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Prevention of Home & Work Related fall-Injuries: Using a Transdisciplinary Approach Course Instructor: Dr. Jose R. Rafols OTD, MHSA, OTR/L, CEAS Dangerous.

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Presentation on theme: "Prevention of Home & Work Related fall-Injuries: Using a Transdisciplinary Approach Course Instructor: Dr. Jose R. Rafols OTD, MHSA, OTR/L, CEAS Dangerous."— Presentation transcript:

1 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

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:

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.

4 Prevention of Home & Work Related fall-Injuries: A Transdisciplinary Approach The leading causes of falls among Aged Adults

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

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.

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

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.

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).

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.

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.

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.

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.

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

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)

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

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).

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).

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 pharmacy…most pharmacies have medical data-bases that alert the pharmacist of possible drug interactions.

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.

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

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.

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)

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

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

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.

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.

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.

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

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!)

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

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.

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.

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.

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

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.

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

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.

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.

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.

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

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

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. ½ to ¾ inch plywood can be placed over these irregular surfaces until the patients balance or ambulation-skills improves. B

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.

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.

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.

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

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).

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.

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

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

52 Abatement Considerations Prevention of Home & Work Related fall-Injuries: Abatement Considerations RMFs (Retrofits, Modifications, and Functional Improvements) THINK FUNCTION

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.

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.

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!

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?

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.

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.

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

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.

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.

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.

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

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.

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.

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.

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).

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.

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).

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 fallsfree@ncoa.org fallsfree@ncoa.org NCOA (National Council on Aging); (pdf) fact- sheet on seniors & falls at home; also, Debunking the myths of older adults and falls fallsfree@ncoa.org fallsfree@ncoa.org

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

72 Prevention of Home & Work Related fall-Injuries: What is functional mobility?

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

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.

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

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).

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

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…?

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).

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).

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.

82 Prevention of Home & Work Related fall-Injuries: What to look for Bedroom Mobility: Bedrooms, Clutter, and Oversized Bedspreads

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.

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 entrance…etc.

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.

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.

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).

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

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.

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

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?

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.).

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

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

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.

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.

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

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).

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).

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).

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).

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).

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).

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).

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)

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).

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.).

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.

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

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