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With falls the leading cause of death among older adults and the most common cause of nonfatal injuries, occupational therapists have found a growing niche market to put their skills to good use.

“OTs are trained to pay attention to the many different factors that affect overall functioning,” says Elizabeth Peterson, MPH, OTR/L, FAOTA, clinical associate professor at the University of Illinois at Chicago in the department of occupational therapy. “We are in a terrific position to look at the big picture to determine what activities older adults are involved in [that could contribute to fall risk], and to work as part of an interdisciplinary team to support their functioning.”

The Centers for Disease Control and Prevention estimates that one-third of adults age 65 and older fall each year. And as the number of older adults increases, the CDC estimates the financial burden to reach nearly $50 billion in the next 10 years. Even though falls are a serious problem among older adults, they are preventable. The key is to first determine those factors that put seniors at risk.

Identifying Risk
Just as muscles, organs, and other areas of the body deteriorate as we age, vestibular functioning, or inner ear health, can as well, says Gaye Cronin, OTD, OTR/L, an occupational therapist specializing in vestibular rehabilitation at the Atlanta Ear Clinic. “When you have a multisensory dysfunction, the brain has to work harder to compensate for changes in the muscles, joints, eyes, and vestibular systems,” Cronin says. “Over time, our sensory systems change and degenerate, so for example, if you try to get up at night, you may fall if you are reliant on your eyes and your inner ear system is not working correctly.”

Peterson says several factors typically work together to create fall risk in seniors, such as certain medications or a combination of medications that cause dizziness or vertigo and affect cognitive ability; physical impairments such as muscle weakness, vision problems, and arthritis; and environmental obstacles such as poor lighting and slippery floors. “The first step is to identify risk factors and then focus on the ones you can modify,” she says.

Deconditioning due to fear of falling is an especially important risk factor to consider. “One of the major reasons people cut back on activities is because of fear of falling - and then it becomes a self-fulfilling prophecy,” Peterson says. Occupational therapists can work with older adults to reduce fear of falling and to help them discriminate between a “healthy caution” of activities that are beyond their ability level and a fear of falling that is keeping them from participating in activities they are safely able to perform.

Reducing Risk
Consistent exercise is one of the best defenses against falls, says Deborah Morawski, OTR/L, an occupational therapist with Sierra Nevada Memorial Hospital in Grass Valley, Calif. Morawski spearheaded a vestibular therapy program at the rural area hospital, in part to treat benign paroxysmal positional vertigo. BPPV causes dizziness and vertigo because of calcium carbonate crystals collecting in the inner ear.
Symptoms often flare while bending over, rolling in bed, and moving the head too fast. “It is the most common cause of inner ear problems of people over the age of 60,” Morawski says. “It is easy to diagnose and easy to treat but very underdiagnosed.”

Treatment of BPPV includes particle repositioning maneuvers that help to detach the crystals, as well as vestibular retraining therapy that combines head and body movements with eye exercises. The brain ultimately can be retrained to coordinate body and eye movements so as not to cause disorientation or dizziness, and, in turn, help prevent falls.

Whether the risk of falls is caused by physical impairments, medications, or environmental obstacles, Peterson says a multifactorial approach to reducing fall risk works best. Interventions may include helping older adults identify and manage their vision problems, and teaching them how to modify activities; identify and address fall hazards in the home; and communicate their needs assertively. Interventions that empower older adults to use problem solving and action planning to reduce their own fall risk may be most effective in the long term.

Peterson was involved in the development and evaluation of the “Matter of Balance” program, a nine-session, group-based intervention offered to older adults living in the community. “The goal is to reduce the fear of falling,” Peterson says. By teaching older adults how to control their risk of falls, activity can be safely increased.
Two versions of “Matter of Balance” are now available. The original program was developed for use by healthcare professionals. A volunteer lay version has been developed and is being implemented by MaineHealth’s Partnership for Healthy Aging.

The PHA team offers a “train-the-trainer” that has led to “Matter of Balance” use in senior centers, area agencies on aging, and other community-based organizations serving older adults. Community efforts to provide the Matter of Balance program are just one example of how people can work together to reduce falls among older adults. “With the help of the National Council on Aging, fall coalitions have been set up in many states,” Peterson says. “Everybody has a role in this grassroots initiative to prevent what has become a huge problem.” •

Meghan Gourley is a medical writer for the Gannett Healthcare Group.

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