1. A Team Approach in Dementia Care

2. Strategies for Reducing Falls Among Residents with Dementia In Long Term Care Facilities Introduction Strategies for Reducing Falls Among Residents with Dementia In Long Term Care Facilities Introduction

3. Rate of falls in long term care facilities is 3x greater than people over 65 living in the community Residents with Dementia present a greater challenge Falls have serious consequences

4. Program Goal: Help facilities develop effective approaches for reducing falls Program Developers: Nurses Certified Nursing Assistants Therapists Social Workers Administrators

5. Interactive DVD Sections specific to your role in the facility May be used in a group or individually Quizzes and case studies to review topic

6. Dementia affects more than 60% of all nursing home residents Specialized dementia units provide care to residents in more advanced stages of dementia Residents with mild to moderate dementia may live in any area of a nursing home

7. Staff working on a dementia unit generally receives more specific training for caring for their residents. Staff working in other areas may be given some education regarding dementia but not necessarily detailed information.

9. This section presents basic information about the changes in the brain. The effects of those changes on a person’s ability to function Our goal is to help you better understand residents with dementia to reduce their risk for falls.

10. Everyone in a facility has an important role in fall prevention. All employees, volunteers and visitors can have an impact on reducing the risk of falls BE ALERT and TAKE ACTION

11. What “Dementia” means: A group of symptoms that result from a disease or condition Alzheimer’s is an example of a disease that causes symptoms of dementia. Stroke is an example of a condition that causes symptoms of dementia.

12. Most common symptoms of Dementia loss of memory loss of “thinking” skills loss of language skills decrease perception

13. When the brain is affected by injury or disease, neurons die and areas of the brain atrophy. Early stages of Alzheimer's Disease: short term memory loss confusion about familiar places takes longer to accomplish familiar tasks trouble handling money poor judgment mood and personality changes

14. Advanced Alzheimer’s disorientation to place, date and time decreased communication; using wrong words or repeating themselves loss of self care abilities incontinence difficulty walking Symptoms will change over time

15. When judgment, memory and thinking processes are affected by loss of brain tissue, a person’s ability to function in their environment is reduced and risk for fall Increased. It is important to understanding how symptoms of dementia can cause changes in physical functioning, decrease the ability to recognize limitations and express needs.

16. Introduction to Strategies for Reducing Falls Falls cause stress for everyone. Injuries may lead to loss of function or may be life threatening. Fall prevention begins with awareness and understanding of fall risk factors. Everyone has an important role in fall prevention.

17. Goals of Fall Prevention: Assess risk factors Analyze circumstances after a fall Correct problems and minimize risk on a daily basis

18. Intrinsic Risk Factors-related to resident’s health status Gait instability Lower limb weakness Balance problems Urinary incontinence or frequency The effects of certain drugs, particularly sedatives and hypnotics visual impairment dizziness

19. Residents with Dementia may also exhibit: Disorientation Anxiety and agitation Impaired judgment and decision making Impaired perception Impaired communication Failure to recognize limitations

20. Extrinsic Risk Factors-related to physical environment Poor lighting Wet or shiny floors Physical obstacles Walkers/wheelchairs Restraints Inappropriate footwear or clothing

21. Organizational Risk Factors-any other extrinsic factors not related to health status or environment Staff Training

22. Most effective strategies for managing falls in long term care facilities involves everyone who works at the facility and also includes support from families.

23. Guiding Principles to Fall Management Recognition that a comprehensive team approach to fall assessment and management is an integral part of the care process. Commitment to a facility-wide approach That includes every employee and volunteer as well as family members. A goal to create an environment that is safe, with sufficient staff to adequately monitor and assist residents as needed, while allowing as much individual freedom and autonomy as possible for residents, based on their capabilities.

24. Guiding Principles to Fall Management cont’d A systematic approach, involving an Interdisciplinary Falls Management Team, for collecting and analyzing data on falls and conducting thorough assessments of each incident to identify and address risk factors. Knowing that each resident has unique capabilities and intrinsic risk factors, so fall prevention strategies must be individualized. Recognition that the intrinsic risk factors for each resident will change over time as their physical and mental health status changes, and individualized care plans and fall-prevention strategies must be modified to accommodate these changes.

25. Although restraints can increase falls, some can give freedom and mobility.

26. Risk Assessment and Problem Solving

27. This module will: Review elements of fall management program Review risk assessment for intrinsic and extrinsic factors Describe procedures for post fall assessment Offer ideas for reducing risk with emphasis on dementia Practice exercises

28. A formal assessment of fall risk should be completed: Prior to or at time of admission At re-admission from hospital A resident’s health status changes

29. Conditions affecting fall risk generally included in a Fall Risk Assessment: A history of falls Mental status Cardiovascular and pulmonary systems Neuromuscular system Orthopedic conditions Vision Pain Physical functioning Medications Difficulties with communication and other factors

30. Fall risk assessments are used to identify fall risk factors and assist to develop care plan approaches to prevent falls Every member of the care team-including family-should be aware and understand risk factors that are specific to a resident

31. All staff members-direct care AND indirect care including volunteers- have an important role in looking for fall risks and Take Action: Report changes (mental or physical) in residents Move or report environmental hazards Interact with and engage residents

32. Role of Therapy in Fall Prevention

33. Goal of intervention and care plan approaches is to minimize risk of fall while maintaining functional mobility and ADL skills Risk factors predict likelihood of fall Therapist’s role is to identify actions that challenge balance to recommend interventions and train staff

34. Standardized testing may be limited Vestibular system may be tested by observing Body sway Presence of nystagmus Observation of gait for loss of balance with head turning Modify Functional Reach test to reach for object at a preset distance Observe, observe, observe functional mobility and ADLs Observe in different setting and at different times of day

35. Additional training for direct care staff for communication or task segmentation List specific directions or commands in care plan approaches Emphasize importance of consistency

36. Following a fall Review circumstances Determine root cause Be objective and identify details Encourage creativity and think imaginatively

37. Post Fall Review Circumstances of a fall are reviewed immediately after a fall when details of the fall are easier to remember. The Post Fall tool is used to help determine “root cause” of a fall and possible care plan approaches to prevent another fall.

38. Problem Solving to Reduce Risk of Falls

39. The best ideas or solutions to reduce the risk of a fall are the ones created based on the unique mix of intrinsic and extrinsic risk factors for a specific resident in a particular situation and organizational factors.

40. Root Cause Analysis Ask at least 5 “Why” questions when reviewing the circumstances that may have contributed to a fall. Answers will help to find solutions to prevent another similar fall.

41. Residents with dementia are more apt to fall when they are not engaged in an activity, are unattended or when they wander. Risk reduction strategies focus on ways to provide engaging activities for residents and increase interaction.

42. Suggestions for active engagement: Memory Boxes Sing Alongs Movies Music Balls Quiet area

43. Suggestions cont’d Tai Chi Hand Massages Repetition Reading with resident Talk about families Know the resident’s like and dislikes

44. Environmental Changes: Lighting Gait or unit entryway Decoration/Pictures Non-skid surfaces No overhead paging Simple carpeting Staff education and awareness

45. Enlist the help of all staff (direct and indirect care) volunteers and families to “brainstorm” creative ways to reduce the risk of falls.