Health & Medical Question

In most homes we can identify hazards that may present as a risk for falling, specifically for older adults. However, rarely do we identify them unless we are looking for them – or a fall has taken place.

The following is the checklist included in the Safe City Windsor – Fall Prevention Brochure:

(see files)

Using this checklist – conduct an assessment your own dwelling environment. You can choose just one room, or multiple rooms. There should be at least one room for each group member. Providing photographs in an appendix is encouraged. Together, write a two page report about the:

This assignment needs to be 1 page, my group partner will write the second page!

APA FORMAT

Please go in depth, this is a masters class at a canadian Univeristy

Please read the pdf files I send to look over what is discussed in class!

You can find pictures online or even use pictures in your own home!

1. Advantages of using a checklist such as this one
2. Disadvantages of using a checklist such as this one
3. Recommendations as a result of this checklist on how to improve your environmental hazards regarding fall prevention

Appendix: can be hand written assessment form used as part of the assignment. Photographs of the environment may be advantageous.

Note: a title page for the individual weekly assignment is not necessary.

• Text/Format Specifics: Single spaced typed, Calibri 12-point font, 1 inch margins, page numbers as the bottom centred.

References within text should be numerical in order of appearance, with square [1] brackets. Formatting for references: [1] Ronholm, E., Pittman, R., Suboni, P., Otte, G., & Coene, W. (2024). Title of article. Journal Name, Vol (issue): Pg-Pg. [2] Wrigley, T., & Fenway, R. (2024: Pg-Pg). Chapter Title. Book Title. Editors. Location [3] Heart & Stroke Canada: www.heartandstroke.ca Last visited on: Jan. 8th, 2024 Note: you are not permitted to reference the class lectures or asynchronous materials Note: references should not be older than 10 years (i.e., 2014) when possible

The evidence on modifications or assessments made to the environment and the
relation to fall prevention is still emerging [Iwarsson et al., 2009]. Although empirical
evidence on reducing home hazards is weak, there are various checklists that have
been developed [Pynoos et al., 2005; Iwarsson et al., 2009]. Checklists are often
preferable because they are low- to no-cost. Unfortunately, checklists – whether
they are used as a self-assessment, or conducted by another individual such as an
Occupational Therapist or Kinesiologist – they rarely afford the opportunity to watch
an individual, or individuals, engage with their environment while performing various
tasks [Pynoos et al., 2005]. Thus, it may be advantageous to pair an environmental
assessment with a functional performance test.
Again, a common question ends up being – who is responsible for performing the
assessments and making recommendations? There are a lot of programs that
afford an Occupational Therapist to do a home visit and assess the dwelling
environment of an individual. However, that does not necessarily mean that the
entire house will be assessed – rather it may be that only a certain room or rooms
are looked at. Commonly, the bathroom is assessed for the need of grab bars.
On a personal note, when my sister Laura (born with Down Syndrome) was alive,
we were recognizing that her living at home was becoming too challenging for
many reasons. Part of the assessment process was having an Occupational
Therapist perform an environmental assessment. However, it was during COVID19, thus the assessment needed to be done via the telephone (in other words, the
Occupational Therapist never stepped foot in the house where my sister lived, he
did not even see a picture). Due to my knowledge and expertise, my mother had
me take the phone call. This was helpful to the Occupational Therapist, as he noted
on several occassions, to have this discussion with someone who understood what
he was asking was refreshing. Nonetheless, he provided a report with almost 80
recommendations. 80!!!! Perhaps a bit overwhelming? Perhaps. It would have also
been cheaper to, as my mother said: “level the house and build a new one”.
Meaning, the recommendations were not remotely feasible. Yet, the Occupational
Therapist was proud of his work, thought he was thorough, and was truly helping
my family. In reality, he was not helpful. He actually created more anxiety, increased
frustration, and a general sense of being overwhelmed. My sister would pass away
less than two weeks of this assessment – could you imagine if a family began to
spend the money to make the changes, and then their loved one passes away?
True – if it was following universal design principles, these changes would – shouldbe beneficial for everyone. The majority of the suggestions made in this scenario
would not have aligned with the principles. I am not sure if the Occupational
Therapist was even aware of universal design. He was doing his job – but it
definitely illustrated that just because one modification may be ideal for one person,
does not always mean it is advantageous for another. How do we ensure concepts
like universal design are embedded in assessments? That the individual performing
the assessments and providing recommendations is aware of these concepts?
There are many studies that include follow-ups 3 months, 6 months, 12 months, or
even 24 months after a fall prevention intervention has taken place. However,
because their main concern was the occurrence of a fall, that is typically the
outcome measure being evaluated. Therefore, any improvements in fall prevention
are implied to be caused by the recommendations provided through the
environment modifications. This can only be an assumption, however. It is
imperative that follow-ups are done to see how many recommendations were
actually implemented. You may be surprised how often the answer will be that littleto-none are implemented. Why?
They were deemed not necessary.
They were too expensive.
They weren’t going to help.
I meant too, but I forgot.
My son or daughter was against the idea.
Perhaps 80 recommendations were given and they were just
overwhelmed.
The list could go on. Even when grab bars are installed in the bathroom, and follow
universal design principles – that does not mean they are used.
Thus, if you are conducting research or implementing changes in your own field of
work, consider the fidelity – the extent to which older adults adhere to the provided
recommendations.
The intent of environment modifications is to reduce the potential threat to falling,
but to also support independent living by making tasks easier to perform. After
scoping the literature, Pynoos et al., (2005) provided eight main environmental
factors one should consider modifying as they may affect the risk of falling:
1. Poor or inadequate lighting
2. Changes in floor surface or slippery surfaces (e.g., wet or polished
floors, and non-slip-resistant bathtub surfaces)
3. High-gloss floors and/or walking surfaces
4. Problems associated with stairs (e.g., lack of handrails)
5. Inappropriate chair or cabinet heights
6. Clutter, storage problems, and tripping hazards such as furniture or
throw rugs
7. Poor sidewalk and pavement conditions
8. Pets and pet-related objects
Pynoos et al., (2005) also reported on the main areas that pose the biggest
threats:
1. Outside steps to the entrance à perhaps modify with a ramp
2. Inside stairs to a second floor à there may be the need for railings
3. Unsafe bathrooms à alter for easier access and support (e.g., grab
bars)
Some of the easiest and low-cost modifications can include [Pynoos et al., 2005]:
Removing hazards (e.g., clutter, throw rugs)
Adding assistive devices (e.g., grab bars, ramps)
Moving furnishings
Changing where activities occur (e.g., sleeping on the first instead of
second floor)
Renovations (e.g., installing a roll-in shower)
Although this publication is from the year 2005 – the same issues and the same
low-cost modifications remain relatively the same.
CC0 Public Domain via Max Pixel
Universal Design often implies accessibility. However, just because something is sold
with the idea that it has a universal design, does not mean that is true in practice
[Mustaquim, 2015]. I know personally there are many products that claim they are
“ergonomic” – when that is not even close to the case. Sometimes certain words
become the “hot descriptor” or “halo words” that sells. The term universal design has
definitely fallen victim.
The next video I invite you to watch is among my favourite. It is important to note
from the beginning that this building has won awards for its design – do you think it
was award worthy? The title of the video may give the answer away. Watch this
video that was published on YouTube in 2017 by the Toronto Star entitled: Ryerson’s
new Student Learning Centre fails accessibility test (despite winning awards!):
Ryerson’s new Student Learning Centre fails accessibility te…
te…
Was that building, even just the entry way, really designed for any person, regardless
of age and ability, to use without additional adaptations or modifications?
Universal design is ensuring that a product, or an environment, can be used
universally by all, or most, people. Universal design should help ensure the removal
of environmental barriers to promote inclusion rather than exclusion of certain
populations. Integration should also help to minimize the many stigmas that exist
when populations are excluded. This can be particularly important for individuals
who may be trying to reintegrate within their society [de Souza et al., 2016].
For more information on universal design aginginplace.com provides the following:
Aging In Place – Universal Design
or see the link: https://aginginplace.com/universal-design/