Falls in the long term care setting account for nearly 25% of hospitalizations of the elderly and 40% of all nursing home admissions. Declining strength, cognition, balance and poor safety awareness related disease processes can negatively impact a resident’s ability to perform functional transfers, ambulate and independently perform routine tasks of daily living.
For the institutionalized elderly falls are more likely to occur early in the morning or late and night and are often associated with toileting, disorientation, and medication. Falls are not an inevitable consequence of aging. Falls and subsequent injuries among the elderly are the result of the complex interaction between physical changes, disease processes, environment, and social/lifestyle changes.
Physical, Occupational, and Speech therapists are uniquely qualified to address many of the deficits related to increased fall risk and balance problems. Physical Therapy can provide the resident with a balance/gait assessment to determine fall risk, such as the Tinetti Mobility Scale, which contains both Balance and Gait performance components or Berg Balance Scale. In addition, the Physical Therapist will assess the resident for abnormal gait, decreased mobility, transfers, strength and endurance.
Occupational Therapy can assess the resident’s ability to perform self-care activities safely, including the need for adaptive devices. Occupational therapy also assesses seating and postural stability related to functional tasks, reflex integrity and fine and gross motor coordination skills. Home and/or environmental assessments may be performed by both Occupational and Physical Therapy to detect barriers to safety.
Speech Therapy can assess for cognitive deficits that negatively impact safety awareness including the ability of the resident to follow task instructions, memory and ability to recall safety strategies as well as attention to task and problem solving. Speech Therapy can teach the resident compensatory strategies and techniques to compensate for these losses.
Communication at all levels of care is crucial. Fall prevention requires an interdisciplinary team approach in order to ensure that interventions are used consistently by all members of the health care team to prevent falls with injury.