Category: Incontinence

Home Hazards…Are they related to falls?

A 2018 study titled, The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk, by Judy A. Stevens, PhD and Robin Lee, PhD, MPH estimated the prevalence of seven fall risk factors and the effectiveness of seven evidence-based fall interventions.

Stevens & Lee defined a “fall risk factor as an attribute or characteristic of an individual that increases the likelihood of a fall occurring”. They go on to say that many fall risk factors are potentially modifiable (e.g. poor balance, mobility problems, impaired vision, and insufficient vitamin D). Contributing factors increase the chance of falls such as the side effects of medications and the presence of home hazards.

Lets take a focus on home hazards. Most of us feel our homes are the place we feel most safe and comfortable. But does that mean our home is truly “safe”. Here are some questions to ask your self to determine where your home sits on the safety spectrum and some techniques you can use to enhance safety.

Can you safely enter and exit your home? 
Do you have stationary chairs with arm rests that do not rock or glide? 
Does every room have a night light? 
Can you read your medication bottles? 
Can you enter and exit your shower or tub without a loss of balance?
Can you transfer to and from your toilet without difficulty? 
Do you have clear pathways throughout the home? 
Are your kitchen goods stored between the height of your knees and your shoulders? 
Are you able to retrieve items from under your bathroom sink with ease? 
Do you have throw rugs picked up? 
Do you know how to use your microwave correctly? 
Do you remember to turn off the stove or oven when finished? 
Are cords clear from being in the walkways? 
Do you know how to use your thermostat? 
Have you been free from falling in the last year?  
Do you take your medication on time consistently? 
Is there a table next to your bed for a light and to set items on? 
Is your carpet and flooring free from tears and ripples? 

Home Safety Strategies:

  1. Remove all scatter rugs, repair frayed carpet, tape or tack down loose carpet edges.
  2. Arrange furniture to allow adequate space for safe walking between and within all rooms.
  3. When using oxygen, do not smoke or use an open flame.
  4. Do not overload circuits – unplug appliances when not in use.
  5. Wear close-fitting sleeves to prevent spills and burns that could happen with loose, long sleeves.
  6. Clean up spills immediately.
  7. Use a step stool or reacher to reach high shelves – do not stand on chairs or stools.
  8. Place safety strips or a non-skid mat in bathtub/shower and install grab bars – do not use soap dishes or towel racks for support when sitting or standing.
  9. Keep closet doors and drawers closed to prevent bruises or tripping.
  10. Keep walking aids within reach and keep a nightlight on or flashlight within reach of your bed.

If you are interested in having an occupational therapist conduct a home safety assessment in your home please contact our office at (970) 204-4331. And keep in mind, most insurance plans cover the visit.

The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk Judy A. Stevens, PhD,1 Robin Lee, PhD, MPH2

Pelvic Dysfunction & Aging

Thank you to Guest Blogger and CSU Graduate, Hailey Jungerman.

Although many believe that it is a natural part of ageing, “age doesn’t cause urinary incontinence, age-related changes may predispose an individual” (Garvey 14). Not only is it not a normal part of ageing, but “more than 50 percent of older Americans struggle with incontinence” (Reinberg). It is important to understand that bladder and bowel incontinence is an issue that can go beyond just toileting. As owner Krista Covell-Pierson OTR/L, BCB-PMD points out in her article Are You Addressing Incontinence at Home? An OT’s Guide, “Unaddressed incontinence can lead to the following additional problems: depression, social withdrawal, anxiety, fatigue, increased fall risk, restricted sexual activity, increased expenses for supplies, higher risk of infection, and skin irritation.” All of these things can lead to reduced participation in activities of daily living.

So, how can OT help address incontinence? “Occupational therapists provide a comprehensive approach that looks beyond musculoskeletal skills deficits and recognizes the need for changes in performance patterns, such as habits and routines, while also considering the context and activity demands related to the problem. Additionally, occupational therapy practitioners have the background and training to understand the related distress and provide support for the psychosocial aspects of these disorders” (Neuman et al.).

Krista Covell-Pierson OTR/L explained to me what a normal plan to manage
incontinence would look like. The evaluation will touch on bowel and bladder health. Krista says it is important to look at both as the bladder can affect the bowel and vice versa. The therapist will discuss with the patient about their diet, toileting and leave the patient with incontinence reading material and a voiding diary. From there the rest of the sessions are working on finding the issue and working on the pelvic floor muscles. The therapist will work as an investigator to solve the problem. They will recommend small changes to see if that is helping, and work in stages as to not be overwhelming for the patient. If needed, the therapist can also use a
biofeedback machine to better understand what the pelvic floor muscles are doing and to get patients working them. Though the internal biofeedback is not required, Krista said there is about an 87% rate of improvement over those that do not do the biofeedback.

Incontinence is a serious issue that can lead to a decline in quality of life. It is the number one reason why people put a loved one in an assisted living community as it is draining on the patient as well as any caregivers. Getting the issue resolved can improve the quality of life and keep our loved ones home for longer. If you have any questions regarding incontinence our owner Krista Covell-Pierson is a great resource as she is Board Certified in Biofeedback.

Please call Covell Care and Rehabilitation at (970) 204-4331 to get more information or an appointment scheduled with us to address incontinence.


Citations:
Covell-Pierson, Krista. “Are You Addressing Incontinence at Home? An OT’s Guide.” 2018 National Patient Safety Goals: Communication | MedBridge Blog, Medbridge, 20 Apr. 2018, www.medbridgeeducation.com/blog/2018/04/addressing-incontinence-home-ots-guide/. Garvey, Kathleen A. “Toileting: Making the Most of Our Time in the Bathroom.” MiOTA Conference. 12 Oct. 2015, www.miota.org.
Neumann, B & Tries, J & Plummer, M. (2009). The role of OT in the treatment of incontinence and pelvic floor disorders. OT Practice. 14. 10-1318.
Reinberg, Steven. “Over Half of Seniors Plagued by Incontinence: CDC.” Consumer HealthDay, HealthDay, 25 June 2014.

The Fear of Falling

Guest blogger Colorado State University and Covell Care Intern, Hailey Jungerman.

Falling can cause major issues for older adults. Injuries can range from an ankle sprain to a traumatic brain injury. These injuries can lead to high direct medical costs and indirect medical costs. Not only that, but it can lead to an increase in fall risk factors.

“Fear of falling often develops after experiencing a fall” (Tomita et al.).The same study shows that even one fall can lead to developing fear. There is a vicious circle that is associated with the fear of falling that can be hard to break without intervention. “Fear of falling is associated with negative physical and psychosocial health outcomes, including depression and
activity restriction” (Lee, Oh and Hong 2018). Once an older adult obtains this fear, the less likely they are willing to participate in activities such as exercise or even leaving their house. This can lead to weakened muscles and depression. Which in turn are more risk factors for older adults.

A team of therapists including occupational and physical therapists can help to overcome the fear of falling. Occupational therapists can assess the home for safety, both occupational and physical therapists can do a fall risk assessment on the client, and both can create a plan to address risk factors. They can suggest home modifications, address risk factors around the house, see how the patient gets around their home, and giving the patient exercises to build strength and work on balance. As the American Occupational Therapy Association’s page says, “Identifying environmental factors that contribute to falls and implementing the occupational therapy strategies to ameliorate these elements can improve safety and reduce health care costs while enhancing the participation of older adults in those communities.”

In order to keep older adults independent, it is important to have them assessed to find their risk factors. Each individual is unique, and so are their needs. Therapists working together can help to improve the quality of life by addressing fall risk in our loved ones.

For more information on Home Safety or Fall Risk Assessments call Covell Care & Rehabilitation at 970.204.4331.

Citations:
Lee, Seonhye, et al. “Comparison of Factors Associated with Fear of Falling between Older Adults with and without a Fall History.” International Journal of Environmental Research
and Public Health, vol. 15, no. 5, May 2018, p. 982., doi:10.3390/ijerph15050982.
Tomita, Yoshihito, et al. “Prevalence of Fear of Falling and Associated Factors among Japanese Community-Dwelling Older Adults.” Medicine, vol. 97, no. 4, Jan. 2018, doi:10.1097/md.0000000000009721.
Toto, Pamela. “Occupational Therapy and Prevention of Falls.” Aota.org, American
Occupational Therapy Association, 2017, www.aota.org/About-Occupational-Therapy/Professionals/PA/Facts/Fall-Prevention.aspx.

Is your bowel or bladder controlling you???

People of all ages live with bowel and/or bladder issues. Bowel and bladder dysfunction arise for various reasons: childbirth, prostate issues, a recent surgery, cancer treatment, lack of pelvic floor strength, the food & drink a person consumes and the list goes on.

There is even a thought that incontinence is just a normal part of aging. I am here to tell you that is not the case. Whether you suffer from stress or urge bladder incontinence, bowel incontinence or mix…You can take back your life and make changes NOW!

It is good to understand what a healthy bowel and bladder look like.

  • The average bladder can hold 2 cups of urine before needing to be emptied.
  • We should urinate 6-8 times in 24 hours, and have a bowel movement 3x/day-3x/week. As we age we may need to go more because our bladder shrinks but should not need to go more than every 2 hours.
  • Urine should flow out easily without straining and should come out in a steady stream.
  • An urge is the sensation you feel as the bladder stretches and fills. It does not always mean your bladder is full and urges should be controlled.
  • Your bladder should be completely emptied when you use the toilet.
  • Void positioning: knees higher than hips, lean forward and put elbows on your knees, bulge out your abdomen and straighten your spine (squatting position).
  • Holding your bladder for an excessive time (more than 4 hours) is NOT healthy for your bladder.
  • Don’t go to the bathroom “just in case” or more than every 2 hours.
  • Drink 6-8 glasses of water everyday unless your physician advises otherwise. When your urine is dark and has a foul odor, you may not be taking in enough fluid.
  • Avoid food and drink irritants. Limit alcohol! Alcohol actually increases urine production and also makes it difficult for the brain to coordinate the bladder control.
  • Too much sugar and/or fatty foods, a sedentary lifestyle, medications, ignoring the need to have a BM are all potential causes of constipation.
  • Avoid constipation by having a balanced diet of fiber. Gradually increase fiber intake to 25-35 grams per day.

Did you get all of that? Follow these bladder/bowel guidelines and see if anything changes.

Have questions about irritants or fiber? Join Covell Care for an intimate presentation on on this topic March 7th 11:30-1:15 (includes lunch!), next week at The Hillcrest of Loveland, 535 Douglas Ave, Loveland, CO 80537. Contact the Hillcrest with questions & to RSVP: (970) 541-4173. https://www.mbkseniorliving.com/senior-living/co/loveland/hillcrest-of-loveland/