The Problem of Falls Among the Older Population Research Paper

Critical Incident in Work Place

The problem of falls among the older patient population is very serious because this problem can cause physical injuries which in turns affect the health of patients. In such a situation, the underestimation of risks by the nursing staff and health care professionals can cause serious health problems in older patients caused by falls. Knowing this, nurses should come to work prepare and be aware of the risks of falls and its harmful effects on the patients’ health. At the moment, many studies reveal the fact that the risk of falls among the older patient population is high, but there is no homogeneous approach to the prevention of falls among older patients. The current study focuses on the problem of falls among the older inpatient population. In terms of the current study, the major causes and risk factors leading to falls will be analyzed and falls’ management and prevention strategy will be elaborated on the ground of the literature survey dedicated to the problem of falls among the older population and the prevention of this problem. The current study focuses on the analysis of the major risk factors and causes of falls and existing strategies and recommendations that help to prevent falls among the older patient population. In this regard, the training of the nursing staff along with the adaptation of the environment to special needs of the older patient population along with the permanent monitoring and control over their health condition are essential steps toward the prevention of risks of falls among older patients.

Exposure to Falls of The Older Patient Population

Existing studies (Rubenstein & Josephson, 2002) reveal the fact that the risk of falls among older patients increases as they grow older. To put it more precisely, one of the recent studies shows that about thirty percent of people over the “age 65 and 50% of those over 80 fall each year” (Rubenstein & Josephson, 2002). Older adults who have had the experience of falls before are several times more likely to fall again compared to other patients (Rubenstein & Josephson, 2002). Therefore, if patients have fall history, then they have the higher risk of falls than patients that have not had such history.

Furthermore, “twenty to thirty percent of those who have fallen suffer injuries” that cause them not to be able to perform their daily activities and even become sicker (Tinetti, 2003). Also, a smaller number of patients, who have experienced falls, require medical aid and treatment of fractures (Tinetti, 2003). “During one year follow up, 20% of frequent fallers were in hospital”, and some have died (Tinetti, 2003). Therefore, falls can cause serious injuries in patients that may result in the development of serious health problems or even cause a death of patients. In this respect, inpatients still face the risk of falls just like other patients, who stay at home, that means that they are vulnerable to the same risks as other patients do.

In fact, “approximately 50% of older adult in residential care facilities fall at least once a year” (Rubenstein & Josephson, 2002). This is the high rate of older adult in residential care facilities, who fall regularly. Therefore, the staff of residential care facilities should come prepared to manage the problem of falls and their effects. At this point, it is possible to refer to a case of a 71 years old female patient, who fell in a hospital, when she walked through the hospital’s facility and fell because of the slippery floor, when the facilities have been just cleaned. After the fall, the patient suffered a hip fracture and needed treatment.

Risks Causing Falls

Some medicines can increase the risk of falls, while older patients may take such medicines to treat their health problems. The medical condition is another risk factor that can cause falls among the older patient population. Health problems, such as visual impairment, foot problems and other health problems increase the risk of falls among elderly patients.

At the same time, there are environmental factors that can increase the risk of falls substantially, such as “poor lighting, slippery floors, uneven surfaces, footwear and clothing” (Rubenstein & Josephson, 2002) that may cause falls. Another risk factor is inappropriate walking aids or assistive devices. Environmental risks are very serious and threaten to older patients. The nursing staff and health care professionals are responsible for the creation and maintenance of the safe environment for patients but they cannot always create such safe environment not because of their negligence but because of their poor knowledge or the lack of awareness of the risk of falls among the older inpatient population.

In such a context, one of the main risks of falls of older patients is the lack of training and preparedness of the nursing staff and health care professionals to work with older patients and to prevent falls among them. The lack of training among nurses and health care professionals is serious risk factors because nurses and health care professionals can prevent or minimize the risk of falls through enhancement the safety of patients’ environment.

Briefly, the risk factors and causes of falls among the old patient population are presented in the following table below: 

Table 1. Some of the causes of falls among the elderly

CAUSE MEAN (%)* RANGE †
Accident and environment-related  factors 31 1 to 53
Unstable gait and balance 17 4 to 39
Feeling of dizziness and vertigo 13 0 to 30
Drop attack 9 0 to 52
Altered mental status 5 0 to 14
A drop in blood pressure 3 0 to 24
Visual problems 2 0 to 5
Syncope episode 0.3 0 to 3
Some other specified causes‡ 15 2 to 39
Unknown causes 5 0 to 21

Source: Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med 2002; 18:146.

In such a way, physical health problems, medication and environmental factors along with the lack of nurses and health care professionals’ awareness of the risk of falls are the major risk factors that can cause falls among older patients.

Effects of Falls among The Older Patient Population

Falls can cause multiple negative effects that can have a considerable impact on older patients’ health. In this regard, fractures are widely-spread among older patients, who have experienced falls. “The proportion of falls that resulted in fracture is low; the absolute number of older adult suffering from fractures is high and this placed heavy demands on the health care systems” (Tinetti, 2003).  “Approximately 10% of falls result in serious injury, of which 5% are fractures” (Tinetti, 2003).  At the same time, older patients are likely to develop specific health problems and fractures, which are, to a significant extent, determined by their age. Older patients are more likely to suffer fractures caused by falls, including fractures of wrist, spine, hip, humerus, pelvis (Tinetti, 2003). Returning to the case of the female patient, her injury was not rare. On the contrary, hip fractures made up of 25% fractures resulting from falls in the community (Tinetti, 2003). “The incidence of hip fracture is higher in residential settings, with rates of up to 81 per 1000 person years reported” (Tinetti, 2003). “At least 95% of those hip fractures are caused by falls” (Tinetti, 2003). In such a way, the injury of the female patient, who suffered the hip fracture as a result of the fall, was not rare but, instead, it was a frequent case of injury caused by the fall of an older patient.

Management and Prevention Of Falls Among The Older Patient Population

In such a situation, it is obvious that nursing staff and health care professionals should be aware of all risk factors associated with falls. Nurses and health care professionals are responsible for the creation of safe environment and monitoring of the health condition of their patients as well as the study of their history to assess adequately the risk of falls. However, often the nursing staff and health care professionals underestimate such risks because of the lack of awareness and understanding of such risks.

In addition, nursing staff and health care professionals need the training to work with the older patients and prevent the risk of falls. The training can help to tackle the problem of falls among older patients successfully because the professional training of nurses can help them to become aware of the high risk of falls among older patients and, more important, they will be able to learn effective ways of prevention of falls among older patients. In such a way, the risk of falls will decrease, while patients can enjoy the high quality of nursing care.

The following table shows basic strategies and intervention strategies respectively to risk factors, which can cause falls among the older patient population (See Table 2):

Table 2.

Clinical Assessments and Interventions for Older Persons at Risk for Falls

ASSESSMENT AND RISK FACTOR INTERVENTIONS
Understanding the circumstances of previous falls* Changes in environment and activity to reduce the likelihood of recurrent falls
Using psychotropic medication Inform primary care physician (pcp) to review and adjust medication dosage
High-risk medications (e.g., benzodiazepines, other sleeping medications, neuroleptics, antidepressants, anticonvulsants, or class IA antiarrhythmic)
Four or more medications
Vision* Ensue good lighten around the house,; avoidance of multifocal glasses while walking; referral to an ophthalmologist

 

 

 

 

 

Ensure acuity < 20/60
Decreased depth perception
Decreased contrast sensitivity
Cataracts
Postural blood pressure check (after five or more minutes in a supine position, immediately after standing, and two minutes after standing ‡); ≥20 mm Hg (or ≥ 20 percent) drop in systolic pressure, with or without symptoms, repeat immediately or after two minutes of standing Pcp to diagnosis and treatment of underlying cause, if possible; review and make some adjustment to medications; modification of salt restriction; adequate hydration; compensatory strategies.
Assessing gait and balance Diagnosis unstable gait, environmental interventions; retreatment of underlying cause, referral to physical therapist for assistive device and for gait and progressive balance training
 Report observation of unsteadiness and report.
Impairment on brief assessment (e.g., the “Get Up and Go” test or performance-oriented assessment of mobility)
    Neurologic examination Diagnosis and treat underlying cause, if possible; increase in proprioceptive input (with an assistive device or appropriate footwear that encases the foot and has a low heel and thin sole); reduction of medications that impede cognition; awareness on the part of caregivers of cognitive deficits; reduction of environmental risk factors; referral to physical therapist for gait, balance, and strength training
Proprioception Impaired
Cognition Impaired
Decreased muscle strength
    Musculoskeletal examination:        examination of legs (joints and range of motion) and feet. Diagnosis and treat of underlying cause. referral to physical therapist for strength, range-of-motion, and gait and balance training and for assistive devices; use of appropriate footwear; referral to podiatrist
    Cardiovascular examination Referral client to a cardiologist. (in the case of syncope)
Assess arrhythmia (if there is known cardiac a disease, an abnormal electrocardiogram, and syncope)
Evaluate home for hazard after hospital         discharge Ensure no loose rugs and use of night lights, non-slip bath mats, and stair rails; other interventions as necessary

Source: Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med 2003; 348:45.

 

In such a way, the nursing staff and health care professionals should come prepared to prevent the problem of falls among the older patient population. In this regard, the development of training programs for nurses and other health care professionals is essential for raising their awareness of risks of falls as well as elaboration of effective strategies of falls’ prevention. The understanding of the problem and risks associated with falls among older patients is the first and major step toward the resolution of the problem.

Furthermore, nurses and other health care professionals should create comfortable and safe environment that minimizes the risk of falls among the older population. For example, non-slippery floors, even surface, good lighting, comfortable and safe footwear and clothing for patients can minimize the risk of falls substantially. Nurses and health care professionals should be aware of their responsibility to create safe environment. However, what is safe for younger patients may be unsafe for older ones. For example, in case of the female patient, who has suffered the hip fracture, the slippery floor after the cleaning was the cause of the fall, while cleaning was supposed to secure the environment from the spread of infections, bacteria and other threats to patients’ health. In this case, the nursing staff could have just underestimated the risk of slippery floor for the safety of older patients that eventually resulted in the fall and injury of the female patient. Instead, if nurses have managed to create the safe environment, they would definitely create safe conditions for their patients that would have prevented the fall of the female patient.

In addition, the nursing staff and health care professionals should monitor the medical condition of patients to prevent the risk of falls. For example, the negative impact of medication can increase the risk of falls. Therefore, if nurses notice such symptoms as dizziness they may report about such facts to physicians, who, in their turn, should decide whether to change the dosage or replace the medicine to prevent the risk of falls through negative side-effects.

The regular monitoring of physical condition of patients will also help to identify the risk of falls. For example, negative changes in the behavior of older patients and the history of falls should increase the awareness of nurses and other health care professionals for the risk of falls. Regular monitoring of physical condition of patients can help health care professionals to identify the problem before a fall occurs. Therefore, if they diagnose a health problem that increases the risk of fall, nurses should pay more attention to those patients and the treatment of these patients should include the fall prevention strategy.

Finally, the change of activities of patients may also contribute to the reduction of falls, if their physical condition increases the risk of falls and they cannot perform physical activities, which they are accustomed to perform. For example, excessive physical activities can cause falls of older patients. Therefore, the nursing staff and health care professionals should schedule activities of older patients to minimize the risk of falls. In a combination with regular monitoring of their physical health, this measure will help to decrease the risk of falls substantially.

Conclusion

Thus, the current study focused on the analysis of causes, effects and management of falls and their prevention among older inpatient population. The study has revealed the fact that the older population faces the higher risk of falls, which may be provoked both by internal and external factors, such as physical condition of patients, their environment and others. In such a situation, nurses and other health care professionals are responsible for patients’ safety. They should monitor the physical condition of patients regularly and help patients to minimize the risk of falls. If necessary, changes in their treatment, for example, medication should be introduced to decrease the risk of falls. Finally, they should create safe environment, where the risk of falls would be minimal.

 

References:

Rubenstein, L.Z. and Josephson, K.R. (2002).The epidemiology of falls and syncope,” Clin Geriatr Med, 18, 146.

Tinetti, M.E. (2003). “Clinical practice. Preventing falls in elderly persons,” N Engl J       Med, 348, 45.

The terms offer and acceptance. (2016, May 17). Retrieved from

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"The terms offer and acceptance." freeessays.club, 17 May 2016.

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"The terms offer and acceptance." freeessays.club, 17 May 2016

[Accessed: March 28, 2024]

"The terms offer and acceptance." freeessays.club, 17 May 2016

[Accessed: March 28, 2024]

"The terms offer and acceptance." freeessays.club, 17 May 2016

[Accessed: March 28, 2024]

"The terms offer and acceptance." freeessays.club, 17 May 2016

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