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QUESTION 04.1 (posted 2/11/02):
Dr. Tideiksaar,
I work in an adult day program for approximately 90 adults, ages 20-80, with severe and profound mental retardation and other
developmental disabilities. We are in the early stages of putting together falls prevention material. I know that our population is at high risk because of
decreased cognitive abilities/safety awareness, and physical challenges (lack of protective reflexes, decreased motor planning and coordination) etc.
Can you provide any direction on resources related to this population? Thank you for any suggestions.
Kim Shank
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ANSWER TO QUESTION 04.1:
Dear Kim Shank:
Falls account for up to 50% of all injuries in adults with developmental disabilities and mental retardation; individuals over 70 years of
age are at the greatest risk of injurious falls (Hsieh, et al. Risk factors for injuries and falls among adults with developmental disabilities. Journal of
Intellectual Disability Research. Vol. 45: 76-82, 2001). Most falls occur in bathrooms and dayrooms when individuals are going about their usual
activities (typically, individuals experience loss of balance during transfer pivots/turns). Individuals with disabilities typically don't have the protective
reflexes or reactions necessary to prevent serious injuries when they fall (i.e., mental conditions increase the possibility of injurious falls). Aside from the
usual suspects, specific fall risk factors for individuals with developmental disabilities include: previous falls, destructive or aggressive behaviors, multiple
functional disabilities, and use of antipsychotic medications. Designing an effective fall prevention program includes a combination of approaches (e.g.,
identifying individuals at high risk, evaluating the causes and risk factors related to falls, reducing unnecessary medications, providing exercise
programs to improve muscle strength and gait/balance, modifying hazardous environmental surroundings, providing ambulation devices as appropriate,
and teaching elders certain adaptive behaviors to reverse persistent risk). Given the high prevalence of falls and serious consequences in patients with
developmental disabilities, the lack of available resource support to implement simple fall prevention programs in adult day programs is surprising. >From
my experience in developing similar programs, the most important components include: (1) Education of staff to increase awareness of "at-risk" elders
and preventive strategies is crucial; (2) Revising staffing procedures (1:1, direct observation of high-risk patients; reassessing staffing needs in relation
to high risk patients); and (3) Contracting with a fall preventive expert for advise on program development and implementation (this is probably the most
important thing that you can do).
I hope that this information is useful.
Thank you for your question.
--Dr. Rein Tideiksaar
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