Utilization of Occupational Therapy by Older Healthy Adults at Risk for Falls Is Low

PURPOSE: The purpose of this pilot study was to understand how spine surgeons recognize possible executive function (EF) impairments and fall risk in older adults and the degree to which referrals are generated to occupational therapy (OT). Serious traumatic spinal cord injury (SCI) due to falls is on the rise, especially among older adults (Kannus, Palvanen, Niemi, & Parkkari, 2007). In the United States, falls are the leading cause of SCI in healthy adults age 45 and older (Chen, Tang, Vogel, & DeVivo, 2013). Although EF has long been a recognized factor in fall prevention for adults with chronic diseases associated with cognitive decline (e.g., multiple sclerosis, Parkinson’s disease; Mazumder, Murchison, Bourdette, & Cameron, 2014; Paul et al., 2014), there is now emerging evidence that shows a relationship between EF and falls in healthy older adults, with performance on EF tests predicting risk for falls (National Spinal Cord Injury Statistical Center, 2013). Older adults seeking consultation from spine surgeons for spinal stenosis and other spine impairments may be at greatest risk for fall-related SCI. There may be opportunity to educate spine surgeons about the role of OT in EF screening and fall risk.

DESIGN: A retrospective content analysis was completed on medical record dictations for 50 healthy adults age 65 and older who were seen at an orthopedic spine ambulatory clinic. Dictations were deidentified, assigned a study-specific identifier, and exposed to content analysis. International Classification of Diseases, Ninth Revision codes were used to exclude potential participants with diagnoses known to affect neurocognition.

METHOD: Dictations were analyzed using coding and text frequency features of NVivo software (QSR International, Doncaster, Victoria, Australia). Analysis involved searching for documentation of cognitive or EF screening and falls risk and incidence. Types of previously received services, including OT, physical therapy (PT), and home care services, were analyzed, and reasons for these services were coded.

RESULTS: Nine percent of all dictations had documentation about a previous fall or risk for falling, and 0% had documentation of cognitive or EF screening. For types of services previously received, analysis of dictations showed that 0% of dictations indicated previous OT or home care services. Sixty-one percent of dictations indicated previous PT services, and the most common reasons were lower-extremity pain and weakness (71%) and back pain (55%); 5% of previous PT services were related to a fall injury. For service referrals, analysis of dictations revealed that 0% of dictations included a referral for OT or home care services. Forty percent of dictations included a referral for PT services, and the most common reasons were lower-extremity pain, weakness, or parasthesia (85%); 9% of PT referrals were related to managing fall risk or injury.

CONCLUSION: These results reveal an opportunity to educate spine surgeons on the role of OT in managing fall risk among healthy older adults receiving care in an orthopedic spine ambulatory clinic. Despite the incidence of falls among this population, the results suggest that physicians may not be screening for EF impairment and that treatment of fall injuries is allocated to PT only. OT can enhance current treatment strategies by conducting EF screens and by working with patients to adapt physical and cognitive skills, activity demands, and environments to prevent future falls.

References

Chen, Y., Tang, Y., Vogel, L. C., & DeVivo, M. J. (2013). Causes of spinal cord injury. Topics in Spinal Cord Injury Rehabilitation, 19, 1–8. https://doi.org/10.1310/sci1901-1

Kannus, P., Palvanen, M., Niemi, S., & Parkkari, J. (2007). Alarming rise in number and incidence of fall-induced cervical spine injuries among older adults. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 62, 180–183.

Mazumder, R., Murchison, C., Bourdette, D., & Cameron, M. (2014). Falls in people with multiple sclerosis compared with falls in healthy controls. PLOS ONE, 9(9), e107620. https://doi.org/10.1371/journal.pone.0107620

National Spinal Cord Injury Statistical Center. (2013). Complete public version of the 2013 annual statistical report for the SCI model systems. Birmingham, AL: Author.

Paul, S., Sherrington, C., Canning, C., Fung, V., Close, J., & Lord, S. (2014). The relative contribution of physical and cognitive fall risk factors in people with Parkinson’s disease: A large prospective cohort study. Neurorehabilitation and Neural Repair, 28, 282–290. https://doi.org/10.1177/1545968313508470