How Speech-Language Pathologists Can Be More Involved with Fall Prevention

By Joseph Coleman, MS, CCC-SLP

speech-language pathologist

Falls result in nearly 3 million injuries requiring emergency department visits each year. Approximately 25 percent of those will lead to hospitalizations and nearly 30,000 deaths annually. Those are incredibly frightening numbers to me and I know that we can do better and have a positive impact on decreasing falls by changing our therapeutic approaches.

We all know that falls occur for a number of reasons, and many times they can be avoided with rehabilitative interventions. Speech-language pathologists are not usually the first discipline that comes to mind when thinking of preventing falls but we can play a much more active role in fall prevention through the use of more effective communication strategies.  Our work can ensure our patients and their caregiver understand the instructions they are given to complete exercises and better execute strategies implemented by the interdisciplinary rehabilitation team.

SLP TACTICS TO PREVENT FALLS BY PATIENTS WITH RECEPTIVE & EXPRESSIVE LANGUAGE DISORDERS

Breakdowns in communication can be a factor that leads to safety risks and falls for a number of reasons. SLPs can address the language deficits often associated with communication impairment that prevent carryover of safety techniques that can lead to falls.

Say the patient isn’t trainable with appropriate return demonstration. We should intervene with caregiver training. Educate the caregiver on appropriate strategies to ensure that there is carryover of home exercise programs, techniques for safety, or setting up schedules to anticipate their needs to prevent falls.

Some more questions to ask yourself when following your plan of care that includes fall risks are:

• Do the patient and caregiver understand the rationale behind your clinical reasoning for making recommendations to improve safety?
• Can the patient make their needs known effectively across various communication partners and settings?
• Are we presenting information broken down in a way that is easily understandable (simple rather than complex commands, one-step directions, etc.), especially in distracting and/or stressful environments?

It should be part of every fall intervention to assess where and why the breakdown occurred resulting in a fall or near miss which should include an assessment of communication and cognition. If the answer to any of the previous questions is “no,” then a referral to us is very likely indicated.

HOW SLPs CAN PREVENT FALLS FOR COGNITIVELY IMPAIRED PATIENTS

Cognitive impairment obviously also plays a role. As SLPs, we are able to identify cognitive-communication deficits that may increase the risk of or even cause a fall. Plans can be individualized to address all areas of orientation (temporal, place, visual-spatial, situational, etc.), areas of memory that they can utilize most effectively (auditory, visual, procedural, episodic, etc.), problem-solving, and higher-level executive function skills.

Some questions to ask yourself to ensure all areas impacting safety are addressed are:

• Can your patients actually execute what you’re attempting to teach them rather than just recite it back verbatim?
• How are their thought organization and abstract reasoning?
• Do they need more visual or tactile prompts to make things more concrete?
• What is their attention to task like?

These are all areas where an SLP can have a positive impact if deficits are found or suspected.

THE REAL ROLE OF THE SLP IN FALL PREVENTION

We, as clinicians, should be looking comprehensively and holistically at our patients in order to take an active role in environmental assessments. SLPs can help minimize clutter and distractions and assist in setting up appropriate routines with caregiver education on best communication strategies to promote effective communication between partners. Personally, I’ve given live demonstrations of how falls can happen by actually getting in a wheelchair or using a rollator walker inappropriately. By taking advantage of potentially more intact visual and episodic memory, we can help minimize or eliminate safety risks which can lead to falls. This facilitates the abilities of patients and caregivers to understand the reality of falls and improve carryover

An organized living setting makes locating and retrieving necessary items for activities of daily living tasks and routines easier and more efficient to complete. Ensure that patients and/or their caregivers understand the role communication plays in learning new information. Teaching a fall prevention strategy after the fact is new information, and if it’s not, there has been a communication breakdown somewhere along the way that was not addressed. This new information must be executed correctly and consistently in order to lead to the lifestyle changes that need to occur to prevent future falls.

SLPs can and should play a more active role in fall prevention by addressing hearing, language, cognitive, visual, and environmental hindrances. We can make the difference between successful rehabilitation and another fall through improved communication. Sometimes this requires thinking outside the box and individualizing our plan of treatment to go above and beyond for our patients.

Fall prevention is everyone’s responsibility. SLPs are sometimes the missing component to help avoid the physical and social impact falls can have on older adults through isolation because of associated fear.

The saying, “If you don’t use it, you lose it,” does not just apply to muscles. So when physical and occupational therapy colleagues are extensively noting carryover and continued safety concerns, we all must look to communication impairment as a possible factor. Improving the safety of our patients functionally is one of the most important ways we as SLPs can help navigate these frustrating and potentially dangerous situations.

Keep older adults active.

Keep them social.

Keep them safe.

Keep them at home.