“

H

elp! I’ve fallen, and I can’t get up!” This familiar phrase was heard on commercials, and comedians frequently made jokes and discriminating comments about older adults. Today, however, as the baby boomers are becoming older, falling is no longer a joke, and fall prevention and health promotion are now necessities.By 2020, there will be over 52 million people in the United States over 65 years of age, while almost seven million people will be 85 years or older^1,2. Further, older adults are becoming more diverse. For example, by 2050, the Hispanic older population is expected to grow from 4 to 16 percent.1 The Centers for Disease Control and Prevention (CDC) indicated that falls occur in approximately one out of every three older adults in the United States, are frequent causes for hospitalizations, and are a primary cause of death³. In fact, the annual average death rate attributed to falls among older adults is about 9,000¹.
       As our society ages and becomes more culturally diverse, health promotion and prevention of disease are imperative^2,4. Providing various types of geriatric fall prevention programs addresses the Healthy People 2010 focus on providing health promotion and preventative measures among older adults of various ethnicities to enhance their quality of life, achieve a longer, healthier life, and eliminate disparities in education, disability, gender, race, living in rural or urban environments, sexual orientation, and/or income⁵.

Fall Prevention Strategies
Numerous strategies exist to address fall prevention and safety concerns and lessen the risk of fall-related injuries among older adults^3,6,7. Research has demonstrated that participating in regular exercise programs, having medications reviewed and adjusted to avoid side effects, eating a well balanced diet, and having regular physical and eye examinations may lessen the possibilities of falling^3,8. Another fall prevention strategy relates to interior and exterior home modifications, as needed, to ensure a safe environment. Fall prevention programs for older adults have been found beneficial for those who are at risk for falls and/or report a fear of falling⁷. The provision of fall prevention educational programs may benefit those living in the community, senior apartments, assisted living facilities, and nursing homesSPICE for Life Program
One example of a fall prevention program is the Senior Safety Prevention Intervention Community-based Education (SPICE) for Life program in eastern North Carolina^9,10. This program is a collaborative community-based program sponsored by a Council on Aging community agency and a private outpatient occupational therapy clinic. The program was funded through a grant from the local hospital’s medical foundation. Occupational therapists and certified occupational therapy assistants were the primary providers of the grant’s services. The first component of the SPICE for Life program focused on providing fall prevention, home safety evaluations, and home modifications for low-income community-dwelling adults^9,10. The second component of the grant included the development and implementation of four preventative and promotional health presentations for older adults throughout the community. One of the community education programs provided through this grant, Fall Prevention and Home Safety, will now be discussed.

SPICE for Life Fall Prevention and Home Safety Program
The Fall Prevention and Home Safety educational program was developed and implemented first, since the responses from the needs assessment indicated its high importance for older adults living in this community^9,10. The length of the presentation was based on the time allocated by the presentation site and varied from 15 minutes to two hours. Council on Aging senior centers, church groups, physician offices, senior apartment complexes, and assisted living facilities were contacted by phone and/or mail to market this educational program. Other marketing strategies included posting flyer announcements on the downtown library’s community bulletin board and using the local television and radio stations for announcements, interviews, and advertisements. The Fall Prevention and Home Safety presentation was given at churches, an Elder Fair, senior apartments, assistive living facilities, senior centers, the downtown library, and national and state conferences. Audience size for each presentation ranged from four to about 250. Thus far, over 1,000 older adults and healthcare professionals have attended this fall prevention presentation. There was no fee for attending this presentation.

Components of the Fall Prevention and Home Safety Presentation
Through lectures, demonstrations, discussions, games, handouts, and videos, this fall prevention program included education about falls and home safety. Components of the presentation included the impact intrinsic and extrinsic risk factors have in relation to falls and home safety, the normal aging process, environmental safety to help older adults identify and eliminate safety hazards within their environment, and durable medical equipment that may cause or deter falls within the home.
       Initially, information about the SPICE for Life program was discussed. Then all participants over 50 years of age were asked to complete a fall prevention questionnaire¹¹. Data gained from this questionnaire included if the person had fallen, where and when the fall occurred, type of injuries incurred, and if the person had or has disengaged in activities as a result of the fall or has a fear of falling, etc¹¹.

Intrinsic Risk Factors
Associated with Falls
After an introduction and completion of the questionnaire, community-dwelling older adults and/or healthcare professionals were instructed in the intrinsic factors or personal factors that may increase the risk of falling. Implications and recommendations were discussed in relation to the neurophysiological changes associated with the normal aging process and limitations associated with many chronic diseases. For instance, visual impairments, such as glaucoma, macular degeneration, and cataracts, may place a person at risk for falls. Eye impairments associated with diabetes or other neurological disorders, such as stroke, may also increase the potential for an older person to fall. Fall prevention strategies associated with these visual changes may include educating the person on the importance of having an annual eye exam, avoiding clutter on the floor, using a bell on a pet’s neck collar, avoiding glare, and using high wattage light bulbs for reading or other home activities.
       Other normal age-related changes discussed related to how musculoskeletal changes influence mobility, muscle strength, reaction times, reflexes, and postural righting reactions^12–15. Diseases and medical conditions (i.e., osteoporosis, osteoarthritis, rheumatoid arthritis, Parkinson’s disease, etc.) that may influence the likelihood of falling were also reviewed. General fall prevention strategies relating to intrinsic factors were also reviewed including having annual hearing exams, having medications reviewed for possible side effects, ramifications of disengaging from normal activities from the fear of falling, and beginning a physician-approved regular exercise program^16,17.

Extrinsic Risk Factors
Associated with Falls
Extrinsic risk factors discussed included environmental causes of injuries or falls to older adults, such as uneven door thresholds, unstable furniture, dim or absent lighting, small bumps and/or slits in carpet or floors, and clutter on floor or stairways^9,13,14. Using a cane or walker and/or wearing non-slip shoes may prevent falls¹. The majority of audience members asked questions about how to make the bathroom safer. Suggestions included not to use towel racks, toilet paper dispensers, shower curtains, walkers, or other insecure devices to pull up from the toilet or hold on to in order to get in or out of the shower. Rather, have grab bars installed by the toilet, outside of the shower/tub, and inside of the shower/tub. If shower stools are used, be sure there is a back to the chair and the height is adjusted correctly. An extended shower seat, if bathroom size permits, was recommended to individuals with balance problems or orthopedic conditions that make it difficult to raise the legs over the side of the tub. Other bathroom suggestions included using a shower mat, adjusting the hot water temperature to no more than 120? to prevent burns, and installing proper lighting including a night light.
       Extrinsic factors related to safety outside the home include walking on uneven or unstable surfaces, such as a driveway, sand, snow, or ice, patio furniture in poor condition, and yard tools and/or garden hoses left in the yard, etc. Removal of wet leaves, garden hoses and/or tools, and/or oil spills on walking surfaces has been found to be an effective extrinsic fall prevention strategy. Participants were given information on preventing falls related to environmental modifications, bathroom safety equipment, and adaptive equipment. Durable medical equipment, in addition to the bathroom equipment, was demonstrated when time permitted. Examples included a reacher, lift seat, instructions on cane and walker safety, and using rubber grip materials to stabilize throw rugs on linoleum and carpet.
       A resource list was provided at the end of the presentation. “What You Can Do to Prevent Falls” and “The Home Safety Checklist” pamphlets were provided to all participants^18,19. These free pamphlets were particularly useful with large groups, such as an Elder Fair, and are available in English and Spanish. If time permitted, a video and/or Senior Solitaire learning activity was performed at the conclusion of the presentation^20,21. These activities reinforced the fall prevention strategies discussed and demonstrated in the presentation.

Conclusion
As our society ages, the need for health promotion and prevention is imperative. Fall prevention programs, such as the SPICE for Life Fall Prevention and Home Safety education program, have proven to be a valuable method in educating older adults and healthcare professionals in eastern North Carolina.