Home | About | Events | Contact | Advisory Board | Writer’s Guidelines | Reprints | Organizations | Advertising
January/February 2021
Easy Does It An Occupational Therapy–Based Fall Prevention Program Falls are one of the leading causes of injury in community-dwelling older adults. These incidents can have potentially serious consequences and contribute significantly to morbidity and mortality rates for this cohort.1 As this population continues to grow, fall-related injuries will have an increasing impact on the US health care system. Many normal physiologic changes associated with aging contribute to increased fall risk; these include changes in vision, cognition, balance, muscle strength, flexibility, and proprioception.2 While the normal process of aging cannot be avoided, targeted interventions provided through fall prevention programs can mitigate some of the factors that contribute to fall risk. The Occupational Therapy Approach Fall Prevention Strategies The mind-body component of yoga provides this modality with the potential to be more therapeutic than traditional forms of exercise. When the mind is focused on what the body is doing and feeling, one's sense of proprioception increases along with body awareness.5 A study of yoga’s effect on falls found the frequency of falls to be reduced significantly after yoga intervention.6 Tai chi is a traditional practice consisting of slow weight-shifting movements that require an increased level of concentration and attention; this practice is associated with feelings of physical and psychological relaxation that facilitate resilience in stressful situations.7 Evidence supports the use of tai chi as an effective modality in reducing falls in older adults through the improvement of balance-control and flexibility.8 The Feldenkrais Method is another practice that ties together the concept of body awareness through the use of gentle movement and directed attention. Research into the practice has demonstrated a significant decrease in fear of falling and increase in balance and mobility offsetting age-related declines in movement in the older adult population.9 This practice aims to discover efficient movement patterns and to generalize these to everyday life. In addition to physical modalities, various environmental and behavioral interventions have been studied as a means of reducing falls. Behavioral interventions are centered around client education. Common topics include footwear risk, orthostatic hypotension, and energy conservation strategies.10 Clients are educated about modifying their behavior (eg, rushing to the phone or bathroom) and are encouraged to be less impulsive and to make transitional movements such as going from sitting to standing more slowly to minimize fall risk. Environmental interventions include home assessments that address hazards such as poorly placed electrical cords, loose stair rails, and cluttered walkways. Assistive devices may also be introduced, particularly equipment in the bathroom such as grab bars and nonskid mats. The combination of physical, behavioral, and environmental strategies empowers older adults to take an active role in their safety at home and in the community. The Easy Does It Fall Prevention Program Emerging Trends For one Likert scale, participants were asked to identify two functional activities influenced by their fear of falling and rate their performance and satisfaction before and after the program. The average post score was higher than the average pre score for all participants when analyzing these results. Additionally, at the end of each session participants rated their overall sense of body awareness, including their sense of stability while standing, walking, and reaching. Their responses indicated improvements in awareness and stability over the course of the program. Qualitative data collected through participant interviews proved successful in highlighting the physical, behavioral, and environmental domains addressed by the program, with multiple participants discussing changes that fall within these parameters. Participants described experiencing physical changes as a result of program participation. Some examples of these changes include an increase in range of motion, strength, and overall flexibility. Participants expressed being more aware of their bodies after participating in the program, acknowledging a behavioral change. They implemented techniques such as standing with their knees a little bent, or “soft,” and used more of their body rather than one isolated area to engage in functional activities. According to one participant, “[When] reaching for the canister, I don't just reach with my arm; I turn my body and I reach with both hands.” Another emphasized awareness of her knees, saying, “I’m more aware of what I’m doing, like I’m really remembering my knees, ’cause I didn’t realize I was locking them.” A member of the program explained that she had a tendency to walk fast, however, after the program she became more cautious of controlling her speed while walking, thus becoming more aware of her foot placement against the floor. Participants also noticed a difference in the way that they sit since participating in the program. One participant stated that she is mindful not to “plop” into her seat when traveling on the bus. Change is difficult. It unsettles engrained habits, which can impede compliance. This is a key challenge all health professionals face when recommending lifestyle changes. To address this issue, participants were asked during the first session to clasp their hands and notice which index finger was on top, the right or left. Next, without looking, everyone was asked to clasp their hands again, but this time change the grasp, so opposite index finger was on top. This hand clasp took more time as participants had to think about the movement and to most it felt unnatural. Some could not do it. This experience illustrated that change, although initially unsettling, is possible and that with time, this new way will feel familiar and right. Whenever someone in the group became frustrated or stuck, someone would say, “Remember the hand clasp.” The participant would smile, and the group continued. The ideas shared in this article can easily be adapted to ongoing fall prevention programs. The key components are: 1) regardless of the physical exercises, relate the movements, when possible, to everyday activities; 2) provide a home safety checklist with a follow-up discussion on what people have discovered; 3) during breaks, talk about strategies for modifying behaviors that get us into trouble, such as rushing to pick up the phone or standing on rickety stools; and 4) have participants identify two activities that have been negatively influenced by their fear of falling. After a set period of time, have them reassess their level of confidence while engaging in those activities. Conclusion Advocacy for the connection between movement and function, well understood by occupational therapists, can support the safety and well-being of community-dwelling older adults and reduce their risk of falls. The involvement and collaboration of various health care providers with occupational therapists is integral to a complete fall prevention initiative. Providers who work with this population and wish to support their safety and well-being can implement the principles of the Easy Does It Program within their own fall prevention initiatives. — Richard Sabel, MA, MPH, OTR, GCFP, is a clinical assistant professor at SUNY Downstate Medical Center’s Occupational Therapy Program and the educational director of East West Rehab. — Katherine D. Balton, BA, OTS, CYT, is a certified yoga instructor and occupational therapy student at SUNY Downstate Medical Center's Occupational Therapy Program. She looks forward to working with both adults and children as a licensed occupational therapist in the near future. — Krista Rozas has a BA in psychology and is an occupational therapy student at SUNY Downstate Medical Center's Occupational Therapy Program. — Isaura Reyes has a BA in psychology and is an occupational therapy student at SUNY Downstate Medical Center's Occupational Therapy Program. — Brooke Serebryansky has a BS in nutrition and exercise science and is an occupational therapy student at SUNY Downstate Medical Center's Occupational Therapy Program.
References 3. Gawande A. Being Mortal: Medicine and What Matters in the End. New York, NY: Metropolitan Books; 2014:37-42. 4. Occupational therapy and prevention of falls. American Occupational Therapy Association website. https://www.aota.org/About-Occupational-Therapy/Professionals/PA/Facts/Fall-Prevention.aspx. Published 2017. Accessed April 22, 2020. 5. Schmid AA, Van Puymbroeck M, Koceja DM. Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study. Arch Phys Med Rehabil. 2010;91(4):576-583. |
