among people 85 and over, falls are the leading cause of injury-related deaths. For those ages 65 to 84, falls are the second-leading cause of these types of deaths, according to the Centers for Disease Control and Prevention.1
· About one in three people over age 65 falls each year, and the per person direct cost for their care was $1,400 in 1994, according to the National Center for Prevention and Control. That same year, almost 7,390 people over age 65 died as a result of falls.2
Private duty providers can help reduce their patients' risk of devastating falls by assessing clients' homes and daily activities and recommending both environmental modifications and assistive devices, sources say. Patricia F. Haley, MSA, manager of personal care services at Mercy Home Care in Urbana, OH, offers these reasons why elderly people usually fall:
· decreased vision with resulting contrast sensitivity and changes in depth perception and visual field;
· loss of equilibrium;
· slowed responses to sudden posture changes and muscles used to avoid falling;
· reduced muscle strength and limited lower extremity range of motion;
· low self-confidence performing normal daily activities.
"Almost all [at home] falls are unwitnessed," says Haley. That makes it tough to pinpoint their causes, especially if patients have cognitive impairments or are embarrassed to disclose when they have fallen.
Prevention is the best strategy, sources say. At St. Francis, this begins before the patient goes home. Therapists discuss patients' mobility limits and ask them to describe their home. The therapist reviews special considerations. For example, they may ask a newly wheelchair-bound patient to take them on a mental tour of their home, focusing on room-to-room passageways and bathroom accessibility.
Patients themselves can often identify structural issues such as small door frames or stairways. When major modifications are necessary, St. Francis staff accompany the patient and family members on a pre-discharge home visit to allow time for changes. For those with fewer anticipated adaptations, the home visit occurs the day of discharge.
Simple adjustments, small accessoriesA physical or occupational therapist assesses every room of the home and watches patients perform virtually all daily activities. "We start from the beginning of the day to the end of the day," says Flaspoehler. (See sample rehab assessment form, pp. 72-73.)
Therapists observe patients perform actions such as opening their refrigerators and sitting in their favorite chairs or sofas to be sure the furniture is stable and the patients can get in and out of them easily. Patients also show how well they can get in and out of bed, bathtub or shower, and on and off the toilet.
Recommended environmental adjustments may range from pushing a bed against the wall for added stability to installing rails around toilets and showers. Staff may also help rearrange personal items so that those used most are most accessible. In the kitchen, pots and pans must be near the stove to reduce the need for stooping or reaching, which can cause falls. Silverware and dishes should be easy to grab. Food and other items commonly used throughout the home need to be within reach. "We want [things] real accessible so as not to risk a fall or something falling on [patients]," says Flaspoehler.
Bathrooms, in particular, require close attention. A little splash of water on a hard tile or linoleum floor can lead to a dangerous fall. "It's a very risky place," says Flaspoehler. "Bathrooms are usually where there's the most need for adaptations."
Remove all throw rugs, Flaspoehler advises. They can be dangerous to patients using wheelchairs, walkers, and canes. Hand-held shower nozzles and shower benches may lessen demands on patients' balance or mobility in the bath or shower. If a bathroom doorway is too narrow for a wheelchair or walker, take the door off its hinges - if privacy is not an issue - or remove molding for a few more inches of leeway, Flaspoehler suggests. This is especially helpful if the patient uses a master bath and the bedroom door can be closed instead for privacy.
Creativity is important, especially for patients with limited funds. For example, staff may recommend a sturdy lawn chair in place of a shower bench. St. Francis social workers also help identify resources for patients with limited financial resources.
St. Francis therapists also carry equipment samples, such as bedside toilets and rails, so patients can try them out. And they encourage family members to be on hand during the assessment so they can describe any challenges they see. Therapists document the safety assessment, suggested modifications, and possible purchase locations, leaving both patients and family members a complete record of identified safety issues.
St. Francis conducts the home visits for all rehabilitation unit patients, regardless of whether the client will receive home care. For those who do, "hopefully most safety issues will be addressed before home care ever opens the case," says Flaspoehler. want to make it as safe as possible for them at home," she adds.
References1. Centers for Disease Control and Prevention. Injury Mortality, 1986 - 1992. Atlanta; 1992.
2. Economic dimensions of slips and fall injuries. J Forensic Sci 1996; 733-746.
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