Stand Up To Falling. Facilitator Script (Optional Talking Points for Presentation)

Transcription

1 PowerPoint TM Script (32 slides): Slide 1 Stand Up To Falling Facilitator Script (Optional Talking Points for Presentation) Introduce yourself. Thank participants for coming. Distribute Lesson 1 PowerPoint TM handout.. Participant Activity (This question can be asked here or during slide 2): By a show of hands, who in this room has experienced a fall or knows of someone who has fallen? Encourage participants to briefly share their story. Educational programs of Kentucky Cooperative Extension serve all people regardless of race, color, age, sex, religion, disability or national origin.

2 Slide 2 Fall Facts In a given year, 1 in 3 older adults (65+) can expect to fall. Falls are the leading cause of injury and injury-related death for 65+. Falls are the leading cause for traumarelated hospital admission for 65+. Falls jeopardize health and independence of older adults. The risk of being seriously injured in a fall increases with age. Participant Activity (if not used with Slide 1) By a show of hands, who in this room has experienced a fall or knows of someone who has fallen? Encourage participants to briefly share their story. A quick summary of WHO falls (Loyola Health Systems) Older women (specifically Caucasians and Asians) 65+ yr olds who can t stand on one leg for more than 5 seconds Those who use 4+ prescription and over-the-counter drugs Older adults who live alone Miscellaneous Facts from the CDC (2010): (May want to highlight 2 or 3) Every 18 seconds, a 65+ yr. old is treated in an ER for a fall. Every 35 minutes, an older adult dies due to fall-related injury. Fall-related injuries for 65+ cost around $ billion/yr. If the current rate of falls among seniors is not reduced, fall-related treatment costs will reach $43.8 billion/yr by Men are more likely to die from a fall than women. Women = 67% more likely than men to have a nonfatal fall injury. Rates of fall-related fractures among older adults are more than twice as high for women as for men. In 2003, about 72 percent of older adults admitted to the hospital for hip fractures were women. Nearly 85% of deaths from falls in 2004 were among 75+ yr. old. People 75+ who fall are 4-5 times more likely to be admitted to a long-term care facility for a year or longer. Page 2

3 Slide 3 Kentuckians 65+ Approx. 33,000 older adults were treated for fall-related injuries in KY hospitals in ,000 older adults hospitalized each year More than 150 older adults die each year from the consequences of falls. Approximately 17,000 older adults have fall-related emergency department visits. On a typical day in 2007, falls among Kentuckians 65 and older resulted in 70 emergency room visits, 16 hospitalizations, and 8 to 9 hip fractures. Kentucky's older adult population is projected to nearly double between 2010 and 2030, substantially increasing the number of people most at risk of being injured in a fall. In Sept. 2009, Gov. Steve Beshear officially proclaimed the first day of fall as Fall Prevention Awareness Day in the Commonwealth of Kentucky. The resolution was unanimously passed by Congress in Sept. of Sources: Kentucky Injury Prevention and Research Center (2011). AARP. (2009). National Council on Aging. (2011). Page 3

4 Slide 4 Common Fall-Related Injuries Bruises Fractures (hip, spine, forearm, leg, ankle, pelvis, upper arm, hand) Head trauma Participant Discussion: As a group, brainstorm and discuss the consequences of falling beyond an injury (try to tie this into the discussion you may have had about falling during Slide 1 or 2). - Consequences may include: reduced independence, dependence, hospitalization, fear of falling (fears of falling will be discussed on next slide), decreased confidence, social isolation, institutionalization, decreased interest/ability to participate in physical activity/exercise, hurt pride, feeling old. Talk about why it is important to prevent falls from occurring - Note: Injuries (slide information) limit independent living AND can increase the risk of early death Source: U.S. Centers for Disease Control and Prevention (CDC). (2009). Page 4

5 Slide 5 Fear of Falling It is not uncommon for people who fall (regardless of degree of injury) to develop a fear of falling. Such fear: Limits activity Causes increased dependency Leads to social isolation Participant Activity: Ask, by a show of hands, who in the room thinks about falling or is afraid of falling? - Encourage participants to briefly share their story. It is not uncommon for people who fall (regardless of degree of injury) or for those who feel unsteady on their feet, to develop a fear of falling. Such fear can: 1. Limit activity which in turn leads to reduced mobility and fitness which increases one s risk for falling. - Note: Loss of muscle tone and strength occurs in a short amount of time but muscle tone/strength can be increased, even in old age. - With a fear of falling, a person may become more hesitant when walking, which can lead to falling. - A person may also feel anxious if he/she is fearful of falling. With such apprehensions, a person might reach out to take hold of a piece of furniture to support themselves BUT, this method of reaching and grasping can cause a person to lose balance which can further increase the fear of falling and can cause a fall itself. 2. Increase the need to be dependent with fear and the consequent loss of mobility and decrease in physical and social activities, a person will be more likely to depend on others in order to carry out everyday activities including hygiene needs, household tasks, and leisure activities such as walking outside, going shopping, or going to church. 3. Lead to social isolation older adults living alone are more likely to fall. Page 5

6 Slide 6 People are NOT falling because they are old The good news: People are NOT falling because they are old. They are falling due to a number of internal (intrinsic) and external (extrinsic) RISK factors (see next slide for more detail) that make them more susceptible to falling. We are here today to discuss in greater detail the PREVENTABLE RISK FACTORS so that we can lower the risk of falling and prevent falls from occurring. Page 6

7 Slide 7 Why Older Adults are at Increased Risk for Falling Risk Factors: Something that increases a person s risk or susceptibility to a medical problem or disease: Internal Risk Factors External Risk Factors Falls don't "just happen," and people don't fall because they get older. - Usually, more than one underlying cause or risk factor is involved in a fall. - A risk factor is something that increases a person's risk or susceptibility to a medical problem or disease or in this case, a fall. As the numbers of risk factors rise, so does the risk of falling. Risk factors for falls can be grouped into two categories: 1. Internal or Intrinsic Factors (originate within the person). 2. External or Extrinsic Factors (occur due to outside factors). Many falls involving older adults are linked to BOTH internal and external risk factors. Page 7

8 Slide 8 Internal Risk Factors (originate within a person) Normal age-related changes (e.g., problems with vision, weaker muscle strength, poor balance, gait problems) Neurological/cognitive disorders (e.g. gait disorders, stroke, Parkinson s disease, Multiple Sclerosis (MS), traumatic brain injury) Disease/medical problems linked to physical condition (e.g., heart problems, diabetes, circulatory disease, depression, arthritis, postural hypotension, gastrointestinal problems, reactions to medicine) Internal Factors originate within the person and relate to how well a person can see, walk, maintain balance, exhibit muscle strength and endure physical activity. A variety of internal risk factors can lead to falling: 1) normal age-related changes; 2) neurological/cognitive disorders; and 3) Disease/medical problems linked to physical conditions. It is important to be aware of internal risk factors and ways in which you can stay healthy to help prevent falling. MORE DETAIL FOR OPTIONAL PRESENTATON MATERIAL ABOUT INTERNAL RISK FACTORS: 1. Normal age-related changes that can lead to falling: - Weak Bones: As we age, bones become weaker and more vulnerable to fractures. Osteoporosis (a bone disease that makes bones fragile) increases the risk of falling. To help prevent bone deterioration: medication, diet, regular weight-bearing exercise. - Arthritis: Osteoarthritis is the most common type of arthritis. It affects 30 to 60% of people 65+ yrs. old. Arthritis affects load-bearing areas of the joints. This results in pain, stiffness, and decreased range of motion of the knees and hips. Pain and inflammation in the joints can decrease a person s balance, strength, and ability to get up from a chair or climb the stairs. All of these factors contribute to the risk of falling. While there is no proven way to prevent arthritis, it is important to maintain a healthy weight, engage in regular exercise, and eat a healthy diet that includes fruits, vegetables, and whole grains. - Vision Impairment: After the age of 50, vision becomes increasingly impaired due to the normal aging process. With age, you are also more susceptible to eye disorders and vision problems including cataracts, glaucoma, and age-related macular degeneration. Common age-related vision impairments and diseases of the eye will be discussed soon (Slides 12-14). To help prevent vision impairment: Older people should have yearly eye exams and treat vision issues to prevent them from becoming bigger problems. - Weak Muscles: Decreased muscle strength is associated with falling. With age, flexibility, coordination, balance & strength can be improved with exercise. More on the importance of physical activity and exercise will be discussed in a little bit (Slides 20-27). 2. Neurological/Psychological disorders and Diseases: Certain diseases and psychological disorders can cause changes in coordination, strength, and balance. Walking may be become more difficult. People may have distorted judgment or depth perception. Page 8

9 Common disorders/diseases linked to falling include: Parkinson s disease, Alzheimer s disease, advanced diabetes. In terms of preventing falls, disease prevention can be key to a successful strategy. - Note: A fall can be the first sign of the onset of an illness or infection. It also can be the first sign that a chronic illness is getting worse, especially if the person has a cardiac, nerve, or a muscle disease. - Note: Chronic diseases, especially in women, have been found to increase the risk of falling. Confusion, even for a short while, can lead to falling. For example, if you wake up in an unfamiliar environment, you might feel unsure of where you are. If you feel confused, wait for your mind to clear or until someone comes to help you before trying to get up and walk around. Medications and certain diseases can also cause confusion. More Information on Specific Internal Factors: The following information provides a more complete list of some relatively common internal or intrinsic factors that contribute to falls in older adults. You might look at some of these intrinsic factors and say, a fall IS inevitable I can t do anything about this stuff. But that is NOT true. Research has demonstrated that prevention and control of chronic disease can be a successful strategy to help reduce and prevent falls from occurring. Other diseases or treatments of diseases that can lead to increased risk for falls: Cancer/Cancer treatment: cancer and cancer treatment can weaken an individual. Treatment can also cause anemia (lack of healthy red blood cells), which often causes a person to feel tired and leads to an increased risk for falls. Congestive Heart Failure: The ability to walk at a regular and steady pace is affected in people with congestive heart failure. Heart failure causes decreased muscle strength, lack of endurance, and increased fatigue that all lead to changes in gait, or the way a person walks. Edema or fluid in the lower extremities: Edema causes swelling. Swollen legs can diminish an individual s ability to maintain balance. The increased weight in the legs due to the water retention also causes a change in how people walk. The change in balance and the way in which a person walks increases the risk of falling. Blood Pressure: The receptors in arteries that detect sudden changes in blood pressure become less sensitive with age. As a result, an older body s ability to recognize changes in blood pressure is decreased. An older body has more difficulty maintaining blood pressure to the brain when sudden changes in posture occur particularly when an older adult goes from a lying to a standing position. As a result a person s blood pressure drops suddenly (this is called: orthostatic or postural hypotension). When blood pressure drops, a person may feel nothing OR become lightheaded, and/or dizzy leading to a fall. This condition can result from dehydration, or certain medications. It might also be linked to diabetes, neurological conditions such as Parkinson's disease, or an infection. Approximately 30% of older adults suffer from postural hypotension (Source: NIH Senior Health: Gatrointestinal Problems: Issues that require an older adult to make multiple trips to the bathroom increases their risk of falling, especially if they are trying to move quickly to avoid having an accident on the floor or in a chair. Diarrhea, nausea, and vomiting also increase the chance of the older person becoming dehydrated because of the excessive loss of fluid without an increased intake of food or drink. Dehydration further weakens and debilitates an individual, increasing the risk of falling. Incontinence: a person who cannot control his/her bladder (or bowels) will often try to make it to the bathroom, lose bladder control on the way, and then slip and fall on the wet floor or fall due to the rush in Page 9

10 getting to the bathroom on time. A bedside commode can help minimize these problems while still allowing the older person some independence. Sources: Aldridge, S. (2003). Chronic diseases linked to falls. British Medical Journal 27th September 2003 /Created on: 10/09/2003; Reviewed on: 12/22/2009. Retrieved January 28, 2010, from: Gann, K. (2004). Preventing Falls in Older Adults: Train the Trainer. Module 2: Identifying Fall Risk Factors. Retrieved February 14, 2009, from NIH Senior Health. (2008). Causes and Risk Factors: Page 10

11 Slide 9 External Risk Factors (occur due to outside factors) Physical environment Reaction to medication Reaction to alcohol Assistive devices Footwear External Risk Factors: are features/issues outside the human body that contribute to a person s risk of falling. Such factors may include reaction to medication and alcohol, or a person s physical environment, including their home which might have poor lighting, slippery floors, or throw rugs. External factors also include any assistive mobility device such as a cane, walker, or wheelchair and inappropriate clothing or footwear. Any of these can increase a person s risk of falling. PARTICIPANT DISCUSSION: Ask: Do you see another external risk factor in this photo, besides the walker? Answer: The dog! Animals are our friends, but their movements can be unpredictable and therefore put people at risk for falling. MORE DETAIL FOR OPTIONAL PRESENTATON MATERIAL ABOUT EXTERNAL RISK FACTORS: Reactions to Medications: Four or more prescription and/or over-the-counter medications put a person at a higher risk for falling due to drug interactions and/or side effects. As the number of medications increases, there is an increasing number of possible side effects and drug interactions such as low blood pressure, dizziness, incontinence, fatigue, etc. Antidepressants and sedatives are two drugs in particular that increase fall risk. Medications will be further discussed soon (Slide 10). Environmental Hazards: 60% of falls among older adults occur in the home. People fall due to poor lighting, loose throw rugs, objects in the pathway, uneven floors, climbing on furniture/ladders, and walking up/down stairs. We will discuss the importance of home safety soon (Slide 16). Alcohol: Older adults metabolize alcohol more slowly than younger people and this can cause alterations in cognition and perception of space, which can increase the risk of falling. Assistive devices: not knowing how to properly use a walker, cane, or wheelchair can increase the risk of falling. Footwear: not wearing proper shoes or shoes that do not fit properly can increase the risk of falling. Sources: Aldridge, S. (2003). Chronic diseases linked to falls. British Medical Journal 27th September 2003 / Created on: 10/09/2003; Reviewed on: 12/22/2009. Retrieved January 28, 2010, from: Gann, K. (2004). Preventing Falls in Older Adults: Train the Trainer. Module 2: Identifying Fall Risk Factors. Retrieved February 14, 2009 from Page 11

12 Slide 10 Preventable Risk Factors Vision impairments Unsafe home environments Medication usage Lack of physical activity/exercise For the rest of today s program, we are going to concentrate on four preventable risk factors: 1. Vision impairments 2. Unsafe home environments 3. Medication usage 4. Lack of physical activity/exercise The KEY to fall prevention: Address the preventable risk factors to lower the chances of falling and to prevent a fall from occurring. Refer participants to the six fall-prevention publications. If you have not already distributed publications, please do so at this time. FCS7-xxx: Stand Up to Falling: How to Prevent Falls FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention FCS7-190: Stand Up to Falling: Medications and Fall Prevention FCS7-191: Stand Up To Falling: Home Safety and Fall Prevention FCS7-192: Stand Up to Falling: Vision Impairment and Fall Prevention FCS7-193: Stand Up to Falling: A Matter of Balance and Fall Prevention Page 12

13 Slide 11 Common Age-Related Vision Impairments that Lead to Falls: Increased sensitivity to glare and light changes Decreased ability to see in dim light Decreased ability to see contrast Decrease in color sensitivity Decreased depth perception Decline in visual acuity (sharpness) Refer to Vision Impairment publication: FCS7-192: Stand Up To Falling: Vision Impairment and Fall Prevention This slide highlights NORMAL age-related vision impairment. After the age of 50, vision becomes increasingly impaired due to the normal aging processes. - Increased sensitivity to glare: Glare comes from bright sunlight, exposed light bulbs, and light reflected on shiny floors, walls, and windows. Glare can cause pain and limit a person s ability to identify objects such as things on the floor which can increase the risk of falling. A cataract, a common eye disease in old age, also increases a person s sensitivity to glare. - Increased sensitivity to light changes: The older eyes take more time to adjust when going from indoors (dark) to outdoors (light) and vice versa. Allow time for your eyes to adapt. You can do this by waiting at the doorway before continuing into a room. - Decreased ability to see in dim light: As we age, we need more light to see properly. This is because the pupil (opening located in the center of the iris of the eye that allows light to enter the retina) becomes smaller and less light reaches the retina of the eye. This makes it harder for older people to see especially in low lighting or in dark areas. Older people need two to three times more brightness or light to see properly than those who are younger. As a result, older people may not see objects that blend in with the rest of the environment such as chair legs on a dark surface or a tan dog on a tan rug. To adapt: be sure that workspaces, hallways, stairwells, rooms, etc. are properly lit. - NOTE: There are times when lower levels of lighting may be appropriate. For example, people with cataracts or glaucoma may be sensitive to bright lights. In such cases bright light may actually increase the risk of falling. It is important to consider each person individually and base lighting recommendations or changes on individual needs. - Decreased ability to see contrast: This means that a person has a difficult time differentiating an object from its surrounding background. For example, if colors are similar (the tan dog on tan carpet, or the dark chair legs against a dark surface) it can be difficult to see objects or hazards including the edge of steps or curbs, cracks in a sidewalk, raised thresholds, toilet seats, etc. The use of contrasting colors will help with this (e.g., a black toilet seat on a white toilet/white floor; floorboards a different color than the wall, the side of a step painted or carpeted in a contrasting color from the top of the step.) Page 13

14 - Decrease in color sensitivity: Related to decreased ability to see contrast is the decrease in color sensitivity. The natural yellowing of the lens of the eye makes it difficult for older people to identify certain colors like blue, green, and violet. These colors appear darker and more yellow to older people. When using color to point out distinctions, be sure to use contrasting color (e.g., dark on light). - Decrease in depth perception: With age, the lens of the eye becomes less flexible, which can cause the eye to lose its ability to focus on close objects. A less flexible lens also causes a decrease in the eye s ability to accommodate for changes in depth. Depth perception is important for climbing stairs, getting in/out of transportation, and other daily activity. Older adults need to be extra careful when navigating stairs, curbs, and doorway thresholds. To decrease the chances of tripping over things and/or falling, it is important to keep pathways free of clutter and it is important to be familiar with your environment. - Decline in visual acuity: Acuity refers to how sharply or clearly you can see something. This function decreases as a person gets older, making it more difficult to distinguish between different shapes and contrasts. Decreased visual acuity makes the world appear less bright/less clear. Glasses and contact lens are often prescribed to help with acuity issues. - Prescriptions of bifocals and multi-focal lenses: Bifocals and multi-focal lenses can blur the vision-field used to detect floor-level objects, increasing the risk for falling. Single-lens distance glasses in place of multifocal glasses are recommended when in higher-risk situations such as negotiating stairs, walking outside, and getting on/off transportation. The CDC recommends that older adults seek yearly eye exams and treat vision problems to prevent them from becoming bigger issues. Sources: U.S. Centers for Disease Control and Prevention (CDC). (2010). FCS7-192: Stand Up to Falling: Vision Impairment and Fall Prevention. Gann, K. (2004). Preventing Falls in Older Adults: Train the Trainer. Module 2: Identifying Fall Risk Factors. Retrieved February 14, 2009, from Page 14

15 Slide 12 Four Eye Disorders Common to Older Adults Cataracts Age-related Macular Degeneration (AMD) Glaucoma Diabetic Retinopathy Refer to Vision Impairment publication FCS7-192: Stand Up To Falling: Vision Impairment and Fall Prevention This slide and the next four slides (Slides 12-14) are optional. In case you decide to skip these slides, refer participants to their Fall and Vision Impairment publication for information regarding common aging eye disorders that can lead to vision impairment and falls. Optional Activity for these slides: Pass around age simulation glasses for participants to experience what it would be like to have one of these disorders As a group, discuss how easily the vision impairments could lead to a fall. As a group, brainstorm ways in which the environment can be adapted to reduce the risk of falling (think about contrasting colors, depth perception, glare, etc.). NOTE: Simulation goggles are available for checkout through Cooperative Extension (see Facilitator s Guide, Page 2 for contact information). OR you can make your own glasses (refer to How To Make Vision Impairment Goggles Instruction Sheet). Page 15

16 Slide 13: (Optional Slide) Older Adults and Common Eye Disorders Cataract - clouding of the natural lens, the part of the eye responsible for focusing light and producing clear, sharp images. Age-related Macular Degeneration (AMD) - destroys the clear, "straight ahead" central vision necessary for reading, driving, identifying faces, watching television, doing fine detailed work, safely navigating stairs and performing other daily tasks. AMD creates challenges to see contrast and it can change the way color is seen. Dry AMD In case you decide to skip this slide, refer participants to the Fall and Vision Impairment publication for information regarding common eye disorders that can lead to vision impairment and falls. FCS7-192: Stand Up To Falling: Vision Impairment and Fall Prevention Cataract: A cataract is a clouding of the natural lens, the part of the eye responsible for focusing light and producing clear, sharp images. The lens is contained in a sealed bag or capsule. As old cells die they become trapped within the capsule. Over time, the cells accumulate, causing the lens to cloud, making images look blurred or fuzzy. For most people, cataracts are a natural result of aging. Cataracts are the leading cause of visual loss among adults 55 and older. Eye injuries, certain medications, and diseases such as diabetes and alcoholism have also been known to cause cataracts. Age-related Macular Degeneration (AMD): AMD is the No. 1 cause of severe vision loss and legal blindness in adults over 60 in the U.S. It is estimated that 14-24% of the U.S. population aged years and 35% of people aged 75 years or more have the disease. As the population ages and the Baby Boomers advance into their 60s and 70s, we will see an outbreak of AMD. AMD occurs in two forms: wet and dry - Wet AMD: Wet AMD, also known as Advanced AMD, causes the loss of central vision quickly and does not progress in stages. The pathology: abnormal blood vessels behind the retina start to grow under the macula, lifting it from its normal place at the back of the eye, causing rapid damage to the macula. - Dry AMD: Dry AMD has three stages: early, intermediate and advanced Pathology light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. The most common symptom of dry AMD is slightly blurred vision. People with dry AMD may also have difficulty recognizing faces and may need more light for reading and other tasks. Page 16

17 Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected. Optional Activity for this slide: Pass around age simulation glasses for participants to experience what it would be like to have a cataract or AMD. As a group, discuss how easily the vision impairments could lead to a fall. As a group, brainstorm ways in which the environment can be adapted to reduce the risk of falling (think about contrasting colors, depth perception, glare, etc.). NOTE: Simulation goggles are available for checkout through Cooperative Extension (see Facilitator s Guide, Page 2 for contact information). OR you can make your own glasses (refer to How To Make Vision Impairment Goggles Instruction Sheet). Source: National Eye Institute: - Cataract: - AMD: facts.asp Slide 14: (Optional Slide) Page 17

18 Older Adults and Common Eye Disorders, cont. Glaucoma - group of eye diseases in which the optic nerve at the back of the eye is slowly destroyed. Diabetic Retinopathy - the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In case you decide to skip this slide, refer participants to the Fall and Vision Impairment publication for information regarding common eye disorders that can lead to vision impairment and falls. FCS7-192: Stand Up To Falling: Vision Impairment and Fall Prevention Glaucoma: Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. Glaucoma occurs when the normal fluid pressure inside the eyes slowly rises. Damage progresses very slowly and gradually destroys vision, starting with the side vision. Usually one eye will cover for the other eye, and you remain relatively unaware of a problem until major damage has occurred (the majority of nerve fibers have been destroyed) and a large part of your vision has been destroyed. This damage is irreversible. Treatment cannot recover what has been lost. But it can stop or at least slow down the process especially if treatment is started as soon as possible. Diabetic Retinopathy: Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. (The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.) If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes. Optional Activity for this slide: Pass around age simulation glasses for participants to experience what it would be like to have one of these disorders As a group, discuss how easily the vision impairments could lead to a fall. As a group, brainstorm ways in which the environment can be adapted to reduce the risk of falling (think about Page 18

19 contrasting colors, depth perception, glare, etc.). NOTE: Simulation goggles are available for checkout through Cooperative Extension (see Facilitator s Guide, Page 2 for contact information). OR you can make your own glasses (refer to How To Make Vision Impairment Goggles Instruction Sheet). Sources: National Eye Institute - Glaucoma: glaucoma_facts.asp - Diabetic Retinopathy: diabetic/retinopathy.asp Page 19

20 Slide 15 Vision Impairment and Falls, cont. What to do to help prevent falls: Sunglasses, wide-brimmed hats, nonglare surfaces, window coverings Give eyes time adapt to light changes Properly light workspaces, hallways, stairwells, rooms Use contrasting colors on walls, stairs, toilets, etc. Be familiar with the environment, keep it clutter free, take extra time on steps Proper prescription lenses when needed Be careful with multifocal lenses Regular eye exams Refer to Vision Impairment publication: FCS7-192: Stand Up To Falling: Vision Impairment and Fall Prevention This slide highlights what a person can do about common age-related vision impairments to help prevent falls. - Sunglasses, wide-brimmed hats, non-glare surfaces, window coverings - Give eyes time to adapt to light changes - Properly light workspaces, hallways, stairwells, rooms - Use contrasting colors on walls, stairs, toilets, etc. - Be familiar with the environment, keep it clutter free, take extra time on steps - Proper prescription lenses when needed - Be careful with multifocal lenses - Regular eye exams Sources: FCS7-192: Stand Up To Falling: Vision Impairment and Fall Prevention Gann, K. (2004). Preventing Falls in Older Adults: Train the Trainer. Module 2: Identifying Fall Risk Factors. Retrieved February 14, 2009, from Page 20

21 Slide 16 Home Environment and Falls 50-75% of falls happen in the home due to hazards overlooked every day. Proper lighting Floors and Stairs - Handrails - Remove or tack rugs/carpeting - Clean up spills Secure electrical cords Remove clutter Pets/small children Kitchen Bedroom - Bedside table Bathroom Refer to Home Safety and Falls participant handout FCS7-191: Stand Up To Falling: Home Safety and Fall Prevention You can talk about this slide/slide script OR read through the safety list in the participant handout, explaining to participants that the safety checklist is broken down room by room. In the left-hand column, a list of fall hazards are presented in the right-hand column a list of corrective measures is proposed. ENCOURAGE participants to go through their own home, or the home of a family member or friend (with permission), with the home safety checklist. If participants identify hazards in their home, challenge them to correct the problem. Encourage group discussion about home safety, personal experiences, and how participants keep themselves or loved ones safe from falls at home. General Safety Recommendations: Proper Lighting: - In general, older people need two to three times more light than younger people to see properly. This is because of the decline in vision that we discussed earlier. - However, there are times when lower levels of lighting can be appropriate; for instance, people with cataracts or glaucoma may be sensitive to bright lights and bright lights could increase their risk of falling. - It is important to make lighting and environmental recommendations on an individual basis based on individual need. Floors and Stairs - Polished or wet floors and scatter rugs can be extremely slippery and can lead to falls. - Floors and rugs should be slip-resistant. - Scatter rugs should be eliminated or have a no-slip backing. - Any carpeting that is wrinkled, curled up or worn out should be repaired. - Carpeting should be low pile (a person who needs a mobility aide to walk may have difficulty moving about on a deep pile carpet; tips of canes and/or walkers may get caught in the pile and lead to a trip and/or fall). - Stairs, like floors, can be slippery and should be checked for worn treads as well as carpeting that is curled Page 21

22 up or worn out. - Stairways should have sturdy handrails (people with decreased strength use rails to help pull themselves up the stairs or hold the railings to steady themselves while going down). - Handrails should be round and non-slip to provide a better/safer surface for grasping. Secure electrical cords - Coil or tape cords and wires next to the wall to prevent tripping. - Have an electrician add extra outlets if needed. Remove Clutter - Put items where they belong! Keep floors and stairs free of objects and clutter. - Have a clear and safe walking path through each room. Pets/small children - Pets and small children can be hard to see. They can also be fast and unpredictable in their movements. It is important to be aware of pets and children in a room. - Some pets like to sleep at people s feet, or they get up when you get up many falls occur while stepping over a dog or cat that is napping or walking under your feet on the floor. Sometimes the pet decides to get up when the person is stepping over them. DO NOT step over pets. Train pets to stay lying down on command. Kitchen - Keep items within reach (ideally between hip and eye level) use reachers (adaptive/assistive technology) for those items that you cannot safely reach OR ask for help. - DON T use a kitchen chair or bar stool to reach higher places. If you need to stand on something, be sure that the stool you choose is a steady stepstool made to be stepped on OR ask someone for help. - Non-skid wax/non-glare floors are best. - Clean all spills immediately. Bedroom - Bedside table: is your lamp or clock hard to reach? Then move the nightstand closer to the bed. - Keep a flashlight in your nightstand for emergencies. - Use nightlights to light bathrooms and hallways (keep in mind the time it may take your eyes to adjust to a bright light if you turn one on in the middle of the dark night). Bathroom - Never use towel bars, shelves, or the backs of toilet for support. These are not made to support your weight, nor are they properly anchored in the wall for that purpose. - Use non-slip rubber mats in the bathtub and/or shower. - Make sure the height of the toilet is right for you. Toilet risers can be purchased to make a toilet taller. Taller toilets can be replaced if a shorter one is needed. - Install proper grab bars for around the toilet and tub/shower. A physical or occupational therapist, or a certified aging-in-place specialist can help you with proper placement. A carpenter can help you with safe and proper installation. - ASK FOR ASSISTANCE if you do not feel safe getting in/out of tub or shower or on/off the toilet! It can be very difficult for older adults to move over the rim of the tub. Once inside the bathtub, it can become difficult to get out. Some people might choose to sit on the rim and grab the fixtures for support. This can Page 22

23 affect balance and cause a fall. Portable bathtub grab rails can be installed on the rim for extra support. - Even though showers may be easier for some older adults to get in/out, showers also need proper grab bars. Soap dishes and towel bars are NOT safe supports. Additional notes on bathrooms: Bathrooms can be difficult places for older people to maneuver, especially if they are weak or need mobility aides to get around. - Doorways can be narrow making it difficult to enter the room with a wheelchair or walker. - The door may open into the bathroom, limiting the amount of space available to move around. - As a result, an older adult might try to drag the walker into the room or leave the walker or wheelchair outside the room and use the sink and/or towel bars for support instead. Both of these maneuvers can cause a fall. Sources: FCS7-191: Stand Up To Falling: Home Safety and Fall Prevention Gann, K. (2004). Preventing Falls in Older Adults: Train the Trainer. Module 2: Identifying Fall Risk Factors. Retrieved February 14, 2009, from index.htm Page 23

24 Slide 17 (Optional Slide & Activity) Mobility Aides (assistive devices) Canes Walkers Wheel Chairs This information is NOT covered in the fall prevention publications. Mobility Aides fall into the External Risk Factor Category. The use of mobility aides should be routinely evaluated. Poor use of these devices (e.g. an older adult reaching out for the device, slipping from inappropriate use, or trying to catch the device if it tips over or starts to fall to the floor) can cause an individual to lose his/her balance and fall. Canes - Canes are usually recommended to people who cannot walk because of a one sided injury (e.g., stroke). - Canes need to be adjusted to the user s height. A physical therapist should be consulted to provide instruction regarding proper use. Walkers - To properly use a standard pick-up walker (walker without wheels) a person needs upper arm strength and the person must be able to maintain his/her balance while lifting the walker up and then placing it down again. When this becomes too challenging, many older adults start to push the walker along the floor which can increase the risk of falling (especially on thick carpets or bumpy sidewalks). - Gliding walkers (two front wheels) allow a person to walk by pushing the walker forward instead of having to pick it up. This method is less strenuous and mimics a more normal way of walking. The disadvantage is that in the home, the floor surface needs to be flat and smooth in order to properly use this type of walker. - Carpet edges and door thresholds will cause walkers to come to a sudden stop and possibly tip over causing the user to lose his/her balance and fall. Wheel Chairs - Homes should be evaluated to ensure that a wheelchair can maneuver safely especially in the bedroom and bathrooms. A safe environment is one in which the person can safely operate the chair and transfer to/from the chair. Page 24

25 Note: Sensory problems can cause falls, too. If a person s senses are impaired, he/she might be less aware of the environment. For example, if your feet are numb, you may not sense where you are stepping. Adaptive mobility equipment can help a person better sense his/her environment while also providing a certain degree of confidence and safety. Speaker Opportunity: Physical Therapists can provide training and/or demonstrations for proper use of assistive devices and assure that the devices have been fitted appropriately to the individual. Group Activity: Simulation mobility aides are available for checkout through Cooperative Extension (see Facilitators Guide, Page 2 for contact info). Encourage participants to try different environments (indoors, bathroom, outdoors) with the mobility equipment. If a Physical Therapist is present, ask them to demonstrate common mistakes with mobility aides in addition to the proper techniques. Source: Gann, K. (2004). Preventing Falls in Older Adults: Train the Trainer. Module 2: Identifying Fall Risk Factors. Retrieved February 14, 2009, from Page 25

26 Slide 18 (Optional Slide) Footwear Proper fit Slip-resistant soles Low heels This information is NOT covered in the fall prevention publications. Shoes and footwear fall into the External Risk Factor Category. Be sure that shoes fit properly. - You should never buy shoes without trying them on. - An older adult s foot often swells during the day; therefore, it is better to buy shoes in the late afternoon because it helps to capture the foot s maximum size. - Shoes should have an inner sole that cushions the foot. A cushioned sole absorbs foot pressure and protects feet from impact injuries that might occur when walking on hard surfaces. Buy non-slip soles to help prevent slipping on wet or shiny surfaces. Shoes should have low heels. - A safe heel should be no higher than 1 ½ and should be approximately 2 wide. This will provide maximum balance support. - When walking, the heel of the shoe should stay in place and should not sway from side to side or ride up and down the back of the foot. Sources: Gann, K. (2004). Preventing Falls in Older Adults: Train the Trainer. Module 2: Identifying Fall Risk Factors. Retrieved February 14, 2009, from NIH Senior Health. (2009). gov/falls/causesandriskfactors/09.html). Page 26

27 Slide 19 Medication, Alcohol, and Falls Multiple medications cause drug interactions and side effects Sedatives reduce excitability/calm a person Diuretics water pills these increase the flow of urine, causing the body to get rid of excess water Antidepressants treat depression Laxatives stimulate intestines, causing the body to eliminate waste Alcohol Refer to Medication and Falls publication FCS7-190: Stand Up To Falling: Medications and Fall Prevention The risk of falling increases when: - a person is taking multiple medications (in particular, four or more). - A person is placed on a new medication. - A dose of the current medication is increased for medical reasons. Medications can contribute to the problem of falls in older people. An older person living in the community is taking an average of 3.7 different medications. As the number of medications increases, there is an increasing number of possible side effects and drug interactions. Medications are not cleared as easily from the body as a person gets older and, as a result, side effects of medications can be stronger in older adults. Side effects of some of the medications commonly prescribed to older adults that can put a person at risk of falling include decrease in blood pressure when trying to stand up (known as orthostatic or postural hypotension), dizziness, drop in blood sugar, slowing of the heart rate, loss of balance, dehydration, incontinence, and fatigue. Side effects of medications, particularly sedatives and antidepressants, can increase the risk of falling. Other medications associated with falling include those for pain, anxiety, high blood pressure, water retention, seizures, coughs, overactive bladder, and tranquilizers. Be sure to communicate with your physician and/or pharmacist if you have concerns, begin to experience unexplainable problems, or change/add additional medications to your regime. ACTIVITY: Walk through the Medication Log in the medication publication. Talk about its importance. Encourage group sharing. Sources: FCS7-190: Stand Up To Falling: Medications and Fall Prevention Gann, K. (2004). Preventing Falls in Older Adults: Train the Trainer. Module 2: Identifying Fall Risk Factors. Retrieved February 14, 2009, from Page 27

28 Slide 20 Inactivity and Falls Decrease Flexibility Inactivity Muscle Weakness Falls Poor Balance Strength, balance, and flexibility can be accomplished through physical activity and exercise, which lead to decreased chances of falling in addition to multiple fitness and health benefits. Refer to Physical Activity and Falls publication FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention Participant Discussion: Ask participants the following questions: By a show of hands, do you currently exercise? In what types of exercise do you participate? Discuss the differences between exercise and physical activity: 1. Exercise: Planned activity performed for the purpose of obtaining fitness and health benefits (swimming, cycling, golfing, tai chi) 2. Physical Activity: Daily activities that involve movement (housework, gardening, walking, climbing stairs). Engage a group discussion regarding why people do/do not exercise and/or engage in physical activity and why it IS important to be physically fit at any age. The human body is able to sense its position in space this ability (called proprioception) is essential for balance, posture, and movement. With age, however, this sense of position becomes less effective. Proprioception combined with decreased muscle tone and strength, contributes to older adults becoming more prone to slipping, tripping, and falling. Exercise helps to maintain muscle strength, flexibility, balance, endurance. - The National Council on Aging recommends exercises that improve balance and leg strength to fight falls. Tai Chi is a recommended exercise for older adults. - Encourage participants to become or remain active. Sources: FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention Gann, K. (2004). Preventing Falls in Older Adults: Train the Trainer. Module 2: Identifying Fall Risk Factors. Retrieved February 14, 2009, from Page 28

29 Slide 21 Strength Strength helps with muscle tone, balance, and it aids mobility. Decreased muscle strength is associated with falling % of muscle mass is lost by age Muscle loss in the legs creates challenges when standing and walking. The good news: older adults who strength train are able to increase muscle mass and strength. Increased strength leads to greater levels of independence and improvements in the ability to walk and carry out daily activities. Refer to Physical Activity and Falls and Matter of Balance publications FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention FCS7-193: Stand Up To Falling: A Matter of Balance and Fall Prevention How to Improve Your Strength Even very small changes in muscle strength can make a real difference in function, especially in people who have already lost a lot of muscle. An increase in muscle that you can t even see can make it easier to do everyday things like get up from a chair, climb stairs, carry groceries, open jars, and even play with your grandchildren. Lower-body strength exercises also will improve your balance. You can build muscle and increase strength at any age. Activities: The next few slides will walk you through example exercises (recommended by the National Institute on Aging) to help improve strength, balance, and flexibility. These exercises are also located in the Activity and Fall Participant Handout. Additional exercises are provided in the Matter of Balance Participant Handout. For additional information/exercises, go to: Exercise & Physical Activity: Your Everyday Guide from the National Institute on Aging. (2009). Retrieved January 28, 2010, from: Page 29

30 Slide 22 Strength Exercise: Leg Strengthening 1. Sit in a sturdy chair with your back supported by the chair. Only the balls of your feet and your toes should rest on the floor. Put a rolled bath towel at the edge of the chair under thighs for support. Breathe in slowly. 2. Breathe out and slowly extend one leg in front of you as straight as possible, but don t lock your knee. 3. Flex foot to point toes toward the ceiling. Hold position for 1 second. 4. Breathe in as you slowly lower leg back down. 5. Repeat times. 6. Repeat times with other leg. 7. Repeat more times with each leg. Refer to Physical Activity and Falls publication FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention About Strength Exercises To perform quality strength exercises, you need to lift or push weights. You can use weights, resistance bands, or common objects from your home. Or, you can use the strength-training equipment at a fitness center or gym. Start with light weights and gradually increase the amount of weight you use. How Much, How Often? Try to do strength exercises for all of your major muscle groups on 2 or more days per week for 30-minute sessions each (or 3 sessions of 10 minutes), but don t exercise the same muscle group on any 2 days in a row. Activity: Try the exercise on the slide. Follow the directions printed on the slide (and below). Tell participants that directions are also located in their participant handout. Remind participants that this particular exercise needs no weight or resistance bands. Share with participants that this exercise strengthens the thighs and that strong leg muscles are important internal factors that help prevent falls. Exercise Instructions: 1. Sit in a sturdy chair with your back supported by the chair. Only the balls of your feet and your toes should rest on the floor. Put a rolled bath towel at the edge of the chair under thighs for support. Breathe in slowly. 2. Breathe out and slowly extend one leg in front of you as straight as possible, but don t lock your knee. 3. Flex foot to point toes toward the ceiling. Hold position for 1 second. 4. Breathe in as you slowly lower leg back down. 5. Repeat times. 6. Repeat times with other leg. 7. Repeat more times with each leg. Optional Information: When using weights or resistance bands: Depending on your condition, you might need to start out using 1- or 2-pound weights, or no weight at all. Page 30

31 Your body needs to get used to strength exercises. - Use a light weight the first week, then gradually add more weight starting out with weights that are too heavy can cause injuries. - Gradually add more weight in order to benefit from strength exercises. You need to challenge your muscles to get the most benefit from strength exercises. - It should feel somewhere between hard and very hard for you to lift or push the weight. It shouldn t feel very, very hard. If you can t lift or push a weight 8 times in a row, it s too heavy for you and you should reduce the amount of weight. - Take 3 seconds to lift or push a weight into place, hold the position for 1 second, and take another 3 seconds to return to your starting position. Don t let the weight drop; returning it slowly is very important. - Try to do 10 to 15 repetitions for each exercise. Think of this as a goal. If you can t do that many at first, do as many as you can. You may be able to build up to this goal over time. A repetition, or rep, is one complete movement of an exercise. A set is one group of reps. The National Institute on Aging (NIA) recommends that a set of strength exercises is 10 to 15 repetitions. Sources: FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention FCS7-193: Stand Up To Falling: A Matter of Balance and Fall Prevention Exercise & Physical Activity: Your Everyday Guide from the National Institute on Aging. (2009). Retrieved January 28, 2010, from: Page 31

32 Slide 23 Balance Weak leg muscles, poor vision, and slow reaction time increase an older adult s poor balance and risk for falling. Medical complications, medications, and balance disorders also contribute to poor balance and falls. Refer to Physical Activity and Falls publications FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention FCS7-193: Stand Up To Falling: A Matter of Balance and Fall Prevention Just as you can train your body to improve strength, you can train your body for better balance. Balance exercises work toward preventing falls and increasing daily activity and quality of life. Many balance exercises can be performed anytime, anywhere. Sources: FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention FCS7-193: Stand Up To Falling: A Matter of Balance and Fall Prevention Exercise & Physical Activity: Your Everyday Guide from the National Institute on Aging. (2009). Retrieved January 28, 2010, from: Page 32

33 Slide 24 Balance: Stand on One Foot 1. Stand on one foot behind a sturdy chair, holding on for balance. 2. Hold position for up to 10 seconds. 3. Repeat times. 4. Repeat times with other leg. 5. Repeat more times with each leg. Refer to Physical Activity and Falls publication FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention How Much, How Often? Anytime, anywhere. You can do exercises to improve your balance almost anytime, anywhere, and as often as you like, as long as you have something sturdy nearby to hold on to if you become unsteady. In the beginning, using a chair or the wall for support will help you work on your balance safely. Balance exercises often overlap with lower-body strength exercises, which also can improve your balance. Safety Have a sturdy chair or a person nearby to hold on to if you feel unsteady. Talk with your doctor if you are unsure about doing a particular exercise. Activity: Try the exercise on the slide. Follow the directions printed on the slide (and below). Tell participants that directions are also located in their participant handout. Remind participants that this particular exercise needs no weight or resistance bands. Also remind participants that they can do this exercise while standing in line at the grocery store, watching TV, or waiting for transportation! Exercise Instructions: 1. Stand on one foot behind a sturdy chair, holding on for balance. 2. Hold position for up to 10 seconds. 3. Repeat times. 4. Repeat times with other leg. 5. Repeat more times with each leg. Optional Information: Progressing Exercises can improve your balance even more if you modify them as you progress. Start by holding on to a sturdy chair for support. Page 33

34 To challenge yourself, try holding on to the chair with only one hand; then with time, you can try holding on with only one finger, then no hands. If you are steady on your feet, try doing the exercise with your eyes closed. Sources: FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention Exercise & Physical Activity: Your Everyday Guide from the National Institute on Aging. (2009). Retrieved January 28, 2010, from: Page 34

35 Slide 25 Flexibility Flexible muscles allow you to move smoothly, avoid muscle tension, and protect your body from injury. As muscles stiffen and joints get sore with age, older adults begin to lose flexibility. Stretching is one way to keep the body flexible. Stretching also: - improves performance - reduces risks of falling and injury - reduces muscle soreness and improves posture - helps reduce lower back pain - Increases blood and nutrients to the tissues - improves your coordination - helps you enjoy exercise and reduce stress Refer to Physical Activity and Falls publications FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention FCS7-193: Stand Up To Falling: A Matter of Balance and Fall Prevention An older adult s reflexes may be slower than when he/she was a younger person. The increased amount of time it takes an older adult to react may make it harder for him/her to catch his/her balance if he/she begins to fall Sources: FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention FCS7-193: Stand Up To Falling: A Matter of Balance and Fall Prevention NIH Senior Health. (2008). Falls and Older Adults: Causes and Risk Factors. Retrieved on January 28, 2010, from: causesandriskfactors/07.html Page 35

36 Slide 26 Flexibility: Back Stretch 1. Sit up toward the front of a sturdy chair with armrests. Stay as straight as possible. Keep your feet flat on the floor, shoulder-width apart. 2. Slowly twist to the left from your waist without moving your hips. Turn your head to the left. Lift your left hand and hold on to the left arm of the chair. Place your right hand on the outside of your left thigh. Twist farther, if possible. 3. Hold the position for seconds. 4. Slowly return to face forward. 5. Repeat on the right side. 6. Repeat at least 3-5 more times. Tip: As you progress, try lifting your left arm and resting it comfortably on the back of the chair. Hold on to the left armrest with your right arm. Repeat on right side. Refer to Physical Activity and Falls publications FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention FCS7-193: Stand Up To Falling: A Matter of Balance and Fall Prevention How to Improve Your Flexibility Stretching or flexibility exercises are an important part of a physical activity program. Stretching and flexibility exercises give you more freedom of movement for your physical activities and for everyday activities such as getting dressed and reaching objects on a shelf. Stretching exercises can improve your flexibility but will not improve your endurance or strength. How Much, How Often? Do each stretching exercise 3 to 5 times at each session. Slowly stretch into the desired position, as far as possible without pain, and hold the stretch for 10 to 30 seconds. Relax, breathe, then repeat, trying to stretch farther. Activity: Try the exercise on the slide. Follow the directions printed on the slide (and below). Tell participants that directions are also located in their participant handout. Remind participants that this particular exercise needs no weight or resistance bands. Also remind participants that they can do this exercise or something similar in many places. Exercise Instructions: 1. Sit up toward the front of a sturdy chair with armrests. Stay as straight as possible. Keep your feet flat on the floor, shoulder-width apart. 2. Slowly twist to the left from your waist without moving your hips. Turn your head to the left. Lift your left hand and hold on to the left arm of the chair. Place your right hand on the outside of your left thigh. Twist farther, if possible. 3. Hold the position for seconds. 4. Slowly return to face forward. 5. Repeat on the right side. Page 36

37 6. Repeat at least 3-5 more times. Tip: As you progress, try lifting your left arm and resting it comfortably on the back of the chair. Hold on to the left armrest with your right arm. Repeat on right side. Safety Talk with your doctor if you are unsure about a particular exercise. For example, if you ve had hip or back surgery, talk with your doctor before doing lower-body exercises. Always warm up before stretching exercises. Stretch after endurance or strength exercises (weightlifting). If you are doing only stretching exercises, warm up with a few minutes of easy walking first. Stretching your muscles before they are warmed up may result in injury. Always remember to breathe normally while holding a stretch. Stretching may feel slightly uncomfortable; for example, a mild pulling feeling is normal. - BUT you are stretching too far if you feel sharp or stabbing pain, or joint pain while doing the stretch or even if you feel pain the next day. Reduce the stretch so that it doesn t hurt. Never bounce into a stretch. Make slow, steady movements instead. Jerking into position can cause muscles to tighten, possibly causing injury. Avoid locking your joints. Straighten your arms and legs when you stretch them, but don t hold them tightly in a straight position. Your joints should always be slightly bent while stretching. Progressing You can progress in your stretching exercises. For example, as you become more flexible, try reaching farther, but not so far that it hurts. Sources: FCS7-189: Stand Up To Falling: Physical Activity, Exercise and Fall Prevention FCS7-193: Stand Up To Falling: A Matter of Balance and Fall Prevention Exercise & Physical Activity: Your Everyday Guide from the National Institute on Aging. (2009). Retrieved January 28, 2010, from: Page 37

38 Slide 27 A Matter of Balance Based on the fear of falling, A Matter of Balance is a program that prepares the mind and body for endurance, strength, balance, and stretching exercises. The program consists of an 8-session evidence-based fallsmanagement program led by trained volunteer lay leaders. Goals: - reduce the fear of falling - stop the fear of falling cycle - increase activity levels among community-dwelling older adults Refer to A Matter of Balance Participant Handout FCS7-193: Stand Up To Falling: A Matter of Balance and Fall Prevention Use this slide and the participant handout if you are interested in plugging or following-up this lesson with A Matter of Balance. Be sure to have the appropriate contact information available to participants so that they can find a nearby class. For more information on A Matter of Balance, contact: Nicole Peritore, Get Moving Kentucky Extension Coordinator: (859) or Nicole.Peritore@uky.edu -OR- Kentucky Department for Independent Living (DAIL): (502) or Page 38

39 Slide 28 What To Do If You Fall Do not panic. Try to stay calm. Take several breaths to relax. Assess the situation and determine if you are hurt. Whether you're at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible. Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling. It will also give you time to decide if you're hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse. Sources: American Academy of Orthopedic Surgeons (AAOS). Getting up from a fall. Retrieved March 11, 2010, from: topic.cfm?topic=a00098 Loyola University Health System. (2001). Falls. Retrieved on February 12, 2010, from: NIH Senior Health. (2008). If you Fall. Retrieved on February 12, 2010, from: gov/falls/ifyoufall/01.html Page 39

40 Slide 29 What To Do If You Fall, cont. If you re hurt and cannot get up, ask for help or call 911. If you re alone, try to find a tolerable position until help comes. Personal emergency response systems can be helpful. Carry a portable phone with you. If you're hurt or can't get up on your own, ask someone for help or call 911. If you're alone, try to get into a comfortable position and wait for help to arrive. If you have problems with balance or dizziness after your fall, be sure to discuss this with your doctor. If you are often alone, and at increased risk of falling, consider getting a personal emergency response system. This service, which works through your telephone line, provides a necklace or bracelet to wear at all times in your home. - If you fall or need emergency assistance for any reason, a push of a button located on the necklace or bracelet will alert the service who will then contact emergency medical personnel. There is a fee for medical monitoring services, but it may be worth the cost. Carrying a portable phone with you as you move about your house could make it easier to call someone if you need assistance. You might also put a telephone in a place that you can reach from the floor in case you fall and need help. Be sure that your phone battery is always charged. Sources: American Academy of Orthopedic Surgeons (AAOS). Getting up from a all. Retrieved March 11, 2010, from: topic.cfm?topic=a00098 Loyola University Health System. (2001). Falls. Retrieved on February 12, 2010, from: NIH Senior Health. (2008). If you fall. Retrieved on February 12, 2010, from: gov/falls/ifyoufall/01.html Page 40

41 Slide 30 Getting Up From a Fall Roll over naturally, turning your head in the direction of the roll. If you can, crawl to strong, stable furniture like a chair, and pull yourself up. Approach the chair from the front and put both hands on the seat. Slowly, begin to rise. Bend whichever knee is stronger; keep your other knee on the floor. Slowly twist around and sit in the chair. After you fall, panic is often your first reaction. However, how you react after a fall can cause more injuries than the fall itself. If you try to get up too quickly or in the wrong position, you may make an injury worse. Remember to take several deep breaths, assess the situation and determine if you are hurt. - If you believe you are injured, do not attempt to get up. Instead, call 911 or get help from a family member. - If you feel strong enough to get up, you should try to follow the following steps recommended by the American Academy of Orthopedic Surgeons/Loyola University Health System: 1. Roll over naturally, turning your head in the direction of the roll. 2. If you can, crawl to strong, stable furniture like a chair, and pull yourself up. Approach the chair from the front and put both hands on the seat. 3. Slowly, begin to rise. Bend whichever knee is stronger; keep your other knee on the floor. 4. Slowly twist around and sit in the chair. Activity: As a group, practice how to safely get up from a fall. Sources: American Academy of Orthopedic Surgeons (AAOS). Getting up from a all. Retrieved March 11, 2010, from: topic.cfm?topic=a00098 Loyola University Health System. (2001). Falls. Retrieved on February 12, 2010, from: Learn Not To Fall. (2009). Retrieved May 16, 2011, from: Page 41

42 Slide 31 What YOU Can Do To Prevent Falls Be physically active. Get regular vision checkups. Assess the safety of the environment. Have your medicines reviewed. Have your blood pressure checked when lying and standing. Wear safe footwear. Know how to properly use mobility aides. Educate yourself/family/client. Report a fall to your doctor. Older adults should be evaluated for fall risk on a yearly basis. - In addition, fall risk should be looked at if an older adult has a change in medication, in health status, or in place of residence. Older adults, family members, and caregivers should be educated about fall risk. Education includes knowing what causes falls in older adults, the importance of regular check-ups, home safety issues, information on proper exercise, and information on proper footwear. Exercise, Exercise, Exercise. Exercise programs geared toward strength and balance training can reduce both falls and injury. Exercises that improve strength and balance are especially effective. Report all falls. Some older adults and caregivers do not report falls, especially if only one s pride and not a bone or skin is broken. BUT, a fall could be a sign of a new medical problem that needs attention, such as an infection or a cardiovascular disorder. It could also suggest that a treatment for a chronic ailment, such as Parkinson's disease or dementia, needs to be changed. Be sure to discuss any and all falls with your doctor. Write down when, where, and how you fell so you can discuss the details with your doctor. The doctor can assess whether a medical issue or other cause of the fall needs to be addressed. Knowing the cause can help you plan to prevent future falls. Sources: Gann, K. (2004). Preventing Falls in Older Adults: Train the Trainer. Module 2: Identifying Fall Risk Factors. Retrieved February 14, 2009, from NIH Senior Health: falls/causesandriskfactors/15.html). Slide 32 Page 42

43 Fill in name/title Fill in date of presentation Copyright 2010 for materials developed by University of Kentucky Cooperative Extension. This publication may be reproduced in portions or its entirety for educational or nonprofit purposes only. Permitted users shall give credit to the author(s) and include this copyright notice. Educational programs of Kentucky Cooperative Extension serve all people regardless of race, color, age, sex, religion, disability, or national origin. Ask if participants have any questions. Thank everyone for coming. Put in an additional plug for the program, A Matter of Balance. DON T FORGET TO ADMINISTER THE POST-SESSION EVALUATION! Page 43