Safety in Elderly
Topic: Falls & Fall Risk Reduction.
Answer the Question(s) completely.
1. Mention and discuss Fall Risk Assessment Instruments (mention at least 3).
2. Signs and symptoms of traumatic brain injury in older adults (mention at least 5).
Guidelines:
Important: The answer should be based on the knowledge obtained from the File attached in Word called “Fall. Fall Risk Reduction ” and approved online literature cited below. Not just your opinion.
· You must complete the question completely.
· All points must be well developed.
· APA Format Time New Roman 12 font. strictly enforced.
· Minimum of 400 words.
Referenced from Online Resources: Must NOT BE OLDER THAN 5 years
Approved Web site for references must have:
• Serial/journal articles
• Volume number, in italics.
• Issue number. This is bracketed immediately after the volume number but not italicized.
• Month, season or other designation of publication if there is no volume or issue number.
• Include all page numbers. Ex: 7(1),24 Sergiev, P. V., Dontsova, O. A., & Berezkin, G. V. (2015).
References:
Book. Ebersole and Hess’ Gerontological Nursing and Healthy Aging 5th. Author: Theris A. Touhy; Kathleen F. Jett. Edition: 5th, Fifth, 5e Year: 2017 “
Approved Online Resources are:
1. CDC.gov – www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.
2. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion: Healthy People 2020, 2012. – www.healthypeople.gov/2020
3. CDC: STEADI (Stopping Elderly Accidents, Deaths & Injuries
4. Gericareonline: Story of Your Falls
5. American Geriatrics Society/British Geriatrics Society:
Falls
Falls are one of the most important geriatric syndromes and the leading cause of morbidity and mortality for people older than 65 years of age. In the United States, falls occur in one-third of adults 65 and older. Among older adults, falls are the leading cause of both fatal and nonfatal injuries and the most common cause of hospital admissions for trauma. Approximately 20% to 30% of people who fall suffer moderate to severe injuries (lacerations, hip fracture, traumatic brain injury [TBI]) (Centers for Disease Control and Prevention [CDC], 2015a; Gray-Micelli & Quigley, 2012). Estimates are that up to two-thirds of falls may be preventable (Lach, 2010).
Box 15.1 presents further data on falls.
Statistics on Falls and Fall-Related Concerns
· Up to 50% of hospitalized patients are at risk for falls and almost half of those who fall suffer an injury. Between 50% and 75% of nursing home residents fall annually, twice the rate of community-dwelling older adults.
· The death rate from falls is 40% higher for men than women.
· Rates of fall-related fractures among older adults are more than twice as high for women as for men.
· More than 95% of hip fractures among older adults are caused by falls. White women have significantly higher hip fracture rates than black women.
· Up to 25% of adults who lived independently before their hip fracture have to stay in a nursing home for at least 1 year after their injury.
· The direct medical costs of fall injuries are $31 billion annually. Hospital costs account for two-thirds of the total costs.
· Falls are considered a nursing-sensitive quality indicator.
Falls are considered a nursing-sensitive quality indicator. In acute care hospitals, patient falls are the most common incidents reported (Zhao & Kim, 2015). All falls in skilled nursing facilities are considered sentinel events and must be reported to the Centers for Medicare and Medicaid Services (CMS). The Joint Commission (TJC) has established national patient safety goals (NPSG) for fall reduction in all TJC-approved institutions across the health care continuum. CMS implemented a new policy in 2008 that eliminated the reimbursement to hospitals for treatment of injuries 202resulting from falls occurring during hospitalization (Zhao & Kim, 2015). Healthy People 2020 includes several goals related to falls (Box 15.2).
Safety Alert
Education on falls and fall risk reduction is an important consideration in the Quality and Safety Education for Nurses (QSEN) safety competency, which addresses the need to minimize risk of harm to patients and providers through both system effectiveness and individual performance. Safe and effective transfer techniques are an important component of safety measures.
Box 15.2 Healthy People 2020
Falls, Fall Prevention, Injury
• Reduce the rate of emergency department visits due to falls among older adults.
• Reduce fatal and nonfatal injuries.
• Reduce hospitalizations for nonfatal injuries.
• Reduce emergency department visits for nonfatal injuries.
• Reduce fatal and nonfatal traumatic brain injuries.
Consequences of Falls
Hip Fractures
More than 95% of hip fractures among older adults are caused by falls. Hip fracture is the second leading cause of hospitalization for older people, occurring predominantly in older adults with underlying osteoporosis. Hip fractures are associated with considerable morbidity and mortality. Recovery from hip fractures is complicated by the presence of multiple comorbid conditions and potentially avoidable problems such as weight loss, delirium, pain, falls, and incontinence (Popejoy et al., 2012).
Only 50% to 60% of patients with hip fractures will recover their pre-fracture ambulation abilities in the first-year post fracture. Older adults who fracture a hip have a five to eight times increased risk of mortality during the first 3 months after hip fracture. This excess mortality persists for 10 years after the fracture and is higher in men. Most research on hip fractures has been conducted with older women, and further studies of both men and racially and culturally diverse older adults are necessary.
Traumatic Brain Injury Older adults (75 years of age and older) have the highest rates of traumatic brain injury (TBI)-related hospitalization and death. Falls are the leading cause of TBI for older adults. Advancing age negatively affects the outcome after TBI, even with relatively minor head injuries.
Factors that place the older adult at greater risk for TBI include the presence of comorbid conditions, use of aspirin and anticoagulants, and changes in the brain with age. Brain changes with age, although clinically insignificant, do increase the risk of TBIs and especially subdural hematomas, which are much more common in older adults.
There is a decreased adherence of the dura mater to the skull, increased fragility of bridging cerebral veins, and increased subarachnoid space and atrophy of the brain, which results in more space within the cranial vault for blood to accumulate before symptoms appear (Timmons & Menaker, 2010).
While most TBIs occur from falls, older people may experience TBI with seemingly more minor incidents (e.g., sharp turns or jarring movement of the head). Some patients may not even remember the incident. In cases of moderate to severe TBI, there will be cognitive and physical sequelae obvious at the time of injury or shortly afterward that will require emergency treatment. However, older adults who experience a minor incident with seemingly lesser trauma to the head often present with more insidious and delayed symptom onset. Because of changes in the aging brain, there is an increased risk for slowly expanding subdural hematomas. Health professionals should have a high suspicion of TBI in an older adult who falls and strikes the head or experiences even a more minor event, such as sudden twisting of the head. For older adults who are receiving anticoagulant therapy and experience minor head injury with a negative computed tomography (CT) scan, a protocol of 24-hour observation followed by a second CT scan is recommended (Mendito et al., 2012).
Manifestations of TBI are often misinterpreted as signs of dementia, which can lead to inaccurate prognoses and limit implementation of appropriate treatment. Box 15.4 presents signs and symptoms of TBI.
Signs and Symptoms of Traumatic Brain Injury (TBI) in Older
· Adults Symptoms of Mild TBI
· Low-grade headache that will not dissipate
· Having more trouble than usual remembering things, paying attention or concentrating, organizing daily tasks, or making decisions and solving problems
· Slowness in thinking, speaking, acting, or reading
· Getting lost or easily confused
· Feeling tired all of the time, lack of energy or motivation
· Change in sleep pattern (sleeping much longer than usual, having trouble sleeping)
· Loss of balance, feeling light-headed or dizzy
· Increased sensitivity to sounds, lights, distractions
· Blurred vision or eyes that tire easily
· Loss of sense of taste or smell
· Ringing in the ears
· Change in sex drive
· Mood changes (feeling sad, anxious, listless, or becoming easily irritated or angry for little or no reason) Symptoms of Moderate to Severe TBI • Severe headache that gets worse or does not disappear
· Repeated vomiting or nausea
· Seizures
· Inability to wake from sleep
· Dilation of one or both pupils
· Slurred speech
· Weakness or numbness in the arms or legs
· Loss of coordination
· Increased confusion, restlessness, or agitation NOTE: Older adults taking blood thinners should be seen immediately by a health care provider if they have a bump or blow to the head, even if they do not have any of the symptoms listed here.
Fallophobia “ Fear of falling”
Even if a fall does not result in injury, falls contribute to a loss of confidence that leads to reduced physical activity, increased dependency, and social withdrawal.
(fallophobia) may cause a person to restrict his or her physical and social activities, leading to further functional decline, depression, social isolation, and decreased quality of life (Zhao & Kim, 2015).
Fear of falling is an important predictor of general functional decline and a risk factor for future falls (Hill et al., 2010; Rubenstein et al.,…
