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  • Lauren Robins

The Occupational Therapist’s Role in Falls Prevention

Falls are the most common preventable injury in Canada 1 . According to the Canadian Institute for Health Information, there were almost 654,000 reported emergency department (ED) visits for injuries sustained after unintentional falls, accounting for almost a third of all reported ED visits for injury and trauma in 2017 2 . While unintentional falls are typically associated with the older adult population, falls are common in younger individuals as well. In fact, when looking at demographics, 72% of reported ED visits for falls were made by patients younger than sixty-five 2 .


Occupational therapists (OTs) are well-positioned to approach falls prevention by addressing the personal, environmental and behavioral factors that influence people’s

participation in activities at home and in the community. OTs can assess clients in their home environments and provide interventions that include education and skill development to help their clients safely engage in their daily lives and reduce risk of falls. This is particularly important for the clients we work with at NCCO who may be experiencing multiple different challenges and symptoms due to their injuries that can increase their risk of falls. For example, clients with lower extremity injuries and amputations may be at increased risk of falls while adjusting to new ways of walking and completing activities. Furthermore, clients may be experiencing cognitive impairments from traumatic brain injuries (TBIs). Some common symptoms of TBIs include headaches, dizziness, reduced energy levels and balance issues. Unfortunately, these symptoms can make a person more likely to experience a fall.


Given the importance of navigating the environment in daily routines and the challenges commonly experienced by our clients, we want to share some common interventions and strategies that assist our clients to prevent falls and safely complete their daily activities!


1. Home Assessment. Your home environment can increase your risk for a fall. Up

to 75% of falls occur in the home environment, particularly in the bathroom,

kitchen and stairways 3 . OTs can look out for hazards in the home, such as high

bed/toilet heights, clutter, slippery floors and rugs, and inadequate lighting.

During the assessment, OTs can observe clients:

  • Transferring from the bed and toilet and in/out of the shower or bathtub

  • Going up and down stairs

  • Reaching up and bending down to receive objects in the kitchen

These observations can help the OT to determine where the greatest risks are in

the home environment and intervene accordingly.


2. Assistive Devices. Based on the assessment, OTs may recommend assistive

devices to help you reduce the likelihood of falls. Some common ones include:

  • Raised toilet seat – this makes the toilet seat higher so that it is easier for people to transfer on/off the toilet.

  • Grab bars next to toilet/in the shower – these provide a secure way for individuals to maintain balance in the bathroom instead of grabbing onto towel racks, sink edges, etc. for support as these can be unstable.

  • Nightlight in the bedroom/hallway – this can be particularly helpful for individuals who frequently use the bathroom at night. Adding lighting to these areas is a simple method to reduce your risk of falls.

  • Reacher – this device can help people to reach items in very high/low places so that they do not have to stand on an unsafe surface (ie. a chair) or bend over which can increase risk of falls.


3. Proper Footwear. Improper footwear, such as slippers and socks, can lead you to

trip and result in unintentional falls 4 . Some common recommendations OTs make

include:

  • Wearing supportive shoes with a secure back in the home environment instead of socks/slippers, particularly when navigating stairs.

  • Wearing proper snow boots in the winter if you plan to go outside.


4. Remaining Active. Being physically active helps you to maintain your overall

strength, endurance and balance. OTs encourage clients to remain active by

engaging in activities that are enjoyable and meaningful to them, such as

gardening, swimming, walking with friends, or yoga. Participating in an activity

that you enjoy increases the likelihood that you will want to keep doing it!


5. Energy Conservation. OTs may also highlight energy conservation as a means to

reduce your risk of falls. There are 4 P’s of energy conservation 5 :

  • Prioritize - Decide what needs to be done today and what can be done later in the week. This can help make sure you are completing more strenuous/important tasks when you are most energized.

  • Plan – plan out your activities ahead of time to avoid unnecessary trips/steps.

  • Pace – maintain a slow pace and don’t rush. When people rush, they are more likely to experience a fall!

  • Position – sit when you can to conserve energy and reduce risk of falls (ie. while cooking, brushing teeth, showering).


Please note that recommendations that are more individualized to your abilities and needs can be made with a formal assessment. If you feel that the recommendations/strategies above may be helpful for you or a family member/friend, please consult with your OT or reach out to us at NCCO for a referral!


References

1. Parachute. (2021). Cost of injury in Canada. Retrieved from

https://parachute.ca/en/professional-resource/cost-of-injury-in-canada/

2. Canadian Institute for Health Information. (2017). Exercise caution: Canadians

frequently injured in falls. Retrieved from https://www.cihi.ca/en/exercise-caution-

canadians-frequently-injured-in-falls

3. Hall, C. (2018). Occupational therapy toolkit: patient handouts and treatment guides for

physical disabilities, chronic conditions and geriatrics. Tomonium, MD: Hallen House

Publishing.

4. Cumming, R. G., Thomas, M., Szonyi, G., Frampton, G., Salkeld, G., & Clemson, L.

(2001). Adherence to occupational therapist recommendations for home modifications for

falls prevention. The American journal of occupational therapy, 55(6), 641-648.

5. St. Joseph’s Healthcare. (2013). Energy Conservation. Retrieved from

https://www.stjoes.ca/patients-visitors/patient-education/a-

e/PD%208278%20Energy%20Conservation.pdf

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