AVOIDING FALLS BY USING THE ENVIRONMENT TO REDUCE...
Transcript of AVOIDING FALLS BY USING THE ENVIRONMENT TO REDUCE...
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
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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
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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
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HammondCare. © HammondCare
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…AND BACK TO CORRIDOR THAT LEADS TO
THE LOUNGE
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facility owned by HammondCare. © HammondCare
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…...BACK UP THE CORRIDOR TO THE DINING
ROOM AND KITCHEN
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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
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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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