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Falls in the Elderly

Case Scenario:

Share a Narrative

A story regarding the implication of falls within the elderly of the community.

Your patient is an 82 year old female admitted to hospital with head injury due to a fall at home.

References

American Association of Neuroscience Nurses. (n.d.). Retrieved from http://www.aann.org/pdf/cpg/aannneuroassessmentolderadult.pdf

American Geriatrics Society [AGS]. (2009). Prevention of Falls in Older Person: AGS/BGS Clinical Practice Guideline. Retrieved from http://www.medcats.com/FALLS/frameset.htm

Besdine, R. W. (n.d.). Retrieved from http://www.merckmanuals.com/professional/geriatrics/approach_to_the_geriatric_patient/evaluation_of_the_elderly_patient.html

Centers for Disease Control and Prevention [CDC]. (2012). Home and Recreational Safety Falls – Older Adults. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Dunning, K., LeMasters, G. & Bhattacharya, A. (2010). A major public health issue: the high incidence of falls during pregnancy. Maternal Child Health Journal, 14, 720 – 725.

Fuller, G.F. (2000). Falls in the Elderly. American Family Physician. 2000 Apr 1; 61(7):2159-2168.

Harvey, K., Kramlich, D., Chapman, J., Parker, J., Blades, E. (2010). Exploring and evaluating five paediatric falls assessment instruments and injury risk indicators: an ambispective study in a tertiary care setting. Journal of Nursing Management, 18, 531 – 541.

Hill-Rodriguez, D., Messmer, P., Williams. P., Zeller, R., Williams, A., Wood, M. & Henry, M. (2009). The humpty dumpty falls scale: a case-control study. JSPN, 14(1), 22 – 32.

Maloney, M., Edwards, H., Harris, C., Ljubicic, B., Meighan, K. & Streitenberger, K. Prevention of entanglement, strangulation, entrapment and falls related to medical and non-medical equipment. The Hospital for Sick Children, Toronto, ON. Retrieved from http://www.sickkids.ca/pdfs/Nursing/14443-Prevention_of_Entanglement.pdf

McWilliams, J.R. (2011). Pediatric fall risk assessment tool for home health practice. Home Healthcare Nurse, 29 (2), 98 – 105.

Merck Manuals. (2010). Falls in the Elderly. Retrieved from http://www.merckmanuals.com/professional/geriatrics/falls_in_the_elderly/falls_in_the_elderly.html

Potter, P. A., & Perry, G. A. (2006). Canadian Fundamentals of Nursing 3rd Edition. Toronto: Elsevier Mosby.

Public Health Agency of Canada. (2005). Report on Seniors' Falls in Canada. Ottawa: Minister of Public Works and Government Services Canada.

Registered Nurses of Ontario Association. (2005). Prevention of Falls and Fall Injuries in the Older Adult. RNAO.

Udesky, L. M. (2010). 10 questions to ask an older adult about falling. Retrieved from http://www.caring.com/checklists/questions-about-falling-down-injuries

Risk of Falls

Adult Population

History Assessment

Falls During Pregnancy

Why is this population at risk?

  • Illness
  • Environment
  • Gait
  • Medications
  • Cardiovascular
  • Extremity Weakness

Assessment

  • Morse Fall Scare
  • Hendrich II Fall Risk Model
  • STRATIFY Falls Assessment Tool

Falls Prevention

Neurological Assessment

Motor Examination

  • Muscle size, strength and tone
  • Get Up and Go Test
  • Reflexes
  • Sensory Response

Assessment

Why is this population at risk?

  • Physiological changes
  • Increase risk for pregnancy complications

Assessment

  • After fall
  • Falls risk

Fall Prevention

  • Moving slow
  • Sitting or laying when need be
  • Proper positioning
  • Use of safety equipment
  • Exercise as recommended
  • Proper footwear

Pediatric Population

Based on changes that occur:

  • Patience
  • Assistive device use
  • ADL's
  • Aleep
  • Mental Status
  • Neuroanatomical
  • Artherosclerosis
  • Neurochemical changes

History taking and Examining the Geriatric Patient

Issues that may affect assessment

  • Environment
  • Polypharmacy
  • Fluid/ Electrolytes
  • Infection
  • Fatigue
  • Pain

Why is this population at risk?

  • Age
  • Unaware of surroundings
  • Illness
  • Medications
  • Weakness

Assessment

  • Pediatric Falls Assessment Tool
  • Falls/ESE

Falls Prevention

  • Low risk
  • Proper footwear/clothing
  • Adequate lighting
  • Education
  • "baby-proofing"
  • High Risk
  • Evaluation of medications
  • Organization
  • Check on client often
  • Assist with ambulation
  • Use of safety equipment
  • Introduction
  • Technique
  • Content
  • Physical Examination

-Pay special attention too...

  • -Key points...

Falls

Predictor of Falls

  • Intrinsic Factors
  • Extrinsic Factors
  • Situational Factors

Fall Statistics in Canada

•Almost 62% of injury related hospitalizations for seniors are the result of falls•The fall related injury rate is 9 times greater among seniors than among those less than 65 years of age•Falls cause more than 90% of all hip fractures in seniors, and 20% die within a year of the fracture (Public Health Agency of Canada, 2005)•In Ontario, falls were responsible for 80% of head injury hospitalizations in seniors (Registered Nurses of Ontario Association, 2005).

Falls in the Geriatric Population

  • Safety concern
  • Individual and Environmental factors
  • Nursing interventions
  • Threaten of independence
  • According to the Center for Disease Control and Prevention (2012)...

I HATE FALLING: A Mnemonic for Key Physical Findings in the Elderly Patient who Falls or Nearly Falls

Reasons for Falls:

  • Physiological changes
  • History
  • Lack of Physical Exercise
  • Medical
  • Disease
  • Environment

Evaluation of Falls

Falls Prevention

  • Regular exercise
  • Poly pharmacology review
  • Vision tests
  • Increasing home safety
  • Reduced fall risk strategies
  • Reduce hip fracture risks through
  • Adequate Ca and Vit. D
  • Weight bearing exercises
  • Screened for Osteoporosis
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