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2015: Identifying and Mitigating Fall Risk in the Home Environment for Seniors-Nelson

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Identifying and Mitigating Fall Risk in the Home Environment for Seniors

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2015: Identifying and Mitigating Fall Risk in the Home Environment for Seniors-Nelson

  1. 1. Jeremy D. Nelson MPT Physical Therapist www.structuredmotion.com Identifying and Mitigating Fall Risk in the Home Environment for Seniors
  2. 2. Objectives for Discussion  Identify the common causes of falls and interventions to reduce risk in each part of a typical home  Discuss decreasing fall risk to promote Aging in Place  Review common field tests to decrease fall risk  Discuss interventions to improve patient stability and mobility
  3. 3. What causes falls – External Demands and Internal Capacity  Interaction between person and environment  COG within BOS  Multiple systems interact to maintain this relationship over varying external demands  Sensation  Mobility  Stability  Vestibular input  Vision  As we move, BOS changes shape  Seated  Double Limb Support  Symmetrical  Asymmetrical  Single Limb Supported  Can the neuromuscular system coordinate muscle timing to keep the COG in BOS  Physical capacity must meet or exceed the demands of the environment in terms of attenuating forces, timing, control.
  4. 4. Universal Design & Aging in Place  Universal Design - AKA Barrier Free Design  Supported by ADA  “Matching the environment to minimize imposed demands”  In Senior population meant to provide a safe environment for the progressive decline in function associated with aging.  Seeks to provide surfaces at heights most efficient for human function.  “Aging In Place”  Trend for modifying currently owned residence to compensate for changes in physical capacity.
  5. 5. Age Related Changes - Internal Mithal A, Bonjour J-P, Boonen S, Burckhardt P, Degens H, El Hajj Fuleihan G, Josse R, Lips P, Morales Torres J, Rizzoli R, Yoshimura N, Wahl D.A., Cooper C, Dawson-Hughes B(2011) Impact of nutrition on muscle strength and performance in older adults. Osteoporosis International
  6. 6. The At Risk Senior  Person  Gait Unsteady  Shuffling gait  Poor weight shifting during double limb support  Trendelenburg sign in single limb support  Dizziness  c/o room spinning when head turns, turning in bed  Orientation  Intermittent disorientation more likely to increase falls  Weakness  Neurologic, sarcopenia related, hypoglycemia  Poor Posture – Posterior COG  L/S lordosis  T/S Kyphosis  C/S Forward head posture
  7. 7. Diagnosis Associated with Increased Fall Risk – Home Modifications  Neurological  CVA, Dementia – Creating Safe Passages  Orthopedic  OA, DDD, RA, THA, TKA (Impaired mobility/stability)  Changing heights of furniture/ Bathroom to promote Sit to Stand  Metabolic  DM, (Insulin OD, hypoglycemia, Peripherial Neuropathy)  Changing from Plush Carpet to hardwoor, low ply carpet, linelum surfaces  Cardiac  HTN,CHF, CAD, MI ( Medications, OH)  Changing Environment to promote energy conservation  Pulmonary  COPD, PE (Medications, OH)  Changing Envinronment to promote energy conservation
  8. 8. Increased Environmental Demands What are the demands imposed by the patients environment?  Unlit areas  Obstacles  Uneven Surfaces  Slippery Surfaces  Distracting Areas  Changes in environment can decrease the disability threshold. Senior Assessment of their Environment - CDC
  9. 9. Match or Mismatch?  Functional Reserve (FR) vs. Environmental Demands  Mrs. J – Uses walker, Unable to Sit to Stand without UE  FR Adequate on even surfaces - MATCH  Tile surfaces in kitchen  Bathroom linoleum surface  FR inadequate on Uneven surfaces - MISMATCH  Plush carpeting in hallway  Bedroom
  10. 10. Into Out of Home
  11. 11. Kitchen
  12. 12. Bathroom
  13. 13. Bed Room
  14. 14. Stairs
  15. 15. Equipment  2+ Hand Touch  2 Hand Touch
  16. 16.  1 ½ Hand Touch  1 Hand Touch
  17. 17. Research  A Multifactorial Intervention To Reduce The Risk Of Falling Among Elderly People Living In The Community. (Tinetti, Mary E.; Baker, Dorothy I.; McAvay, Gail; Claus, Elizabeth B.; Garrett, Patricia; Gottschalk,  Margaret; Koch, Marie L.; Trainor, Kathryn; Horwitz, Ralph I.) NewEngland Jounal of Medecine Volume 331(13) 29 Sep 1994 pp 821-827  A Randomized, Controlled Trial of Fall Prevention Programs and Quality of Life in Older Fallers  A Review of Balance Instruments for Older Adults; Susan L. Whitney, Janet L. Poole, Stephen P. Cass September 1998, Volume 52, Number 8  Aging, muscle activity, and balance control: physiologic changes associated with balance impairment  Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers
  18. 18. Resources  http://agingresearch.buffalo.edu/hssat/  AARP  CDC  APTA  http://sandiego.networkofcare.org/content/client/4 /Home-Modification-Program-Home- Safety2013.pdf

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