Occupational Therapy’s Role in Fall Prevention

According to the American Occupational Therapy Association (AOTA), almost 3.2 million older adults per year end up in an emergency room and needing medical intervention due to a fall.

Out of the 3 million, over 36,000 of those people die from their injuries. The CDC reports that these falls are also the leading cause of death among those over 65 years old, with the rate increasing over time. These are significant statistics!

Thankfully, as occupational therapists, we play a central role in improving safety and reducing fall risk at home for our patients. In fact, AOTA has partnered with the National Center for Injury Prevention and Control to issue recommendations regarding fall prevention in the US.

To start, it is important for patients, medical staff, and insurers to coordinate providing services that focus on fall prevention. Some of the most important services performed by occupational therapists are home assessments, adaptation recommendations, and home modifications.

But, what exactly should we, as OTs, be doing for our older adult patients to help them prevent falls?

This article will discuss some of the issues surrounding fall prevention in the elderly and what action we can take as OTs to help reduce falls.

What Does the Research Say?

While literature on the role of occupational therapy in fall prevention is readily available, quality studies on the role and effectiveness of occupational therapy on fall prevention in the United States is lacking.

Leland, et. al. (2012) conducted a scoping review of the literature and found evidence supporting the involvement of occupational therapy in environmental modifications, exercise, and multifactorial interventions. The quality of this evidence was inconsistent and not sufficient enough to support a systematic review or a meta-analysis.

This review found very limited information on occupational therapy’s involvement in modifying behaviors, managing postural hypotension, recommending appropriate footwear, or managing medications, all areas of intervention according to the 2010 recommendations on fall prevention.

This review also found that much of the research regarding fall prevention was conducted outside of the U.S. The authors pointed out that differences in health care coverage and provision of services might yield different results than studies conducted inside the U.S. and more research is needed to determine occupational therapy’s involvement in fall prevention in the United States.

Best Practices in Fall Prevention

So, what exactly should we, as occupational therapy practitioners, be doing to prevent falls? Most of us have conducted home assessments and recommended modifications to reduce or eliminate safety hazards.

These could include:

• Removing clutter and excess furniture
• Removing or securing throw rugs
• Installing hand rails and grab bars by stairs and in bathrooms
• Repositioning bedroom furniture
• Installing grab rails on beds
• Providing durable medical equipment such as bedside commodes, bath benches, and raised toilet seats.
• Increasing in-home lighting

These home adaptations are all useful and valuable steps in reducing the risk of falls, but they do not represent everything that occupational therapists can do to prevent falls for their patients.

In addition to identifying and addressing the above environmental hazards, other fall prevention practices can include designing targeted fall prevention home exercise programs, providing ongoing patient and caregiver education to increase carry-over, and collaborating and educating other healthcare professionals on your team about best practices for reducing falls.

Important Considerations for Fall Prevention

Here are some of the most important considerations to keep in mind when working with your patients to reduce falls.

Use a structured tool when completing home assessments.

Most clinics have a home safety checklist that is used for home assessments but utilizing a standardized tool with adequate inter-rater reliability will make your home assessments more thorough and consistent. AOTA lists several assessments on their website.

One of the more recent standardized tools available, the In-Home Occupational Performance Evaluation (I-HOPE) developed by the occupational therapy program at Washington University School of Medicine in St. Louis, measures in-home activity performance using a standardized methodology both before and after environmental modifications are provided.

The patient/client plays an active role in identifying environmental barriers and prioritizing modifications to optimize occupational engagement with the use of this tool.

Don’t underestimate the roles that exercise and general conditioning play in fall prevention.

While physical exercise programs that improve balance and strength are typically considered physical therapy’s domain, these types of exercises can be carried over by occupational therapists and applied to the functional activities that patients do during their day.

Exercises can even be incorporated into a patient’s daily activity schedule, which has been shown to improve compliance with exercise programs (Ballenger and Brooks, 2013).

Consider the patient’s fear of falling.

If a patient is afraid to participate in activity due to a fear of falling, whether or not he or she has fallen before, this fear will significantly limit participation in daily activity. It is important to genuinely address this fear and work with the patient to develop solutions that will help the patient to feel more secure at home and in the community.

Make sure that your patients are actively involved in addressing risk factors in their own homes. A patient who has worked with the occupational therapist to come up with practical safety solutions for the home is much more likely to follow through with those solutions than the patient who brings home a list of “the usual” recommendations on a piece of paper that is tossed in with the rest of the patient’s discharge papers.

Allowing your patient to lead the process and make the primary decisions, if the patient is capable, will result in action on the patient’s part when it comes to making modifications and obtaining adaptive equipment.

Addressing Falls for Patients with Dementia

A patient’s active participation in the decision-making process regarding home modifications for safety is very important, but what if the patient has dementia?

That patient’s ability to participate in the problem solving and decision-making process may be significantly limited. People with dementia tend to be resistant to change, so a patient with dementia experiencing falls at home might be reluctant to make home modifications in the usual manner.

When this occurs, the occupational therapist should work with both the patient and the patient’s caregiver or involved family member. The support person involved in the process should know the patient well and should be able to determine which types of modifications the patient will accept, and which will just make the person upset.

Modifications that can be easily incorporated into the patient’s existing daily routine should be given priority. If training is required to use a modification or a piece of durable medical equipment, the caregiver should be trained in its use along with the patient so that the caregiver can help the patient become used to the modification.

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Fall prevention is an extremely important area of practice for occupational therapists and taking a holistic approach to reducing falls for patients will result in better outcomes for your patients.

Our primary goal is to make sure our patients stay safe at home, and you can help improve their chances by following the guidelines covered here, regardless of your setting.

Remember that one less fall is…one less fall!

This article was co-written by Janet Meydam, OTR/L and Sarah Stromsdorfer, OTR/L. It was initially published in 2018 and updated on March 4, 2023.

References

Ballinger, C., & Brooks, C. (2013, May). An overview of best practice for falls prevention from an occupational therapy perspective. The Health Foundation. Retrieved June 11, 2018, from http://patientsafety.health.org.uk/sites/default/files/resources/an_overview_of_best_practice_for_falls_prevention_from_an_occupational_therapy_perspective_0.pdf

Home Safety and Accessibility Assessments. (n.d.). American Occupational Therapy Association. Retrieved June 11, 2018, from https://www.aota.org/Practice/Productive-Aging/Home-Mods/Rebuilding-Together/assessments.aspx

Improve Public Policy Response and Medicare Coverage for Fall Prevention and Intervention. (2010, July). American Occupational Therapy Association. Retrieved June 11, 2018, from https://www.aota.org/Practice/Productive-Aging/Falls/CDC/Summary.aspx

In-Home Occupational Performance Evaluation (I-HOPE) Kit. (n.d.). Washington University School of Medicine in St. Louis, Program in Occupational Therapy. Retrieved June 11, 2018, from https://starklab.wustl.edu/i-hope-kit/#order

Leland, N. E., Elliott, S. J., O’Malley, L., & Murphy, S. L. (2012, March 01). Occupational Therapy in Fall Prevention: Current Evidence and Future Directions. American Journal of Occupational Therapy March/April 2012, Vol. 66, 149-160. doi:10.5014/ajot.2012.002733 Retrieved June 11, 2018, from https://ajot.aota.org/article.aspx?articleid=1851552