GERO GEMS Falls - Threat to Independence

Part 3 – Environmental Challenges September, 2010

Physical environment plays a critical role in maintaining health, safety and quality of life at any age. From dim lighting, uneven terrain and steps, to throw rugs, slippery surfaces and pets, environmental hazards are everywhere. In addition to environmental factors, decreased strength, diminished vision and a variety of other age-related changes [mental and physical] increase the risk of older adults falling indoors and outside. As you know, falls threaten independence and the fear of falling often leads people to pursue sedentary lifestyles. We focus this edition of our Falls series on common risks to safety for older adults that occur in everyday environments. It has long been recognized that as we age, negotiating the physical environment becomes increasingly challenging and many older adults may need support to live safely. Renowned gerontologist M. Powell Lawton suggests there is a need to ensure that the environment “fits” the older adult and supports the person at his/her competency (capability) level.6 For example, if an older adult has declining vision, there may be a need to increase the lighting to match visual capability. The increased lighting may help the person safely function in his/her environment. Without sufficient lighting meeting daily needs and performing routine activities may be risky. Evidence indicates that Lawton’s person-environment fit was found to be the best predictor of falls inside the home.7 Research indicates that many older people do not perceive themselves at risk for falls.8 Health care and social service professionals need to help older people create more “user friendly” living areas by raising their awareness about fall risks such as pets, loose rugs, inappropriate use of assistive devices, walking on cracked or uneven surfaces and more. Professionals are aware that education alone is not a panacea, but making people aware of potential risk is a critical first step.

Did you know?

Studies indicate 1/3 of falls involving community-dwelling older people occur as a result of accidents or environment factors. 1

Falls are the greatest 2, 3

source of injury for older adults.

About 45% of falls occur in or around the home; 60% or more occur in nursing homes

Nearly 60% of falls result in an emergency room visit

Environmental fall risks in the home include: 4

dim lighting highly polished floors loose rugs inappropriate use of assistive

devices (e.g., cane, walker) pets going barefoot or use of

inappropriate footwear stairs without rails

Risky behaviors that increase fall risk include:

Using step ladders or getting up on chairs

Reaching high above the head or forward

Walking on uneven surfaces Rushing/multi-tasking

According to the American Academy of Orthopedic Surgeons, “Falls could reach epidemic levels as the population ages. Older people at highest risk for falls include: older women, those unable to stand on one leg for more than five seconds, multiple medications, living alone.” 5

Best Practice Examples of Environmental Tips to Reduce Fall Risk As part of a multifactorial approach to fall prevention and risk reduction, we offer a few examples of environmentally-based fall risk screening tips. These tips may be helpful when advising older adults to check and see if making modifications to their home environment may reduce common risks and make the home a better fit. Things to assess include:

Surfaces are free of spills, clutter, unevenness, loose rugs (get rid of loose rugs or use tape) Level of illumination fits the person and functions properly (enough working lights) Grab rails and grab bars are attached in the bathroom (near toilet, in bathtub/shower area) Adaptive aides are being used properly and are in good repair (canes/walkers, reachers, etc.) 9, 10

Because many older people do not perceive themselves at risk for falls, Lawton’s environmental perspective may be helpful. Lawton suggests it may be more helpful to frame education about fall risk by using person-environment fit concepts rather than the more traditional age-related, increasing vulnerabilities discussion. Perhaps a focus on vulnerability does not match the older person’s self-image. However, suggesting people make changes or adapt their environment to better fit their capabilities, enhance safety and maintain independence may be more helpful.

The literature includes scant research on environmental risk for falls that occur outside. We offer a few common sense tips such as paying more attention when walking on uneven surfaces (curbs, cracked walkways), avoiding dimly lit areas, increase caution on wet or icy surfaces, avoid multi-tasking and wear appropriate footwear. Health care and social service professionals play a key role in helping to include awareness and understanding of older adults about environmental risks for falls and encouraging risk reduction methods to prevent falls.

The CDC offers an easy to use fall prevention checklist designed for use by older people. It is available at: www.cdc.gov/HomeandRecreationalSafety/Falls/CheckListForSafety.html.

References: 1. Rubenstein, L., & Geffen, D. (2006). Falls and their prevention in elderly people: What does the evidence show? Medical Clinics of North America, 90,

807-824 2. Shiller, J., Kramarow, E., & Dey, A. (2007). Fall injury episodes among noninstitutionalized older adults: United States, 2001-2003. Adv Data, 392, 1-16. 3. Chen, L., Warner, M., Fingerhut, L., & Makuc, D. (2009). Injury episodes and circumstances: National Health Interview Survey, 1997-2007. National

Center for Health Statistics. Vital Health Stat (10) 241. 4. Chang, J., et al. (2004). Interventions for the prevention of falls in older adults: Systematic review and meta-analysis of randomized controlled trials.

British Medical Journal, 328 (7441), 680. 5. American Academy of Orthopedic Surgeons. (2007). Don’t let a fall be your last trip: Who is at

risk? http://orthoinfo.aaos.org/topic.cfm?topic=A00118&return_link=0n 6. Lawton, M., & Nahemow, L. (1973). Ecology and the aging process. In Eisdorfer and Lawton

(Eds.), Psychology of Adult Development and Aging. Washington, D. C., American Psychological Association.

7. Iwarsson, S., et al. (2009) Person-environment fit predicts falls in older adults better than the consideration of environmental hazards only. Clinical Rehabilitation, 4, 23: 558-567.

8. Hughes, K., et al. (2008). Older persons’ perceptions of risk of falling: Implications for fall-prevention campaigns. American Journal of Public Health, 98(2): 351–357.

9. AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons. American Geriatrics Society. www.americangeriatrics.org/health_care_professionals/clinical_practice/ clinical_guidelines_recommendations/prevention_of_falls_summary_of_recommendations/

10. Hartford Institute of Geriatric Nursing. Nursing Standard of Practice Protocol: Falls. http://consultgerirn.org/topics/falls/want_to_know_more#item_4

College of Nursing

University of Cincinnati 3110 Vine Street, Procter Hall

PO Box 210038 Cincinnati, OH 45221-0038

(513) 558-2428

www.SAFEafter60.org

GERO GEMS is a publication of the Center for Aging with Dignity. The Center is devoted to keeping people “SAFE After 60” by advocating for, advancing and developing best-practice programs on the safety and mistreatment of older adults. Written by Evelyn Fitzwater. Edited by Charles Puchta. Copyright © 2010 University of Cincinnati.

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GERO GEMS – page 2