Falls Prevention In The Elderly

As older adults age, their ability to function gradually decreases. This decrease in function, such as mobility, vision, or hearing, causes the older population to become vulnerable. As nurses, we have a responsibility to keep our patients safe and provide optimal care. The purpose of this discussion is to discuss one thing I have learned that I did not know previously, and what I found to be most surprising. Finally, I will discuss one piece of information most likely to affect my nursing practice.

In week 7 we had visited Wesburn Manor, the Long-term Care (Clinical Placement) setting. It was our first time there, therefore as a group, we oriented the place. At this time, we went to each nursing station on each floor and introduced ourselves from the organization we were from and how we will be providing patient care to the clients in this setting. We were educated by our clinical instructor on the different access codes in the building, the policies and guidelines, our assigned floor and the appointed personal support worker. Our role of professionalism as a nursing student was represented as we came prepared and greeted each healthcare and staff member. From the professional standards, I have learned throughout my clinical

The Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) to have higher sensitivity in assessing fall risk in the geri-psychiatric population (Edmonson et. al, 2011). This project of EPFRAT will let the progress of a fall risk prevention protocol to provide the safest environment and best quality of care possible for the geriatric psychiatric inpatient.

Some of the databases that were searched for information about my PICOT questions were not directly related to patients in long-term care facilities. The Databases that were searched included CINAHL, National Guideline Clearing House, Ovid, and EBSCO, articles related to my PICOT was found on National Guideline Clearing House and Ovid. Some of the key words that were used during the search were Hendrich II fall risk tool, fall in Long-term care facilities, Geriatric falls, fall prevention and predicting fall. National Guideline Clearing (www.guideline.gov) produced about ten results directly related to the content in the PICOT question and CINAHL had thirty nine results.

This act created a major revision of standards of care for nursing homes. This legislation also changed the expectations and the quality of care that patients should receive in long term care facilities. This Nursing Home Reform Act passed by congress specifically stated “that each residents have the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms”. While there may be some benefits to using restraints in nursing homes, however, studies have shown that using restraints in nursing homes negatively impacts patients and for the most part does not prevent them from falling or from other incidents that may occur. There are very high levels of risks associated with the use of restraints (Lapane,150). The OBRA act has encouraged providers to use other alternatives and methods other than restraint because it has been proven to be quite harmful. There are various risked associated with restraints and of these risk include patients potentially patients even losing their lives. Because of the nature of the restraint on patients, patients sometimes end up losing muscle and bone density which then results to immobility and immobility itself results in loss of endurance and muscle strength (Lane 2008). When a patient has lost endurance and muscle strength, they have problems

Hence, the role of a community physiotherapist can include making a referral to an occupational therapist (WCPT, 2003) as he or she could help in assessing and modifying the home environment to make it an elderly friendly apartment. Apart from physiotherapists, occupational therapists can also help in facilitating the patient’s safety. In addition, the bathroom which is the location of the fall should be assessed and identified for any hazards to prevent future falls. A study by Cumming et al. (1999), it was shown that occupational therapists were able to impede future falls in the elderly by visiting the patients’ homes so that the patients will be able to live safely. Further interventions include home modifications which can also result in positive behaviour outcomes. The intervention had shown to be statistically significantly better in the intervention group (36%) had than the control group (45%) with a decreasing percentage of subjects who had fallen. Together with the prescribed home exercise programme and home modification for safety, these interventions can decrease the rate and risk of future falls (Gillespie et al.,

I enjoyed reading your post. I would like to expand on your post about promoting interprofessional collaborative care with occupational therapy. Care coordination is dependent on a deliberate organization of patient care activities between two or more participants, including the patient (Moyers & Metzler, 2014). As you mention, accountable care organizations and patient-centered medical homes are excellent examples that benefit from interprofessional collaboration.

Numerous research has shown evidence-based practice strategies to help reduce and prevent falls in hospitalized patients. According to Day et al. (2012), exercise is one approach used by Geriatric nurse practitioners to reduce and prevent falls in the elderly. Physical activities such as strength, gait, and coordination training which last for a minimum of 12 weeks has been effective in reducing falls in the elderly. The researcher further elaborated that a primary care provider such as a nurse practitioner can refer a patient who is at risk for falls to a Tai Chi program, an operative, and cost effective technique to encourage exercise and strength training in the elderly. Exercise has been revealed to decrease falls in the elderly by 22% - 37% and reduce the risk of falling by 20%-37% (Hale, Taylor, & Waters, 2012). Fuzhong, Harmer, & Fitzgerald (2016), performed a study to evaluate the effectiveness Tai Ji Quan, a form of balance exercise in fall prevention in older adults. The training focused on gait initiation, alignment, coordination, and

(Joint Commissions, 2014).It is important for nurses to explain how to use the call light to the elderly patients, and also to ask for help before getting out of bed. Vulnerable patients should be placed close to the nursing station for close monitoring. It is very important to educate health care workers on the approaches used to prevent falls. The measures used to prevent falls in the elderly could include; carrying out a risk assessment during admission, placing colorful stickers outside their doors, stopping the use of psychotropic medications, teaching them the best way to use their assistive device, placing their call light and belonging within their reach, placing their beds in the lowest position with brakes /wheels locked at all times, removing throw rugs from their surroundings, making sure that they are wearing non-skid shoes/socks before ambulating and also giving them their prescribed Vitamin D supplement as well as encouraging them on the use of their corrective glasses or hearing aids. It is very important to educate health care workers on the approaches used to prevent

Research suggests that each year an estimated 1 in 3 older adults fall. Many older adults lose their lives from falls. Fall related injuries are responsible hundreds of thousands of hospitalizations each year. With the main focus on universal fall precautions and environmental safety, traditional fall prevention and fall management programs have been less than fully effective. A large problem that continues in acute care is the lack of an injury risk screening tool. A research study was conducted on reducing severe injury from falls in 2 veteran’s hospital medical-surgical units. The research study was done by Patricia A. Quigley, PhD, ARNP, CRRN and a team of RN’s. A large veteran’s hospital participated in a 1 year long collaborative project

Bilik, O., Damar, H. T., & Karayurt, O. (2017). Fall behaviors and risk factors among elderly patients with hip fractures. Acta Paulista De Enfermagem, 30(4), 420-427. doi:10.1590/1982-0194201700062

This research project will study the differences between geriatric trauma patient outcomes and non-geriatric trauma patient outcomes at a Level 1 trauma center. Specific psychological outcomes include depression, posttraumatic stress disorder (PTSD) symptoms, resiliency, and alcohol abuse. These outcomes will be identified using various assessments at time of hospitalization and 12 months post-injury as part of the Baylor Trauma Outcomes Project (BTOP) database, a prospective longitudinal study aimed at measuring psychological, physical, and functional outcomes after injury. The following assessments will be used to evaluate their respective psychological outcomes. The Patient Health Questionnaire 8 (PHQ-8) is a brief self-report measure of

According to Dyck, Thiele, Kebicz, Klassen and Erenberg (2013), fall related injuries are a huge concern for patient care and the main focus of their study. The study looked into focusing on starting hourly rounding for fall prevention. They felt there was a good opportunity to reduce fall and injury rates by initiating hourly rounds. This study focused on the change initiative they could make by implementing

The rehabilitation team meets on a daily basis to discuss the progress and plan of care of every patient in the unit. The facility’s comprehensive rehabilitation team has developed and implemented the Neurocognitive Engagement Therapy (NET) program that is based on the on-site research of rehabilitation and quality of life of patients with various cognitive impairments. The primary concern of the facility’s healthcare team is each patient’s stage of cognitive impairment which can result in the orthopaedic conditions or fractures. During the clinical experience the majority of patients seen were the patients with hip fractures, total hip arthroplasty (THA) surgeries, and patients suffering from cerebrovascular accidents (CVA). The physical therapy interventions consist primarily of therapeutic exercise, gait training, and the use of physical agents such as electrical stimulation and short wave diathermy therapy. The focus of physical therapy is not limited to primary concerns of rehabilitation and regaining functionality from a

This program, called the Nijmegen Falls Prevention Program, included one hundred thirteen elderly clients with a history of falls. Exercise sessions were held twice a week for five weeks with fall monitoring done before and after the experiment. Control assessments were also done continuously thru the study to determine client changes in standing balance, balance confidence, and obstacle avoidance skills. The results of the Nijmegen Falls Prevention Program showed that the number of falls within the exercise group dropped by a significant forty six percent! Not only less falls, but obstacle avoidance skills dramatically improved as did balance