Falls happens in an instant – a missed step, a curled-up rug, an untied shoe – and your patient is on the ground. Falls are on the rise in the U.S. with deadly implications (CDC website). So, as you look for a comprehensive falls prevention program for your OT patients or your OT facility, look for these ten elements.

Enjoy!
Cheryl Hall, OT
Author and Illustrator, Occupational Therapy Toolkit

1. Survey of Risk Factors – More risk factors increase the chance of a fall, so it is important to have a comprehensive checklist of potential hazards to review with the patient. The list should include personal factors like age and health conditions; environmental conditions like scatter rugs and poor lighting, as well as behaviors like multitasking and not using handrails. The survey should be done with the patient and the results shared with caregivers, family members and the rest of the health care team.
2. Increased Activity – Not only do active people fall less, but they are less likely to be hurt if they do fall. A good falls prevention program will include a plan to build strength, balance and flexibility. OTs can help patients design a home exercise program at that addresses all three elements. Look for programs that are evidence-based like Tai Ji Quan: Moving for Better Balance©.
3. Creating a Safe Home – Most falls occur at home, so the program should include a walk-through of the patient’s home and yard with special attention to the three major problem areas: stairs, the bathroom and the bedroom. Lighting, trip hazards and adaptive equipment should all be evaluated and addressed.
4. Safety Away from Home – Control diminishes when leaving home, so awareness needs to increase. A good program will cover the unique hazards patients will encounter outside the home like curbs, weather, transportation and crowds.
5. Healthy Feet/ Safe Footwear and Clothing – A good falls prevention program will address foot health including self-inspection and when to consult with a physician. The program should make recommendations for footwear choice and fit, as well as clothing that should be avoided.
6. Impact of Chronic and Short-Term Illnesses – Health issues can increase a patient’s risk of falling. Blood pressure fluctuations, diabetes, stroke, arthritis, Parkinson’s and osteoporosis all put a patient at higher risk of falling or injury. The potential impact of short-term illnesses, like the flu, should also be addressed.
7. Side Effects of Medication – Prescriptions and over-the-counter medications can cause drowsiness, dizziness or fainting all of which can lead to a fall. A good program will include a way for patients to track medications and their side effects. Patients should be encouraged to discuss increased risk with their doctor or pharmacist.
8. Effects of Falling – Patients may be more likely to comply with a falls prevention program if they understand the impact of falling. Injury is the key risk, but once a patient has fallen they may be fearful of participating in activities. Falling will impact quality of life, so share these facts from the CDC’s website. Even I found them alarming!
   • More than one out of four older people fall each year, but less than half tells their doctor.
   • Falling once doubles your chances of falling again.
   • More than 95% of hip fractures are caused by falling, usually by falling sideways.
   • Falls are the most common cause of traumatic brain injuries (TBI).

   Source: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

9. Fall Triage – While a good program is designed to prevent a fall, patients should also be counselled on what to do if they fall. First, and foremost, all falls should be evaluated by medical staff. The program should cover when immediate attention is needed and when they could wait for an appointment. Patients should also be taught how to get up from a fall and have a back-up plan if they are unable to get up.
10. Post-Fall Survey – Finally, every fall or near fall should be evaluated by the patient, their caregivers and their health care team. An evaluation can be critical in preventing another fall by uncovering hazards, environmental factors or behaviors that could be easily addressed.

My book, the Occupational Therapy Toolkit includes my own fall prevention booklet “Don’t Let a Fall Get You Down”, “Post-Fall Survey” and other patient education handouts for medication management, medical conditions, exercise programs and foot safety. My book also includes resources for the Occupational Therapist: “Fall Triggers and Tips to Prevent Falls” and the “Home Safety and Performance Assessment”.