The role of OTs in fall prevention

Posted November 4, 2015

I am an Occupational Therapist on the North Simcoe Muskoka Integrated Regional Falls Program (IRFP).  The IRFP is a community based fall prevention program.  My primary role is to complete home safety assessments. I also conduct education sessions as part of an inter-disciplinary team.  I have the opportunity to work with clients who have already completed a thorough falls risk assessment with a registered nurse on our team.  The majority of clients that are referred to OT have also been assessed by a physiotherapist.  This teamwork is both professionally rewarding and beneficial to the clients in our program.

  

Clients are referred for an OT Home Safety Assessment when they are identified as being at a moderate to high fall risk, and home safety is a concern.  Interestingly enough, in my experience, the majority of the clients I work with do not identify with being at an increased risk for falls.  This includes clients who have a fall history and other multiple risk factors.  However, their spouse, children or significant others may believe that the client is at risk for a fall.

  

The disconnect between the client's perception of themselves and their risk for falls can pose a challenge.  It forces us to examine the questions:  "How can we use ourselves therapeutically to make a real difference for our clients, even if "fall prevention" is not their goal but rather our clinical goal?"; and "How can we be most effective in reducing an individual client's fall risk? "

  

The CAOT's (Canadian Association of Occupational Therapists) statement with regards to falls reminds us that "Occupational Therapists approach fall prevention by addressing personal, environmental and behavioural factors which influence people's participation in activities at home and in the community."

  

A home safety assessment is more than providing recommendations, and giving a client handouts and checklists.  It is about completing a task analysis of the various activities that a client performs on a regular basis and identifying the barriers to completing those tasks safely. 

  

For example:


  • Is it safe to complete the tub transfer with extreme flexion when you have a history of osteoporosis?  Would education on bone health and osteoporosis friendly movements help the client to make an informed choice about bathing? 

  • Does a male client need to consider sitting down on the toilet instead of standing to address balance or strength limitations?  Is he receptive to making that lifestyle change?

  • Will re-hinging the bathroom door provide a cost effective means of having more space available to maneuver inside the bathroom while using a gait aid?  If a fall occurs, a door that swings out instead of in allows someone else to enter the room more readily. 

  • Would it be helpful to replace the towel rack with grab bars if it is inevitably used for support, despite "knowing" it is not safe to do?  Habits are hard to break.

  • Would handles or grab bars in door thresholds provide the needed upper body support when negotiating doorways with a step?

  • Does the client have the executive skills necessary to arrange for implementation of the home safety recommendations?  Are there cognitive concerns that warrant further investigation into cognitive and functional abilities?


Are finances a concern to implementing equipment and home adaptation recommendations?  Useful resources may include: 



When clients are at increased fall risk, a demonstration or trial of getting up from the floor can also be very helpful.  This can be beneficial for the both the person at risk of a fall, as well as the person who is likely to be there to assist.  Handouts are available to provide visual aids and instructions on how to assist persons with getting up from a fall.  Helpful resources on this topic include: 

 


Clients may require additional supports to manage their day-to-day activities and which could reduce their fall risk.  The website www.nsmhealthline.ca offers information on a wide range of public and private health care resources that offer this support from foot care providers to housekeeping assistance.

  

It is a privilege to work with clients in their own homes. It is my responsibility to make recommendations to improve home safety and fall prevention while assessing and respecting where the client is at in relation to their readiness for change.  I need to align my "fall prevention" goal to an individual's priorities with regards to their personal health and wellness.  My role is to help an individual make informed decisions about options to improve home safety and fall prevention strategies while appreciating individual choice.  

  

Whatever your motivation is for reading this article, I hope there was something useful for you.  Please feel free to comment below or contact me if you have any additional thoughts or comments. 

  

Take good care,

  

Donna Henderson, OT Reg (ON)

Occupational Therapist

North Simcoe Muskoka Integrated Regional Falls Program

dlhenderson@osmh.on.ca

 

Content Related To: Occupational Therapy (OT)