In the geriatric population, falls remain one of the most common cause of nonfatal injuries. In the article “Fall Prevention for Older Adults” three kinds of falls are described: anticipated physiological falls, unanticipated physiological falls, and accidental falls. Anticipated physiological falls “occur among people who are at a high risk for falling.” (Lyons, 2004). For the resident BK, this is the type of fall she experiences. BK is at a high risk for falling. In the last six months, she has fallen three times. In her most recent fall on Sept. 25, 2015, she was in her room being assisted with dressing before breakfast. While she was holding her walker, she lost her balance and fell backward. This fall didn’t result in her losing consciousness, and at the time, didn’t cause her any …show more content…
pain. Later she reported pain in her lower back and knees. She also had bruising on her buttock. Unfortunately, this situation is not uncommon. During her last three falls, she was either walking or trying to stand on her own. When she falls, she generally reports her knees causing her pain. This pain tends to continue even a few weeks after the fall. Many factors related to BK’s health and care are putting her at risk for these falls and injuries to reoccur. BK has multiple health problems that may contribute to her reoccurring falls.
One such disease is osteoarthritis. Osteoarthritis also known as degenerative joint disease. It often affects weight bearing joints as well as the hands, feet, and spine. As she loses more of her cartilage, the harder it will be for her to walk and stand, especially in the morning when her joints are stiffer. BK also has lumbar spinal stenosis. This is a narrowing of the open space in the lumbar region of the spine. Symptoms of this include pain with walking and tingling, weakness, or numbness in the lower extremities (Meiner 2012). This may contribute to the falls, because the weakness and numbness of the legs affect balance. BK currently has generalized muscle weakness. This means she all of her muscles are weak. Due to the weakness she cannot support herself properly when she stands or ambulates. This can lead to a fall. BK also has Alzheimer’s disease. Alzheimer’s disease can present as confusion and become noticeable forgetfulness, and decreased memory function. (Meiner 2012). This is important for fall risks. BK can’t focus on the task at hand and may get confused, causing her to lose her
balance. These health conditions and her other current health conditions make it harder for BK to preform her activities of daily living (ADLs). Currently, she needs help with almost all of her ADLs. She can still feed herself, but because of her poor memory, she sometimes needs cueing. She also needs cueing for transferring as well as a one to two person assist with the help of her four wheeled walker. Once she is transferred from sitting to standing, she is weight-bearing, so she can use her walker to walk. She needs more extensive assistance with her dressing and bathing. When it comes to personal hygiene and oral care she needs for it to be set up and cueing. For her hygiene in regards to toileting, she needs the assistance of someone else as well as assistance with her clothing afterwards. To use the toilet, she needs a one to two person assist with the help of her walker. Though she needs assistance with all of her ADLs, the staff encourages her to do as much of these activities as she can manage. All of BK’s current health conditions and problems with ADLs, contribute to her substantial amount of medications. Due to this polypharmacy, BK is at risk for more falls. According to Meiner (2012), “Polypharmacy is ‘giving two similar medications for the same indication, giving medications that are contraindicated, and/or giving medications where the dosage is either too high or too low.” BK takes fourteen prescriptions and over the counter medications and supplements multiple times a day. Some of the medications she is taking for the same condition. For instance, she is currently taking three pills for her urinary tract infection. She is also taking twelve pills at the same time in the morning. Polypharmacy is clearly prevalent in her situation. According to a study by Ziere et al. (2005) the risk for falls increases when a fall risk drug is added onto the polypharmacy. These at risk drugs include any central nervous system/psychotropic drug (i.e. sedatives, antidepressants, antipsychotics, benzodiazepines), cardiovascular drugs (i.e. diuretics, antiarrhythmics, cardiac glycosides), and antidiabetic agents (Lyons 2004). BK is currently taking two of these fall risk drugs. She is taking Venlafaxine which is a SSRI antidepressant. She is also taking Lasix, which is a diuretic to help with her edema. In order to better understand what may be causing BK’s falls, assessments were performed. Most of BK’s vitals were within normal limits. The vitals that were within normal limits include temperature (98.6 degrees Fahrenheit), pulse (80 beats per minute), and respiratory rate (18 breaths per minute). The only vital that was high was her blood pressure at 130/80 mm Hg. She said her pain was about two out of ten, but when her knees where touched, she said it was about a four. The first assessment after vitals was vision. BK was wearing glasses. With these she was able to accommodate. Her peripheral vision was also intact. While talking to BK, it was apparent that she had impaired mental status. She was only alert and oriented times two. She could not tell me the date or what day of the week it was. She also was confused at dinner as to what was happening and needed cuing to eat. Neurological assessments revealed her sense of touch and balance was intact. In regards to her musculoskeletal system, she has a full range of motion in her knees and feet. She is weight bearing, so her muscles strength is good, but it is only a four. She still has to go to personal and occupational training and do exercises every day to increase it. Her spine is also relatively straight, and she is not hunched over. Her only cardiovascular problem is peripheral vascular disease. This may be contributing to her edema which was only showcased in a slight swelling of her knees and ankles. She also has both urinary and bowel incontinence. This is one of the risk factors in Hendrich fall risk assessment. In this assessment she scored greater than a five which means she is at a high risk for falling. The factors that caused her to score this high were confusion, altered elimination, and the need of assistance to rise. Because BK is in an assisted living home, her environment has only a few fall risks. For a person who falls a considerable amount of times, it is important that the walkway is clear from obstruction. Though this was mostly the case in KB’s room, there was a painting laying against the wall on the floor under the TV. This wouldn’t be a problem unless she gets up to turn on the television or she tries to walk towards the window and walks a little too close to the wall. For her safety there was a cushioning mat by her bed in case she fell. Her bed was also supposed to be low to the ground in case she fell. The bed was adjustable, but it wasn’t as low as it could go. I don’t know if this was for easier transferring, but it is not as beneficial if she falls. Each unit has carts in the hallway. If left in the way, she could hit them if she was confused or distracted. Bk usually walks with a walker, but recently she has been using her wheelchair more. She doesn’t want to fall again. Both her wheelchair and walker are in good condition and should not be contributing to her falls. Through this assessment it is clear that there are a few main causes of falls for this client. One cause is her dementia. It is clear that she is not completely oriented to her environment. This means that she may not understand what she is doing and can’t focus on walking. Another major contributor to her falls is the polypharmacy. She is on many medications as well as being on a couple that increase her risk for falls. This combination is not beneficial for a patient that is likely to fall again. Her constant knee pain suggests that her osteoarthritis is impacting her. Weight-bearing joints are extremely important in walking and their weakness makes BK unsteady. The final contributor to BK’s falls is her muscle weakness. Her muscles need to be strong in order to keep her balanced and keep her moving. Her weak muscle contribute to a slow, uneven gait and may cause her to become tired. The more tired she is the less likely she will be able to support herself. Because there is multiple contributors to BK’s reoccurring falls, the nursing care plan can include multiple nursing diagnosis and interventions. One diagnosis could be impaired memory related to neurological function as evidenced by reduced awareness of her environment and impaired short term memory. Another diagnosis is impaired walking related to insufficient muscle strength as evidenced by three falls in the last six months, muscle strength grade of four, and difficulty standing and walking by self. Through interventions there can be multiple expected outcomes. One outcome is the patient will verbally express her knowledge on how to safely transfer before each transfer. She will also remain focused on ambulating each time while walking. BK will demonstrate increased balance within the month. Lastly, BK will show a reduced frequency in falls in the next year. In order to reach these outcomes certain intervention must be put in place. Before every transfer, BK needs to be shown and read a sheet with instructions on transferring. This way she can remember how to safely transfer each time. Since she is likely to forget that she is not allowed to get up on her own, her bed should always be placed as low to the ground as possible while she is in it. This way if she tries to get up, her fall will not be as long. While she is ambulating conversation should be focused on the walking. If she is talking about something else, she cannot focus on what she is doing and will lose her balance. Her balance is also effected by her muscle weakness. This can be improved by working with the physical therapists to create a program specifically for her. This exercise program should not only focus on muscle strength, but also balance. Sherrington et al. (2008) showed in their analysis that “Exercise can prevent falls in older people. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program”. Lastly, the nursing team needs to work with the provider to decrease the number of medications that BK is on. If this is not possible it would benefit BK greatly if she was not taking the medications multiple times a day and at the same time of day. Using these interventions, I believe that all of the outcomes are manageable and the BK will not continue to fall.
As people age, they face difficulties with seeing and also with mobility, declines in their physiological systems impact balance, range and speed. These physiological problems can result in falls, which tend to be really problematic for the elderly living alone at home. The Hendrich II Fall Risk Model (HFRM) was used on Mr. T.C to assess his fall risk; this tool is used in acute care facilities to estimate the risk for falls in adults (Hendrich, 2013). The client scored a 6, any score exceeding a 5 is considered a high risk for fall. Being a male is one of the predetermined risk points that make one susceptible of falling as well their symptomatic depression, both which the client falls under. The Get-Up-and-Go Test is also a predetermined risk factor of HFRM; it determines the client’s ability to rise from a seated position. It took the client 3 attempts to fully stand up from a seated position.
In over-all, 65 years and older suffer from many geriatric symptoms, due to psychotropic and anti-psychotropic medications, including Electroconvulsive therapy (ECT), mobility challenges, incontinence, poor balance, disorganization and confusion which all lead to high falls. According to a study in the International Journal of Geriatric Psychiatry, patients with the highest risk for falls presented with one or more of the following variables such as Parkinson’s syndrome, Dementia, female gender, mood stabilizers, cardiac arrhythmia, and ECT. Edmonson et. al established, “The Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) specific to the psychiatric, geriatric population and found initial testing of EPFRAT to have higher sensitivity in assessing fall risk in the geri-psych inpatient population” (Edmonson, Robinson, & Hughes, 2011). This project purpose is to investigate and explore whether an Edmonson Fall risk assessment Toll decreases patient falls in inpatient geri-psych units. Stakeholders and Change
Jones, D., & Whitaker, T. (2011). Preventing falls in older people: assessment and interventions. Nursing Standard, 25(52), 50-55.
Falls in nursing homes residents are associated with morbidity, mortality, and healthcare costs. The centers for Medicare and Medicaid indicate falls as the quality indicator. (Leland, Gozalo, Teno, Mor, 2012). Factors such as new environment, medication, cognition, and non-compliance contribute to falls. A significant number of falls occur from wheelchairs. (Willy, 2013). Newly admitted residents to long-term care facilities are confused with the change. The new environment and the new unfamiliar faces increase the level of anxiety. Pain may also contribute to falls. In order to take tailor made preventative measures, fall risk factors for each resident should be evaluated periodically. Tools scoring risk factors can be utilized.
The National Patient Safety Goal (NPSG) for falls in long term care facilities is to identify which patients are at risk for falling and to take action to prevent falls for these residents. (NPSG.09.02.01). There are five elements of performance for NPSG: 1. Assess the risk for falls, 2. Implement interventions to reduce falls based on the resident’s assessed risk, 3. Educate staff on the fall reduction program in time frames determined by the organization, 4. Educate the resident and, as needed, the family on any individualized fall reduction strategies, and 5. Evaluate the effectiveness of all fall reduction activities, including assessment,
The nurse would firstly identify if Mrs Jones is at risk of falls by conducting a falls risk assessment using an evaluation tool such as the Peninsula Health Falls Risk Assessment Tool (FRAT) (ACSQHC, 2009). The falls risk assessment enables the nurse to identify any factors that may increase the risk of falls (ACSQHC, 2009). The falls risk assessment tool focuses on areas such as recent falls and past history of falls; psychological status for example, depression and anxiety; cognitive status; medications including diuretics, anti-hypertensives, anti-depressants, sedatives, anti-Parkinson’s and hypnotics; as well as taking into account any problems in relation to vision, mobility, behaviours, environment, nutrition, continence and activities
Patient falls in the hospital is a serious issue and challenging problem that could lead to prolonged hospital stay, longer recovery time for patients, increased costs for hospitals, and a source of distress and anxiety for patients, nurses, and families. Patient falls can cause minor or major serious physical injury depending on the situation and the age of the client. In addition to the physical harms, patients can suffer from psychological injuries which make them lose their independence and confidence on themselves and build a lot of anger, distress and fears of falling.
Registered Nurses’ Association of Ontario (RNAO). (2005). Prevention of falls and fall injuries in the older adult. Retrieved from http://rnao.ca/sites/rnao-ca/files/Prevention_of_Falls_and_Fall_Injuries_in_the_Older_Adult.pdf
As technology advances and medical aid becomes readily available it is no wonder that the elderly within our communities are living longer. Unfortunately this poses a serious issue for health professionals as elderly are becoming more prevalently injured, presenting with complications of higher severity than their younger counterparts (Ng et al., 2002). This essay will discuss the epidemiology, assessment and presentation of an elderly patient suffering from a traumatic injury. It will also examine the considerations specific to the elderly in terms of management, and ethical and cultural differences.
A fall is an “untoward event which results in the patient coming to rest unintentionally on the ground” (Morris & Isaacs, 1980). When it comes to patient safety in health care, there isn’t any subject that takes precedence. Patient falls are a major cause for concern in the health industry, particularly in an acute-care setting such as a hospital where a patient’s mental and physical well being may already be compromised. Not only do patient falls increase the length of hospital stays, but it has a major impact on the economics of health care with adjusted medical costs related to falls averaging in the range of 30 billion dollars per year (Center for Disease Control [CDC], 2013). Patient falls are a common phenomenon seen most often in the elderly population. One out of three adults, aged 65 or older, fall each year (CDC, 2013). Complications of falls are quite critical in nature and are the leading cause of both fatal and nonfatal injuries including traumatic brain injuries and fractures. A huge solution to this problem focuses on prevention and education to those at risk. ...
A fall is a lethal event that results from an amalgamation of both intrinsic and extrinsic factors which predispose an elderly person to the incident (Naqvi et al 2009). The frequency of hospital admission due to falls for older people in Australia, Canada, UK and Northern Ireland range from 1.6 to 3.0 per 10 000 population (WHO 2012). The prevalence of senior citizen’s falls in acute care settings varies widely and the danger of falling rises with escalating age or frailty. Falls of hospitalized older adults are one of the major patient safety issues in terms of morbidity, mortality, and decreased socialization (Swartzell et al. 2013). Because the multi-etiological factors contribute to the incidence and severity of falls in older society, each cause should be addressed or alleviated to prevent patient’s injuries during their hospital stay (Titler et al. 2011). Therefore, nursing interventions play a pivotal role in preventing patient injury related to hospital falls (Johnson et al. 2011). Unfortunately, the danger of falling rises with age and enormously affect one third of older people with ravages varying from minimal injury to incapacities, which may lead to premature death (Johnson et al. 2011). In addition, to the detrimental impacts on patient falls consequently affect the patient’s family members, care providers, and the health organization emotionally as well as financially (Ang et al. 2011). Even though falls in hospital affect young as well as older patients, the aged groups are more likely to get injured than the youth (Boltz et al. 2013). Devastating problems, which resulted from the falls, can c...
When taking steps to analyze and apply intervention strategies for falls, we must examine the factors that cause these occurrences. There are numerous reasons that falls occur, such as intrinsic and or extrinsic risk factors. Intrinsic risk factors for falls may be due to changes that are part of the normal aging process and acute or chronic conditions. According to Zheng, Pan and Hua et al. (2013), about 35-45 percent of individuals who are usually older than 65 years and other 50 percent of the elderly individuals report cases of fall every year. Extrinsic factors are those related to physical environment such as lack of grab bars, poor condition of floor surfaces, inadequate or improper use of assistive devices (Currie). Patient falls is not an easy thing to eliminate. With many clinical challenges, there’s no easy answer to the challenges posed by patient falls; howe...
Falls are the leading cause of injuries, disabilities, and deaths among community-dwelling older adults (Moyer, 2012). According to the Center for Disease Control and Prevention (CDC, 2016), each year one out of three community-dwelling older adults aged 65 years or above falls at least once. There is a need to identify effective interventions pertinent to the primary-care setting to prevent falls among older adults living in the community. The guideline titled “Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force recommendation statement” is focused on determining the effectiveness and harms of different fall-prevention interventions relevant to primary care for adults aged 65 years or above (Moyer,
This study into osteoarthritis was made in an attempt to better understand how Hellenistic Greek colonization (620 BCE-229 BCE) may have bioculturally impacted the ancient Illyrians, who were traditionally a transhumant pastoral society. Some of the questions I was attempting to illustrate through this study was whether or not the Illyrians became the new labor force in the region, and if the Illyrian way of life change drastically after Greek colonial expansion. In order to understand these changes, this thesis tested the null hypothesis that there were no differences in workloads and life for the inhabitants of Corinthian, Apollonian, Epidamnus, and Lofkënd did not change regardless of pre- or post-colonization.
Fall is sudden, unpredicted, unintentional occurrence resulting in-patient landing on ground or at lower level. Falls and fall related injuries incur cost for the patient as well as the health cares system. The fall has a significant impact in patient quality of life and usually fall has many reasons to happen. Thus, preventing falls among patients in healthcare settings requires a complex approach, and recognition, evaluation and prevention of patient falls are significant challenges. Falls are a common cause of injury and the leading cause of nonfatal injuries and trauma-related hospitalizations in the United States (Barton, 2009). Falls occur in all types of healthcare institutions and to all patient populations. Up to 12% of hospitalized patients fall at least once during their hospital stay (Kalisch, Tschannen, & Lee, 2012). It has been using different strategies in many hospitals to prevent or at least to decrease the incidence of fall. However, the number of falls in the hospitals increases at alarming rate in the nation. The hospitals try to implement more efficient intervention strategies, but the number fall increase instead of decrease. In fact, many interventions to prevent falls and fall-related injuries require organized support and effective implementation for specific at risk and vulnerable subpopulations, such as the frail elderly and those at risk for injury.