Individual Care and Falls Prevention

My mother in her mid-to-late 80s had a serious fall while living in a retirement village. Fortunately, she did not suffer any fractures and, though having appeared to have suffered a minor stroke as a result, fully recovered. Her experience was by no means an isolated case. The findings of researchers in the field of falls prevention show that amongst the aged there is a high incidence of falls in hospitals and even higher rates in the wider community. And it is the aged with cognitive impairment, including dementia, who are the most vulnerable to falls.

Falls Stop Campaign in New Zealand

I was immensely impressed with the presentations at a recent Falls Prevention seminar, part of the Falls Stop campaign being conducted by New Zealand’s Health Quality and Safety Commission (HQSC) aimed at hospitals and aged care residential facilities, but having in mind extension to wider community programmes.[1]

According to keynote speaker, Dr Anne-Marie Hill of Curtin University, Australia, successful falls prevention programmes rely on effective communication between carer and patient or resident. This communication should ensure aged persons are properly informed of the nature of the risk and enabled to participate in taking care for themselves in a way that effectively lowers the risk, improves the quality of life and potentially extends the span of their lives. Anne-Marie convincingly argued that enabling a person to learn is a key driver of effective falls prevention programmes. This entails the carer taking time, and utilising the appropriate skills, to understand the individual person and her needs. In particular the carer should take time to discover that person’s preferred way of learning which guides how information should be conveyed and her personality, life history etc. Another important factor is including family in this process. These factors are even more critical in the case of those cognitively impaired who require specialised  skills on the part of carers.

Everyone at the seminar was deeply struck by the presentation of Colleen Hill and Wendy Stanbrook-Mason from the Whanganui District Health Board. Under the leadership of the outstanding Sandy Blake,  Colleen and Wendy presented research that showed how the Care with Dignity programme at Whanganui hospital has significantly reduced falls and harm from falls for the cognitively impaired aged admitted to the hospital.

Both of these presentations clearly showed that, unless programmes are designed and implemented in a manner that meets individual needs, they are doomed to fail with a considerable waste of time, money and effort.

Feldenkrais® and Falls Prevention

The experience of attending this seminar and listening to the words of these committed carers made me appreciate yet again how unique and valuable is the contribution that the Feldenkrais Method® and we practitioners make towards the wellbeing of individuals including the needs of the aged. The Feldenkrais Method® is a form of somatic education with a focus on improving overall functioning of “body and mind” – the whole person.  It uses accessible (mostly slow and small) movement to foster sensory awareness. It is this awareness that brings about real improvement in carrying out all activities in which people engage. It very much relates to the themes of the Falls Stop seminar in being fundamentally concerned with an individual person’s own learning rather than as someone to be “treated” or “instructed” on what they ought to do, or take, to be better or safer.

In both our one to one work (Functional Integration® “lessons”) and our group classes (Awareness Through Movement®) we not only give emphasis to communicating to the client or student in a way that informs their individual learning, but also to receiving information from the client or student about their individual needs through our observations and hands on touch and movement of the client. This is very much a kind of somatic learning based on care and mutual respect. It fosters self-care and realisation of the person’s potential for improvement. We work with a wide range of people of all ages and conditions responsive to sensorimotor based learning. This approach is supported by the rapidly increasing scientific understanding of neuroplasticity – the capacity of the brain and entire nervous system to re-pattern itself in the direction of better mental and body functioning. 

As a Certified Feldenkrais® Practitioner I would not be unique in having in my group classes a person who is approaching 90 and several others in their 70s and 80s. What attracts them to attend and to keep attending my classes? It is the realisation that armed with nothing but an attitude of openness to learning they are able start from wherever they are at and begin to embed learning in their daily functioning for ongoing improvement. A key component of learning in this way is improvement that addresses directly the different elements of balance that can make all the difference when it comes to preventing falls and when falls do happen minimising the damage from them.[2]

Care and Respect

What struck me most about the presentations at the Falls Stop seminar was the underlying message.  A passionate desire on the part of institutions and carers in them to show genuine respect for the dignity and unique identity of each person as an adult and their individual needs is the basis of successful programmes for the aged. Kindness and friendliness towards residents and their families is an essential starting and ending point in hospitals and care institutions for the aged. This was shown to be especially important for finding the key to unlocking the potential for improvement in the case of the cognitively impaired aged. For without that core value of care the necessary specialised skills will be wasted.

– © Alan Cameron, 2017

[1] Falls amongst the ageing population is increasingly recognized as a major but previously under appreciated phenomenon with a high incidence of serious injury. This includes fractured hips which has a significant life-shortening effect. New Zealand’s Health Quality and Safety Commission has sought to address this problem. Its focus has been on falls in hospitals and rest homes with a view to improvement in the wider community where the incidence of falls is considerably higher.

[2] For an outstanding example of a person who overcame a whole raft of traumatic brain injury effects, including balance issues, using neuroplasticity based learning see Clark Elliot’s The Ghost in My Brain, Viking, 2015.