Falls prevention starts at home
Almost half of falls amongst older adults in Western Australia occur in the home and garden. Hazards in the home environment, particularly in combination with other falls-risk factors, have a major impact on the risk of slips, trips and falls. Fortunately health and community care professionals in the community can support older adults to significantly reduce their risk and stay independent for as long as possible.
To assist health and community care professionals to provide evidence-based falls prevention information and services to older adults in the community, the Injury Control Council of WA and the Stay On Your Feet® program, held the third Move Improve Remove forum; Make Your Home Safer.
On Thursday 7 April 2016, an audience of allied health and other professionals working with older adults in the community attended in-person at the Boulevard Centre in Floreat, and via webinar, to learn and share their experience preventing falls. Those attending the evening also had the opportunity to reconnect with colleagues and network with other professionals working in this unique falls prevention space.
“Beyond mats and poor lighting”
The evening began with the first of three guest speakers, each established in their respective fields and well-equipped to share their knowledge and experience about the prevention of falls in and around the homes of older adults.
Occupational Therapist Anne Pressley’s aptly named presentation explored the scope of the occupational therapist’s role in falls and maximising the independence of their older clients.
Occupational therapists have a comprehensive skill set including the ability to conduct specialist assessment of function in unique environmental contexts whilst considering the impact of a client’s medical conditions, disabilities and cognitive or perceptual impairments.
An occupational therapist will then apply goal setting, self-management and behaviour change strategies to support clients to adopt functional strategies and adapt to the required environmental modifications.
“There is strong evidence to support an occupational therapy home visit as part of a multidisciplinary approach to prevent falls” Anne said however also noted that behaviour, cognition, culture and past experience shape a client’s attitude towards falls prevention and strongly influence their likelihood of adopting new or modifying old behaviours to reduce their risk of falling, “We need to have a very clear working relationship and understanding of where your client’s attitudes sit. At the end of the day, a successful falls intervention in a client’s home is going to come down to the relationship that you build with the client”.
Enablement and opening the lines of communication
Following on from Anne’s presentation, El Bennet; the Operations Manager of Home and Community Care organisation Melville Cares, shared her experience delivering enablement training to her support staff.
“Enablement training is not just about conditioning the client’s thought processing; it’s also to enable the support staff to have the confidence to discuss the issues that may be presented by occupational therapists and take the client on the journey to achieving sustainable behaviour change”.
An important discussion that arose from El’s presentation involved the link between health professionals and Home and Community Care (HACC) providers. It became clear that HACC support staff have the potential to play a key role in enabling clients to complete, for example, an occupational therapist or physiotherapist prescribed exercise program or changes in the performance of everyday tasks.
El believed that the support worker-client relationship could be credited for the achievement of sustained behaviour change in many older adults receiving HACC services from Melville Cares, however this relationship was not being utilised to its full potential. “HACC support workers may not have the knowledge that occupational therapists have but they do have the privilege of being in the client’s home for a lot longer and building the trust (required to facilitate behaviour change)”.
El described the need for a link, funded or not, between the worlds of health professionals and support workers to prevent not only falls but many other adverse events from happening in the community. For example, if a support worker was notified and present during their client’s occupational therapy assessment, they could then certainly assist with supporting the client to make the necessary modifications to current behaviour as outlined in a care plan.
The current situation was summed up perfectly by El, “HACC support staff have the time with client but they don’t have the education. Health professionals have the education but don’t have the time”.
There was agreement amongst attendees that open lines of communication between health professionals and HACC providers would be ideal of great benefit to clients. However determining how this would be achieved remained elusive.
Livable housing for an independent life
To conclude the evening, accredited access consultant at Planot, Claire Cunningham, shared her knowledge and passion for livable housing as “housing that is for anybody, of any age, of any ability”.
Claire encouraged the audience to think about their home and how their ‘nanna’ would navigate, for example, the four steps up to the front door, the narrow width of the corridor when attempting to manoeuvre her walking frame, or entering the shower with a high threshold.
This helped attendees understand the significance of the home environment in the ability of older adults to perform activities of daily living and how certain features may increase or decrease their risk of falls.
Claire then outlined the following areas of the home that can be modified, or better yet, designed prior to construction, to meet the criteria of a livable house: paths of travel, lighting, thresholds, door widths and circulation space. The specifications required of each area are described in various Australian guidelines and standards, rather than a single document. However she said there was limited uptake of these guidelines by the construction industry as they are not legislated.
Despite this, Claire’s take home message remained that “the answer lies in planning rather than modification”. When audience members inquired about the increased costs associated with livable housing, Claire said that the “benefits far outweigh the costs and the costs themselves can be minimal”. Planning and constructing livable homes that can be easily adapted for modifications in the future or better still, that require minimal modifications, is far less costly than carrying out major modifications to homes built without considering the needs of occupants across their lifespan.
The Injury Control Council of WA and the Stay On Your Feet® program would like to thank all those who attended the evening and for contributing to the prevention of falls in the Western Australian community.
Feedback collected from those in the audience was largely positive noting that forum contained information relevant to their current role and had increased their awareness and knowledge of the topics discussed.
The next Move Improve Remove forum will be held during the three-month Strengthen Your Legs campaign launching in September 2016.