Ministry of Health Malaysia
MODULE NO. 7
FALLS PREVENTION &
SAFE ENVIRONMENT
Occupational Therapy (OT) handout
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INTERVENTION STEERING COMMITTEE INTERVENTION STEERING COMMITTEE
MinistryMINISTRY OF HEALTH
of Health Malaysia MALAYSIA MINISTRY OF HEALTH MALAYSIA
OCCUPATIONAL THERAPY (OT)
GENERAL ROLES
To participate independently in daily living task (ADL and IADL) in a safe environment
SPECIFIC ROLES
To provide interventions that target improving functional abilities in fine motor skills and gross motor skills
To change the activity patterns and behaviour according to patients’ priorities
To prescribe assistive devices and mobility aids so that patients are able to walk without any falls
To adapt and/or modify patient’s home and other environment to prevent further falls
To educate and/or train patient and carer on simple activities, based on energy conservation and work simplification techniques
OT ASSESSMENTS
1. ACTIVITY DAILY LIVING (ADL) 3. COGNITIVE FUNCTION
Modified Barthel Index (MBI) SLUMS and/or MMSE
2. INSTRUMENTAL ACTIVITY DAILY LIVING (IADL) 4. HOME ASSESSMENT
Lawton Activities Daily Living Scale Home Fast
Home Evaluation Checklist
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1. ADL
ADL ASSESSMENT
• Modified Barthel Index (MBI) is used for Activity Daily Living (ADL) assessment.
• The MBI is a tool developed by Shah et al. to measure the degree of disability in a patient based on
daily living activities (ADLs).
• MBI assesses a patient's capacity for daily living through tasks such as eating, bathing, grooming,
transferring, using the toilet, dressing, and mobility.
• The MBI has a maximum score of 100, with higher scores indicating greater ADL. The scores are
distributed among 10 items, with each item earning points for each activity.
ADL INTERVENTION
• ADL retraining consists of occupation-based activities in a natural environment, simulation activities to
work on specific skills, and introduction to adaptive equipment or strategies to overcome task barriers.
• Areas of training: personal hygiene, bathing, feeding, toileting, stair climbing, dressing, chair/bed
transfer, ambulation, wheelchair (if patient is unable to ambulate and is trained in wheelchair).
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2. IADL
IADL ASSESSMENT
• Lawton-Brody Instrumental Activities of Daily Living Scale (IADL) is a tool used to evaluate independent
living skills.
• Simple-to-use assessment tool that gathers self-reported data on functional skills required for
community living.
• It measures eight domains of function, with women scoring in all eight areas and men scoring in 0-5.
IADL INTERVENTION
• Areas of training: ability to use telephone, shopping, food preparation, housekeeping, laundry, mode of
transportation, responsibility for own medications, ability to handle finances.
• Training independency by:
o changing activity pattern and behavior
o prescribing assistive device and mobility aids
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3. COGNITIVE
COGNITIVE ASSESSMENT
• 2 assessment that assess for cognitive function such as The Saint Louis SLUM University Mental Status (SLUMS) and/or
Mini Mental State Examination (MMSE).
SLUMS:
o screening tool that may identify signs of cognitive impairment. In some cases, these signs may indicating dementia.
o 11 questions that evaluate memory, attention, visual-spatial function, and executive functioning.
o A lower score on the SLUMS test suggests the person may be experiencing cognitive decline or dementia.
MMSE:
o a tool that can be used to systematically and thoroughly assess mental status.
o 11-question measure that tests five areas of cognitive function: orientation, registration, attention and calculation,
recall, and language.
o the maximum score is 30. A score of 23 or lower is indicative of cognitive impairment.
COGNITIVE INTERVENTION
• Cognitive Training (CT) works on the premise that cognitive abilities can be maintained or improved by exercising the
brain, in a way similar to fitness routines/exercising improving physical fitness. CT uses intense mental exercises to
target and work on the brain’s core cognitive skills.
• Cognitive skills: attention, working memory, problem solving abilities, logic and reasoning,
Examples of activities: reality orientation, memory training, and group therapy
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GOOD PRACTICE IN WARD ENVIRONMENT
1. PATHWAY 1. BEDSIDE
• Avoid clutters along the pathways • Locker must be placed close to the patient’s bed
and easily reachable
2. BED • If patient had body weakness, the locker must be
• Make sure bed railing is up (if required) at the strong side of the body
• Height of bed: • Place locker within the visual field of the patient
o Just Right - Sit on the edge of the bed. The • Provide nightlight at bedside
height is perfect if the hips and knees are
aligned and the feet are flat on the floor 4. TOILET
o Too Low - the knees are above the hips, • Door width:
the bed is too low o sliding types, light weight, no slope
o Too High - if the feet can’t reach the floor o standard bathroom door is
comfortably, the bed is too high 32 inches (81cm)
o for small space, the door width down to
28 inches (71cm)
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GOOD PRACTICE IN WARD ENVIRONMENT
Height of toilet:
o height of a standard toilet (regular toilet) - Is about 15 • Lighting: good lighting, avoid dim and yellowish light
inches from floor to seat. • Door mat: non-slip types
Types: • Sink: choose types of sink that have space to assess
wheelchair.
o Sitting toilet type is safer than squatting type
o Commode chair - suitable for toiler user 5. FLOOR
o Commode wheelchair - suitable for bedside user and • Patient with eye-sight problem may have problems in :
more stable o depth perception & visual acuity
Grab bars: - having difficulties to differentiate distance
o Types of grab bars: horizontal, vertical o figure ground discrimination
o Grab bars should be provided on the side wall closest to - having difficulties in distinguish between 2 surfaces
the toilet to help with sitting or standing, or in
transferring from a wheelchair onto the toilet seat • Suggestions: using colour contrast such as different
There should also be a grab bar placed on the wall colour of floor tile, different colour of curve tile, and
behind the toilet, if needed using coloured tapes to differentiate surfaces between
steps in stairs and floor
*Guide for installation:
The best height for grab bars is always going to be where it 6. CHAIR
will be the most secure and comfortable for the intended • Chair with armrest, heavy, and stable base
user. A petite person will need grab bars placed at a lower
position while a tall person need a higher grab bar.
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HOME MODIFICATION
Home modification for falls prevention means to change or alter the environment to make daily activities
easier, reduce accidents, and support independent living.
TOILET & BATHROOM
suitable door width, alert on curbs, suitable height of toilets, suitable types of toilet, installing non-slip floor
mat, and installing grab bars
FLOOR
using colour contrast to differentiate floor surfaces
STAIRS
using colour contrast to differentiate the steps distances and distinguish surfaces
LIGHTING
good lighting, avoid dim and yellowish lights in the toilet, living room, bedrooms and other areas
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HOME MODIFICATION
Home modification for falls prevention means to change or alter the environment to make daily activities
easier, reduce accidents, and support independent living.
KITCHEN & STORAGE
arrange things by categories and neat, wheelchair accessible, cabinet accessible
FURNITURE ARRANGEMENT
avoid clutter, make arrangement for wheelchair/ walking aids accessible
BEDROOM
avoid clutter, neat arrangement, suitable height of bed and door types
PATHWAY
avoid clutter along the pathways around the house
LIVING ROOM
check on furniture arrangement, use of suitable chair, electrical switches/outlets are accessible.
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TYPES OF WHEELCHAIR
Standard Standard Forearm Lightweight Lightweight Reclining
Detachable
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PATIENT / CARER EDUCATION
1. FOOT WEAR
• Types: closed shoes, velcro
• Size: fit correctly
• Weight: not too heavy/ too light
• Heel: low heel
• Sole material/ design: anti-slip material
• Insoles: sturdy and not too flexible
2. TYPES OF ASSISTIVE DEVICE
• Long handle shoe – for wearing shoes activity
• Transfer board – for transferring activity
• Long handle sponge – for bathing activity
• Enlarged spoon/fork – for feeding activity
• Reacher – for reaching activity
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PATIENT / CARER EDUCATION
3. ENERGY CONSERVATION AND WORK SIMPLIFICATION
• Pacing activities
o break tasks into smaller, manageable steps and pace themselves to avoid overexertion, which
can lead to fatigue and increased risk of falls
o alternate between periods of activity and rest to conserve energy and maintain balance
• Encourage using assistive devices/ easy to assess
o reacher for reaching activities
o pump type shower gel
o suitable/ simple type of water pipe
• Optimizing body mechanics
o practice proper body mechanics when performing tasks that involve bending, lifting, or reaching
to minimize strain on muscles and joints.
o use techniques such as bending patient’s knees when lifting objects, keeping their back
straight, and using their legs to generate power.
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FEAR OF FALL
1. MAJOR FACTORS:
• Physical limitations - cut back on activities they can lose leg strength and balance
• Overestimate abilities - take too many risks
• Trust issues – did not trust others while performing activities
2. GROUP THERAPY/ SUPPORT GROUP FOR INTERVENTIONS:
• to built trust among patient with multidisciplinary team
• support each other by sharing experiences after a fall or using walking aids
• work with service users, caregivers, family and friends to adopt a positive approach to balancing
risk and activity
• provide support group for those patient that had multiple falls and educate their family members
regarding the falls
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THANK YOU
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