Falls Risk Reduction And Prevention Physical therapists can use this Power Point to provide live educational sessions for Seniors or individuals who may be at risk for falls within the community. * 1 The American Geriatrics Society. AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons (2010). http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/ What Is a Fall?An event whereby an individual unexpectedly comes to rest on the ground or another lower level without known loss of consciousness1 * Why Are Falls Important to Me? 1More than 1/3 of adults 65 and older fall each year in the United States. Among older adults, falls cause over 39% of injury deaths, making them the leading cause by a wide margin. In 2007, 18,334 people 65 and older died from injuries related to falls. 1 Centers for Disease Control and Prevention, http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html. * Why Are Falls Important to Me? 1In 2009, 2.2 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 581,000 of these patients were hospitalized. By 2020, the cost of fall injuries is expected to reach $54.9 billion (in 2007 dollars). 1 Centers for Disease Control and Prevention, http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html. * Why Are Falls Important to Me?120% to 30% of people who fall suffer moderate-to-severe injuries such as bruises, hip fractures, or head traumas. Fall injuries can limit mobility and independent living, and can increase the risk of early death. Every hour, there are 2 deaths and 251 emergency department visits for falls-related injuries among older adults. . 1 Centers for Disease Control and Prevention,http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html. * What Are the Risk Factors For Falling? Research shows that a combined effect of many interacting factors increases fall risk.2 Difficulty With Walking/Balance Multiple Medications Dizziness Muscle Weakness Foot Problems Heart Rate/ Rhythm Problem History of Falls Vision Problems 2Panel on Prevention of Falls in Older Persons. Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. American Geriatrics Society/British Geriatric Society. http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010. * Am I at Risk for Falling As I Age? Falling and fear of falling as you age should NOT be accepted as a “normal” process of aging. The causes of falls can be found and addressed. * Am I at Risk for Falling As I Age? There are certain changes that may cause people to fall:Less flexibility in the lower extremity jointsDecreased muscle strength around the ankles, knees, and hipsSlower walking speed ...

1. Falls Risk Reduction
And Prevention
Physical therapists can use this Power Point to provide live
educational sessions for Seniors or individuals who may be at
risk for falls within the community.
*
1 The American Geriatrics Society. AGS/BGS Clinical Practice
Guideline: Prevention of Falls in Older Persons (2010).
http://www.americangeriatrics.org/health_care_professionals/cli
nical_practice/clinical_guidelines_recommendations/2010/
What Is a Fall?An event whereby an individual unexpectedly
comes to rest on the ground or another lower level without
known loss of consciousness1
*

2. Why Are Falls Important to Me? 1More than 1/3 of adults 65
and older fall each year in the United States. Among older
adults, falls cause over 39% of injury deaths, making them the
leading cause by a wide margin. In 2007, 18,334 people 65 and
older died from injuries related to falls.
1 Centers for Disease Control and Prevention,
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls
.html.
*
Why Are Falls Important to Me? 1In 2009, 2.2 million people
65 and older were treated in emergency departments for
nonfatal injuries from falls, and more than 581,000 of these
patients were hospitalized. By 2020, the cost of fall injuries is
expected to reach $54.9 billion (in 2007 dollars).
1 Centers for Disease Control and Prevention,
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls
.html.
*
Why Are Falls Important to Me?120% to 30% of people who

3. fall suffer moderate-to-severe injuries such as bruises, hip
fractures, or head traumas. Fall injuries can limit mobility and
independent living, and can increase the risk of early death.
Every hour, there are 2 deaths and 251 emergency department
visits for falls-related injuries among older adults.
.
1 Centers for Disease Control and
Prevention,http://www.cdc.gov/HomeandRecreationalSafety/Fal
ls/adultfalls.html.
*
What Are the Risk Factors
For Falling?
Research shows that a combined effect of many interacting
factors increases fall risk.2
Difficulty With Walking/Balance
Multiple
Medications
Dizziness
Muscle
Weakness

4. Foot Problems
Heart Rate/ Rhythm Problem
History of
Falls
Vision
Problems
2Panel on Prevention of Falls in Older Persons. Summary of the
Updated American Geriatrics Society/British Geriatrics Society
Clinical Practice Guideline for Prevention of Falls in Older
Persons. American Geriatrics Society/British Geriatric Society.
http://www.americangeriatrics.org/health_care_professionals/cli
nical_practice/clinical_guidelines_recommendations/2010.
*
Am I at Risk for Falling
As I Age?
Falling and fear of falling as you age should NOT be accepted
as a “normal” process of aging.
The causes of falls can be found and addressed.
*

5. Am I at Risk for Falling
As I Age?
There are certain changes that may cause people to fall:Less
flexibility in the lower extremity jointsDecreased muscle
strength around the ankles, knees, and hipsSlower walking
speed, tendency to take smaller steps
*
Am I at Risk for Falling
As I Age?
There are certain changes that may cause people to fall
(cont’d):Decreased balance Less coordinationDecreased
reflexes and longer reaction timeChanges in vision and
sensation Decreased activity
*
Is a lasting concern about falling that can lead to an individual

6. avoiding activities that he/she remains capable of performing3
Is a serious and widespread problem among older adults
3Tinetti M, Powell L. Fear of falling and low self-efficacy: a
case of dependence in elderly persons. J Gerontol. 1993;48:35-
38.
Fear of Falling …
Am I at Risk for Falling
As I Age?
*
Can restrict a person’s normal activities causing less
independence
Includes these risk factors: Fair/poor perceived health, feeling
unsteady, having 2 or more falls4
4Lach HW. Incidence and risk factors for developing fear of
falling in older adults. Public Health Nurs. 2005;22:45-52.
Fear of Falling …
Am I at Risk for Falling
As I Age?
*

7. Am I at Risk for Falling
As I Age?
Certain medical conditions may increase the risk of falling as
you age:
Diabetes (peripheral neuropathy, visual & sensation changes)
Arthritis
Osteoporosis (changes in posture, increased risk of fracture with
fall)
Stroke
Cardiovascular conditions (irregular heart rate, dizziness when
standing (orthostatic hypotension)
Neurological diseases (Parkinson)
Others
*
What Else Can Cause Me to be at Risk for a Fall?
Intrinsic Factors: These are factors are internal and specific to
the individual.
Extrinsic Factors: These factors are external to the individual.
Often, a fall is a result of the interaction between the intrinsic
and extrinsic factors.
*

8. What Else Can Cause Me to be at Risk for a Fall?
Lower extremity weakness
Previous falls
Gait & balance disorders
Decline in vision
Depression
Functional & cognitive impairment
Dizziness
Low body mass index
Urinary incontinence
Female sex
Being over age 80
Taking over 4 prescription medications
Stairs
Clutter
Wet surfaces
Loose rugs/carpets
Cords
Poor lighting
Hurrying/rushing
Intrinsic Factors
Extrinsic Factors
AGS/BGS Clinical Practice Guideline:
Prevention of Falls in Older Persons (2010).
http://www.americangeriatrics.org/health_care_professionals/cli
nical_practice/clinical_guidelines_recommendations/2010/
*

9. Extrinsic Factors
The home is the PRIMARY location for non-fatal unintentional
falls.
The home is defined as the
inside of the home and the outside areas immediately
surrounding the home. The outside environment can pose
several major safety hazards such as stairs with no handrails
and uneven pathways.
*
How do I Find Out My
Risk for Falls?
To assess your fall risk, you should see a physical therapist for
a fall risk assessment.
The physical therapist will take a thorough history, perform
tests and measures, and provide you with interventions to
reduce your risk for falling.
To find a physical therapist in your area go to:
www.apta.org/findapt.

10. *
What Is My Risk for Falls?
Here is a quick test:If you are unable to balance 5 seconds on
one leg you are at risk for INJURIOUS falls.Goal is 30 seconds
for single leg stance.
Do not attempt to do this test alone—make sure that you have
someone next
to you to decrease the potential risk of falling.
If you have a history of falls, you are at risk.
*
What Can I Do to Decrease
My Risk of Falls?
The most effective program is multi-factorial.
This means using more than one strategy:
*

11. What Can I Do to Decrease
My Risk of Falls?
Successful programs for fall prevention may include:Physical
therapy Exercise EducationMedication management
Environmental modification Other approaches targeted to
individual risk factors that may contribute to falls (such as
impairments in vision, foot problems, continence)
The expertise of many health professionals may be involved in
your fall prevention program.
*
Physical Therapy
A physical therapist will:Conduct an examination and
evaluation for fall riskDesign an individual plan of care to
address:StrengthMobilityBalance Posture GaitComplete a
home assessment for safety to:Eliminate hazards Recommend
safety equipment and task re-designRecommend structural
changes
Flexibility Appropriate footwear Need for assistive devices
Pain Function/ADL
*

12. Exercise to Prevent Falls
Benefits:Reduce fear of fallingImprove flexibility, strength,
enduranceImprove cardiovascular healthHelp decrease
depressionReduce sleep disorders
*
Exercise to Prevent FallsHave sufficient intensity to improve
muscle strengthAre regular and sustainableInclude dynamic
balance activitiesCan be done at home or at a center/clinicCan
be group or individual programsAre simple and low cost
Characteristics of successful programs:
*
Exercise and ProgramsWalking programTai ChiYogaAerobic
exercisesBowling, dancing, gardening
Examples:

13. *
Exercise and ProgramsTai Chi Moving for Better Balance
Stepping On Otago Exercise Program
Specific Program Examples:
*
Balance Exercises
Hand support
No hand support
Eyes closed
Unstable surface
Progression:
Hand support
No hand support
*

14. Sample Balance Exercises
The following slides are examples of balance exercises that
your physical therapist may prescribe. Do not begin any
exercise program without consulting with your physical
therapist.
Do not attempt to do the exercises alone—make sure that you
have someone next to you to decrease the potential risk of
falling.
Note: Information is provided for informational purposes only
and is not a substitute for professional advice. You should seek
the advice of a health care professional in all matters relating to
your health.
*
Sample Balance Exercises
Stand straight; hold onto a sturdy table or chair for balance.
Slowly stand on tip toe, as high as possible.
Hold position for 1 second.
Slowly lower heels all the way back down. Pause.
Repeat 10 to 15 times.
Heel Rises
*

15. Sample Balance Exercises
Stand straight; hold onto a sturdy table or chair for balance.
Slowly bend your right knee toward your chest—do not bend at
the waist.
Hold position for 1 second.
Slowly lower the leg all the way back down. Pause.
Repeat with the left leg.
Alternate legs so you have repeated 10 to 15 times on each leg.
Hip Bending
*
Sample Balance Exercises
Stand straight, feet slightly apart; hold onto a sturdy table or
chair for balance.
Slowly lift your right leg straight out to the side—keep your
back straight and your toes pointing forward.
Hold position for 1 second.
Slowly lower the leg all the way back down. Pause.
Repeat with the left leg.
Alternate legs so you have repeated 10 to 15 times on each leg.
Side Leg Raise
*

16. Sample Balance Exercises
Stand up and sit down from a chair without using your hands
and keeping your back straight.
Stand on 1 leg while waiting in line (you can use a counter or
other stable object for balance).
Exercises you can do anywhere
*
Education
Risk factors for fallsFall preventionFall injury
reductionMedication managementHome safetyPhysical activity
Can include education on:
*
Medication Management
Review your drugs with every health care provider.Always
carry a list of your medications.Remember to take your
medications as prescribed.Do not share medications.Know the
common side effects/“red flag” symptoms.Ask to be prescribed

17. the lowest dose possible.Consult your physician prior to taking
any herbal or over the counter medications.
*
Environmental Modifications
Includes physical changes:To the place where you liveTo your
vehicleTo your workplace
Environmental modifications
help you to live with greater independence and safety.
*
Environmental Modifications
Protect all stairs and steps with a secure banister or hand-rail on
both sides and keep them clear of clutter.Use the highest safe
wattage in light fixtures. Nightlights can help light the way
during night-time hours.
*

18. Environmental Modifications
Use a non-slip mat, or install adhesive safety strips or decals in
bathtubs and showers. Install grab bars in bath and shower
stalls. Choose a latex-backed bath mat to avoid slipping when
getting out of the tub and shower.
*
What Can I Do to Reduce the Impact of Extrinsic Factors?
Do a home safety check:To find and fix hazardsTo remove
clutter
*
Extrinsic Hazards That Can Be Modified
HazardModificationIs there clutter on the floor?
Remove clutter from walkways; keep floors, stairs, and
pathways clearIs there liquid or food on the floor?Sweep often;
wipe up spills immediatelyAre there throw rugs in
walkways?Remove or secure unsecured rugsDo you have to

19. walk over or around electrical cords or wires?Tape cords and
wires to the wall; keep cords hidden and away from walking
areasIs lighting inadequate?Keep rooms well lit, change burned-
out bulbs, keep flashlights handyAre stools/chairs
unstable?Discard or fix wobbly chairsAre there stairs, or
hazardous steps or curbs?Avoid, fix, use handrails, and keep
well lit
*
Keep Your Bathroom Falls Free
Add grab bars in the shower, tub, and toilet areas.Use nonslip
adhesive strips or a rubber mat inside and outside the
shower/tub.Sit on a shower bench or chair in the shower/tub.Use
an elevated toilet seat.
*

20. What Do I Do if I Fall?
You should always have a plan to get help in case of an
emergency. If you fall:
Stay calm: If you are hurt, put your emergency plan into place.
If you are not hurt badly, you can begin to get up from the fall.
First, roll onto your side.
Next, find a sturdy piece of furniture (chair, kitchen table,
countertop)
and crawl or roll over to it.
*
What Do I Do if I Fall?
Then, from a kneeling position, put your arms up onto the stable
surface.
Finally, put one foot flat on
the floor and push up into
the stable surface.
Sit down and rest.

21. *
What Can I Do to Prevent Falls?Exercise regularly.Review your
medications with your health care provider or pharmacist.Have
your vision and hearing checked.Correct common home safety
hazards.
*
Special Thanks to:Kathryn Brewer, PT, GCS, MEd,
CEEAARoberta Newton, PT, PhD, FGSA, FAPTAJudy Daniel,
PT, MS, GCSCathy Cioleck, PT, DPT, GCS
For their expertise, generous support, and dedication to falls
prevention.
*
Resources
The American Physical Therapy Association:
http://www.moveforwardpt.com/

22. Centers for Disease Control and Prevention:
http://www.cdc.gov/Homeandrecreationalsafety/Falls/adultfalls.
html/
Home Safety Council:
http://www.homesafetycouncil.org/SafeSeniors/sen_safeseniors
_w001.asp
*
Resources
Center for Healthy Aging:
http://www.healthyagingprograms.com/content.asp?sectionid=1
07
National Council on Aging: http://www.ncoa.org/
National Safety Council:
http://www.nsc.org/safety_home/Resources/Pages/Falls.aspx
The National Blueprint: http://www.agingblueprint.org/tips.cfm
*
PHT1251C PATIENT CARE PROCEDURES
STUDENT NAME:_____________________________________
DATE:__________

23. HOME ASSESSMENT & RESEARCH ASSIGNMENT
Objective:
1. Analyze and interpret evidence-based physical therapy
research to support clinical decision
making. [K] [B]
2. Inspect the physical environment and measure physical
spaces to identify environmental issues.
[K]
Description:
treating the patient at his/her home
and are concerned about the patient’s home environment due to
the patient being at risk for falls.
eo regarding Home Safety Tips:
http://www.moveforwardpt.com/PatientResources/VideoLibrary/
detail/caregivers-home-
safety-tips
3)
http://www.stopfalls.org/files/ProgramExpansion-
HomeAssessmentTool.pdf (Posted on

24. Blackboard in Week 3)
the following:
1. Identification and description of safety concerns (explain and
apply the importance of
inspecting the physical environment for safety)
2. Recommendations of items to be discussed with PT to
address each safety concern with
specific environmental modifications in order to reduce risk for
falls
3. Select ONE research article from a peer-reviewed Physical
Therapy Journal that supports
your recommendation. Suggested key words for your search may
include “physical
therapy best practices for fall prevention at home”, “home
assessment”, “balance”, “fall
prevention”, “risk for falls”, “physical therapy interventions”,
“best practices”,
“environmental interventions”.
a. Suggested journals may include Physical Therapy, Journal of
Geriatric Physical
Therapy, Journal of Orthopedic Physical Therapy, Journal of
Sports Physical

25. Therapy, SPINE, etc.) A research article is not a clinical
commentary or an
editorial review!).
b. Read the article thoroughly.
c. Include in the narrative your analysis and interpretation of
how this research
article is clinically relevant and provides evidence to support
your clinical
decision making/recommendation.
The faculty strongly recommend students to visit the Writing
Studio for paper review prior to
submission.
Submit a paper copy of this assignment with the rubric, as well
as an electronic copy via SafeAssign
on Blackboard by 8AM on due date. If any of these items are
missing, it will be considered late
(Refer to PTA Student Handbook for Policy on late
assignments)
http://www.moveforwardpt.com/PatientResources/VideoLibrary/
detail/caregivers-home-safety-tips
http://www.moveforwardpt.com/PatientResources/VideoLibrary/

26. detail/caregivers-home-safety-tips
http://www.stopfalls.org/files/ProgramExpansion-
HomeAssessmentTool.pdf
HOME ASSESSMENT RUBRIC Score:
____/24
CATEGORY Excellent 4 Good 3 Satisfactory 2 Needs
Improvement 1
Content Includes assessment and
modifications (as
needed) for 6/6 of the
following:
1. Pathways/Entrance
to Home
2. Hallways
3. Stairs and Steps
4. Living Room - Family
Room
5. Bathrooms
6. Bedrooms
Includes client’s
information
Includes assessment and
modifications (as needed)
for 5/6 of the following:
1. Pathways/Entrance
to Home
2. Hallways
3. Stairs and Steps

27. 4. Living Room - Family
Room
5. Bathrooms
6. Bedrooms
Includes client’s
information
Includes assessment
and modifications (as
needed) for 4/6 of the
following:
1. Pathways/Entran
ce to Home
2. Hallways
3. Stairs and Steps
4. Living Room -
Family Room
5. Bathrooms
6. Bedrooms
Includes client’s
information
Includes assessment and
modifications (as needed)
for 3/6 or less of the
following:
1. Pathways/Entrance to
Home
2. Hallways
3. Stairs and Steps

28. 4. Living Room - Family
Room
5. Bathrooms
6. Bedrooms
Does not include client’s
information
Mechanics No (0) grammatical,
spelling, or punctuation
errors. (Typos are
errors.)
Paper is stapled, typed
and clean
Writer makes 1-2 errors in
grammar or spelling.
Paper is not stapled, but
is typed and clean
Writer makes 3-4
errors in grammar,
spelling, or
punctuation.
Paper is typed, but
not stapled and
appears somewhat
dirty.
Many grammatical,
spelling, or punctuation
errors (5 or more).

29. Paper is not stapled,
handwritten and appears
dirty.
Amount of
Information
All topics are addressed
in at least 4 paragraphs
with a minimum of 5
sentences each.
All topics are addressed
in at least 4 paragraphs
with 3-4 sentences each.
All topics are
addressed in at least
3 paragraphs with a
minimum of 5
sentences each.
All topics are addressed in
at least 2 paragraphs with
a minimum of 5 sentences
each.
Organization The information is very
well organized. All
paragraphs include the
information requested
that reflect the use the
student's own words.
The Information is

30. moderately organized.
Most paragraphs include
the information requested
that reflect the student's
own words.
Paragraphs included
related information
but were typically not
constructed well.
Information is
somewhat organized.
Students own words
are used.
Paragraphing structure
and content was not clear
and sentences were not
typically related within the
paragraphs. The
information appears to be
disorganized.
Poor paraphrasing.
Citation All sources of information
are accurately
documented using APA
format without errors.
All sources of information
are accurately
documented using APA

31. format with 1-2 errors.
All sources of
information are
accurately
documented using
APA format with 3-4
errors.
Sources of information are
not documented using
APA format, or using APA
with 5 or more errors.
Evidence
Based
Practice
The paper is supported
by an article published
within the last 5 years in
a peer- reviewed journal.
(Physical Therapy,
JOSPT, PAIN, etc…)
AND No use of
commercial websites
(.com)
May use .edu or .gov
websites in addition to
peer-reviewed articles.
The paper is supported
by an article published
within the last 10 years in
a peer- reviewed journal.

32. (Physical Therapy,
JOSPT, PAIN, etc…)
AND No use of
commercial websites
(.com)
May use .edu or .gov
websites in addition to
peer-reviewed articles.
The paper is
supported by an
article published
within the last 5 years
in a non-peer-
reviewed journal.
The paper is supported by
an article published within
the last 10 years in a non-
peer- reviewed journal.