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OIB Live Forum - Fall Prevention

During our live forum, we will address the hot button topic of fall prevention.  This Live Forum will be conducted on Wednesday, August 28th at 1:00 PM EDT, 12:00 PM CDT, 11:00 AM MDT, and 10:00 PDT on the OIB-TAC’s Community of Practice (www.oib-tac.org).   We look forward to a lively discussion and your participation. To participate in the forum, please type any add a comment with any questions or insights you may have about the topic. Dr. Steinman and other participants can then reply to your comment. Information will be added for an hour while our expert, Dr. Steinman, answers our questions. There is no audio or video.

Our guest is Bernard A. Steinman, Ph.D. who lives happily in the Rocky Mountain town of Laramie, Wyoming with his terriers Brandy and Coco. He is an assistant professor at the University of Wyoming in the Department of Human Development and Family Sciences. Generally, Bernard’s research interests pertain to health and aging—particularly with vision impairment, and aging in place in the community. Bernard’s original interest in age-related vision loss began 16 years ago when he started working as a research assistant at the (then) Rehabilitation Research and Training Center on Blindness and Low Vision at Mississippi State University.  While there, he worked on a five-year exploratory research project funded by NIDILRR entitled Persons Aging with Hearing and Vision Loss.

Comments

Bill Tomlin's picture

One out of three seniors over age 65 fall each year, with many of those resulting in serious injuries or death. According to CDC statistics, 800,000 patients are hospitalized annually because of a falls injury. Also, the rate of falls-related mortality has climbed dramatically over the last decade due to unprecedented growth in the older population. Falls prevention programs are becoming standard fare in most communities that have amenities for older adults. How can we engage with these programs to insure their programs are accessible for older individuals with vision loss?
Belinda Ballard's picture

Does anyone have tips for ensuring successful cane use in older adults with vision loss?
Adele Crudden's picture

VisionAware has some resources at: https://www.visionaware.org/info/essential-skills-2/an-introduction-to-orientation-and-mobility-skills/low-vision-and-the-white-cane-a-tool-for-fall-prevention/235 It is titled: Low Vision and the White Cane: A Tool for Fall Prevention
Bill Tomlin's picture

That is a great resource that you shared Adele
Kendra Farrow's picture

Orientation and mobility instruction with a white cane will help individuals with vision loss to have more information about the travel environment, which should help them anticipate the changes. This should help to reduce falls form unexpected steps up, down, and surface changes.
Belinda Ballard's picture

I already do work as an OM instructor for older individuals with vision loss, I guess my question was more about asking other OM instructors if they have strategies that differ from instruction with younger individuals and how to get older adults to buy into using a cane. Also, how do you get overprotective family members to back off and let you teach your lesson?
Adele Crudden's picture

If there are support groups for seniors with vision loss in the area, they can be very helpful in assisting persons with adjustment to vision loss, including accepting use of a cane. Seeing other seniors travel with a cane can have a powerful impact.
Kendra Farrow's picture

One of the things you can talk about with consumers unwilling to accept the cane is that people see their bumping into things, uncertainty about which way to go because they can't read signs, etc. People will draw conclusions, that person is confused/has dementia or that person has had too much to drink. Wouldn't it be a better conclusion to think that you are blind or vision impaired over those options?
Kendra Farrow's picture

Recently a course about the role of the family was added to our OIB-TAC continuing education course offerings.
Emily Damm's picture

The Role of the Family course can be found on our NTAC-BVI website: https://www.ntac.blind.msstate.edu/courses/courses.php?course=working-with-older
Belinda Ballard's picture

All of these ideas are great! I'd also love to see the course on family members of individuals with low vision.
Bill Tomlin's picture

If you have any questions or comments we would love to have you share with the Group. The first question is: How can we engage with these programs to insure their programs are accessible for older individuals with vision loss?
Bernard A. Steinman's picture

This seems like a really important question. It is my sense that there are usually at least some falls prevention options in most communities for older adults. However, all too often there is not consideration for persons with vision impairment, and certainly not for those who are legally blind. This is somewhat ironic, since we know that vision impairment is SUCH a big risk factor for most people. As the question implies, I think it will be very important for OIB programs to sort of lead the way in making inroads. Any ideas about how that my begin?
Belinda Ballard's picture

I think reaching out to your local agency on aging and local senior centers can be a good place to start.
Bernard A. Steinman's picture

I definitely agree with this comment. Though I don't speak for them, I think that the senior center here in Laramie would in all likelihood be more than happy to form a partnership with the state OIB program if they were approached.
Kendra Farrow's picture

I think it would be good to make contact with programs and ask them if they have made accommodations for individuals with limited vision. If they haven't thought about it you could provide some suggestions about adaptations. Some of these adaptations can be found on our community of practice documents. One example for walking a short distance, was to use a table to trail around instead of using a cone.
Bernard A. Steinman's picture

Good afternoon everyone. Thanks for inviting me to the forum to discuss falls and falls prevention, especially with regard to older adults who are blind or have vision impairment. If you have questions, or discussion points, then fire away!
Bill Tomlin's picture

Has your program incorporated any specific programming to address fall prevention? Explain
Bernard A. Steinman's picture

While we're waiting, maybe I can talk about some of the ways that we conceptualize falls risk. It is important I think for people to know that most falls are caused by multiple factors, vision often being one of them. I have heard falls risk factors categorized as being intrinsic, extrinsic, and behavior. Intrinsic falls risks are things inherent in the person, for example, having poor lower limb strength, or age-related macular degeneration, would be examples of that. Extrinsic falls risks are, as you probably guessed, conditions of the environment that place people at risk, for example poor lighting, or clutter, or a pet underfoot. I think that environmental factors are especially pertinent to older adults who have vision impairment. Finally, behavioral risk factors are things that we do that we shouldn't do, or things that we don't do that we SHOULD do, for example, climbing up on a rickety stool to reach something in a high cupboard places us at risk. Most of the time, falls risks can be placed into one of these categories, or at least I have yet to come across one that doesn't.
Adele Crudden's picture

Thank you for sharing that. I think many of us need to be reminded to be more cautious about doing things that put us at risk and evaluating the environment to reduce things that may contribute to falls.
Bernard A. Steinman's picture

Hi Adele! I was on the CDC website this morning to refresh my numbers, and it looks like the number of deaths caused by falls has increased by over 30% the last ten years. I suspect this is because of population aging, but I wonder what progress we have made in terms of actually reducing falls. With the increase in programs, you would hope that even though numbers have gone up, the proportions of older adults falling has gone down. I have not seem that data, but I assume that preventing falls IS possible through changing our environments and our behaviors. Am I allowed to post links? Here's the CDC reference I mentioned. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
Adele Crudden's picture

I believe that in home environmental assessments have been effective in reducing falls. Wondering if OIB staff are conducting these? But a medication review may also be in order if someone is experiencing balance issues.
Kay McGill's picture

I have been doing outreach with a specific Dept of Public Health program that incorporates falls prevention into their curriculum. Several of our providers and peer groups have conducted programs on falls prevention in their respective areas. This is a topic we are gaining more momentum and sharing info statewide.
Bill Tomlin's picture

That is a great comment!
Bernard A. Steinman's picture

Hello Kay. Your name sounds familiar to me. A long time ago, I used to work at the RRTC doing the Georgia OIB evaluation report with Elton Moore. Can't remember if we've ever met. I was wondering if any of the public health programs that you refer to take special considerations for people who are blind or visually impaired, or whether the programs are just for general population, and willing to make accommodations if asked.
Cathy Bryce's picture

Similarly, we have partnered with the Stepping On program.
Bill Tomlin's picture

Do you ask any assessment questions about falls? If so, please share the wording. Do you ask again after services have been provided to measure your effectiveness in helping to prevent falls?
Bernard A. Steinman's picture

This is a really important question as well. One of the major problems that we have as researchers in this area is the lack of good data. Over time, I think it has improved somewhat, but a good pre/post assessment question, if one exists, would still be highly coveted by someone doing research in this area. It may be, after all, that the OIB program, just delivered as it is, could help to prevent falls, but how would we know without data?
Bernard A. Steinman's picture

A few years back, I had written a proposal to develop a falls prevention program specifically with the needs of older adults with vision impairments in mind. Well, the grant was not funded but to me that STILL seems like a great idea, given the some of the unique challenges that could be experienced by our population.
Kay McGill's picture

Yes, I am that same person. Elton conducted our site reviews via MSU prior to his retirement. It is a small world! Because of my involvement with this particular entity, they are in tune with people with vision loss and address vision loss even when I'm not there! The outreach efforts are finally paying off with Public Health and Aging. It is really a relationship building endeavor as well as being there so they don't forget people with vision loss.
Bernard A. Steinman's picture

I remember I went with him one year to the site visit. I may have met you then. It was a long drive, but great to travel with and learn from Elton.
Bill Tomlin's picture

We at the OIB-TAC will continue to monitor this discussion, so if there are any more comments posted or unanswered question we will address them as they come. I would like to thank you for your participation in this event.