Reducing Accidental Falls Modifying Personal Risk Factors, Part 2 of 2

University of Nevada, Reno
Southern Area Cooperative Extension
Seniors CAN

Lesson Plan

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

Lesson Number: S-2

Introduction:

“Reducing Accidental Falls” is a two-part lesson designed to reduce the risk that Learners will be victims of accidental falls. Part 1 focuses on modifying home environment 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 personal factors 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:
    • Personal risk factors associated with falls.
    • Techniques for reducing personal 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.

________________________________________________________________________

Set up at previous meeting:

Next week, we will be exploring how to cope with personal factors associated with falling, such as visual impairment or physical inactivity.

We will also participate in a short exercise activity so bring or wear shoes that are comfortable.

________________________________________________________________________

Set up immediately prior to this meeting:

Facilitator determines what type of exercise activity may be most appropriate for the Learners and prepare accordingly. This will be subject to modification based on Learners’ preferences.

______________________________________________________________________

Materials:

Provided by Facilitator:

One of the following for each Learner:

Provided by all Learners:

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.

________________________________________________________________________

Activities: (if feasible)

________________________________________________________________________

References:

Administration on Aging. (2001). Elder Action: Action Ideas for Older Persons and Their Families—Home Modification and Repair. [Online]. http://wasearch.loc.gov/sep11/20011130235211/http://www.aoa.dhhs.gov/aoa/eldractn/homemodf.html [Access date: 7/23/08].

Administration on Aging. (2000). Elder Action: Action Ideas for Older Persons and Their Families—Fitness Facts for Older Americans. [Online]. http://wasearch.loc.gov/sep11/20011130234049/http://www.aoa.dhhs.gov/aoa/eldractn/fitfact.html [Access date: 7/23/08]

Frightened of Falling, Dr. Andrew Weil’s Self Healing Newsletter, February 2004. Q & A on Tai Chi Benefits, November 2004.

Aging and Your Eyes, National Institute on Aging, October 2005. http://www.niapublications.org/agepages/eyes.asp. Web page updated 1/13/2006 and viewed 6/8/2006.

Depression and Older Adults: What it is and how to get help, American Academy of Family Physicians, September 2000. www.familydoctor.org/558.xml?printxml. Web page updated 7/0/2005 and viewed 6/8/2006.

Check for Safety: A Home prevention checklist for older adults. CDC Foundation and MetLife Foundation brochure, 2005.

Older Adults: Depression and suicide facts, NIH Publication No. 03-4593, Revised May 2003. http://www.nimh.nih.gov/publicat/elderlydepsuicide.cfm. Web page updated 2/17/06 and viewed 6/8/06.

Exercise: A guide from the National Institute on Aging. NIH Publication No. 01-4258, Reprinted September 2007.

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

Medicines and You: A Guide for older adults, 4/04. Council on Family Health Brochure in cooperation with FDA and AOA.

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.

Anticipatory Set:

Last week, we talked about being injured in accidental falls and what a serious problem this can be for older adults. We talked about assessing and making changes in your home to reduce the chances that you will be injured in an accidental fall. We also discussed other environmental risk factors. Today we will explore personal risks associated with accidental falls for several reasons:

  1. There are individual risk factors that make it more likely that someone will be injured in a fall, like being over the age of 55 or being a woman. Women are more likely to fall than men.
  2. It is estimated that about 40 percent of all nursing home admissions are due to accidental falls.
  3. Inactivity leads to poor balance and muscle weakness which are crucial to overall health and fall reduction.

Share the Objective:

  1. During this meeting, we will be talking about the following information:
    1. Personal risk factors associated with falls, such as physical inactivity and poor eyesight.
    2. Techniques for modifying or coping with personal risk factors that may cause you 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 Handouts

These summarize the main ideas we will be discussing today. [Pass out handouts.] Please take notes as we go through the materials and ask questions as they arise.

Input:

I. Risk factors:

  1. There are several personal risk factors associated with falls.
  2. Some of those risks cannot be reduced through our own initiative.
    1. Being over age 55
    2. Being female
    3. This means that if you are female, you are more likely to fall. It doesn’t mean that all females fall, or that men don’t fall. Both older women and older men are at increased risk for experiencing an accidental fall.
  3. Some of the risk factors for accidental falls in older adults that can be controlled include
    1. Visual impairment
    2. Improper footwear
    3. Postural Hypotension
    4. Medications
    5. Multiple diseases
    6. Depression
    7. Experiencing a fall in the past
    8. Inactivity

II. How to reduce risks related to personal factors that we have some control over (in some cases we have a lot of control; in others, we have less):

  1. Visual impairment
    1. Have regular eye exams and have your vision corrected, if needed. Wear properly fitted clean glasses. Some eye disorders/diseases can limit your vision or cause blindness, like age-related macular degeneration or cataracts, so take extra precautions with visual impairments to reduce falls.
  2. Improper footwear
    1. Choose footwear with closed heels and toes, as they are less likely to catch on something that could possibly cause a fall. Make sure the soles of your shoes and slippers are not too slippery and have good traction. Wear shoes while you are inside and outside of the house and avoid going barefoot.
    2. Let’s all look at our feet for a minute. How well do the shoes you are wearing protect you from slipping and tripping?
  3. Postural Hypotension
    1. This is caused by a decrease in blood pressure upon standing up and it makes you feel dizzy or lightheaded when you stand up. Having some hypotension is normal, but it can be severe enough to cause fainting, especially when standing up after being in bed for several days. Hypotension can also increase in severity with various illnesses and medication.
    2. One suggestion for reducing dizziness with postural hypotension is to try raising your arms over your head to increase the flow of blood to your brain.
    3. If you have been especially inactive due to illness, be careful getting out of bed in case you start to feel light-headed or dizzy. Get up gradually—sit before you stand and stand a moment or two before you walk. You may wish to use a walker or some heavy, solid object like a large, stable chair to support you in this situation.
    4. If for any reason, illness or fatigue for example, you feel unstable on your feet, use a walker or a cane until you feel more stable.
  4. Use of medications, both prescriptions and over-the-counter.
    1. Medications can produce side effects that vary in different people. Some medications may cause a side effect in one person, but not in another person. Some medications produce side effects such as blurred vision, unsteadiness, dizziness and postural hypotension (light-headedness upon standing, which we talked about earlier). If you experience side effects like these, then these medicines have the potential to increase your risk of falling.
    2. Medications that may have some of those side effects include some, but not all, antidepressants, muscle relaxants, high blood pressure medicine, blood thinners, pain relievers, sedatives and tranquilizers. Within each of these categories of medicines are other medications that help with the same medical problem but may not produce the same side effects. If you report side effects to your doctor, s/he might be able to switch you to a different medicine without the side effects.
    3. You should have medication monitored by your doctor regularly. Report any side effects to your doctor. It is possible that the dosage or exact type of medication prescribed can be adjusted by your doctor to eliminate side effects.
    4. Also, be aware that if you are taking more than one medication, there may be side effects produced by the interaction of the drugs with each other in your body.
    5. In addition to promptly reporting any side effects of medication to your doctor, you should also keep a list of all prescription and over the counter medications that you take and take that list to your doctor’s office at each visit so that the doctor can review what you are taking.
      • a. Your doctor receives updated information on medications on a continual basis. So even if your visit to the doctor's office is unrelated to other medication, have your doctor review your current medication list while you are there.
      • b. Some of you see an assortment of doctors—your primary care physician and specialists. Having a list of all the medications you take, and showing it to all doctors you visit, will help make it less likely that one of your doctors will prescribe a medication that will interact poorly with another medication you are taking.
  5. Multiple diseases
    1. This is a risk factor that we do not have total control over. However, we can reduce the risk of getting some major diseases in the future through the choices about nutrition and exercise that we make now. It is also possible to reduce complications of some diseases, like diabetes, through nutrition and exercise.
  6. Depression
    1. A person who is depressed may experience inattention, be anxious and in a hurry, fatigued, irritable, impatient or have a misperception of their environment; symptoms that can lead to an accidental fall.
    2. Depression is more common than you might think among older adults. A depressed person may experience one or more of the following symptoms:
      • a. irritability
      • b. chronic aches and pains
      • c. ongoing sad, anxious or empty feelings
      • d. feelings of guilt, worthlessness or helplessness
      • e. early morning awakening or other problems with sleep
      • f. appetite problems; weight gain or loss
      • g. loss of interest or pleasure in formerly interesting activities
      • h. lack of energy; thoughts of death or suicide
      • i. memory problems
      • j. difficulty in concentration or decision-making
    3. If you think you might be depressed, there’s no shame in it. Just talk with your doctor about what you are experiencing and discuss treatment options.
    4. You can lower your risk for becoming depressed by:
      • a. maintaining friendships with people who will be there for you during major life transitions and losses.
      • b. becoming physically fit and getting proper nutrition.
      • c. keeping active both mentally and physically.
      • d. developing hobbies and interests.
      • e. telling your doctor about problems you have with medications and illnesses.
  7. Experiencing a fall in the past
    1. It is possible that experiencing one fall makes a person more fearful of falling again in the future. This may cause older persons to restrict their physical activity, or to become more rigid or overly cautious about walking. This fear of falling may actually increase the likelihood that one may fall again in the future. It may also cause older persons to become increasingly dependent or depressed.
  8. Inactivity
    1. Inactivity leads to poor balance and muscle weakness, which are crucial for overall health and fall reduction.
    2. When we do not exercise, muscles become smaller and weaker, and fat replaces muscle. Weak muscles make us more prone to falls because they cannot help to protect our joints or provide the strength and balance we need.
    3. People who do not exercise are more likely to be severely injured if they do fall. Without exercise (and proper nutrition, as we have discussed in recent/will discuss in future lesson plans) our bones tend to become thin and porous and may lead to osteoporosis, which causes our bones to break easily. Proper exercise and nutrition can help ward off or slow osteoporosis.
      • a. As (we have discussed/we will discuss) adequate calcium is essential for strong bones. You may also be interested in knowing that soy, which you can purchase rather inexpensively as tofu, may also help prevent osteoporosis. Soy has naturally occurring chemicals that are similar to estrogen which may help to protect your bones from osteoporosis.
    4. There was a time when it was considered “accepted knowledge” that older people could not increase their muscle strength. However, studies have shown that this simply isn’t true.
      • a. One study of frail older people in their late 80’s and 90’s showed that after six weeks of weight training, they had increased their muscle strength on average by 180 percent.
    5. We are talking about exercise today because we are talking about how to prevent an accidental fall. If you exercise, you can increase your balance, strength and mobility, and this helps to prevent falls. Exercise can also:
      • a. help to prevent osteoporosis.
      • b. strengthen your heart.
      • c. help you to maintain lung capacity.
      • d. help to slow or prevent the build-up of cholesterol in your arteries.
      • e. help to prevent hardening of the arteries.
      • f. help to reduce high blood pressure, which is a major risk factor for heart attack and stroke.
      • g. help to control diabetes.
      • h. improve the functioning of vital organs such as the liver.
    6. Four types of exercises that help older adults gain health benefits include endurance, flexibility, balance and strength. Walking is a good exercise because:
      • a. it can be done at a pace that you set.
      • b. it takes good walking shoes, but no other equipment.
      • c. it can be done when and where you want.
      • d. it strengthens muscles in the lower body.
      • e. it helps build new joint bone and tissue.
      • f. it helps to prevent or slow down osteoporosis.
      • g. it enhances your mood.
    7. If you decide to begin an exercise program, start off slowly and increase exercise gradually. Some people over-exert themselves when they start exercising. You should check with your doctor before starting any exercise program.
      • a. The Administration on Aging says:
        1. “Studies have found that violent physical exertion is no more useful to gaining and maintaining fitness than is moderate exercise. What is more, violent physical exertion can result in increased risk of injury or heart attacks for those who are not in prime physical condition. So start off slowly and go slow with your new exercise program.”
        2. Don’t start or stop exercising abruptly. Take time to warm up beforehand and cool down afterward.
        3. Don’t do any strenuous workout during hot, humid weather or within two hours after eating. In the Las Vegas summers, early morning (sunrise) is the coolest time of day to exercise. Also, some air-conditioned malls open early for walkers.
        4. Be aware of the warning signs of overexertion. If you have any of these check with your doctor as soon as possible:
          • a. Inability to talk
          • b. Dizziness
          • c. Disorientation
          • d. Nausea
          • e. Pains in chest, upper back, left shoulder, or arm
    8. Handout: I have passed out an article to you from the Administration on Aging on fitness for older adults. This article has much of the information on exercise we have just talked about. It also has information about choosing and starting out exercise programs and a method for you to use to determine the right intensity of your exercise.
    9. Guide Book: I am also passing around an exercise guide from the National Institute on Aging. It has a lot of good information in it about exercise for seniors and it includes exercises on strength and balance, as well as chapters on safety, motivation, progress and nutrition. If free copies for the class were not available, write the toll-free number on the cover for Learners to make a note of if they are interested in ordering a free copy.

Modeling And Guided Practice:

I mentioned last week that we could take a short walk just to get a little fresh air and exercise (or introduce the pedometer or exercise demonstration). Did everyone wear or bring comfortable shoes?

When everyone is ready, facilitator and group will take part in the exercise activity.

Upon completion: How does everyone feel? Let’s discuss what we talked about today.

Monitoring / Discussion:

Q: The purpose of our activity was to get a little exercise to improve our balance and mobility. How many of you currently exercise? What are some of the activities you do?

Q: Did you see or hear anything today when we talked about preventing falls that you think might be a good idea for you?

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

Q: Of all we talked about today, what would be the easiest change for you to make in order 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 . . ..”