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Falls prevention is a key focus for our Physiotherapists and Occupational Therapists as the outcome of a fall can possibly change a person’s life forever. Most excitingly, there is plenty that our team can do to assist people to decrease their risk of falling!
The World Health Organization defines a fall as ‘coming to rest unintentionally at a lower level’. A fall is not just the process of falling all the way down to the ground – it can also refer to losing balance and falling into a wall, or falling onto a piece of furniture, for example.
Statistics show falls are the second leading cause of unintentional injury deaths worldwide. Each year an estimated 684 000 individuals die from falls globally. Community Therapy understands the risks involved in someone falling and why falls prevention is a critical part of our journey to create a healthier community.
Falls prevention relates to circumventing any situation in which someone unintentionally lands somewhere due to tripping, slipping or loss of balance. Falls prevention aims to enable someone to take a step or use a clear strategy to prevent themselves from falling. It also refers to strategies to reduce the risk of a fall, such as making someone’s home environment safer.
How We Lower Falls
Luckily, there is a lot we can do to prevent falls in the home and the community.
Environmental changes are significant when it comes to falls prevention.
This may take the form of removing trip hazards (i.e. mats or other such as electrical cords). It also involves an assessment of pathways from one room or hallway to the next, identifying any changes in height or flooring to ensure there is adequate light at all times.
From a physical point of view, there are also significant things people can do to reduce their risk of falls, such as adhering to the Australian physical activity guidelines. These guidelines state that everyone should undertake a minimum of 150 minutes of moderate physical activity (such as walking, cycling or swimming) per week, together with twice-weekly strength and balance exercises.
A Physiotherapist will assess someone’s physical function to determine if there are deficits in balance, strength, mobility, coordination, reflexes or the ability to multitask. They will then be able to design a program to work on improving a person’s function to decrease their risk of falling due to the deficits in the physical function they had.
Why We Fall
There are many factors associated that can increase the risk of falls. The prevalent factors are:
- Decreased strength.
- Decreased cognitive processing speed, meaning that thinking and multitasking can become slower as you age or with certain medical conditions.
- The ability to initiate speed and power in the body is lowered, affecting the capacity to step quickly enough and to then stop the momentum that is created from falling.
- Decreased vision. As we age, the amount of light needed to detect changes in flooring and surfaces within the environment increases. Therefore, someone can be at increased risk of falling in low light conditions or at nighttime. Many medical conditions affect vision as well which may increase someone’s falls risk if not appropriately assessed and managed.
We Help Individuals & Aged Care Facilities Lower Falls Risks
The majority of falls prevention work we do is in the community, through one on one sessions. One great example of our falls prevention strategies was provided to an 85 year old man who had a series of falls in his own home. Assessing the current living situation by identifying risks and hazards, our team was able to plan out a new arrangement and set goals for the client.
With that said, we also partner with providers to deliver group programs. These include looking at group exercise initiatives and other falls prevention programs. There are well researched group programs that demonstrate significant decreases in falls risk.
In the residential aged care environment, Community Therapy undertakes a combination of individual and group-based therapies. This includes environmental reviews, equipment reviews as well as working collaboratively to make sure risks of poly-pharmacy, nutrition, optometry and podiatry are all well managed. Through integration with a facility, we help all staff to become aware of simple changes that can be made to both environments and equipment in order to decrease fall risks.
Identifying People at High Risk of Falling
There are validated falls risk assessment tools that can be used to determine a score that represents someone’s risk of falling. This is particularly relevant in cases where someone has not yet had a fall. They can still be identified ‒ through balance or falls-specific outcome measures.
Importantly, many of those outcome measures can also identify the reasons why someone is at risk. For example, they might show an increased risk of falling in narrowed stances, while turning, or while having their eyes closed. With this information, we can develop a treatment pathway in order to improve those specific deficits.
Falls Rates in Facilities can be Measured, Reviewed and Improved
The reporting of falls in residential care is becoming a mandatory quality indicator, meaning that residential facilities report any falls that occur to the Department of Health. We work with our partner residential facilities to identify and assess all falls on an individual basis and then also look at trends at a facility level on a regular basis by an appointed falls committee.
The committee is then in a position to identify any trends as to why falls are happening, and develop strategies so that they can be prevented. For example, if a trend indicates that more falls are occurring during a particular shift (for example overnight or early morning) then the committee can advise on strategies. This might include increasing the number of staff rostered on at that time, reviewing toileting schedules or meal times in order to decrease that falls risk.
Improving Walking Pattern through Physiotherapy
Step height and length may decrease due to age-related strength decreases, or due to a lack of physical activity over a short or long period of life. In cases where someone has lost strength, speed and power, we can develop a program to improve those things over time.
Neurological conditions such as stroke can also affect gait, making it difficult for someone to lift their foot high enough to avoid tripping on their toes or their feet. In some cases, equipment such as an ankle-foot orthosis can help clear the foot while walking.
Community Therapy has vast experience in the Aged Care sector and we are particularly specialised in assisting our patients to improve their gait.
Community Therapy is up to date with Current Evidence on Falls
Community Therapy stays up to date with current industry information and evidence in several ways. These include:
- Our online learning platform which has on-demand training and webinars covering current best practice
- Maintaining subscriptions to the latest industry research and information
- Attendance at the Australian Physiotherapy Conference each year
Goal Setting for patients with Falls Prevention as part of their Therapy Plan
Falls, and fear of falling, impacts people in many different ways.
Some clients set a simple goal of avoiding future falls, but typically clients express more meaningful goals such as “I’m really fearful of falling in the community so I no longer go to church” or “I no longer go shopping by myself“….”I want to regain that ability!”
At Community Therapy, we like to identify a meaningful goal such as these, because it typically improves motivation to do exercises which ultimately decreases fall risk.
Falls Prevention FAQ
Does someone require a GP referral to contact you for this service?
No, most of our services do not require a GP referral.
The only exception to this is if a client is looking to receive a Medicare rebate through a chronic disease management plan or a DVA referral. In these cases, a GP referral is required.
What is the average length of engagement when someone contacts you for this service?
Typically, our falls prevention programs run for 6 to 12 weeks.
Over those 6 to 12 weeks a client may be seen weekly or fortnightly, or even twice weekly.
Decisions around the frequency of appointments are based on factors such as the significance of their fall risk, capacity, as well as budget considerations within their home care package, NDIS plan or private budget.
After this initial period, some clients will continue to require weekly, fortnightly, or monthly reviews in order to continue to build their capacity or to maintain the level of function that they have achieved.
When someone falls, it's possible they may become stuck on the floor. This poses its own problems such as dehydration, muscle damage, pneumonia, et cetera. Does Community Therapy put strategies in place such as buzzers or hip protectors for their safety?
As part of a Physiotherapy assessment, we’ll look at the client’s ability to stand up from the floor. If this is something they cannot achieve, we consider them to be a high risk for what is referred to as a ‘long lie’, which is associated with negative outcomes. This means if someone did fall, they would be at risk of laying on the floor until someone found them if they were unable to let anyone know they were on the floor.
In these cases, additional strategies such as sensors, buzzers or call systems are considered. The same considerations apply within residential care facilities.
Hip protectors are not a falls prevention strategy. They are an injury minimization strategy. Hip protectors can be used to try to decrease the risk of a hip or pelvic fracture.
Research suggests that the use of hip protectors should be considered for those who have had previous hip fractures because they may contribute to a small decrease in the risk of a further fracture. In most other cases, hip protectors are not indicated.
How would you help someone develop the capacity to lower and raise themselves off the ground?
As part of our Physiotherapy program, we aim to build the capacity for someone to move down to the floor and back up. We primarily develop this capacity through exercises which strengthen the person’s trunk muscles, hip muscles and leg muscles.
These exercises are geared towards building up the ability to get into some form of a lunge, typically with upper limb support such as leaning on a bench or a chair. The ability to regain that function will depend on what conditions the client is living with and how much strength they need to rebuild, but many of our clients are able to regain that strength. For example, one of our clients was 98 years old with a history of multiple falls. In addition, she had experienced a long lie on the floor after falling and not being able to get up until a family member could arrive at the house.
Over 12 to 16 weeks, we were able to build her ability to hold onto a chair, lunge down, lower down onto the floor, and then get herself all the way back into a standing position. These significant improvements mean that if she does have a fall in the future, she is able to get herself back up independently. This function also led to her having the confidence to tend to her garden again, hang her washing on the line and stand up in the shower whilst showering. These sound like simple functions, but when you have not been able to do them, regaining the ability is life changing. What an inspiration!
Do you work with any falls clinics or community rehabilitation centres?
Community Therapy partners with a home care package and CHSP providers. With these partners, we run programs delivering falls-specific training, which takes place either individually or in groups.