Introduction
The Office of the Chief Coroner of Ontario released a report from the Geriatric and Long-Term Care Review Committee in 2021 about deaths from power recliner lift chairs. This resource is intended to alert occupational therapists to the potential dangers of power recliner lift chairs for clients with cognitive impairment to prevent future deaths and injuries related to these chairs.
Power recliner lift chairs (also known as power-lift chairs or lift chairs) can be used as an assistive device to help clients with mobility issues sit down and stand up.
Based on the training, knowledge, and skills of occupational therapists, they can assess the risks and benefits of power recliner lift chairs to optimize client safety and well-being. This document is meant to be informative and used as a resource to support an occupational therapist’s clinical decision-making for the safe use of power recliner lift chairs.
Recommendation by the Geriatric and Long-Term Care Review Committee (GLTCRC) 2021:
“Power recliner lift chairs should be included in home assessments with consideration of safety in patients with cognitive decline.”
Summary of Case Reviews
As described in the Geriatric and Long-Term Care Review Committee report (GLTCRC-2021-7A, 7B and 7C) in 2018, there were three cases involving individuals with cognitive decline who used the remote control of their power recliner lift chair to get into a standing position before having an unwitnessed fall to the ground. In all cases, these falls led to injuries, complications, and subsequent death.
The falls did not appear to be influenced by medication, and it was noted that all three individuals would spend prolonged times sitting or sleeping in their chairs.
None of the chairs were evaluated or “approved” by health professionals. In each case, the chairs involved were manufactured by a different company and appeared to be older and discontinued models. This suggests that the risks of using this device may not be directly related to a particular brand but may be influenced by factors related to the person and environment.
Main concern
In multiple cases, activation of a power lift recliner chair by elderly individuals with cognitive decline has led to a fall to the ground, causing injury and subsequent death.
| Age | Diagnosis/Medical History | Where did the fall occur? |
|---|---|---|
| 87 years | Dementia, seizure disorder, atrial fibrillation with pacemaker, hypertension, colitis, bladder stones and right hip fracture with total hip arthroplasty after previous fall. | Private residence |
| 96 years | Severe Alzheimer’s disease, osteoporosis, diabetes (type 2), hypertension, and a complex left hip fracture. | Long-term care home |
| 92 years | Mild dementia, frequent falls, hypothyroidism, and hypertension | Retirement home |
Refer to Appendix A – Geriatric Long Term Care Review Committee (GLTCRC) Report for more details about each individual case.
The Use of Power Recliner Lift Chairs
Power recliner lift chairs are useful in helping clients to lift themselves out of a chair. There are many models available on the market that provide unique features and different levels of size and comfort to best suit the client’s needs.
Power recliner lift chairs are used by people in both their own homes and in long-term care. Clients may purchase a power recliner lift chair without a recommendation from a health care professional and they may be unaware of the risks associated with using this device. These chairs may pose a greater risk of injury or death for the elderly, mobility challenged, and cognitively impaired.
| Benefits of these chairs | Risks of these chairs |
|---|---|
| • Assists in transitioning from a sit-to-stand (and vice-versa) position independently • Helps maintain independence and mobility • Can promote aging in place • User-friendly remote-control mechanism | • Serious injury that may lead to death. • Falls risks for all users (of any physical/cognitive ability) • Clients with decreased cognitive abilities may engage the chair without consideration to safety or environmental hazards (location of remote etc.) • Provide comfort and a functional place to sit or sleep in a common area versus lying in bed • Allows for the client to easily adjust their position while seated |
Considerations
Reflection Questions for Occupational Therapy Home Assessment
The following questions were developed to help guide occupational therapists when considering the safety of power recliner lift chairs in a person’s environment. This is not an exhaustive list of safety considerations, and occupational therapists should use their clinical reasoning to complete an assessment that involves physical, cognitive, environmental, and behavioral considerations and resulting recommendations based on client need.
Reminder: It is important to provide education to the client/family/caregivers about the risks, benefits, and safe operation of the chair to prevent injury.
- Will the client’s cognitive abilities prevent safe operation of the power recliner lift chair?
- Are the client’s cognitive abilities expected to fluctuate or significantly decline in the foreseeable future?
- Is the client/substitute decision-maker aware and able to appreciate the risks associated with using a power recliner lift chair?
- Does the client require assistance to transfer in/out of a power recliner lift chair?
- Will the use of a mobility device impact the safe operation of the chair?
- Is there enough space in the environment for the person to transfer in/out of the chair (with or without mobility devices)?
- Can the client demonstrate safe and appropriate use of the device in the presence of the occupational therapist?
- Are there any potential environmental hazards surrounding the chair , for example, where it is plugged in, close reach of tables, lamps, or a telephone, other barriers preventing the chair from engaging in its proper tilt/recline positions?
- Are there any risks to others in the environment when the chair is engaged, for example, children, pets, etc.?
- Are there any other device or equipment alternatives appropriate for the client?
Evaluating Risk
Use this section in conjunction with the Reflection Questions for Occupational Therapy Home Assessment to determine the level of risk associated with using a power recliner lift chair.
Risk Analysis
Based on the College’s 2020 Prescribed Regulatory Education Program module on Managing Risks in Occupational Therapy Practice, conduct a risk analysis for each of the risk factors listed above:
- Identify how likely it is for the risk to occur (low, moderate, or high)
- Identity the severity and impact of the risk (low, moderate, or high)
- Use the Qualitative Risk Chart to identify overall level of risk for each factor (low, moderate, or high).
Consider the implications of the risk and how you might address the risk, especially if it is an overall moderate or high risk.
Risk Identification
| High | • Highly likely to occur and/or severity has a high impact to the client • Consider alternative devices or additional equipment/strategy to mitigate risks |
| Moderate | • Likely to occur and/or severity has a moderate impact to the client • Proceed with caution, provide client education about the risks and safety considerations |
| Low | • Unlikely to occur and/or the severity has a low impact to the client • It is likely safe for the client to use a power recliner lift chair |
Summary
The Office of the Chief Coroner of Ontario has requested the College to notify occupational therapists about the potential dangers of power recliner lift chairs.
The report recommends that the use of power recliner lift chairs be included in home assessments with consideration of safety, especially for clients with cognitive decline.
As occupational therapists work in a variety of practice environments where power recliner lift chairs may have been recommended or purchased by clients themselves, occupational therapists are well positioned to assess the client to identify any risks to client safety. Occupational therapists must use a collaborative approach, prioritizing the client’s occupational engagement, considering safety concerns, and providing education to reduce the likelihood of any future deaths from the use of this type of equipment.
Appendix A: Geriatric Long Term Care Review Committee (GLTCRC) Report
Reference
- College of Occupational Therapist of Ontario (2020). Prescribed Regulatory Education Program (PREP) Module on Managing Risks in Occupational Therapy Practice.
- College of Occupational Therapists of Ontario (2021). Decision-Making Framework.
- Community Occupational Therapy (COT) in Newport, UK. Retrieved November 18, 2021 from: https://www.newport.gov.uk/documents/Community-Occupational-Therapy-(COT)/COT-Risk-Assessment-Riser-Recliner-Chairs-16-10-12.pdf