AVOIDING FALLS BY USING THE ENVIRONMENT TO REDUCE...

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AVOIDING FALLS BY USING THE ENVIRONMENT TO REDUCE CONFUSION AND AGITATION Professor Richard Fleming

Transcript of AVOIDING FALLS BY USING THE ENVIRONMENT TO REDUCE...

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AVOIDING FALLS BY USING THE

ENVIRONMENT TO REDUCE CONFUSION

AND AGITATION

Professor Richard Fleming

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“In the largest prospective study of predictors of

falls in dementia to date, we have demonstrated

that older people with dementia experience 8 times

more incident falls than those without dementia.”

Allan, L. M., C. G. Ballard, et al. (2009). "Incidence and prediction

of falls in dementia: a prospective study in older people." PLoS

ONE [Electronic Resource] 4(5): e5521.

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PREDICTIVE FACTORS

• Use of cardioactive medication

• Total autonomic symptom score

• Symptomatic orthostatic hypotension

• Cornell depression score >9

• Physical activity (protective)

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PRINCIPLES OF DESIGN 1. Unobtrusively reduce risks

2. Allow people to see and be seen

3. Reduce unhelpful stimulation

4. Optimise helpful stimulation

5. Support movement and engagement

6. Provide a human scale

7. Create a familiar space

8. Provide opportunities to be alone or with others

9. Provide links to the community

10.Respond to a vision for a way of life

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UNOBTRUSIVELY REDUCE RISKS

These photographs were taken at a residential aged care facility owned by

HammondCare. © HammondCare

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NORWEGIAN FENCES

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This photograph was taken at a residential aged care facility owned by

HammondCare. © HammondCare

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PROVIDE A HUMAN SCALE (NUMBERS)

• The fewer people a resident with dementia

has to deal with the less confused they will

be.

• 8 is good

• 14 -17 is good and affordable

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SCALE (SIZE)

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ALLOW PEOPLE TO SEE AND BE SEEN

• Ensure that all key locations, i.e. lounge,

dining room, kitchen, bedroom, exit to garden

and toilet can be seen from all points in the

‘public’ area.

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Click on the photo

The Meadows is a residential aged care facility owned by HammondCare. © HammondCare

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TOTAL VISUAL ACCESS:

This photographs was taken at a residential aged care facility owned by

HammondCare. © HammondCare

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TOTAL VISUAL ACCESS:

This photographs was taken at a residential aged care facility owned by

HammondCare. © HammondCare

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REDUCE UNHELPFUL STIMULATION

• Reduce unnecessary noise

• Reduce through traffic

• Reduce visibility of ‘trouble spots’, e.g. doors

onto street, cleaners cupboards, power points,

etc. by blending them with the background

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REDUCTION IN STIMULATION: HIDING THE

FRONT DOOR

This photographs was taken at a residential aged care facility owned by

HammondCare. © HammondCare

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REDUCTION IN STIMULATION: HIDING A

WARDROBE

This photographs was taken at a residential aged care facility owned by

HammondCare. © HammondCare

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REDUCE THROUGH TRAFFIC

This photographs was taken at a residential aged care facility owned by

HammondCare. © HammondCare

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OPTIMISE HELPFUL STIMULATION

• Highlight things that you want the resident to

see, e.g. paint the toilet doors a different colour

from walls and other doors, and

• Place toilet in an obvious position, seen as soon

as toilet door is open.

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OPTIMISING HELPFUL STIMULATION: MAKING THE

TOILET OBVIOUS

This photographs was taken at a residential aged care facility owned by

HammondCare. © HammondCare

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OPTIMISING HELPFUL STIMULATION: LANDMARK

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SUPPORT MOVEMENT AND ENGAGEMENT

• Wandering is sometimes a feature of the

behaviour of the dementing person. The design

should allow it to take place safely and provide

opportunities for engagement with other activities.

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This photographs was taken at a residential aged care facility owned by

HammondCare. © HammondCare

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AN INTERESTING PLACE TO STOP

This photographs was taken at a residential aged care facility owned by

HammondCare. © HammondCare

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…AND BACK TO CORRIDOR THAT LEADS TO

THE LOUNGE

This photograph was taken at a residential aged care

facility owned by HammondCare. © HammondCare

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…...BACK UP THE CORRIDOR TO THE DINING

ROOM AND KITCHEN

This photograph was taken at a residential aged care

facility owned by HammondCare. © HammondCare

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START AGAIN?

This photograph was taken at a residential aged care

facility owned by HammondCare. © HammondCare

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CREATE A FAMILIAR SPACE

• People with dementia are living in the past.

• Don’t fight it.

• Provide furnishings, colours etc. that they

were familiar with in their early adulthood.

• Pay particular attention to taps, door handles

and switches.

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PROVIDE OPPORTUNITIES TO BE ALONE OR WITH OTHERS

These photographs were taken at a residential aged care facility owned by

HammondCare. © HammondCare

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PROVIDE LINKS TO THE COMMUNITY

This photograph was taken at a residential aged care

facility owned by HammondCare. © HammondCare

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CLOSE TO THE COMMUNITY: AVOIDING STIGMA

This photograph was taken at a residential aged care

facility owned by HammondCare. © HammondCare

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RESPOND TO A VISION FOR WAY OF LIFE

May be to provide a domestic environment.

Not only

• ‘Ordinary’ furniture and fittings

• A place for residents own belongings

But also

• Facilities for domestic activities

• Expectation of involvement (even if passively) with ADL.

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TOOL

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THE ENVIRONMENTAL AUDIT TOOL (EAT)*

Evaluates the environment

• Safety

• Size

• Visual Access

• Reduction of unhelpful stimulation

• Enhancement of helpful stimulation

• Provision for ‘wandering’

• Familiarity

• Range of engagement in social interactions

• Links with the community

• Domestic nature

* Fleming R, Forbes I, Bennett K. Adapting the ward for people with

dementia. Sydney: NSW Department of Health; 2003.

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COMPARING FACILITIES

0.00

10.00

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Environmental Audit Tool subscale scores

Special Care Unit Non purpose built facilities (N=32) Purpose built facilities (N=24)

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THE IPHONE APP

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