RHONDA DEMENO: We're excited to have you. And next, I'd like to introduce to you Camille Jordan. Camille is a senior vice president of clinical services of Brookdale Senior Living. Welcome, Camille.
CAMILLE JORDAN: Thank you so much, Rhonda. It's a pleasure to be here with both of you and Neely today.
RHONDA DEMENO: We're very excited to have both of you. And very appreciative for spending time with us today to talk about this very important topic of fall management and the importance of wellness and rehabilitation. This episode will address wellness and fall mitigation programs, such as physical therapy, occupational therapy, balance and fall prevention classes, in addition to other wellness programs that are successful for fall mitigation.
This episode will further highlight the importance of wellness assessments and comprehensive rehabilitation programs. Rehabilitation programs in senior living can have a significant positive impact on residents' wellness and community safety plans. So, let's get started. I'm going to start off with Camille. I'd like to start out by hearing about, from a nurse's perspective, on how tailored exercise programs help seniors improve their balance and reduce the risk of falls.
CAMILLE JORDAN: Absolutely. So tailored exercise programs play a crucial role in helping seniors improve their balance and reduce the risk of falls by addressing the specific needs and challenges associated with aging. So, these programs are designed to cater to individual's physical abilities, their medical conditions, and their fitness goals.
So, it really has to be a personalized approach. Tailored exercise programs should take into account a senior's current fitness level, their medical history, and any existing conditions. This individual approach ensures that exercises are safe, appropriate, and effective for their unique circumstances. So, we should also focus on fall prevention. So, seniors are at higher risk of falls due to age related changes in muscle strength, bone density, and sensory perception. So tailored exercises include movements that challenge balance control systems, which can help seniors regain and maintain their equilibrium by reducing their risk of falls.
It's impactful for muscle strengthening. Weak muscles, particularly in the legs and core, contribute to instability and falls. So tailored exercise programs incorporate resistance and weight-bearing exercises that gradually build muscles-- muscle strength, providing seniors with better support and control. And of course, coordination and proprioception. So, exercises can focus on coordination and proprioception, which is awareness of one's body position. This can help seniors react effectively to sudden movements or shifts in their balance and can significantly improve their ability to recover from situations that might otherwise result from a fall.
RHONDA DEMENO: Really good information. Can you explain some effective strategies to get residents motivated? Motivated to really engage in a regular physical activity or anything in specific to maintain their mobility and independence?
CAMILLE JORDAN: Absolutely, some effective strategies to encourage our seniors are education about benefits. So, we need to explain the numerous benefits of regular physical activity, such as improved balance, strength, flexibility, and cardiovascular health. We need to highlight how staying active can enhance their overall quality of life and independence.
We should also tailor the exercise recommendations to their individual needs and preferences. Consider their current health status, interests, and limitations to create a personalized and achievable plan. We need to help them set specific, measurable, attainable, and relevant, and time-bound or SMART goals. Break down larger goals into smaller milestones to make progress feel more achievable and rewarding to the senior.
Encourage participation in group activities or exercise classes specifically designed for seniors. Social interactions can make exercise more enjoyable and provide the senior with a sense of community. And then we need to introduce a variety of activities to prevent the monotony and to keep them engaged. Activities like dancing, water aerobics, even Tai Chi or gardening can be enjoyable alternatives to traditional workouts. And involve the senior's family. Family support can provide motivation and accountability for seniors to stick to their exercise routine. All of us need an accountability partner. And sometimes, our families can serve as that purpose to keep us motivated.
RHONDA DEMENO: Those are all really good points. And I'm going to transition this conversation over to some of the physical things that happen with residents. And I realize that oftentimes seniors' dietary needs change. We never tie falls or fall prevention into a dietary plan. What role does proper nutrition play in supporting seniors' rehabilitation efforts and overall well-being?
CAMILLE JORDAN: So, nutrition plays a crucial role in supporting seniors rehabilitation efforts and overall well-being in several ways. It helps with muscle and bone health. Adequate protein intake is important for maintaining muscle mass. And this is especially vital during rehabilitation after injuries or surgeries, as protein supports tissue repair and recovery.
Nutrient dense foods provides the energy seniors need for physical activity and daily tasks. So having a well-balanced meal can help seniors to prevent fatigue and support their ability to engage in rehabilitation exercise and activity. Cognitive function, nutrients like omega 3 fatty acids, antioxidants, and B vitamins are associated with brain health. A balanced diet rich in these nutrients can support cognitive function and reduce the risk of cognitive decline.
Calcium and vitamin D are vital for maintaining bone density and preventing osteoporosis. Seniors with fractures or those at risk of fractures need sufficient intake of these nutrients to support their rehabilitation. Medication interactions, some medications may interact with certain nutrients. So, seniors need to be mindful of potential interactions and consult their healthcare provider about appropriate dietary adjustments.
Proper hydration is crucial for overall health and recovery. Seniors should drink enough fluids to stay hydrated, which supports bodily functions and can aid in healing. Nutrient deficiencies can affect the senior's mood, their mental health. So, a balanced diet rich in vitamins, minerals, and omega 3 fatty acids, as we discussed before, can help contribute to emotional well-being and reduce the risk of depression in seniors.
Chronic disease management, many seniors have chronic health conditions like diabetes, hypertension, or heart disease. So proper nutrition can help manage those conditions, leading to better rehabilitation outcomes. And then good nutrition is important for overall quality of life. Good nutrition supports seniors' overall quality of life by providing energy and nutrients needed to engage in activities they enjoy and to help them maintain their independence.
RHONDA DEMENO: Well, those are all really good points, Camille. You've hit on some amazing areas for really maintaining overall good health, and wellbeing, and then really addressing other medication interactions and the importance of having a really good diet, especially with the chronic disease management piece.
So, I'm going to pivot the conversation now to social interaction and community involvement. How does rehab or wellness program help contribute to overall well-being? Camille, can you speak from your experience?
CAMILLE JORDAN: Yeah, so social interaction and community involvement have a profound impact on physical and mental well-being of our seniors during their rehabilitation. So, the physical well-being, it provides motivation and accountability. Engaging with others in a group setting provides the senior with the motivation and accountability that they need.
Seniors are more likely to stick to their rehabilitation routines when they have friends or peers to exercise with. Social activities and group events create a structured routine. So regular participation in these activities encourages seniors to stay committed to the rehabilitation exercises and overall goals. It also-- the physical well-being aspect of it, increased physical activity, social interaction often involves movement. Whether it's walking together, participating in group exercise classes, or engaging in recreational activities, these increased physical activities support the rehabilitation process for our seniors.
There's also the mental health factors. So social interaction combats feelings of isolation and loneliness, which are very common among our seniors. This reduction in negative emotion positively impacts their mental health. Also, it helps to-- for cognitive stimulation, engaging in conversations, problem solving and games during social interactions stimulates cognitive function and helps to keep the senior's mind sharp.
It also helps with stress reduction. Interaction with others and participating in enjoyable group activities releases endorphins and reduces stress. And this contributes to an overall positive mood and mental well-being.
RHONDA DEMENO: The next question I'm going to ask you, Camille, is what are the benefits that you see of integrating mindfulness and relaxation techniques into a senior's rehabilitation routines to enhance their overall quality of life?
CAMILLE JORDAN: Absolutely, Rhonda, so integrating mindfulness and relaxation techniques into senior's rehabilitation routines can offer a range of benefits that contribute to their overall quality of life. So, some potential advantages are stress reduction. Mindfulness and relaxation techniques, such as deep breathing and meditation, can help seniors manage stress and anxiety associated with the rehabilitation process.
By reducing stress, seniors may experience improved emotional well-being and better coping mechanisms. Another potential advantage is pain management. So, mindfulness practices can enhance pain tolerance and pain management. Seniors can learn to focus on their breath or sensations which may help them better tolerate discomfort during rehabilitation exercises or while managing chronic pain conditions.
Another advantage is improved focus and concentration. Mindfulness exercises emphasize present moment awareness. So, practicing mindfulness can help seniors improve their ability to focus and concentrate, which is valuable for following rehabilitation instructions and staying engaged in the process.
It also provides an enhanced mind-body connection. So, it encourages awareness of the body and its sensation. This heightened mind-body connection can help seniors move more mindfully during exercises, reducing the risk of injury, and improving overall movement patterns.
Better sleep is another advantage. Many seniors struggle with sleep disturbances. Mindfulness techniques can promote relaxation and calmness, making it easier for seniors to fall asleep and enjoy better quality sleep, which is crucial for healing and recovery. It also helps enhance respiratory function.
Mindful breathing exercises can improve lung capacity and respiratory function. This is particularly valuable for seniors recovering from surgeries or illnesses that may have impacted their breathing. Also, another advantage is reduction in depression and anxiety. These practices have been associated with decreased symptoms of depression and anxiety. And seniors experiencing these conditions can benefit from integrating mindfulness into their daily routine. RHONDA DEMENO: So, we've really addressed quite a bit. And all those areas will definitely impact an overall resident wellness program. And now, I'm going to shift to some questions onto Neely. I know the last episode that we recorded, we talked about partnerships between nursing, and therapy, and fall prevention. It can't be one discipline's responsibility. It can't be nursing. It can't be rehab. What other members would you suggest from other disciplines? Neely?
NEELY SULLIVAN: Thank you, that's a great question. As we all know and we discussed in the last podcast, that multidisciplinary team is so important for the success of the wellness program in your community. And the members of the fall prevention team are far reaching in your community.
So, I am pleased because I get to wear several hats in the communities I work in. I'm the director of wellness. But I'm also a physical therapist by training. And so, I get to really see how the multidisciplinary team collaborates to create great wellness programming. So, there are people on this multidisciplinary team that you might expect.
So, these are people like the client that you're working with and their caregivers. And of course, the client is the leader of this team. And we expect them to tell team members about their fall history, or their fear of falling, or really how they approach falls in their day-to-day life. Another person you might expect to be part of this multidisciplinary team is, of course, the physician.
And the physician is the person that's really looking at the big picture for the client and understands the client's health and conditions like diabetes for instance, that can impact fall risk for that client. That physician is also looking for those medical causes of falls. Maybe the client has something like dehydration, heart problems, or even a drop in blood pressure when they're moving from lying to standing.
Another member of the team that we've talked about that I am proud to be part of is that rehab team. As a physical therapist, we address many aspects of balance during standing, walking, moving in the community. Of course, therapists assist our clients by working on their strength, working on their balance reactions, as well as their ability to navigate in their community.
So, they're navigating obstacles all day long in their community. And therapy is working on that with that client. Of course, we know that therapists can suggest the use of assistive devices like canes or grab bars. We can also analyze activities in their life. For instance, if you have a client and they love cooking or they love cleaning, we can analyze what type of safety we need to carry out these activities. And then we can also suggest strategies for improving that safety, things like using non-skid rugs. Or making sure the client has good lighting in their room, et cetera.
There are also wellness professionals on this multidisciplinary team. And wellness professionals, we call them wellness coordinators at Select Rehab, these professionals implement mental and physical activities to keep our client’s brain's sharp, as well as their bodies on task as well to improve balance and strength.
So, we might see our wellness coordinators working with our clients on activities like Tai Chi, or using resistance bands, or lifting handheld weights if they're working on that physical component of wellness. And of course, there's a lot of different components of wellness.
Other people you might not expect to be part of this multidisciplinary team, there are psychologists who are constantly screening for cognitive declines or depression. And we know that both of these are risk factors for falls. There's pharmacists who are looking at the medications that your clients are using. They're looking for side effects like dizziness or that drop in blood pressure that we always talked about that can impact balance.
They can also work with the client's physician to look at other drug options or perhaps minimize the side effects of the necessary drugs that your clients may be taking. Other people you may not expect, an optometrist or ophthalmologist can look at vision and make recommendations. Audiologist can work with clients on that inner ear, which is a major control center for balance. They can also screen for hearing for your clients regularly.
And then there are a lot of community-based organizations which are part of that multidisciplinary team. Community groups can provide resources that support your fall prevention plan, including free and reduced-price exercise programs. I know, for instance, the town I live in, the YMCA is very proactive in offering fall prevention programming to a lot of different people in the community at a very affordable price. So, everybody has access to these fall prevention programs.
RHONDA DEMENO: That is awesome. I love hearing that about the YMCA and those programs that really can help residents partake in a wellness activity and actually help improve their overall fall prevention plan. So that's awesome. I know the last episode, Neely, we discussed how falls are multifaceted. I think both you and Camille have really addressed that. We know that falls are caused by many intrinsic and extrinsic factors. Specifically, what can a wellness program do to prevent falls in the community?
NEELY SULLIVAN: So, I do want to distinguish between the wellness program and the therapy program in your community. So, I'm going to actually start with therapy and then move to wellness. As I think we are all aware, therapists in your communities play a leadership role in that prevention of loss of function as well as really helping your clients maintain their functional mobility and their ability to complete those activities of daily living that are important to them.
Now, with therapy, the client is referred by the physician. They evaluate the client. And then they come up with that plan of care for the client. Therapy and the client together are working on short-term goals. They're working on long-term goals. They are constantly reassessing the client for either a decline or improvement in function.
When a client's plateaued or met all their goals in therapy, this is when wellness steps in. And wellness really ensures the continuum of care. And it's used as an adjunct to therapy. By providing a means to preserve the skills that client has just learned in therapy. So, wellness programs can help clients before they actually need rehab services as well as after a client is discharged from rehab services.
And that wellness rehab partnership is so important. And it really allows for cross referrals to identify appropriate candidates for skilled interventions that therapy would provide to skilled services, as well as wellness programs. So, all of your therapists, your physical therapists, occupational therapists, speech language pathologists, as well as, and in addition to, your wellness professionals can really help separate a great senior living community from an average one.
RHONDA DEMENO: Thank you for that. I love the cross-referral opportunity that you spoke about and how these programs really open up endless opportunities for seniors to really get support. I know there's a lot of discussion. In our fourth episode on fall management, we're going to be discussing innovation in artificial intelligence. So, can you give me some examples of innovative wellness fall prevention programs that are being implemented to address wellness or to address falls? Neely, can you answer that question?
NEELY SULLIVAN: Sure, Rhonda, and have to be careful here because I could talk for hours about this. Because there's so many great wellness programs that address fall prevention out there. I do want to highlight really quickly a study by Dr. Mary Tinetti, who is a big deal in the therapy world, she completed the study at Yale University. And then she published it in The New England Journal of Medicine. And it showed that the incidence of falls in two regions in the state of Connecticut, so this was local to the state of Connecticut, but these falls were decreased by 11% after implementation of a fall prevention program. Now to go a little bit further, this study also found that fall related head injuries and hip fractures decreased by almost 10%. That 11% difference translates into about 1,800 fewer injuries and about $21 million less in healthcare costs in this particular region, which is Connecticut, where the interventions took place, compared with the usual care.
So, I say all of this to really highlight that those innovative fall management programs, they work. So, some of my favorite innovative evidence-based programs that address falls that can be implemented by therapists but also by wellness professionals include first the Otago exercise program. And this is an exercise program that was initiated in New Zealand. And then it was adopted by the CDC.
And this program is individualized to address balance and strength. In this program, it's pretty cool, the exercises are actually progressed over the course of a year. And it does include a walking plan. But it's not simply just a walking plan because walking plans are important. But just walking is not going to improve our strength.
So, it is a targeted walking plan. The evidence for Otago is pretty strong. And it's been shown to reduce falls by 35% among high-risk individuals. And it has been also shown to be most effective for adults aged 80 years or older, who have fallen within the last year, and who have moderate to severe decreased strength and balance. And that could be due to risk factors, for instance, including arthritis, or deconditioning, or inactivity.
Now, also want to highlight another innovative program called A Matter of Balance. And this program actually is one of those programs that I refer to when I was talking about community partnerships. Here in the town, I live in, the Matter of Balance is actually run out of the YMCA. But it can be run out of your community. It can be run out of therapy offices. It can be run out of any kind of community center.
What we know is that a lot of older adults experience a fear of falling. And people who develop this fear often limit their activities, which then results in physical weakness, making the risk of falling even greater. This is a great program. It's pretty easy to implement. It includes eight two-hour sessions for a small group of participants led by a trained facilitator.
And A Matter of Balance really emphasizes practical coping strategies that reduce the fear of falling and then teach fall prevention strategies. It is full of structured group intervention activities, including group discussion, problem solving, skill building, assertiveness training, videos. It also shares practical solution and exercise training.
So, it is not simply focusing on the physical. But it's really focusing on that psychosocial component of falls, which is so important not to forget when we're really looking at a comprehensive fall prevention program. Now two other things I want to highlight, these are not new wellness fall prevention programming. In fact, they've been along for quite a long time.
But through the practice of both yoga and Tai Chi, we have seen some strong evidence really highlighting that both of these forms of activities and exercise can have a pretty significant impact on your falls in your community. There is research that illustrates that yoga is shown to be beneficial in improving balance and flexibility. I don't think that's a surprise to any of us.
Also, Tai Chi is very varied. There's a lot of different styles out there. But there's a lot of research supporting Tai Chi and its ability to decrease falls. And both Tai Chi and yoga fits very nicely into wellness programming in communities all over the country.
RHONDA DEMENO: Really helpful information. I'm certainly going to check out Otago, A Matter of Balance, and I know about yoga and Tai Chi. And thank you for that information. I'd like to now move the conversation to some of the challenges that wellness professionals face when addressing falls. Can you opine on that?
NEELY SULLIVAN: I would love to. There are so many opportunities for wellness professionals. But as with any program you're starting, there are challenges, especially when you're implementing a new fall program in your community. So, for fall programming, it's really important for the wellness professional to establish systems to identify clients who may be at risk for falling.
Wellness coordinators should look at what's happening in their community and then establish systems that help identify residents who, for instance, are confined or choose to remain in their rooms to ensure that they're provided appropriate and stimulating wellness activity choices. They should also be able to identify residents who perhaps are sitting for longer periods of time or are not participating in meaningful activities.
We want to make sure in our communities that we are providing individualized wellness choices. We know for our clients that sit long periods of time and remain in their rooms, their chances of falling are greater. We also want to establish systems to identify clients who are demonstrating physical or cognitive impairments which impact that overall participation in leisure or wellness activities.
Because I can't emphasize this enough, if the client starts to not participate in activities or sit in their room, then once again, the chance of falling goes up. So, another barrier that I see my wellness professionals facing when they're implementing fall programming in their communities is the promotion of that fall prevention program.
Unfortunately, if you don't do a good job promoting the program, your fall prevention program may not succeed. So, there's a lot of different ways you can promote fall prevention activities. You can do this through formal promotional activities. Perhaps you write an article in your monthly newsletter. Or you have educational seminars.
I know at Select; we have something called a Healthy Living series. Where once a month, we give a very quick 15-minute talk on a wellness topic. And a lot of times, the wellness topic will focus on falls. Other formal promotional activities might be incorporating scheduled tours or promoting your program through the new resident orientation.
There's also informal promotional activities that you can do by simply knowing your clients and recognizing your clients by name. If someone feels like you know them and that you take a vested interest in them, they might be more likely to join a fall prevention program, and participate, and be compliant with that fall prevention program. Other informal promotional activities might include giving that client or those members of your community space to socialize and time during that fall prevention program to really talk about what they're facing when it comes to preventing falls or being even afraid of falling.
RHONDA DEMENO: I really like that. Very easy for the residents to feel relaxed in their approach to really talking about the problems that they're encountering or their fears of falling.
NEELY SULLIVAN: Yes, yes, giving them time and space is really important for those clients.
RHONDA DEMENO: There's a couple other questions I really want to get to. I know we've focused most of this call-- and we probably could use another whole hour or two-- really discussing fall prevention. I mean, there's so many different facets. But we have a couple minutes just to talk about employee wellness programs and their potential to reduce injuries for staff and the communities. Neely, did you want to address anything in particular on this topic? NEELY SULLIVAN: Yes, and I'm so glad you brought this up because this is a very big piece of making sure that not only our clients are healthy and preventing injury for our clients, but also our staff as well. I did want to just highlight that there is a great organization, the International Council of Active Aging. And they published a white paper about the benefit case for wellness programs in retirement communities and senior housing.
And I'm not going to go through a lot of details because we're short on time. But if you have a chance, check out this white paper. This report really details the benefits of extending wellness programs to employees in your community. So, we know that workplace wellness programming can benefit your community.
And when you're coming up with workplace wellness ideas, I like to follow the same model of the seven dimensions of wellness. And I like to think of wellness ideas for our staff for all of those different areas, like spiritual wellness, cognitive wellness, emotional wellness, environmental wellness.
So, I just want to very quickly run through a couple of ideas for your staff. Vocational wellness activities might include providing them with opportunities for volunteerism or providing them with skills classes and opportunity for mentoring, both mentoring of the staff members as well as giving them opportunities to mentor others.
When we're addressing cognitive wellness, we might provide cultural activities for the staff or even games and puzzles. I know a lot of times I see this in break rooms, giving them cognitive puzzles to work on, or providing some type of lifelong learning programs. One more example to help with emotional wellness for our clients, I mean, I think we all know that we work in high stress environments. And we work long hours.
You can provide opportunities for humor and laughter. Give people opportunities to share their personal histories, as well as really celebrate our staff. So, all of that has to do with workplace wellness for your clients and potential of reducing injuries and falls for staff in the community by really focusing on the staff member as a whole.
RHONDA DEMENO: And that's so important, especially as we are challenged and taxed with staffing shortages and really keeping our employees healthy. So, in closing and wrapping up our conversation, Camille, do you have any last comments about the importance of fall prevention and wellness for senior living communities?
CAMILLE JORDAN: Oh, absolutely, Rhonda. So, prevention is key. The best way to address fall mitigation is through prevention. And identifying and eliminating fall hazards is the first step in keeping yourself and others safe. Staying active. We've talked a lot about wellness here. Staying active and maintaining strength through regular exercise and strength training can help improve balance and coordination and reducing the risk of falls.
So, I just don't want anyone to ever underestimate the power of physical activity in fall prevention. Footwear matters. I don't think we talked at all about footwear. But proper footwear with good traction is essential, especially in slippery conditions, to make sure your shoes or boots are appropriate for the environment you're in. And looking around the home, home safety, at home, we need to make sure we keep walkways clear of clutter. Handrails on stairs and install grab bars and bathrooms and simple modifications can make a big difference.
I think one thing we didn't talk about here, Rhonda, is regular vision checkups. As we age, our vision seems to diminish. So poor vision can contribute to falls. So regular eye exams can help detect and correct vision problems that may increase our risk for falls. So again, knowledge is power. We need to make sure we stay informed. We seek help if we need it. And to spread awareness and share information about fall mitigation with friends and families. It's a shared responsibility. Again, as we said in the last podcast, it takes a village. Let's be proactive and take steps to encourage others to do the same to create safer environments for everyone.
RHONDA DEMENO: Really well stated, Camille. And Neely, do you have any parting comments or any takeaways from our conversation today?
NEELY SULLIVAN: Sure, I did want to emphasize one more time how important that collaboration is between the multidisciplinary team. So, it's not just nursing. It's not just therapy. It's not just wellness. It's all of us together that make a pretty profound impact on falls in your community.
When we do have that impact on falls in our community, using all of the great tools that we discussed here on the podcast today, and all of the great tools that Camille just highlighted, we need to make sure that we are really celebrating our successes in our community. That we're letting people know what's going well, what's really working, what those numbers actually look like for decreasing falls in our community.
And if something's not going well, we have to really look at the individuals living in our community and tailor our fall prevention programming in what works for them. And I think that if we put everything in place that we talked about today, we should have some pretty dynamic and innovative fall prevention programs that can really have an impact on our clients and our communities.
RHONDA DEMENO: I agree. I agree. My big takeaway for today is that rehabilitation and wellness programs can positively impact the lives of seniors and mitigate fall risk for senior living communities. That's my big takeaway.
And I'm going to close this podcast today by thanking both Neely and Camille for spending time with us to discuss this very important topic. Thank you, Neely, for your time today. We really appreciate it.
NEELY SULLIVAN: Thank you. It was such a great experience. And I'm so grateful for this opportunity.
RHONDA DEMENO: We really enjoyed having you. And Camille, thank you again, this was your second podcast. And I know you spent some considerable time preparing for this. We really appreciate your contributions. Thanks, Camille.
CAMILLE JORDAN: Thank you so much, Rhonda. And it was a pleasure participating with you, Neely. I look forward to doing it again and talking with you both in the future.
RHONDA DEMENO: For our listeners, you can find more information about our speakers by going to our podcast page to learn more about them. This does conclude our second episode of our fall management series. We hope you listen to our next episode number three on claims, underwriting, and insurance implications. Again, thank you very much for your time. And we hope you found the information informative. Thank you.
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