How to Reduce Fall Risk with Speech-Language Pathology Treatment

By Megan Swavely, M.S., CCC-SLP

Speech-Language Pathologist

We have all seen the commercials, “Help! I’ve fallen and I can’t get up!” The vision of the older adult lying on the floor is seared into our minds. As a granddaughter and a speech-language pathologist, I know that falls happen a lot. According to the CDC, approximately one out of four individuals over the age of 65 will fall.

Not only is a fall detrimental to a person’s physical health, but it is also very costly. Medicare pays over $31 billion dollars yearly for falls related to the geriatric population. Fall-related injuries are the leading cause of institutionalization and morbidity in the geriatric population.

THE CONNECTION BETWEEN FALLS & SPEECH-LANGUAGE PATHOLOGIST TREATMENT

This begs the question, what can a speech-language pathologist do to help? When someone falls, the caregivers immediately think this person may benefit from physical and occupational therapy. These recommendations are a great start, but more can be done to increase their safety, reduce the risk of future falls and maintain independence. There are interventions that a speech-language pathologist can do to increase a person’s success in their other therapies.

What is the missing piece to reducing fall risk for older adults? It may be cognitive therapy.

Individuals in the geriatric population don’t just sit around and think about falls. The discussion of falls usually doesn’t start until they have experienced their first one. And a  person who suffers a fall has a huge battle ahead of them. Did they sustain an injury during their initial fall? Do they have help? Was something medically occurring that lead to the fall? Possibly an infection, an improper dosage of medication? What can be done to prevent this from happening again?

HOW SPEECH-LANGUAGE PATHOLOGY CAN IMPROVE COGNITIVE FUNCTION TO KEEP ADULTS AT HOME

It may come as a surprise, but a speech-language pathologist can help an individual remain safely in their home. Speech-Language Pathologists are well versed in cognitive functioning and can focus on memory, reasoning/problem solving, sequencing, attention, orientation, and executive functioning. All which play a role in an individual’s ability to reduce falls.

• The first area of cognitive functioning, and possibly the most easily recognized, is memory. There are different types of memory. Memory deficits can have a significant impact on fall risk management. For example, maybe in the last few months, your grandfather has fallen. As a family, it is decided that living in a smaller apartment closer to the family might increase his safety. This sounds like a great start, but now a world of problems has suddenly appeared. Medications, or medi-sets, get lost because his routine and lifestyle has changed. His whole day-to-day pattern may be uprooted because he has to start a whole new way of life and organize their belongings. Medications may get lost, which reduces compliance and may result in greater health risks increasing a person’s risk for falls.
• The next area is reasoning and problem-solving. One of my favorite quotes is, “Work smarter, not harder.” As a person gets older, he or she has to work smarter to conserve their energy and maintain safety. Safety can be directly impacted by a person’s ability to reason and problem solve. Maybe a new medication causes unbearable side effects. The side effects may cause dizziness or nausea. A person’s first instinct may be to stop the medication. It’s causing problems, therefore I will stop the symptoms if I stop taking the medication. This person may not realize the consequence of stopping medication without a doctor’s approval. Many medications may cause serious problems, possibly leading to a fall or even a stroke, if not taken as directed.
• Next regarding cognitive functioning is sequencing. This is a person’s ability to execute an activity in a particular order. Maybe someone fell and suffered a hip fracture. Their way of life may be turned upside down with new recommendations (and not to mention new medications, possibly including a narcotic). Now not only does this person have to recall and sequence the hip precautions, but now transfers, dressing, and completing activities of daily living are so much harder. Failing to sequence their activities of daily living may lead to more falls, pain, or even avoidance of important ADLs (showering or cooking).
• Attention is another important factor that can have a direct impact on a person’s safety. Were they paying attention when the doctor was explaining recommendations or were they focused on their pain? Were they able to pay attention to their cooking or medication management or were they distracted by the phone call or the person knocking at the door?
• Orientation is so much more than knowing what day or month it is. For someone to maintain their independence, following a calendar for appointments, medications, or even reading the dates on their food can have a significant impact on a person’s safety. Another component of orientation is understanding their own limitations. A person who has been independent their whole life may become disorientated to their deficits.  A person may say, “Oh, I won’t fall” or “I don’t need help, I can figure it out” has a higher risk of falls.
• The last topic of cognitive functioning to discuss is executive functioning. This includes time management, planning, and organization. A person downsizing may have to find the “perfect place” to put items to clear the clutter. Or he or she may not recognize the need to call the doctor to reschedule appointments or request refills of a medication. This is a high-level brain functioning that can result in an increased risk of falls.

Cognitive functioning can have a significant impact on a person’s ability to safely remain in their home. You may notice that an older family member or friend may be “a little off,” doing things differently or in an unsafe manner. Or maybe even reports of falls or even bruising can be the first sign.

Whatever red flags you see, or even if a fall is the first sign, a person may qualify and benefit from a speech evaluation and treatment. A person’s independence, safety, and quality of life are what you want to preserve for many years to come.