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Provide special consideration to patients who are at an increased risk for falls due to impaired cognition or vision or to decreased strength or balance.
The Occupational Therapy Practice Guidelines for Home Modifications defines home modifications as adaptations to environments that are intended to increase use, safety, security, and independence.6 Modifications may include, but are not limited to, the use of medical equipment or universally designed products; architectural modifications or major home renovations; and education of the patient regarding new strategies to use in the home environment.6
Therapeutic intervention that includes home modifications may prevent premature long-term care by supporting aging in the home,3 as well as improve the patient’s functional performance and reduce the risk of falls and physical demands on caregivers.6 Additionally, home adaptations may reduce costs while older adults age in the home.4
When considering home modifications, the patient's physical functionality is one of the main factors for the therapist to keep in mind.4 The therapist must also take into consideration the patient's perception of the home modifications, readiness to change the environment, and costs.7 The therapist must work with the patient or caregiver (or both) and have the patient’s consent before making any changes in the home.
In the kitchen, the therapist should assess the height of the counters and cabinets, amount and quality of the counter space, condition of the seating, type of flooring, and lighting. These contribute to patient safety in the kitchen. Reaching cabinets may be a challenge for patients due to decreased shoulder range of motion, use of a mobility device, and decreased balance when reaching overhead. Countertops need to be assessed for clutter or visual interference. Other considerations include the physical layout of the kitchen, including the layout of the appliances.
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Take note of preexisting conditions such as visual or hearing impairment, neuromuscular dysfunction, fatigue or reduced energy, and postural hypotension.
Rationale: Having a clear counter space allows the patient to transport items along the counter.
Rationale: Recommendations depend on the patient’s specific visual impairments and preferred lighting needs.
Somerville, E., Stark, S. (2015). Home modifications to improve the performance and participation of older adults with chronic conditions. AJOT: The American Journal of Occupational Therapy, 69, 6911515046p1. doi:10.5014/ajot.2015.69S1-RP102C
*In these skills, a "classic" reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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