How to Address Fall Risk in Senior Living Communities: Occupational Therapy’s Toolkit
By Christopher Meketansky, OTR/L, LSVT
Occupational Therapist
Fall prevention is an important factor for older adults to consider in maintaining healthy aging. Every year, 25 percent of older adults will fall, making it the leading cause of fatal injury.
Rehabilitation therapists working with older adults in senior living communities and beyond possess expertise in falls prevention; each discipline is able to offer unique insight into this topic. Occupational therapists work in conjunction with physical therapists and speech-language pathologists to form the steady steps upon which fall prevention is achieved. Occupational therapists come from a particular place in contributing to falls prevention for older adults. This is because we look at a wide array of factors, such as cognition, the patient’s environment, vision, and dressing among many others to help prevent falls.
HOW COGNITIVE INTERVENTIONS CAN HELP PREVENT FALLS
Cognition refers to the mental functions required to perform the tasks that we undertake on a daily basis. Conditions like dementia, Alzheimer’s, and Parkinson’s disease along with many others can impact cognition in older adults. Some important aspects of cognition in regard to falls prevention include memory, perception (the ability to discriminate senses), attention, and judgment.
Memory is important for many reasons, like preserving a senior living resident’s ability to remember to use a walker, take medication that helps them move around easier, or put on their shoes so they have traction when walking. Occupational therapists use techniques to address memory impairments. These can include memory aids, training for older adults to keep durable medical equipment in close proximity, and cognitive strategies to safely get up from a chair. Sometimes people have difficulty feeling items with their hands, like those individuals suffering from neuropathy. Occupational therapists can train on approaches to compensate for this impairment by using visual checks while holding walkers or suggest equipment like special gloves to increase the perception of items in hand.
A vital aspect of falls prevention is an individual’s safety awareness, which encompasses attention and judgment. Educating and practicing safety techniques, training on situational awareness of dangerous situations, and helping acquire the proper assistive equipment are just a few ways occupational therapists can address a residents’ safety awareness impairments. Ultimately the occupational therapist’s role is to take into account all of the cognitive factors present and help the patient be able to stay safe, exercise good judgment, and problem solve when needed.
CREATING A SAFER ENVIRONMENT FOR OLDER ADULTS
Safely aging often requires changes in order to make the environment secure and prevent the individual from suffering a fall as they get older. Occupational therapists are experts in this area.
One particular room that poses a significant fall risk is the bathroom. Considering the range of toilets, sinks, tubs, and showers that every individual room can have requires a variety of equipment and alterations in order to make the bathroom a safe place. With any environment modification in a community, be mindful of its regulations.
Toilets pose a fall risk in two key ways: going to sit on them and reaching for items while seated. Customizing toilets with rails, elevated toilet seats, or commode overlays can make “the throne” a safer seat. Occupational therapists can analyze the risks, recommend equipment, and train individuals in their proper use. Another common obstacle in the bathroom is the tub or shower stall. Some have a walk-in stall but still may require additions like grab bars, non-skid mats, or other items to reduce the risk of a fall while showering. Tubs with an elevated lip become more challenging and possess an increased fall risk. A transfer bench or a rail secured to the lip of the tub, along with proper training in the use of these pieces of equipment, greatly reduces the risk of a fall. The sink is a common item people will try to hold when walking, sitting, and standing in the bathroom. Sinks by nature are wet. Occupational therapists can help strategize the placement of grab bars to get the individual away from using the sink for balance and instead utilize a safer alternative.
Throughout someone’s living space, there are many obstacles that necessitate modifications to become less risky. An occupational therapist can perform a home safety assessment by looking for any area that may present a fall risk. Once assessed, they can then recommend equipment, modifications, or tools and train the individual to properly use them, thus helping minimize any risk of a fall.
Some examples of safety risks in the home include saddles (those little bumps between rooms) and raised throw rugs in the middle of the floor. And these are just two common challenges among many others. The occupational therapist can offer safe alternatives to turn a stumbling block into a smooth walkway.
HOW OCCUPATIONAL THERAPISTS CAN ASSIST WITH VISION
Vision changes are a natural part of aging. Common diagnoses for older adults that lead to reduced vision include macular degeneration, glaucoma, and cataract.
The occupational therapist has many ways to reduce the risk of falls for individuals with reduced vision. Education and practice of compensatory techniques are pivotal aids. One example is to practice scanning via head turns where vision is limited when walking. Others include cognitive techniques to remember corrective eyewear when standing up from a seat increase can help.
When vision is limited, lighting becomes vitally important. Occupational therapists can assess if there’s adequate lighting and recommend modifications where needed. One of the most common lighting issues is a lack of illumination in frequently trafficked walkways. This issue can be helped via string lights, fluorescent tape, or motion-sensor lights to help make moving around safer. Occupational therapists can take a look at areas where individuals cook, dress, or do other activities and make recommendations to increase lighting, decrease glare, or modify the activity so it is done in a more vision-friendly way.
Another tool to address poor vision or low visibility is adjusting the contrast of color and texture, which can be accomplished by adapting the environment to make walkways, furniture, and other areas stand out from the background. Looking beyond the older adult, educating all caregivers and family on decluttering walkways, removing tripping hazards, and making items of interest closer to eye level can assist in helping cope with reduced vision.
DRESSING: A PIVOTAL POINT FOR DAILY LIVING
Occupational therapists work a lot with activities of daily living. Dressing is an ADL that presents added fall risks. Whether putting on clothes while standing or sitting, dressing can leave older adults vulnerable to a fall. Occupational therapists work with patients on training on various types of assistive equipment including sock aides, dressing sticks, and reachers to make dressing easier and safer. Occupational therapists can educate and train on compensatory techniques for dressing. These techniques may include putting pants on in bed, getting shoes on without reaching toward the ground and pulling up socks in an easier fashion.
Keep in mind that the choice of clothing can present a risk, especially when it comes to footwear. Patients sometimes deal with swelling, neuropathy, and limited movement of their feet and occupational therapists can work with them to obtain footwear that works for their unique challenges.
As an occupational therapists working with older adults, it is our duty to look at many different aspects of an individual’s life to keep them healthy, happy, and safe in their own homes. Preventing falls for older adults can present as a daunting challenge, but with the proper guidance from skilled therapists, it is one which can be met. Addressing the areas discussed in this article can help individuals continue doing the things they love, the things that matter to them as they age healthily.