Staying Happy on Your Feet

1. Tina Young, MSOT, OTR/L OOTA Older Adult MSG March 2012, Cleveland District Staying Happy on Your Feet

2. Objectives • Review of Balance tests to assess fall risk • Provide treatment strategies for Balance-client specific • Provide treatment strategies for Fall Prevention- client and community education • Educate on Ohio Older Adults Falls Prevention Coalition: OIPP

3. A fall is defined as “an unintentional change in position resulting in coming to rest on the ground or at a lower level” -J. Wells

4. Falls and loss of balance are symptoms of some underlying problem M.Robinson Falls Are Not a Normal Part of the Aging Process

5. Facts about Falls and Older Ohioans 30% age 65 and older living in the community fall each year Falls are the leading cause of injury-related deaths and the most common cause of nonfatal injuries and admissions An older adult falls in Ohio every 2.5 minutes on average, resulting in two deaths each day, two hospitalizations each hour Ohioans age 65 and older make up 13.7% of population and account for >80% of fatal falls

6. Facts about Falls and Older Ohioans Fatal fall rates increased 125% from 2000 to 2009 Most fractures among older adults are caused by falls Risk of falling increases significantly after age 75 Falls account for more than 90% of all accidental hip fractures 1 in 3 older Ohioans' fall leads to injuries that resulted in a doctor visit or restricted activity

7. Ohio Injury Prevention PartnershipOIPPOlder Adults Falls Prevention Coalition Mission Website review Resources My role Fall Prevention Day-what you can do Facts and Statistics

8. Ohio Injury Prevention PartnershipOIPPOlder Adults Falls Prevention Coalition http://www.ohiopha.org/Tabs/Publications/OPHAProjectDetails.aspx?DID=158

9. FALLS_2011_Symposium1-0711Beeghly.pdf

10. OIPP Falls Coalition 2011 Factsheet Falls Among Older Adults in Ohio[1].ppdf

11. AGS_06_falls_general_information[1].pdf

12. Aging Well, Winter 08 • Safety of Seniors Act of 2007 passed authorizing new programs to help prevent falls through public education, research and safety demonstrations • Falls don’t discriminate • 3 times more likely to fall again if fallen • Multiple medication usage and frailty are the next most common causes of falls

13. Falling and being homebound are associated with: Increased mortality Increased depression Increased morbidity Increased helplessness Reduced function Decreased confidence Premature nursing home admissions Journal of the American Geriatric Society, J. wells; OT Practice 2003/ California Journal 2008

14. Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997). 9 Joe wells • Fear leads to decreased activity and increased sedentary lifestyle therefore increases fall risk (AJOT, 2004)

15. Fall Risk Assessment • Proactive Fall Interventions • Patient and Caregiver Education • Evaluation of Fall Prevention Program - HHQI Best Practice: Fall Prevention Program17, J. Wells

16. Identify risk factors • Pertinent medical/ fall history • Medication review • Assessments: • E.g.: Berg’s Balance Test, Timed-Up-Go • Orthostatic Hypotension • Body structures • Body Functions • Home Environmental Safety • Support system J. Wells

17. Environment Lighting Visual Cognition Somato-sensory Postural Control Vestibular Restraints Musculo skeletal

18. Age Related Changes that Affect Balance and Falls= Natural Risk Factors • Vision-acuity, depth perception, visual fields • Hearing • Strength/flexibility • Bone density • Posture

19. Age Related Changes that Affect Balance and Falls= Natural Risk Factors • Velocity/speed/reaction time • Dual tasks • Proprioception • Chronic diseases and medical complications

20. Fall Risk Factors • Age (>65 years and increase >75/85) • Female gender • Past history of a fall and/or hip fracture • Weakness in lower extremities • Foot disorders (bunions, ulcerations, toe or nail problems) and footwear

21. Fall Risk Factors • Hearing or vision loss (4) • Incontinence • Restraints • Faulty equipment or needing equipment • Altered/impaired Cognition and dementia • Balance problems

22. Fall Risk Factors • Blood pressure • Low vitamin D levels • Poly-pharmacy- over 4 medications, Tylenol pm • Arthritis, Osteoporosis, Frailty • Parkinson’s disease, TBI, CVA, Alzheimer's • Chronic pain, foot pain • Behaviors as a result of a fall, depression

23. Client Identified Fall Risk Factors • Hurrying • Carelessness • Inattention AJOT 2003

24. Extrinsic Factors • Uncontained Incontinence • Physical Restraint • Environmental Obstacles • Poor lighting • Faulty equipment • Type of Footwear M.Robinson

25. Intrinsic Factors • Medication Side Effects and Interactions • Visual impairment • Vestibular dysfunction • Somatosensory deficit • Musculoskeletal deficit • Orthostatic Hypotension • Cognition • Behavioral M. Robinson

26. Typical OT Evaluation • Functional Mobility, transfers • ADL’s • ROM and Strength (functional-lifting, carrying) • Sensation • Vision • Balance and posture-where are head and eyes • IADL’s • Cognition

27. Gericareonline.net_Falls_Tool_5_Story_of_Your_Falls[1].pdf

28. Falls & Allen - GSISJUNE05.pdf

29. EBP Standardized Balance Tests • Functional Reach • Timed Up & Go • Gait Speed • Berg Balance Test • Tinetti • Modified Clinical Test for Sensory Interaction in Balance (CTSIB) • 30 sec Chair Stand and Arm Curl

30. The TUG was found to have : • 87% sensitivity for predicting falls with a score >14 seconds • It was also found that measurement of mobility under multi-task conditions was not a better indicator for the likelihood of falls. -Shumway-Cook et al. (2000)18 • The Berg Balance Test: 83% of subjects were correctly identified as fallers (the gold standard) based upon the dichotomous rule to classify fallers at a cut-off point of <40 (BBT Score). -Riddle & Stratford (1999)19 J. Wells

31. Fall Prevention Assessment TUG 1107.pdf

32. Gericareonline.net_Falls_Tool_2_Get_Up_and_Go_Test[1].pdf

33. Home Safety Evaluation • Reduce Safety Hazards- E.g.: Throw rugs, lighting, pets, oxygen tubing, clutter, extension cords, etc. • Medication management • Cardiac status: Orthostatic hypotension, arrhythmias • Bowel/ bladder habit and management • Proper footwear • Nutrition/ hydration status- need for referral • Physical Therapy and/ or Occupational Therapy J. Wells

34. Medication Review and Education • Client example • ACP example • CDC example • Common side effects: dizziness, drowsiness, decreased balance • Treatment suggestion: look up meds

35. AGS_14_put_your_best_foot_forward[1].pdf

36. Treatment for a Client’s Fall Prevention • AE/DME • Modify ADLs/IADLs (foot wear, scanning) • Modify environment (contrast, grab bars, cell phone) • ECT • Life Alert, emergency numbers

37. Treatment for a Client’s Fall Prevention • Home Assessments: Housing Enabler Safe at Home Westmead ROTE SAFER Home v3 GEM HOMEFAST Cougar Rebuilding Together CASPAR

38. Double sided tape Organization Accessible switches Nonskid Bathmats TTB/shower chair Handheld shower Non adhesive strips Roll in shower Loops and Lever handles RTS Home Assessment/checklists • Common items: Lighting-florescent, glare Contrasts Foot wear Throw rugs Cords Clutter Nightlights Handrails No bare feet

39. Home AssessmentTool SS0610.xls

40. Home Safety Checklist Clermont County 2008.xls

41. Home AssessmentTool SS0610.xls

42. Age in Place/Universal Design • NAHB- 3 day program • RT- Rebuilding Together • OTs give recs on assistive products, identify resources, evaluate safe use • CAPS (Certified Aging in Place Specialists) have relationship with contractors, assist with visitability OT Practice 2009

43. CAPS Pullout shelves Flat panel light switches Counter heights Wide doors/hallways Chair lifts Remodel bathroom Ramps Flooring Home alarm systems, exit door bells Age in Place/Universal Design • Common sense Increase lighting Remove objects/cords/clutter Grab bars Nonslip mats and footwear Reduce glare Night light Increase contrast

44. Age in Place/Universal Design • Barriers: Personal items in home are meaningful, perspectives Finances/Costs Adherence to recommendations (80%noncompliance) Safety + aesthetics +client goal + OT goal

45. Treatment for a Client’s Balance EXERCISE !!!! Standing-on one foot and two Stand in corner and move shoulders/hips Fixate on object with eyes and move head in different directions (saccades and pursuits), walk and turn head Extension!!!!!

46. Treatment for a Client’s Balance Walk heel to toe, walk on toes, walk on heels Walk backwards, walk sideways on stairs Stand up and sit down without hands Focus on LE, Core, Triceps UE- scapular retraction, rowing

47. Treatment for a Client’s Balance • Improve flexibility-stretching, Tai Chi, Yoga • Deep breathing • Floor transfers • Improve posture • Cognition under 4.4 ACL- no DME • Medication review-4+ meds, side effects • Vision screening

48. Treatment for a Client’s Balance • Obstacle courses • Joint mobilizations to the spine • Dancing • Do ADLs on one foot • Begin walking programs • Electrical stimulation • Consider DME/AE-hip protectors, walkers, canes, etc

49. Treatment for a Client’s Balance • Aquatic programs • Strategies-ankle, hip, step • Eyes open and closed • Reaching/bending/weight shifts/lifting/carrying • Balls/BAPS board

50. Treatment for a Client’s Balance • Do things during balance exercises: Add music Change surface-unlevel Change footwear Adjust lighting-include low lighting Do math Categorize Name items with letter i.e. “b”