Authors (including presenting author) :
Poon A, Cheng HT, Wong KC, Tse KY, Leung YS, Ip WM, Lau M
Affiliation :
Occupational Therapy Department, Shatin Hospital
Introduction :
Developing smart care, grounded in evidence-based practices, is set to be a key focus for occupational therapy in the coming five years. With a significant role in fall prevention, occupational therapists employ a diverse array of evidence-based strategies to identify fall risks and develop individualized, multifactorial intervention plans that address physical, personal, environmental and behavioral domains. Implementing a program-based fall rehabilitation initiative can facilitate early discharge and provide essential post-discharge support, significantly improving fall-related outcomes, enhancing quality of life and reducing healthcare facility readmissions among community-dwelling older adults.
Objectives :
To provide evidence-based fall prevention program aim at:
1) Identify Fall Risks: To assess and recognize individual fall risks through evidence-based measures.
2) Enhance efficacy of patients and care-giver: To provide comprehensive education on fall prevention, home safety and adaptive techniques.
3) Enhance Quality of Life & functional status: To improve functional outcomes and quality of life through tailored intervention programs.
4) Reduce Fall Incidence: To decrease the number of falls and related injuries among community-dwelling older adults.
Methodology :
The program involved recruiting medical and geriatric patients admitted to the geriatric day hospital of Shatin Hospital. Inclusion criteria included a documented history of falls and identified fall risks. Patients participated in fall prevention program during their stay at the day hospital. The program covered strengthening and balance training which integrated in ADL, environmental intervention, modification of fall risk factors, education on home safety concepts, clothing and footwear recommendations, adaptive ADL techniques, post-fall management skills and assistive technology prescription.
The effectiveness of the fall prevention program was assessed using several validated tools include Modified Barthel Index, Lawton IADL Scale, Fall Efficacy Scale, Fall Risk Assessment Score for the Elderly (FRASE), patient knowledge evaluation in fall prevention, patient satisfaction survey and monitoring fall incidents within a 3-month period before and after program intake.
Result & Outcome :
Total 161 medium to high fall risk patients (FRASE mean=14.7) were recruited from April to November 2024. The mean age was 79.6 years with 53 % of female.
Paired sample T-test was used. Significant improvement was seen in Modified Barthel Index (t=-14.0, P=0.00), Lawton IADL Scale (t=-5.0, P=0.00), fall incidence (t=5.5, P =0.00), Fall Efficacy Scale (t=-2.7, P=0.00), patient knowledge evaluation in fall prevention (t=-10.2, P=0.00), FRASE (t=9.9, P=0.00) and fall risk assessment in balance & lower limb strength (t=-3.7, P=0.01).
Patients also perceived the fall prevention program as satisfactory (mean=28.2/30), helpful for improving awareness of fall prevention & post fall management. Most expressed that they have improved insight on own ability in terms of fall prevention.
By focusing on evidence-based strategies and implementing a structured fall prevention rehabilitation program, occupational therapy can play a pivotal role in reducing fall incidences, improving functional status, improving efficacy and the quality of life for older adults. This approach not only supports early discharge but also ensures ongoing support in the community, thereby promoting safer living environments for older adults.
