The Role of Physical and Occupational Therapies in Fall Prevention and Management in the Home Setting

Abstract

Mrs. Smith, a 90-year-old woman living in New York City alone in a one-bedroom apartment, was referred for physical and occupational therapy by her primary care physician after she fell in her bathtub 10 months prior. The episode made the daily newspapers, as this particular fall resulted in Mrs. Smith being impaled by the bathtub faucet in her torso. The faucet had to be detached from the wall and remained lodged in her until she was delivered to the hospital, where it was surgically removed. The injury nearly killed Mrs. Smith. After returning to her home following months in the hospital and an inpatient rehabilitation setting and then receiving temporary Medicare-funded home health aides, Mrs. Smith was once again alone. She was receiving only 2 hours of daily private aide care. Physical and occupational therapists visited Mrs. Smith's home five or six times a week under Medicare Part B. Interventions consisted of strengthening Mrs. Smith's upper and lower extremities and her trunk muscles and increasing her balance. Mrs. Smith was also trained with adaptive equipment, and a tub transfer bench was added to her bathroom. Mrs. Smith had sworn that she would never enter her bathtub again, terrified of a repeat fall. Months of practicing and training with the physical and occupational therapist for the purpose of entering and exiting the tub, increasing her strength and balance, and utilizing the tub transfer bench allowed Mrs. Smith to have a shower in her home after nearly a year without one. Tears of joy and satisfaction streamed down her cheeks, as she recognized that she had conquered her fears and now felt confident again to bathe independently; a stronger, safer, and more capable person. The Centers for Medicare and Medicaid Services, in its July 2007 measure for Medicare Part B fall risk screening, used the definition of Tinetti, Baker, Dutcher, Vincent, and Rozett (1997) to determine the criterion of a fall. The definition reads, A sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force. The definition of a fall seems to vary according to institutions; however, a common element seems to be unintentionally coming to the ground, floor, or other lower level. The Centers for Disease Control and Prevention reports that $19.2 billion annually is spent on treating the elderly for the adverse effects of falls: $12 billion for hospitalization, $4 billion for emergency department visits, and $3 billion for outpatient care. Effective interventions assume that falls are not the result of random accidents but are the result of the presence of numerous risk factors and a compromised medical condition. Two-thirds of those who experience a fall will fall again within 6 months. Two-thirds of falls are preventable. At least one-third of all falls in the elderly involve environmental hazards in the home. Most falls do not result in serious injury. However, there is often a psychological impact. Twenty-five percent of community-dwelling people 75 years old or more unnecessarily restrict their activities because of fear of falling. All health care professionals working with the older population know and understand the implications of falls, and all have a common goal: to improve the quality of life of the older adult. The status of geriatric patients is so complicated for any one medical professional that improved results can be obtained only if the entire interdisciplinary team works together. It is too daunting a task for any one to accomplish alone. The interdisciplinary team must work to maximize the quality of care and the quality of life for patients and their family caregivers. The interdisciplinary team may include but is not limited to the primary care physician, specialist physicians, physician assistants, nurse-practitioners, nurses, social workers, physical therapists, occupational therapists, administrators, nutritionists, and direct care staff such as certified home health aides. …