Prevention of Home & Work Related fall-Injuries: Using a
Transdisciplinary Approach Course Instructor: Dr. Jose R. Rafols
OTD, MHSA, OTR/L, CEAS Dangerous septic tank retrofit, Augusta, GA
Instructors Home Office; Redlands, Miami, FL Slide 2 Prevention of
Home & Work Related fall-Injuries: Using a Transdisciplinary
Approach Conflict of Interest In the effort to comply with
appropriate state boards and professional associations, I declare
that I do not have an affiliation with or financial interest in a
commercial organization that could pose a conflict of interest with
the following presentation: Conflict of Interest In the effort to
comply with appropriate state boards and professional associations,
I declare that I do not have an affiliation with or financial
interest in a commercial organization that could pose a conflict of
interest with the following presentation: Slide 3 Prevention of
Home & Work Related fall-Injuries: Using a Transdisciplinary
Approach Course Objectives 1. Will be able to identify 75% of the
abatement recommendation discussed in the seminar, as well as,
direct clients and family members to the risks factors that lead to
falls at home, per recommendations from the National Center for
Injury Prevention and Control, Atlanta, Georgia. 2. Will be able to
offer six out of eight contemporary off-the-shelve products, such
as, tub-benches, grab bars, motion sensor switches, etc., to
minimize and/or prevent fall-related injuries in and around the
clients home. 3. Will be able to identify three emerging practice
trends in Telehealth, Telemedicine, and medical surveillance to
enhance the home-bound clients ability to gain access to health
care services. 4. Will understand five primary causes of falls and
related injuries among the elderly which impact functional mobility
and independence with ADLs. 5. Will have a superior understanding
of the use of readily available training materials, such as,
handouts, brochures and governmental websites to use adjunctively
to educate clients and care-givers on fall prevention. Course
Objectives 1. Will be able to identify 75% of the abatement
recommendation discussed in the seminar, as well as, direct clients
and family members to the risks factors that lead to falls at home,
per recommendations from the National Center for Injury Prevention
and Control, Atlanta, Georgia. 2. Will be able to offer six out of
eight contemporary off-the-shelve products, such as, tub-benches,
grab bars, motion sensor switches, etc., to minimize and/or prevent
fall-related injuries in and around the clients home. 3. Will be
able to identify three emerging practice trends in Telehealth,
Telemedicine, and medical surveillance to enhance the home-bound
clients ability to gain access to health care services. 4. Will
understand five primary causes of falls and related injuries among
the elderly which impact functional mobility and independence with
ADLs. 5. Will have a superior understanding of the use of readily
available training materials, such as, handouts, brochures and
governmental websites to use adjunctively to educate clients and
care-givers on fall prevention. Slide 4 Prevention of Home &
Work Related fall-Injuries: A Transdisciplinary Approach The
leading causes of falls among Aged Adults Slide 5 Causes of Falls:
I. Decreased Visual Acuity II. Decreased Balance III. Gate
Disturbances IV. Decreased Strength V. Decreased Cardiac Capacity
VI. Decreased Bone Density & OA/DJD VII. Decreased Cognition
VIII. Complication from Co-morbidities IX. Adverse Drug
Interactions X. Fear of Falling XI. Environmental
barriers/obstacles Prevention of Home & Work Related
fall-Injuries: The leading causes of fall among Aged Adults Slide 6
Prevention of Home & Work Related fall-Injuries: The leading
causes of falls among Aged Adults I. Decreased Visual Acuity as
aged adults develop Cataracts, Glaucoma, and require corrective
lenses to see, they may not see obstacles in darkened areas of
their homes. II. Decreased Balance cause aged adults to loose their
balance easily; they also loose their balance due to LE-weakness,
and vestibular irregularities. III. Gait Disturbances are often
caused by poor choice of shoes, use of slick-socks, improper use of
assistive ambulation devises and generalized weakness in LEs. Slide
7 Prevention of Home & Work Related fall-Injuries: The leading
causes of falls among Aged Adults IV. Decreased Visual Acuity
visual impairments rises with age in older adults: From 1.1%
throughout ages 65-to-69 years and this rises to 16.7% at age 80
and above. Nearly 22 Million Americans are diagnosed with
Cataracts. More than 150 million Americans use corrective eye-ware
to compensate for refractive errors (e.g. poor eyesight). Americans
spend more than $15 Billion dollars each year on eye-ware.
Diagnosis- that impact the Visual System due to age related decline
are: Macular Degeneration Glaucoma Diabetic Retinopathy Loss of
peripheral vision Visual acuity & contrast sensitivity Dry Eyes
Reduced Pupil Size Slide 8 Prevention of Home & Work Related
fall-Injuries: The leading causes of falls among Aged Adults IV.
Decreased Cardiac Capacity due to inactivity the aged adults
cardiac vital capacity is impacted; thus, they are unable to engage
in moderate cardiopulmonary exercises. The aged adult may have
trouble performing cleaning chores in & around the house. The
aged adult will have trouble with moderate lifting, bending,
squatting, pushing, pulling tasks at work. The aged adult may have
trouble taking care of a loved one, as a result decreased cardiac
capacity. Slide 9 Prevention of Home & Work Related
fall-Injuries: The leading causes of falls among Aged Adults VI.
(a)Decreased Bone Density as aged adults enter their 5 th, 6 th,
and 7 th decade of life, they lose the rigid supportive framework
within their bones; as the bones become more brittle and less
supportive, they become more susceptible to fractures due to falls.
(*OA-impacts the weight-bearing pillars of the body first; e.g.
hips, knees, ankles, wrists, and shoulders). VI. (b)Osteoarthritis
causes disuse, more so in the morning, and this leads to
inactivity, joint-stiffness, and decreased functional range of
motion and pain. (*OA-impacts the weight-bearing pillars of the
body first; e.g. hips, knees, ankles, wrists, and shoulders). Slide
10 Prevention of Home & Work Related fall-Injuries: The leading
causes of falls among Aged Adults farm-out (e.g. reliable
care-givers) VII. Decreased Cognition aged adults with cognitive
impairments or altered mentation present difficulty in complying
with home- programs. It is best to farm-out these responsibilities
to health care surrogates (e.g. reliable care-givers) who will
insure compliance with HEPs, home-safety, poly-pharmacy and medical
surveillance. Alzheimer's Disease Dementia Parkinsons Disease two
times Aged Adults with mild cognitive impairment are two times more
likely to fall as compared to normal older adults. Slide 11
Prevention of Home & Work Related fall-Injuries: The leading
causes of falls among Aged Adults VIII. Complication from
Co-morbidities (CMs) aged adults presenting with several CMs, such
as, CVA, CHF, DM-II, PVD, or HTN require close medical
surveillance. threemore Co-morbidities red-flag Doctors who manage
these patients report that if their clients present with three (3)
or more Co-morbidities a red-flag should be raised and
Comprehensive Health Care Management should be instituted. Health
Care Providers (HPCs) must coordinate care, poly-drug adherence is
a must, a weekly exercise regime should be incorporated into the
aged adults schedule, and finally, the aged adult must touch-base
with a nurse, PCM or doctor at least once a week. Slide 12
Prevention of Home & Work Related fall-Injuries: The leading
causes of falls among Aged Adults IX. Adverse Drug Interaction aged
adults usually take more than one type of medicine. Key to this
complex issue is that aged adults do not metabolize medication at
the same rate as do younger adults. poly-drug surveillance Current
poly-drug surveillance is hard to implement when patient/clients do
not return to the attending physicians office for routine
check-ups. Education Education on how to properly administer,
safeguard, and store the medication is not always followed. Mixing
of prescription drugs, OTC meds and Herbs & Supplements Mixing
of prescription drugs, OTC meds and Herbs & Supplements without
the attending physicians knowledge can lead to unexpected drug
interactions. Slide 13 Prevention of Home & Work Related
fall-Injuries: The leading causes of falls among Aged Adults X.
Fear of Falling the aged adult is typically cautious when walking
in and around obstacles; they have good reason to: One in three One
in three adults age 65 and older fall each year. Over 95% of hip
fractures Over 95% of hip fractures are caused from falls; the fx
rate for females are three times greater than they are for males
(*Why?). Every 15 seconds every 29 minutes Every 15 seconds, an
older adult is treated in the emergency room for falls & every
29 minutes an older adult dies from fall-related injuries. In the
United States, 16 percent 7 percent In the United States, 16
percent of all Emergency Department visits and almost 7 percent of
all hospitalizations are for fall-related injuries. Slide 14
Prevention of Home & Work Related fall-Injuries: The leading
causes of falls among Aged Adults XI. Environmental barriers the
aged adult is often immersed in a dangerous environment (e.g. home)
that poses great hazards, such as: Slick surfaces Slick surfaces
Uneven surfaces or stairs Uneven surfaces or stairs Darkened
hallways, corridors, entryways, and rooms Darkened hallways,
corridors, entryways, and rooms Clutter filled rooms Clutter filled
rooms Narrow doorways Narrow doorways Lack of hand-rails and
grab-bars for stability Lack of hand-rails and grab-bars for
stability Too much furniture which leads to trip hazards Too much
furniture which leads to trip hazards P3 (pools, patios &
pastures): the exterior of the house P3 (pools, patios &
pastures): the exterior of the house Transitional Spaces
Transitional Spaces Slide 15 Prevention of Home & Work Related
fall-Injuries: Adverse Drug Interactions In the United States $75
Billion Dollars are spent annually on Prescription Medicine (Pham
and Dickman, American Family Physician, 2007) Slide 16 Prevention
of Home & Work Related fall-Injuries: Managing Adverse Drug
Interactions polypharmacy candidate Adverse Drug Interactions the
aged adult who is labeled as a polypharmacy candidate is one that
has several co-morbidities and consumes four or more prescription
medications daily. Providers resort to polypharmacy for symptom
management among patients with complex medical problems. Avoid or
use with extreme caution when administering Digoxin (Lanoxin),
Glyburide (Diabetic Medication), Robaxin (muscle relaxant),
Benzodiazepine (Valium), Chlordiazepoxide (Librium), Meperidine
(Demorol), OTC-drugs, such as, Tylenol PM and Benadryl. Gigoxin
Glyburide Robaxin Benzodiazepine Chlordiazepoxide Meperidine
OTC-drugs Herbs and Remedies Slide 17 Prevention of Home & Work
Related fall-Injuries: Managing Adverse Drug Interaction Why should
we (e.g. providers) be concerned with Polypharmacy? Because more
than 40% 12 % use at least ten (10) medications Because more than
40% of ambulatory adults older than 65 years of age use at least
five (5) medications per week, and 12 % use at least ten (10)
medications a week (Pham and Dickman, 2007). least 5 medications
Because about one in three older adults taking at least 5
medications will experience an adverse drug event each year (Pham
and Dickman, 2007). Patient non-adherence (non-compliance) occurs
at 40-60% Patient non-adherence (non-compliance) occurs at 40-60%
of those taking prescription medication. This issue is dual-hatted
as it indicates that patients do not take their prescribed
medications when told to and when told to stop taking them-patients
continue to consume these medications-thinking they are beneficial
(Pham and Dickman, 2007).. Two-thirds of older adults do not tell
their physician in advance underuse a medication 35% never discuss
Two-thirds of older adults do not tell their physician in advance
that they plan to underuse a medication because of its cost, and in
follow-up visits 35% never discuss that they have underused or
misused the medication. (Pham and Dickman, 2007). Slide 18
Prevention of Home & Work Related fall-Injuries: Managing
Adverse Drug Interaction What are the six questions seniors should
ask their provider (MD, PA, NP, PCM)? 1. What is the name of the
medicine? 2. What is the medicine supposed to do? 3. How and when
do I take it and for how long? 4. What foods drinks, and other
medicines or activities should I avoid while taking this medicine?
5. What are the possible side effects and what do I do if they
occur? 6. Is there any written information about the medicine? By
having the patient/client ask his/her provider these six questions
they can prevent confusion and potentially avert adverse drug
events (ADEs). * By having the patient/client ask his/her provider
these six questions they can prevent confusion and potentially
avert adverse drug events (ADEs). Slide 19 Prevention of Home &
Work Related fall-Injuries: Managing Adverse Drug Interaction Tips
on prevention adverse drug interactions: I. OTCs I. OTCs even
though OTC (over the counter) medications do not need a
prescription they can lead to serious side effects among aged
adults; thus, you should ask your provider prior to taking them.
II. Med-Log II. Med-Log make a list of all the medications you
take, their doses, and how often you take them; remember to update
any new drug(s) or doses to your list when a change is made. III.
Med-Reconciliation III. Med-Reconciliation make an appointment once
or twice a year to review your medicines with your PCP/PCM; ask
whether you need to continue taking each one at its current dose.
IV. Med Instructions IV. Med Instructions take your medicines
exactly as directed by your health care provider; try to have all
your prescriptions filled/dispensed at the same pharmacymost
pharmacies have medical data-bases that alert the pharmacist of
possible drug interactions. Slide 20 Prevention of Home & Work
Related fall-Injuries: Managing Adverse Drug Interaction Medication
Dos and Donts I. Do throw away medication if the medicine has
expired II. Do make a list of your medications and understand what
each one does III. Do ask questions (to MD, PA, NP, Pharmacist,
etc.) IV. Do use a pillbox (dispenser) to help you remember when to
take your medication. V. Dont take medication that has passed its
expiration date. VI. Dont stop taking medication just because you
feel better. VII. Dont ingest alcohol when you take your
medication, unless you have spoken with your doctor first; drinking
alcohol when taking sleep, anxiety or depression medicines is
considered unsafe. Slide 21 Prevention of Home & Work Related
fall-Injuries: Lets take a close look at the many barriers &
obstacles Home Assessment: A Walk Through the Interior &
Exterior Slide 22 Prevention of Home & Work Related
fall-Injuries: Lets take a close look at the many barriers &
obstacles Home Assessment & Safety: Home assessments are
performed to ensure patients can safely return and/or reintegrate
into their home environment. A, B, Cs: Home assessments just follow
the A, B, Cs: a. (Allow) for safe and clutter-free mobility within
the patients home. b. (Barriers) identify potential barriers that
could lead to falls & do so before the pt. returns to his/her
home. c. (Convey) the importance of fall-prevention and home-safety
to family members and care-givers. The general consensus is to grey
in place, thus, older adults want to return to their home after
D/C. Slide 23 Prevention of Home & Work Related fall-Injuries:
Lets take a close look at the many barriers & obstacles Home
Assessment & Safety: Home assessments performedprior to the
patient returning Should be performed prior to the patient
returning to their respective home. (*Gold- Standard)
performedstandardized fashion Should be performed in a standardized
fashion that includes the interior & exterior of the structure
(e.g. home, mobile-home, apartment, townhouse, condo, etc.). never
Should never be complex, lengthy or costly. never 85% of all
abatement recommendations (Stevens, J.A. 2005: NCOA National Center
for Injury Prevention & Control, CDC) Should never cost the
homeowner a lot of money to abate the safety hazard; 85% of all
abatement recommendations for home modifications cost absolutely
nothing (Stevens, J.A. 2005: NCOA National Center for Injury
Prevention & Control, CDC) Slide 24 Prevention of Home &
Work Related fall-Injuries: Lets take a close look at the many
barriers & obstacles Home Assessments & Safety: Home
assessments evaluate the following barriers: 1.Throw-rugs, area
rugs or afghan rugs 2. Extension cords or loose telephone- cords
strewn over common areas 3.Floor-surface: a. a. Tiled surface b. b.
Wood surface c. c. Carpeting d. d. Polished or stained concrete
Slide 25 Prevention of Home & Work Related fall-Injuries: Lets
take a close look at the many barriers & obstacles Home
Assessments & Safety: Home assessments evaluate the following
barriers: 4.Entry threshold (e.g. weather seals) can become a trip
hazard-when using a walker. 5.Long transparent O2-tubing 6.Stairs
and flimsy hand-rails (banisters) a. a. cause bowing b. b. not made
for weight-bearing c. c. can be pulled from the wall (*improperly
anchored) d. d. require additional support Slide 26 Prevention of
Home & Work Related fall-Injuries: Lets take a close look at
the many barriers & obstacles Home Assessments evaluate the
following barriers (Cont.) (*old homes) 7. Narrow doorways (*old
homes) old homes have very narrow doorways (>25 inches wide) 8.
Dimly lit hallways/passage-ways (*difficulty with transfers) 9.
Bathtub height (*difficulty with transfers) 10. Bathtub &
Shower water temperature 11. Steps/stairs leading to the
entrance/exit of the home. The Laws of Unintended Consequences.
Slide 27 Prevention of Home & Work Related fall-Injuries: Lets
take a close look at the many barriers & obstacles Home
Assessments evaluate the following barriers (Cont.) 12. High
kitchen Counters/cabinetry Difficult for wheelchair bound patients
to access. Expensive retrofits for kitchen cabinetry can be
prohibitive in cost. 13. Central Island Designs Force
patients/clients with walkers, canes, and in wheelchairs to
navigate around these Islands. 14.Crowded Kitchen floor-plans
Patients incur falls w/in kitchens because they must crisscross the
area often (or) must navigate around the kitchens central island.
Slide 28 Prevention of Home & Work Related fall-Injuries: Lets
take a close look at the many barriers & obstacles Home
Assessments evaluate the following barriers (Cont.) Flimsy night
tables at bedside 15. Flimsy night tables at bedside Patients tend
to weight-bear over furniture- which lead to falls at night Bed
height 16. Bed height-may be too low or too high Cordless or
Wall-mounted Telephones 17.Cordless or Wall-mounted Telephones:
cause unnecessary walking to answer the phone cell-phones Move
phone to night table & avoid using long telephone extensions or
use cell-phones. Slide 29 Prevention of Home & Work Related
fall-Injuries: Lets take a close look at the many barriers &
obstacles Home Assessments evaluate the following barriers (Cont.):
18. Floor vents 18. Floor vents for (AC/Heating) trip hazards 19
Iron steam heaters 19 Iron steam heaters (*radiator type). May
cause burns due to polyneuropathy and being insensate (* a hazard
for both the elderly and the children). 20. Exposed pipes 20.
Exposed pipes (*in the bathroom sink). Ditto-as per above Slide 30
Prevention of Home & Work Related fall-Injuries: Lets take a
close look at the many barriers & obstacles Home Assessments
evaluate the following barriers (Cont.): 21. In-door Pets 21.
In-door Pets (*poor vision among the aged cause them to trip or
fall over their pets). Pets congregate around their owners when
they stand up. Pets enjoy lying next to their owners feet Pets
require care, maintenance, and supervision Safety concern for
recurring falls (get help!) Slide 31 Prevention of Home & Work
Related fall-Injuries: Lets take a close look at the many barriers
& obstacles My pets! They are adorable and very loved, but they
run around and get under your feet. My grandma has a hard time
moving around the house in her walker sometimes when they are
playing. So, they were responsible for causing her to fall a few
weeks back. My grandmother tripped on one of their play-toys.
Quotes from the granddaughter of an elderly patient who tripped and
sustained a Fxed Hip (2009) TannenBailey Slide 32 Prevention of
Home & Work Related fall-Injuries: Lets take a close look at
the many barriers & obstacles Home Assessments evaluate the
following barriers (Cont.): 22. Light switches (automatic: motion
sensors). Keep the patients hands on the wheel when using assistive
ambulation devices. 23. Rocking chairs (or) chairs w/casters
Chairs/sofas/benches should always be stationary. 24. Piles
newspapers & magazines pack-rat mentality-cant bear to throw
anything away. These are important decisions-enlist the assistance
of family members. Slide 33 Prevention of Home & Work Related
fall-Injuries: Lets take a close look at the many barriers &
obstacles Home Assessments (special considerations) 25. Mobile
Homes: Gaining entry into a mobile home may prove difficult, as a
result of the steps that lead into it. Metal grating steps are
narrow. Metal grating steps are narrow. Metal grating steps are
steep (steep-pitch). Metal grating steps are steep (steep-pitch).
Most steps do not have hand-rails. Most steps do not have
hand-rails. This is a dangerous transitional space for patients
with questionable mobility and balance. This is a dangerous
transitional space for patients with questionable mobility and
balance. Slide 34 Prevention of Home & Work Related
fall-Injuries: Lets take a close look at the many barriers &
obstacles Home Assessments (special considerations) 26. Mobile
Homes: Mobile homes do not allow for extensive modification due to
their construction. Narrow hallways and doorways. Small bathrooms,
bedrooms & closets. Walls are thin and constructed out of
aluminum, plastic, and/or fiberglass. Impairs the patients ability
to ambulate with canes, walkers and wheelchairs. Slide 35
Prevention of Home & Work Related fall-Injuries: Lets take a
close look at the many barriers & obstacles Mobile Homes: Floor
plans-of- single wide mobile homes are less accommodating than are
double wide homes Slide 36 Prevention of Home & Work Related
fall-Injuries: What you should be looking for Mobile Homes: Keep in
mind that patients that live in mobile homes may be renting, thus,
any modifications that are recommended must be cleared through the
landlord first. You cannot advocate for extensive retro- fits to
mobile homes, as any structural change to the home have dangerous
consequences to the structural integrity. Slide 37 Abatement
Considerations CDC-Center for Disease Control & Minnesota
Safety Council, 2004 Prevention of Home & Work Related
fall-Injuries: Abatement Considerations CDC-Center for Disease
Control & Minnesota Safety Council, 2004 RMFs Retrofits,
Modifications and Functional Improvements Slide 38 Abatement
Considerations Prevention of Home & Work Related fall-Injuries:
Abatement Considerations Retrofits, Modification and Functional
Improvements Bathtub grab-bars need to be mounted vertically, as
well as, horizontally. Grab-bars should have a non-slip rough
finish. Grab-bars must be secured with proper anchors to support
wt. bearing. [Do not] use slick porcelain-finished grab bars. [Do
not] use suction-cupped grab bars. Shower-stalls are preferred over
tub-showers: Promotes energy conservation & safety. Hand-Held
Shower-head is preferred over a standard overhead shower. Slide 39
Abatement Considerations Prevention of Home & Work Related
fall-Injuries: Abatement Considerations Retrofits, Modification and
Functional Improvements Sliding glass doors Sliding glass doors
mounted on bathtubs and showers (trip & fall hazard): As a rule
of thumb, glass, water and slick-tile should never mix. Sliding
glass shower doors are generally made of non-tempered glass, thus,
it will shatter and form sharp edges. Patients with poor balance or
cannot transfer independently may weight-bear on the metal
towel-rack and shatter the glass. Slide 40 Abatement Considerations
Prevention of Home & Work Related fall-Injuries: Abatement
Considerations Retrofits, Modification and Functional Improvements
The bed-height should be raised or lowered for the elderly or
disabled patient to use safely. Be careful with bedside-rails these
ought to be installed properly to prevent falls. Bedside rails also
promote transfer independence into/out of the bed. Night-lights are
an invaluable tool for bedrooms, bathrooms and dimly lighted
hallways. Slide 41 Abatement Considerations Prevention of Home
& Work Related fall-Injuries: Abatement Considerations
Retrofits, Modification and Functional Improvements (A) Courtesy of
North Coast Medical; Furniture Riser Set, 2013 The bed-height
(plastic risers); these are commercially available and inexpensive
; (A) Courtesy of North Coast Medical; Furniture Riser Set, 2013
Bedding causing a trip-hazard (e.g. fluffy comforters): Beds with
draped sheets, comforters, or fancy ruffles that are used around
patients with poor ambulation skills or balance must be removed. A
Slide 42 Abatement Considerations Prevention of Home & Work
Related fall-Injuries: Abatement Considerations Retrofits,
Modification and Functional Improvements Doors with keyless entry
or Smart-key Systems can be retrofitted to the homes entrance to
mitigate the need for keys Great for Arthritic &
Neuro-patients; and enhances the security of ones home. Door
handles should be lever-handles not of the door-knob type. [B]
Lathem Keyless Entry Door Lock Model#LX100R B Slide 43 Abatement
Considerations Prevention of Home & Work Related fall-Injuries:
Abatement Considerations Retrofits, Modification and Functional
Improvements Uneven driveways, entryways, decorative pavers,
stamped-concrete need to be assessed. Uneven surfaces can cause
patients to lose their balance when ambulating over them. Concrete
sidewalks with cracks are very much a trip hazard; these need
immediate attention. to inch plywood can be placed over these
irregular surfaces until the patients balance or ambulation-skills
improves. B Slide 44 Abatement Considerations Prevention of Home
& Work Related fall-Injuries: Abatement Considerations
Retrofits, Modification and Functional Improvements Self-dimming
lights are used in frequently traveled areas of the house, such as,
the hallways, bathroom, kitchen and entrance. These lights are
triggered by movement (e.g. motion sensor). Patient or family
member adjusts the time-on and width or sensitivity of the sensor
(beam). When sensor is triggered-the light is turned on for a
preset period of time, then it turns off automatically. Slide 45
Abatement Considerations Prevention of Home & Work Related
fall-Injuries: Abatement Considerations Retrofits, Modification and
Functional Improvements Transitional Spaces: Transitional Spaces:
Entry foyer (front-door) Bath tub or shower Stairs &
Sunken-living-rooms Pools, Patios & Pastures Transitional
Spaces & increased threat of falls: Transitional Spaces &
increased threat of falls: Patients incur a greater risk of falling
Places that are regarded risky if the patient has low vision, poor
balance, and less than ideal functional ambulation skills. Slide 46
Abatement Considerations Prevention of Home & Work Related
fall-Injuries: Abatement Considerations Retrofits, Modification and
Functional Improvements Poor Ergonomics and overuse syndromes:
problems crop-up at home, as well as, the office-workplace
(*Cumulative Trauma Disorders: CTDs). use it; Assess the persons
equipment & how they use it; such as: Keyboard positioning
Monitor location Monitor screen (Polarizing filters) Lumbar support
and overhead lighting Mouse placement and wrist guard Computer
chair with 5-casters vs. 4 casters. Slide 47 Abatement
Considerations Prevention of Home & Work Related fall-Injuries:
Abatement Considerations Retrofits, Modification and Functional
Improvements Many workers are opting to work from their homes
part-time or full-time. Many workers are opting to work from their
homes part-time or full-time. I.Workers are more productive working
from their homes than they are in traditional worksites. II.It
reduces the physical-space requirements of the home-office (e.g.
headquarters). III.It reduces the down-time incurred from
non-productive vehicular commutes. IV.Young parents are better able
to balance children, families, and work responsibilities. Raftey,
I. (2013). Telecommuting, CNBC Telecommuting Slide 48 Abatement
Considerations Campbell, R.J. (2008) Prevention of Home & Work
Related fall-Injuries: Abatement Considerations Campbell, R.J.
(2008) (Computers & Seniors) Seniors and computer-phobia (*A
known myth): goods services. Seniors are interfacing with the home
PC with increasing frequency because they need goods and services.
home-bound. Seniors have accepted this foreign method of
communication because they are home-bound. Seniors make up 28% of
all online users w/in the U.S. (the 55+ y/o) Seniors are the
fastest growing segment of internet users in the U.S. Seniors spend
more time online than do teenagers (13- 19 y/o). Slide 49 Abatement
Considerations Adler, R. (2002) Prevention of Home & Work
Related fall-Injuries: Abatement Considerations Adler, R. (2002)
(Computers & Seniors) Seniors and computer-phobia: Seniors make
up 60% of all healthcare spending in the U.S. ($2.28 Trillion
dollars annually). Seniors purchase 51% of all over the counter
medicines. Seniors spend over $7.5 billion dollars on online
purchases annually. Skype media Seniors are very comfortable in the
use of Skype to connect with their children and grandchildren &
will use this media to speak with their doctor/nurse. Slide 50
Abatement Considerations Prevention of Home & Work Related
fall-Injuries: Abatement Considerations Home Ergonomics
(Computers-&-Access) telehealth, telemedicine, and
tele-consultation Telehealth and Seniors telehealth, telemedicine,
and tele-consultation are becoming acceptable means of monitoring
seniors: Because they are unable to use public transportation
and/or cannot drive to the PCMs office. Because technology
(bandwidth, and internet speed) allows connectivity from virtually
any remote location on earth. high-risk-patients Because elderly
pts with more than three comorbities are considered
high-risk-patients and are the most vulnerable to relapse &
readmissions. Telehealth Program LDLP at FL International
University Slide 51 Abatement Considerations Prevention of Home
& Work Related fall-Injuries: Abatement Considerations Home
Ergonomics (Medical Surveillance) Telehealth and Seniors allow PCMs
and specialists to reach-out to home-bound patients: Frequent
check-ups (Face to Face and Video- Teleconference) keep high-risk
patients out of hospitals. Telemonitoring Telehealth allows for
what is referred to as Telemonitoring vital signs, drug compliance,
wound-care check-ups, proper use of O2, etc. Allows the
PCM/Specialist to answer questions. Rs reassure, review and
redirect Allows for the three Rs (reassure, review and redirect) in
a timely manner. Telehealth Program LDLP at FL International
University Slide 52 Abatement Considerations Prevention of Home
& Work Related fall-Injuries: Abatement Considerations RMFs
(Retrofits, Modifications, and Functional Improvements) THINK
FUNCTION Slide 53 Abatement Considerations Prevention of Home &
Work Related fall-Injuries: Abatement Considerations Retrofits,
Modification and Functional Improvements Approach homes and
surrounding areas as potential hazards. Look at toilet heights.
Look at toilet heights. Look at floor surfaces, such as,
unrecognizable steps (or) step-offs. Look at floor surfaces, such
as, unrecognizable steps (or) step-offs. Non-tempered glass in
shower-stalls. Non-tempered glass in shower-stalls. The
entry-portal of the house and the height of the threshold. The
entry-portal of the house and the height of the threshold. Slide 54
Abatement Considerations Prevention of Home & Work Related
fall-Injuries: Abatement Considerations Retrofits, Modification and
Functional Improvements Shower glass panes: Shower glass panes:
recommend use of another shower or remove glass doors and hang
shower curtains. Concrete stairs: Concrete stairs: build an
appropriate ramp; however, with this abatement a ramp could not be
placed; grab bars were installed in the door-way & double sided
bright tape placed at edge of each concrete step. Slide 55
Abatement Considerations Prevention of Home & Work Related
fall-Injuries: Abatement Considerations Retrofits, Modification and
Functional Improvements Low lying toilet seat: Low lying toilet
seat: use three-in-one toilet chair or the elevated toilet (plastic
toilet seat insert) to promote ease of use. Raised threshold @
entryway: vise-versa Raised threshold @ entryway: change out for
the kind that connects to the bottom of door, thus, allowing for
smooth transition from out- side-to-inside and vise-versa. Ask the
patient, spouse, family members or friends if they feel comfortable
doing the retrofits or modifications or if they prefer to hire a
certified and licensed ADA contractor. Seek-Help! Slide 56
Abatement Considerations Prevention of Home & Work Related
fall-Injuries: Abatement Considerations Retrofits, Modification and
Functional Improvements Home safety should never be taken for
granted. Never assume the patients home is safe, just because they
have never fallen or incurred injury. The patients or caretakers
recollection may be clouded (*poor judgment or poor cognition). how
would I abate these obstacles or safety concerns and how much will
they cost? As you begin to conduct home or environmental
assessments, think how would I abate these obstacles or safety
concerns and how much will they cost? Slide 57 Abatement
Considerations Prevention of Home & Work Related fall-Injuries:
Abatement Considerations Retrofits, Modification and Functional
Improvements Camouflaged Cats: Camouflaged Cats: the area rug in
the living room had to be removed-as the cats blended into the
background. Outdoor Terrace: Outdoor Terrace: there was a dangerous
step- off from the terrace to the backyard; a gentle concrete
incline was used to abate the situation; grass was also planted-to
even out the holes & rough terrain. Slide 58 Abatement
Considerations Prevention of Home & Work Related fall-Injuries:
Abatement Considerations Retrofits, Modification and Functional
Improvements Suspicious Shoe-boxes: Suspicious Shoe-boxes: the
walk-in closet was cleaned up and the empty shoe boxes were
discarded. Computer-Clutter: Computer-Clutter: the work station was
reorganized, plastic tie-ons were used to secure loose cabling;
everything on the floor was removed. [Note]: [Note]: Walk-in
closets are cramped and do not have much room to maneuver, thus,
anything on the floor needs to be picked up or removed. Slide 59
Abatement Considerations Prevention of Home & Work Related
fall-Injuries: Abatement Considerations Retrofits, Modification and
Functional Improvements Concrete barriers & safety hazards-lead
to falls Concrete barriers & safety hazards-lead to falls Home
decorations-obstruct home mobility Home decorations-obstruct home
mobility Doorway obstacles & narrow doorways-limit entry/exit
with assistive ambulation devices Doorway obstacles & narrow
doorways-limit entry/exit with assistive ambulation devices Awkward
stair height-pose trip hazards Awkward stair height-pose trip
hazards Slide 60 Abatement Considerations Prevention of Home &
Work Related fall-Injuries: Abatement Considerations Retrofits,
Modification and Functional Improvements Retaining wall: this
safety and trip hazard caused the patient to incur poly-trauma,
hospitalization and incapacitation due shoddy construction &
poor decision making skills. Retaining wall: this safety and trip
hazard caused the patient to incur poly-trauma, hospitalization and
incapacitation due shoddy construction & poor decision making
skills. I. a pneumatic chisel was rented & the 4 inch retaining
wall was removed. 4 inch retaining wall was removed. II.also a
proper drain-field w/drain was installed by a licensed plumber.
III.grab bars were mounted on each side of the door-frame for
transfer safety. Slide 61 Abatement Considerations Prevention of
Home & Work Related fall-Injuries: Abatement Considerations
Retrofits, Modification and Functional Improvements Christmas Tree
Crowding: Christmas Tree Crowding: the tree was crowding into the
kitchen entryway; abatement consisted of moving the tree back 24
inches. Bathroom door will not open-fully Bathroom door will not
open-fully: the entertainment cabinet (console) was moved 20 inches
to the right to allow the patient with a quad-cane to access the
bathroom. Slide 62 Abatement Considerations Prevention of Home
& Work Related fall-Injuries: Abatement Considerations
Retrofits, Modification and Functional Improvements Narrow bathroom
Doorway: Narrow bathroom Doorway: Some bathroom doors can be as
narrow as 24 inches; this obstacle impairs pts with walkers from
entry/exit safely. Shallow Tiled Stairs: Shallow Tiled Stairs: the
depth of these tiled stairs are shallow & make it awkward to
negotiate; visually impaired pts. may have difficulty seeing the
demarcation of each stair. Slide 63 Abatement Considerations
Prevention of Home & Work Related fall-Injuries: Abatement
Considerations Retrofits, Modification and Functional Improvements
Welcome mats & loose floor mats-pose a trip hazards Welcome
mats & loose floor mats-pose a trip hazards Entryway of
homes/apartments Entryway of homes/apartments Bathrooms Bathrooms
Optical Illusion- many tiled surfaces will appear the same; these
surfaces pose several trip hazards in home Optical Illusion- many
tiled surfaces will appear the same; these surfaces pose several
trip hazards in home Slide 64 Abatement Considerations Prevention
of Home & Work Related fall-Injuries: Abatement Considerations
Retrofits, Modification and Functional Improvements
Unwelcomed-Welcome: Unwelcomed-Welcome: the welcome mat was removed
and a lower-profile mat with rubber backing was used in its place.
Slick Carpeting in Bathroom: Slick Carpeting in Bathroom: slick
area carpet was removed and a porous/absorbent mat was used; also
grab bars were installed in the shower-stall. * * The patient was
also cautioned against using the aluminum towel-rack for weight
bearing purposes. Slide 65 Abatement Considerations Prevention of
Home & Work Related fall-Injuries: Abatement Considerations
Retrofits, Modification and Functional Improvements Optical
Illusion: Optical Illusion: sunken living rooms or awkward steps in
patients homes cause visitors to trip & fall: *
corner-tiledark- brown step- down. *this situation was remedied by
changing out the corner-tile to a dark- brown tile and a laminated
sign placed on the column stating there is a step- down. Slide 66
Abatement Considerations Prevention of Home & Work Related
fall-Injuries: Abatement Considerations Retrofits, Modification and
Functional Improvements Shoring up the hand-railing of stairs-to
support more weight-bearing. Shoring up the hand-railing of
stairs-to support more weight-bearing. Use of house-hold appliances
(e.g. washing machine) Use of house-hold appliances (e.g. washing
machine) Misguided Steps throughout transitional spaces Misguided
Steps throughout transitional spaces Round doorknobs; level type
are better suited for patients with RA, OA and CVA. Round
doorknobs; level type are better suited for patients with RA, OA
and CVA. Slide 67 Abatement Considerations Prevention of Home &
Work Related fall-Injuries: Abatement Considerations Retrofits,
Modification and Functional Improvements Stair-rails: Stair-rails:
stair-well was fitted with rails on both sides to allow better
support; the wall-mounted rail (banister) was reinforced with
additional support cleats to allow for robust weight bearing by the
patient. Top loading washing machine: (*church groups are referred
to as FBOs: faith-based-organizations). Top loading washing
machine: is very difficult to use if you are W/C bound or have poor
standing balance; abatement consisted of having a church- group
adopt pt., and every 7-10 days assisted with the chore (*church
groups are referred to as FBOs: faith-based-organizations). Slide
68 Abatement Considerations Prevention of Home & Work Related
fall-Injuries: Abatement Considerations Retrofits, Modification and
Functional Improvements Misguided step Misguided step the shallow
stairs into the family-room look very similar causing the pt. with
impaired vision to miss one & fall; * * stairs were outlined
with double-sided strips of green & orange tape to identify the
edges of the stairs. Round Door-knobs lever-type Round Door-knobs
these door knobs cause difficulty when opening doors; however, they
may be swapped out for lever-type door knobs-to facilitate opening.
Slide 69 Abatement Considerations Prevention of Home & Work
Related fall-Injuries: Abatement Considerations Fall Prevention
Transdisciplinary Fall Prevention is a Transdisciplinary Effort
Prevention of falls is not some initiative that depends solely on
home-assessments, it must be multi-focal (*multidisciplinary) in
nature: Prevention of falls is not some initiative that depends
solely on home-assessments, it must be multi-focal
(*multidisciplinary) in nature: I.Home-site assessment by a
qualified OTR/PT II.Pharmacological reconciliation (PCP/PCM) III.
Adaptive Equipment needs from an OT or PT IV.Gait analysis and
mobility from a PT V.Neurological assessment by a neurologist
VI.Follow-up assessment by nurse case manager or MSW; ensure pt has
access to community- resources. VII.The family members or
care-givers (*very important). Slide 70 Abatement Considerations
Prevention of Home & Work Related fall-Injuries: Abatement
Considerations Home Ergonomics & Safety (Resources)
nihseniorhealth.gov/falls/homesafety/01.html NIH Senior Health
(Fall Proofing Your Home);
nihseniorhealth.gov/falls/homesafety/01.html
http://go4life.nia.nih.gov/sites/default/files/
http://go4life.nia.nih.gov/sites/default/files/ GO4Life (Prevention
of Falls-Tip Sheet); National Institute on Aging, U.S. Department
of Health & Human Services:
http://go4life.nia.nih.gov/sites/default/files/
http://go4life.nia.nih.gov/sites/default/files/PreventingFalls.pdf
[email protected] [email protected] NCOA (National Council on
Aging); (pdf) fact- sheet on seniors & falls at home; also,
Debunking the myths of older adults and falls [email protected]
[email protected] Slide 71 Prevention of Home & Work Related
fall-Injuries: Ergonomic Considerations Home Ergonomics &
Safety (Cont. Resources) National Institute on Aging (Prevention of
Falls and Fractures among the elderly);
www.nih.gov/health/prevention/falls-ar
www.nih.gov/health/prevention/falls-ar Center for Disease Control
& Prevention CDC-P) and National Center for Injury Prevention
& Control (NCIPC) Fall Prevention Check-List in English,
Spanish, & Chinese
www.Patientsafety.gov/safetytopics/fallstoolkit/index.htmlwww.Patientsafety.gov/safetytopics/fallstoolkit/index.html;
National Resource Center for patient safety-falls tool kit:
www.Patientsafety.gov/safetytopics/fallstoolkit/index.html;
www.Patientsafety.gov/safetytopics/fallstoolkit/index.html Slide 72
Prevention of Home & Work Related fall-Injuries: What is
functional mobility? Slide 73 Prevention of Home & Work Related
fall-Injuries: What to look for Functional Mobility Functional
Mobility is impaired when medical conditions, such as, CVA/stroke,
LE-amputation, osteoarthritis (DJD), disuse atrophy, spinal cord
injuries, COPD and cardio-vascular complications impact the
patient's ability to safely navigate through their homes: Kitchen
mobility tasks Bathroom mobility tasks Bedroom mobility tasks
Gaining entry/exit into the home Pools, Patios, & Pastures (P3)
Home management Tasks Leisure Pursuits & Hobby tasks Slide 74
Prevention of Home & Work Related fall-Injuries: What to look
for Functional Mobility Each room has a different set of criteria
to assess, and each space within the home is uniquely different.
Slide 75 Prevention of Home & Work Related fall-Injuries: What
to look for Concernswet-areasback splash Concerns regarding
wet-areas and back splash on kitchen counters and floors. Most
kitchens movement to various stations Most kitchens require
repeated movement to various stations (e.g. stove top, oven, sink,
food prep-area, food pantry, refrigerator, etc.). Counter top
surfaces Counter top surfaces are high for the W/C-bound Electrical
hazards (*GFI-Outlets ground fault interrupter these outlets are
used in bathrooms, kitchens, near pools, & outdoor areas).
Electrical hazards pose safety concerns-multiple electrical
appliances located near water-source (*GFI-Outlets ground fault
interrupter these outlets are used in bathrooms, kitchens, near
pools, & outdoor areas). Kitchens Slide 76 Prevention of Home
& Work Related fall-Injuries: What to look for Bathroom
Mobility: Standard bathtubs Standard bathtubs are difficult to get
into/out of with impaired mobility. Bathroomstiled surfaces
Bathrooms have tiled surfaces-which cause slips & falls.
Standard bathrooms are small Standard bathrooms are small, cramped
and do not allow for mobility with wheelchair (*ADA requirement is
5 X 5 ft turning radius). Slide 77 Prevention of Home & Work
Related fall-Injuries: What to look for Bathroom Mobility: Most
residential bathrooms Most residential bathrooms have a TTS
configuration (e.g. tub, toilet, sink) and getting to them can be
tricky, if not, down-right dangerous. Doorway entry is difficult
Doorway entry is difficult due to narrow door width (*pts with
walkers, wheelchairs, and canes modify how they enter/exit the
bathroom). Double hinges Double hinges for narrow doorways allow
the door to open up wider and allow patients better access. *****
Picture of double hinge Slide 78 Prevention of Home & Work
Related fall-Injuries: What to look for Bathroom Mobility
Bathrooms: glass-tile-water do not mix well; thus, when possible
eliminate one of these variables from the equation (*the sliding
glass panels were taken off as an abatement recommendation).
Bathrooms: glass-tile-water do not mix well; thus, when possible
eliminate one of these variables from the equation (*the sliding
glass panels were taken off as an abatement recommendation).
However, there still remains a However, there still remains a
step-down shower stall to step-down shower stall to assess and
abate? assess and abate? Slide 79 Prevention of Home & Work
Related fall-Injuries: What to look for Bedroom Mobility: Bed-rest
Bed-rest or convalescing patients spend a considerable amount of
time in this room: (e.g. patients entertain, eat, perform hygiene
and toileting ADLs, as well as, watch TV and sleep). The Bedroom is
turned into a multi-purpose room (e.g. patients entertain, eat,
perform hygiene and toileting ADLs, as well as, watch TV and
sleep). Slide 80 Prevention of Home & Work Related
fall-Injuries: What to look for Bedroom Mobility: Transferring
into/out of the bed Transferring into/out of the bed can become a
chore when ambulation and balance are impaired (e.g. bed height):
plastic risers Use plastic risers to bring the bed up to a height
where the patient can safely transfer in/out of. If plastic risers
are not available you may substitute PVC tubing (polyvinyl
chloride) PVC tubing (polyvinyl chloride) to raise or lower the
patients bed to the appropriate height (*PVC tubing is strong,
lightweight and inexpensive). Slide 81 Prevention of Home &
Work Related fall-Injuries: What to look for Bedroom Mobility:
Bedroom Mobility: (Continued) Weight-bearing Weight-bearing over
flimsy furniture leads to falls. Patients who have poor balance
Patients who have poor balance will weight-bear on furniture
Recommend Recommend that night-tables sturdy be sturdy in the event
the patient weight-bears over it (*they often do!) Bed-rails
Bed-rails must be bolted onto the bed-frame; the kind that slides
between the box-springs & mattress is unacceptable &
unsafe. Slide 82 Prevention of Home & Work Related
fall-Injuries: What to look for Bedroom Mobility: Bedrooms,
Clutter, and Oversized Bedspreads Slide 83 Prevention of Home &
Work Related fall-Injuries: What to look for Bedroom Mobility:
Bedroom Mobility: (Continued) Patients get tangled Patients get
tangled in their bed-sheets, comforters, or bedside furniture.
Patients using walkers, quad-canes or crutches are particularly
vulnerable to entanglement. Slide 84 Prevention of Home & Work
Related fall-Injuries: What to look for Entry Portal: Entry-Portal
The Entry-Portal can be any of the following: the homes main
entrance, the carport entrance, a utility room, the garage
entranceetc. Slide 85 Prevention of Home & Work Related
fall-Injuries: What to look for Gaining Entry/Exit from
Home/Apartment: The Entry Portal The Entry Portal for a pts [home]
is a safety concern because of the many obstacles found stairs, in
this area; obstacles such as: stairs, weather-stripping,
insufficient railing-support, weather-stripping, insufficient
railing-support, poor-lighting, cracked-cement, narrow entry-ways,
poor-lighting, cracked-cement, narrow entry-ways, and the need for
proper ramp-abatement. and the need for proper ramp-abatement.
Slide 86 Prevention of Home & Work Related fall-Injuries: What
to look for Gaining Entry/Exit from Home/Apartment: Weather Weather
impacts the patients ability to enter/exit the home safely. Poor
lighting Poor lighting also impacts safety; particularly with
patients that have decreased visual acuity. Ramps must Ramps must
have a 1:12 ratio, with must regards to incline (*min) and must be
installed by certified/licensed & bonded contractor. Slide 87
Prevention of Home & Work Related fall-Injuries: What to look
for Pools, Patios & Pastures: (P3) Pools and Patios Pools and
Patios are areas of concern, due to water and slick surfaces. Pools
and patios Pools and patios areas are becoming popular areas for
family gatherings Pools and patios: Pools and patios: are used for
entertainment and relaxation Pools and patios: Pools and patios:
are elaborate, made of varying materials (e.g. pavers, stamped
concrete, loose polished rocks, etc.). Pools and patios: Pools and
patios: often require stepping outside the house (*transitional
space). Slide 88 Prevention of Home & Work Related
fall-Injuries: What to look for Pools, Patios & Pastures (P3):
Lawns, gardens, and pastures Lawns, gardens, and pastures are
relaxing, therapeutic, and offer patients a chance to be out-doors;
however, unsupervised use can lead to falls and injuries among
patients with decrease ambulation/balance: Exposed tree-roots or
loose gravel beds Uneven concrete disks or blocks Tall grass (uncut
or unkempt lawns) Mulch beds around trees and bushes Extension
cords for water fountains and decorative lights Slide 89 Prevention
of Home & Work Related fall-Injuries: What to look for The
current trend is to maximize the outdoor living experience, and
therefore, these outdoor spaces will continue to be very elaborate
and popular. Slide 90 Prevention of Home & Work Related
fall-Injuries: What to look for Home Management Tasks: Who will do
the following? Patients who wish to age in place are still required
to manage the home & its surroundings. Who will do the
following? a.Painting & weather proofing the home b.Cutting the
grass & trimming bushes/hedges c.Retrieving the mail (Postal
Service Variances) d.Curb side trash pick-up (Large Trash-bins)
e.Compliance with home-owners association f.Paying the electrical
& gas bills Slide 91 Prevention of Home & Work Related
fall-Injuries: What to look for Home Management Chores: Who will
assist your patients in doing these important chores? Slide 92
Prevention of Home & Work Related fall-Injuries: What to look
for Leisure Pursuits & Hobby Tasks: Patientsreturn to their HOR
Patients who return to their HOR (home of residence/record) wish to
return to the things that they enjoy. When conducting a home
evaluation When conducting a home evaluation also ask if the
patient engages in a particular hobbyleisure pursuit hobby or
leisure pursuit: If [Yes] the evaluator the evaluator needs to look
at modifying the task to fit the patients physical and/or cognitive
abilities. Biomechanical & Safety Biomechanical & Safety
may have to be woven into the activity (e.g. no prolonged standing,
joint protection, use of splints, built-up handles, improved
lighting, etc.). Slide 93 Prevention of Home & Work Related
fall-Injuries: Ramps: What to look for
http://www.access-board.gov/adaag.htm
http://www.access-board.gov/adaag.htmhttp://www.access-board.gov/adaag.htm
Information on ADA guidelines for wheelchair ramps. ADA Homepage
for Accessibility Guidelines for Buildings and Facilities Slide 94
Functional Mobility Ramps: What to look for Heads-up (more
information on Ramps): ADA: Accessibility for Building and an
Facilities, (Guidelines for ADA rated wheelchair ramp s): Standard
Chapter IV, Section 206 :
http://www.ada.gov/reg/regs2010/2010ADAstandards.htm Updated:
11-15-2010 Slide 95 Prevention of Home & Work Related
fall-Injuries: Ramps: What to look for Information Regarding Ramps:
ADA guidelines call for 1:12 inclination; however, 1:16 or 1:20 is
recommended for those with limited ambulatory skills. Handrails
must be placed on both sides of the ramp (*rails must be smooth
& free of splinters). Min. ramp width is 36 inches; however, 42
inches is better Ramps must have a landing that is 60 inches long @
the bottom and top; the landing must be as wide as the ramp.
Pressure treated lumber and galvanized nails/screws are mandated.
Post supports are 4 X 4 posts and are inserted 18 inches into
ground with concrete. Slide 96 Prevention of Home & Work
Related fall-Injuries: Ramps: What to look for Information
Regarding Ramps (More ADA Standards): Information Regarding Ramps
(More ADA Standards): W/C ramps can be permanent or portable
structures Handrails on ramps are required if the ramp is more than
6 high or longer than 72 long. The ramp should not exceed 36 in
height without some sort of directional change (e.g. switch-back).
Ramp landings must be 60 square at the bottom, the top and along
any directional change. Ramps may be built out of a variety of
materials, such as, aluminum, treated lumber, concrete, etc., as
long as they meet ADAs building criteria. Slide 97 Prevention of
Home & Work Related fall-Injuries: What to look for Where do
falls occur around the home? I. Bathrooms II. Stairs III. Kitchen
IV. Entrance or Entryway V. Patio or grassy areas VI. Doorways and
halls Center for Disease Control and Prevention (2010e);
http://www.cdc.gov/homeandRecreationalSafety/Falls/fallcost.html
And Carter, SE, et al. (1997): Environmental Hazards in the Homes
of Older People Slide 98 Rubenstein, L., and Josephson, K. (2006).
Prevention of Home & Work Related fall-Injuries: What to look
for Rubenstein, L., and Josephson, K. (2006). What leads to falls
at home? Lack of physical exercise Lack of physical exercise caused
from poor muscle tone and decreased balance. Impaired vision
Impaired vision age related visual impairments and poor lighting
are generally regarded as two main factors for falls @ home.
Poly-medication Poly-medication taking several meds at the same
time cause, lethargy, vertigo, syncope, etc. (meds such as,
sedatives, anti-depressants, and anti-psychotics) (*NIH Senior
Health 2013). Several co-morbidities Several co-morbidities cause
fatigue, need for supplemental O2, several medicines, decreased
mobility, and dependence on health care provider. Surgery Surgery
post operatively patients are weak and debilitated. Environmental
hazards Environmental hazards one-third of all falls among the
elderly population are caused from hazards originating in the home
(*NIH Senior Health 2013). Slide 99 CDC: What you can do to Prevent
Falls, e-brochure, 2012 Prevention of Home & Work Related
fall-Injuries: A Transdisciplinary Approach CDC: What you can do to
Prevent Falls, e-brochure, 2012 Exercises to Improve Balance: I.
Tight-rope walk: I. Tight-rope walk: walk a straight line 10, 20,
30 feet with hands out to the side for balance (*place a strip of
masking tape on floor). Slide 100 CDC: What you can do to Prevent
Falls, e-brochure, 2012 Prevention of Home & Work Related
fall-Injuries: A Transdisciplinary Approach CDC: What you can do to
Prevent Falls, e-brochure, 2012 Exercises to Improve Balance: II.
Rock-the-boat: II. Rock-the-boat: with hips shoulder-width apart,
weight shift Rt-to-Lt- to-Rt; while wt. shifting to one side, lift
the opposite foot off the ground (*hold X 5, 7, 10 secs). Slide 101
CDC: What you can do to Prevent Falls, e-brochure, 2012 Prevention
of Home & Work Related fall-Injuries: A Transdisciplinary
Approach CDC: What you can do to Prevent Falls, e-brochure, 2012
Exercises to Improve Balance: III. Heal-to-toe: III. Heal-to-toe:
walk placing the toe of one foot immediately behind the heal of the
opposite foot (*do this X 15-20 steps). Slide 102 CDC: What you can
do to Prevent Falls, e-brochure, 2012 Prevention of Home & Work
Related fall-Injuries: A Transdisciplinary Approach CDC: What you
can do to Prevent Falls, e-brochure, 2012 Exercises to Improve
Balance: IV. Flamingo Stand: IV. Flamingo Stand: while stabilizing
(holding) on to the back of chair, stand on one foot (*hold for 10
sec, then change to other foot). Slide 103 Prevention of Home &
Work Related fall-Injuries: A Transdisciplinary Approach Impaired
Mobility Advisory: In 2009 more than 14,400 people over age 65 died
and 1.7 million were treated and hospitalized because of falls
(CDC-Foundation, 2009). Among adults 70 years old, 3 in 10 will
fall each year; 1 in 10 will suffer a serious fall injury, such as,
a broken bone or head injury
(www.fallprevention.org,2010).www.fallprevention.org About 53% of
the elderly population who are D/Ced from the Hospital for fall
related injuries will experience another fall w/in 6 months. (CDC
2007). Slide 104 Prevention of Home & Work Related
fall-Injuries: A Transdisciplinary Approach Impaired Mobility
Advisory: Falls are the leading cause of death among the elderly
due to injury[87%]... of all fractures among the elderly are due to
falls (CDC-Foundation, 2010). The financial toll for older adults
who sustain falls is expected to increase as the population ages
and may reach $54.9 billion by 2020 (CDC-Foundation and CDCP,
2013). 66% of persons who fall will experience another fall within
six months; 50-66% of all falls occur in or around the home (NCIP
Estimates, 2012). Hip Fxs are the most frequent type of
fall-related fracture. The average hospitalization cost was
$18,000; this was 44% of the direct medical-cost for hip Fxs (NCIP
and Pain, Wipf & Ericson, 2011). Slide 105 Functional Mobility
A Transdisciplinary Approach Falls at home (What we know): 1. We
know where our patients/clients fall most often. 2. We know what
the leading causes of falls and injuries are at home. 3. We know
which patients are most vulnerable to falls and injuries. 4. We are
well-prepared and well-equipped to rehab patients once they do
incur injury from falls. 5. And yet, we will freely return (e.g.
after D/C) the patient back to the same environment that caused
their injury and hospitalization in the first place. American
Academy of Orthopedic Surgeons, 2010 (AAOS) Slide 106 Prevention of
Home & Work Related fall-Injuries: A Transdisciplinary Approach
Navigating through, around and over obstacles in the home is most
challenging when the patient presents with neuro-musculo-skeletal
injuries (NMSIs). Slide 107 Prevention of Home & Work Related
fall-Injuries: A Transdisciplinary Approach Functional
Mobility(*Recap and Review) Occupational Therapist (Role) receives
the recommendations on functional-gait and assistive devices
offered by the physical therapist and dovetails these
recommendations into the patient's functional activities (e.g.
bathing, dressing, cooking, bed-mobility, toileting, dressing
etc.). Slide 108 Prevention of Home & Work Related
fall-Injuries: A Transdisciplinary Approach Functional
Mobility(*Recap and Review) Physical Therapist (Role) performs gait
analysis and training while using assistive ambulation devices
(canes, walkers & crutches, wheelchairs, etc.) to ensure the
patient can ambulate safely when working with the occupational
therapist or engaged in functional tasks. Slide 109 Prevention of
Home & Work Related fall-Injuries: A Transdisciplinary Approach
Equipment Index: 1. Automatic (motion sensor) light switch: Home
Depot and Busy Mart stores 2. Bathroom Grab bars: Cambridge Moms
Site 3. Handheld Shower Head: Model Number 75527SN; Lowes hardware
4. Plastic Furniture Riser (Set of Four): Online Product Number
729561; Target Stores 5. Lever Handle for Doors: Model Number 720
CHL; Handle Sets web site 6. Keyless (Smart Key) System for Doors:
Lathem Keyless Entry Door Locks Model#LX100R and Keyless Entry
System Model Number 2835-SN; Home Security Stores (Manufacturer:
Digital Systems). 7. Easy Ergonomics for Desktop Computer Users
(PDF Handout/workbook, 2005):
www.dir.ca.gov/dosh-publications/computergo.pdf
www.dir.ca.gov/dosh-publications/computergo.pdf 8. Plastic (Cable
tie-ons) Nelco Products: Nelco-Products 9. GFI (Ground Fault
Interrupter) Outlets: Grainger Company 10. PVC (Polyvinyl Chloride)
Tubing/Pipes: US-Plastics 11. Bedside Rails to enhance transfer
independence: SKU No. 00001vSTD5800; Parent giving Slide 110
Prevention of Home & Work Related fall-Injuries: A
Transdisciplinary Approach Questions? Slide 111 Slide 112 Slide
113
