Cover story: Reducing falls
By Dori Krahn and Roslyn M. Compton
Could your fire department reduce falls? The Saskatoon Fire Department’s experience says yes
By Dori Krahn and Roslyn M. Compton
Imagine you are an 84-year-old man living with your wife of 63 years in a building that provides you with meals and house cleaning. One day, you fall on your way to the easy chair and can’t get up; this is the first time and you call the fire department for help. The firefighters are professional and kind, and carefully lift you back into your chair. The firefighters are primary care paramedics, so they also take your vitals to ensure there are no signs of other emerging medical conditions. When they leave you think, this is such a wonderful service. A week later you fall in a different location and the story repeats itself. During the next year, firefighters come back 19 times to lift you after a fall. Although everyone is kind and helpful, this seems a bit excessive, even to you.
One day the firefighters tell you about an option, a program called Remembering When. The fire department is offering this program to help older adults stay in their homes by working to prevent fires and falls. You take the chance to explore the program further. When the fire department asks if you would like to have a home visit you agree and are pleasantly surprised that the experience has the same professional and kind vibe as the friendly firefighters who came to lift you. Volunteers from Remembering When came to your home, they cared, they offered suggestions to help prevent falls, most of which you implemented. The volunteers called back in three months to see how you were doing. The experience made a difference because you managed to eliminate some trip hazards, started exercising more and installed grab bars in the bathroom and a Sask-a-Pole by your bed to help you safely transfer into and out of your bed. The falls quit happening – for now.
The Saskatoon Fire Department has been lifting people up throughout the community since 2007. Over the years the department has tried to get help for people who obviously needed it, with varying degrees of success. In 2017, the department partnered with the Saskatoon Council on Aging (SCOA) to implement the NFPA’s Remembering When program to enhance the lift-assist services offered in the community.
Remembering When was developed around 16 fire and fall prevention messages. Canadian older adults are 2.5 times more likely to die in a fire compared to their younger counterparts. Canadians over the age of 65 make up 14 per cent of the Canadian population, but account for about one-third of the fire-related deaths each year. According to NFPA, people over 85 years have the highest risk of death from fire, with cooking being the leading cause of fire-related deaths among that age group. Falls are another concern for older adults. The prevalence of falls among older adults was 34.5 per cent based on data collected in Ontario in 2019. Out of almost 600 participants, at least 20.2 per cent of the older adults who fell needed medical attention. Falls have increased the medical burden on the Canadian health care system and caused physical injuries and trauma for older adults who experience a fall.
Once local fire departments are trained in the Remembering When program, they begin the process of customizing the program for their communities. In Saskatoon, this included:
- Using volunteers who are mainly retired health care professionals. Volunteers receive six hours of training, including motivational interviewing techniques.
- Demonstrating during group presentations and home visits how to get up if you’ve fallen and haven’t hurt yourself. The process used is based on the Public Health Agency of Canada’s guidelines.
- Focusing on the people the fire department had already lifted and helping them prevent the next fall, in addition to doing proactive group presentations and home visits throughout the community.
- Making a three-month follow-up call after a home visit to connect and to find out whether the person provided with the lift assist was able to implement the suggestions provided by the volunteers.
- Asking people to write an “I will . . .” statement after group presentations to encourage participants to personalize the information they heard and for program personnel to evaluate what information is most important to people.
- Establishing partnerships with the Saskatchewan Health Authority, and agencies that focus on older adults and/or provide services in people’s homes.
- Installing smoke alarms during home visits if the smoke alarm either doesn’t work when tested or is outdated.
In April 2021, a research project completed by the University of Saskatchewan determined that Saskatoon’s Remembering When education and intervention approach was effective in improving the quality of life of community dwelling older adults.
The information collected in this study came from people who accessed Remembering When between Jan. 1, 2018, and Dec. 31, 2019. Older adults aged 85 to 89 accounted for 19 per cent of the lift assists, followed by 80 to 84 (17 per cent) and 90 to 94 (15 per cent). More than 50 per cent of the people the Saskatoon Fire Department lifted were 80 years of age or older. During this timeframe, 64 per cent of the people were lifted once, with just four per cent lifted five or more times. In many instances, there was no record of exactly why someone fell, but the most common reason recorded was loss of balance while walking or falling out of bed.
Remembering When uses group presentations and home visits to reach older adults in the community and prevent fires and falls. The most common fire-safety related takeaways identified in the “I will . . .” statements collected after each group presentation were:
- smoke alarms save lives
- stay in the kitchen while cooking
- general fire safety knowledge
The most common takeaways related to fall prevention were:
- engage in regular exercise
- use non-slip mats in the bathroom
- take your time
Home visits proved to be the most effective technique to reduce the number of reported falls. The most common recommendations at a home visit were to:
- exercise regularly
- add/replace smoke alarm
- use non-slip mats in the bathroom
In a phone call three months following the initial home visit, people told program volunteers they had implemented 67 per cent of the provided suggestions.
In interviews with participants, the Saskatoon Fire Department found that Remembering When was:
- a reciprocal learning experience with the volunteers and older adults learning from each other
- more than a safety program – there was a social aspect that was valuable in combating social isolation
- focused on home safety and helped older adults spot safety hazards in their homes
- an opportunity to teach people how to prevent a fall and what to do if they fell
- a gateway program through which people could be referred to appropriate resources
The genius of Remembering When is that it focusses on both fire and fall prevention. The Saskatoon Fire Department has found that fire safety is generally the impetus for older adults to ask for a group presentation, and that fall prevention was viewed as a bonus. However, it flipped when it came to home visits – older adults saw fall prevention as the priority and fire safety as the bonus.
In many jurisdictions throughout Canada, the fire department needs to be invited into people’s homes. Remembering When gets department personnel into people’s homes and allows staff to test smoke alarms and make sure they are not expired, discuss specific home escape plans, and talk about other fire safety topics such as staying in the kitchen when cooking.
Although program administrators knew experientially that Remembering When was an effective tool to prevent fires and falls among older adults, it is helpful to have the data to reinforce the success of the program.
Remembering When is an exciting addition to the Saskatoon Fire Department’s public education initiatives. The positive outcomes for the firefighter and volunteer teams are that we can prevent fires and falls among a population that needs and appreciates help, and on a workload level, we are able to decrease repeated lift assists.
If your department is involved in lift assists, the Saskatoon Fire Department encourages you to explore the NFPA’s Remembering When program and see how it can make a difference in your community. Visit nfpa.org/Public-Education/Teaching-tools/Remembering-When. Note that the program is being updated and online training modules are being created. For more information about the Saskatoon Fire Department’s Remembering When program, please contact Dori Krahn at firstname.lastname@example.org. For more information about Remembering When in Canada, contact Laura King at email@example.com.
Dori Krahn works for the Saskatoon Fire Department as their community relations coordinator and since 2017 has been the impetus behind the department’s implementation of Remembering When. Roslyn Compton is an assistant professor with the College of Nursing at the University of Saskatchewan, whose research focuses on supporting older adults to age in their choice of place.