1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 22 Mobility and Safety

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Age-Related Changes That Affect Mobility and Safety Degenerative changes in bones, muscles, joints and connective tissue Central nervous system changes: slowed reaction time, body sway Osteopenia and osteoporosis

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is True or False. Exercise programs to increase strength and endurance in the older adult population may help delay the onset of the age-related functional consequences of decreased strength and endurance.

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Age-related changes in skeletal muscles, which are controlled by motor neurons, directly affect all activities of daily living. The end result of these age-related changes is a decline in motor function and a loss of strength and endurance, even in healthy older adults. Exercise programs to increase strength and endurance may help delay the onset of the age-related consequences of disability and loss of function.

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which statement about osteoporosis is true? A.Primary osteoporosis occurs with pathologic problems. B. Secondary osteoporosis occurs as a result of age-related changes. C. Osteoporosis can cause serious negative functional consequences even in the absence of additional risk factors. D. Estrogen levels have a minimal impact on the development of osteoporosis.

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Osteoporosis can cause serious negative functional consequences even in the absence of additional risk factors. Osteoporosis is a gradual loss of bone mass that affects all adults to some degree and is strongly associated with low-trauma fractures in older adults. Osteoporosis is classified as primary when it is associated with age- related changes and as secondary when it is caused by medications or pathologic disturbances.

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors That Affect Mobility and Safety Impaired Musculoskeletal Function –Inactivity –Inadequate protein –Vitamin D intake

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors That Affect Mobility and Safety (cont.) Osteoporosis and Fractures –Inadequate calcium and vitamin D intake –Lack of weight-bearing activity –Female gender –Small bones –Increased age –Tobacco smoking –Excessive alcohol drinking –Certain medications

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors That Affect Mobility and Safety (cont.) Falls –Pathologic conditions and functional impairments –Medication effects –Physical restraints

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which statement related to risk factors for falls and the older adult is true? A. Falls are most often the result of an isolated risk factor. B. The risk of falling increases in proportion to the number of risk factors. C. Risk factors for falls do not vary according to the environment. D. Functional abilities of the older adult are not considered a risk factor for falls.

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. The risk of falling increases in proportion to the number of risk factors. Falls are the result of a combination of risk factors rather than one isolated risk factor, and the risk of falls increases in proportion to the number of risk factors.

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Functional Consequences Affecting Musculoskeletal Wellness Diminished muscle strength, endurance, and coordination Increased difficulty performing ADLs Increased susceptibility to falls Increased susceptibility to fall-related injuries, including death Fear of falling

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which statement related to musculoskeletal function and the older adult population is true? A. There is a greater decline in muscle strength in the upper extremities. B. Diminished muscle strength is attributed primarily to age-related loss of muscle mass. C. Older adults experience muscle fatigue after longer periods of exercise than do younger adults. D. Lifelong patterns of exercise and activity have little effect on muscle strength.

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Diminished muscle strength is attributed primarily to age-related loss of muscle mass. Beginning at about the age of 40 years, muscle strength declines gradually, resulting in an overall decrease of 30% to 50% by the age of 80 years, with a greater decline in muscle strength in the lower extremities than in the upper extremities.

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pathologic Condition Affecting Musculoskeletal Wellness Osteoarthritis

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Assessment of Musculoskeletal Function Assessment of overall musculoskeletal performance Risks for osteoporosis –Intake of calcium and vitamin D –History of fractures Identifying risks for falls and injury Assessing for safety of the environment

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Wellness nursing diagnosis: Readiness for Enhanced Self Health Management Related to osteoporosis: Health-Seeking Behaviors, Ineffective Health Maintenance Related to fall risks: Impaired Physical Mobility, Risk for Falls Additional diagnoses that addresses fear of falling: Fear

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning for Wellness Outcomes Balance, Endurance, Mobility, Activity Tolerance Risk Control, Risk Detection Safety Behavior: Fall Prevention, Home Physical Environment Coping, Fear Control, Comfort Level

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Interventions for Musculoskeletal Wellness Teaching about exercise Teaching about osteoporosis –Early detection and treatment –Lifestyle interventions –Nutritional interventions –Medications

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Interventions for Musculoskeletal Wellness (cont.) Implementing fall prevention programs –Eliminating risks –Using monitoring devices –Addressing contributing factors Preventing fall-related injuries and death –Hip protectors –Environmental interventions Addressing fear of falling

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which statement related to adequate calcium supplementation and the older adult is true? A. Calcium supplements are rarely necessary. B. Calcium supplementation lowers the rate of fractures in older adults. C. Calcium supplements have few detrimental effects when taken by older adults. D. Absorption of calcium supplements is optimal at 1500 mg per dose.

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Calcium supplementation lowers the rate of fractures in older adults. A recent report from the U.S. Surgeon General recommended a pyramidal treatment approach to osteoporosis that includes physical activity, fall prevention, and supplementation with calcium and vitamin D as the foundation for fracture prevention. Absorption of calcium supplements is optimal at no more than 600 mg per dose.

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation of Nursing Interventions Maintenance of highest level of safe mobility Incorporation of preventive measures in daily life to ensure safety and prevent osteoporosis Expressed feelings of safety and improved quality of life