Reducing Accidental Falls Modifying Environmental Risk Factors, Part 1 of 2

University of Nevada, Reno
Southern Area Cooperative Extension
Seniors CAN

Lesson Plan

Lesson: Reducing Accidental Falls Modifying Environmental Risk Factors, Part 1 of 2:

Lesson Number: S-1

Introduction:

“Reducing Accidental Falls” is a two-part lesson designed to reduce the risk of Learners becoming victims of accidental falls. Part 1 focuses on modifying environmental risk factors while Part 2 targets modification of personal risk factors.

Learning Overview: The Learner will participate in a lesson designed to teach him/her how to modify his/her home environment to reduce risks that (s)he will have an accidental fall.

Lesson Objectives:

  1. During the lesson, the Learner will be exposed to the following information:
    • Environmental risk factors associated with falls.
    • Techniques for reducing these environmental risk factors for falling.
  2. During the lesson, the Learner will engage in group discussion regarding accidental falls, describing with clarity, at least one example from his/her life experience.
  3. During group discussion, either spontaneously or in response to Facilitator request, the Learner will state with clarity that s/he has selected at least one idea presented during the lesson, what that idea is, and that s/he will try this idea during the following week to see if it works for him/her. Alternatively, the Learner will state with clarity that s/he does not want to try out any of the ideas presented and the reason for the decision.

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Set up at previous meeting:

Next week, we will be exploring how to reduce the risk that you will be injured by an accidental fall.

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Set up immediately prior to this meeting:

Facilitator may briefly walk through building and around outside entrances prior to the start of the meeting so that Facilitator can begin to become aware of possible risks for falls in the building. The Facilitator can also bring in demonstration items that could cause an accidental fall, particularly in a home, like a throw rug or long electrical cord.

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Materials:

Provided by Facilitator:

Note: Facilitator should review lesson plan for this week, last week and next week because information provided at the beginning of each lesson plan is needed for a smooth transition between lessons.

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Activities:

Optional

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References:

Check for Safety: A Home Prevention Checklist for Older Adults. CDC Foundation and MetLife Foundation brochure, 2005.

Preventing Accidental Falls in Your Home. H2U News, October 2005. HCA Healthcare Systems, H2U Newsletter, Sunrise Health.

Roberts, B. L. (1998). Falls. In J. J. Fitzpatrick, (Ed.), Encyclopedia of Nursing Research. New York: Springer Publishing Co. Pp. 190-192.

 U.S. Consumer Product Safety Commission, October 2004. Safety for Older Consumers: Home Safety Checklist (CPSC Document #701). http://www.cpsc.gov/CPSCPUB/PUBS/701.html [Accessed 9/14/06].

Frightened of Falling. Dr. Andrew Weil’s Self Healing Newsletter, February 2004.

Lesson:

Begin Lesson:

Transition from last week

Last week we talked about (name of last week’s unit). Each of us selected one idea to try out. Let’s talk about how those worked (or didn’t work) for us, and also what we learned from last week’s meeting.

If they hesitate, ask one or two questions about last week's topic to encourage discussion.

Anticipatory Set:

Today we will explore reducing the risks of accidental falls. There are three reasons that we think this topic is important:

  1. One in three Americans over the age of 65 fall every year.
  2. Accidental falls are the leading cause of home injury and death for those 65 and older.
  3. About 200,000 people fracture their hip each year. Less than half return to full functioning, 30% require long-term care and nearly one third results in death.

Share the Objective:

  1. During this meeting, we will be talking about the following information:
    1. Risk factors associated with falls in your home environment.
    2. Techniques for modifying risk factors in your home so that you are less likely to be injured in an accidental fall.
  2. During this lesson, I will be providing information, but it is also important that we share information and ask questions in group discussion. I would appreciate it if each of you could bring up at least one example from your life experience.
  3. Also during the lesson today, I’m going to ask each of you to select one idea from the lesson to try out on your own over the next week. I’ll pick one, too. Then each of us can share with the group next week how it worked out.

Share the Handout:

This summarizes the main ideas we will be discussing today. [Pass out fact sheet.] Please feel free to take notes in the margins on the handouts and ask questions as they arise.

Input:

I. Introduction:

  1. There are several risk factors associated with falls.
  2. Some of those risks can be reduced through our own initiative, while others cannot.
  3. Each of the risk factors relates to either personal factors or to risks in an older adult’s environment. Today we will focus on risk factors in your home environment.

II. Risk factors in the environment include:

  1. Inadequate lighting
    1. Older adults require up to three times more light and their eyes do not adjust as quickly to changes in lights conditions, such as those experienced when walking from a brightly lit room to a darker room. Create consistent lighting, add needed lighting fixtures or use a nightlight.
  2. Items on the floor
    1. Loose area rugs should be removed from the home. If you insist upon using rugs secure them will double-sided adhesive tape or rubber matting.
    2. Clear any clutter or unexpected objects from the floor.
    3. Watch for cords such as electrical, phone, computer and vacuum cleaner cords. Also watch for dog leashes, garden hoses or oxygen tubes.
    4. Slippery substances such as water on the floor, especially in the bathroom, kitchen and laundry room area can lead to falls. Dry substances such as salt, powdered laundry detergent and even uncooked spaghetti can lead to slipping and falling.
  3. Typical problems experienced by seniors in their homes are difficulty getting in and out of the tub or shower, and slipping. Safety proof the bathroom by installing grab bars, using a shower seat or transfer bench and having non-skid strips or decals in the tub or shower. NEVER depend on the towel bar to steady yourself. It is not strong enough.
  4. Every day older adults trip on stairs they know well. Both in and outside the home always remember to use the handrails for support, look for objects on the steps and add light to a dark stairway.
  5. Avoid kitchen, garage or storage hazards by storing often used cabinet, closet or shelf items where they are easily reached. NEVER stand on a chair to reach these items or for home repairs like changing a light bulb. Consider using a reach extender, sturdy stepstool or ask for help from a neighbor or friend.
  6. Outside the home be cautious of uneven pavement or sidewalks, loose gravel or curb height differences. Also watch for unexpected spills, loose objects, slippery flooring or rubber mats, especially in unfamiliar surroundings.

III. It is important to always pay attention to your surroundings and never be in a hurry as this can cause accidents!

Modeling and Guided Practice:

Here are some items for students to check in their homes:

Passageways and walkways should be clear. Objects such as loose rugs, debris, electrical cords, furniture or any slippery substances should be removed.

Cords should be along walls where people can’t trip over them. Pay attention to where phone cords are located. Purchase cordless phones when possible. Also, furniture should be arranged so that outlets are near lamps and appliances. This way, cords are less likely to extend across areas where people walk.

Does Learner use an answering machine? Many falls occur when a person is running to answer the telephone. Also, consider whether it is feasible to purchase inexpensive telephones as extensions in various parts of the home, particularly next to the bed.

It is safest to remove all rugs, runners and mats since they cause many falls in the home, approximately 6,800 seniors trip each year (American Association of Orthopaedic Surgeons, 2001). If you won't do that, they should be checked for slip-resistance. If they tend to slide, they should be removed or fixed. They can be anchored with double-faced adhesive carpet tape or rubber matting cut to size. Periodically check for adhesion and wear. Replace if needed. When buying a new rug, look for slip-resistant backing. Washing also causes wear, so you need to periodically check even newer rugs to see if backing needs to be replaced with matting or adhesive.

Check whether lamps are working, light bulbs need to be replaced and whether there is a light switch that works to light a room at each entrance. If daytime, try opening curtains that are not currently open. Ask Learners about their pattern of light usage at night. Consider additional lamps. Consider using a nightlight for dark passageways.

Ask Learners how they access items on high shelves in the kitchen.

Point out that standing on a chair or some other makeshift item to get something from a high shelf is dangerous About 3,000 seniors fall each year from standing on chairs (American Association of Orthopaedic Surgeons, 2001). Consider buying a stepstool, particularly one with handrails you can hold onto while standing on the top step. Make sure any stepstool is fully open and stable before you climb onto it. Tighten any screws or braces. Get rid of stepstools with broken parts.

Consider buying a reach extender, which is a long stick with a gripper on the end that is controlled with a lever. This may be helpful for grabbing lightweight items that are not easily broken.

Look for skid-free mats in kitchen and/or laundry room or where water might be splashed from a sink or other source.

In bathrooms, look for grab rails, shower chairs, non skid decals or mats in the tub or shower and skid free mats on bathroom floors, particularly where water might be splashed from the sink or tub.

Each bathtub or shower should have one, and preferably two, grab bars. Check existing bars for strength and stability—if they do not seem stable, repair as soon as possible.

Grab bars should be attached through the tile to structural supports in the wall. Or, installed bars specifically designed for attachment to the side of a bathtub. If you are not sure how to do this, find someone who is qualified to do this.

In the bathroom, the switch should be near the entrance. Consider a nightlight for the bathroom. Consider replacing the light switch with a switch that glows in the dark.

In bedrooms, lamps and/or switches should be near the door and the bed. Consider rearranging furniture and using a night-light.

For all stairs, inside and out, check lighting. Stairs should be well-lit, but lighting should not cause shadows or glare along the stairway. Make sure stair edges can be easily seen while going up and down stairs—suggest contrasting tape or paint for edges of steps. Be sure to mark steps that are of different sizes than the others—taller, shorter or narrower.

Light switches should be at the top and bottom of long stairways. If lighting near stairways is poor, keep operating flashlights at top and bottom of stairs. Install nightlights nearby. It is possible to trip even on stairs you know well.

Don’t store things on stair steps - even temporarily.

Monitoring / Discussion:

Q: Did you hear anything today when we talked about doing things to prevent falls that you think might be a good idea for you?

Q: Were there any ideas that you didn’t like?

Q: Out of all we talked about today, what would be the easiest change to make to your home to reduce the risk that you will have an accidental fall?

Q: What change would be the hardest, and why?

Independent Practice:

This can be done at any time during the lesson. It seems to work better when it is not done in the rush at the end of a meeting.

"I’d like for each of us to select at least one idea, from what we're learning, to try out this week. Let’s choose something easy to experiment with. Next week we can all compare our experiences and see what worked and what didn't."

Closure/Transition:

Look at next week’s lesson plan for: “Set up at previous meeting.”

It begins: “Next week, we will be exploring . . ..”