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Falls Prevention Program: Keeping on your toes. Staying active and independent. OT Student: Jae-ellen Fowler. Program. Session 1: What are falls and the significance of them? Environment: Safety in and around your room Session 2: - PowerPoint PPT Presentation
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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
(NSW Government, 2009; Queensland Government, 2011)
Walkways◦ Adequate space and access ◦ Are clear◦ Keeping doors fully open or closed◦ Reducing clutter
Bedroom
(NSW Government, 2009; Queensland Government, 2011)
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
(NSW Government, 2009; Queensland Government, 2012)
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
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
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
(Queensland Government, 2011)
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
Making activities easier
(Metro North Health District, 2004)
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
Making activities easier
(Metro North Health District, 2004)
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
Making activities easier
(Metro North Health District, 2004)
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
Making activities easier
(Metro North Health District, 2004)
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
(Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)
◦ 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
(Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)
◦ 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?
(Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)
Long and loose clothing can upset balance and gait
Be aware clothing doesn’t trail around ankles or have loose parts
Safe clothing
(Queensland Government, 2012; Queensland Government, 2011)
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
(Queensland Government, 2012; Queensland Government, 2011)
Spot the trip hazard!Trailing cord
High set board
Turned up rug
Coffee table blocking walkway Books on floor
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
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
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 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
(Queensland Government, 2011; Queensland Government, 2004)
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
(Queensland Government, 2012)
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.
Increasing physical activity
(Queensland Government, 2010)
◦ 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)
Increasing physical activity
(Queensland Government, 2010)
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.
Increasing physical activity
(Queensland Government, 2010)
◦ 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.
Increasing physical activity
(Queensland Government, 2010)
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
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
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
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
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