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Casey Shield

on 18 February 2013

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Transcript of Falls

Casey Shield, Caroline Marriott, Katie Mitchell, Jake Staniels, Kim McCuen, Lucy Ryu, Lizette Quijada Falls What is a fall? The definition of a fall is as follows: To drop or come down freely under the influence of gravity. In terms of elderly the definition may be, “Unintentionally coming to the ground or some lower level and other than a consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in stroke or an epileptic seizure” (Gibson, 1987). - Falls are the leading cause of fatal and nonfatal injuries in the United States and a major cause of functional decline, hospital admission, psychological trauma, and institutionalization in older people.

-About one-third of community-living older adults and more than half of those living in long-term care facilities fall every year; half of those who fall do so more than once. (Miller, 2009) Assessing Risks for Falls Keep the call light within reach at all time
Make sure patients wear sturdy, nonslip footwear
Offer assistance with ADLs (getting out of bed, toileting, transfers)
Encourage patient to call for help when needed
Make sure bed is in the lowest position, wheels locked, and bed alarm on
If appropriate, orient the person to person, place and time every shift as needed
Provide proper lighting (night lights) and keep floor free of clutter
Provide bedside toileting devices (e.g. urinal, bedside commode)
Determine if patient is safe to have access to his/her ambulatory aids at all times Fall Risk Interventions Consequences of falls? - “Between 22% and 60% of older people suffer injuries from falls, 10-15% suffer serious injuries, 2-6% suffer fractures and 0.2- 1.5% suffer hip fractures” (Lord, 2001).

- Most elderly commonly suffer from superficial cuts and abrasions, bruises and sprains.

- Hip fractures are the top cause of morbidity and mortality in fall-related injuries. Education for Older Adult
and Family Instruct the patient and family about the fall prevention program using brochures that provide information about preventing falls and obtaining help if falls occur
Implement any recommendations of rehabilitation therapy
Advise older adult to have vision examinations with provision of corrective lenses and appropriate treatments
Advise the family to make home safer by reducing tripping hazards, removing throw rugs, add grab bars inside and outside the tub
Advise the family to Install stair railings and improve the lighting in homes
Teach older adult about proper use of mobility aids and other assistive devices
Teach older adult about various exercise routines to promote strength and balance Causes of Falls Falls in the geriatric adult have been found to have a number of differing underlying causes dependent upon the age group.

Falls in adults 75 years and younger are often associated with trips and slips that are predominantly attributable to a combination of age related changes and unfavorable environmental conditions.

By contrast falls in adults 75 years and older are usually associated with a combination of disease and medication related factors.
(Miller, 2012) •Decreased muscle mass and decreased strength
•Degenerative changes of joints
•Slower response of the CNS
•Gait changes and Balance Disorders
•Postural Hypotension
•Sensory deficits including visual disturbances Age Related Changes Risk Factors
Common Pathologies •Cardiovascular Disease (Arrhythmias and MI)
•Neurologic Disorders (Parkinsonism, CVA, and TIA)
•Respiratory diseases (COPD)
•Metabolic Disturbances (Electrolyte imbalance and Dehydration)
•Musculoskeletal Problems (Osteoarthritis)
•Cognitive Impairment (Dementia and Confusion)
•Psychosocial Factors (Agitation, Depression, Anxiety)
•Sensory Impairment (Cataracts, Glaucoma, Macular Degeneration)
•Dizziness and Vertigo •Antiarrythmics
(including OTC products like diphenhydramine)
•Benzodiazepines/ Hypnotics
•Alcohol Risk Factors
Medication Effects Risk Factors
Environmental Influences •Inadequate Lighting
•Time of Day
•Lack of handrails and/ or stairs
•Slippery Floors
•Highly polished floors
•Throw Rugs
•Cords (especially loose electrical cords)
•Unfamiliar environments
•Improper height of beds, chairs, or toilets
•Physical restraints (including bedrails) Assessing Risks for Falls Important Areas to Assess: History of Falls Motor Problems Sensory Impairments Cognitive Impairments Orthostatic Hypotension History of Falls Motor Problems Assessing for gait and balance problems, or muscle weakness. Get Up And Go Test is ideal: Quick and easy Ask patient to sit straight in an upright chair, rise, stand for a moment, walk 10 feet, turn around, and return to seat. Evaluate ease to perform each component Fall Risk: If at anytime the patient's actions show undue slowness, hesitancy, abnormal movement of trunk or limbs, staggering, or stumbling, the patient is at risk for falls. Tinetti Gait and Balance Evaluation is a more in-depth option. Sensory Impairments Assessing for obvious stuff like vision and hearing impairments. But might include things like peripheral neuropathy. Simple Visual Test: Ask patient to read a headline and sentence from a story in the newspaper. If they can read both, no impairment Can read just the headline - moderate impairment Reads neither - severe impairment and is a fall risk Can also use Snellen Chart Sensory Organization Test also an option that evaluates vision, vestibular function and also somatosensory processing. Probably need a consult for this because need a specialized machine. Cognitive Impairments Orthostatic Hypotension Assessing for a drop in systolic blood pressure of at least 20mm Hg or a drop in diastolic BP of at least 10mm HG. This condition can cause dizziness, fainting, vertigo, weakness, which can all cause falls. Keep the patient's arm in same position, across or beside torso, for the entirety of the test. Take first BP after patient has lay supine for 5 minutes. Have patient stand and then re-check BP after 1 min. and again after 3 min. A detailed history is essential. If possible, obtain some collateral history.
If the patient has fallen during the present hospital admission or if there was an immediate history of falls from seizures or impaired gait prior to admission. Assessing for cognitive impairments such as memory, language, thinking, and judgement will help determine if the patient has mild cognitive impairment (MCI) may increase your risk of later progressing to dementia, caused by Alzheimer's disease or other neurological conditions.
People with MCI have a significantly increased risk but not a certainty of developing Alzheimer's disease or another type of dementia.
Implement usage of CAM (Confusion Assessment Method)
The Confusion Assessment Method (CAM) is a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately in both clinical and research settings. Assessing for history of falling within the last 3 months : Questions to ask: Was the fall an isolated event or one of many? If many, is there any pattern?
How often do they occur?
What caused the fall?
What was the patient doing at the time?
Was there any loss of consciousness? •If history suggests tripping over things, ask about eyesight and when they were last assessed by an optician.
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