Occupational therapists (OTs) carry out risk assessments and management strategies when providing care to individuals in all work settings, including hospitals, rehabilitation centres and communities, where they assist individuals who are at risk of falling to carry out their daily activities safely. OTs provide individuals with effective strategies, often by increasing safety and independence during activities of daily living (ADLs) (Ballinger and Brooks 2013).
The purpose of this report is to examine the role of occupational therapists in preventing and managing adult inpatient falls in an acute setting. The report will discuss the negative consequences of fall-related ...view middle of the document...
When assessing the risk of falling it is essential to take into account both intrinsic and extrinsic factors in relation to the patient’s condition, current functional status and the patient’s environment
1: Physiological factors
The physiological decline in bodily systems associated with age and chronic conditions can result in a decline in strength, gait, balance, endurance, sensory loss and cognitive impairment. For example, diabetes causes retinopathy which leads to poor sensation, impaired vision or even blindness.
2: Neuromusculoskeletal changes
Gnanasekaran (2012), states that musculoskeletal-related conditions such as arthritis and osteoporosis are characterised by loss of bone mass and density as the bone becomes fragile and porous, leading to a risk of fracture should a patient fall. Consequently, the neuromuscular and movement-related functions such as balance, strength, range of motion, and posture are affected.
3: Sensory /perceptual problems
These involve the actions or behaviours used to physically interact with tasks, objects, and contexts, including locating walking aids, glasses or personal possessions around the bed area. Vestibular problems are associated with symptoms of dizziness that can cause difficulties in balance, gait pattern and movement. It also affects the ability to hear verbal instructions and approaching hazards such as trolleys (American Occupational Therapy Association, 2008).
Cognitive impairment is associated with poor memory, attention, disorientation, concentration and a lack of insight and judgement. Owing to the symptoms of cognitive impairment, new patients, or those transferred to a different hospital or ward, may become agitated, confused, and irritable. They may lack insight regarding their illness and trouble liaising with different professionals, can cause them to feel unsettled, and disoriented (Unsworth, 2010).
Greenberg (2011) states that older patients who experience a fall resulting in no substantial harm may often develop a fear of falling which can cause them to lose confidence when performing functional tasks. They may then withdraw from meaningful occupations, leading to a further decline in functional abilities and eventually to a vicious circle of inactivity, isolation, anxiety and depression
Lack of insight or understanding about their limitations can cause patients to engage in risk-taking behaviours that can predispose them to fall. For example, the patient may not press the buzzer for assistance or refrain from using walking aids as appropriate (Hofmann, 2013).
Environmental risk factors are those that are outside the patient (extrinsic) including lighting, adjustments of bed, chair and toilet heights, clutter surrounding the patient’s bed area, inappropriate walking aids, hospital equipment, clothing, footwear, signage, and floor surface (Victorian Quality Council, hereafter, VQC (2004).
Other risk factors
Frequency of using the...