Safe at Home: Using Support at Home and Physiotherapy to Prevent Falls
In this episode, we welcome back expert pain physiotherapist Meghan Dean to mark Falls Prevention Awareness Month. We explore the critical role of proactive physiotherapy within the Support at Home program and how a multisdisciplinary approach ensures older Australians can remain safe and independent in their own environments.
Key Findings
Hidden Fall Risks
Falls are influenced by a complex mix of cognitive, physical, and environmental factors. Beyond obvious hazards, things like medication load, vision, and "near-miss" stumbles, where someone loses their balance but doesn't actually hit the ground, are vital warning signs.
The Power of Reablement
A major shift in the Support at Home program is the move toward reablement. Rather than just "supporting" a person as they decline, this approach focuses on improving their capacity to perform daily activities like showering, dressing, or gardening independently.
Physio vs. OT
While Occupational Therapists often focus on home modifications and assistive technology, physiotherapists assess the "musculoskeletal" factors. They look at pain, strength, and flexibility to enhance the person’s actual physical capacity to move safely.
The Multisdisciplinary Approach
Real progress happens when clinicians collaborate. A multisdisciplinary team, including physiotherapists, OTs, and carers, works together to preempt issues before they happen, providing a "gold standard" of proactive care.
Funding and Access
Clinical services like physiotherapy are available under Support at Home packages. A significant positive for our community is that these clinical services are often provided without a co-contribution from the client, provided they are identified in a clinical assessment.
Learn more about Fall Prevention Month through the following links:
Full Episode Transcription - 16 Safe at Home: Using Physiotherapy Support to Prevent Falls at Home Feat. Meghan Dean
Giselle
Hello and welcome back to Conversations with G and G. In honor of Falls Prevention Awareness Month, we're exploring how the Support at Home program aims to empower older Australians following your initial clinical assessment. Having a team of integrated clinicians is vital for staying independent.
Today, we're welcoming back expert pain physiotherapist Meghan Dean. We'll discuss how proactive physiotherapy sessions build confidence and why a team approach is the gold standard for care. Welcome back, Meghan.
Meghan
Thank you.
Giselle
It's great to be here. So maybe we'll start off with falls. We'll talk a little bit about that. So what are some of the hidden factors that could increase an older person's risk of falls?
Meghan
Yeah. Great question. We're generally looking within three separate domains. They may be cognitive factors, physical factors, or environmental factors. The physical factors are perhaps the ones that, caregivers and clients themselves are most aware of. Things like, loss of strength, loss of mobility, decreased balance.
And we've got other things that we look for, like sensation loss in your feet secondary to some sort of neuropathy. And we've got maybe, you know, vestibular problems that have caused a decrease in imbalance in other neurological conditions that are very common, like Parkinson's, which can also significantly influence balance.
But then we've got other factors, things like eye medication load or, the presence of a lot of co-morbidities. So a lot of medical conditions in one individual, and cognitive risk factors actually dramatically increase the risk of having a fall. So cognitive decline dementia, Alzheimer's, which can affect risk-taking behavior or the types of decisions that are made, and one person's awareness of their own capabilities.
And then within the environment, we're looking at environmental risks, tripping hazards, footwear, things like this.
Giselle
Yeah. And how does a physio fitting in all of that? So what part would the physio be looking at?
Meghan
So a physiotherapist is trying to assess a lot of those domains. Obviously, we cross over a lot with an occupational therapist. And when it comes to those home risk assessments, the occupational therapist is the one we might lean to if we identify those a lot of more difficult factors that needed addressing.
But from a physiotherapy perspective, we're experts in movement and balance in assessing anything that influences those domains. So we do carry out strength and flexibility assessments. We carry out assessments of pain and what might be contributing to painful joints and limitations. We we cover will we touch on a lot of those factors.
Giovanni
Yeah, just a question around being proactive about, you know, about looking after yourself. Right. If someone is relatively, you know, feeling good and is well and he doesn't, you know, feel like he is a falls risk, you know, as such. What preventative approach can we still take for those people?
Meghan
So how would they know if perhaps a physiotherapy assessment was indicated?
Giovanni
Yeah. Or it could be, you know, good starting point for them. To, strengthen their, you know, balance, for example.
Meghan
3:29 Yeah. So, an actual fall is obviously a clear indication that they need a physiotherapy assessment and support. But if that actually hasn't happened, you know, they're continuing, with their normal life reasonably well, what things they might be looking out for is just a little bit more difficulty in, perhaps rising from a chair or things feeling a little bit more effortful, or perhaps something what we call is a ‘near miss’.
Maybe there's been a few of these near-miss scenarios where they haven't actually fallen, but they've stumbled or lost their balance in the situation where you wouldn't expect to, you know, maybe just walking down the street and turning the head and suddenly taking a few steps to the side, and that's quite common. And people say, oh, you know, I, I might “bounce off the walls”, but laugh it off.
And, you know, that's really a clear sign that there has been a decline. And that is something that we probably should have a look at and see. We can tailor a program around.
Giovanni
That's a very good point. And those are what I would call hidden factors. Right. Because they're not obvious, but they're there and someone doesn't know that they could actually, you know, escalate the situation real quick.
Meghan
Yeah. A physiotherapist is really trying to look for those very small factors as they arise. You know, another thing we see quite often is what we call a ‘wide base gait’. So, an individual would be walking, with their feet just a little bit wider than a standard position.
And that's another indication, another small indication, or even you might see your loved one or notice that you yourself, running your hands or touching furniture or past furniture, walking is another clear sign that perhaps there's some underlying balance deficit or some factors that are leading to a sense of instability when standing and walking.
Giovanni
And all that is very interesting. So definitely a clinical assessment from you know, a health care professional will uncover all these factors and put in place appropriate recommendations.
Meghan
Yeah, absolutely. And the earlier the better. Because a lot of these factors, are modifiable risks and there are strategies that we can put into place. Much better should be done prior to a significant fall.
Gioavnni
And that's why we are all about being proactive and that's why its so key. Yeah, we want to make sure that doesn't happen and see what we can do about it.
Meghan
Yeah. And it doesn't hurt, doesn't it? If you're noticing those things in yourself or in your loved one, it doesn't hurt to say, ‘hey, maybe we should just get some clinical eyes over this and see if there's something that we're missing’.
Giselle
Yep.
Meghan
Sometimes we pick up things prior to even GP's and actually, you know, we get a lot more time. We see somebody and we're there for a full hour with them assessing them in their home, which is a lot more than they would say that general practitioner, when they're in there for ten minutes. So we do have a capacity to actually gather a lot more information and feed that back, to really benefit that person's whole, whole care.
Giovanni
And it's in their own environment. Sorry, Giselle. That's another key point. In their own. So you can, you can actually get to see that person.
Meghan
Oh yeah. Yeah.
Giovanni
Yeah.
Meghan
Yeah, clients present very differently in their own home, too. In the clinic we often see a best case scenario. Best performance. In a clinic, as compared to in their own home.
And you know, a normal physiotherapy assessment would involve a detailed history taking. And as we talked about before, you're taking balance and strength and sensation measurements and things like this. But then we're doing functional assessments. So that includes seeing how somebody interacts with their environment, how they get up and down off their favorite couch. How they move in and out of those tight corners around the base of the bed, how they get on and off the toilet.
Giselle
Yeah.
Meghan
Everything we can, we can tick off or we can write down and say look there's an issue here.
Giselle
Yeah, that was actually my question, what can someone expect, when you walk into the home and you're doing a clinical assessment? What happens?
Meghan
Yeah. Yeah. So as I said it's it does vary person by person as, as to the depth of that. But in terms of my own practice, I would spend the full hour at the house, taking a very detailed medical history, and then a full physical assessment and then a functional style assessment for the home. And then we spend time setting goals together saying it's a and it's a two way discussion. These are the risks that I've identified. These are the sort of things I would recommend and what I can help you with. But also what are your goals?
Giselle
Yep.
Meghan
You know, I had a client the other day and she had been referred, incidentally for a lot of falls. So she's having multiple falls a week. But her first goal wasn't addressing her falls. It was actually addressing her pain.
Giselle
Yeah.
Meghan
Which was just another, part of a complex history.
Giselle
When someone does have a fall, they often lose confidence. I mean, they might not want to go out and about, but how do you bring that confidence back? What are some of the things that a physio could do to help get that back?
Meghan
8:25 Yeah, I mean, bringing the confidence back comes from setting realistic targets. And as that person achieves that goal and they see their forward progress, they, you know, they become, more confident. Or I always talk about having expanding safety loops. So you, feel safe in these very small contexts or movements, and we're going to expand your safety net by practicing those things that you feel a little unsteady on in a very targeted, strategic way, so that your body and your brain can adapt to those movements. And it does improve.
Giovanni
Fantastic. And tell us a little bit more about physiotherapy in terms of, you know what people generally what do they expect. Do they expect someone to come in and then have a bunch of exercise and you know, they have to sweat it off?
Giselle
They have homework.
Giovanni
Is it all of that or?
Meghan
Yeah, sometimes.
Giovanni
There is an element of that.
Meghan
Sometimes there is. As I said people.
Giovanni
People may have resistance to have, a physiotherapist coming over to, you know, being afraid of being, you know, prescribed a bunch of exercise.
Meghan
Yeah, management is so varied and it's a combination, as I said, of that final discussion between the physiotherapist and the patient. You know, what are your goals out of this? What's realistic? And then the management plan that we set is targeted directly towards those goals.
You're right. A lot of individuals are a bit reluctant to engage in, very intensive style programs. But, you know, for some, that's what they're looking for. They're looking for, being stronger. They're looking for being fitter. I would say the large majority of my clients within the Support at Home space, we’re doing targeted interventions for either painful joints, painful shoulder, painful knee, trying to improve the functionality of that joint and trying to improve pain. And where we've got goals around mobility and movement, you know, ‘I want to be able to walk around the block or walk around the supermarket without increasing my back pain’.
And so the goals do they do often, require some active therapies. So that would be some exercise. But you don't actually need to do significantly greater amounts of exercise to see your functional capacity change. So that's the good news. It doesn't have to be all
Giselle
Sweat.
Giovanni
Yeah, so small adjustments
Meghan
Yeah, small adjustments. Maybe 10% more. Just a little bit more here and there. And we look at you know maybe have it stacking. Let's do these three exercises after you've had breakfast. And we'll do a different three after you have lunch. So it's very achievable. Easy to slot in with someone's day without it being feeling like it's too much.
Giovanni
And ultimately it's still up to them to, you know, carry out those exercises right.
Meghan
Yeah.
Giovanni
But it doesn't hurt to have a clinical eye on things.
Meghan
Yeah, well, I think people. It's very difficult. There's, lots of exercises that would be beneficial. And I think it's a physiotherapist's role to work out what would be the most effective. The optimal exercise that will give you more bang for your buck. So that we don't need to spend as much time, but we see the benefit or we achieve the goal we want to achieve.
Giovanni
Excellent, very good.
Giselle
You're speaking about Support at Home, and you Support at Home clients. How does physio fit into the Support at Home program?
Meghan
Yeah. So physiotherapy is alongside the other allied health services and can be provided under Support at Home packages if you have clinical supports I believe it's termed as a part of your, your ongoing package.
What has been a, real positive for clinicians working within this space has been, the dropping of a co-contribution from clients to pay for clinical services. So if you are eligible for clinical services that is provided without a co-contribution. So to access physiotherapy or indeed any other allied health, the first point of call is talking to your care partner. Just you know, assessing you know ‘what does my package actually cover? Is it something that I can be accessing’? And starting that conversation with them.
Giselle
Yeah. Wonderful.
Giovanni
Yeah. That's right, because sometimes those packages might not include clinical component, because your initial assessment didn't require one, but that can always be reassessed. And you can always be, you know, approved to have clinical services included into your package and then being able to access allied health.
Meghan
Yeah. And that's why it's important to voice your needs to your care partner. If you are having difficulty, let them know.
Giselle
Yes.
Meghan
Just say ‘I'm finding it more difficult to get in and out of a car or my hip is paining when I'm doing this’, and they might be able to suggest a clinician who can assist you with assessing that. And actually making some changes there as opposed to just saying, well that's it. That's all that I can do.
Giselle
So from what we've seen in our organisation, OT’s are commonly used and clients are often seeing OT’s in in terms of their environment and reviewing their environment. Not as much physio, but how can we ensure that clients are using physiotherapy services, and how do they complement the OT service, so clients can benefit?
Meghan
Yeah. So physio and OT work together really well as it's quite a synergistic service. We have slightly different approaches to the same problem. If I use a classic example of a client who's having difficulty arising from a chair, and there would be a number of factors behind that, but they might be pain or weakness or stiffness related, what we call musculoskeletal factors.
As a physiotherapist, I would go in and do my physical assessment and then say, well, what exercises could I be prescribing to enhance this person's capacity to complete this task safely to continue to do it? An occupational therapist may come in and see the same problem and say, well, what chair could I prescribe that has a riser that can assist this person to stand up from the chair?
Sometimes a little bit of both is required. A little bit of let's make life easier for this person, a little bit of let's challenge this body a little bit more so that they can continue to do this safely and independently for as long as possible.
Giselle
Do you think it could be because of what we're talking about before, that people might be resistant or hesitant to, or they feel like they're going to be left with doing lots of exercises from the physio, so they sort of go down that OT path.
Meghan
Yeah, I think so. And potentially they remember physiotherapy of old, which probably did function a little bit more like that. I'd like to say physiotherapy as a profession has evolved a lot in the last 20 years. And that the programs that we're prescribing, you know, there's a lot of, science backing, and we're not just saying, ‘well, everybody do 50 setups’. Or a sit to stands, you know. There's a lot of nuance to the exercises that are prescribed.
Giselle
And physios can prescribe massages and.
Meghan
Yeah, so physiotherapy oversight for a massage program is important. And I have prescribed a massage as well, as a part of a holistic pain management program that may include some passive elements, some massage to release tight tissues that may be contributing to pain and to work on flexibility factors.
But then we need some active components to really provide a well-rounded management program. And that would be specific exercises, specific flexibility exercises in particular with strengthening any weakened or compromised areas that might be contributing to that picture.
Giovanni
So would you say the majority of OT assessments would benefit from a follow-up from a physio? Would you say that is accurate?
Meghan
Well, yeah, it may be accurate. I mean, if the assumption is that this person is having difficulties and they require assistive technology, then by the same token, that same assumption
Giovanni
Home modifications.
Meghan
Yeah, there are issues here with the way that this person is moving and interacting in their environment and they may benefit from a reablement approach. And that's really what the physiotherapist provides.
Giselle
Yeah. It's a good point. So they really just go hand in hand.
Meghan
They do. Yeah.
Giselle
So yeah.
Meghan
We really do complement each other. And I really do love working within the multi-disciplinary team and sort of hearing that feedback from my peers. You know that does inform your own practice and approach.
And we all, collaborate where we can and we have our case conferences together and with the care partners to ensure that there really is that full understanding of an individual, their needs, and also preempting things before they happen that really proactive care that we, we were discussing earlier.
Giovanni
That's fantastic. And before you mention a keyword, ‘reablement’.
Meghan
Reablement Yeah.
Giovanni
Can you talk to us a little bit more about that.
Meghan
Reablement is the process of regaining function or improving function. And by function I mean your capacity to perform your ADLs, your ‘activities of daily living’, whether their personal ADLs, that's, like showering or dressing or, you know, even eating, or, you know, ADLs within the home, like, a little bit of, light cleaning, a little bit of, light gardening, things like that.
18:13 So reablement is a key consideration when we're talking about the Support at Home model that we're not looking at, just, you know, supporting, but we're not looking at just putting cushions around somebody and supporting them as they deteriorate. We’re like ‘no, actually we want to reverse this’.
Giselle
We want to make it better.
Meghan
18:37 We want to keep people as independent, as strong, and as safe as they can be in their own home for as long as possible.
Giovanni
Such a great concept.
Giselle
It is a great concept, isn't it?
Giovanni
Yeah, yeah, such great work you guys do. Incredible.
Giselle
Amazing.
Well, it's been so wonderful to have you. Thank you so much for joining us again. I think we've learned a lot about what physios are doing and the Support at Home program and the multidisciplinary approach that physios take with other clinicians. That's been wonderful. Thanks.
Meghan
Thanks.
Giovanni
Thank you so much.