Identifying and Mitigating Fall Risk in the Home Environment for Seniors

1. Jeremy D. Nelson MPT
Physical Therapist
www.structuredmotion.com
Identifying and Mitigating Fall Risk in
the Home Environment for Seniors

2. Objectives for Discussion
 Identify the common causes of falls and
interventions to reduce risk in each part of a
typical home
 Discuss decreasing fall risk to promote Aging in
Place
 Review common field tests to decrease fall risk
 Discuss interventions to improve patient stability
and mobility

3. What causes falls –
External Demands and Internal Capacity
 Interaction between person and environment
 COG within BOS
 Multiple systems interact to maintain this relationship over varying external
demands
 Sensation
 Mobility
 Stability
 Vestibular input
 Vision
 As we move, BOS changes shape
 Seated
 Double Limb Support
 Symmetrical
 Asymmetrical
 Single Limb Supported
 Can the neuromuscular system coordinate muscle timing to keep the COG
in BOS
 Physical capacity must meet or exceed the demands of the
environment in terms of attenuating forces, timing, control.

4. Universal Design & Aging in
Place
 Universal Design - AKA Barrier Free Design
 Supported by ADA
 “Matching the environment to minimize imposed
demands”
 In Senior population meant to provide a safe
environment for the progressive decline in function
associated with aging.
 Seeks to provide surfaces at heights most efficient
for human function.
 “Aging In Place”
 Trend for modifying currently owned residence to
compensate for changes in physical capacity.

5. Age Related Changes - Internal
Mithal A, Bonjour J-P, Boonen S, Burckhardt P,
Degens H, El Hajj Fuleihan G, Josse R, Lips P,
Morales Torres J, Rizzoli R, Yoshimura N,
Wahl D.A., Cooper C, Dawson-Hughes
B(2011) Impact of nutrition on muscle strength
and performance in older adults. Osteoporosis
International

6. The At Risk Senior
 Person
 Gait Unsteady
 Shuffling gait
 Poor weight shifting during double limb support
 Trendelenburg sign in single limb support
 Dizziness
 c/o room spinning when head turns, turning in bed
 Orientation
 Intermittent disorientation more likely to increase falls
 Weakness
 Neurologic, sarcopenia related, hypoglycemia
 Poor Posture – Posterior COG
 L/S lordosis
 T/S Kyphosis
 C/S Forward head posture

7. Diagnosis Associated with Increased
Fall Risk – Home Modifications
 Neurological
 CVA, Dementia – Creating Safe Passages
 Orthopedic
 OA, DDD, RA, THA, TKA (Impaired mobility/stability)
 Changing heights of furniture/ Bathroom to promote Sit to Stand
 Metabolic
 DM, (Insulin OD, hypoglycemia, Peripherial Neuropathy)
 Changing from Plush Carpet to hardwoor, low ply carpet, linelum
surfaces
 Cardiac
 HTN,CHF, CAD, MI ( Medications, OH)
 Changing Environment to promote energy conservation
 Pulmonary
 COPD, PE (Medications, OH)
 Changing Envinronment to promote energy conservation

8. Increased Environmental
Demands
What are the demands imposed by the patients
environment?
 Unlit areas
 Obstacles
 Uneven Surfaces
 Slippery Surfaces
 Distracting Areas
 Changes in environment can decrease the
disability threshold.
Senior Assessment of their Environment - CDC

9. Match or Mismatch?
 Functional Reserve (FR) vs. Environmental
Demands
 Mrs. J – Uses walker, Unable to Sit to Stand
without UE
 FR Adequate on even surfaces - MATCH
 Tile surfaces in kitchen
 Bathroom linoleum surface
 FR inadequate on Uneven surfaces - MISMATCH
 Plush carpeting in hallway
 Bedroom

10. Into Out of Home

11. Kitchen

12. Bathroom

13. Bed Room

14. Stairs

15. Equipment
 2+ Hand Touch  2 Hand Touch

16.  1 ½ Hand Touch  1 Hand Touch

17. Research
 A Multifactorial Intervention To Reduce The Risk Of Falling Among Elderly People Living In The Community.
(Tinetti, Mary E.; Baker, Dorothy I.; McAvay, Gail; Claus, Elizabeth B.; Garrett, Patricia; Gottschalk,
 Margaret; Koch, Marie L.; Trainor, Kathryn; Horwitz, Ralph I.) NewEngland Jounal of Medecine Volume
331(13) 29 Sep 1994 pp 821-827
 A Randomized, Controlled Trial of Fall Prevention Programs and Quality of Life in Older Fallers
 A Review of Balance Instruments for Older Adults; Susan L. Whitney, Janet L. Poole, Stephen P. Cass
September 1998, Volume 52, Number 8
 Aging, muscle activity, and balance control: physiologic changes associated with balance impairment
 Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance
scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers

18. Resources
 http://agingresearch.buffalo.edu/hssat/
 AARP
 CDC
 APTA
 http://sandiego.networkofcare.org/content/client/4
/Home-Modification-Program-Home-
Safety2013.pdf