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Falls Prevention Program: Keeping on your toes

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:

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Falls Prevention Program: Keeping on your toes

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  1. Falls Prevention Program:Keeping on your toes Staying active and independent OT Student: Jae-ellen Fowler

  2. Program • 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

  3. SESSION 1

  4. What are falls and the significance of them?

  5. What is a fall • “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 (Queensland stay on your feet, 2012; Australian Government, 2005; McClure et al., 2008)

  6. Causes for falls • 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) Discussion point: Can anyone name any falls risk factors that may affect them? (Australian Government, 2005; Queensland Government, 2004; Queensland stay on your feet, 2012; Queensland Government, 2006)

  7. Intrinsic risk factors • Dizziness • Low levels of physical activity – decreased muscle strength • Slow reaction time • Concern for falling • Fatigue • Increased age • Being female • History of falls • Certain chronic medical conditions • Taking multiple medications – psychoactive • Poor nutrition • Unsteady gait – mobility aid • Sensory problems (Queensland stay on your feet, 2012; Queensland Government, 2006; NSW Government, 2009; Queensland Government, 2004)

  8. Extrinsic Factors • 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 • Housing and floor plan • Reaching outside the body’s safety zone (Queensland stay on your feet, 2012; Queensland Government, 2006; NSW Government, 2015)

  9. Statistics on Falls • In QLD 1 in 3 older Australians will fall each year • Residents in Residential Aged Care Facilities experienced nearly 5 times the falls (Australian Government, 2005; NSW Government, 2009)

  10. Statistics at Immanuel Gardens – Hostel on Trips/Slips/Falls • In the last 6 months..... • 53 trips/slips/falls • 45 residents Areas of falls 5.6% Outside 5.6% Dining Room 75% Bedroom 9.5% Bathroom (Immanuel Gardens (Hosetl) – Buderim Facility, 2012)

  11. Statistics at Immanuel Gardens – Hostel on Trips/Slips/Falls Outcome of Injury of Falls 11.3% Head injury 47.1% No injury 22.6% Skin tears 5.6% Bruising (Immanuel Gardens (Hosetl) – Buderim Facility, 2012)

  12. Impact of a fall • Cuts, bruising, abrasions, head injuries • Fracture – wrist, hip, trunk, neck • Hospitalisation • Death • Reduced mobility • Decreased independence • Transfer to Nursing Home • Loss of confidence • 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)

  13. YouTube Clip

  14. Safety in and around your room Discussion point: What are types of falls hazards in your environment that concern you? Bedroom? Bathroom? Outside?

  15. Bedroom • 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 (NSW Government, 2009; Queensland Government, 2011)

  16. Bedroom • Appliances • Light beside bed or a night light – easily reachable • Cordless phone or phone beside bed, armchair or on desk • No trailing cords (NSW Government, 2009; Queensland Government, 2011)

  17. Bedroom • Walkways • Adequate space and access • Are clear • Keeping doors fully open or closed • Reducing clutter (NSW Government, 2009; Queensland Government, 2011)

  18. Bathroom • 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 (Queensland Government, 2011; NSW Government, 2009)

  19. Outside paths, walkways and stairs • 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 (NSW Government, 2009; Queensland Government, 2012)

  20. Spot the Trip Hazard! Coffee table in front of curtains High set shelf Low seated armchair Rug Trailing bed covers Items on floor – walkway unclear

  21. References • 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

  22. Falls Prevention Program:Keeping on your toes Staying active and independent OT Student: Jae-ellen Fowler

  23. Program • 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

  24. Last weeks session • Topics • What are falls and the significance of them? • Safety in and around your room 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?

  25. SESSION 2

  26. What you can do to keep yourself safe and active in your daily activities

  27. Safe movements • 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 (Queensland Government, 2011)

  28. Safe movements • 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 • Pushingwith hands • Pauseto steady balance (Queensland Government, 2011)

  29. Safe movements • 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 (Queensland Government, 2011; Queensland Government, 2012)

  30. Making activities easier • 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 Discussion point: What tactics do you use to conserve your energy through the day or through an activity? (Metro North Health District, 2004)

  31. Making activities easier • Handy hints; • Organise the activity before starting • Equipment can make things easier • Large, easy to grip handles • Non-slip matts • Long handles • Lightweight objects (Metro North Health District, 2004)

  32. Making activities easier • 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 (Metro North Health District, 2004)

  33. Making activities easier • 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 (Metro North Health District, 2004)

  34. Making activities easier • 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 (Metro North Health District, 2004)

  35. Safe use of walking aids • 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 (Queensland Government, 2012; Queensland Government, 2004; LifeTec Queensland, 2012a)

  36. Safe use of walking aids – 4ww • 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 (Walkerfacts, 2010; LifeTec Queensland, 2012a)

  37. Safe use of walking aids – 4ww • 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 (Walkerfacts, 2010; LifeTec Queensland, 2012a)

  38. Safe use of walking aids – walking frame • 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 (Walkerfacts, 2010; LifeTec Queensland, 2012b)

  39. Safe use of walking aids - stick • 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 (LifeTec Queensland, 2012c)

  40. Safe use of walking aids - stick • 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 (LifeTec Queensland, 2012c)

  41. Safe footwear • 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 (Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)

  42. Safe footwear • 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 (Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)

  43. Safe footwear • 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 (Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)

  44. Safe footwear • Have laces, zips or Velcro fastenings • Lightweight • Adequate width, depth and height in toe box Discussion point: Which of these shoes is safe? (Queensland Government, 2011; Queensland stay on your feet, 2012; NSW Government, 2009)

  45. Safe clothing • Long and loose clothing can upset balance and gait • Be aware clothing doesn’t trail around ankles or have loose parts (Queensland Government, 2012; Queensland Government, 2011)

  46. Safe clothing • 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 (Queensland Government, 2012; Queensland Government, 2011)

  47. Spot the trip hazard! Trailing cord High set board Turned up rug Coffee table blocking walkway Books on floor

  48. References • 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 fromhttp://www.lifetec.org.au/home/content.asp?pageID=205&main=205&sub=0 • LifeTec Queensland (2012c). Measuring and using a walking stick. Retrieved fromhttp://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

  49. Falls Prevention Program:Keeping on your toes Staying active and independent OT Student: Jae-ellen Fowler

  50. Program • 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

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