This is Part II of an earlier presentation on Falls Prevention in Older Adults, also by Dr. Jayasinghe, entitled Understanding Why Falls Happen.
In this second session of a two-part staff development training series offered by Hospital for Special Surgery VOICES 60+ Senior Advocacy Program in 2011, Dr. Jayasinghe presented an in-depth discussion of falls prevention strategies and interventions for older adults.
Dr. Jayasinghe outlined learning objectives for the presentation, including:
Dr. Jayasinghe explained that for adults aged 65, 70, 80, and above, their fall risks increase significantly and they may be at a higher risk of suffering injuries due to osteoporosis or other illnesses. She also said that people who live alone may be at added risk for fall and greater injury because they are unable to get up and seek help. They could suffer from dehydration, develop sores, and may not be able to get medical care to quickly address any significant harm or health issue.
As stated by Dr. Jayasinghe in Part I of her presentation, it may be better to ask a patient about safety, rather than falling. It’s important to be able to assess his/her risk without making the patient feel uncomfortable. Simply ask questions such as, “Do you worry about your safety? Do you think about your safety?”
If the patient is receptive to these initial questions, follow-up questions regarding their concerns about their falls history could include the following:
It’s always good to remind patients that falling is very common and that they need not be ashamed of it. Getting a snapshot of what's been happening over the last couple of days, months, and years that might have led to tripping and falling could be very useful in understanding the problem.
A lot of people attribute their falls to their environment. They will often say:
The best option would be to sit down with your patients and chat with them about what they can do to protect themselves against falling. It’s important to talk to patients about their concerns and address their needs.
As an additional aid, Dr. Jayasinghe introduced a “Falls Efficacy” scale, on which patients are asked to mark down how worried they are about falling.
Patients are asked to rate on a scale from 1 to 10, with 1 being very confident and 10 being not at all confident, how they feel performing daily activities such as:
Dr. Jayasinghe suggested questions regarding risk factors that should be addressed with patients:
In reference to the 10 risk factors, Dr. Jayasinghe shared a few points to remember:
Dr. Jayasinghe reported that patients often experience some levels of distress after a fall. Literature has shown that many patients will often have a low level of confidence about performing daily activities; they could be at risk of experiencing depression and also symptoms of post-traumatic stress disorder (PTSD).
Low level of confidence can be present in all of the daily activities covered in the aforementioned Falls Efficacy scale.
Signs of depression after falling include:
Signs of PTSD:
It is important to discuss patients' falls risk or expressed concerns with their physician, who may refer them to an occupational or physical therapist who can teach them how to move safely after they have experienced a fall. Upon further medical evaluation for risk factors, the physician may also want to further assess their patient’s medical status, daily medication regimen, etc.
Developing a strategic plan and motivating a patient to develop a plan taking into account his or her needs, as well as providing available informational resources, will help the patient to feel more involved and safe.
There are many specific things that can be done in terms of falls prevention, including:
Motivation for falls prevention is critical for people who are at risk of falling. It helps empower them to be able to take the steps they need to take. And it’s more effective when motivation comes from multiple voices, including their friends, family, and health care providers.
The mission of VOICES 60+ is to enhance the medical care experience of patients 60 and over by helping them to navigate and access the care, community resources, and education they need. These training sessions seek to address staff development needs which advance the Prevention Agenda for Public Health of our hospital’s Community Service Plan.
VOICES 60+ has expanded its existing program priorities to:
Summary by Jacqueline Sandoval, Program Associate, VOICES 60+ and Juliette Kleinman, LCSW, ACSW, Manager, VOICES 60+
Presentation, updates, and edits by
Nimali Jayasinghe, PhD
Clinical Assistant Professor of Psychology in Psychiatry (voluntary faculty since August 2015)
Weill Cornell Medicine