The question of “Do you care enough about preventing falls?” is less about compassion, or our ability to emotionally care about patients. Rather it about how we provide care for patients that fall. Look only at the works, e.g. your treatments. If an outside party was to judge your efforts by looking only at your treatment notes, could they say that you indeed provide enough care to your patients to prevent falls? The following criteria may help make this judgement:
Assessment. A fall-risk assessment should be performed on patients that fall. This assessment should look at multiple reasons why patients fall. The following list is a strong foundation for a complete fall-risk assessment:
– Fall history
– ADL performance
– Cognitive status
– Fear of falling
– Cardiovascular function
– Neurological function
– Leg strength
– Environmental hazards
- Types of exercise. Include both leg strength and balance exercises to reduce the risk of future falls. While patient’s needs vary, the mix of exercises should be about half strength and half balance. As leg strength improves and becomes less of an issue, the focus should shift to more balance exercises. Examples of balance exercises include: standing with heels together, weight shifting side to side, weight shifting forward and back, etc.
- Progression of exercises. Patient’s need to be challenged by exercises in order to make the physical improvements needed to prevent falls. Early treatments should clearly show a progression in strength and balance exercises. It is not uncommon for patients to feel unsteady at times while practicing balance. Because feelings of strain and unsteadiness are needed to make physiological changes in the body, care should be taken to exercise in a safe environment and to progress exercises in a responsible way.
- Education. Making patients more knowledgeable about fall risk should be a component of fall care efforts. Share with your patients tips to prevent falls. Examples of education topics include home fall hazards, orthostatic hypotension, exercise, incontinence, etc.
- Outcomes. At the completion of therapy, or at other time intervals, retake strength and balance tests to better understand how patients respond to your fall care efforts. A positive response will be supported by gains in strength and balance. Such success stories help to prove to patients that they can make a positive change in their health.
Finally, care enough for your patients to plug them into ways they can continue to work on strength and balance once therapy is done (wellness programs, home exercises, senior centers, etc.).