A Team Approach to Falls Prevention

Angela Edney | posted June 30, 2009 |

Falls are a serious problem with seniors. It has been estimated that one out of three people over the age of 65 have at least one fall each year. Unfortunately, many falls lead to injury and may cause loss of mobility and independence for seniors. It’s an even worse problem for older adults with dementia.  

Traditionally, physical therapy has been the primary discipline involved in the development of falls prevention programs, whereas occupational therapy addressed only the environmental changes like removing scatter rugs and installing grab bars for the bathtub and toilet. In order for a falls management program to be successful, I believe that occupational therapy needs to play a much larger role.

Some think falls prevention is only about improving balance and strength. However, balance is a dynamic process that integrates both sensory and motor processes. Therefore, I believe an effective falls prevention program needs to be comprehensive in nature. It should involve a team approach that focuses on the many components of balance. In a skilled nursing facility that team would include the nursing staff, the maintenance staff, the activities coordinator, the dietician and the physical, speech-language and occupational therapists.

Maintaining balance requires applying the correct sequence of sensory input. This involves the processing of that input, the response planning of it, and then acting out that response by applying the appropriate amount and duration of muscle activity. Sensory deficits and cognitive dysfunction can have a significant impact on this process. Knowing a person’s cognitive ability is a key factor in developing a successful program for the individual.

One of the most popular approaches we use to address cognitive disabilities is the Allen Cognitive Model, which measures cognitive ability according to six hierarchical levels. These levels range from Level 0.8, which indicates a profound disability and near unresponsiveness, to Level 6, which indicates normal functioning.  The cognitive levels are further classified into 52 modes of performance that measure and classify smaller increments of change.

There are many assessment tools available to help determine a patient’s Allen Cognitive Level (ACL) score. Once an occupational therapist has an ACL score for a patient, they can then choose from the many treatment guidelines out there to assist them. These resources are unlike cookbooks with step-by-step recipes; they are reference guides meant to provide therapists with suggestions for treatment planning. The Allen Model addresses motor skills, self-care, functional mobility, communication, instrumental activities, continence, safety, environmental modifications, community activities, productive activities, etc.     

Even though the ACL score provides the treatment team with valuable information, it is still very important they consider other underlying factors that impact performance such as sensory and motor dysfunction.  Additionally, the environment, current routines, past roles, interests, and the ability of the caregiver are also important elements that must be considered when developing an optimal program for a patient. It is also important to remember that cognition is dynamic, and therefore, fluctuates with treatment planning.  Because of this, therapists must always use their clinical judgment when making recommendations based on an ACL score.