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Risk Factors for Falls in Elderly Patients

Question:

Discuss about the Fall Prevention Strategies For Geriatric Patients.

Falls are considered by researchers to be one of the leading causes of injury related admission to the emergency departments in the different healthcare centers. It has also been seen to be the primary etiology of accidents mainly in the cohort of the people who are aged 65 years and above (Milos et al. 2014, p 40). The mortality rate for falls is also observed to increase dramatically with the age of the people in both the sexes as well as also in different racial and ethnic groups like the aboriginals and the Torres Islanders. Falls account to about 70 percent of the total accidental deaths of old people who are mainly 75 years of age and older (Bloch et al. 2014, p303-306). One of the striking facts that holds great significance and should be noted is that the rate of fall of geriatric patients is also very high in healthcare centers as well. Falls are usually the markers of poor health as well as declining function. One of an interesting fact stated by researchers is that one third of the geriatric patients who are community dwelling and 60% of the nursing home dwellers have suffered fall once during their stay in the healthcare centers. This occurrence results in increased suffering of the patients associated with long stays of patients on the healthcare centers, poor quality life and depression due to loss of mobility (Wallander et al.2017, pp.449). The assignment will mainly target the aged population who are highly vulnerable towards falls. It will also show how the nursing professionals in the geriatric departments can apply different strategies so that such occurrence does not occur.

With the development of the medical science and healthcare researches over the years, life expectancy has increased. The Australian Bureau of statistics had shown that life expectancy of Australian population has made a record. According to the data released by the board in the year 2014, it was seen that the male life expectancy has increased from 80.1 in 2013 to 80.3 years and female life expectancy has increased from 84.3 to that of 84.4 years. As the average age of the death in Australia has increased to 82.45 years, the population of the aged people are increasing at a fast pace. They are living longer days now than in earlier decades (Soto-varela et al. 2015, pp.8). However, although the expectancy has increased, it had exposed them to a number of chronic disorders like obesity, osteoarthritis, cardiovascular issues and many others. These had provided poor quality lives of aged people for which they spend their days in the community healthcare centers,  nursing homes and residential care as well. All these chronic issues make them lose their independence, as they tend to lose mobility. They lose many of their physical function for which they tend to depend on caregivers for help (Padron Monendra et al. 2017, pp.1559). Such vulnerable conditions often expose them to various types of incidents out of which falls are the most common. A report published by the New South Wales government showed 25.6 % of older people have fallen at least once in the preceding months. Among the old patients who fell, 66.1 % stated that they suffered from injury and 20% of the people also had to be admitted to the hospitals. It was also seen, that patients also had fall in the healthcare centers due to improper risk assessments conducted by the nursing professionals (Hshiesh et al. 2015, pp.512). Moreover, it was also seen that many nurses is not have proper knowledge and skills to handle fall prone patients successfully. All these had exposed the geriatric population to different instances of fall and healthcare costs had increased to a huge extent. The costs associated with this fall account for more than 80% of the cost of treatment for fall related injuries that results in creating pressure not on the financial planning of the patients and family members but also results in excessive outflow of resources in hospitals (Chen, Zhu & Zhou 2014, p.437).

Consequences of Falls in Elderly Patients

Falls are known to threaten independence of elderly people largely. It results in the initiation of a cascade of not only individual but also different socioeconomic consequences. Loss of independence results in development of depression and anxiety among the patients that causes loss of mental stability. They are also seen to increase risks of injury as well as death or hospitalizations. These symptoms are more common in older individuals who are already living with preexisting diseases co morbidities like osteoarthritis, obesity and others (Huang et al. 2016, p.40). Longer-term complications results in decreasing of physical functions, fear of falling and leads to institutionalization. Certain falls cause minor injuries like contusions or abrasions. It also results in various types of major issues of which the most common are fractures of the humerus, pelvis as well as wrists. Hip fractures in the old patients are one of the most notable outcomes not only dye to fall in the houses of the old patients but also in the hospital and healthcare centers. Improper education given by the nurses does not provide proper health literacy to the patients and therefore they tend to be more vulnerable towards incidences of fall (Milos et al. 2014, p40). Other serious injuries include different types of head and internal injuries as well as lacerations. Overall mortality after hip fracture tends to range from 18 to 33% in the first 12 months as they cannot take the suffering and are not properly educated to take post-operative care successfully. Function as well as quality of life is also seen to deteriorate at a drastic rate after a fall. 50% of the aged patients who were in an ambulatory stage before fracturing hip before fall can never get back to their previous level of mobility. Aged individuals, who had previous experiences of fall and sufferings associated with it, develop a fear of falling again (Khosravi & Ghapanchi 2016, p18). Because of this, confidence gets lost in them for which further mobility is reduced. Patients start avoiding daily activities of lives along with other activities like cleaning, shopping, walking and others. Decrease of activities in turn result in stiffness of joints associated with weakness. All these result in mental and physical degradation of the patients (Lopez-Soto et al. 2016, p.19).

Researchers are of the opinion that falls in the elderly patients are rarely because of a single cause or risk factor. They are mainly the results of different types of complex interaction among different factors (Hill et al. 2015, p.2596). These are intrinsic factors, extrinsic factors and different situational factors.

Interventions for Falls in Elderly Patients

Intrinsic factors include age related changes. These impair different systems that are involved in maintaining stability and balance of the aged individuals that include standing, walking as well as sitting of the individuals. This increases their risks of falls. Contrast sensitivity, visual acuity, perception of depth and adaptation to dark all decline when individuals age. Moreover, changes in muscle activation patterns as well as modifications of the capability in generating sufficient muscle power and velocity results in impairing the ability of the aged individuals in maintaining or recovering balance in response to perturbations (Huded et al. 2015, p.1043). These include activities like stepping onto uneven surface or being bumped onto something. Muscle weakness of any types can act as a major predictor of falls. Researchers are also of the opinion that certain chronic and acute disorders and use of their drugs act as major risk factors that causes incidents of falls. Certain psychoactive drugs are seen to increase the risk of falls and result in fall related injuries.

Extrinsic factors mainly include different environmental factors that result in increasing the risks of falls. These factors either work independently or may interact with intrinsic factors resulting in the falls. The risks of fall become the highest when the environment needs greater postural control and mobility like when walking over a slippery surface. Falls may also occur when the environment is unfamiliar like visiting a new place or when relocating of homes are done. Situational factors mainly include certain activities as well as decisions, which increases the risk of falls and other fall related injuries (Kim & Jeong 2015, p.2015). Some of the examples include walking while talking or remaining distracted due to multitasking. This may result in failing of the aged individual to notice the environmental hazard like a curb or steps. Often they may also need to rush to the bathroom in the nights when they are not fully awake or when lighting is also inadequate. This might act as a situation where aged people become highly vulnerable to fall. Rushing to answer phones also result in incidents of falls for frail elderly patients.

Once the patients have been properly assessed about the probability of their chances to fall, nursing professionals should allocate proper interventions that which ensure that the patients are free from any risks of falls. For these reason, they have to be very careful and provide person centered care to patients ensuring that their demands are met; safe care is provided and are made free from any chances of fall. Those elderly patients who are at a high risk for fall should be provided signs or should be secured with wristbands (Frankenthal et al. 2014, p.1658). Wristband identification would help the nursing professionals to remember their vulnerability towards fall. These would help the healthcare professionals to adopt fall precaution behaviors with them that would reduce chances of incidents of falls. The healthcare professionals should also shift such patients to rooms near the nurse station. Researchers are of the opinion that nearby location would help healthcare professionals to develop constant observation and help them in responding quickly to different call needs from such frail patients. Most of the important items that are used by the patients should be kept within the reach of the patients like the call light, water, urinal as well as telephones as items which are too far to reach may contribute to incidents of falls causing hazards. Moreover, the healthcare professionals should make sure that the beds are kept at lowest possible as possible (Wilson et al. 2016, p.1012). If possible, then the healthcare professionals can set the sleeping surface of the patients as adjacent to the floor as much as possible. Another strategy that the healthcare professionals may apply is the use of side rails on beds as required. For cases when the beds are with split rails, the healthcare professionals should make sure that at least one of the rails are down at the foot of the bed. Researchers are of the opinion that when only one of the four rails are left down, patients are less likely to fall. However, nursing professionals should never take the help of restraints for reduction of falls. Use of restraints in turn increases physical harms like bruises and wounds when the patients try their best to be free for such restraints. It also harms their dignity and autonomy and they feel disrespected. It also affects their mental stability resulting in depression and anxiety. The healthcare professionals should also make sure that the rooms have appropriate lighting especially during the night. The patients should be encouraged to wear slippers or shoes that have non-skid soles when walking (Matarese et al. 2015, p.1198). Non-skid footwear helps in decreasing the rate of falls as they ensure sure footing accompanied by diminished foot and toe lift during the time of walking. Moreover, the patients should be made familiarized with the layout of the room and rearrangement of the furniture of the room should be prevented in order to avoid tripping over the furniture. The healthcare professionals should also provide heavy furnitures that do not tip over when aged patients use them as support while ambulating. The primary path should be made clear and straight. Clutters should be avoided on the surface of the floor. Another interesting strategy that can also be applied is the use of bed or chair alarms when the patients try to get up without taking any support or assistance. Such audible alarms are wonderful substitutes of physical restraints and help in reminding the patients that they should not get up alone. The healthcare professionals should collude with other team members for conducting proper assessment and evaluations of the medications of the patients that contribute in falling. Sitters are effective and help in guaranteeing a secured, safe and protected environment (Muller et al. 2015, p.519). They are very much helpful for patients who have impaired ability for following of directions. Allowing patients to take part in exercises and gait training and informing them about the advantage of wearing eyeglasses and hearing aids are other ways to prevent falls. High-risk patients can also be provided with hip pads.

The patients and the family members should be also taught about how to ambulate safely at home. This trainings should include the professionals describing the benefits of the use of handrails in bathrooms and similar others. The caregivers at homes should make sure that the clutters are properly removed and the house is kept neat and tidy. All clutters like stacks of old newspapers, magazines and others in hallways and staircases may result in falls. Moreover, tripping hazards should be removed or repaired. Proper examinations of rooms should be done so that loose carpets, slippery throw rugs as well as wood floorboards that stick up do not act as tripping hazards (Bunn et al.2014, p.13) . Grab bars and handrails should be implemented for going up and downstairs, stepping in and out of the bathtubs and while getting on and off the toilet. Researchers have also found out that loose and baggy clothes worn in homes can make people fall and therefore better fitting and properly hemmed clothing should be used making sure that they do not bunch up or drag on the floor. Care should be also taken that the lighting of the house is adequate installing brighter bulbs where needed. Socks although comfortable should be avoided as they provide a slipping risk. Therefore, the caregivers should purchase non-slip socks and proper non-skid shoes. Bathtubs, showers, floors in kitchens, bathrooms and porches, when wet, can become dangerous. Therefore, care should be taken that they are not left wet. Researchers suggest use of non-slip mats that prevent chances of falls. Even precautions like guard rails can face sometimes and therefore in order to avoid such uncertainty, it is better for the aged people to remain on the lowest level of the house (McKensie et al. 2017, p.4)

Conclusions:

The cases of falls and admissions to healthcare centers are seen to be increasing with the age of the patients. Moreover, many of the frail and elderly patients also suffer from incidents of fall in the healthcare units. This is either due to improper monitoring of the professionals, improper education of the patients by the professionals or due to improper handling of the patients by the professionals. Therefore healthcare professionals should develop knowledge about the complications of falls and how these result in economic burden of the patients and family members along with physical and mental instability. Therefore, it is important for the healthcare professionals to identify the intrinsic, extrinsic and situational factors and thereby provide different fall prevention strategies. Proper strategies when applied in healthcare centers and at homes will ensure reduction of falls resulting in better quality lives.

References:

Bloch, F., Blandin, M., Ranerison, R., Claessens, Y.E., Rigaud, A.S. & Kemoun, G., 2014. Anxiety after a fall in elderly subjects and subsequent risk of developing post traumatic stress disorder at two months. A pilot study. The journal of nutrition, health & aging, 18(3), pp.303-306.

Bunn, F., Dickinson, A., Simpson, C., Narayanan, V., Humphrey, D., Griffiths, C., Martin, W. & Victor, C., 2014. Preventing falls among older people with mental health problems: a systematic review. BMC nursing, 13(1), p.4.

Chen, Y., Zhu, L.L. and Zhou, Q., 2014. Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, & relevant pharmacological interventions on fall risk in elderly patients. Therapeutics and clinical risk management, 10, p.437.

Frankenthal, D., Lerman, Y., Kalendaryev, E. & Lerman, Y., 2014. Intervention with the screening tool of older persons potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria in elderly residents of a chronic geriatric facility: a randomized clinical trial. Journal of the American Geriatrics Society, 62(9), pp.1658-1665.

Hill, A.M., McPhail, S.M., Waldron, N., Etherton-Beer, C., Ingram, K., Flicker, L., Bulsara, M. & Haines, T.P., 2015. Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. The Lancet, 385(9987), pp.2592-2599.

Hshieh, T.T., Yue, J., Oh, E., Puelle, M., Dowal, S., Travison, T. & Inouye, S.K., 2015. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA internal medicine, 175(4), pp.512-520.

Huang, T.T., Chung, M.L., Chen, F.R., Chin, Y.F. & Wang, B.H., 2016. Evaluation of a combined cognitive-behavioural and exercise intervention to manage fear of falling among elderly residents in nursing homes. Aging & mental health, 20(1), pp.2-12.

Huded, J.M., Dresden, S.M., Gravenor, S.J., Rowe, T. & Lindquist, L.A., 2015. Screening for fall risks in the emergency department: a novel nursing-driven program. Western journal of emergency medicine, 16(7), p.1043.

Khosravi, P & Ghapanchi, A.H., 2016. Investigating the effectiveness of technologies applied to assist seniors: A systematic literature review. International journal of medical informatics, 85(1), pp.17-26.

Kim, Y.L. & Jeong, S.H., 2015. Effects of nursing interventions for fall prevention in hospitalized patients: a meta-analysis. Journal of Korean Academy of Nursing, 45(4), pp.469-482.

López-Soto, P.J., Smolensky, M.H., Sackett-Lundeen, L.L., De Giorgi, A., Rodríguez-Borrego, M.A., Manfredini, R., Pelati, C. & Fabbian, F., 2016. Temporal patterns of in-hospital falls of elderly patients. Nursing research, 65(6), pp.435-445.

Matarese, M., Ivziku, D., Bartolozzi, F., Piredda, M. & De Marinis, M.G., 2015. Systematic review of fall risk screening tools for older patients in acute hospitals. Journal of advanced nursing, 71(6), pp.1198-1209.

McKenzie, G., Lasater, K., Delander, G.E., Neal, M.B., Morgove, M. & Eckstrom, E., 2017. Falls prevention education: Interprofessional training to enhance collaborative practice. Gerontology & geriatrics education, 38(2), pp.232-243.

Milos, V., Bondesson, Å., Magnusson, M., Jakobsson, U., Westerlund, T. & Midlöv, P., 2014. Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC geriatrics, 14(1), p.40.

Milos, V., Bondesson, Å., Magnusson, M., Jakobsson, U., Westerlund, T. & Midlöv, P., 2014. Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC geriatrics, 14(1), p.40.

Müller, D., Borsi, L., Stracke, C., Stock, S. & Stollenwerk, B., 2015. Cost-effectiveness of a multifactorial fracture prevention program for elderly people admitted to nursing homes. The European Journal of Health Economics, 16(5), pp.517-527.

Padron-Monedero, A., Lopez-Cuadrado, T., Galan, I., Martinez-Sanchez, E.V., Martin, P. & Fernandez-Cuenca, R., 2017. Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients. Osteoporosis International, 28(5), pp.1559-1568.

Soto-Varela, A., Faraldo-García, A., Rossi-Izquierdo, M., Lirola-Delgado, A., Vaamonde-Sánchez-Andrade, I., del-Río-Valeiras, M., Gayoso-Diz, P. & Santos-Pérez, S., 2015. Can we predict the risk of falls in elderly patients with instability?. Auris Nasus Larynx, 42(1), pp.8-14.

Wallander, M., Axelsson, K.F., Nilsson, A.G., Lundh, D. & Lorentzon, M., 2017. Type 2 Diabetes and Risk of Hip Fractures and Non?Skeletal Fall Injuries in the Elderly: A Study From the Fractures and Fall Injuries in the Elderly Cohort (FRAILCO). Journal of bone and mineral research, 32(3), pp.449-460.

Wilson, D.S., Montie, M., Conlon, P., Reynolds, M., Ripley, R. & Titler, M.G., 2016. Nurses’ perceptions of implementing fall prevention interventions to mitigate patient-specific fall risk factors. Western journal of nursing research, 38(8), pp.1012-1034.

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