The Role of Home and Community Environment in Fall Prevention Excerpts taken from 2005 Joint Conference of the American Society of Aging and The National Council on the Aging, Philadelphia, PA March 12, Presentation by Jon Pynoos, PhD, Andrus Gerontology Center Fall Prevention Task Force of Santa Barbara County presents

Survey Fall Data

Where People Fall Source: National Health Interview Survey, 1007=1998 (Kochera, 2002)

Why is the Home and Community Environment Important The majority of older adults prefer to stay in their own homes and communities However, homes and communities often have numerous hazards, dangerous areas, and lack supportive features

Why is the Home and Community Environment Important Incidents and severity of falls rise steadily after age 60 Some falls are preventable by decreasing risk factors

Why we have Increased Risk of Falls  Reaction time slows  Muscles and joints get stiffer and decreased flexibility  Illness  Medications  Substance abuse  Vision changes  Decreased Balance  Weakness  Decreased sensation in lower extremity  Inappropriate footwear  Environmental Hazards  Orthostatic hypotension

Actions to Reduce the Risk of Falls Regular exercise program that includes stretching, balance training and strengthening Illness – maintain good diet and health Manage medications and the side effects Manage Orthostatic Hypotension Assess Vision Changes Be aware of Sensation loss

Hazards in the Home Approximately 80% of the homes investigated had at least one hazard, and 39% had five or more hazards (Carter et al., 2000) Hazards in the home include: Clutter Electrical cords/phone cords Slippery throw rugs Loose carpet Unsafe bathroom Poor lighting

Modifying Your Home Helps Prevent Falls Home assessment, OT home visits and provision of Home Modifications reduced the risk of falling by 36% among those with history of falls (Cumming et al., 1999) The Community and Home Injury Prevention Program in San Francisco: Home assessment and minor home modification strategies reduced the fall incidence rate by almost 60% among relatively healthy seniors (Rose et. al., 2003)

Home Modification Strategies Removing hazards Adding special features or assistive devices Moving items or furnishings Changing where activities occur Renovating or changing existing structure

Problem Areas in the Home The biggest problem areas of the home: Outside steps to the entrance Inside stairs to a second floor Unsafe bathrooms

Options for Improving Problem Areas Outside steps to entrance Hand rails Ramps Short deep steps Bright automatic lighting Repair uneven steps

Options for Improving Problem Areas Inside stairs Hand rails Ramps Lift seat, Bright Lighting Remove loose or badly worn rugs or tack down carpeting Non skid surface Keep stairs free of clutter

Options for Improving Problem Areas Bathroom Grab bars – not towel bars or doors Non skid strips or rubber mat inside the tub Sitting on bath chair on tub transfer bench A bath mat outside the shower with non skid backing Hand held sprayer

Home Modifications and its Challenges Source: AARP (2000). Fixing to Stay: A National Survey of Housing and Home Modification Issues.

Problems in the Community Outdoor community hazards: Uneven pavement, surfaces and/or cracks To report problems with City sidewalks or burned out street lights within the City limits call , Ext 804 Tree roots Within the city limits, Call , Ext 260) Obstacles in walkway Uneven steps Unsafe stair design Poor lighting

Problems in the Community (cont.) Lack of safety features in your surroundings Handrails Grab bars Ramps Curb cuts

Conclusion Falls can be prevented by Knowing your Risk Focus on those risks with personal changes home modifications and a regular exercise program.