By Natalie Chung-Sayers

“Being in a hospital for a while…you start to yearn for home. Home is great. It is your safe place. You know where things are,” says Jean Bubba, 67.

But home is also where most adults 65 years of age or older, will experience injuries from a fall. The World Health Organization has identified falls as a major public health issue. In Canada, falls cause 70 per cent of major injuries among seniors, with 80% of these falls occurring in the home.

Jean had surgery for a neurological condition. After recovering in acute care, she began rehabilitation at Sunnybrook St. John’s Rehab in the Stroke and Neurological Rehabilitation Program.

When Jean was ready to go home, her therapy team referred her to the Falls Prevention Program, part of the St. John’s Rehab Outpatient Therapy Program. The Program provides free in-home assessments to individuals aged 65 or older who are physician-referred and live in the hospital’s neighbouring communities.

“I assumed the assessment would just be about the bathroom,” recalls Jean. “I wasn’t thinking about the whole place or about managing my medication – but they were!”

“Our in-home assessment team made up of an occupational therapist and a pharmacist go to an individual’s home. They visit to understand how the individual moves within the home to complete daily activities,” says Gary Siu, Project manager, Outpatient Therapy Services, St. John’s Rehab.

“The occupational therapist identifies and provides education about falls risks and hazards within the home. They also observe a client’s functional mobility within the home and make recommendations about home adaptive equipment and safe transfer techniques,” says Gary. “The Pharmacist observes the in-home organization and administration of medications, and makes recommendations to the client and family doctor to decrease falls risk.”

“I was surprised by the team’s findings,” says Jean. “Their assessment gave me a different set of eyes to see how I live.”  She had many scatter mats throughout her home. To her, they were always just pretty and decorative. “Even though they had a non-slip lining, they turned out to be a risk factor. The varying surfaces of the rugs, the likelihood that they could get ‘kicked up’ in the corners, or that I could trip over a fold in one of them – these were things I had never considered before. They also looked at my bathroom and approved what I had installed, but most importantly, my entire apartment was assessed.”

“It was eye-opening and instructive. It’s like getting driving lessons and instead of instructions for ‘skid school’ on what to do when things go bad. To my delight, the experience was more of a preventive approach of what to do to ensure that things don’t go bad. The education didn’t just apply to my home. It made me aware of what risks to look for, outside of my home.”

On the medications assessment, Jean describes it as a holistic approach. “Before I was in the hospital, I was limited to using antibiotics. Now, post-surgery and at home, I had to take new medications that were very foreign to me.”

To help her organize the timing and doses of medications, the pharmacist advised her to get a dosette, and a friendly ‘quack’ alarm sound that she set on her phone reminds her of specific dosage times.

The pharmacist also assessed for factors that affect women – Jean’s vitamin D and calcium levels, and advised her to build up calcium with more dairy in her diet, and reduced caffeinated beverages overall. They also advised her to cut her caffeine in the evenings. This would allow sleep to be more restful, which means less risk of falling if she was to get up at night.

The pharmacist also got Jean’s permission to check with her family doctor about her bone density. “Findings from that conversation were communicated to me. It was full circle with regard to the family physician, and then with me,” she says.

In addition to the in-home assessment, clients attend exercise and education classes at St. John’s Rehab as part of the Falls Prevention Program. “The class encourages long term self-maintenance by working in results of an individualized physical and balance assessment, into a prescribed home exercise program. Clients also receive education on nutrition and the benefits of exercise. Our goal is to keep seniors safely and independently living at home longer,” says Gary.

“Now, I am not a passive patient. I am a person who can make decisions and take steps towards my recovery. The effect of the falls prevention service is self-empowerment. I am able to regain independent living very quickly without worry. It’s one of the biggest steps towards healing.”

“I am safe in my home – and safer – when I go out.”

Natalie Chung-Sayers is a Communications Advisor at Sunnybrook Health Sciences Centre.