Jennifer Jost Hana Kudera Melissa Kumm Concordia University Falls and the Elderly Jennifer Jost Hana Kudera Melissa Kumm Concordia University http://www.healthy.ohio.gov/~/media/HealthyOhio/ASSETS/Images/injury%20prevention/fallspageimage.ashx

Falls One out of three older adults fall each year Less than half of them inform their health care provider about their falls Leading cause of fatal and nonfatal injuries 2010, over $30 billion were toward medical costs related to falls

Outcomes linked to falls Injuries Lacerations, hip fractures, head traumas Most common cause of traumatic brain injuries 46% of fatal falls in 2000 were due to traumatic brain injuries Most common fractures Spine, hip, forearm, leg, ankle, pelvis, upper arm and hand Once a fall occurs, the older adult develops a fear of falling. The fear can cause the older adult to limit their activities which will then increase their risk of falling

Who is at risk? Fall Related Deaths 21,700 older adults died from falls in 2010 Men 40% more likely than women in 2010 Older white adults are 2.4 times more likely Older non-Hispanics have a higher fatality rate than Hispanics

Who is at risk? Fall Injuries 75 years and older who fall 4-5 times more likely than aged 65-74 years old to be admitted to a nursing home for a year or longer Fractures occur almost two times more often in women than men 2010, there were 258,000 hip fractures 95% of hip fractures are caused by falls

Prevention Exercise regularly Improve leg strength and balance Tai Chi is good because promotes flexibility, balance, improved body awareness Have the doctor or pharmacist review all their medications Look for interactions that may cause dizziness or drowsiness Change medications is able Have their eyes checked at least yearly http://www.taichichen.org/images/hwick01.jpg

Prevention In the home Good fitting shoes Add grab bars next to toilet and in shower/bath areas Railings on all stairways Improve lighting Reduce tripping hazards Clear walk areas and remove area rugs Good fitting shoes http://nihseniorhealth.gov/falls/faq/images/shoe_r.gif

Prevention To reduce risk of hip fractures Increase calcium and vitamin D intake Weight bearing exercises Screened for osteoporosis If needed, get treatment

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Legal and ethical considerations related to falls If a fall is the result of neglect, the nurse could lose her job, license, be sued for compensation, and could face jail time depending on the outcome of the fall. Ethically Accountability of the caregiver and/or nurse to be loyal and responsible for the older adult Doing what is right when no one is watching Older adult wanting to do for self when it isn’t safe

CUTLURAL, PROFESSIONAL AND SPIRITUAL CONSIDERATIONS RELATED TO FALLS Cultural competence sex orientation, age, and race, faith or conviction Language access Pastoral access Patient advocacy Patient safety Patient provider communication Health care policy Research and risk management.

RESEARCH FINDINGS ON NURSING INTERVENTIONS RELEVANT TO FALLS Inherent factors (poor indicators for change in risk status d/t slow changing over time) Visual deficiencies Muscle weakness Impaired balance Transient factors (good indicators for change in risk status) Rise in temperature Dehydration Changing medication Room change

RESEARCH FINDINGS ON NURSING INTERVENTIONS RELEVANT TO FALLS CONT. . Little evidence reveals the cost benefit of fall prevention and injury protections programs No regulations for postulating the right combination of intervention techniques to ensure protection of at-risk population There is no one study that delivers an absolute multifactorial model to guide practice in nursing homes

RESEARCH FINDINGS ON NURSING INTERVENTIONS RELEVANT TO FALLS CONT. Once a nursing home resident falls, they are more likely to fall again and have an increase of injuries due to these falls. Continuous evaluation after the fall is required to determine the extent of injury, especially in residents with impaired mental condition. Extra care and evaluation of these residents after a fall are necessary to avoid missing post fall injuries that might not be self-reported or observed on initial assessment.

Case Study Mr. Jones is a 90 year old white male who lives at home. He has come into the office for a routine care visit. His daughter accompanies him. She reports that Mr. Jones has had multiple falls in the past 6 months. Mr. Jones agrees that he has had multiple falls recently be attributes it to old age. Mr. Jones’ health history is significant for hypertension, diabetes mellitus type 2, and congestive heart failure. Upon review of his medications the nurse notices he is on Lasix, lisinopril, metformin, and lantus

Case Study Cont. Risk Factors for Falls hypotension r/t lisinopril, and Lasix hypo/hyperglycemia as r/t diabetes mellitus, metformin, lantus Urinary frequency/urgency as r/t Lasix age

Case Study Cont. Fall Prevention - Teachings Educate on need to monitor blood pressures to prevent hypotension, before and after taking medications Teach how to monitor blood glucose levels to prevent hypoglycemia Teach on s/s of hypoglycemia, Educate on keeping walk areas clutter free, proper lighting, non slip surfaces, non-slip shoes, grab bars, remove throw rugs etc.

References Centers for Disease Control and Prevention. (2013). Falls Among Older Adults: An Overview. Retrieved from: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html Ensign, M. R. (2004). Ethical Issues and the elderly: guidance for eldercare provider. Retrieved from: http://www.ensignlaw.com/Ethical%20Issues%20and%20Elderly.html Falls Among Older Adults. (2014). Retrieved from: http://www.healthy.ohio.gov/~/media/HealthyOhio/ASSETS/Images/injury%20prevention/fallspageimage.ashx Ginsburg & Associates. (2013). Elderly Falls Injury. Retrieved from: http://www.ginsburg-law.com/nursing-home-abuse/elderly-falls/ Gray-Micelli, D., Quigley, P. (2012). Fall prevention: assessment, diagnosis, and intervention strategies. Retrieved from http://consultgerirn.org/topics/falls/want_to_know_more#Wrap Fuller GF. (2000). Falls in the Elderly. American Family Physician. 61(7):2159-2168 Falls in the Elderly. American Family Physician. 61(7):2159-2168 Media Cache Picture (2014). Retrieved from: http://media-cache-ak0.pinimg.com/originals/e1/2d/1b/e12d1be14bffa74dfb3d2421ee0901a5.jpg  

References Neyens JCL, Dijcks BPJ, Haastregt JCM van, et al. (2009) A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomized controlled trial. Age Ageing. 38 (2): 194-199 NIHSeniorHealth. (2013). Falls and Older Adults: Causes and Risk Factors. Retrieved from: http://nihseniorhealth.gov/falls/causesandriskfactors/01.html   NIHSeniorHealth. (2014). Retrieved from: http://nihseniorhealth.gov/falls/faq/images/shoe_r.gif Quigley, P., et al. Fall Prevention and Injury Protection for Nursing Home Residents. Journal of the American Medical Directors Association, Volume 11, Issue 4, 284 - 293. Tabloski, P. (2010). Gerontological Nursing (2nd ed.). Upper Saddle River, New Jersey: Pearson. Tai Chi. (2014). Retrieved from: http://www.taichichen.org/images/hwick01.jpg Weil, A. (2014). Can Tai Chi Slow Aging? Retrieved from: http://www.drweil.com/drw/u/WBL02406/Can-Tai-Chi-Slow-Aging.html