Environmental assessment and modification as a fall management strategy

Falls are a major cause of injury and mortality among older adults, especially those who live in the community. Falls can result in physical, psychological, and social consequences, such as reduced mobility, fear of falling, loss of independence, and increased health care costs. Therefore, preventing falls is a priority for promoting the health and well-being of older adults.

One of the strategies to prevent falls is environmental assessment and modification (EAM), which involves identifying and removing or reducing environmental hazards that may increase the risk of falling. Environmental hazards can be intrinsic (related to the person’s physical or mental condition), extrinsic (related to the home or community setting), or behavioral (related to the person’s activities or choices). Examples of environmental hazards are poor lighting, slippery floors, loose rugs, clutter, uneven surfaces, stairs, lack of grab bars, inappropriate footwear, and medication use.

EAM can be delivered by various professionals, such as occupational therapists, nurses, physiotherapists, or home care workers. However, evidence suggests that EAM is most effective when it is led by an occupational therapist, who can conduct a comprehensive and individualized functional assessment of the person in their home environment, use a joint problem-solving approach with the person and their caregivers, and provide follow-up as required. Occupational therapists can also address other factors that may influence the person’s risk of falling, such as their physical abilities, cognitive status, emotional state, lifestyle habits, and personal goals.

EAM can be implemented as a standalone intervention or as part of a multifactorial fall prevention program that includes other components, such as exercise, education, medication review, vision screening, and referral to other services. Research findings indicate that EAM is an effective approach to reducing falls and that EAM for fall prevention should be of high intensity (at least 5 hours of contact time), provided by occupational therapists and targeted to high-risk populations (those who are over 65 years old, have a history of falls, use a mobility device, need assistance with daily activities, take psychoactive medications, or are concerned about falling).

EAM has several benefits for older adults and their caregivers. It can improve the safety and accessibility of the home environment, enhance the person’s functional performance and confidence, reduce the fear of falling and the risk of injury, increase the quality of life and satisfaction with living arrangements, and decrease the need for institutionalization or hospitalization.

To summarize, EAM is a fall management strategy that involves assessing and modifying the environmental factors that may contribute to falls among older adults. It is best delivered by occupational therapists who can tailor the intervention to the person’s needs and preferences. EAM can reduce falls and improve outcomes for older adults who are at high risk of falling.

References:

– Pynoos J., Steinman B.A., Nguyen A.Q.D. (2010). Environmental assessment and modification as fall-prevention strategies for older adults. Clinics in Geriatric Medicine , 26 (4): 633-644. https://doi.org/10.1016/j.cger.2010.07.001
– Pighills A., Drummond A., Crossland S., Torgerson D.J. (2019). What type of environmental assessment and modification prevents falls in community dwelling older people? BMJ , 364 : l880. https://doi.org/10.1136/bmj.l880
– Furness L., McEvoy M.P., Murphy G., Cassar K., Dollard J., Maher C.G., Lewis L.K., Wiles L.K., Taylor A.W., Hill C.L. (2017). Falls prevention environmental assessment and modification in regional Australia: study protocol for a randomized controlled trial. Trials , 18 : 1-9. https://doi.org/10.1186/s13063-017-1858-3

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